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Verma Y, Perera Molligoda Arachchige AS. Advances in Tumor Management: Harnessing the Potential of Histotripsy. Radiol Imaging Cancer 2024; 6:e230159. [PMID: 38639585 DOI: 10.1148/rycan.230159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Tissue ablation techniques have long been used in clinical settings to treat various oncologic diseases. However, many of these techniques are invasive and can cause substantial adverse effects. Histotripsy is a noninvasive, nonionizing, nonthermal tissue ablation technique that has the potential to replace surgical interventions in various clinical settings. Histotripsy works by delivering high-intensity focused ultrasound waves to target tissue. These waves create cavitation bubbles within tissues that rapidly expand and collapse, thereby mechanically fractionating the tissue into acellular debris that is subsequently absorbed by the body's immune system. Preclinical and clinical studies have demonstrated the efficacy of histotripsy in treating a range of diseases, including liver, pancreatic, renal, and prostate tumors. Safety outcomes of histotripsy have been generally favorable, with minimal adverse effects reported. However, further studies are needed to optimize the technique and understand its long-term effects. This review aims to discuss the importance of histotripsy as a noninvasive tissue ablation technique, the preclinical and clinical literature on histotripsy and its safety, and the potential applications of histotripsy in clinical practice. Keywords: Tumor Microenvironment, Ultrasound-High-Intensity Focused (HIFU), Ablation Techniques, Abdomen/GI, Genital/Reproductive, Nonthermal Tissue Ablation, Histotripsy, Clinical Trials, Preclinical Applications, Focused Ultrasound © RSNA, 2024.
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Affiliation(s)
- Yash Verma
- From the Norfolk and Norwich University Hospital, Colney Ln, Norwich NR4 7UY, England (Y.V.); and Faculty of Medicine, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Milan, Italy (A.S.P.M.A.)
| | - Arosh S Perera Molligoda Arachchige
- From the Norfolk and Norwich University Hospital, Colney Ln, Norwich NR4 7UY, England (Y.V.); and Faculty of Medicine, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Milan, Italy (A.S.P.M.A.)
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Witte C, Schmidt DM, Cimiano P. Comparing generative and extractive approaches to information extraction from abstracts describing randomized clinical trials. J Biomed Semantics 2024; 15:3. [PMID: 38654304 DOI: 10.1186/s13326-024-00305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Systematic reviews of Randomized Controlled Trials (RCTs) are an important part of the evidence-based medicine paradigm. However, the creation of such systematic reviews by clinical experts is costly as well as time-consuming, and results can get quickly outdated after publication. Most RCTs are structured based on the Patient, Intervention, Comparison, Outcomes (PICO) framework and there exist many approaches which aim to extract PICO elements automatically. The automatic extraction of PICO information from RCTs has the potential to significantly speed up the creation process of systematic reviews and this way also benefit the field of evidence-based medicine. RESULTS Previous work has addressed the extraction of PICO elements as the task of identifying relevant text spans or sentences, but without populating a structured representation of a trial. In contrast, in this work, we treat PICO elements as structured templates with slots to do justice to the complex nature of the information they represent. We present two different approaches to extract this structured information from the abstracts of RCTs. The first approach is an extractive approach based on our previous work that is extended to capture full document representations as well as by a clustering step to infer the number of instances of each template type. The second approach is a generative approach based on a seq2seq model that encodes the abstract describing the RCT and uses a decoder to infer a structured representation of a trial including its arms, treatments, endpoints and outcomes. Both approaches are evaluated with different base models on a manually annotated dataset consisting of RCT abstracts on an existing dataset comprising 211 annotated clinical trial abstracts for Type 2 Diabetes and Glaucoma. For both diseases, the extractive approach (with flan-t5-base) reached the best F 1 score, i.e. 0.547 ( ± 0.006 ) for type 2 diabetes and 0.636 ( ± 0.006 ) for glaucoma. Generally, the F 1 scores were higher for glaucoma than for type 2 diabetes and the standard deviation was higher for the generative approach. CONCLUSION In our experiments, both approaches show promising performance extracting structured PICO information from RCTs, especially considering that most related work focuses on the far easier task of predicting less structured objects. In our experimental results, the extractive approach performs best in both cases, although the lead is greater for glaucoma than for type 2 diabetes. For future work, it remains to be investigated how the base model size affects the performance of both approaches in comparison. Although the extractive approach currently leaves more room for direct improvements, the generative approach might benefit from larger models.
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Affiliation(s)
- Christian Witte
- Semantic Computing Group, Center for Cognitive Interaction Technology, Bielefeld University, Inspiration 1, Bielefeld, 33619, NRW, Germany
| | - David M Schmidt
- Semantic Computing Group, Center for Cognitive Interaction Technology, Bielefeld University, Inspiration 1, Bielefeld, 33619, NRW, Germany.
| | - Philipp Cimiano
- Semantic Computing Group, Center for Cognitive Interaction Technology, Bielefeld University, Inspiration 1, Bielefeld, 33619, NRW, Germany
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De A, Jee JP, Park YJ. Why Perfluorocarbon nanoparticles encounter bottlenecks in clinical translation despite promising oxygen carriers? Eur J Pharm Biopharm 2024:114292. [PMID: 38636883 DOI: 10.1016/j.ejpb.2024.114292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/23/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
Artificial Oxygen Carriers (AOCs) have emerged as ground-breaking biomedical solutions, showcasing tremendous potential for enhancing human health and saving lives. Perfluorocarbon (PFC)-based AOCs, in particular, have garnered significant interest among researchers, leading to numerous clinical trials since the 1980 s. However, despite decades of exploration, the success rate has remained notably limited. This comprehensive review article delves into the landscape of clinical trials involving PFC compounds, shedding light on the challenges and factors contributing to the lack of clinical success with PFC nanoparticles till date. By scrutinizing the existing trials, the article aims to uncover the underlying issues like pharmacological side effects of the PFC and the nanomaterials used for the designing, complex formulation strategy and poor clinical trial designs of the formulation. More over each generation of the PFC formulation were discussed with details for their failure in the clinical trials limitations that block the path of PFC-based AOCs' full potential. Furthermore, the review emphasizes a forward-looking approach by outlining the future pathways and strategies essential for achieving success in clinical trials. AOCs require advanced yet biocompatible single-componentformulations. The new trend might be a novel drug delivery technique, like gel emulsion or reverse PFC emulsion with fluoro surfactants. Most importantly, well-planned clinical trials may end in a success story.
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Affiliation(s)
- Anindita De
- Department of Pharmacy, Ajou University, College of Pharmacy, 206 Worldcup-ro, Yeongtong-gu, Suwon-si 16499, Gyeonggi-do, Republic of Korea
| | - Jun-Pil Jee
- College of Pharmacy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Republic of Korea
| | - Young-Joon Park
- Department of Pharmacy, Ajou University, College of Pharmacy, 206 Worldcup-ro, Yeongtong-gu, Suwon-si 16499, Gyeonggi-do, Republic of Korea; Research Center, IMDpharm Inc., 17 Daehak 4-ro, Yeongtong-gu, Suwon-si 16226, Korea.
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Choi HS, Choi AY, Kopp JB, Winkler CA, Cho SK. Review of COVID-19 Therapeutics by Mechanism: From Discovery to Approval. J Korean Med Sci 2024; 39:e134. [PMID: 38622939 PMCID: PMC11018982 DOI: 10.3346/jkms.2024.39.e134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/18/2024] [Indexed: 04/17/2024] Open
Abstract
The global research and pharmaceutical community rapidly mobilized to develop treatments for coronavirus disease 2019 (COVID-19). Existing treatments have been repurposed and new drugs have emerged. Here we summarize mechanisms and clinical trials of COVID-19 therapeutics approved or in development. Two reviewers, working independently, reviewed published data for approved COVID-19 vaccines and drugs, as well as developmental pipelines, using databases from the following organizations: United States Food and Drug Administration (US-FDA), European Medicines Agency (EMA), Japanese Pharmaceutical and Medical Devices Agency (PMDA), and ClinicalTrials.gov. In all, 387 drugs were found for initial review. After removing unrelated trials and drugs, 66 drugs were selected, including 17 approved drugs and 49 drugs under development. These drugs were classified into six categories: 1) drugs targeting the viral life cycle 2) Anti-severe acute respiratory syndrome coronavirus 2 Monoclonal Antibodies, 3) immunomodulators, 4) anti-coagulants, 5) COVID-19-induced neuropathy drugs, and 6) other therapeutics. Among the 49 drugs under development are the following: 6 drugs targeting the viral life cycle, 12 immunosuppression drugs, 2 immunostimulants, 2 HIF-PHD targeting drugs, 3 GM-CSF targeting drugs, 5 anti-coagulants, 2 COVID-19-induced neuropathy drugs, and 17 others. This review provides insight into mechanisms of action, properties, and indications for COVID-19 medications.
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Affiliation(s)
- Hee Sun Choi
- Department of Pharmacology, Ajou University School of Medicine, Suwon, Korea
| | - A Young Choi
- Department of Pharmacology, Ajou University School of Medicine, Suwon, Korea
| | - Jeffrey B Kopp
- Kidney Disease Section, Kidney Diseases, Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Cheryl A Winkler
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD, USA
| | - Sung Kweon Cho
- Department of Pharmacology, Ajou University School of Medicine, Suwon, Korea
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD, USA.
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Discepolo V, Kelly CP, Koning F, Schuppan D. How Future Pharmacologic Therapies for Celiac Disease Will Complement the Gluten-Free Diet. Gastroenterology 2024:S0016-5085(24)00416-5. [PMID: 38604542 DOI: 10.1053/j.gastro.2024.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 04/13/2024]
Abstract
The only proven treatment for celiac disease is adherence to a strict, lifelong, gluten-free diet. However, complete dietary gluten avoidance is challenging and a substantial number of patients do not respond fully, clinically, or histologically, despite their best efforts. As celiac disease is common and its central pathophysiology is well elucidated, it has become attractive for drug development to address the limitations of dietary treatment. Most efforts address nonresponsive celiac disease, defined as continued symptoms and/or signs of disease activity despite a gluten-free diet, including the more severe forms of refractory celiac disease, types I and II. An increasing spectrum of therapeutic approaches target defined mechanisms in celiac disease pathogenesis and some have advanced to current phase 2 and 3 clinical studies. We discuss these approaches in terms of potential efficiency, practicability, safety, and need, as defined by patients, regulatory authorities, health care providers, and payors.
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Affiliation(s)
- Valentina Discepolo
- Department of Translational Medical Science and European Laboratory for the Investigation of Food Induced Diseases, University of Naples Federico II, Naples, Italy.
| | - Ciarán P Kelly
- Celiac Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Frits Koning
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Detlef Schuppan
- Celiac Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Institute of Translational Immunology and Research Center for Immunotherapy, Center for Celiac Disease and Autoimmunity, Johannes-Gutenberg University, Mainz, Germany.
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Lan RH, Perez-Guerrero E, Saeed M, Perez MV. The Rising Trend in the Use of Patient-Reported Outcomes in Atrial Fibrillation Clinical Trials. Heart Rhythm 2024:S1547-5271(24)02342-7. [PMID: 38604591 DOI: 10.1016/j.hrthm.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Roy H Lan
- Department of Medicine, Stanford University School of Medicine
| | | | - Mohammad Saeed
- Department of Cardiology, Texas Heart Institute; Center for Cardiac Arrhythmias and Electrophysiology, Texas Heart Institute
| | - Marco V Perez
- Cardiovascular Institute, Stanford University; Stanford Center for Inherited Cardiovascular Disease; Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine.
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González-Seguel F, Letelier-Bernal R. Early Mobilization Dose Reporting in Randomized Clinical Trials with Patients Who Were Mechanically Ventilated: A Scoping Review. Phys Ther 2024:pzae048. [PMID: 38519113 DOI: 10.1093/ptj/pzae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/12/2023] [Accepted: 03/20/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE The aim of this scoping review was to investigate the mobilization dose reporting in the randomized clinical trials (RCTs) of patients receiving mechanical ventilation in the intensive care unit. METHODS In this scoping review, RCTs published from inception to December 2022 were searched in relevant electronic databases. Trials that involved adults receiving mechanical ventilation (>48 hours) and any early mobilization modality were analyzed. Two independent authors screened, selected, and extracted data. The mobilization doses of the intervention groups (IG) and the comparator groups (CG) were assessed as the proportion of reported items/total applicable from the main items of the Consensus on Exercise Reporting Template (CERT). RESULTS Twenty-three RCTs comprising 2707 patients (1358 from IG and 1349 from CG) were included, involving studies on neuromuscular electrical stimulation (n = 7), progressive mobility (n = 6), leg cycling (n = 3), tilt table (n = 1), and multicomponent (n = 6) mobilization. The pooled reporting of CERT items was 68% (86% for IG and 50% for CG). The most reported CERT items were type of exercise (100%) and weekly frequency (100%) for IG, whereas the least reported were intensity (4%) and individualization (22%) for CG. Regardless of the group, individualization, progression, and intensity of mobilization were the least reported items. Eight IGs (35%) reported all CERT items, whereas no CGs reported all of them. CONCLUSIONS Deficits in mobilization dose reporting of intensive care unit RCTs were identified, especially for exercise intensity in adults receiving mechanical ventilation. One-third of IG reported all exercise dosing items, whereas no CG reported all of them. Future studies should investigate the details of optimal dosage reporting, particularly for CG. IMPACT The lack of dose reporting may partially explain the inconsistency in the meta-analysis results of early mobilization trials, thus limiting the interpretation for clinical practice in the intensive care unit.
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Affiliation(s)
- Felipe González-Seguel
- School of Physical Therapy, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Programa de Magíster en Fisiología Clínica del Ejercicio, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile
| | - Renato Letelier-Bernal
- Programa de Magíster en Fisiología Clínica del Ejercicio, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile
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Gao T, Wang S, Zhu Z, Lin L, Luo Y, Lu M, Liao W. Components from Curcuma longa (Turmeric) Against Hepatobiliary Diseases Based on Gut-Liver Axis: Pharmacotherapeutic Properties and Potential Clinical Applications. Am J Chin Med 2024; 52:387-415. [PMID: 38490808 DOI: 10.1142/s0192415x24500162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Turmeric is widely used worldwide, and there are many examples of its use in treating hepatobiliary diseases. The gut-liver axis is a bidirectional relationship between gut microorganisms and the liver that is closely related to the pathogenesis of hepatobiliary diseases. This review systematically summarizes the components of turmeric. It links the studies on turmeric affecting gut microorganisms to its effects on liver and biliary diseases to explain the potential mechanism of turmeric's regulation of the gut-liver axis. Besides, ethnopharmacology, phytochemicals, and clinical adverse events associated with turmeric have been researched. Furthermore, turmeric is a safe agent with good clinical efficacy and without apparent toxicity at a certain amount. By summarizing the influence of turmeric on the liver by regulating the gut-liver axis, especially the gut microbiota, it provides a preclinical basis for using turmeric as a safe and effective therapeutic agent for the prevention and treatment of hepatobiliary diseases based on the gut-liver axis. However, more efforts should be made to exploit its clinical application further.
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Affiliation(s)
- Tianhui Gao
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy/ School of Modern Chinese Medicine Industry, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, P. R. China
| | - Shuyi Wang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy/ School of Modern Chinese Medicine Industry, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, P. R. China
| | - Zongping Zhu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy/ School of Modern Chinese Medicine Industry, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, P. R. China
| | - Liting Lin
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy/ School of Modern Chinese Medicine Industry, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, P. R. China
| | - Yirong Luo
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy/ School of Modern Chinese Medicine Industry, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, P. R. China
| | - Meigui Lu
- Huachiew TCM Hospital, Bangkok 10100, Thailand
| | - Wan Liao
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy/ School of Modern Chinese Medicine Industry, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, P. R. China
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Shahid Z, Etra AM, Levine JE, Riches ML, Baluch A, Hill JA, Nakamura R, Toor AA, Ustun C, Young JAH, Perales MA, Epstein DJ, Murthy HS. Defining and Grading Infections in Clinical Trials Involving Hematopoietic Cell Transplantation: A Report From the BMT CTN Infectious Disease Technical Committee. Transplant Cell Ther 2024:S2666-6367(24)00251-3. [PMID: 38458478 DOI: 10.1016/j.jtct.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/10/2024]
Abstract
The Blood and Marrow Transplant Clinical Trials Network (BMT-CTN) was established in 2001 to conduct large multi-institutional clinical trials addressing important issues towards improving the outcomes of HCT and other cellular therapies. Trials conducted by the network investigating new advances in HCT and cellular therapy not only assess efficacy but require careful capturing and severity assessment of adverse events and toxicities. Adverse infectious events in cancer clinical trials are typically graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE). However, there are limitations to this framework as it relates to HCT given the associated immunodeficiency and delayed immune reconstitution. The BMT-CTN Infection Grading System is a monitoring tool developed by the BMT CTN to capture and monitor infectious complications and differs from the CTCAE by its classification of infections based on their potential impact on morbidity and mortality for HCT recipients. Here we offer a report from the BMT CTN Infectious Disease Technical Committee regarding the rationale, development, and revising of BMT-CTN Infection Grading System and future directions as it applies to future clinical trials involving HCT and cellular therapy recipients.
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Affiliation(s)
- Zainab Shahid
- Department of Medicine, Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
| | - Aaron M Etra
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John E Levine
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marcie L Riches
- Department of Medicine, Center for International Blood and Marrow Transplantation Research (CIBMTR), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aliyah Baluch
- Division of Infectious Diseases, Moffitt Cancer Center, Tampa, Florida
| | - Joshua A Hill
- Department of Medicine, University of Washington, WA and Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Wisconsin
| | - Ryo Nakamura
- Division of Hematology and HCT, City of Hope, Duarte, California
| | - Amir A Toor
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Celalettin Ustun
- Division of Hematology, Oncology and Cell Therapy, Section of Bone Marrow Transplantation and Cellular Therapy, Rush Medical College, Chicago, Illinois
| | - Jo-Anne H Young
- Department of Medicine, Division of Infectious Disease and International Medicine, Program in Adult Transplant Infectious Disease, University of Minnesota, Minneapolis, Minnesota
| | - Miguel-Angel Perales
- Department of Medicine, Weill Cornell Medical College, New York, New York; Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center; Weill Cornell Medical College, New York, New York
| | - David J Epstein
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
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Wang K, Zhang Y, Xing Y, Wang H, He M, Guo R. Current and future of immunotherapy for thyroid cancer based on bibliometrics and clinical trials. Discov Oncol 2024; 15:50. [PMID: 38403820 PMCID: PMC10894806 DOI: 10.1007/s12672-024-00904-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/21/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Thyroid cancer is a leading endocrine malignancy, with anaplastic and medullary subtypes posing treatment challenges. Existing therapies have limited efficacy, highlighting a need for innovative approaches. METHODS We analyzed 658 articles and 87 eligible clinical trials using bibliometric tools and database searches, including annual publication and citation trends, were executed using Web of Science, CiteSpace, and VOS Viewer. RESULTS Post-2018, there is a surge in thyroid cancer immunotherapy research, primarily from China and the University of Pisa. Of the 87 trials, 32 were Phase I and 55 were Phase II, mostly exploring combination therapies involving immune checkpoint inhibitors. CONCLUSION The study's dual approach verifies the swift advancement of thyroid cancer immunotherapy from diverse perspectives. Immune checkpoint inhibitors have become the preferred regimen for advanced MTC and ATC in late therapeutic lines. However, since ICB plays a pivotal role in ATC, current clinical trial data show that ATC patients account for more and the curative effect is more accurate. Anticipated future developments are inclined toward combination regimens integrating immunotherapy with chemotherapy or targeted therapies. Emerging approaches, such as bispecific antibodies, cytokine-based therapies, and adoptive cell therapies like CAR-T and TCR-T, are exhibiting considerable potential. Upcoming research is expected to concentrate on refining the tumor immune milieu and discovering novel biomarkers germane to immunotherapeutic interventions.
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Affiliation(s)
- Ke Wang
- Department of Clinical Laboratory, The First Hospital of Jilin University, Jilin University, 1 Xinmin Str, Changchun, 130021, Jilin, China
| | - Ying Zhang
- Cancer Center, The First Hospital of Jilin University, Chang Chun, China
| | - Yang Xing
- Cancer Center, The First Hospital of Jilin University, Chang Chun, China
| | - Hong Wang
- Cancer Center, The First Hospital of Jilin University, Chang Chun, China
| | - Minghua He
- College of Computer Science and Technology, Jilin University, Chang Chun, China
| | - Rui Guo
- Department of Clinical Laboratory, The First Hospital of Jilin University, Jilin University, 1 Xinmin Str, Changchun, 130021, Jilin, China.
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Williams DKA, Christophers B, Keyes T, Kumar R, Granovetter MC, Adigun A, Olivera J, Pura-Bryant J, Smith C, Okafor C, Shibre M, Daye D, Akabas MH. Sociodemographic factors and research experience impact MD-PhD program acceptance. JCI Insight 2024; 9:e176146. [PMID: 38329127 DOI: 10.1172/jci.insight.176146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
The 2014 NIH Physician-Scientist Workforce Working Group predicted a future shortage of physician-scientists. Subsequent studies have highlighted disparities in MD-PhD admissions based on race, income, and education. Our analysis of data from the Association of American Medical Colleges covering 2014-2021 (15,156 applicants and 6,840 acceptees) revealed that acceptance into US MD-PhD programs correlates with research experience, family income, and research publications. The number of research experiences associated with parental education and family income. Applicants were more likely to be accepted with a family income greater than $50,000 or with one or more publications or presentations. Applicants were less likely to be accepted if they had parents without a graduate degree, were Black/African American, were first-generation college students, or were reapplicants, irrespective of the number of research experiences, publications, or presentations. These findings underscore an admissions bias that favors candidates from affluent and highly educated families, while disadvantaging underrepresented minorities.
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Affiliation(s)
- Darnell K Adrian Williams
- Albert Einstein College of Medicine, Medical Scientist Training Program, Bronx, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
- American Physician Scientists Association, Westford, Massachusetts, USA
| | - Briana Christophers
- American Physician Scientists Association, Westford, Massachusetts, USA
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, New York, USA
| | - Timothy Keyes
- American Physician Scientists Association, Westford, Massachusetts, USA
- Stanford University Medical Scientist Training Program, Stanford, California, USA
| | - Rachit Kumar
- American Physician Scientists Association, Westford, Massachusetts, USA
- Perelman School of Medicine at the University of Pennsylvania, Medical Scientist Training Program, Philadelphia, Pennsylvania, USA
| | - Michael C Granovetter
- American Physician Scientists Association, Westford, Massachusetts, USA
- University of Pittsburgh-Carnegie Mellon University Medical Scientist Training Program, Pittsburgh, Pennsylvania, USA
| | - Alexandria Adigun
- American Physician Scientists Association, Westford, Massachusetts, USA
- Perelman School of Medicine at the University of Pennsylvania, Medical Scientist Training Program, Philadelphia, Pennsylvania, USA
| | - Justin Olivera
- Albert Einstein College of Medicine, Bronx, New York, USA
- American Physician Scientists Association, Westford, Massachusetts, USA
| | - Jehron Pura-Bryant
- Albert Einstein College of Medicine, Bronx, New York, USA
- American Physician Scientists Association, Westford, Massachusetts, USA
| | - Chynna Smith
- Albert Einstein College of Medicine, Medical Scientist Training Program, Bronx, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
- American Physician Scientists Association, Westford, Massachusetts, USA
| | - Chiemeka Okafor
- American Physician Scientists Association, Westford, Massachusetts, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mahlet Shibre
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dania Daye
- American Physician Scientists Association, Westford, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Myles H Akabas
- Albert Einstein College of Medicine, Medical Scientist Training Program, Bronx, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
- Departments of Neuroscience and Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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Pandey P, Nautiyal G, Purohit D, Lata S, Kumar V, Makhija M, Manchanda D, Minocha N, Kumar S, Kaushik D. Role of Nanoformulations in the Treatment of Lung Cancer. Recent Pat Nanotechnol 2024; 18:NANOTEC-EPUB-138330. [PMID: 38321901 DOI: 10.2174/0118722105264531231205042817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/19/2023] [Accepted: 11/06/2023] [Indexed: 02/08/2024]
Abstract
Lung cancer is the second deadliest disease in the world. A major portion of deaths related to cancer are due to lung cancer in both males and females. Interestingly, unbelievable advances have occurred in recent years through the use of nanotechnology and development in both the diagnosis and treatment of lung cancer. Due to their in vivo stability, the nanotechnology-based pharmacological system gained huge attractiveness, solubility, absorption from the intestine, pharmacological effectiveness, etc. of various anticancer agents. However, this field needs to be utilized more to get maximum results in the treatment of lung cancer, along with wider context medicines. In the present review, authors have tried to concentrate their attention on lung cancer`s difficulties along with the current pharmacological and diagnostic situation, and current advancements in approaches based on nanotechnology for the treatment and diagnosis of lung cancer. While nanotechnology offers these promising avenues for lung cancer diagnosis and treatment, it is important to acknowledge the need for careful evaluation of safety, efficacy, and regulatory approval. With continued research and development, nanotechnology holds tremendous potential to revolutionize the management of lung cancer and improve patient outcomes. The review also highlights the involvement of endocrine systems, especially estrogen in lung cancer proliferation. Some of the recent clinical trials and patents on nanoparticle-based formulations that have applications in the treatment and diagnosis of lung cancer are also discussed.
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Affiliation(s)
- Parijat Pandey
- Department of Pharmaceutical Sciences, Gurugram University, Gurugram - 122018, Haryana India
| | - Gunjan Nautiyal
- Department of Pharmaceutical Sciences, Gurugram University, Gurugram - 122018, Haryana India
| | - Deepika Purohit
- Department of Pharmaceutical Sciences, Indira Gandhi University, Meerpur, Rewari - 123401, Haryana, India
| | - Sneh Lata
- Department of Pharmaceutical Sciences, Indira Gandhi University, Meerpur, Rewari - 123401, Haryana, India
| | - Virender Kumar
- College of Pharmacy, Pandit Bhagwat Dayal Sharma University oh Health Sciences, Rohtak - 124001, Haryana, India
| | - Manish Makhija
- Department of Pharmaceutical Sciences, Indira Gandhi University, Meerpur, Rewari - 123401, Haryana, India
| | - Deeksha Manchanda
- Department of Pharmaceutical Sciences, Indira Gandhi University, Meerpur, Rewari - 123401, Haryana, India
| | - Neha Minocha
- Amity Institute of Pharmacy, Amity University, Gurugram - 122413, Haryana, India
- Chitkara University School of Pharmacy, Chitkara University, Himachal Pradesh - 174103, India
| | - Sunil Kumar
- Department of Pharmaceutical Sciences, Indira Gandhi University, Meerpur, Rewari - 123401, Haryana, India
| | - Deepak Kaushik
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak - 124001, Haryana, India
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Shahzad M, Khalid MF, Amin MK, Basharat A, Ammad-Ud-Din M, Park R, Anwar I, Faisal MS, Jaglal M. Geographic and Racial Disparities in Chimeric Antigen Receptor-T Cells and Bispecific Antibodies Trials Access for Diffuse Large B-Cell Lymphoma. Clin Lymphoma Myeloma Leuk 2024:S2152-2650(24)00034-X. [PMID: 38342727 DOI: 10.1016/j.clml.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND We investigate the geographical and racial disparities in accessing CAR-T and bispecific antibodies trials for DLBCL. MATERIALS AND METHODS ClinicalTrials.gov was searched, and 75 trials with at least 1 open site in the US were included. 2020 US Census Bureau data was used to obtain data on race and ethnicity. SPSS version 26 was used for analysis. RESULTS There were 62 CAR-T and 13 bispecific antibodies trials with 6221 enrolled or expected to enroll patients. Eighty-five percent of the clinical trials were only open in the US, and the majority 64% were pharmaceutical-funded. There were 126 unique study sites distributed over 31 states with 11 (0-51) mean number of trials per state and 4.5 (1-26) and 4.4 (1-24) mean number of CAR-T and bispecific antibodies trials per site, respectively. Southern states had the most number of trials 31%, followed by Midwestern 25%, Northeastern 24%, and Western 20%. The highest number of study locations were in California 13, New York 9, and Pennsylvania 9, while the highest number of open studies were in California 51, Texas 32, and New York 23. Twenty states had no open CAR-T or bispecific antibodies trials. Only 33% of African Americans (AA) lived in a county with a trial, and 7 out of 10 states with the highest proportion of AA residents (18.6%-41.4%) have no or less than 4 trial sites. Of the 62 counties analyzed, 92% were White predominant, while only 8% were AA predominant (P = .009). CONCLUSIONS Strategies should be framed to address the observed disparities and to improve access.
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Affiliation(s)
- Moazzam Shahzad
- H. Lee Moffitt Cancer Center, Tampa, FL; University of South Florida, Tampa, FL.
| | | | | | | | | | - Robin Park
- H. Lee Moffitt Cancer Center, Tampa, FL; University of South Florida, Tampa, FL
| | - Iqra Anwar
- Kansas University Medical Center, Kansas City, KS
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Akat A, Karaöz E. Cell Therapy Strategies on Duchenne Muscular Dystrophy: A Systematic Review of Clinical Applications. Stem Cell Rev Rep 2024; 20:138-158. [PMID: 37955832 DOI: 10.1007/s12015-023-10653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
Duchenne Muscular Dystrophy (DMD) is an inherited genetic disorder characterized by progressive degeneration of muscle tissue, leading to functional disability and premature death. Despite extensive research efforts, the discovery of a cure for DMD continues to be elusive, emphasizing the need to investigate novel treatment approaches. Cellular therapies have emerged as prospective approaches to address the underlying pathophysiology of DMD. This review provides an examination of the present situation regarding cell-based therapies, including CD133 + cells, muscle precursor cells, mesoangioblasts, bone marrow-derived mononuclear cells, mesenchymal stem cells, cardiosphere-derived cells, and dystrophin-expressing chimeric cells. A total of 12 studies were found eligible to be included as they were completed cell therapy clinical trials, clinical applications, or case reports with quantitative results. The evaluation encompassed an examination of limitations and potential advancements in this particular area of research, along with an assessment of the safety and effectiveness of cell-based therapies in the context of DMD. In general, the available data indicates that diverse cell therapy approaches may present a new, safe, and efficacious treatment modality for patients diagnosed with DMD. However, further studies are required to comprehensively understand the most advantageous treatment approach and therapeutic capacity.
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Affiliation(s)
- Ayberk Akat
- Life Park Hospital, Cellular and Biological Products Manufacturing Center, Ragıp Kenan Sok. No:8, Ortakoy, 99010, Nicosia (Lefkosa), Cyprus.
| | - Erdal Karaöz
- Liv Hospital Ulus, Regenerative Medicine and Stem Cell Center, Istanbul, Turkey
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15
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Dobra R, Davies J, Elborn S, Kee F, Madge S, Boeri M. A discrete choice experiment to quantify the influence of trial features on the decision to participate in cystic fibrosis trials. J Cyst Fibros 2024; 23:73-79. [PMID: 38042750 DOI: 10.1016/j.jcf.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/20/2023] [Accepted: 04/09/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Patient-centred trial design optimises recruitment and retention, reduces trial failure rates and increases the diversity of trial cohorts. This allows safe and effective treatments to reach clinic more quickly. To achieve this, patients' views must be incorporated into trial design. METHODS A discrete choice experiment was used to quantify preferences of pwCF for trials features; medicine type, trial location, stipend, washout, drug access on trial completion and trial design. Respondents were presented pairs of hypothetical trial scenarios with different level combinations assigned through experimental design. Respondents were asked to pick their preferred option or decline both. The cross-sectional data were explored using a Random Parameters Logit model. RESULTS We received 207 eligible responses between Oct2020-Jan2021. The strongest influence on the decision to participate was trial location; pwCF favour participation at their usual clinical centre. Greater travel distances made respondents less willing to participate. Post-trial drug access ranked second. pwCF would rather participate in modulator trials than trials of other drugs. In general, pwCF did not favour a washout period, but were more prepared to washout non-modulators than modulators. Stipend provision was not ranked highly, but higher stipends increased intention to participate. Trial design (placebo vs open-label) had minimal influence on the decision to participate. There are complex interactions between placebos and washouts. CONCLUSIONS We used quantitative methods to systematically elicit preferences of pwCF for clinical trials' features. We explore the relevance of our findings to trial design and delivery in the current CF trials landscape.
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Affiliation(s)
- Rebecca Dobra
- National Heart and Lung Institute, Imperial College London, UK; Department of Paediatrics, Royal Brompton Hospital, London, UK.
| | - Jane Davies
- National Heart and Lung Institute, Imperial College London, UK; Department of Paediatrics, Royal Brompton Hospital, London, UK
| | - Stuart Elborn
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University, Belfast, UK
| | - Susan Madge
- Department of Adult Cystic Fibrosis, Royal Brompton Hospital, London, UK
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Solitano V, Schaeffer DF, Hogan M, Vande Casteele N, Pai RK, Zou G, Pai RK, Parker CE, Rémillard J, Christensen B, Danese S, Peyrin-Biroulet L, Panaccione R, Sands BE, D'Haens G, Feagan BG, Ma C, Jairath V. Reliability and Responsiveness of Histologic Indices for the Assessment of Crohn's Disease Activity. Clin Gastroenterol Hepatol 2023:S1542-3565(23)00969-2. [PMID: 38056798 DOI: 10.1016/j.cgh.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND & AIMS The operating properties of histologic indices for evaluating Crohn's disease (CD) activity are poorly characterized. We assessed the reliability and responsiveness of existing histologic indices/items used in CD and ulcerative colitis (UC), in addition to 3 novel items, and developed exploratory ileal, colonic, and colonic-ileal CD instruments. METHODS Blinded central readers independently reviewed paired baseline and week 12 image sets from the EXTEND trial. Disease activity was scored using 4 indices (the Global Histologic Activity Score, Geboes Score, Nancy Histological Index, and Robarts Histopathology Index) and 3 items identified by an expert panel (mucin depletion, basal plasmacytosis, and ileal pyloric gland metaplasia). Reliability and responsiveness were quantified using the intraclass correlation coefficient (ICC) and area under the receiver operating curve (AUC), respectively. Exploratory indices were developed using backward stepwise linear regression analysis. Candidate independent variables were items with an inter-rater ICC ≥0.40 and AUC ≥0.56. The dependent variable was histologic disease activity measured by a 100-mm visual analogue scale. RESULTS Paired image sets were available from 55 patients. Substantial to almost perfect inter-rater reliability (ICC, 0.63-0.87) and some responsiveness (AUC, 0.57-0.94) were observed for all existing indices regardless of whether individual colonic and ileal segments, combined colonic segments, or combined colonic and ileal segments were assessed and the calculation method used. Five items were tested as candidate items, and exploratory colonic, ileal, and colonic-ileal indices were developed. CONCLUSIONS CD and UC indices were similarly reliable and responsive in measuring histologic CD activity. Exploratory index development did not offer benefit over current histologic instruments.
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Affiliation(s)
- Virginia Solitano
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada; Alimentiv Inc, London, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - David F Schaeffer
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Niels Vande Casteele
- Alimentiv Inc, London, Ontario, Canada; Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Rish K Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Guangyong Zou
- Alimentiv Inc, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Reetesh K Pai
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | - Britt Christensen
- Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia; The University of Melbourne, Melbourne, Australia
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IBD Center, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Vandœuvre-lès-Nancy, France; INSERM, NGERE, University of Lorraine, Nancy, France; INFINY Institute, Nancy University Hospital, Vandœuvre-lès-Nancy, France; FHU-CURE, Nancy University Hospital, Vandœuvre-lès-Nancy, France; Groupe Hospitalier privé Ambroise Paré - Hartmann, Paris IBD center, Neuilly sur Seine, France; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Remo Panaccione
- Alimentiv Inc, London, Ontario, Canada; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bruce E Sands
- Alimentiv Inc, London, Ontario, Canada; Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Geert D'Haens
- Alimentiv Inc, London, Ontario, Canada; Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Brian G Feagan
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada; Alimentiv Inc, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Christopher Ma
- Alimentiv Inc, London, Ontario, Canada; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vipul Jairath
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada; Alimentiv Inc, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
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Ahmed NJ, Haseeb A, AlQarni A, AlGethamy M, Mahrous AJ, Alshehri AM, Alahmari AK, Almarzoky Abuhussain SS, Mohammed Ashraf Bashawri A, Khan AH. Antibiotics for preventing infection at the surgical site: Single dose vs. multiple doses. Saudi Pharm J 2023; 31:101800. [PMID: 38028220 PMCID: PMC10661588 DOI: 10.1016/j.jsps.2023.101800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
Background Surgical site infections are common and expensive infections that can cause fatalities or poor patient outcomes. To prevent these infections, antibiotic prophylaxis is used. However, excessive antibiotic use is related to higher costs and the emergence of antimicrobial resistance. Objectives The present meta-analysis aimed to compare the effectiveness of a single dosage versus several doses of antibiotics in preventing the development of surgical site infections. Methods PubMed was used to find clinical trials evaluating the effectiveness of a single dosage versus several doses of antibiotics in avoiding the development of surgical site infections. The study included trials that were published between 1984 and 2022. Seventy-four clinical trials were included in the analysis. Odds ratios were used to compare groups with 95% confidence intervals. The data were displayed using OR to generate a forest plot. Review Manager (RevMan version 5.4) was used to do the meta-analysis. Results Regarding clean operations, there were 389 surgical site infections out of 5,634 patients in a single dose group (6.90%) and 349 surgical site infections out of 5,621 patients in multiple doses group (6.21%) (OR = 1.11, lower CI = 0.95, upper CI = 1.30). Regarding clean-contaminated operations, there were 137 surgical site infections out of 2,715 patients in a single dose group (5.05%) and 137 surgical site infections out of 2,355 patients in multiple doses group (5.82%) (OR = 0.87, lower CI = 0.68, upper CI = 1.11). Regarding contaminated operations, there were 302 surgical site infections out of 3,262 patients in a single dose group (9.26%) and 276 surgical site infections out of 3,212 patients in multiple doses group (8.59%) (OR = 1.11, lower CI = 0.84, upper CI = 1.47). In general, there were 828 surgical site infections out of 11,611 patients in a single dose group (7.13%) and 762 surgical site infections out of 11,188 patients in multiple doses group (6.81%) (OR = 1.05, lower CI = 0.93, upper CI = 1.20). The difference between groups was not significant. Conclusion The present study showed that using a single-dose antimicrobial prophylaxis was equally effective as using multiple doses of antibiotics in decreasing surgical site infections.
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Affiliation(s)
- Nehad J. Ahmed
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullmoin AlQarni
- Infectious Diseases Department, Alnoor Specialist Hospital, Makkah, Saudi Arabia
| | - Manal AlGethamy
- Department of Infection Prevention & Control Program, Alnoor Specialist Hospital Makkah, Makkah, Saudi Arabia
| | - Ahmad J. Mahrous
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ahmed M. Alshehri
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Abdullah K Alahmari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | | | | | - Amer H. Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
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Lawrance R, Skaltsa K, Regnault A, Floden L. Reflections on estimands for patient-reported outcomes in cancer clinical trials. J Biopharm Stat 2023:1-11. [PMID: 37980609 DOI: 10.1080/10543406.2023.2280628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/27/2023] [Indexed: 11/21/2023]
Abstract
It is common and important to include the patient's perspective of the impact of treatment on health-related quality of life (HRQoL) outcomes. In this commentary, we focus on applying the new addendum to ICH E9 guideline E9 (R1) relating to the estimand framework to Patient Reported Outcomes (PROs) collected in cancer clinical trials, from a statistician's viewpoint. Currently, common practice for statistical analysis of PRO endpoints of published cancer clinical trials demonstrates ambiguity, leaving critical questions unspecified, hindering conclusions about the effect of treatment on PRO endpoints as well as comparability between clinical trials. To avoid this scenario, we advocate the systematic use of the estimand framework which requires the prospective definition of clear PRO research questions. Among the five attributes of the estimands framework, the definition of the endpoint (what is the right PRO measure and timeframe to target and why?), the intercurrent event identification and management (what happens with PRO data post-disease progression, what is the impact of death?) and the population-level summary (what is an acceptable statistical summary for PRO data?) require the most attention for PRO estimands. We identify good practice and highlight discussion points including the challenges of statistical analysis in the presence of missing and/or unobservable data and in relation to death. Through this discussion we highlight that there is no "statistical magic", but that the estimand framework will help you find out what you really want to know when quantifying the benefit of treatments from the patients' perspective.
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Affiliation(s)
- Rachael Lawrance
- Members of the EFSPI/PSI Estimands in Oncology Special Interest Group, PRO Task Force
- Adelphi Values Ltd, Macclesfield, UK
| | - Konstantina Skaltsa
- Members of the EFSPI/PSI Estimands in Oncology Special Interest Group, PRO Task Force
- IQVIA, Barcelona, Spain
| | - Antoine Regnault
- Members of the EFSPI/PSI Estimands in Oncology Special Interest Group, PRO Task Force
- Modus Outcomes, Lyon, France
| | - Lysbeth Floden
- Members of the EFSPI/PSI Estimands in Oncology Special Interest Group, PRO Task Force
- Clinical Outcome Solutions, Tuscon, USA
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Weir IR, Dufault SM, Phillips PP. Estimands for clinical endpoints in Tuberculosis treatment randomized controlled trials: a retrospective application in a completed trial. Res Sq 2023:rs.3.rs-3486707. [PMID: 37986887 PMCID: PMC10659528 DOI: 10.21203/rs.3.rs-3486707/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Randomized trials for the treatment of tuberculosis (TB) rely on a composite primary outcome to capture unfavorable treatment responses. However, variability between trials in the outcome definition and estimation methods complicates across-trial comparisons and hinders the advancement of treatment guidelines. The International Council for Harmonization (ICH) provides international regulatory standards for clinical trials. The estimand framework outlined in the recent ICH E9(R1) addendum offers a timely opportunity for randomized trials of TB treatment to adopt broadly standardized outcome definitions and analytic approaches. We previously proposed and defined four estimands for use in this context. Our objective was to evaluate how the use of these estimands and choice of estimation method impacts results and interpretation of a large phase III TB trial. Methods We reanalyzed participant level data from the REMoxTB trial. We applied four estimands and various methods of estimation to assess non-inferiority of both novel 4-month treatment regimens against standard of care. Results With each of the four estimands we reached the same conclusion as the original trial analysis; that the novel regimens were not non-inferior to standard of care. Each estimand and method of estimation gave similar estimates of the treatment effect with fluctuations in variance and differences driven by the methods applied for handling intercurrent events. Conclusions Our application of estimands defined by the ICH E9(R1) addendum offers a formalized framework for addressing the primary TB treatment trial objective and can promote uniformity in future trials by limiting heterogeneity in trial outcome definitions. We demonstrated the utility of our proposal using data from the REMoxTB randomized trial. We outlined methods for estimating each estimand and found consistent conclusions across estimands. We recommend future late-phase TB treatment trials to implement some or all of our estimands to promote rigorous outcome definitions and reduce variability between trials.Trial registration: NCT00864383.
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Seront E, Van Damme A, Legrand C, Bisdorff-Bresson A, Orcel P, Funck-Brentano T, Sevestre MA, Dompmartin A, Quere I, Brouillard P, Revencu N, De Bortoli M, Hammer F, Clapuyt P, Dumitriu D, Vikkula M, Boon LM. Preliminary results of the European multicentric phase III trial regarding sirolimus in slow-flow vascular malformations. JCI Insight 2023; 8:e173095. [PMID: 37937645 PMCID: PMC10721262 DOI: 10.1172/jci.insight.173095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/27/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUNDSlow-flow vascular malformations frequently harbor activating mutations in the PI3K/AKT/mTOR cascade. Phase II trials pinpointed sirolimus effectiveness as a drug therapy. Efficacy and safety of sirolimus thus need to be evaluated in large prospective phase III trials.METHODSThe Vascular Anomaly-Sirolimus-Europe (VASE) trial, initiated in 2016, is a large multicentric prospective phase III trial (EudraCT 2015-001703-32), which evaluates efficacy and safety of sirolimus for 2 years in pediatric and adult patients with symptomatic slow-flow vascular malformations. In this interim analysis, we studied all patients enrolled up to October 2021 who received sirolimus for 12 or more months or who prematurely stopped the treatment.RESULTSThirty-one pediatric and 101 adult patients were included in this analysis; 107 completed 12 or more months of sirolimus, including 61 who were treated for the whole 2-year period. Sirolimus resulted in a clinical improvement in 85% of patients. The efficacy appeared within the first month for the majority of them. Grade 3-4 adverse events were observed in 24 (18%) patients; all resolved after treatment interruption/arrest. Sirolimus increased feasibility of surgery or sclerotherapy in 20 (15%) patients initially deemed unsuitable for intervention. Among the 61 patients who completed the 2-year treatment, 33 (54%) reported a recurrence of symptoms after a median follow-up of 13 months after sirolimus arrest. While there was no difference in efficacy, clinical improvement was faster but subsided more rapidly in PIK3CA-mutated (n = 24) compared with TIE2-mutated (n = 19) patients.CONCLUSIONSirolimus has a high efficacy and good tolerance in treatment of slow-flow vascular malformations in children and adults.TRIAL REGISTRATIONClinicalTrials.gov NCT02638389 and EudraCT 2015-001703-32.FUNDINGThe Fonds de la Recherche Scientifique (FNRS grants T.0247.19, P.C005.22, T.0146.16, and P.C013.20), the Fund Generet managed by the King Baudouin Foundation (grant 2018-J1810250-211305), the Walloon Region through the FRFS-WELBIO strategic research programme (WELBIO-CR-2019C-06), the MSCA-ITN network V.A. Cure no. 814316, the Leducq Foundation Networks of Excellence Program grant "ReVAMP" (LFCR grant 21CVD03), the European Union's Horizon 2020 research and innovation programme under grant agreement no. 874708 (Theralymph), the Swiss National Science Foundation under the Sinergia project no. CRSII5_193694, and a Pierre M. fellowship.
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Affiliation(s)
- Emmanuel Seront
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Institut Roi Albert II, Department of Medical Oncology, and
| | - An Van Damme
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Institut Roi Albert II, Department of Pediatric Hematology & Oncology, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | | | - Annouk Bisdorff-Bresson
- Neuroradiology Department of Pr Houdart Lariboisière Hospital, Center of vascular anomalies clinic VASCERN VASCA European Reference Centre, Paris, France
| | - Philippe Orcel
- Department of Rheumatology – DMU Locomotion, AP-HP Nord – University of Paris and INSERM U1132 BIOSCAR, Paris, France, Paris, France
| | - Thomas Funck-Brentano
- Department of Rheumatology – DMU Locomotion, AP-HP Nord – University of Paris and INSERM U1132 BIOSCAR, Paris, France, Paris, France
| | | | - Anne Dompmartin
- Department of Dermatology, CHU Université Caen Normandie, Caen, France
| | - Isabelle Quere
- IDESP, Univeristy of Montpellier – INSERM, CHU Montpellier, CRMR FAVA-Multi, Montpellier, France
| | - Pascal Brouillard
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
| | - Nicole Revencu
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Centre for Human Genetics, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Martina De Bortoli
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
| | - Frank Hammer
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Division of Interventional Radiology, and
| | - Philippe Clapuyt
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Department of Pediatric Radiology, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Dana Dumitriu
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Department of Pediatric Radiology, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Miikka Vikkula
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
- WELBIO department, WEL Research Institute, Wavre, Belgium
| | - Laurence M. Boon
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
- Division of Plastic Surgery, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium
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21
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Kah Man L, An Gie O, Chian Huey M, Yong P, Siik Kee L, Cheng Ze L, Ming Yu T, Foo JB, Hamzah S. The Cutting-edge of CRISPR for Cancer Treatment and its Future Prospects. Curr Pharm Biotechnol 2023:CPB-EPUB-135615. [PMID: 37921129 DOI: 10.2174/0113892010258617231020062637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/23/2023] [Accepted: 09/01/2023] [Indexed: 11/04/2023]
Abstract
CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) is a versatile technology that allows precise modification of genes. One of its most promising applications is in cancer treatment. By targeting and editing specific genes involved in cancer development and progression, CRISPR has the potential to become a powerful tool in the fight against cancer. This review aims to assess the recent progress in CRISPR technology for cancer research and to examine the obstacles and potential strategies to address them. The two most commonly used CRISPR systems for gene editing are CRISPR/Cas9 and CRISPR/Cas12a. CRISPR/Cas9 employs different repairing systems, including homologous recombination (HR) and nonhomologous end joining (NHEJ), to introduce precise modifications to the target genes. However, off-target effects and low editing efficiency are some of the main challenges associated with this technology. To overcome these issues, researchers are exploring new delivery methods and developing CRISPR/Cas systems with improved specificity. Moreover, there are ethical concerns surrounding using CRISPR in gene editing, including the potential for unintended consequences and the creation of genetically modified organisms. It is important to address these issues through rigorous testing and strict regulations. Despite these challenges, the potential benefits of CRISPR in cancer therapy cannot be overlooked. By introducing precise modifications to cancer cells, CRISPR could offer a targeted and effective treatment option for patients with different types of cancer. Further investigation and development of CRISPR technology are necessary to overcome the existing challenges and harness its full potential in cancer therapy.
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Affiliation(s)
- Liau Kah Man
- School of Pharmacy, Taylor's University, Subang Jaya, Selangor, 47500, Malaysia
| | - Ooi An Gie
- School of Pharmacy, Taylor's University, Subang Jaya, Selangor, 47500, Malaysia
| | - Mah Chian Huey
- School of Pharmacy, Taylor's University, Subang Jaya, Selangor, 47500, Malaysia
| | - Penny Yong
- School of Pharmacy, Taylor's University, Subang Jaya, Selangor, 47500, Malaysia
| | - Ling Siik Kee
- School of Pharmacy, Taylor's University, Subang Jaya, Selangor, 47500, Malaysia
| | - Loo Cheng Ze
- School of Pharmacy, Taylor's University, Subang Jaya, Selangor, 47500, Malaysia
| | - Tay Ming Yu
- School of Pharmacy, Taylor's University, Subang Jaya, Selangor, 47500, Malaysia
| | - Jhi Biau Foo
- School of Pharmacy, Taylor's University, Subang Jaya, Selangor, 47500, Malaysia
- Medical Advancement for Better Quality of Life Impact Lab, Taylor's University, 47500, Subang Jaya, Selangor, Malaysia
| | - Sharina Hamzah
- School of Pharmacy, Taylor's University, Subang Jaya, Selangor, 47500, Malaysia
- Medical Advancement for Better Quality of Life Impact Lab, Taylor's University, 47500, Subang Jaya, Selangor, Malaysia
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22
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Boston D, Larson AE, Sheppler CR, O'Connor PJ, Sperl-Hillen JM, Hauschildt J, Gold R. Does Clinical Decision Support Increase Appropriate Medication Prescribing for Cardiovascular Risk Reduction? J Am Board Fam Med 2023; 36:777-788. [PMID: 37704387 PMCID: PMC10680997 DOI: 10.3122/jabfm.2022.220391r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/30/2023] [Accepted: 05/25/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE To assess the impact of a clinical decision support (CDS) system's recommendations on prescribing patterns targeting cardiovascular disease (CVD) when the recommendations are prioritized in order from greatest to least benefit toward overall CVD risk reduction. METHODS Secondary analysis of trial data from September 20, 2018, to March 15, 2020, where 70 community health center clinics were cluster-randomized to the CDS intervention (42 clinics; 8 organizations) or control group (28 clinics; 7 organizations). Included patients were medication-naïve and aged 40 to 75 years with ≥1 uncontrolled cardiovascular disease risk factor, with known diabetes or cardiovascular disease, or ≥10% 10-year reversible CVD risk. RESULTS Among eligible encounters with 29,771 patients, the probability of prescribing a medication targeting hypertension was greater at intervention clinic encounters when CDS was used (34.9% [95% CI, 31.5 to 38.3]) versus dismissed (29.6% [95% CI, 26.7 to 32.6]; P < .001), but not when compared with control clinic encounters (34.9% [95% CI, 31.1 to 38.7]; P = .998). Prescribing for dyslipidemia was significantly higher at intervention encounters where the CDS system was used (11.3% [95% CI, 9.3 to 13.3]) compared with dismissed (7.7% [95% CI, 6.1 to 9.3]; P = .003) and to control encounters (8.7% [95% CI, 7.0 to 10.4]; P = .044); smoking cessation medication showed a similar pattern. Except for dyslipidemia, prescribing rates increased according to their prioritization. CONCLUSIONS Use of this CDS system was associated with significantly higher prescribing targeting most cardiovascular risk factors. These results highlight how displaying prioritized actions to reduce reversible CVD risk could improve risk management. TRIAL REGISTRATION ClinicalTrials.gov, NCT03001713, https://clinicaltrials.gov/.
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Affiliation(s)
- David Boston
- From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH).
| | - Annie E Larson
- From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH)
| | - Christina R Sheppler
- From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH)
| | - Patrick J O'Connor
- From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH)
| | - JoAnn M Sperl-Hillen
- From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH)
| | - Jennifer Hauschildt
- From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH)
| | - Rachel Gold
- From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH)
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Zendedel E, Tayebi L, Nikbakht M, Hasanzadeh E, Asadpour S. Clinical Trials of Mesenchymal Stem Cells for the Treatment of COVID 19. Curr Stem Cell Res Ther 2023:CSCR-EPUB-134842. [PMID: 37815188 DOI: 10.2174/011574888x260032230925052240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 10/11/2023]
Abstract
Mesenchymal Stem Cells (MSCs) are being investigated as a treatment for a novel viral disease owing to their immunomodulatory, anti-inflammatory, tissue repair and regeneration characteristics, however, the exact processes are unknown. MSC therapy was found to be effective in lowering immune system overactivation and increasing endogenous healing after SARS-CoV-2 infection by improving the pulmonary microenvironment. Many studies on mesenchymal stem cells have been undertaken concurrently, and we may help speed up the effectiveness of these studies by collecting and statistically analyzing data from them. Based on clinical trial information found on clinicaltrials. gov and on 16 November 2020, which includes 63 clinical trials in the field of patient treatment with COVID-19 using MSCs, according to the trend of increasing studies in this field, and with the help of meta-analysis studies, it is possible to hope that the promise of MSCs will one day be realized. The potential therapeutic applications of MSCs for COVID-19 are investigated in this study.
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Affiliation(s)
- Elham Zendedel
- Shahrekord University of Medical Sciences Tissue Engineering and Applied Cell Sciences Shahr-e Kord Iran
| | - Lobat Tayebi
- Shahrekord University of Medical Sciences Dentistry Shahr-e Kord Iran
| | - Mohammad Nikbakht
- Shahrekord University of Medical Sciences Medical Biotechnology Shahr-e Kord Iran
| | - Elham Hasanzadeh
- Mazandaran University of Medical Sciences Tissue Engineering & Regenerative Medicine Sari Iran
| | - Shiva Asadpour
- Shahrekord University of Medical Sciences Tissue Engineering and Applied Cell Sciences Shahr-e Kord Iran
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24
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McDermott DH, Velez D, Cho E, Cowen EW, DiGiovanna JJ, Pastrana DV, Buck CB, Calvo KR, Gardner PJ, Rosenzweig SD, Stratton P, Merideth MA, Kim HJ, Brewer C, Katz JD, Kuhns DB, Malech HL, Follmann D, Fay MP, Murphy PM. A phase III randomized crossover trial of plerixafor versus G-CSF for treatment of WHIM syndrome. J Clin Invest 2023; 133:e164918. [PMID: 37561579 PMCID: PMC10541188 DOI: 10.1172/jci164918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 08/08/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUNDWarts, hypogammaglobulinemia, infections, and myelokathexis (WHIM) syndrome is a primary immunodeficiency disorder caused by heterozygous gain-of-function CXCR4 mutations. Myelokathexis is a kind of neutropenia caused by neutrophil retention in bone marrow and in WHIM syndrome is associated with lymphopenia and monocytopenia. The CXCR4 antagonist plerixafor mobilizes leukocytes to the blood; however, its safety and efficacy in WHIM syndrome are undefined.METHODSIn this investigator-initiated, single-center, quadruple-masked phase III crossover trial, we compared the total infection severity score (TISS) as the primary endpoint in an intent-to-treat manner in 19 patients with WHIM who each received 12 months treatment with plerixafor and 12 months treatment with granulocyte CSF (G-CSF, the standard of care for severe congenital neutropenia). The treatment order was randomized for each patient.RESULTSPlerixafor was nonsuperior to G-CSF for TISS (P = 0.54). In exploratory endpoints, plerixafor was noninferior to G-CSF for maintaining neutrophil counts of more than 500 cells/μL (P = 0.023) and was superior to G-CSF for maintaining lymphocyte counts above 1,000 cells/μL (P < 0.0001). Complete regression of a subset of large wart areas occurred on plerixafor in 5 of 7 patients with major wart burdens at baseline. Transient rash occurred on plerixafor, and bone pain was more common on G-CSF. There were no significant differences in drug preference or quality of life or the incidence of drug failure or serious adverse events.CONCLUSIONPlerixafor was not superior to G-CSF in patients with WHIM for TISS, the primary endpoint. Together with wart regression and hematologic improvement, the infection severity results support continued study of plerixafor as a potential treatment for WHIM syndrome.TRIAL REGISTRATIONClinicaltrials.gov NCT02231879.FUNDINGThis study was funded by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- David H. McDermott
- Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases
| | - Daniel Velez
- Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases
| | - Elena Cho
- Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases
| | - Edward W. Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases
| | | | | | | | | | - Pamela J. Gardner
- Office of the Clinical Director, National Institute of Dental and Craniofacial Research
| | | | | | | | - H. Jeffrey Kim
- Otolaryngology Branch, National Institute on Deafness and other Communication Disorders, and
| | - Carmen Brewer
- Otolaryngology Branch, National Institute on Deafness and other Communication Disorders, and
| | - James D. Katz
- Rheumatology Fellowship and Training Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, USA
| | | | | | - Dean Follmann
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Michael P. Fay
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Philip M. Murphy
- Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases
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25
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Khanna R, Ma C, Hogan M, Zou G, Bessissow T, Bressler B, Colombel JF, Danese S, Daperno M, East JE, Hookey L, Loftus EV, McDonald JWD, Panaccione R, Peyrin-Biroulet L, Rutter M, Sands BE, Vermeire S, Rémillard J, McFarlane SC, Sandborn WJ, D'Haens GR, Feagan BG, Jairath V. Standardizing Scoring Conventions for Crohn's Disease Endoscopy: An International RAND/UCLA Appropriateness Study. Clin Gastroenterol Hepatol 2023; 21:2938-2950.e6. [PMID: 37308036 DOI: 10.1016/j.cgh.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND AIMS Endoscopic assessment of disease activity is integral for evaluating treatment response in patients with Crohn's disease (CD). We aimed to define appropriate items for evaluating endoscopic activity and conventions for consistent endoscopic scoring rules in CD. METHODS A 2-round modified RAND/University of California at Los Angeles Appropriateness Method study was conducted. A panel of 15 gastroenterologists used a 9-point Likert scale to rate the appropriateness of statements pertaining to the Simple Endoscopic Score for CD, Crohn's Disease Endoscopic Index of Severity, and additional items relevant to endoscopy scoring in CD. Each statement was voted as appropriate, uncertain, or inappropriate based on the median panel rating and presence of disagreement. RESULTS Panelists voted that it is appropriate for all ulcers to contribute to endoscopic scoring in CD, including aphthous ulcers, ulcerations at a surgical anastomosis, and anal canal ulcers (scored in the rectum). Endoscopic healing should reflect an absence of ulcers. Narrowing should be defined as a clear decrease in luminal diameter; stenosis should be defined by an impassable narrowing, and if occurring at the junction of 2 segments, scored in the distal segment. Scarring and inflammatory polyps were considered inappropriate for including in the affected area score. The optimal method for defining ulcer depth remains uncertain. CONCLUSIONS We outlined scoring conventions for the Simple Endoscopic Score for CD and Crohn's Disease Endoscopic Index of Severity, noting that both scores have limitations. Therefore, we identified priorities for future research and steps for developing and validating a more representative endoscopic index in CD.
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Affiliation(s)
- Reena Khanna
- Department of Medicine, Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada
| | - Christopher Ma
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alimentiv Inc, London, Ontario, Canada
| | | | - Guangyong Zou
- Alimentiv Inc, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Brian Bressler
- Division of Gastroenterology, Department of Medicine, University of British Colombia, Vancouver, British Colombia, Canada; Division of Gastroenterology, Department of Medicine, St. Paul's Hospital, Vancouver, British Colombia
| | - Jean-Frédéric Colombel
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Silvio Danese
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Daperno
- Division of Gastroenterology, Ospedale Mauriziano Umberto I, Torino, Italy
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom; Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, United Kingdom
| | - Lawrence Hookey
- Department of Medicine, Division of Gastroenterology, Queen's University, Kingston, Ontario, Canada
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | | | - Remo Panaccione
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Laurent Peyrin-Biroulet
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré - Hartmann, Neuilly-sur-Seine, France; Nutrition-Genetics and Environmental Risk Exposure, INSERM, Université de Lorraine, Nancy, France
| | - Matt Rutter
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees, United Kingdom; Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Catholic University Leuven, Leuven, Belgium
| | | | | | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Geert R D'Haens
- Alimentiv Inc, London, Ontario, Canada; Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
| | - Brian G Feagan
- Department of Medicine, Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada; Alimentiv Inc, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada; Alimentiv Inc, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
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26
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Racadio ER, Rai A, Kizilirmak P, Agarwal S, Sosa E, Desborough C, Adnan T, Zhou L, Balasubramanian A, Sharma A, Motsepe-Ditshego P. Diversity and Representation Among United States Participants in Amgen Clinical Trials. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01768-2. [PMID: 37755687 DOI: 10.1007/s40615-023-01768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Describe the demographic profile of US participants in Amgen clinical trials over a 10-year period and variations across therapeutic areas, indications, and geographies. METHODS Cross-sectional retrospective study including participants enrolled (2005-2020) in phase 1-3 trials completed between January 1, 2012 and June 30, 2021. RESULTS Among 31,619 participants enrolled across 258 trials, one-fifth represented racial minority populations (Asian, 3%; Black or African American, 17%; American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, multiracial, each < 1%); fewer than one-fifth (16%) represented an ethnic minority population (Hispanic or Latino). Compared with census data, representation of racial and ethnic groups varied across US states. Across most therapeutic areas (bone, cardiovascular, hematology/oncology, inflammation, metabolic disorders, neuroscience) except nephrology, participants were predominantly White (72-81%). A similar proportion of males and females were enrolled between 2005 and 2016; male representation was disproportionately higher than female between 2016 and 2020. Across most medical indications, the majority of participants were 18-65 years of age. CONCLUSIONS AND RELEVANCE While the clinical research community is striving to achieve diversity and proportional representation across clinical trials, certain populations remain underrepresented. Our data provide a baseline assessment of the diversity and representation of US participants in Amgen-sponsored clinical trials and add to a growing body of evidence on the importance of diversity in clinical research. These data provide a foundation for strategies aimed at supporting more equitable and representative research, and a baseline from which to assess the impact of future strategies to advance health equity.
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Affiliation(s)
| | | | | | | | | | | | | | - Lei Zhou
- Amgen Inc, Thousand Oaks, CA, USA
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27
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Li J, Li Y, Pan Y, Guo J, Sun Z, Li F, He Y, Tao C. Mapping Vaccine Names in Clinical Trials to Vaccine Ontology using Cascaded Fine-Tuned Domain-Specific Language Models. Res Sq 2023:rs.3.rs-3362256. [PMID: 37841880 PMCID: PMC10571639 DOI: 10.21203/rs.3.rs-3362256/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background Vaccines have revolutionized public health by providing protection against infectious diseases. They stimulate the immune system and generate memory cells to defend against targeted diseases. Clinical trials evaluate vaccine performance, including dosage, administration routes, and potential side effects. ClinicalTrials.gov is a valuable repository of clinical trial information, but the vaccine data in them lacks standardization, leading to challenges in automatic concept mapping, vaccine-related knowledge development, evidence-based decision-making, and vaccine surveillance. Results In this study, we developed a cascaded framework that capitalized on multiple domain knowledge sources, including clinical trials, Unified Medical Language System (UMLS), and the Vaccine Ontology (VO), to enhance the performance of domain-specific language models for automated mapping of VO from clinical trials. The Vaccine Ontology (VO) is a community-based ontology that was developed to promote vaccine data standardization, integration, and computer-assisted reasoning. Our methodology involved extracting and annotating data from various sources. We then performed pre-training on the PubMedBERT model, leading to the development of CTPubMedBERT. Subsequently, we enhanced CTPubMedBERT by incorporating SAPBERT, which was pretrained using the UMLS, resulting in CTPubMedBERT + SAPBERT. Further refinement was accomplished through fine-tuning using the Vaccine Ontology corpus and vaccine data from clinical trials, yielding the CTPubMedBERT + SAPBERT + VO model. Finally, we utilized a collection of pre-trained models, along with the weighted rule-based ensemble approach, to normalize the vaccine corpus and improve the accuracy of the process. The ranking process in concept normalization involves prioritizing and ordering potential concepts to identify the most suitable match for a given context. We conducted a ranking of the Top 10 concepts, and our experimental results demonstrate that our proposed cascaded framework consistently outperformed existing effective baselines on vaccine mapping, achieving 71.8% on top 1 candidate's accuracy and 90.0% on top 10 candidate's accuracy. Conclusion This study provides a detailed insight into a cascaded framework of fine-tuned domain-specific language models improving mapping of VO from clinical trials. By effectively leveraging domain-specific information and applying weighted rule-based ensembles of different pre-trained BERT models, our framework can significantly enhance the mapping of VO from clinical trials.
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Affiliation(s)
- Jianfu Li
- The University of Texas Health Science Center at Houston
| | - Yiming Li
- The University of Texas Health Science Center at Houston
| | | | | | - Zenan Sun
- The University of Texas Health Science Center at Houston
| | - Fang Li
- The University of Texas Health Science Center at Houston
| | | | - Cui Tao
- The University of Texas Health Science Center at Houston
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28
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Thiele C, Hirschfeld G. An observational study on the adherence to study registrations in German interventional and observational studies from various fields. PeerJ 2023; 11:e16015. [PMID: 37780396 PMCID: PMC10538302 DOI: 10.7717/peerj.16015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/10/2023] [Indexed: 10/03/2023] Open
Abstract
Background The registration of studies, especially in the case of clinical trials, is required by the declaration of Helsinki and the policies of various scientific journals. However, numerous analyses have found considerable discrepancies between published articles and accompanying trial registrations. The aim of this study is to assess such discrepancies for a sample of studies with recruiting locations in Germany. Additionally, the association between the adherence to registrations and possible involvement of Coordinating Centers for Clinical Studies (KKS) as well as Universities of Excellence was tested. Methods For a sample of 376 interventional or observational study registrations, we found 115 published articles. Subsequently, we searched for discrepancies in the study design, the key inclusion criteria, the interventions, the blinding, and a primary and a secondary outcome. Results We found discrepancies in 26% of all studies, most frequently in the secondary outcomes, where 16.5% of the secondary outcomes per study that were registered in most detail had discrepancies. When running regression models for adherence discrepancies, the only variable that had a statistically significant association with better adherence was registration on ClinicalTrials.gov. The association of potential involvement of a KKS with adherence ratings was positive, too, but statistically insignificant. Conclusions In summary, the amount of discrepancies between registrations and published articles remains elevated.
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Affiliation(s)
- Christian Thiele
- University of Applied Sciences and Arts Bielefeld, Bielefeld, Germany
| | - Gerrit Hirschfeld
- University of Applied Sciences and Arts Bielefeld, Bielefeld, Germany
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Vivarelli M, Colucci M, Algeri M, Zotta F, Emma F, L’Erario I, Busutti M, Rota S, Capelli C, Introna M, Todeschini M, Casiraghi F, Perna A, Peracchi T, De Salvo A, Rubis N, Locatelli F, Remuzzi G, Ruggenenti P. A phase I study of autologous mesenchymal stromal cells for severe steroid-dependent nephrotic syndrome. JCI Insight 2023; 8:e169424. [PMID: 37561590 PMCID: PMC10561718 DOI: 10.1172/jci.insight.169424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/08/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUNDSevere forms of idiopathic nephrotic syndrome (INS) require prolonged immunosuppressive therapies and repeated courses of high-dose glucocorticoids. Mesenchymal stromal cells (MSCs) have promising immunomodulatory properties that may be employed therapeutically to reduce patient exposure to medications and their side effects.METHODSWe performed a phase I open-label trial assessing safety and feasibility of autologous bone marrow-derived MSCs (BM-MSCs) in children and young adults with severe forms of steroid-dependent nephrotic syndrome. Following autologous BM-MSC preparation and infusion, oral immunosuppression was tapered. Safety, efficacy, and immunomodulatory effects in vivo were monitored for 12 months.RESULTSSixteen patients (10 children, 6 adults) were treated. Adverse events were limited and not related to BM-MSC infusions. All patients relapsed during follow-up, but in the 10 treated children, time to first relapse was delayed (P = 0.02) and number of relapses was reduced (P = 0.002) after BM-MSC infusion, compared with the previous 12 months. Cumulative prednisone dose was also reduced at 12 months compared with baseline (P < 0.05). No treatment benefit was observed in adults.In children, despite tapering of immunosuppression, clinical benefit was mirrored by a significant reduction in total CD19+, mature, and memory B cells and an increase in regulatory T cells in vivo up to 3-6 months following BM-MSC infusionCONCLUSIONTreatment with autologous BM-MSCs is feasible and safely reduces relapses and immunosuppression at 12 months in children with severe steroid-dependent INS. Immunomodulatory studies suggest that repeating MSC infusions at 3-6 months may sustain benefit.TRIAL REGISTRATIONEudraCT 2016-004804-77.FUNDINGAIFA Ricerca Indipendente 2016-02364623.
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Affiliation(s)
- Marina Vivarelli
- Division of Nephrology, and
- Laboratory of Nephrology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Manuela Colucci
- Laboratory of Nephrology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Mattia Algeri
- Department of Pediatric Hematology/Oncology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | | | | | | | | | - Stefano Rota
- Unit of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale (ASST), Bergamo, Italy
| | - Chiara Capelli
- Center of Cellular Therapy “G. Lanzani,” Haematology Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Martino Introna
- Center of Cellular Therapy “G. Lanzani,” Haematology Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marta Todeschini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | | | - Annalisa Perna
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Tobia Peracchi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Andrea De Salvo
- Psychology Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Nadia Rubis
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology/Oncology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Piero Ruggenenti
- Unit of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale (ASST), Bergamo, Italy
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
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Franco-Ramírez GDJ, Cabrales-García F, Godínez-García F. [Comparison of cervical fusion with autografting of fibula vs titanium cage]. Rev Med Inst Mex Seguro Soc 2023; 61:S193-S199. [PMID: 38011687 PMCID: PMC10773913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/10/2023] [Indexed: 11/29/2023]
Abstract
Background The anterior cervical discectomy and fusion (ACDF) is the gold standard in the treatment of cervical compression pathology and the titanium cage for fusion represents the most used procedure at an institutional level. A technique using fibular autograft has been described, with good results, lower morbidity and lower cost. Objective To compare the rate of fusion, subsidence and functional clinical results after discectomy with titanium cage and fibular autograft. Material and methods A clinical trial with follow-up at 3 and 6 months was carried out in patients diagnosed with cervical spondylosis, candidates for ACDF. 2 groups were formed: fibular autograft and titanium cage. Pre and post functional evaluation using the cervical disability score was made, as well as radiographic fusion and subsidence evaluation. Descriptive statistics, Fisher's exact test, t-test and ANOVA were obtained, establishing p < 0.05. Results A sample of 20 patients with an average age of 56 years was obtained, finding a fusion rate of 90% for fibular autograft and 30% for titanium (p = 0.02) at 3 months. 10% of patients with fibular autograft presented subsidence and 70% with titanium cage at 3 and 6 months (p = 0.02). In the functional results was not found difference between both procedures (p = 0.874). Conclusions The use of autologous fibular graft offers a better rate of fusion and subsidence compared to the titanium cage, as well as similar functional results at 3 months of follow-up. It represents an excellent treatment option for cervical spondylosis.
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Affiliation(s)
- Gerardo de Jesús Franco-Ramírez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, Servicio de Traumatología y Ortopedia. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Francisco Cabrales-García
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, Servicio de Traumatología y Ortopedia. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Francisco Godínez-García
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, Unidad de Cuidados Intensivos. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Bhalla M, Mittal R, Kumar M, Bhatia R, Kushwah AS. Metabolomics: A Tool to Envisage Biomarkers in Clinical Interpretation of Cancer. Curr Drug Res Rev 2023:CDRR-EPUB-134451. [PMID: 37702236 DOI: 10.2174/2589977516666230912120412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/22/2023] [Accepted: 07/20/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Cancer is amongst the most dreadful ailments of modern times, and its impact continuously worsens global health systems. Early diagnosis and suitable therapeutic agents are the prime keys to managing this disease. Metabolomics deals with the complete profiling of cells and physiological phenomena in their organelles, thus helping in keen knowledge of the pathological status of the disease. It has been proven to be one of the best strategies in the early screening of cancer. OBJECTIVE This review has covered the recent updates on the promising role of metabolomics in the identification of significant biochemical markers in cancer-prone individuals that could lead to the identification of cancer in the early stages. METHODS The literature was collected through various databases, like Scopus, PubMed, and Google Scholar, with stress laid on the last ten years' publications. CONCLUSION It was assessed in this review that early recognition of cancerous growth could be achieved via complete metabolic profiling in association with transcriptomics and proteomics. The outcomes are rooted in various clinical studies that anticipated various biomarkers like tryptophan, phenylalanine, lactates, and different metabolic pathways associated with the Warburg effect. This metabolite imaging has been a fundamental step for the target acquisition, evaluation of predictive cancer biomarkers for early detection, and outlooks into cancer therapy along with critical evaluation. Significant efforts should be made to make this technique most reliable and easy.
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Affiliation(s)
- Medha Bhalla
- Department of Pharmacology, Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College of Pharmacy, Ropar 140111, India
| | - Roopal Mittal
- Department of Pharmacology, IKG Punjab Technical University, Jalandhar 144601, India
- Department of Pharmacology, R.K.S.D. College of Pharmacy, Kaithal 136027, India
| | - Manish Kumar
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India
| | - Rohit Bhatia
- Department of Pharmaceutical Chemistry, ISF College of Pharmacy, Moga 142001, India
| | - Ajay Singh Kushwah
- Department of Pharmacology, Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College of Pharmacy, Ropar 140111, India
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Hughes M, Maltez N, Brown E, Hickey V, Shea B, Pauling JD, Proudman S, Merkel PA, Herrick AL. Domain reporting in Systemic Sclerosis-Related Digital Ulcers: An OMERACT Scoping Review. Semin Arthritis Rheum 2023; 61:152220. [PMID: 37236843 DOI: 10.1016/j.semarthrit.2023.152220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Digital ulcers (DUs) are a major cause of pain and disability in patients with systemic sclerosis (SSc). The aim of this scoping review was to evaluate the outcome domains used in studies of SSc-associated DUs. METHODS Electronic databases (EMBASE, MEDLINE and the Cochrane Library) were searched for articles written (1947 onwards) in English relating to SSc-DUs. A minimum of 15 participants for studies of imaging and 25 participants for questionnaire-based studies was required for inclusion. Information on all primary and secondary domains was extracted. RESULTS 4869 manuscripts were identified, of which 40 met the eligibility criteria and were included in the synthesis. Most studies were randomized controlled trials (n=13), or prospective (n=12)/retrospective (n=8) observational studies. Interventions included oral or intravenous drugs (n=25), topical/local treatments (n=5), and surgical interventions (n=2). Approximately half the studies assessed either the count/number of DUs (n=23) and/or improvement in DUs (n=20). Functional impact of DUs was examined in 25% (n=10) of studies. Other domains were related to complications of DUs (n=7), pain (n=6), health-related quality of life (n=4), microvascular assessment/pathophysiology (n=4), global assessment of DUs (n=2), and histopathology (n=1). CONCLUSION This scoping review identified a broad range of disease-related domains used to study SSc-DUs. There is significant heterogeneity in these domains. These data will inform the ongoing work of the OMERACT Vascular Disease in Systemic Sclerosis Working Group to define a core set of disease broad domains to capture the burden of DUs in SSc.
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Affiliation(s)
- Michael Hughes
- Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK; Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Nancy Maltez
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Beverley Shea
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - John D Pauling
- North Bristol NHS Trust, Bristol, UK; Bristol Medical School, University of Bristol, Bristol, UK
| | - Susanna Proudman
- Discipline of Medicine, University of Adelaide and Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Fairley R, Lillard JW, Berk A, Cornew S, Gaspero J, Gillespie J, Horne LL, Kidane S, Munro SB, Parsons M, Powers ER, Rizzo SE, Tishcler A, Wohl H, Weiss MC. Increasing Clinical Trial Participation of Black Women Diagnosed with Breast Cancer. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01644-z. [PMID: 37314691 DOI: 10.1007/s40615-023-01644-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/15/2023]
Abstract
Despite racial disparities in breast cancer mortality, Black women remain underrepresented in clinical trials. In this mixed methods research, 48 Black women were engaged via focus group discussions and in-depth interviews to better understand the lived experience of women with breast cancer. The results of this qualitative study informed the development of a subsequent online survey to identify barriers, motivators, and other factors that influence decision-making by Black women diagnosed with breast cancer when considering clinical trial participation. Among the 257 Black survey participants, most (95%) were aware of clinical trials; of those, most viewed them as lifesaving (81%) and/or benefiting others (90%). Negative perceptions such as serious side effects (58%), not receiving real treatment (52%), or risk of potential harm (62%) were indicated. Barriers included financial expenses (49%), concerns that their condition could be made worse (29%), that they would receive a placebo (28%), or that treatment was unapproved (28%). Participants were more likely than their health care providers (HCPs) to initiate discussions of clinical trials (53% versus 33%), and 29% of participants indicated a need for more information about risks and benefits, even after having those conversations. The most trustworthy sources of information on clinical trials were HCPs (66%) and breast cancer support groups (64%). These results suggest that trusted communities are key for providing education on clinical trials. However, there is also a need for HCPs to proactively discuss clinical trials with patients to ensure that they are adequately informed about all aspects of participation.
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Affiliation(s)
- Ricki Fairley
- TOUCH, The Black Breast Cancer Alliance, Annapolis, MD, USA
| | - James W Lillard
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Sophia Cornew
- Patient Network and Data, Invitae, San Francisco, CA, USA
| | | | | | - LaTrisha L Horne
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA, USA
| | | | | | | | - Emily R Powers
- TOUCH, The Black Breast Cancer Alliance, Annapolis, MD, USA.
| | | | | | | | - Marisa C Weiss
- Breastcancer.org, Ardmore, PA, USA
- Lankenau Medical Center, Wynnewood, PA, USA
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Ahmadi A, Begue G, Valencia AP, Norman JE, Lidgard B, Bennett BJ, Van Doren MP, Marcinek DJ, Fan S, Prince DK, Gamboa J, Himmelfarb J, de Boer IH, Kestenbaum BR, Roshanravan B. Randomized crossover clinical trial of coenzyme Q10 and nicotinamide riboside in chronic kidney disease. JCI Insight 2023; 8:e167274. [PMID: 37159264 PMCID: PMC10393227 DOI: 10.1172/jci.insight.167274] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/03/2023] [Indexed: 05/10/2023] Open
Abstract
BackgroundCurrent studies suggest mitochondrial dysfunction is a major contributor to impaired physical performance and exercise intolerance in chronic kidney disease (CKD). We conducted a clinical trial of coenzyme Q10 (CoQ10) and nicotinamide riboside (NR) to determine their impact on exercise tolerance and metabolic profile in patients with CKD.MethodsWe conducted a randomized, placebo-controlled, double-blind, crossover trial comparing CoQ10, NR, and placebo in 25 patients with an estimated glomerular filtration rate (eGFR) of less than 60mL/min/1.73 m2. Participants received NR (1,000 mg/day), CoQ10 (1,200 mg/day), or placebo for 6 weeks each. The primary outcomes were aerobic capacity measured by peak rate of oxygen consumption (VO2 peak) and work efficiency measured using graded cycle ergometry testing. We performed semitargeted plasma metabolomics and lipidomics.ResultsParticipant mean age was 61.0 ± 11.6 years and mean eGFR was 36.9 ± 9.2 mL/min/1.73 m2. Compared with placebo, we found no differences in VO2 peak (P = 0.30, 0.17), total work (P = 0.47, 0.77), and total work efficiency (P = 0.46, 0.55) after NR or CoQ10 supplementation. NR decreased submaximal VO2 at 30 W (P = 0.03) and VO2 at 60 W (P = 0.07) compared with placebo. No changes in eGFR were observed after NR or CoQ10 treatment (P = 0.14, 0.88). CoQ10 increased free fatty acids and decreased complex medium- and long-chain triglycerides. NR supplementation significantly altered TCA cycle intermediates and glutamate that were involved in reactions that exclusively use NAD+ and NADP+ as cofactors. NR decreased a broad range of lipid groups including triglycerides and ceramides.ConclusionsSix weeks of treatment with NR or CoQ10 improved markers of systemic mitochondrial metabolism and lipid profiles but did not improve VO2 peak or total work efficiency.Trial registrationClinicalTrials.gov NCT03579693.FundingNational Institutes of Diabetes and Digestive and Kidney Diseases (grants R01 DK101509, R03 DK114502, R01 DK125794, and R01 DK101509).
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Affiliation(s)
- Armin Ahmadi
- Department of Medicine, Division of Nephrology, UCD, Davis, California, USA
| | - Gwenaelle Begue
- Kinesiology Department, California State University, Sacramento, California, USA
| | - Ana P. Valencia
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Jennifer E. Norman
- Department of Internal Medicine, Division of Cardiovascular Medicine, UCD, Davis, California, USA
| | - Benjamin Lidgard
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Brian J. Bennett
- Obesity and Metabolism Research Unit, Western Human Nutrition Research Center, USDA, ARS, Davis, California, USA
| | | | - David J. Marcinek
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Sili Fan
- Department of Biostatistics, UCD, Davis, California, USA
| | - David K. Prince
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Jorge Gamboa
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Jonathan Himmelfarb
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Ian H. de Boer
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Bryan R. Kestenbaum
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Baback Roshanravan
- Department of Medicine, Division of Nephrology, UCD, Davis, California, USA
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Singh A, Afshan N, Singh A, Singh SK, Yadav S, Kumar M, Sarma DK, Verma V. Recent trends and advances in type 1 diabetes therapeutics: A comprehensive review. Eur J Cell Biol 2023; 102:151329. [PMID: 37295265 DOI: 10.1016/j.ejcb.2023.151329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/12/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023] Open
Abstract
Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by the destruction of pancreatic β-cells, leading to insulin deficiency. Insulin replacement therapy is the current standard of care for T1D, but it has significant limitations. However, stem cell-based replacement therapy has the potential to restore β-cell function and achieve glycaemic control eradicating the necessity for drugs or injecting insulin externally. While significant progress has been made in preclinical studies, the clinical translation of stem cell therapy for T1D is still in its early stages. In continuation, further research is essentially required to determine the safety and efficacy of stem cell therapies and to develop strategies to prevent immune rejection of stem cell-derived β-cells. The current review highlights the current state of cellular therapies for T1D including, different types of stem cell therapies, gene therapy, immunotherapy, artificial pancreas, and cell encapsulation being investigated, and their potential for clinical translation.
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Affiliation(s)
- Akash Singh
- Stem Cell Research Centre, Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Noor Afshan
- Stem Cell Research Centre, Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anshuman Singh
- Stem Cell Research Centre, Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Suraj Kumar Singh
- Stem Cell Research Centre, Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sudhanshu Yadav
- Stem Cell Research Centre, Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Manoj Kumar
- ICMR-National Institute for Research in Environmental Health, Bhopal, India
| | | | - Vinod Verma
- Stem Cell Research Centre, Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
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Sim HW, Lorrey S, Khasraw M. Advances in Treatment of Isocitrate Dehydrogenase (IDH)-Wildtype Glioblastomas. Curr Neurol Neurosci Rep 2023; 23:263-276. [PMID: 37154886 DOI: 10.1007/s11910-023-01268-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE OF REVIEW The management of isocitrate dehydrogenase (IDH)-wildtype glioblastomas is an area of unmet need. Despite multimodal therapy incorporating maximal safe resection, radiotherapy, and temozolomide, clinical outcomes remain poor. At disease progression or relapse, available systemic agents such as temozolomide, lomustine, and bevacizumab have limited efficacy. We review the recent advances in the treatment of IDH-wildtype glioblastomas. RECENT FINDINGS A broad repertoire of systemic agents is in the early stages of development, encompassing the areas of precision medicine, immunotherapy, and repurposed medications. The use of medical devices may present opportunities to bypass the blood-brain barrier. Novel clinical trial designs aim to efficiently test treatment options to advance the field. There are a number of emerging treatment options for IDH-wildtype glioblastomas which are undergoing evaluation in clinical trials. Advances in our scientific understanding of IDH-wildtype glioblastomas offer hope and the prospect of incremental improvements in clinical outcomes.
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Affiliation(s)
- Hao-Wen Sim
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, 2050, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2010, Australia
- Department of Medical Oncology, The Kinghorn Cancer Centre, Sydney, NSW, 2010, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, NSW, 2050, Australia
| | - Selena Lorrey
- Department of Immunology, Duke University Medical Center, Durham, NC, 27710, USA
- Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, 27710, USA
| | - Mustafa Khasraw
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, 2050, Australia.
- Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, 27710, USA.
- Duke University School of Medicine, Duke University Medical Center, Box 3624, Durham, NC, 27710, USA.
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Matthew-Onabanjo AN, Nortey G, Matulewicz RS, Basak R, Culton DA, Weaver KN, Gallagher KK, Tan HJ, Rose TL, Milowsky M, Bjurlin MA. Diversity, equity, and inclusion in genitourinary clinical trials leading to FDA novel drug approval: An assessment of the FDA center for drug evaluation and research drug trials snapshot. Curr Probl Cancer 2023; 47:100958. [PMID: 37084464 PMCID: PMC10523926 DOI: 10.1016/j.currproblcancer.2023.100958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/23/2023]
Abstract
To determine the distribution of race and ethnicity among genitourinary oncology trial participants leading to FDA approval of novel molecular entities/biologics. Secondarily, we evaluated whether the proportion of Black participants in clinical trials increased over time. We quired the FDA Center for Drug Evaluation and Research Drug Trials Snapshot (DTS) between 2015 and 2020 for urologic oncology clinical trials leading to FDA approval of novel drugs. Enrollment data was stratified by race and ethnicity. Cochran-Armitage Trend tests were used to examine changes in Black patient participation over years. Nine clinical trials were identified that led to FDA approval of 5 novel molecular entities for prostate and 4 molecular entities for urothelial carcinoma treatment. Trials for prostate cancer included 5202 participants of which 69.8% were White, 4.0% Black, 11.0% Asian, 3.6% Hispanic, <1% American Indian/Alaska Native or Native Hawaiian/Pacific Islander, 3% other. Trials in urothelial carcinoma had 704 participants of which 75.1% were male, 80.8% White, 2.3% Black, 2.4% Hispanic, <1% American Indian/Alaska Native or Native Hawaiian/Pacific Islander, 5% other. Black participation rates over time did not change for urothelial (P = 0.59) or the combined cancer cohort (P = 0.29). Prostate cancer enrollment trends among Black participant declined over time (P = 0.03). Participants in genitourinary clinical trials leading to FDA approval of novel drugs are overwhelmingly white. Involving stakeholders who represent the needs and interests of underrepresented populations in the design and implementation of clinical trials of novel agents may be a strategy to increase diversity, equity, and inclusion among genitourinary clinical trials.
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Affiliation(s)
| | - Gabrielle Nortey
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - Richard S Matulewicz
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Ramsankar Basak
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Donna A Culton
- Department of Dermatology, University of North Carolina, Chapel Hill, NC
| | - Kimberly N Weaver
- Division of Gastroenterology & Hepatology, University of North Carolina, Chapel Hill, NC
| | | | - Hung-Jui Tan
- Department of Urology, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Tracy L Rose
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; Division of Oncology, University of North Carolina, Chapel Hill, NC
| | - Matthew Milowsky
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; Division of Oncology, University of North Carolina, Chapel Hill, NC
| | - Marc A Bjurlin
- Department of Urology, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
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Oakley J, Worley C, Yu LU, Brooks RR, Özçelik I, Skjellum A, Obeid JS. Scrybe: A Secure Audit Trail for Clinical Trial Data Fusion. Digit Threat 2023; 4:24. [PMID: 37937206 PMCID: PMC10629820 DOI: 10.1145/3491258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 09/09/2021] [Indexed: 11/09/2023]
Abstract
Clinical trials are a multi-billion dollar industry. One of the biggest challenges facing the clinical trial research community is satisfying Part 11 of Title 21 of the Code of Federal Regulations [7] and ISO 27789 [40]. These controls provide audit requirements that guarantee the reliability of the data contained in the electronic records. Context-aware smart devices and wearable IoT devices have become increasingly common in clinical trials. Electronic Data Capture (EDC) and Clinical Data Management Systems (CDMS) do not currently address the new challenges introduced using these devices. The healthcare digital threat landscape is continually evolving, and the prevalence of sensor fusion and wearable devices compounds the growing attack surface. We propose Scrybe, a permissioned blockchain, to store proof of clinical trial data provenance. We illustrate how Scrybe addresses each control and the limitations of the Ethereum-based blockchains. Finally, we provide a proof-of-concept integration with REDCap to show tamper resistance.
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Korpics MC, Onderdonk BE, Dadey RE, Hara JH, Karapetyan L, Zha Y, Karrison TG, Olson AC, Fleming GF, Weichselbaum RR, Bao R, Chmura SJ, Luke JJ. Partial tumor irradiation plus pembrolizumab in treating large advanced solid tumor metastases. J Clin Invest 2023; 133:162260. [PMID: 37183819 PMCID: PMC10178837 DOI: 10.1172/jci162260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 03/24/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUNDWe previously demonstrated the safety of stereotactic body radiotherapy followed by pembrolizumab (SBRT+P) in patients with advanced solid tumors. This phase I clinical trial was expanded to study the safety of partial tumor irradiation (partial-Rx). We assessed irradiated local failure (LF) and clinical outcomes with correlations to biomarkers including CD8+ T cell radiomics score (RS) and circulating cytokines.METHODSPatients received SBRT to 2-4 metastases and pembrolizumab for up to 7 days after SBRT. Tumors measuring up to 65 cc received the full radiation dose (complete-Rx), whereas tumors measuring more than 65 cc received partial-Rx. Landmark analysis was used to assess the relationship between tumor response and overall survival (OS). Multivariable analysis was performed for RS and circulating cytokines.RESULTSIn the combined (expansion plus original) cohort, 97 patients (219 metastases) were analyzed and received SBRT+P. Forty-six (47%) patients received at least 1 partial-Rx treatment. There were 7 (7.2%)dose-limiting toxicities (DLTs). 1-year LF was 7.6% overall, and 13.3% and 5.4% for partial-Rx and complete-Rx tumors, respectively (HR 2.32, 95% CI 0.90-5.97, P = 0.08). The overall, unirradiated, and irradiated objective response rates were 22%, 12%, and 34%, respectively. Irradiated tumor response to SBRT+P was associated with prolonged OS; 1-year OS was 71% (responders), 42% (mixed-responders), and 0% (nonresponders) (P < 0.01). High-RS was significantly associated with improved LF, progression-free survival (PFS), and OS. Elevated circulating IL-8 was independently associated with inferior PFS and OS.CONCLUSIONSBRT+P is safe in patients with large, advanced solid tumors. Additional studies are warranted to assess noninferiority of complete versus partial irradiation of tumors in the setting of immunotherapy.TRIAL REGISTRATIONClinicaltrials.gov NCT02608385FUNDINGMerck Investigator Studies Program; Hillman Fellows for Innovative Cancer Research Program; NIH grants UM1CA186690-06, P50CA254865-01A1, P30CA047904-32, and R01DE031729-01A1.
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Affiliation(s)
- Mark C Korpics
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois, USA
| | - Benjamin E Onderdonk
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois, USA
| | - Rebekah E Dadey
- UPMC Hillman Cancer Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jared H Hara
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois, USA
| | - Lilit Karapetyan
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Yuanyuan Zha
- Human Immunological Monitoring Core, Biological Sciences Division
| | | | - Adam C Olson
- UPMC Hillman Cancer Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Gini F Fleming
- Department of Medicine, Section of Hematology/Oncology, and
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois, USA
- Ludwig Center for Metastasis Research, The University of Chicago, Chicago, Illinois, USA
| | - Riyue Bao
- UPMC Hillman Cancer Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Steven J Chmura
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois, USA
| | - Jason J Luke
- UPMC Hillman Cancer Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Radermecker R. [The placebo effect in functional disorders]. Rev Med Liege 2023; 78:250-254. [PMID: 37350197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Functional disorders are clinical entities corresponding to complaints mimicking diseases without a clearly identified organic substrate despite a rigorous history and clinical examination. Sometimes, complementary examinations are necessary to rule out an organic lesion that could explain the symptomatology. The notion of a diagnosis of exclusion is therefore very present. The physician must constantly re-evaluate the diagnosis of functional disorder in order not to «miss» a diagnosis with an organic cause.The treatment of these functional disorders is sometimes based on psychological treatment when a psychogenic dimension seems to be involved. This is not always the case. In such cases it is necessary to be able to consider a placebo approach with the hope that the placebo effect may improve the patient's condition. This article discusses the placebo effect in functional disorders without omitting to address ethical and philosophical considerations.
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Affiliation(s)
- Régis Radermecker
- Service de Diabétologie, Nutrition et Maladies métaboliques, CHULiège, Pharmacologie clinique ULiège, Belgique
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Liaw W, Northrup TF, Stotts AL, Bakos-Block C, Suchting R, Chen A, Hernandez A, Finzetto L, Green C, Murphy T. Medical-Legal Partnership Effects on Mental Health, Health Care Use, and Quality of Life in Primary Care: A Randomized Clinical Trial. J Am Board Fam Med 2023:jabfm.2022.220349R1. [PMID: 37028914 DOI: 10.3122/jabfm.2022.220349r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 04/09/2023] Open
Abstract
PURPOSE To determine whether an immediate referral to a medical-legal partnership (MLP), compared with a 6-month waitlist control, improved mental health, health care use, and quality of life. METHODS This trial randomly assigned individuals to an immediate referral or a wait-list control. The MLP involved a collaboration between the primary care clinic and a legal services organization. The primary outcome was stress (6 months) as measured by the Perceived Stress Scale (PSS). Secondary measures included the Center for Epidemiologic Studies Depression Scale; Generalized Anxiety Disorder scale (GAD-7); Patient-Reported Outcomes Measurement Information System (PROMIS); and emergency department (ED), urgent care, and hospital visits. Assessments were at baseline and 3-, 6-, and 9-month follow-ups. Bayesian statistical inference and a 75% posterior probability threshold were used to identify noteworthy differences. RESULTS Immediate referral was associated with lower PSS scores and higher GAD-7 scores. PROMIS scores were higher for the immediate referral group with respect to several subdomains. At 6 months, the immediate referral group demonstrated 21% fewer ED visits and 75.6% more hospital visits. CONCLUSION Immediate referral to the MLP was associated with lower stress and a lower rate of ED visits but higher anxiety and a higher rate of hospital visits. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03805126.
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Affiliation(s)
- Winston Liaw
- From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Texas (WL); Department of Family & Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School (TFN, ALS, TM); School of Biomedical Informatics, University of Texas Health Science Center at Houston (CBB); Faillace Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston (RS); University of Texas Health Science Center at Houston, McGovern Medical School, (AC); Department of Medicine, University of Texas Health Science Center at Houston (AH); Department of Counseling, Wake Forest University, Winston-Salem, North Carolina (LF); Department of Pediatrics, University of Texas Health Science Center at Houston (CG).
| | - Thomas F Northrup
- From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Texas (WL); Department of Family & Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School (TFN, ALS, TM); School of Biomedical Informatics, University of Texas Health Science Center at Houston (CBB); Faillace Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston (RS); University of Texas Health Science Center at Houston, McGovern Medical School, (AC); Department of Medicine, University of Texas Health Science Center at Houston (AH); Department of Counseling, Wake Forest University, Winston-Salem, North Carolina (LF); Department of Pediatrics, University of Texas Health Science Center at Houston (CG)
| | - Angela L Stotts
- From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Texas (WL); Department of Family & Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School (TFN, ALS, TM); School of Biomedical Informatics, University of Texas Health Science Center at Houston (CBB); Faillace Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston (RS); University of Texas Health Science Center at Houston, McGovern Medical School, (AC); Department of Medicine, University of Texas Health Science Center at Houston (AH); Department of Counseling, Wake Forest University, Winston-Salem, North Carolina (LF); Department of Pediatrics, University of Texas Health Science Center at Houston (CG)
| | - Christine Bakos-Block
- From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Texas (WL); Department of Family & Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School (TFN, ALS, TM); School of Biomedical Informatics, University of Texas Health Science Center at Houston (CBB); Faillace Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston (RS); University of Texas Health Science Center at Houston, McGovern Medical School, (AC); Department of Medicine, University of Texas Health Science Center at Houston (AH); Department of Counseling, Wake Forest University, Winston-Salem, North Carolina (LF); Department of Pediatrics, University of Texas Health Science Center at Houston (CG)
| | - Robert Suchting
- From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Texas (WL); Department of Family & Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School (TFN, ALS, TM); School of Biomedical Informatics, University of Texas Health Science Center at Houston (CBB); Faillace Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston (RS); University of Texas Health Science Center at Houston, McGovern Medical School, (AC); Department of Medicine, University of Texas Health Science Center at Houston (AH); Department of Counseling, Wake Forest University, Winston-Salem, North Carolina (LF); Department of Pediatrics, University of Texas Health Science Center at Houston (CG)
| | - Alvin Chen
- From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Texas (WL); Department of Family & Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School (TFN, ALS, TM); School of Biomedical Informatics, University of Texas Health Science Center at Houston (CBB); Faillace Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston (RS); University of Texas Health Science Center at Houston, McGovern Medical School, (AC); Department of Medicine, University of Texas Health Science Center at Houston (AH); Department of Counseling, Wake Forest University, Winston-Salem, North Carolina (LF); Department of Pediatrics, University of Texas Health Science Center at Houston (CG)
| | - Abigail Hernandez
- From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Texas (WL); Department of Family & Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School (TFN, ALS, TM); School of Biomedical Informatics, University of Texas Health Science Center at Houston (CBB); Faillace Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston (RS); University of Texas Health Science Center at Houston, McGovern Medical School, (AC); Department of Medicine, University of Texas Health Science Center at Houston (AH); Department of Counseling, Wake Forest University, Winston-Salem, North Carolina (LF); Department of Pediatrics, University of Texas Health Science Center at Houston (CG)
| | - Lisandra Finzetto
- From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Texas (WL); Department of Family & Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School (TFN, ALS, TM); School of Biomedical Informatics, University of Texas Health Science Center at Houston (CBB); Faillace Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston (RS); University of Texas Health Science Center at Houston, McGovern Medical School, (AC); Department of Medicine, University of Texas Health Science Center at Houston (AH); Department of Counseling, Wake Forest University, Winston-Salem, North Carolina (LF); Department of Pediatrics, University of Texas Health Science Center at Houston (CG)
| | - Charles Green
- From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Texas (WL); Department of Family & Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School (TFN, ALS, TM); School of Biomedical Informatics, University of Texas Health Science Center at Houston (CBB); Faillace Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston (RS); University of Texas Health Science Center at Houston, McGovern Medical School, (AC); Department of Medicine, University of Texas Health Science Center at Houston (AH); Department of Counseling, Wake Forest University, Winston-Salem, North Carolina (LF); Department of Pediatrics, University of Texas Health Science Center at Houston (CG)
| | - Thomas Murphy
- From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Texas (WL); Department of Family & Community Medicine, University of Texas Health Science Center at Houston, McGovern Medical School (TFN, ALS, TM); School of Biomedical Informatics, University of Texas Health Science Center at Houston (CBB); Faillace Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston (RS); University of Texas Health Science Center at Houston, McGovern Medical School, (AC); Department of Medicine, University of Texas Health Science Center at Houston (AH); Department of Counseling, Wake Forest University, Winston-Salem, North Carolina (LF); Department of Pediatrics, University of Texas Health Science Center at Houston (CG)
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Navidifar T, Mahdizade Ari M, Alipourkermani A, Afifirad R, Asadollahi P, Veisi A, Ghanavati R, Darbandi A. Clinical Efficacy of Probiotics for Oral Health: A Systematic Review of Clinical Trials Running title: Probiotics and oral health. Curr Pharm Biotechnol 2023:CPB-EPUB-130710. [PMID: 37038663 DOI: 10.2174/1389201024666230405135457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION The aim of the present study was to review the clinical efficacy of probiotics for oral health in randomized controlled trials. METHOD An electronic search was conducted in December 2020 in Embase, Medline, The Cochrane Library, ProQuest, and Google Scholar using the following keywords: "mouthwash" and "probiotics".The titles and abstracts of 3,775 articles were screened and 24 publications that fulfilled the inclusion criteria were included. RESULT A total of 24 clinical trials were reviewed, including 1612 participants receiving either probiotics or mouth treatments. The results of this review indicated that individuals receiving probiotic products have a significant reduction (65% reduction; p<0.05) in the count of Streptococcus mutants in their mouths. It was also found that probiotic products were more effective or equal in effect compared to chlorhexidine in reducing oral pathogens, gingival index, and plaque index scores. On the other hand, the consumption of xylitol mouthwash was shown to cause an improvement in salivary parameters. Considering their safety and effectiveness, the use of probiotic products, such as kefir and mouthwashes, has been recommended against cariogenic bacteria and periodontal diseases. CONCLUSION Probiotics are considered a safe alternative to conventional therapies, such as chlorhexidine and fluoride. Co-administration of chlorhexidine, fluoride, and probiotics seems to be a perfect package.
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Affiliation(s)
- Tahereh Navidifar
- Shushtar Faculty of Medical Sciences Department of Medical Microbiology Shushtar Iran
| | - Marzie Mahdizade Ari
- Iran University of Medical Sciences Department of Medical Microbiology Tehran Iran
| | - Asma Alipourkermani
- Kerman University of Medical Sciences Faculty of Veterinary Medicine Kerman Iran
| | - Roghayeh Afifirad
- Tehran University of Medical Sciences Department of Medical Microbiology Tehran Iran
| | - Parisa Asadollahi
- Medical University of Ilam Department of Microbiology, School of Medicine ?l?m Iran
| | - Ali Veisi
- Behbahan Faculty of Medical Sciences Department of Medical Microbiology Behbahan Iran
| | - Roya Ghanavati
- Ahvaz Jundishapur University of Medical Sciences Department of Medical Microbiology Ahv?z Iran
- Behbahan Faculty of Medical Sciences Behbahan Iran
| | - Atieh Darbandi
- Iran University of Medical Sciences Department of Medical Microbiology Tehran Iran
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Bondarenko I, Agarwal A, Van Hemelrijck M, Lawler M, Zubaryev M, Sullivan R. Far-reaching impact of the Russian invasion of Ukraine on global cancer research. Eur J Cancer 2023; 183:95-97. [PMID: 36812845 DOI: 10.1016/j.ejca.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 02/05/2023]
Abstract
Clinical research is crucial for national cancer control plans. Prior to the Russian invasion on 24th Feb 2022 both Russia and Ukraine were significant contributors to global clinical trials and cancer research. In this short analysis we describe this and the impact that the conflict has had with wider consideration for the global cancer research ecosystems.
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Affiliation(s)
- Igor Bondarenko
- Head of Oncology and Medical Radiology Dept., Dnipro State Medical University, Dnipro, Ukraine.
| | - Ajay Agarwal
- Dept of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Mieke Van Hemelrijck
- Centre for Cancer, Society & Public Health, School of Cancer Sciences, King's College London, UK.
| | - Mark Lawler
- School of Medicine, Queen's University, Belfast, Ireland.
| | - Mykola Zubaryev
- Department of Surgical Oncology, National Cancer Institute of Ukraine, Kyiv, Ukraine.
| | - Richard Sullivan
- Institute of Cancer Policy, Global Oncology Group, Centre for Cancer, Society & Public Health, King's College London, London UK.
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Gupta R, Behnoush AH, Khalaji A, Malik AH, Kluck B. Endovascular Thrombectomy in Basilar-Artery Occlusion Stroke. Eur J Intern Med 2023; 110:113-116. [PMID: 36424272 DOI: 10.1016/j.ejim.2022.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA.
| | | | | | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Bryan Kluck
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA
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McClary T, Blee S, Avinger A, Dai Q, Switchenko J, Dixon M, Pentz R. Accounting for the High Enrollment of African Americans on Winship Cancer Institute's Myeloma Clinical Trials. Ethics Med Public Health 2023; 27:100877. [PMID: 37007841 PMCID: PMC10062432 DOI: 10.1016/j.jemep.2023.100877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Background Thirty-four percent of Multiple Myeloma (MM) clinical trial participants at Winship Cancer Institute (Winship) are African American (AA); however, AAs make up only 4.5 percent of myeloma clinical trial participants in the United States. Given our high enrollment, we aimed to measure AAs' trust in providers and identify if clinical trial enrollment barriers exist. Methodology A member of the ethics research team surveyed AA patients who had consented to a MM clinical trial at Winship. Three validated surveys were used: Trust in Medical Research (TMR); Human Connection (THC) which measures how much patients feel they are heard and valued by their physicians; and the Duke Intrinsic Religiosity Scale (DUREL) which measures strength of religious engagement and belief. The survey also included questions about the impact of side effects, distance to the trial center and trial related costs on the decision to participate in clinical trial. Results Ninety-two percent (61/67) of patients approached consented. The mean TMR score and the mean THC score were significantly higher (P-value < 0.001) than the results obtained in key national surveys (TMR 14.9 compared to 11.65; THC 57.7 compared to 54.6). These two surveys were significantly correlated, meaning trust and human connection increase or decrease in tandem. The 3 religiosity subscale results showed high religiosity (3.84, 4.36, and 4.35 with 5 being the highest score). The mean scores of the importance of the investigational agent's side effects, trial costs, and distance to trial center on the decision to enroll in a clinical trial were also high (8.5, 7.8, and 6.5, respectively, with 10 being the most important). Conclusion In our study population, high trust and human connection overcame other trial participation barriers: strong religious beliefs and concerns about side effects, costs, and travel distance. We present a roadmap to guide investigators to increase human connection, and hopefully trust.
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Affiliation(s)
- T.S. McClary
- Emory University, Winship Cancer Institute, 1365, Clifton Road, 30322 Atlanta, GA, USA
- South University Orlando Campus5900 Lake Ellenor Dr, Orlando Fl 32809
| | - S.M. Blee
- Emory University, Winship Cancer Institute, 1365, Clifton Road, 30322 Atlanta, GA, USA
- Creighton University Medical School2621 Burt Street, Omaha, Nebraska 68178
| | - A.M. Avinger
- Emory University, Winship Cancer Institute, 1365, Clifton Road, 30322 Atlanta, GA, USA
- Wake Forest University School of Medicine, 475 Vine St, Winston-Salem, NC 27101
| | - Q. Dai
- School of Public Health, Emory University Rollins, 1518, Clifton Road, 30322 Atlanta, GA, USA
| | - J. Switchenko
- School of Public Health, Emory University Rollins, 1518, Clifton Road, 30322 Atlanta, GA, USA
| | - M.D. Dixon
- Emory University, Winship Cancer Institute, 1365, Clifton Road, 30322 Atlanta, GA, USA
| | - R.D. Pentz
- Emory University, Winship Cancer Institute, 1365, Clifton Road, 30322 Atlanta, GA, USA
- Emory University School of Medicine, 100, Woodruff Circle, 30322 Atlanta, GA, USA
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Ouboter LF, Barnhoorn MC, Verspaget HW, Plug L, Pool ES, Szuhai K, Hawinkels LJ, van Pel M, Zwaginga JJ, Roelen D, Koning F, Pascutti MF, van der Meulen-de Jong A. Local administration of mesenchymal stromal cells is safe and modulates the immune compartment in ulcerative proctitis. JCI Insight 2023; 8:167402. [PMID: 36951952 DOI: 10.1172/jci.insight.167402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/17/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Due to their immunoregulatory and tissue regenerative features, mesenchymal stromal cells (MSCs) are a promising novel tool for the management of ulcerative proctitis (UP). Here we report on a phase IIa clinical study to evaluate the impact of local MSC therapy in UP. METHODS Thirteen refractory UP patients, with endoscopic Mayo score (EMS) 2 or 3, were included. Seven patients received 20-40 x 106 allogeneic MSCs (cohort 1), while six patients received 40-80 x 106 MSCs (cohort 2). Adverse events (AEs) were assessed at baseline and week 2, 6, 12, and 24. Clinical, endoscopic, and biochemical parameters were assessed at baseline, week 2 and 6. Furthermore, we evaluated the engraftment of MSCs, presence of donor-specific human leukocyte antigen (HLA) antibodies (DSAs), and we determined the impact of MSC therapy on the local immune compartment. RESULTS No serious AEs were observed. The clinical Mayo score was significantly improved at week 2 and 6, and the EMS was significantly improved at week 6, compared to baseline. At week 6, donor MSCs were still detectable in rectum biopsies of 4/9 patients and DSAs against both HLA-class I and -class II were found. Mass cytometry showed a reduction of activated CD8+ T cells and CD16+ monocytes and an enrichment in mononuclear phagocytes and natural killer cells in biopsies after local MSC therapy. CONCLUSION Local administration of allogeneic MSCs is safe, tolerable, and feasible for treatment of refractory UP and shows encouraging signs of clinical efficacy and modulation of local immune responses. This sets the stage for larger clinical trials. TRIAL REGISTRATION clinicaltrialsregister.eu, EudraCT: 2017-003524-75, Dutch Trial register: NTR7205. FUNDING ECCO grant 2020.
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Affiliation(s)
- Laura F Ouboter
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Marieke C Barnhoorn
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Hein W Verspaget
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Leonie Plug
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Emma S Pool
- Department of Hematology, Leiden University Medical Center, Leiden, Netherlands
| | - Karoly Szuhai
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Lukas Jac Hawinkels
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Melissa van Pel
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Jaap Jan Zwaginga
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Dave Roelen
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | - Frits Koning
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | - M Fernanda Pascutti
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
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Seidler AL, Hunter KE, Barba A, Aberoumand M, Libesman S, Williams JG, Shrestha N, Aagerup J, Gyte G, Montgomery A, Duley L, Askie L. Optimizing cord management for each preterm baby - Challenges of collating individual participant data and recommendations for future collaborative research. Semin Perinatol 2023:151740. [PMID: 37019711 DOI: 10.1016/j.semperi.2023.151740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
The optimal cord management strategy at birth for each preterm baby is still unknown, despite more than 100 randomized controlled trials (RCTs) undertaken on this question. To address this, we brought together all RCTs examining cord management strategies at preterm birth in the iCOMP (individual participant data on COrd Management at Preterm birth) Collaboration, to perform an individual participant data network meta-analysis. In this paper, we describe the trials and tribulations around obtaining individual participant data to resolve controversies around cord clamping, and we derive key recommendations for future collaborative research in perinatology. To reliably answer outstanding questions, future cord management research needs to be collaborative and coordinated, by aligning core protocol elements, ensuring quality and reporting standards are met, and carefully considering and reporting on vulnerable sub-populations. The iCOMP Collaboration is an example of the power of collaboration to address priority research questions, and ultimately improve neonatal outcomes worldwide.
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Affiliation(s)
- Anna Lene Seidler
- Senior Research Fellow, NHMRC Clinical Trials Centre, University of Sydney, Australia.
| | - Kylie E Hunter
- Human Mvt, Senior Evidence Analyst, NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Angie Barba
- Senior Evidence Analyst, NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Mason Aberoumand
- Evidence Analyst, NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Sol Libesman
- Post Doctoral Research Associate, NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Jonathan G Williams
- BMedBiotech, Evidence Analyst, NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Nipun Shrestha
- Post Doctoral Research Associate, NHMRC Clinical Trials Center, University of Sydney, Australia
| | - Jannik Aagerup
- Research Administration Officer, NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Gill Gyte
- Consumer Editor, Cochrane Pregnancy and Childbirth, University of Liverpool, UK
| | - Alan Montgomery
- Professor of Medical Statistics and Clinical Trials, Nottingham Clinical Trials Unit, University of Nottingham, UK
| | | | - Lisa Askie
- MPH FAHMS FHEA, University of Sydney, Australia
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Grigsby KB, Mangieri RA, Roberts AJ, Lopez MF, Firsick EJ, Townsley KG, Beneze A, Bess J, Eisenstein TK, Meissler JJ, Light JM, Miller J, Quello S, Shadan F, Skinner M, Aziz HC, Metten P, Morrisett RA, Crabbe JC, Roberto M, Becker HC, Mason BJ, Ozburn AR. Preclinical and clinical evidence for suppression of alcohol intake by apremilast. J Clin Invest 2023; 133:e159103. [PMID: 36656645 PMCID: PMC10014105 DOI: 10.1172/jci159103] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
Treatment options for alcohol use disorders (AUDs) have minimally advanced since 2004, while the annual deaths and economic toll have increased alarmingly. Phosphodiesterase type 4 (PDE4) is associated with alcohol and nicotine dependence. PDE4 inhibitors were identified as a potential AUD treatment using a bioinformatics approach. We prioritized a newer PDE4 inhibitor, apremilast, as ideal for repurposing (i.e., FDA approved for psoriasis, low incidence of adverse events, excellent safety profile) and tested it using multiple animal strains and models, as well as in a human phase IIa study. We found that apremilast reduced binge-like alcohol intake and behavioral measures of alcohol motivation in mouse models of genetic risk for drinking to intoxication. Apremilast also reduced excessive alcohol drinking in models of stress-facilitated drinking and alcohol dependence. Using site-directed drug infusions and electrophysiology, we uncovered that apremilast may act to lessen drinking in mice by increasing neural activity in the nucleus accumbens, a key brain region in the regulation of alcohol intake. Importantly, apremilast (90 mg/d) reduced excessive drinking in non-treatment-seeking individuals with AUD in a double-blind, placebo-controlled study. These results demonstrate that apremilast suppresses excessive alcohol drinking across the spectrum of AUD severity.
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Affiliation(s)
- Kolter B. Grigsby
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, and VA Portland Health Care System, Portland, Oregon, USA
| | - Regina A. Mangieri
- Waggoner Center for Alcohol and Addiction Research, Division of Pharmacology and Toxicology, College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
| | - Amanda J. Roberts
- Animal Models Core Facility, The Scripps Research Institute, La Jolla, California, USA
| | - Marcelo F. Lopez
- Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Evan J. Firsick
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, and VA Portland Health Care System, Portland, Oregon, USA
| | - Kayla G. Townsley
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, and VA Portland Health Care System, Portland, Oregon, USA
| | - Alan Beneze
- Pearson Center for Alcoholism and Addiction Research, Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Jessica Bess
- Pearson Center for Alcoholism and Addiction Research, Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Toby K. Eisenstein
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Joseph J. Meissler
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | | | - Jenny Miller
- Pearson Center for Alcoholism and Addiction Research, Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Susan Quello
- Pearson Center for Alcoholism and Addiction Research, Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Farhad Shadan
- Pearson Center for Alcoholism and Addiction Research, Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Michael Skinner
- Pearson Center for Alcoholism and Addiction Research, Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Heather C. Aziz
- Waggoner Center for Alcohol and Addiction Research, Division of Pharmacology and Toxicology, College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
| | - Pamela Metten
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, and VA Portland Health Care System, Portland, Oregon, USA
| | - Richard A. Morrisett
- Waggoner Center for Alcohol and Addiction Research, Division of Pharmacology and Toxicology, College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
| | - John C. Crabbe
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, and VA Portland Health Care System, Portland, Oregon, USA
| | - Marisa Roberto
- Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Howard C. Becker
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, USA
- RHJ Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Barbara J. Mason
- Pearson Center for Alcoholism and Addiction Research, Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Angela R. Ozburn
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, and VA Portland Health Care System, Portland, Oregon, USA
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Saluzzo F, Espinosa-Pereiro J, Dressler S, Tàvora Dos Santos Filho E, Seidel S, Gonzalez Moreno J, Heinrich N, Sanchez-Montalva A, Cirillo DM. Community Engagement in Tuberculosis research: the EU-PEARL experience. Int J Infect Dis 2023:S1201-9712(23)00085-1. [PMID: 36906120 DOI: 10.1016/j.ijid.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVES Community representatives are key to ensure that TB research is relevant, culturally sensitive, and appropriate. For all trials (new drugs or treatment regimens, diagnostics, or vaccines) this can result in improvement of recruitment, retention, and adherence to the trial schedule. The early engagement of the community will, later in time, support the process of implementation of new policies designed on successful products. We aim at developing a structured protocol for the early engagement of TB community representatives developed in the context of the EU-PEARL project. RESULTS The EU-PEARL IMI2 project Tuberculosis work package has developed a community engagement framework to ensure fair and efficient participation of community in the design and implementation of TB clinical platform trials. We showed that early engagement of EU-PEARL Community Advisory Board highly contributes to the process of development of a community acceptable Master Protocol Trial and Intervention Specific Appendixes. We identified capacity building and training as major gaps to advance community engagement in the TB field. CONCLUSION Develop strategies to address these needs can contribute to prevent tokenism and increase acceptability and appropriateness of TB research.
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Affiliation(s)
- Francesca Saluzzo
- Vita-Salute San Raffaele University, Milan, Italy; Division of Immunology, Transplantation & Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Juan Espinosa-Pereiro
- Infectious Diseases Department, Vall d'Hebrón University Hospital, Global Health Program from the Catalan Health Institute (PROSICS), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Stephan Dressler
- EU-PEARL: EU Patient-cEntric clinicAl tRial pLatforms, WP5 - Integrated Research Platform for Tuberculosis (TB) Community Advisory Group, Berlin, Germany
| | - Ezio Tàvora Dos Santos Filho
- EU-PEARL: EU Patient-cEntric clinicAl tRial pLatforms, WP5 - Integrated Research Platform for Tuberculosis (TB) Community Advisory Group, Rio De Janeiro, Brazil
| | - Stephanie Seidel
- Community Engagement and Stakeholder Relations, Global Alliance for TB Drug Development, New York, USA
| | | | - Norbert Heinrich
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU, Munich, Germany
| | - Adrian Sanchez-Montalva
- Infectious Diseases Department, Vall d'Hebrón University Hospital, Global Health Program from the Catalan Health Institute (PROSICS), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Mycobacterial Infection Study Group from the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIM-SEIMC), Barcelona, Spain
| | - Daniela Maria Cirillo
- Vita-Salute San Raffaele University, Milan, Italy; Division of Immunology, Transplantation & Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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50
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Staley A. Transforming patient engagement in clinical trials: Moving from a transactional relationship to human-centered care. Drug Discov Today 2023; 28:103509. [PMID: 36708759 DOI: 10.1016/j.drudis.2023.103509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/30/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
Engagement with patients during the clinical trial process encompasses all of the interactions that those running clinical trials have with the participants. The essence of patient engagement is to ensure patients feel supported, connected and empowered before, during and after the clinical trial process. There has been significant progress in the past few years and, while there is still a long way to go, 92% of clinical trial executives believe that clinical trials are now more patient-centric than ever.
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