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Vanstapel FJLA, Orth M, Streichert T, Capoluongo ED, Oosterhuis WP, Çubukçu HC, Bernabeu-Andreu FA, Thelen M, Jacobs LHJ, Linko S, Bhattoa HP, Bossuyt PMM, Meško Brguljan P, Boursier G, Cobbaert CM, Neumaier M. ISO 15189 is a sufficient instrument to guarantee high-quality manufacture of laboratory developed tests for in-house-use conform requirements of the European In-Vitro-Diagnostics Regulation. Clin Chem Lab Med 2023; 61:608-626. [PMID: 36716120 DOI: 10.1515/cclm-2023-0045] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 01/15/2023] [Indexed: 01/31/2023]
Abstract
The EU In-Vitro Diagnostic Device Regulation (IVDR) aims for transparent risk-and purpose-based validation of diagnostic devices, traceability of results to uniquely identified devices, and post-market surveillance. The IVDR regulates design, manufacture and putting into use of devices, but not medical services using these devices. In the absence of suitable commercial devices, the laboratory can resort to laboratory-developed tests (LDT) for in-house use. Documentary obligations (IVDR Art 5.5), the performance and safety specifications of ANNEX I, and development and manufacture under an ISO 15189-equivalent quality system apply. LDTs serve specific clinical needs, often for low volume niche applications, or correspond to the translational phase of new tests and treatments, often extremely relevant for patient care. As some commercial tests may disappear with the IVDR roll-out, many will require urgent LDT replacement. The workload will also depend on which modifications to commercial tests turns them into an LDT, and on how national legislators and competent authorities (CA) will handle new competences and responsibilities. We discuss appropriate interpretation of ISO 15189 to cover IVDR requirements. Selected cases illustrate LDT implementation covering medical needs with commensurate management of risk emanating from intended use and/or design of devices. Unintended collateral damage of the IVDR comprises loss of non-profitable niche applications, increases of costs and wasted resources, and migration of innovative research to more cost-efficient environments. Taking into account local specifics, the legislative framework should reduce the burden on and associated opportunity costs for the health care system, by making diligent use of existing frameworks.
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Key Words
- AB, accrediting body
- BRCA1/2, breast cancer genes 1 and 2
- CA, competent authority
- CAPA, corrective and preventive actions
- CDx, companion diagnostics
- CGP, comprehensive genomic profile
- CRGA, clinically relevant genomic alterations
- EEA, European economic area
- EFLM, European Federation of Clinical Chemistry and Laboratory Medicine
- EMA, European Medicines Agency
- EU, European Union
- European Regulation 2017/746 on In-Vitro-Diagnostic Devices
- FMEA, failure-mode effects analysis
- GA, genomic alterations
- GDPR, General Data Protection Regulation
- HI, health institution
- HRD, homologous recombination deficiency
- HRR, homologous recombination repair
- ISO 15189:2012
- ISO, International Organization for Standardization
- IVDD, In-Vitro Diagnostic Device Directive
- IVDR, In-Vitro Diagnostic Device Regulation
- LDT, laboratory-developed test
- MDCG, Medical Device Coordination Group
- MSI, micro satellite instability
- MU, measurement uncertainty
- NB, notified body
- NGS, next generation sequencing
- NTRK, neurotrophic tyrosine receptor kinase
- PARPi, poly (ADP-ribose) polymerase inhibitors
- PRRC, person responsible for regulatory compliance
- PT, proficiency testing
- RUO, research use only
- RiliBÄk, Richtlinie der Bundesärztekammer zur Qualitätssicherung Laboratoriums medizinischer Untersuchungen
- SOP, standard operating procedure
- TMB, tumor mutational burden
- UDI, unique device identifier
- VAF, variant allele frequency
- iQC, internal quality control
- laboratory-developed tests for in-house use
- method validation
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Affiliation(s)
- Florent J L A Vanstapel
- Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
- Department of Public Health, Biomedical Sciences Group, Catholic University Leuven, Leuven, Belgium
| | - Matthias Orth
- Institute of Laboratory Medicine, Vinzenz von Paul Kliniken gGmbH, Stuttgart, Germany
- Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Thomas Streichert
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ettore D Capoluongo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università Federico II, Naples, Italy
| | - Wytze P Oosterhuis
- Department of Clinical Chemistry, Reinier Haga Medical Diagnostic Centre, Delft, The Netherlands
| | - Hikmet Can Çubukçu
- Ankara University Stem Cell Institute, Ankara, Türkiye
- Department of Rare Diseases, General Directorate of Health Services, Turkish Ministry of Health, Ankara, Türkiye
| | - Francisco A Bernabeu-Andreu
- Servicio Bioquímica Análisis Clínicos, Hospital Universitario Puerta de Hierro Majadahonda (Madrid), Majadahonda, Spain
| | - Marc Thelen
- Result Laboratory for Clinical Chemistry, Amphia Hospital, Breda, The Netherlands
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Leo H J Jacobs
- Laboratory for Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
| | | | - Harjit Pal Bhattoa
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Patrick M M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Pika Meško Brguljan
- Department of Clinical Chemistry, University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Guilaine Boursier
- Department of Molecular Genetics and Cytogenomics, Rare and Autoinflammatory Diseases Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Christa M Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Michael Neumaier
- Institute for Clinical Chemistry, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
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Wichitnithad W, Nantaphol S, Noppakhunsomboon K, Rojsitthisak P. An update on the current status and prospects of nitrosation pathways and possible root causes of nitrosamine formation in various pharmaceuticals. Saudi Pharm J 2023; 31:295-311. [PMID: 36942272 PMCID: PMC10023554 DOI: 10.1016/j.jsps.2022.12.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/18/2022] [Indexed: 12/25/2022] Open
Abstract
Over the last two years, global regulatory authorities have raised safety concerns on nitrosamine contamination in several drug classes, including angiotensin II receptor antagonists, histamine-2 receptor antagonists, antimicrobial agents, and antidiabetic drugs. To avoid carcinogenic and mutagenic effects in patients relying on these medications, authorities have established specific guidelines in risk assessment scenarios and proposed control limits for nitrosamine impurities in pharmaceuticals. In this review, nitrosation pathways and possible root causes of nitrosamine formation in pharmaceuticals are discussed. The control limits of nitrosamine impurities in pharmaceuticals proposed by national regulatory authorities are presented. Additionally, a practical and science-based strategy for implementing the well-established control limits is notably reviewed in terms of an alternative approach for drug product N-nitrosamines without published AI information from animal carcinogenicity testing. Finally, a novel risk evaluation strategy for predicting and investigating the possible nitrosation of amine precursors and amine pharmaceuticals as powerful prevention of nitrosamine contamination is addressed.
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Key Words
- AI, acceptable intake
- APIs, active pharmaceutical ingredients
- ARBs, angiotensin II receptor blockers
- AZBC, 4′-(azidomethyl)-[1.1′-biphenyl]-2-carbonitile
- AZBT, 5-(4′-(azidomethyl)-[1,1′-biphenyl]-2-yl)-1H-tetrazole
- AZTT, 5-(4′-((5-(azidomethyl)-2-butyl-4-chloro-1H-imidazol-1-yl) methyl)-[1,1′-biphenyl]-2-yl)-1H-tetrazole
- CDER, center for drug evaluation and research
- CPNP, 1-cyclopentyl-4-nitrosopiperazine
- Control limits
- DBA, N,N-dibutylamine
- DEA, N,N-diethylamine
- DIPEA, N,N-diisopropylethylamine
- DMA, dimethylamine
- DMF, N,N-dimethyl formamide
- DPA, N,N-dipropylamine
- EMA, European Medicines Agency
- EPA, Environmental Protection Agency
- FDA, Food and Drug Administration
- HSA, Health Sciences Authority
- IARC, International Agency for Research on Cancer
- ICH, International Council for Harmonisation
- LD50, median lethal dose
- MBA, N-methylamino-N-butyric acid
- MDD, maximum daily dose
- MNP, 1-methyl-4-nitrosopiperazine
- NAP, nitrosation assay procedure
- NDBA, N-nitrosodibutylamine
- NDEA, N-nitrosodiethylamine
- NDIPA, N-nitrosodiisopropylamine
- NDMA, N-nitrosodimethylamine
- NDSRIs, Nitrosamine drug substance-related impurities
- NEIPA, N-nitroso ethylisopropylamine
- NMBA, N-nitroso-N-methyl-4-aminobutyric acid
- NMP, N-methyl pyrrolidinone
- NOCs, N-nitroso compounds
- Nitrosamines
- Nitrosation
- PPRs, proportionate reporting ratios
- Ranitidine
- SARs, structure–activity relationships
- Sartans
- TD50, median toxic dose
- TEA, triethylamine
- TMA, trimethylamine
- TTC, threshold of toxicological concern
- USFDA, United States Food Drug and Administration
- USP, United States Pharmacopoeia
- WHO, World Health Organization
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Affiliation(s)
- Wisut Wichitnithad
- Department of Analytical Development, Pharma Nueva Co., Ltd, Bangkok 10900, Thailand
- Department of Clinical Development, Pharma Nueva Co., Ltd, Bangkok 10900, Thailand
| | - Siriwan Nantaphol
- Department of Clinical Development, Pharma Nueva Co., Ltd, Bangkok 10900, Thailand
| | | | - Pornchai Rojsitthisak
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
- Center of Excellence in Natural Products for Ageing and Chronic Diseases, Chulalongkorn University, Bangkok 10330, Thailand
- Corresponding author at: Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, 254 Phayathai Road, Patumwan, Bangkok 10330 Thailand.
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Rakete S, Schubert T, Vogeser M. Semi-automated serum steroid profiling with tandem mass spectrometry. J Mass Spectrom Adv Clin Lab 2022; 27:40-48. [PMID: 36619216 PMCID: PMC9813517 DOI: 10.1016/j.jmsacl.2022.12.006] [Citation(s) in RCA: 2] [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: 07/26/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/16/2022] Open
Abstract
Objectives Highly selective and sensitive multi-analyte methods for the analysis of steroids are attractive for the diagnosis of endocrine diseases. Commercially available kits are increasingly used for this purpose. These methods involve laborious solid phase extraction, and the respective panels of target analytes are incomplete. We wanted to investigate whether an improvement of kit solutions is possible by introducing automated on-line solid phase extraction (SPE) and combining originally separate analyte panels. Methods Sample preparation was performed using automated on-line SPE on a high-pressure stable extraction column. Chromatographic separation, including isobaric compounds, was achieved using a 0.25 mM ammonium fluoride-methanol gradient on a small particle size biphenyl column. Standard compounds and internal standard mixtures of two panels of a commercially available kit were combined to achieve an optimized and straightforward detection of 15 endogenous steroids. Validation was performed according to the European Medicines Agency (EMA) guidelines with slight modifications. Results Validation was successfully performed for all steroids over a clinically relevant calibration range. Deviations of intra- and inter-assay accuracy and precision results passed the criteria and no relevant matrix effects were detected due to highly effective sample preparation. External quality assessment samples showed the applicability as a routine diagnostic method, which was affirmed by the analyses of anonymized clinical samples. Conclusions It was found possible to complement a commercially available kit for quantitative serum steroid profiling based on isotope dilution LC-MS/MS by implementing automated on-line SPE, thereby improving the practicality and robustness of the measurement procedure.
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Key Words
- A4, Androstendione
- ALDO, Aldosterone
- APCI, Atmospheric pressure chemical ionization
- CAH, Congenital adrenal hyperplasia
- CE, Collision energy
- CE-IVD, Certified in-vitro-diagnostic device
- CV, Coefficient of variation
- DHEA, Dehydro-epiandrosterone
- DHEA-S, Dehydro-epiandrosterone sulfate
- DHT, Dihydrotestosterone
- DOC, 11-deoxycorticosterone
- E, Cortisone
- E2, Estradiol
- EMA, European Medicines Agency
- EQA, External quality assessment
- ESI, Electrospray ionisation
- F, Cortisol
- IVD, In-vitro-diagnostic
- IVDR, EU In vitro Diagnostic Regulation
- LC, Liquid chromatography
- LC–MS/MS, Liquid chromatography tandem mass spectrometry
- LDT, Laboratory developed test
- LLOQ, Lower limit of quantification
- MRM, Multiple reaction monitoring
- On-line solid phase extraction (SPE)
- P4, Progesterone
- QC, Quality control
- Robustness
- S/N, Signal-to-noise ratio
- SID, Stable-isotope dilution
- SPE, Solid phase extraction
- SST, System suitability test
- Serum steroid profiling
- Stable-isotope dilution liquid chromatography-tandem mass spectrometry (SID LC-MS/MS)
- UHPLC, Ultra high performance liquid chromatography
- ULOQ, Upper limit of quantification
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Affiliation(s)
| | | | - Michael Vogeser
- Corresponding author at: Institute of Laboratory Medicine, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany.
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Joubert A, Joubert A, van der Merwe M, Norman J, Castel S, Denti P, Sliwa K, Maartens G, Sinxadi P, Wiesner L. Validation of a quantitative multiplex LC-MS/MS assay of carvedilol, enalaprilat, and perindoprilat in dried blood spots from heart failure patients and its cross validation with a plasma assay. J Mass Spectrom Adv Clin Lab 2022; 27:7-17. [PMID: 36568714 PMCID: PMC9772843 DOI: 10.1016/j.jmsacl.2022.12.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Adherence to medication is an important determinant of outcomes in chronic diseases like heart failure. Drug assays provide objective adherence biomarkers. Dried blood spots (DBS) are appealing samples for drug assays due to less demanding transportation and storage requirements. Objectives To analytically validate a LC-MS/MS method for the simultaneous quantification of carvedilol, enalaprilat, and perindoprilat in DBS and evaluate the feasibility of using the method as an adherence determining assay. To validate the assay further clinically by establishing correlation and agreement between plasma and DBS samples from a pharmacokinetic pilot study. Methods The method was validated over a concentration range of 1.00-200 ng/mL according to FDA guidelines. Adherence tracking ability of the assay was evaluated using a pharmacokinetic pilot study. Correlation and agreement were evaluated through Deming regression and Bland-Altman analysis, respectively. Results Accuracy, precision, selectivity, and sensitivity were proven with complete and reproducible extraction recovery at all concentrations tested. Stability of the analytes in the matrix and throughout sample processing was proven. The full range of concentrations of the pharmacokinetic pilot study could be quantified for enalaprilat, but not for carvedilol and perindoprilat. The difference between the observed and calculated plasma concentrations was less than 20 % of their mean for >67 % of samples for all analytes. Conclusions The assay is suitable as a screening tool for carvedilol and perindoprilat, while suitable as an adherence determining assay for enalaprilat. Equivalence between observed and predicted plasma concentrations proves DBS and plasma concentrations can be used interchangeably.
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Key Words
- ACE-I, Angiotensin-converting enzyme inhibitors
- ALQ, Above the Limit of Quantitation
- Adherence
- BD, Bidaily
- BMI, Body mass index
- CHF, Chronic Heart Failure
- CID, Collision-induced dissociation
- CV, Co-efficient of variation
- Carvedilol
- DBS, Dried Blood Spots
- Dried blood spots
- EMA, European Medicines Agency
- ESI, Electrospray ionization
- Enalaprilat
- HF, Heart Failure
- ISTD, Internal standard
- ITP, Initial testing procedure
- LC-MS/MS
- LC-MS/MS, Liquid Chromatography with tandem mass spectrometry
- LLOQ, lower limit of quantitation
- LOD, Limit of detection
- MRM, Multiple reaction monitoring
- NYHA FC, New York Heart Association Functional Classification
- OD, Once Daily
- Perindoprilat
- QC DIL, Quality control dilution
- QC LLOQ, Quality control lowest level of quantification
- QC, Quality Control
- QCH, Quality control high
- QCL, Quality control low
- QCM, Quality control medium
- S/N, signal-to-noise ratio
- SOP, Standard operating procedure
- ULOQ, upper limit of quantification
- VAMS, volumetric absorptive micro sampling
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Affiliation(s)
- Andre Joubert
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Anton Joubert
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Marthinus van der Merwe
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jennifer Norman
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sandra Castel
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Karen Sliwa
- Cape Heart Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa,Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Phumla Sinxadi
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa,Corresponding author.
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Roncati L, Manenti A. Apropos of menstrual changes and abnormal uterine bleeding after COVID-19 vaccination. Brain Hemorrhages 2022; 4:S2589-238X(22)00080-8. [PMID: 36406341 PMCID: PMC9642033 DOI: 10.1016/j.hest.2022.11.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
It is news of 28 October 2022 that the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency has recommended to add heavy menstrual bleeding among the side effects of unknown frequency inside the package insert of nucleoside-modified messenger ribonucleic acid vaccines to prevent coronavirus disease 2019 (COVID-19). The decision has been made in the light of the numerous reports of unexpected menstrual changes or abnormal uterine bleeding following COVID-19 vaccination. Here we advance a possible involvement of the particular adenohypophyseal microcirculation in these strange and still unexplained events.
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Affiliation(s)
- Luca Roncati
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Manenti
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Hole G, Hole AS, McFalone-Shaw I. Digitalization in pharmaceutical industry: What to focus on under the digital implementation process? Int J Pharm X 2021; 3:100095. [PMID: 34712948 PMCID: PMC8528719 DOI: 10.1016/j.ijpx.2021.100095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/26/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022] Open
Abstract
Digitalization of any manufacture industry is a key step in any progress of the production process. The process of digitalization includes both increased use of robotics, automatization solutions and computerization, thereby allowing to reduce costs, to improve efficiency and productivity, and to be flexible to changes. Pharmaceutical Industry (PI) has however been resistant to digitalization, mainly due to fair experience and complexity of the entailed development and manufacture processes. Nevertheless, there is a clear need to digitalize PI as the demand in both traditional and new drugs is constantly growing. Contract Development Manufacture Organizations (CDMOs) have a special digitalizing challenge. Digitalization of PI, and CDMO precisely, should be tightly related to the main aspects of Good Manufacture Practice (GMP), and, to succeed in PI digitalizing requires constant focus on GMP. Close collaboration with constantly changing stakeholders is another important factor which should be in focus during digitalization of CDMO. This paper represents an overview over the main aspects of CDMO digitalization and discusses both the opportunities and challenges of the process, focusing on the practical solutions for successive digital implementation.
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Key Words
- AIDS, Acquired Immune Deficiency Syndrome
- CDMO, Contract Development and Manufacturing Organization
- Contract development manufacture organization
- Digitalization
- EMA, European Medicines Agency
- EU, European Union
- FDA, Food and Drug Administration
- GMP, Good Manufacturing Practice
- ITA., International Trade Administration
- MHRA, Medicines and Healthcare Products Regulatory Agency
- PAI, Pre-Approval Inspections
- PI, Pharmaceutical Industry
- Pharmaceutical industry
- Process improvements
- TDM, Traditional Drug Manufacturing
- USD, United States Dollars
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Affiliation(s)
- Glenn Hole
- Molde University College, Molde and Procuratio Consulting, Drammen, Norway
| | | | - Ian McFalone-Shaw
- Molde University College, Molde and Procuratio Consulting, Drammen, Norway
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Lagerwall C, Shahin H, Abdallah S, Steinvall I, Elmasry M, Sjöberg F, El-Serafi AT. Xeno-free workflow exhibits comparable efficiency and quality of keratinocytes isolated from human skin biopsies. Regen Ther 2021; 18:401-407. [PMID: 34722836 PMCID: PMC8531849 DOI: 10.1016/j.reth.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/21/2021] [Revised: 09/05/2021] [Accepted: 09/15/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Regenerative solutions of the skin represent a hope for burn victims with extensive skin loss and chronic wound patients. The development of xeno-free workflow is crucial for clinical application in compliance with the directives of the European Medicines Agency. This study aimed at evaluating the outcome of the xeno-free isolation workflow of keratinocytes from human skin biopsy. METHODS Skin biopsies were obtained from volunteers. The epidermis was digested with TrypLE™ Select, which was deactivated by dilution or with trypsin, deactivated by media with fetal bovine serum. Freshly isolated cells were compared for total cell number, viability, activity of caspase 3, gene expression and the presence of the keratinocyte surface markers cytokeratin 14. The cells were cultured in xeno-free conditions for one week and characterized regarding the number and viability as well as the metalloproteinase secretion. RESULTS The number of obtained cells was similar in both workflows. The cell viability was less in the TrypLE group, with slight reduction of the cell surface marker cytokeratin 14. Caspase 3 activity was comparable as well as the gene expression of the apoptotic markers BAX, BCL2 and SLUG, as well as the keratinocyte markers cytokeratin 14, stratifin and filaggrin. Upon culture, the number of keratinocytes, their viability and secretion of matrix metalloproteinases 1 and 10 were equal in both groups. CONCLUSION This study reports the possibility of isolating functioning and viable keratinocytes through a xeno-free workflow for clinical application.
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Affiliation(s)
- Cathrine Lagerwall
- Department of Hand Surgery and Plastic Surgery and Burns, Linköping University Hospital, Sweden
| | - Hady Shahin
- Department of Hand Surgery and Plastic Surgery and Burns, Linköping University Hospital, Sweden
- The Department of Biomedical and Clinical Sciences (BKV), Linköping University, Sweden
- Faculty of Biotechnology, Modern Sciences and Arts University, Cairo, Egypt
| | - Sallam Abdallah
- The Department of Biomedical and Clinical Sciences (BKV), Linköping University, Sweden
| | - Ingrid Steinvall
- Department of Hand Surgery and Plastic Surgery and Burns, Linköping University Hospital, Sweden
- The Department of Biomedical and Clinical Sciences (BKV), Linköping University, Sweden
| | - Moustafa Elmasry
- Department of Hand Surgery and Plastic Surgery and Burns, Linköping University Hospital, Sweden
- The Department of Biomedical and Clinical Sciences (BKV), Linköping University, Sweden
| | - Folke Sjöberg
- Department of Hand Surgery and Plastic Surgery and Burns, Linköping University Hospital, Sweden
- The Department of Biomedical and Clinical Sciences (BKV), Linköping University, Sweden
| | - Ahmed T. El-Serafi
- Department of Hand Surgery and Plastic Surgery and Burns, Linköping University Hospital, Sweden
- The Department of Biomedical and Clinical Sciences (BKV), Linköping University, Sweden
- Medical Biochemistry Department, Faculty of Medicine, Suez Canal University, Egypt
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Martín J, Tena N, Asuero AG. Current state of diagnostic, screening and surveillance testing methods for COVID-19 from an analytical chemistry point of view. Microchem J 2021; 167:106305. [PMID: 33897053 PMCID: PMC8054532 DOI: 10.1016/j.microc.2021.106305] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 02/10/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/18/2022]
Abstract
Since December 2019, we have been in the battlefield with a new threat to the humanity known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this review, we describe the four main methods used for diagnosis, screening and/or surveillance of SARS-CoV-2: Real-time reverse transcription polymerase chain reaction (RT-PCR); chest computed tomography (CT); and different complementary alternatives developed in order to obtain rapid results, antigen and antibody detection. All of them compare the highlighting advantages and disadvantages from an analytical point of view. The gold standard method in terms of sensitivity and specificity is the RT-PCR. The different modifications propose to make it more rapid and applicable at point of care (POC) are also presented and discussed. CT images are limited to central hospitals. However, being combined with RT-PCR is the most robust and accurate way to confirm COVID-19 infection. Antibody tests, although unable to provide reliable results on the status of the infection, are suitable for carrying out maximum screening of the population in order to know the immune capacity. More recently, antigen tests, less sensitive than RT-PCR, have been authorized to determine in a quicker way whether the patient is infected at the time of analysis and without the need of specific instruments.
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Key Words
- 2019-nCoV, 2019 novel coronavirus
- ACE2, Angiotensin-Converting Enzyme 2
- AI, Artificial Intelligence
- ALP, Alkaline Phosphatase
- ASOs, Antisense Oligonucleotides
- Antigen and antibody tests
- AuNIs, Gold Nanoislands
- AuNPs, Gold Nanoparticles
- BSL, Biosecurity Level
- CAP, College of American Pathologists
- CCD, Charge-Coupled Device
- CG, Colloidal Gold
- CGIA, Colloidal Gold Immunochromatographic Assay
- CLIA, Chemiluminescence Enzyme Immunoassay
- CLIA, Clinical Laboratory Improvement Amendments
- COVID-19
- COVID-19, Coronavirus disease-19
- CRISPR, Clustered Regularly Interspaced Short Palindromic Repeats
- CT, Chest Computed Tomography
- Cas, CRISPR Associate Protein
- China CDC, Chinese Center for Disease Control and Prevention
- Ct, Cycle Threshold
- DETECTR, SARS-CoV-2 DNA Endonuclease-Targeted CRISPR Trans Reporter
- DNA, Dexosyrosyribonucleic Acid
- E, Envelope protein
- ELISA, Enzyme Linked Immunosorbent Assay
- EMA, European Medicines Agency
- EUA, Emergence Use Authorization
- FDA, Food and Drug Administration
- FET, Field-Effect Transistor
- GISAID, Global Initiative on Sharing All Influenza Data
- GeneBank, Genetic sequence data base of the National Institute of Health
- ICTV, International Committee on Taxonomy of Viruses
- IgA, Immunoglobulins A
- IgG, Immunoglobulins G
- IgM, Immunoglobulins M
- IoMT, Internet of Medical Things
- IoT, Internet of Things
- LFIA, Lateral Flow Immunochromatographic Assays
- LOC, Lab-on-a-Chip
- LOD, Limit of detection
- LSPR, Localized Surface Plasmon Resonance
- M, Membrane protein
- MERS-CoV, Middle East Respiratory Syndrome Coronavirus
- MNP, Magnetic Nanoparticle
- MS, Mass spectrometry
- N, Nucleocapsid protein
- NER, Naked Eye Readout
- NGM, Next Generation Molecular
- NGS, Next Generation Sequencing
- NIH, National Institute of Health
- NSPs, Nonstructural Proteins
- Net, Neural Network
- ORF, Open Reading Frame
- OSN, One Step Single-tube Nested
- PDMS, Polydimethylsiloxane
- POC, Point of Care
- PPT, Plasmonic Photothermal
- QD, Quantum Dot
- R0, Basic reproductive number
- RBD, Receptor-binding domain
- RNA, Ribonucleic Acid
- RNaseH, Ribonuclease H
- RT, Reverse Transcriptase
- RT-LAMP, Reverse Transcription Loop-Mediated Isothermal Amplification
- RT-PCR, Real-Time Reverse Transcription Polymerase Chain Reaction
- RT-PCR, chest computerized tomography
- RdRp, RNA-Dependent RNA Polymerase
- S, Spike protein
- SARS-CoV-2
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- SERS, Surface Enhanced Raman Spectroscopy
- SHERLOCK, Specific High Sensitivity Enzymatic Reporter UnLOCKing
- STOPCovid, SHERLOCK Testing on One Pot
- SVM, Support Vector Machine
- SiO2@Ag, Complete silver nanoparticle shell coated on silica core
- US CDC, US Centers for Disease Control and Prevention
- VOC, Variant of Concern
- VTM, Viral Transport Medium
- WGS, Whole Genome Sequencing
- WHO, World Health Organization
- aM, Attomolar
- dNTPs, Nucleotides
- dPCR, Digital PCR
- ddPCR, Droplet digital PCR
- fM, Femtomolar
- m-RNA, Messenger Ribonucleic Acid
- nM, Nanomolar
- pM, Picomolar
- pfu, Plaque-forming unit
- rN, Recombinant nucleocapsid protein antigen
- rS, Recombinant Spike protein antigen
- ssRNA, Single-Stranded Positive-Sense RNA
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Affiliation(s)
- Julia Martín
- Departamento de Química Analítica, Escuela Politécnica Superior, Universidad de Sevilla, C/ Virgen de África 7, Sevilla E-41011, Spain
| | - Noelia Tena
- Departamento de Química Analítica, Facultad de Farmacia, Universidad de Sevilla, Prof. García González, 2, Sevilla 41012, Spain
| | - Agustin G Asuero
- Departamento de Química Analítica, Facultad de Farmacia, Universidad de Sevilla, Prof. García González, 2, Sevilla 41012, Spain
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9
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Merlo-Mas J, Tomsen-Melero J, Corchero JL, González-Mira E, Font A, Pedersen JN, García-Aranda N, Cristóbal-Lecina E, Alcaina-Hernando M, Mendoza R, Garcia-Fruitós E, Lizarraga T, Resch S, Schimpel C, Falk A, Pulido D, Royo M, Schwartz S, Abasolo I, Pedersen JS, Danino D, Soldevila A, Veciana J, Sala S, Ventosa N, Córdoba A. Application of Quality by Design to the robust preparation of a liposomal GLA formulation by DELOS-susp method. J Supercrit Fluids 2021; 173:105204. [PMID: 34219919 PMCID: PMC8085735 DOI: 10.1016/j.supflu.2021.105204] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Robust preparation of liposomal formulation by DELOS-susp method. Implementation of Quality by Design methodology to liposomes preparation. Influence of critical parameters on quality was studied through DoE analysis. Design Space was obtained for GLA-loaded liposomes formulation.
Fabry disease is a lysosomal storage disease arising from a deficiency of the enzyme α-galactosidase A (GLA). The enzyme deficiency results in an accumulation of glycolipids, which over time, leads to cardiovascular, cerebrovascular, and renal disease, ultimately leading to death in the fourth or fifth decade of life. Currently, lysosomal storage disorders are treated by enzyme replacement therapy (ERT) through the direct administration of the missing enzyme to the patients. In view of their advantages as drug delivery systems, liposomes are increasingly being researched and utilized in the pharmaceutical, food and cosmetic industries, but one of the main barriers to market is their scalability. Depressurization of an Expanded Liquid Organic Solution into aqueous solution (DELOS-susp) is a compressed fluid-based method that allows the reproducible and scalable production of nanovesicular systems with remarkable physicochemical characteristics, in terms of homogeneity, morphology, and particle size. The objective of this work was to optimize and reach a suitable formulation for in vivo preclinical studies by implementing a Quality by Design (QbD) approach, a methodology recommended by the FDA and the EMA to develop robust drug manufacturing and control methods, to the preparation of α-galactosidase-loaded nanoliposomes (nanoGLA) for the treatment of Fabry disease. Through a risk analysis and a Design of Experiments (DoE), we obtained the Design Space in which GLA concentration and lipid concentration were found as critical parameters for achieving a stable nanoformulation. This Design Space allowed the optimization of the process to produce a nanoformulation suitable for in vivo preclinical testing.
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Key Words
- BCA, Bicinchoninic acid assay
- CMA, Critical Material Attributes
- CO2, Carbon dioxide
- CPP, Critical Process Parameters
- CQA, Critical Quality Attribute
- Chol, Cholesterol
- Chol-PEG400-RGD, Cholesterol pegylated with arginyl–glycyl–aspartic (RGD) acid peptide
- CoA, Certificate of Analysis
- Cryo-TEM, Cryogenic Transmission Electron Microscopy
- DELOS
- DELOS-susp, Depressurization of an Expanded Liquid Organic Solution into aqueous solution
- DLS, Dynamic Light Scattering
- DMSO, Dimethyl sulfoxide
- DPPC, 1,2-Dipalmitoyl-sn-glycero-3-phosphocholine
- DoE, Design of Experiments
- EA, Enzymatic Activity
- EE, Entrapment Efficiency
- EHS, Environment, Health and Safety
- EMA, European Medicines Agency
- ERT, Enzyme Replacement Therapy
- EtOH, Ethanol
- FDA, Food and Drug Administration
- Fabry disease
- GLA, α-galactosidase A enzyme
- H2O, Water
- HPLC, High Performance Liquid Chromatography
- ICH, Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use
- LSD, Lysosomal storage disorders
- MKC, Myristalkonium chloride
- N2, Nitrogen
- NTA, Nanoparticle Tracking Analysis
- PEG, Polyethylene Glycol
- PIC, Pressure Indicator Controller
- PLS, Partial Least Squares
- PdI, Polydispersity Index
- Protein-loaded liposomes
- Pw, Working pressure
- QbD, Quality by Design
- Quality by Design
- RGD, Arginine-Glycine-Aspartic acid
- S-MLS, Static Multiple Light Scattering
- SAXS, Small-Angle X-ray Scattering
- SDS-PAGE, Sodium Dodecyl Sulfate Polyacrylamide Gel Electrophoresis
- SbD, Safe by Design
- Scale-up
- TFF, Tangential Flow Filtration
- TGX, Trys-Glycine eXtended
- TIC, Temperature Indicator Controller
- TSI, Turbiscan Stability Index
- Tw, Working temperature
- USP, United States Pharmacopeia
- XCO2, Carbon dioxide molar fraction
- fsingle, Ratio of monolayered liposomes
- nanoGLA, GLA-loaded nanoliposomes
- α-galactosidase
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Affiliation(s)
- Josep Merlo-Mas
- Nanomol Technologies S.L., 08193 Cerdanyola del Vallès, Spain
| | - Judit Tomsen-Melero
- Nanomol Technologies S.L., 08193 Cerdanyola del Vallès, Spain.,Institut de Ciència de Materials de Barcelona, ICMAB-CSIC, 08193 Bellaterra, Spain.,Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | - José-Luis Corchero
- Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain.,Institut de Biotecnologia i Biomedicina (IBB-UAB), 08193 Cerdanyola del Vallès, Spain
| | - Elisabet González-Mira
- Institut de Ciència de Materials de Barcelona, ICMAB-CSIC, 08193 Bellaterra, Spain.,Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | | | - Jannik N Pedersen
- Department of Chemistry and Interdisciplinary Nanoscience Center (iNANO), Aarhus University, 8000, Aarhus, Aarhus C Denmark
| | - Natalia García-Aranda
- Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain.,Functional Validation and Preclinical Research, Drug Delivery & Targeting, CIBBIM-Nanomedicina, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Edgar Cristóbal-Lecina
- Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain.,Institut de Química Avançada de Catalunya (IQAC-CSIC), 08034 Barcelona, Spain
| | | | - Rosa Mendoza
- Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain.,Institut de Biotecnologia i Biomedicina (IBB-UAB), 08193 Cerdanyola del Vallès, Spain
| | - Elena Garcia-Fruitós
- Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain.,Institut de Biotecnologia i Biomedicina (IBB-UAB), 08193 Cerdanyola del Vallès, Spain
| | | | - Susanne Resch
- BioNanoNet Forschungsgesellschaft mbH, 8010 Graz, Austria
| | | | - Andreas Falk
- BioNanoNet Forschungsgesellschaft mbH, 8010 Graz, Austria
| | - Daniel Pulido
- Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain.,Institut de Química Avançada de Catalunya (IQAC-CSIC), 08034 Barcelona, Spain
| | - Miriam Royo
- Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain.,Institut de Química Avançada de Catalunya (IQAC-CSIC), 08034 Barcelona, Spain
| | - Simó Schwartz
- Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain.,Functional Validation and Preclinical Research, Drug Delivery & Targeting, CIBBIM-Nanomedicina, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Ibane Abasolo
- Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain.,Functional Validation and Preclinical Research, Drug Delivery & Targeting, CIBBIM-Nanomedicina, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Jan Skov Pedersen
- Department of Chemistry and Interdisciplinary Nanoscience Center (iNANO), Aarhus University, 8000, Aarhus, Aarhus C Denmark
| | - Dganit Danino
- CryoEM Laboratory of Soft Matter, Faculty of Biotechnology and Food Engineering, Technion - Israel Institute of Technology, 32000 Haifa, Israel
| | | | - Jaume Veciana
- Institut de Ciència de Materials de Barcelona, ICMAB-CSIC, 08193 Bellaterra, Spain.,Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | - Santi Sala
- Nanomol Technologies S.L., 08193 Cerdanyola del Vallès, Spain
| | - Nora Ventosa
- Institut de Ciència de Materials de Barcelona, ICMAB-CSIC, 08193 Bellaterra, Spain.,Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | - Alba Córdoba
- Nanomol Technologies S.L., 08193 Cerdanyola del Vallès, Spain
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10
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Múdry P, Kýr M, Rohleder O, Mahdal M, Staniczková Zambo I, Ježová M, Tomáš T, Štěrba J. Improved osteosarcoma survival with addition of mifamurtide to conventional chemotherapy - Observational prospective single institution analysis. J Bone Oncol 2021; 28:100362. [PMID: 33948428 PMCID: PMC8080518 DOI: 10.1016/j.jbo.2021.100362] [Citation(s) in RCA: 3] [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: 12/09/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 10/26/2022] Open
Abstract
Purpose Conventional osteosarcoma is an orphan disease. Current treatment approaches include combining a three drug chemotherapy schedule and surgery. The 3- and 5-year event-free survival (EFS) in localized disease is roughly 65 and 60%, respectively. The registration study of mifamurtide reported survival benefit, but some methodological controversies have been insufficient for FDA market authorization in contrast to EMA. Methods prospective single centre survival analysis of a mifamurtide addition to conventional therapy in 23 patients over a 5.5 year enrolment period is reported and compared to a historical control of 26 patient with localized disease. Bias arising from observational methodology was addressed using Landmark analysis and time-dependent Cox models. Blood count dynamics were analysed during the treatment. Results The adverse event profile was as expected with no dose limiting toxicities. There were no local relapses observed, one patient died in the first complete remission due to doxorubicin cardiotoxicity, one patient had pulmonary metastatic relapse. The observed 3- and 5-year EFS was 87.4% (CI 72.4-100%) and 87.4% (CI 72.4-100%), progression free survival (PFS) was 92.9% (CI 80.3-100%) and 92.9% (CI 80.3-100%), overall survival was 94.1% (CI 83.6-100) and 80.7% (CI 58.3-100), respectively. Comparison to the historical control showed statistically significant better PFS for mifamurtide patients (Landmark analysis; p = 0.044). Risk of progression was 5-times lower for the mifamurtide group (Cox model; HR 0.21, p = 0.136). Only subtle differences in lymphocyte counts were observed across treatment. Conclusion the PFS benefit of mifamurtide is reported herein. The addition of mifamurtide could be considered as a best treatment option for localized osteosarcoma.
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Key Words
- A/AP, adriamycin (doxorubicin)/adriamycin (doxorubicin) and cisplatin
- AIC, Akaike information criterion
- BIC, Bayesian information criterion
- CI, confidence interval
- CTCAE, common terminology criteria for adverse events
- Comparative analysis
- EFS, event free survival
- EMA, European Medicines Agency
- FDA, Food and Drug Administration
- HR, hazard ratio
- LY, lymphocytes
- M/F, male/female
- MFS, metastatic free survival
- MONO, monocytes
- MTX, methotrexate
- Mifamurtide
- NEU, neutrophiles
- Osteosarcoma
- PFS, progression free survival
- PLT, platelets
- R0 and R1 resection, free margins and microscopic rest after resection respectively
- SD, standard deviation
- Single institution analysis
- Survival
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Affiliation(s)
- Peter Múdry
- Department of Paediatric Oncology, University Hospital Brno and School of Medicine, Masaryk University, Cernopolni 9, Brno 613 00, Czech Republic.,International Clinical Research Centre, St. Anne's University Hospital Brno, Pekarska 53, Brno 656 91, Czech Republic
| | - Michal Kýr
- Department of Paediatric Oncology, University Hospital Brno and School of Medicine, Masaryk University, Cernopolni 9, Brno 613 00, Czech Republic.,International Clinical Research Centre, St. Anne's University Hospital Brno, Pekarska 53, Brno 656 91, Czech Republic
| | - Ondřej Rohleder
- Department of Paediatric Oncology, University Hospital Brno and School of Medicine, Masaryk University, Cernopolni 9, Brno 613 00, Czech Republic.,International Clinical Research Centre, St. Anne's University Hospital Brno, Pekarska 53, Brno 656 91, Czech Republic
| | - Michal Mahdal
- 1 Department of Orthopaedics, St. Annés University Hospital Brno and School of Medicine, Masaryk University, Pekarska 53, Brno 613 00, Czech Republic
| | - Iva Staniczková Zambo
- 1 Department of Pathology, St. Anne's University Hospital Brno and School of Medicine, Masaryk University, Pekarska 53, Brno 613 00, Czech Republic
| | - Marta Ježová
- Department of Pathology, University Hospital Brno and School of Medicine, Masaryk University, Jihlavska 20, Brno 625 00, Czech Republic
| | - Tomáš Tomáš
- 1 Department of Orthopaedics, St. Annés University Hospital Brno and School of Medicine, Masaryk University, Pekarska 53, Brno 613 00, Czech Republic
| | - Jaroslav Štěrba
- Department of Paediatric Oncology, University Hospital Brno and School of Medicine, Masaryk University, Cernopolni 9, Brno 613 00, Czech Republic.,International Clinical Research Centre, St. Anne's University Hospital Brno, Pekarska 53, Brno 656 91, Czech Republic
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11
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Abstract
Pemphigus is an epidemiologically heterogeneous group of autoimmune bullous diseases comprising pemphigus vulgaris (PV), pemphigus foliaceus, paraneoplastic pemphigus, IgA pemphigus, and pemphigus herpetiformis. Recently, our knowledge about the frequency of pemphigus, which is highly variable between different populations, has considerably expanded, and the first non-HLA genes associated with PV have been identified. In addition, a variety of comorbidities, including other autoimmune diseases, hematological malignancies, and psoriasis, have been described in this variant. Here, initial data about the impact of COVID-19 on this fragile patient population are discussed and perspectives for future epidemiological studies are outlined.
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Key Words
- ACE, angiotensin-converting enzyme
- AIBD, autoimmune bullous disease
- CAAR, chimeric autoantibody receptor
- CI, confidence interval
- DSG, desmoglein
- EADV, European Academy of Dermatology and Venereology
- EC, extracellular
- EMA, European Medicines Agency
- FS, fogo selvage
- HR, hazard ratio
- ICD, International Classification of Diseases
- PF, pemphigus foliaceus
- PNP, paraneoplastic pemphigus
- PV, pemphigus vulgaris
- SMR, standardized mortality ratio
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Affiliation(s)
- Khalaf Kridin
- Lűbeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Enno Schmidt
- Lűbeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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12
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Silva Paiva R, Gomes I, Casimiro S, Fernandes I, Costa L. c-Met expression in renal cell carcinoma with bone metastases. J Bone Oncol 2020; 25:100315. [PMID: 33024658 PMCID: PMC7527574 DOI: 10.1016/j.jbo.2020.100315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/13/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/12/2022] Open
Abstract
Bone is a common metastatic site in renal cell carcinoma (RCC). HGF/c-Met pathway is particularly relevant in tumors with bone metastases. c-Met/HGF pathway is involved in RCC progression, conferring poor prognosis. Several c-Met targeting therapies are currently in clinical development. c-Met expression is an important therapeutic target in RCC with bone metastases.
Hepatocyte growth factor (HGF)/c-Met pathway is implicated in embryogenesis and organ development and differentiation. Germline or somatic mutations, chromosomal rearrangements, gene amplification, and transcriptional upregulation in MET or alterations in autocrine or paracrine c-Met signalling have been associated with cancer cell proliferation and survival, including in renal cell carcinoma (RCC), and associated with disease progression. HGF/c-Met pathway has been shown to be particularly relevant in tumors with bone metastases (BMs). However, the efficacy of targeting c-Met in bone metastatic disease, including in RCC, has not been proven. Therefore, further investigation is required focusing the particular role of HGF/c-Met pathway in bone microenvironment (BME) and how to effectively target this pathway in the context of bone metastatic disease.
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Key Words
- ALK, anaplastic lymphoma kinase gene
- AR, androgen receptor
- ATP, adenosine triphosphate
- AXL, AXL Receptor Tyrosine Kinase
- BME, bone microenvironment
- BMPs, bone morphogenetic proteins
- BMs, bone metastases
- BPs, Bisphosphonates
- BTAs, Bone-targeting agents
- Bone metastases
- CCL20, chemokine (C-C motif) ligand 20
- CI, confidence interval
- CRPC, Castration Resistant Prostate Cancer
- CSC, cancer stem cells
- CTC, circulating tumor cells
- CaSR, calcium/calcium-sensing receptor
- EMA, European Medicines Agency
- EMT, epithelial-to-mesenchymal transition
- FDA, US Food and Drug Administration
- FLT-3, FMS-like tyrosine kinase 3
- GEJ, Gastroesophageal Junction
- HCC, Hepatocellular Carcinoma
- HGF, hepatocyte growth factor
- HGF/c-Met
- HIF, hypoxia-inducible factors
- HR, hazard ratio
- IGF, insulin-like growth factor
- IGF2BP3, insulin mRNA Binding Protein-3
- IL, interleukin
- IRC, independent review committees
- KIT, tyrosine-protein kinase KIT
- Kidney cancer
- M-CSF, macrophage colony-stimulating factor
- MET, MET proto-oncogene, receptor tyrosine kinase
- NSCLC, non-small cell lung carcinoma
- ORR, overall response rate
- OS, overall survival
- PDGF, platelet-derived growth factor
- PFS, progression free survival
- PTHrP, parathyroid hormone-related peptide
- RANKL, receptor activator of nuclear factor-κB ligand
- RCC, renal cell carcinoma
- RET, rearranged during transfection proto-oncogene
- ROS, proto-oncogene tyrosine-protein kinase ROS
- RTK, receptor tyrosine kinase
- SCLC, Squamous Cell Lung Cancer
- SREs, skeletal-related events
- SSE, symptomatic skeletal events
- TGF-β, transforming growth factor-β
- TIE-2, Tyrosine-Protein Kinase Receptor TIE-2
- TKI, tyrosine kinase inhibitor
- TRKB, Tropomyosin receptor kinase B
- Targeted therapy
- VEGFR, vascular endothelial growth factor receptor
- VHL, Hippel-Lindau tumor suppressor gene
- ZA, zoledronic acid
- ccRCC, clear-cell RCC
- mAb, monoclonal antibodies
- pRCC, papillary renal cell carcinoma
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Affiliation(s)
- Rita Silva Paiva
- Oncology Division, Hospital de Santa Maria, CHULN, 1649-035 Lisboa, Portugal
| | - Inês Gomes
- Instituto de Medicina Molecular - João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
| | - Sandra Casimiro
- Instituto de Medicina Molecular - João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
| | - Isabel Fernandes
- Oncology Division, Hospital de Santa Maria, CHULN, 1649-035 Lisboa, Portugal
- Instituto de Medicina Molecular - João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
| | - Luís Costa
- Oncology Division, Hospital de Santa Maria, CHULN, 1649-035 Lisboa, Portugal
- Instituto de Medicina Molecular - João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
- Corresponding author at: Oncology Division, Hospital de Santa Maria, 1649-035 Lisbon, Portugal.
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13
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Canonica GW, Blasi F, Paggiaro P, Senna G, Passalacqua G, Spanevello A, Aliberti S, Bagnasco D, Bonavia M, Bonini M, Brussino L, Bucca C, Caiaffa MF, Calabrese C, Camiciottoli G, Caminati M, Carpagnano GE, Caruso C, Centanni S, Conte ME, Corsico AG, Cosmi L, Costantino MT, Crimi N, D’Alò S, D'Amato M, Del Giacco S, Farsi A, Favero E, Foschino Barbaro MP, Guarnieri G, Guida G, Latorre M, Lo Cicero S, Lombardi C, Macchia L, Mazza F, Menzella F, Milanese M, Montagni M, Montuschi P, Nucera E, Parente R, Patella V, Pelaia G, Pini L, Puggioni F, Ricciardi L, Ricciardolo FL, Richeldi L, Ridolo E, Rolla G, Santus P, Scichilone N, Spadaro G, Vianello A, Viviano V, Yacoub MR, Zappa MC, Heffler E. Oral CorticoSteroid sparing with biologics in severe asthma: A remark of the Severe Asthma Network in Italy ( SANI). World Allergy Organ J 2020; 13:100464. [PMID: 32999699 PMCID: PMC7509464 DOI: 10.1016/j.waojou.2020.100464] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 04/16/2020] [Revised: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022] Open
Abstract
According to the data derived from several national and international registries, including SANI (Severe Asthma Network Italy), and considering the strong impact that frequent or regular use of oral corticosteroid has on quality of life (QoL) of severe asthmatics, as well as on the costs for managing corticosteroid-related diseases, oral corticosteroid sparing up to withdrawal should be considered a primary outcome in the management of severe asthma. New biologics have clearly demonstrated that this effect is possible, with concomitant reduction in the rate of exacerbations and in symptom control. Then, there is no reason for using so frequently oral corticosteroid before having explored all alternatives currently available for a large part of severe asthmatics.
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Key Words
- Biologics
- CRSwNP, chronic rhinosinusitis with nasal polyposis
- EMA, European Medicines Agency
- FDA, Food & Drug Administration
- FEV1, forced expiratory volume in the 1st second
- GINA, Global Initiative for Asthma
- GRADE, Grading of Recommendations Assessment, Development and Evaluation
- ISAR, International Severe Asthma Registry
- OCSs, Oral CorticoSteroids
- Oral corticosteroids
- RW, Real World
- Real-life
- Registr
- SA, severe asthma
- SANI, Severe Asthma Network in Italy
- SARP, Severe Asthma Research Program
- SHARP, Severe Heterogeneous Asthma Research collaboration, Patient-centred
- Severe asthma
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Francesco Blasi
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | - Gianenrico Senna
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | | | - Stefano Aliberti
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | | | - Matteo Bonini
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
| | - Luisa Brussino
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Caterina Bucca
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Maria F. Caiaffa
- Department of Medical Sciences and Surgery, School and Chair of Allergology and Clinical Immunology, University of Foggia, Italy
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Gianna Camiciottoli
- Deptartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, Respiratory Unit, Careggi University Hospital, Florence, Italy
| | - Marco Caminati
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
| | - Giovanna E. Carpagnano
- Respiratory Medicine Section, Policlinico of Bari, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Stefano Centanni
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria E. Conte
- Respiratory Unit, Presidio Ospedaliero of Pordenone, Italy
| | - Angelo G. Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo, Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria T. Costantino
- Allergy and Clinical Immunology Unit, Department of Medicine, “Carlo Poma” Hospital, Mantova, Italy
| | - Nunzio Crimi
- Division of Pneumology and Allergology, Policlinico, University of Catania, Italy
| | - Simona D’Alò
- Allergology Unit, AV3 ASUR Marche, Hospital Civitanova Marche, Macerata, Italy
| | - Maria D'Amato
- Respiratory Department, Division of Respiratory Diseases “Federico II” University, AO Dei Colli, Naples, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Alessandro Farsi
- SOS of Allergology and Clinical Immunology, Azienda USL Toscana Centro, Prato, Italy
| | - Elisabetta Favero
- Severe Asthma Multidisciplinary Outpatient Clinic, Vittorio Veneto Hospital, Treviso, Italy
| | - Maria P. Foschino Barbaro
- Section of Respiratory Diseases, Medical and Surgical Sciences Department, University of Foggia, Italy
| | - Gabriella Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Italy
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S. Croce & Carle, Cuneo, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | | | - Carlo Lombardi
- Departmental Unit of Allergology and Pneumology, Hospital Institute Fondazione Poliambulanza, Brescia, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | | | - Francesco Menzella
- Pneumology Unit, Santa Maria Nuova Hospital, Azienda USL di Reggio Emilia IRCCS, Italy
| | - Manlio Milanese
- Pulmonology Unit, ASL2 Savonese, Pietra Ligure, Savona, Italy
| | | | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine Catholic, University of the Sacred Heart Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Nucera
- Catholic University S. Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberta Parente
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Italy
| | - Vincenzo Patella
- Allergology and Clinical Immunology Unit, Department of Medical Science, “Santa Maria Della Speranza” Hospital of Battipaglia, Salerno, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University Magna Graecia, Catanzaro, Italy
| | - Laura Pini
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Luisa Ricciardi
- Allergy and Clinical Immunology Unit, University Hospital “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Fabio L.M. Ricciardolo
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Luca Richeldi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Italy
| | - Giovanni Rolla
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Pierachille Santus
- Department of Clinical and Biomedical Sciences, University of Milan, Respiratory Diseases, Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Giuseppe Spadaro
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Diseases, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Andrea Vianello
- Division of Respiratory Pathophysiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Vittorio Viviano
- Allergology, Pneumology and Respiratory Department 42 PTA Biondo-Regional Center for Allergy Prevention and Anaphylactic Shock, Palermo, Italy
| | - Mona R. Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria C. Zappa
- Pulmonology Department, Sandro Pertini Hospital, Rome, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - SANI (Severe Asthma Network Italy)
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
- University of Insubria, ICS Maugeri, IRCCS, Varese, Italy
- Respiratory Rehabilitation, ASL3, Genoa, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
- Department of Medical Sciences and Surgery, School and Chair of Allergology and Clinical Immunology, University of Foggia, Italy
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
- Deptartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, Respiratory Unit, Careggi University Hospital, Florence, Italy
- Respiratory Medicine Section, Policlinico of Bari, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
- Respiratory Unit, Presidio Ospedaliero of Pordenone, Italy
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo, Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Allergy and Clinical Immunology Unit, Department of Medicine, “Carlo Poma” Hospital, Mantova, Italy
- Division of Pneumology and Allergology, Policlinico, University of Catania, Italy
- Allergology Unit, AV3 ASUR Marche, Hospital Civitanova Marche, Macerata, Italy
- Respiratory Department, Division of Respiratory Diseases “Federico II” University, AO Dei Colli, Naples, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
- SOS of Allergology and Clinical Immunology, Azienda USL Toscana Centro, Prato, Italy
- Severe Asthma Multidisciplinary Outpatient Clinic, Vittorio Veneto Hospital, Treviso, Italy
- Section of Respiratory Diseases, Medical and Surgical Sciences Department, University of Foggia, Italy
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Italy
- Allergy and Pneumology Unit, A.O. S. Croce & Carle, Cuneo, Italy
- Department of Pneumology, Niguarda Hospital, Milan, Italy
- Departmental Unit of Allergology and Pneumology, Hospital Institute Fondazione Poliambulanza, Brescia, Italy
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
- Pneumology Unit, Santa Maria Nuova Hospital, Azienda USL di Reggio Emilia IRCCS, Italy
- Pulmonology Unit, ASL2 Savonese, Pietra Ligure, Savona, Italy
- UOC Allergology Department, Piacenza, Italy
- Department of Pharmacology, Faculty of Medicine Catholic, University of the Sacred Heart Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University S. Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Italy
- Allergology and Clinical Immunology Unit, Department of Medical Science, “Santa Maria Della Speranza” Hospital of Battipaglia, Salerno, Italy
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University Magna Graecia, Catanzaro, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
- Allergy and Clinical Immunology Unit, University Hospital “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, Italy
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
- Department of Medicine and Surgery, University of Parma, Italy
- Department of Clinical and Biomedical Sciences, University of Milan, Respiratory Diseases, Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo, Italy
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Diseases, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
- Division of Respiratory Pathophysiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
- Allergology, Pneumology and Respiratory Department 42 PTA Biondo-Regional Center for Allergy Prevention and Anaphylactic Shock, Palermo, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pulmonology Department, Sandro Pertini Hospital, Rome, Italy
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14
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Popov TA, Passalacqua G, González-Díaz SN, Plavec D, Braido F, García-Abujeta JL, Dubuske L, Rouadi P, Morais-Almeida M, Bonini S, Cheng L, Ansotegui IJ. Medical devices in allergy practice. World Allergy Organ J 2020; 13:100466. [PMID: 33024482 PMCID: PMC7529824 DOI: 10.1016/j.waojou.2020.100466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/22/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022] Open
Abstract
Medical devices provide people with some health benefits in terms of diagnosis, prevention, treatment, and monitoring of disease processes. Different medical specialties use varieties of medical devices more or less specific for them. Allergology is an interdisciplinary field of medical science and teaches that allergic reactions are of systemic nature but can express themselves at the level of different organs across the life cycle of an individual. Subsequently, medical devices used in allergology could be regarded as: 1) general, servicing the integral diagnostic and management principles and features of allergology, and 2) organ specific, which are shared by organ specific disciplines like pulmonology, otorhinolaryngology, dermatology, and others. The present position paper of the World Allergy Organization (WAO) is meant to be the first integral document providing structured information on medical devices in allergology used in daily routine but also needed for sophisticated diagnostic purposes and modern disease management. It is supposed to contribute to the transformation of the health care system into integrated care pathways for interrelated comorbidities.
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Key Words
- AAP, Asthma Action Plan
- ATS, American Thoracic Society
- Airway inflammation
- Allergic rhinitis
- Allergology
- Allergy
- Allergy diagnosis
- Asthma
- CE mark, Conformité Européenne mark
- CO, Carbon monoxide
- DPIs, Dry Powder Inhalers
- EAI/AAI, Epinephrine/Adrenaline Auto-Injector
- EBC, Exhaled Breath Condensate
- EBT, Exhaled Breath Temperature
- EDS, Exhalation Delivery Systems
- EMA, European Medicines Agency
- ERS, European Respiratory Society
- ERV, Expiratory Reserve Volume
- FDA, Food and Drug Administration
- FEF, Forced Expiratory Flows
- FEV1, Forced Expiratory Volume in 1 second
- FOT, Forced Oscillation Technique
- FRC, Functional Residual Capacity
- FVC, Forced Vital Capacity
- FeNO, Fractional Exhaled Nitric Oxide
- GLI, Global Lung Function Initiative
- IOS, Impulse Oscillometry
- IRV, Inspiratory Reserve Volume
- Lung function tests
- MDPS, Metered-Dose Pump Sprays
- Medical devices
- NDDD, Nasal Drug Delivery Device
- NO, Nitric oxide
- PDMI, Pressurized Metered Dose Inhaler
- PEF, Peak Expiratory Flow
- PNIF, Peak Nasal Inspiratory Flow
- PT, Patch Tests
- PhPT, Photopatch tests
- Ppb, part per billion
- RV, Residual Volume
- SPT, Skin Prick Test
- Skin tests
- TLC, Total Lung Capacity
- UV, Ultra Violet
- VC, Vital Capacity
- VT, Tidal Volume
- WAO, World Allergy Organization
- WHO, World Health Organization
- m-health
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Affiliation(s)
| | | | | | | | | | | | - Lawrence Dubuske
- The George Washington University School of Medicine, Washington DC, USA
| | | | | | - Sergio Bonini
- Institute of Translational Pharmacology, Italian National Research Council, Rome, Italy
| | - Lei Cheng
- Nanjing Medical University, First Affiliated Hospital, Nanjing, China
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15
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Martins AM, Pessoa ALS, Quesada AA, Ribeiro EM. Unmet needs in PKU and the disease impact on the day-to-day lives in Brazil: Results from a survey with 228 patients and their caregivers. Mol Genet Metab Rep 2020; 24:100624. [PMID: 32742934 PMCID: PMC7387838 DOI: 10.1016/j.ymgmr.2020.100624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Accumulation of phenylalanine (Phe) due to deficiency in the enzyme phenylalanine hydroxylase (PAH), responsible for the conversion of Phe into tyrosine leads to Phenylketonuria (PKU), a rare autosomal recessive inborn error of metabolism with a mean prevalence of approximately 1:10,000 to 1:15,000 newborns. Physical, neurocognitive and psychiatric symptoms include neurodevelopmental disorder as intellectual disability and autism spectrum disorder. The most common treatments such as low-Phe diet and supplements may decrease blood Phe concentrations, but neuropsychological, behavioral and social issues still occur in some patients. This study aimed to better understand (i) the Brazilian population's knowledge about newborn screening (NBS), the main diagnostic method for PKU, as well as (ii) the impacts of phenylketonuria in the daily lives of patients and parents. METHODS Two surveys in Real World Data format gathering of Brazilian residents by online questionnaires with (i) 1000 parents of children up to 5 years old between March and April 2019; (ii) 228 PKU patients and caregivers in March 2019. The survey was conducted in partnership with Abril Publisher and two Brazilian patient associations: Metabolic Mothers and SAFE Brasil, for families with rare diseases and PKU patients, respectively. RESULTS The first questionnaire shows that 93% of parents recognize the importance of NBS and 92% report that their children have undergone the test. Still, two out of ten participants did not know what the exam is or what it is for. From the second questionnaire nine out of ten patients had their PKU diagnosis by NBS. Although strict dietary controls for PKU were claimed by 44% of respondents from second questionnaire, 55% assume not following all nutritionist recommendations and 52% did not maintain routinely Phe control levels. In addition, 53% said they had high spending on medical appointments, therapies and purchase of special foods. CONCLUSIONS Despite the lack of understanding, the awareness of NBS importance is present in the studied population. The early diagnosis of most PKU patients in the study corroborates with neonatal screening central role of PKU early detection. The difficulty in adhering to dietary adjustments and the possibility that current and new therapeutic strategies other than diet could be determinant to achieve the recommended Phe levels.
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Affiliation(s)
- Ana Maria Martins
- Reference Center in Inborn Errors of Metabolism, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Andre Luiz Santos Pessoa
- Albert Sabin Children's Hospital, Fortaleza, Ceará, Brazil
- State University of Ceará (UECE), Fortaleza, Ceará, Brazil
| | | | - Erlane Marques Ribeiro
- Albert Sabin Children's Hospital, Fortaleza, Ceará, Brazil
- Christus University Center Medical School, Fortaleza, Brazil
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16
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McSweeney L, Breckons M, Fattakhova G, Oluboyede Y, Vale L, Ternent L, Balp MM, Doward L, Brass CA, Beyer F, Sanyal A, Anstee QM. Health-related quality of life and patient-reported outcome measures in NASH-related cirrhosis. JHEP Rep 2020; 2:100099. [PMID: 32435754 PMCID: PMC7229498 DOI: 10.1016/j.jhepr.2020.100099] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/04/2020] [Accepted: 02/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND & AIMS Non-alcoholic steatohepatitis (NASH) is known to have a negative impact on patients' health-related quality of life (HRQoL), even before progression to cirrhosis has occurred. The burden of NASH-related cirrhosis from the patient perspective remains poorly understood. Herein, we aimed to identify the burden of disease and HRQoL impairment among patients with NASH-related compensated cirrhosis. METHODS This targeted literature review sought first to identify the humanistic burden of disease from the perspective of patients with diagnosed NASH-cirrhosis and, secondly, to identify generic or disease-specific patient-reported outcome measures (PROMs) used to assess the impact of NASH-cirrhosis. Searches were conducted in bibliographical databases, grey or unpublished literature, liver disease websites, support group websites and online blogs. A quality assessment of specific PROMs was conducted. RESULTS Patients with NASH-cirrhosis are reported to suffer from lower HRQoL than patients with non-cirrhotic NASH and the general population with respect to physical health/functioning, emotional health and worry, and mental health. Thirteen PROMs were identified, of which 4 were liver-disease specific: CLDQ, CLDQ-NAFLD, LDQoL and LDSI. The most commonly used measures do not comply with current industry or regulatory standards for PROMs and/or are not validated for use in a cirrhotic NASH population. CONCLUSIONS Patients with NASH-cirrhosis have lower HRQoL and poorer physical health than patients with non-cirrhotic NASH. However, the literature lacked detail of the everyday impact on patients' lives. Currently, a number of PROMs are available to measure the impact of the disease in patients with chronic liver conditions. The lack of studies that include qualitative insights in this population mandates further exploration and research. LAY SUMMARY It is not well understood how having non-alcoholic fatty liver disease (NAFLD)-related cirrhosis affects a person's everyday wellbeing and quality of life. Some research has been done with patients who have early stages of liver disease but not people with cirrhosis. We found that patients with NAFLD-related cirrhosis tended to have poorer health than patients without cirrhosis. But there was not very much information from patients themselves and there were no tools or questionnaires just for this group of patients.
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Key Words
- CLDQ, chronic liver disease questionnaire
- COSMIN, The COnsensus-based Standards for the selection of health Measurement INstruments
- Cirrhosis
- EMA, European Medicines Agency
- FDA, United States Food and Drug Administration
- FIS, fatigue impact scale
- HRQoL, health-related quality of life
- LDQoL, liver disease quality of life questionnaire
- LDSI, liver disease symptom index
- MS, multiple sclerosis
- NAFL, non-alcoholic fatty liver
- NAFLD
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- Non-alcoholic steatohepatitis
- PHAQ, patient-reported outcome measurement information system health assessment questionnaire
- PRO, patient-reported outcome
- PROM, patient-reported outcome measure
- QoL, quality of life
- RI, researcher interpretation
- SF-36, short form health profile 36
- health-related quality of life
- liver
- patient-reported outcome measures
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Affiliation(s)
- Lorraine McSweeney
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew Breckons
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Gulnar Fattakhova
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Ternent
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lynda Doward
- RTI-Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, UK
| | | | - Fiona Beyer
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Arun Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, United States
| | - Quentin M. Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK & Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
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17
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Abstract
Phase II clinical studies represent a critical point in determining drug costs, and phase II is a poor predictor of drug success: >30% of drugs entering phase II studies fail to progress, and >58% of drugs go on to fail in phase III. Adaptive clinical trial design has been proposed as a way to reduce the costs of phase II testing by providing earlier determination of futility and prediction of phase III success, reducing overall phase II and III trial sizes, and shortening overall drug development time. This review examines issues in phase II testing and adaptive trial design.
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Affiliation(s)
- Gail A. Van Norman
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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18
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Takkis K, Veigure R, Metsvaht T, Hallik M, Ilmoja ML, Starkopf J, Kipper K. A sensitive method for the simultaneous UHPLC-MS/MS analysis of milrinone and dobutamine in blood plasma using NH 4F as the eluent additive and ascorbic acid as a stabilizer. Clin Mass Spectrom 2019; 12:23-29. [PMID: 34841076 PMCID: PMC8620135 DOI: 10.1016/j.clinms.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 11/28/2022]
Abstract
The purpose of this work was to develop and validate an HPLC-MS/MS method suitable for quantifying two important cardiovascular drugs, milrinone and dobutamine, in neonatal and paediatric patients' blood plasma samples. Sufficiently low LLOQ levels were required to obtain adequate pharmacokinetic data for the evaluation of optimal dosing. Since the specifics of the patient group set some restrictions on the available sample volume, the method was designed to use only 20 µL of plasma for the analysis. Analytes were separated chromatographically in a biphenyl column using a conventional water-methanol-formic acid eluent with the addition of ammonium fluoride. The latter provided a significant signal enhancement in positive ion mode detection for both analytes allowing the LLOQ to reach below 1 ng/mL. Matrix matched calibration was linear in the range of 1-300 ng/mL, between-run accuracy remained within 107-115%, and precision within 4.8-7.4% for both analytes over the calibration range (including LLOQ level). Dobutamine degradation in plasma samples was prevented by the usage of ascorbic acid. The method was applied to plasma samples of neonates from two pharmacokinetic/pharmacodynamics studies (n = 38).
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Key Words
- Ammonium fluoride
- Ascorbic acid
- CCBV, calculated circulating blood volume
- CPD, citrate phosphate dextrose
- CV, coefficient of variation
- Dobutamine
- EDTA, ethylenediaminetetraacetic acid
- EMA, European Medicines Agency
- ESI, electrospray ionisation
- EU, European Union
- IS, internal standard
- LC, liquid chromotography
- LLOQ, lowest limit of quantification
- MED, quality control sample at the concentration between ULOQ and 3xLLOQ
- MF, matrix factor
- MRM, multiple reaction monitoring
- MS, mass spectrometry
- MS/MS, tandem mass spectrometry
- MeOH, methanol
- Milrinone
- NH4F, ammonium fluoride
- PCR, polymerase chain reaction
- PD, pharmacodynamics
- PK, pharmacokinetics
- QC, quality control sample
- Signal enhancement
- TOC, total organic carbon
- UHPLC, ultra-high performance liquid chromotography
- UHPLC-MS/MS
- ULOQ, upper limit of quantification
- cAMP, cyclic 3,5 adenosine monophosphate
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Affiliation(s)
- Kalev Takkis
- University of Tartu, Institute of Chemistry, 14a Ravila Street, 50411 Tartu, Estonia
- Analytical Services International, St George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - Rūta Veigure
- University of Tartu, Institute of Chemistry, 14a Ravila Street, 50411 Tartu, Estonia
| | - Tuuli Metsvaht
- Tartu University Hospital, Lunini 6, 51014 Tartu, Estonia
| | - Maarja Hallik
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Tartu University, L. Puusepa 8 - G1. 209, 50406 Tartu, Estonia
- Department of Anaesthesiology and Intensive Care, Tallinn Children's Hospital, Tervise 28, 13419 Tallinn, Estonia
| | - Mari-Liis Ilmoja
- Department of Anaesthesiology and Intensive Care, Tallinn Children's Hospital, Tervise 28, 13419 Tallinn, Estonia
| | - Joel Starkopf
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Tartu University, L. Puusepa 8 - G1. 209, 50406 Tartu, Estonia
- Clinic of Anaesthesiology an Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Karin Kipper
- University of Tartu, Institute of Chemistry, 14a Ravila Street, 50411 Tartu, Estonia
- Analytical Services International, St George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
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19
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Ciplea AM, Laeer S, Burckhardt BB. A feasibility study prior to an international multicentre paediatric study to assess pharmacokinetic/pharmacodynamic sampling and sample preparation procedures, logistics and bioanalysis. Contemp Clin Trials Commun 2018; 12:32-39. [PMID: 30225392 PMCID: PMC6139604 DOI: 10.1016/j.conctc.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/25/2018] [Revised: 07/24/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background Variability in pre-analytical procedures such as blood sampling, sample preparation and transport can substantially influence bioanalytical results and subsequently impair reliability of data gathered during clinical trials. Especially in vulnerable populations, all efforts should be made to facilitate high-quality data extraction excluding unnecessary or repeated intervention. Methods The EU-funded LENA project (Labeling of Enalapril from Neonates up to Adolescents) included a feasibility study in its preparatory procedures prior to first-in-child studies. Derived from a regular study visit, it encompassed all procedures, from sampling of two study-specific drugs and four sensitive humoral parameters to bioanalysis, to evaluate the quality of obtained samples and applicability of logistical and bioanalytical procedures. Drug administration to healthy adults was circumvented by pre-spiking the blood collection tubes with a drug solution. Five clinical sites were evaluated. Results Clinical teams' preparedness and applicability of required sampling procedures was investigated in 18 volunteers, on-site. 97% of collected pharmacokinetic (PK) samples and 93% of samples for humoral parameters were obtained eligibly. Results met expectations, though one team had to be re-trained and performed a re-run. Planned procedures for sampling, sample preparation, transport and analysis were found to be suitable for being applied within paediatric trials. Conclusion The concept of the presented feasibility study that simultaneously assesses PK/PD sampling, sample preparation, logistics and bioanalysis proved to be a promising tool for trial preparation. It revealed improperly installed processes and bottlenecks that required adjustments prior to start of recruitment. It facilitated high-quality conduct from the first moment of paediatric pivotal studies.
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Key Words
- ACE, Angiotensin-converting-enzyme
- Clinical trial
- Cmax, maximum serum concentration
- ELISA, Enzyme-linked immunosorbent assay
- EMA, European Medicines Agency
- EU, European Union
- FDA, U.S. Food and Drug Administration
- Feasibility
- GCP, Good Clinical Practice
- LC-MS/MS, Liquid chromatography-tandem mass spectrometry
- LENA, Labeling of Enalapril from Neonates up to Adolescents
- PD, Pharmacodynamic(s)
- PK, Pharmacokinetic(s)
- Pharmacodynamic
- Pharmacokinetic
- Pilot
- RAA system, Renin-angiotensin-aldosterone system
- RIA, Radioimmunoassay
- Training concept
- pp, Percentage points
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Affiliation(s)
- Agnes Maria Ciplea
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University, Dusseldorf, Germany
| | - Stephanie Laeer
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University, Dusseldorf, Germany
| | - Bjoern Bengt Burckhardt
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University, Dusseldorf, Germany
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20
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Abstract
The regulation of medical drugs and devices involves competing goals of assuring safety and efficacy while providing rapid movement of innovative therapies through the investigative and regulatory processes as quickly as possible. The United States and the European Union approach these challenges in different ways. Whereas the United States has always relied on a strictly centralized process through 1 agency, the Food and Drug Administration (FDA), the European Commission synchronized the regulations of 28 different countries as they combined to create the European Union. The FDA historically developed as a consumer protection agency, whereas the regulations from the European Commission arose out of a need to harmonize inter-state commercial interests while preserving national "autonomy." Thus, whereas the FDA has the advantages of centralization and common rules, the European Union regulates medical drug and device approvals through a network of centralized and decentralized agencies throughout its member states. This study explores some of the similarities and differences in European and U.S. regulation of drugs and devices, and discusses challenges facing each.
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Key Words
- BMJ, British Medical Journal
- CE, Conformité Européenne
- DAD, drugs and devices
- EC, European Commission
- EMA
- EMA, European Medicines Agency
- EU, European Union
- European Commission
- FDA
- FDA, Food and Drug Administration
- MHRA, Medicines and Healthcare Products Regulatory Agency
- NB, Notified Bodies
- PMA, pre-market approval
- device approval
- drug approval
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Affiliation(s)
- Gail A. Van Norman
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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Refalo N, Chetcuti D, Tanti A, Serracino-Inglott A, Borg JJ. Changing paradigms in bioequivalence trials submitted to the EMA for evaluation - A clinical and regulatory perspective. Saudi Pharm J 2016; 25:280-289. [PMID: 28344480 PMCID: PMC5355546 DOI: 10.1016/j.jsps.2016.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/25/2016] [Indexed: 12/01/2022] Open
Abstract
Background The selection of a robust bioequivalence (BE) study designs for registering a generic product remains still a hard task. This task is still challenging despite the fact that generic products are much needed by health care providers in economical terms. Thus, BE study designs could be a means to allow companies to reduce costs and reach the market earlier. We therefore investigated whether different approaches in various products assessed by the European Medicines Agency during the approval phase resulted in a reduction in resources required to show bioequivalence for different medicinal products. Methods European Public Assessment Reports (EPARs) for off-patent medicinal products authorised within the European Union (EU) through the centralised procedure during the period 2007–2015 were retrieved and reviewed to identify the clinical studies that resulted in fewer number of subjects, the number of centres or trial duration versus the two-period crossover design. Results 7 studies out of 108 were considered as having benefitted from having a different design. Differences noted included having a different dose allocation scheme, having a different number of dosing periods, having a different number of treatment arms, and having one study evaluating different strengths. Benefits noted included a decrease in the number of subjects and centres required, decreases in study duration and a reduced number of studies required to demonstrate bioequivalence. Conclusion Bioequivalence studies can be designed in a specific manner to require fewer resources to carry out. Fewer resources required to register a medicinal product, could impart an advantage to companies (such as to be first on the market) or could even translate to making medicines more accessible (such as cheaper) to patients.
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Key Words
- API, active pharmaceutical ingredient
- BCS, Biopharmaceutics Classification System (BCS)
- BE, bioequivalence
- BSA, body surface area
- Bioequivalence
- CHMP, Committee for Medicinal Products for Human Use
- EMA, European Medicines Agency
- EPAR, European Public Assessment Report
- EU, European Union
- Generic medicinal products
- MA, marketing authorisation
- Marketing authorisation
- NHS, National Health System
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Affiliation(s)
- Nathaniel Refalo
- Medicines Authority, Sir Temi Żammit Buildings, Malta Life Sciences Park, San Ġwann, Malta
| | - Daniel Chetcuti
- Medicines Authority, Sir Temi Żammit Buildings, Malta Life Sciences Park, San Ġwann, Malta
| | - Amy Tanti
- Medicines Authority, Sir Temi Żammit Buildings, Malta Life Sciences Park, San Ġwann, Malta
| | - Anthony Serracino-Inglott
- Medicines Authority, Sir Temi Żammit Buildings, Malta Life Sciences Park, San Ġwann, Malta
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - John Joseph Borg
- Medicines Authority, Sir Temi Żammit Buildings, Malta Life Sciences Park, San Ġwann, Malta
- Department of Biology, School of Pharmacy, University of Tor Vergata, Rome, Italy
- Corresponding author at: Malta Medicines Authority, Sir Temi Żammit Buildings, Malta Life Sciences Park, San Ġwann, Malta.Malta Medicines AuthoritySir Temi Żammit BuildingsMalta Life Sciences ParkSan ĠwannMalta
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Jacquemart R, Vandersluis M, Zhao M, Sukhija K, Sidhu N, Stout J. A Single-use Strategy to Enable Manufacturing of Affordable Biologics. Comput Struct Biotechnol J 2016; 14:309-18. [PMID: 27570613 PMCID: PMC4990569 DOI: 10.1016/j.csbj.2016.06.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [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: 04/29/2016] [Accepted: 06/27/2016] [Indexed: 11/23/2022] Open
Abstract
The current processing paradigm of large manufacturing facilities dedicated to single product production is no longer an effective approach for best manufacturing practices. Increasing competition for new indications and the launch of biosimilars for the monoclonal antibody market have put pressure on manufacturers to produce at lower cost. Single-use technologies and continuous upstream processes have proven to be cost-efficient options to increase biomass production but as of today the adoption has been only minimal for the purification operations, partly due to concerns related to cost and scale-up. This review summarizes how a single-use holistic process and facility strategy can overcome scale limitations and enable cost-efficient manufacturing to support the growing demand for affordable biologics. Technologies enabling high productivity, right-sized, small footprint, continuous, and automated upstream and downstream operations are evaluated in order to propose a concept for the flexible facility of the future.
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Key Words
- Affinity membrane chromatography
- Antibody manufacturing paradigms
- B&E, bind and elute
- CapEx, capital expense
- CoG, cost of goods
- Continuous bioprocessing
- DSP, downstream process
- EBA, expanded bed adsorption
- EMA, European Medicines Agency
- FDA, Food and Drug Administration
- FT, flow through
- Flexible, single-use facilities
- HCP, host cell protein
- MV, membrane volume
- OpEx, operating expense
- PAT, process analytical technology
- Process economics
- SMB, simulated moving bed
- USP, upstream process
- cGMP, current good manufacturing practice
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Affiliation(s)
- Renaud Jacquemart
- Natrix Separations Inc., 5295 John Lucas Drive, Burlington, Ontario L7L 6A8, Canada
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Bonneau N, Schmitz-Afonso I, Brunelle A, Touboul D, Champy P. Validation data for the quantification of the Annonaceous acetogenin annonacin in Rat brain by UPLC-MS/MS. Data Brief 2016; 7:1633-8. [PMID: 27222866 PMCID: PMC4866534 DOI: 10.1016/j.dib.2016.04.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/28/2016] [Revised: 04/20/2016] [Accepted: 04/28/2016] [Indexed: 10/27/2022] Open
Abstract
Annonaceous acetogenins (AAGs) are environmental neurotoxins from the fruit pulp of several Annonaceae species, whose consumption was linked to the occurrence of sporadic atypical Parkinsonism with dementia. The quantification of the prototypical AAG annonacin in Rat brain homogenates was performed by UPLC-MS/MS in selected reaction monitoring (SRM) mode, using a triple quadrupole mass analyzer. A natural analog of annonacin was used as an internal standard. Analyzed data set of the analytical validation of this method is presented, including stability of the samples, extraction recovery and matrix effect, supporting the results described in the article "Quantification of the environmental neurotoxin annonacin in Rat brain by UPLC-MS/MS" N. Bonneau, I. Schmitz-Afonso, D. Touboul, A. Brunelle, P. Champy (2016) [1].
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Key Words
- AAG, Annonaceous acetogenin
- EMA, European Medicines Agency
- IS, internal standard
- LLOQ, lower limit of quantification
- MF, matrix factor
- MQC, medium concentration quality control
- QC, quality control
- RSD, relative standard deviation
- SRM, selected reaction monitoring
- ULOQ, upper limit of quantification
- UPLC-MS/MS, ultra-performance liquid chromatography tandem mass spectrometry
- amu, atomic mass unit
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Affiliation(s)
- Natacha Bonneau
- Laboratoire de Pharmacognosie, BioCIS, Univ. Paris-Sud, CNRS, Université Paris-Saclay, UFR Pharmacie, 5 rue J.-B. Clément, 92290 Châtenay-Malabry, France
| | - Isabelle Schmitz-Afonso
- Institut de Chimie des Substances Naturelles, CNRS UPR2301, Université Paris-Saclay, Avenue de la Terrasse, 91198 Gif-sur-Yvette Cedex, France
| | - Alain Brunelle
- Institut de Chimie des Substances Naturelles, CNRS UPR2301, Université Paris-Saclay, Avenue de la Terrasse, 91198 Gif-sur-Yvette Cedex, France
| | - David Touboul
- Institut de Chimie des Substances Naturelles, CNRS UPR2301, Université Paris-Saclay, Avenue de la Terrasse, 91198 Gif-sur-Yvette Cedex, France
| | - Pierre Champy
- Laboratoire de Pharmacognosie, BioCIS, Univ. Paris-Sud, CNRS, Université Paris-Saclay, UFR Pharmacie, 5 rue J.-B. Clément, 92290 Châtenay-Malabry, France
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24
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Buijs PRA, Verhagen JHE, van Eijck CHJ, van den Hoogen BG. Oncolytic viruses: From bench to bedside with a focus on safety. Hum Vaccin Immunother 2016; 11:1573-84. [PMID: 25996182 DOI: 10.1080/21645515.2015.1037058] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Oncolytic viruses are a relatively new class of anti-cancer immunotherapy agents. Several viruses have undergone evaluation in clinical trials in the last decades, and the first agent is about to be approved to be used as a novel cancer therapy modality. In the current review, an overview is presented on recent (pre)clinical developments in the field of oncolytic viruses that have previously been or currently are being evaluated in clinical trials. Special attention is given to possible safety issues like toxicity, environmental shedding, mutation and reversion to wildtype virus.
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Key Words
- CAR, Coxsackie Adenovirus receptor
- CD, cytosine deaminase
- CEA, carcinoembryonic antigen
- CVA, Coxsackievirus type A
- DAF, decay accelerating factor
- DNA, DNA
- EEV, extracellular enveloped virus
- EGF, epidermal growth factor
- EGF-R, EGF receptor
- EMA, European Medicines Agency
- FDA, Food and Drug Administration
- GBM, glioblastoma multiforme
- GM-CSF, granulocyte-macrophage colony-stimulating factor
- HA, hemagglutinin
- HAdV, Human (mast)adenovirus
- HER2, human epidermal growth factor receptor 2
- HSV, herpes simplex virus
- ICAM-1, intercellular adhesion molecule 1
- IFN, interferon
- IRES, internal ribosome entry site
- KRAS, Kirsten rat sarcoma viral oncogene homolog
- Kb, kilobase pairs
- MeV, Measles virus
- MuLV, Murine leukemia virus
- NDV, Newcastle disease virus
- NIS, sodium/iodide symporter
- NSCLC, non-small cell lung carcinoma
- OV, oncolytic virus
- PEG, polyethylene glycol
- PKR, protein kinase R
- PV, Polio virus
- RCR, replication competent retrovirus
- RCT, randomized controlled trial
- RGD, arginylglycylaspartic acid (Arg-Gly-Asp)
- RNA, ribonucleic acid
- Rb, retinoblastoma
- SVV, Seneca Valley virus
- TGFα, transforming growth factor α
- VGF, Vaccinia growth factor
- VSV, Vesicular stomatitis virus
- VV, Vaccinia virus
- cancer
- crHAdV, conditionally replicating HAdV
- dsDNA, double stranded DNA
- dsRNA, double stranded RNA
- environment
- hIFNβ, human IFN β
- immunotherapy
- mORV, Mammalian orthoreovirus
- mORV-T3D, mORV type 3 Dearing
- oHSV, oncolytic HSV
- oncolytic virotherapy
- oncolytic virus
- rdHAdV, replication-deficient HAdV
- review
- safety
- shedding
- ssRNA, single stranded RNA
- tk, thymidine kinase
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Affiliation(s)
- Pascal R A Buijs
- a Department of Surgery; Erasmus MC; University Medical Center ; Rotterdam , The Netherlands
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25
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Abstract
Adjuvants mainly interact with the innate immune response and are used to enhance the quantity and quality of the downstream adaptive immune response to vaccine antigens. Establishing the safety of a new adjuvant-antigen combination is achieved through rigorous evaluation that begins in the laboratory, and that continues throughout the vaccine life-cycle. The strategy for the evaluation of safety pre-licensure is guided by the disease profile, vaccine indication, and target population, and it is also influenced by available regulatory guidelines. In order to allow meaningful interpretation of clinical data, clinical program methodology should be optimized and standardized, making best use of all available data sources. Post-licensure safety activities are directed by field experience accumulated pre- and post-licensure clinical trial data and spontaneous adverse event reports. Continued evolution of safety evaluation processes that keep pace with advances in vaccine technology and updated communication of the benefit-risk profile is necessary to maintain public confidence in vaccines.
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Abstract
Biosimilar monoclonal antibodies are being developed globally for patients with different types of solid tumors and hematologic malignancies. Applications for proposed biosimilar monoclonal antibodies are being submitted to the regulatory authorities around the world and may increase patient access to key treatment options upon approval. An understanding among stakeholders (e.g., physicians, patients and their caregivers, pharmacists, payers) of the approval criteria, as well as the similarities and differences in regulatory pathways involved in biosimilar approval in different countries, as presented in this review, will facilitate identification of high-quality, safe, monoclonal antibodies that have been developed according to strict, biosimilar regulatory standards. Further guidance and resolution of the ongoing discussions on biosimilar labeling, naming, automatic substitution, and indication extrapolation may ensure, in the future, an effective and appropriate use of biosimilar monoclonal antibodies by oncologists and other stakeholders in daily clinical practice.
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Key Words
- ADR, adverse drug reaction
- ASBM, Alliance for Safe Biologic Medicines
- CBER, US Center for Biologics Evaluation and Research
- CDER, US Center for Drug Evaluation and Research
- EBE, European Biopharmaceutical Enterprises
- EMA, European Medicines Agency
- EPAR, European Public Assessment Report
- FDA, US Food and Drug Administration
- INN, International Non-proprietary Name
- SEB, subsequent entry biologic
- SmpC, Summary of Product Characteristics
- WHO, World Health Organization
- biologics
- biosimilars
- interchangeability
- labeling
- mAbs, monoclonal antibodies
- naming
- regulatory
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Luciani F, Galluzzo S, Gaggioli A, Kruse NA, Venneugues P, Schneider CK, Pini C, Melchiorri D. Implementing quality by design for biotech products: Are regulators on track? MAbs 2016; 7:451-5. [PMID: 25853461 DOI: 10.1080/19420862.2015.1023058] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Quality by design (QbD) is an innovative approach to drug development that has started to be implemented into the regulatory framework, but currently mainly for chemical drugs. The recent marketing authorization of the first monoclonal antibody developed using extensive QbD concepts in the European Union paves the way for future further regulatory approvals of complex products employing this cutting-edge technological concept. In this paper, we report and comment on insights and lessons learnt from the non-public discussions in the European Medicines Agency's Biologicals Working Party and Committee for Medicinal Products for Human Use on the key issues during evaluation related to the implementation of an extensive QbD approach for biotechnology-derived medicinal products. Sharing these insights could prove useful for future developments in QbD for biotech products in general and monoclonal antibodies in particular.
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Affiliation(s)
- Francesca Luciani
- a National Center for Immunobiologicals Control and Evaluation (CRIVIB); Istituto Superiore di Sanità ; Rome , Italy
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Préaud E, Uhart M, Böhm K, Aidelsburger P, Anger D, Bianic F, Largeron N. Cost-effectiveness analysis of a vaccination program for the prevention of herpes zoster and post-herpetic neuralgia in adults aged 50 and over in Germany. Hum Vaccin Immunother 2016; 11:884-96. [PMID: 25933182 PMCID: PMC4514364 DOI: 10.1080/21645515.2015.1011561] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Indexed: 11/27/2022] Open
Abstract
Herpes zoster (HZ; shingles) is a common viral disease that affects the nerves and surrounding skin causing a painful dermatomal rash and leading to debilitating complications such as, mainly, post-herpetic neuralgia (PHN). Currently, there is no effective treatment for HZ and PHN. The objective of this study was to assess the cost-effectiveness of a HZ vaccination program in Germany. An existing Markov Model was adapted to the German healthcare setting to compare a vaccination policy to no vaccination on a lifetime time-horizon, considering 2 scenarios: vaccinating people starting at the age of 50 or at the age of 60 years, from the perspective of the statutory health insurance (SHI) and the societal perspective. According to the perspective, vaccinating 20% of the 60+ German population resulted in 162,713 to 186,732 HZ and 31,657 to 35,793 PHN cases avoided. Corresponding incremental cost-effectiveness ratios (ICER) were 39,306 €/QALY from the SHI perspective and 37,417 €/QALY from a societal perspective. Results for the 50+ German population ranged from 336,468 to 394,575 HZ and from 48,637 to 56,087 PHN cases avoided from the societal perspective. Corresponding ICER were 39,782 €/QALY from a SHI perspective and 32,848 €/QALY from a societal perspective. Sensitivity analyses showed that results are mainly impacted by discount rates, utility values and use of alternative epidemiological data.The model indicated that a HZ vaccination policy in Germany leads to significant public health benefits and could be a cost-effective intervention. The results were robust and consistent with local and international existing literature.
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Key Words
- ASHIP, Association of Statutory Health Insurance Physicians
- CEAC, Cost-effectiveness acceptability curves
- CMI, Cell-mediated immunity
- DSA, Deterministic sensitivity analysis
- EBM, German uniform assessment standard (Einheitlicher Bewertungsmaßstab)
- EMA, European Medicines Agency
- EQ-5D, EuroQoL
- G-DRG, German Diagnosis Related Groups
- GePaRD German Pharmacoepidemiological Research Database
- Germany
- HZ, Herpes zoster
- ICER, Incremental cost-effectiveness ratio
- IQWIG, German Institute for Quality and Efficiency in Health Care
- NNV, Number needed to vaccinate
- PHN, Post-herpetic neuralgia
- PSA, Probabilistic sensitivity analysis
- QALY, Quality-adjusted life year
- SHI, Statutory health insurance
- SPS, Shingles Prevention Study
- STIKO, German Standing Committee on Immunisation
- STPS, Short-Term Persistence Substudy
- US, United States
- VZV, Varizella zoster virus
- YO, Years old
- ZEST, Zostavax® Efficacy and Safety Trial
- cost-effectiveness
- herpes zoster
- mBPI-SF Modified short form brief pain inventory
- markov model
- post-herpetic neuralgia
- vaccination
- zostavax
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Hiroi S, Morikawa S, Nakata K, Maeda A, Kanno T, Irie S, Ohfuji S, Hirota Y, Kase T. Trivalent influenza vaccine-induced antibody response to circulating influenza a (H3N2) viruses in 2010/11 and 2011/12 seasons. Hum Vaccin Immunother 2015; 11:386-90. [PMID: 25692378 DOI: 10.1080/21645515.2015.1009338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
To evaluate antibody response induced by trivalent inactivated influenza vaccine (TIV) against circulating influenza A (H3N2) strains in healthy adults during the 2010/11 and 2011/12 seasons, a hemagglutination-inhibition (HI) assay was utilized to calculate geometric mean antibody titer (GMT), seroprotection rate (post vaccination HI titers of ≥1 :40), and seroresponse rate (4-fold increase in antibody level). In the 2010/11 season, GMT increased 1.8- to 2.0-fold following the first dose of TIV against 3 circulating strains and 2.2-fold following the second compared to before vaccination. The seroresponse rate ranged from 22% to 26% following the first dose of TIV and from 31% to 33% following the second (n = 54 ). The seroprotection rate increased from a range of 6% to 13% to a range of 26% to 33% following the first dose of TIV and to a range of 37% to 42% following the second (n = 54 ). In the 2011/12 season, GMT increased 1.4-fold against A/Osaka/110/2011 and 1.8-fold against A/Osaka/5/2012. For A/Osaka/110/2011, the seroresponse rate was 29%, and the seroprotection rate increased from 26% to 55% following vaccination (n = 31 ). For A/Osaka/5/2012, the seroresponse rate was 26%, and the seroprotection rate increased from 68% to 84% following vaccination (n = 31 ). HI assays with reference antisera demonstrated that the strains in the 2011/12 season were antigenically distinct from vaccine strain (A/Victoria/210/2009). In conclusion, the vaccination increased the seroprotection rate against circulating H3N2 strains in the 2010/11 and 2011/12 seasons. Vaccination of TIV might have potential to induce reactive antibodies against antigenically distinct circulating H3N2 viruses.
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Affiliation(s)
- Satoshi Hiroi
- a Department of Infectious Diseases ; Osaka Prefectural Institute of Public Health ; Osaka , Japan
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Abstract
Cancer vaccines are aimed at stimulating an immune response to tumor tissue. There is a high level of clinical activity in this rapidly advancing field with over 1,400 trials registered on Clincaltrials.gov. The recent approval of Sipuleucel-T which is the first cancer vaccine approved in the US and EU has encouraged developers in this field. In contrast to more established approaches for treating cancer such as chemotherapy, regulatory guidelines have been developed relatively recently for cancer vaccines. These guidelines advise on general clinical requirements. As there is an increase in innovative strategies with novel products, a 2-way dialog with regulators is recommended on a case-by-case basis to justify the clinical development plan, taking into account specific quality issues related to the product(s) in development. It is important that the rationale, background and justification for the planned development is convincing when interacting with the regulatory authorities, to enable drug developers and regulators to reach agreement.
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Key Words
- AIDS, Acquired Immunodeficiency Syndrome
- CAR, T-cell Chimeric Antigen Receptor T-cell
- CTL-4, Cytotoxic T-lymphocyte-associated protein 4
- DCs, Dendritic cells
- EBV, Ebstein Barr Virus
- EMA, European Medicines Agency
- EU, European Union
- FDA, Federal Drug Administration
- HHV-8, Human Herpes Virus 8
- HTA, Health Technology Assessment
- ICH, International Conference on Harmonisation
- ICI, Immune Checkpoint Inhibitors
- ITF, Innovation Task Force
- MDSC, Myeloid-derived suppressor cells
- MHRA, Medicines and Healthcare products Regulatory Agency
- MUC1, Membrane-bound glycoprotein MUC1 mucin
- NICE, National Institute for Heath and Care excellence
- OS, Overall survival
- PD, Pharmacodynamic
- PD-1, Programmed cell death 1
- PFS, Progression-free survival
- PMDA, Pharmaceutical and Medical Devices Agency
- PTLD, Post-transplant lymphoproliferative disease
- RECIST, Response Evaluation Criteria in Solid Tumors
- Serum Igs, Serum immunoglobulins
- T cells
- TAA, Tumor associated antigens
- TIMs, Tumor Infiltrating Myeloid Cell
- Tregs, Regulatory T cells
- US, United States of America
- antigens
- cancer vaccines
- immune system
- immunesurveillance
- siRNA, Small interfering RNA
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Angel J, Steele AD, Franco MA. Correlates of protection for rotavirus vaccines: Possible alternative trial endpoints, opportunities, and challenges. Hum Vaccin Immunother 2015; 10:3659-71. [PMID: 25483685 PMCID: PMC4514048 DOI: 10.4161/hv.34361] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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] [Indexed: 12/24/2022] Open
Abstract
Rotavirus (RV) is a major vaccine-preventable killer of young children worldwide. Two RV vaccines are globally commercially available and other vaccines are in different stages of development. Due to the absence of a suitable correlate of protection (CoP), all RV vaccine efficacy trials have had clinical endpoints. These trials represent an important challenge since RV vaccines have to be introduced in many different settings, placebo-controlled studies are unethical due to the availability of licensed vaccines, and comparator assessments for new vaccines with clinical endpoints are very large, complex, and expensive to conduct. A CoP as a surrogate endpoint would allow predictions of vaccine efficacy for new RV vaccines and enable a regulatory pathway, contributing to the more rapid development of new RV vaccines. The goal of this review is to summarize experiences from RV natural infection and vaccine studies to evaluate potential CoP for use as surrogate endpoints for assessment of new RV vaccines, and to explore challenges and opportunities in the field.
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Key Words
- ASC, antibody secreting cells
- CO, cutoff
- CoP, correlate of protection
- EMA, European Medicines Agency
- GAVI, Global Alliance for Vaccines and Immunisation
- GE, gastroenteritis
- GMT, geometric mean titers
- HAI, haemagglutination inhibition
- IgA
- MenC, Meningococcal serogroup C
- RRV-TV, Rhesus RV-Tetravalent vaccine
- RV, rotavirus
- RV-NA, RV specific neutralizing antibodies
- RV-SIg, rotavirus secretory Ig
- RV-T cells, rotavirus specific T cells
- RV1, Rotarix®
- RV5, RotaTeq®
- RV5-precursor, RV5 precursor reassortants
- SBA, serum bactericidal assay
- SGE, severe gastroenteritis
- VE, vaccine efficacy
- VEI, VE estimated with an immunological endpoint
- WHO, World Health Organization
- correlates of protection
- mBc, memory B cells
- mucosal
- rSAB, serum bactericidal assay using rabbit serum
- rotavirus
- vaccines
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Affiliation(s)
- Juana Angel
- a I nstituto de Genética Humana; Facultad de Medicina ; Pontificia Universidad ; Javeriana , Bogotá
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Abstract
The commercial pipeline of recombinant antibody therapeutics is robust and dynamic. As of early December 2014, a total of 6 such products (vedolizumab, siltuximab, ramucirumab, pembrolizumab, nivolumab, blinatumomab) were granted first marketing approvals in 2014. As discussed in this perspective on antibodies in late-stage development, the outlook for additional approvals, potentially still in 2014 and certainly in 2015, is excellent as marketing applications for 7 antibody therapeutics (secukinumab, evolocumab, mepolizumab, dinutuximab, nivolumab, blinatumomab, necitumumab) are undergoing a first regulatory review in the EU or US. Of the 39 novel mAbs currently in Phase 3 studies, a marketing application for one (alirocumab) may be submitted in late 2014, and marketing application submissions for at least 4 (reslizumab, ixekizumab, ocrelizumab, obiltoxaximab) are expected in 2015. Other 'antibodies to watch' are those in Phase 3 studies with estimated primary completion dates in late 2014 or 2015, which includes 13 for non-cancer indications (brodalumab, bimagrumab, bococizumab, MABp1, gevokizumab, dupilumab, sirukumab, sarilumab, tildrakizumab, guselkumab, epratuzumab, combination of actoxumab + bezlotoxumab, romosozumab) and 2 (racotumomab and clivatuzumab tetraxetan) undergoing evaluation as treatments for cancer. In addition to the novel antibody therapeutics mentioned, biosimilar infliximab and biosimilar trastuzumab are 'antibodies to watch' in 2015 because of their potential for entry into the US market and regulatory review, respectively.
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Key Words
- BLA, biologics license application
- EMA, European Medicines Agency
- European Medicines Agency
- FDA, Food and Drug Administration
- Food and Drug Administration
- IV, intravenous
- MTX, methotrexate
- PA, protective antigen
- PCSK9, proprotein convertase subtilisin/kexin type 9
- RA, rheumatoid arthritis
- SLE, systemic lupus erythematosus
- biosimilar antibodies
- cancer
- clinical studies
- immune-mediated disorders
- interleukin, IL
- mAb, monoclonal antibody
- monoclonal antibodies
- pharmacokinetic, PK
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Abstract
A growing number of innovative mAb therapeutics are on the global market, and biosimilar versions have now also been approved, including in India. Although efficacy and safety is demonstrated prior to approval, targeted pharmacovigilance is essential for the identification and assessment of risk for any mAb products. We analyzed the ADR data related to mAbs reported to the NCC-PvPI through the spontaneous reporting system Vigiflow during April 2011 to February 2014 to identify mAbs with the highest number of ADR including fatal/serious ADR. Only 0.72% reports were related to mAbs. Although 15 mAbs are approved in the country, only 6 mAbs were reported through Vigiflow. Rituximab was highly reported, and no fatal/serious ADR related to any mAbs were reported during the study period. Our study shows that PvPI is effective and robust system in the detection and assessment of risks associated with the use of mAbs.
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Key Words
- ADR, adverse drug reactions
- ADR/E, adverse drug reactions/event
- AMCs, ADR monitoring centers
- CDSCO, Central Drugs Standard Control Organization
- CLL, chronic lymphocytic leukemia
- DCGI, Drug Controller General of India
- EMA, European Medicines Agency
- EU, European Union
- GEAC, Genetic Engineering Appraisal Committee
- HBV, hepatitis B virus
- ICSRs, Individual Case Safety Reports
- IPC, Indian Pharmacopoeia Commission
- MHRA, Medicines and Healthcare Products Regulatory Agency
- MedDRA, Medical Dictionary for Regulatory Activities
- MoEF, Ministry of Environment and Forests
- MoHFW, Ministry of Health and Family Welfare
- NCC-PvPI
- NCC-PvPI, National Coordination Centre-Pharmacovigilance Program of India
- NHL, non Hodgkin lymphoma
- NRA, National Regulatory Authority
- PML, progressive multifocal leukoencephalopathy
- PSUR, Periodic Safety Updates Report
- RCGM, Review Committee on Genetic Manipulation
- SOC, System Organ Class
- US, Unites States of America
- USFDA, United States Food and Drug Administration
- Vigiflow
- WHO, World Health Organization
- mAb, monoclonal antibody
- mAbs, monoclonal antibodies
- monoclonal antibody
- rDNA, recombinant DNA
- spontaneous reporting
- targeted pharmacovigilance
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Affiliation(s)
- M Kalaivani
- a Scientific Assistant; Biologics Section; Indian Pharmacopoeia Commission ; Ministry of Health and Family Welfare (Govt. of India) ; Ghaziabad , India
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Ait-Belkacem R, Berenguer C, Villard C, Ouafik L, Figarella-Branger D, Beck A, Chinot O, Lafitte D. Monitoring therapeutic monoclonal antibodies in brain tumor. MAbs 2015; 6:1385-93. [PMID: 25484065 DOI: 10.4161/mabs.34405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Bevacizumab induces normalization of abnormal blood vessels, making them less leaky. By binding to vascular endothelial growth factor, it indirectly attacks the vascular tumor mass. The optimal delivery of targeted therapies including monoclonal antibodies or anti-angiogenesis drugs to the target tissue highly depends on the blood-brain barrier permeability. It is therefore critical to investigate how drugs effectively reach the tumor. In situ investigation of drug distribution could provide a better understanding of pharmacological agent action and optimize chemotherapies for solid tumors. We developed an imaging method coupled to protein identification using matrix-assisted laser desorption/ionization mass spectrometry. This approach monitored bevacizumab distribution within the brain structures, and especially within the tumor, without any labeling.
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Key Words
- 5 DAN, 1
- 5-diaminonaphtalene
- BBB, blood-brain barrier
- CRC, metastatic colorectal cancer
- CSF, cerebrospinal fluid; 1
- EMA, European Medicines Agency
- FDA, Food and Drug Administration
- GBM, glioblastoma multiforme
- IMS, imaging mass spectrometry
- ISD, in-source decay
- ITO, indium tin oxide
- LC-MS/MS, liquid chromatography coupled to tandem mass spectrometry
- MALDI imaging mass spectrometry
- MALDI, matrix-assisted laser desorption/ionization
- NSCLC, non-small cell lung cancer
- RMS, root mean square
- RP-HPLC, reversed phase high-performance liquid chromatography
- TOF, time of flight
- VEGF, vascular endothelial growth factor
- VEGFR, vascular endothelial growth factor receptor
- VH, variable domain of the heavy chain
- VL, variable domain of the light chain
- WHO, world health organization
- bevacizumab
- glioblastoma multiforme
- mAbs, monoclonal antibodies
- monoclonal antibodies
- pE, pyroglutamate
- palivizumab
- top down in source decay
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Affiliation(s)
- Rima Ait-Belkacem
- a Aix-Marseille Université Inserm ; CRO2 UMR S-911; Marseille , France
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Zhu L, Guo Q, Guo H, Liu T, Zheng Y, Gu P, Chen X, Wang H, Hou S, Guo Y. Versatile characterization of glycosylation modification in CTLA4-Ig fusion proteins by liquid chromatography-mass spectrometry. MAbs 2015; 6:1474-85. [PMID: 25484062 DOI: 10.4161/mabs.36313] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
CTLA4-Ig is a highly glycosylated therapeutic fusion protein that contains multiple N- and O-glycosylation sites. Glycosylation plays a vital role in protein solubility, stability, serum half-life, activity, and immunogenicity. For a CTLA4-Ig biosimilar development program, comparative analytical data, especially the glycosylation data, can influence decisions about the type and amount of animal and clinical data needed to establish biosimilarity. Because of the limited clinical experience with biosimilars before approval, a comprehensive level of knowledge about the biosimilar candidates is needed to achieve subsequent development. Liquid chromatography-mass spectrometry (LC-MS) is a versatile technique for characterizing N- and O-glycosylation modification of recombinant therapeutic proteins, including 3 levels: intact protein analysis, peptide mapping analysis, and released glycans analysis. In this report, an in-depth characterization of glycosylation of a candidate biosimilar was carried out using a systematic approach: N- and O-linked glycans were identified and electron-transfer dissociation was then used to pinpoint the 4 occupied O-glycosylation sites for the first time. As the results show, the approach provides a set of routine tools that combine accurate intact mass measurement, peptide mapping, and released glycan profiling. This approach can be used to comprehensively research a candidate biosimilar Fc-fusion protein and provides a basis for future studies addressing the similarity of CTLA4-Ig biosimilars.
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Key Words
- 2-AB, 2-aminobenzamide
- CTLA-4, cytotoxic T-lymphocyte-associated antigen 4
- CTLA4-Ig fusion protein
- DTT, dithiothreitol
- EMA, European Medicines Agency
- ESI, electrospray ionization
- FA, formic acid
- FDA, Food and Drug Administration
- GFP, [Giu1]-Fibrinopeptide B
- IAM, Iodoacetamide
- LC, Liquid chromatography
- MS, mass spectrometry
- PNGase F, peptide N-glycosidase
- PTMs, post-translational modifications
- Q-Tof quadrupole-time of flight
- RA, Rheumatoid arthritis
- TIC, Total Ion Chromatography
- Tof, Time of flight
- UPLC, Ultra-performance liquid chromatography
- characterization
- glycan
- glycosylation modification
- intact protein
- mass spectrometry
- peptide mapping
- similarity
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Affiliation(s)
- Lei Zhu
- a International Joint Cancer Institute; Second Military Medical University ; Shanghai , China
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Song JY, Cheong HJ, Lee J, Wie SH, Park KH, Kee SY, Jeong HW, Kim YS, Noh JY, Choi WS, Park DW, Sohn JW, Kim WJ. Phase IV: randomized controlled trial to evaluate lot consistency of trivalent split influenza vaccines in healthy adults. Hum Vaccin Immunother 2014; 10:2958-64. [PMID: 25483462 DOI: 10.4161/21645515.2014.970950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Influenza vaccines are the primary method for preventing influenza and its complications. Considering the increasing demand for influenza vaccines, vaccine manufacturers are required to establish large-scale production systems. This phase IV randomized trial was conducted to evaluate the lot consistency of trivalent split influenza vaccines regarding immunogenicity and safety. A total of 1,023 healthy adults aged 18-64 y were enrolled in the study. Subjects were randomly assigned in a 1:1 ratio to receive the GC FLU® Prefilled Syringe or the GC FLU® Injection, and they were further randomized to one of 3 lots of each vaccine in a 1:1:1 ratio. In both GC FLU® Injection and GC FLU® Prefilled Syringe groups, immune responses were equivalent between lots for each of the 3 vaccine strains on day 21. The 2-sided 95% CI of GMT ratios between pairs of lots were between 0.67 and 1.5, meeting the equivalence criteria. After vaccination, all 3 criteria of the European Medicines Agency were met in both GC FLU® Injection and GC FLU® Prefilled Syringe groups. The vaccines showed tolerable safety profiles without serious adverse events. The demonstration of lot consistency, robust immunogenic responses and favorable safety profiles support the reliability of mass-manufacturing systems for the GC FLU® Injection and GC FLU® Prefilled Syringe.
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Affiliation(s)
- Joon Young Song
- a Division of Infectious Diseases; Department of Internal Medicine ; Korea University College of Medicine ; Seoul , Korea
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Marinos G, Naziris N, Limnaios SA, Drakoulis N. Genes and personality characteristics: Possible association of the genetic background with intelligence and decision making in 830 Caucasian Greek subjects. Meta Gene 2014; 2:844-53. [PMID: 25606466 PMCID: PMC4287817 DOI: 10.1016/j.mgene.2014.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 09/30/2014] [Accepted: 10/27/2014] [Indexed: 10/27/2022] Open
Abstract
It is well known that intelligence consists of a variety of interactional and cognitive skills and abilities (e.g. tradecraft; critical and divergent thinking; perception of foreign information). Decision making is defined as the conscious choice between given options, relating to a problem. Both genetic background and environment comprise key elements for personality characteristics of the human being. The aim of this study is to determine the frequency distribution of rs324420, rs1800497, rs363050, rs6265, rs1328674 polymorphisms known to be involved in individual personality characteristics, in 830 Greek Subjects. The study is independent from direct clinical measurements (e.g. IQ measurements; physiological tests). The population of the volunteers is described, based on genotype, sex, with the respective gene frequencies, including the Minor Allele Frequency (MAF). A potential influence of the volunteer gender with the above characteristics (based on genotypes and alleles) is examined and finally, volunteers are classified as follows: A volunteer receives + 1, for each genotype/allele, which enhances his intelligence or his decision-making. In contrast, he receives - 1, for each genotype/allele, which relegates the individual characteristic. No statistically significant gender-characteristics correlation is observed. According to their genetic profile, a rate of 92.5%, of the volunteers may be characterized by prudence and temperance of thought, with only a small proportion of them (7.5%) may be classified as genetically spontaneous and adventurous. Regarding intelligence, the study population may lay around average and a little above it, at a rate of 96.3%, while the edges of the scale suggest only a 0.5% of the volunteers, who, although the "smartest", somehow seem to lack prudence. In conclusion, individuals with low cognitive ability may be more prudent than others and vice versa, while the "smartest" ones tend to be more risky, in decision-making. Therefore, intelligence and decision-making may, after all, be less linked to each other than expected.
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Key Words
- 5-HT2A
- 5-HT2A, 5-Hydroxytryptamine Receptor 2A
- ANKK1
- ANKK1, Ankyrin Repeat and Kinase Associated Containing 1
- BDNF
- BDNF, Brain-Derived Neurotrophic Factor
- Decision making
- EMA, European Medicines Agency
- EQ, Emotional Quotient
- FAAH1
- FAAH1, Fatty-Acid Amide Hydrolase 1
- GPCR, G Protein-Coupled Receptors
- IQ, Intelligence Quotient
- Intelligence
- MAF, Minor Allele Frequency
- Personality
- SNAP-25
- SNAP-25, Synaptosomal-Associated Protein, 25 kDa
- SNAREs, Soluble N-ethylmaleimide-sensitive Factor Attachment Protein REceptors
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Affiliation(s)
- Georgios Marinos
- National and Kapodistrian University of Athens, School of Health Sciences, Faculty of Pharmacy, Greece
| | - Nikolaos Naziris
- National and Kapodistrian University of Athens, School of Health Sciences, Faculty of Pharmacy, Greece
| | - Stefanos A Limnaios
- Hellenic Police, Forensic Science Division/Subdivision of Biological & Biochemical Examination & Analysis, Athens, Greece
| | - Nikolaos Drakoulis
- National and Kapodistrian University of Athens, School of Health Sciences, Faculty of Pharmacy, Greece
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