Patient-Reported Outcomes in Latin America: Implementation in Research and Role in Emerging HTA Systems

BACKGROUND

Patient-reported outcomes (PROs) are increasingly used to demonstrate the value of interventions and support health technology assessment (HTA).

OBJECTIVE

The objective of this work was to analyze trends regarding PROs in Latin America (LatAm), highlight challenges in the application of PROs in this region, and suggest solutions.

METHODS

A team of researchers with expertise in PROs conducted a nonsystematic PubMed literature search pertaining to the use of PROs in LatAm. The experts also drew on their experience working with PROs to assess the application of PROs in LatAm.

RESULTS

The literature search yielded more than 4000 publications, with an increasing publication rate in recent years. PROs are being used in LatAm in various study types: instrument validation, phase III international clinical trials, health service research. A large Inter-American Development Bank study demonstrates the growing importance of PROs in the region. The growth in local value sets for the EuroQol five-dimensional questionnaire in LatAm reflects the regional emergence of HTA systems. Operational challenges relate to ensuring the use of good-quality questionnaires that, at a minimum, have undergone appropriate cultural adaptation and ideally have established psychometric properties.

CONCLUSIONS

PROs are increasingly important in LatAm. Future efforts should aim to strengthen the operational and research infrastructure around PROs in the region. Innovation should be encouraged, including studying alternative methods of eliciting health utilities for economic evaluation. A wider scope around PRO uses for decision making by HTA bodies is an international trend with potential positive prospects in LatAm.

Antimicrobial activity of lactic acid bacteria isolated from Tenerife cheese: initial characterization of plantaricin TF711, a bacteriocin-like substance produced byLactobacillus plantarumTF711

AIMS

The screening and initial characterization of bacteriocins produced by lactic acid bacteria (LAB) from raw Tenerife goats' cheese with possible application as biopreservatives or ripening accelerators for Tenerife cheese.

METHODS AND RESULTS

One hundred and eighty LAB of the genera Lactobacillus (95), Leuconostoc (64) and Lactococcus (21) isolated from raw Tenerife goats' cheese were screened for the production of antimicrobial substances. Lactobacillus plantarum TF711, which had the broadest spectrum of antimicrobial activity, was selected for further characterization. The antimicrobial compound was determined as a proteinaceous substance, as it was sensitive to proteases. The bacteriocin-like substance, which we called plantaricin TF711, was active against the Gram-positive bacteria Bacillus cereus, Clostridium sporogenes and Staphylococcus aureus; and against the Enterobacteriaceae Shigella sonnei and Klebsiella pneumoniae. It was stable to heat and to treatment with surfactants and organic solvents. Highest antimicrobial activity was found between pH 1 and 9. Plantaricin TF711 exhibited primary metabolite kinetics, a bacteriostatic mode of action and a molecular mass of c. 2.5 kDa as determined by tricine SDS-PAGE.

CONCLUSIONS

Lact. plantarum TF711 produces a low molecular mass bacteriocin-like compound with a wide spectrum of activity and interesting technological properties (thermostability, good pH stability and stability against surfactants and organic solvents).

SIGNIFICANCE AND IMPACT OF THE STUDY

Plantaricin TF711 was found to have potential for use as a biopreservative in the food industry.

Random amplified polymorphic DNA analysis for differentiation of Leuconostoc mesenteroides subspecies isolated from Tenerife cheese

AIMS

In the present study, a RAPD-PCR fingerprinting method was developed to assign Tenerife cheese Leuconostoc mesenteroides strains to its three subspecies (mesenteroides, cremoris and dextranicum).

METHODS AND RESULTS

Arbitrarily primed-PCR gave different DNA banding patterns for each type strain of Leuc. mesenteroides subspecies consisting in three major and intense bands of: 1800, 1600 and 1150 bp for subspecies mesenteroides 1800, 1150 and approximately 350 bp for subspecies cremoris; and 1800, 1600 and 1500 bp for subspecies dextranicum. DNA fingerprints of Tenerife cheese Leuc. mesenteroides subspecies were coincident to that of their respective type strain. RAPD profiles were reproducible with DNA template obtained by two different extraction methods.

CONCLUSIONS

Tenerife cheese Leuc. mesenteroides strains were rapidly and unequivocally assigned to one of the subspecies by comparing their RAPD-PCR fingerprints with those displayed by type strains used as standards. This technique can be applied to complement preliminary identification of Leuc. mesenteroides to the species level by other molecular methods such as protein fingerprinting.

SIGNIFICANCE AND IMPACT OF THE STUDY

RAPD-PCR allows reliable, reproducible and rapid molecular differentiation of Tenerife cheese Leuc. mesenteroides subspecies with no need to use time-consuming and often ambiguous biochemical tests.

Schizosaccharomyces pombe fragile mutants as a host for heterologous protein production

In order to gain information about the potential interest of the Schizosaccharomyces pombe srb 1 fragile mutants as a host for heterologous protein production, the extracellular secretion of homologous and heterologous invertases was investigated. Under catabolic derepression the fragile srb 1 mutants released into the extracellular medium 5-6-fold more invertase than the parental strain. When transformed with the SUC2 gene, which codes for Saccharomyces cerevisiae invertase, the srb 1-3 fragile mutant, grown under catabolic repression, released into the medium 3-fold more invertase than the wild-type transformant, even though the majority of the enzyme remained associated with the cell wall. Electrophoretic analysis revealed the presence in the fragile strains of some invertase forms with molecular weights smaller than their parallel wild-type strains, suggesting that the srb 1 mutants may underglycosylate not only their homologous but also the heterologous proteins.

Isolation and characterization of Schizosaccharomyces pombe fragile mutants

Three Schizosaccharomyces pombe fragile mutants requiring the presence of an osmotic stabilizer to grow, that lyse when transferred into hypotonic solutions and that secrete to the extracellular medium more protein than the parental strain were isolated. In the three mutants, the fragile phenotype segregated in a Mendelian fashion, indicating a single chromosomal gene mutation, and behaved as a recessive character. By complementation analysis, the three fragile mutants fell in a single complementation group, defining the same gene (SRB1). Mutations of this gene are responsible for alterations in the cells such as fragile character, increase in the cell wall porosity, changes in the cell morphology and floc-forming ability. The study of the three srb1 alleles indicated that the degree of these alterations is proportional to a significant decrease in the galactomannan fraction of the mutants cell wall. The data presented in this report suggest that the product of the SRB1 gene is critical for the maintenance of the integrity and structure of Sz. pombe cell wall.

Characterization of the heterologous invertase produced by Schizosaccharomyces pombe from the SUC2 gene of Saccharomyces cerevisiae

In order to gain information on the ability of Schizosaccharomyces pombe to process heterologous glycoproteins, the heterologous invertase, obtained from the expression in Schiz. pombe of the SUC2 gene of Saccharomyces cerevisiae, was characterized. In Schiz. pombe the heterologous invertase is secreted into the cell wall and seems to be firmly bound to this structure. After the isolation of the heterologous invertase the study of its enzymatic characteristics revealed that it is more similar to the Sacch. cerevisiae external invertase than to the Schiz. pombe invertase. However, it is glycosylated like the Schiz. pombe invertase since it reacts with the lectin from Bandeiraea simplicifolia seeds conjugated to fluorescein isothiocyanate, which indicates the presence of terminal galactose residues in the enzyme. Moreover, the presence of galactose in the heterologous invertase has been confirmed after analysis of the sugars present in its carbohydrate moiety by gas liquid chromatography.