Recent Updates in the Alzheimer's Disease Etiopathology and Possible Treatment Approaches: A Narrative Review of Current Clinical Trials

BACKGROUND

Alzheimer's disease (AD) is the most frequent subtype of incurable neurodegenerative dementias and its etiopathology is still not clearly elucidated.

OBJECTIVE

Outline the ongoing clinical trials (CTs) in the field of AD, in order to find novel master regulators.

METHODS

We strictly reviewed all scientific reports from Clinicaltrials.gov and PubMed databases from January 2010 to January 2019. The search terms were "Alzheimer's disease" or "dementia" and "medicine" or "drug" or "treatment" and "clinical trials" and "interventions". Manuscripts that met the objective of this study were included for further evaluations.

RESULTS

Drug candidates have been categorized into two main groups including antibodies, peptides or hormones (such as Ponezumab, Interferon β-1a, Solanezumab, Filgrastim, Levemir, Apidra, and Estrogen), and naturally-derived ingredients or small molecules (such as Paracetamol, Ginkgo, Escitalopram, Simvastatin, Cilostazo, and Ritalin-SR). The majority of natural candidates acted as anti-inflammatory or/and anti-oxidant and antibodies exert their actions via increasing amyloid-beta (Aβ) clearance or decreasing Tau aggregation. Among small molecules, most of them that are present in the last phases act as specific antagonists (Suvorexant, Idalopirdine, Intepirdine, Trazodone, Carvedilol, and Risperidone) or agonists (Dextromethorphan, Resveratrol, Brexpiprazole) and frequently ameliorate cognitive dysfunctions.

CONCLUSION

The presences of a small number of candidates in the last phase suggest that a large number of candidates have had an undesirable side effect or were unable to pass essential eligibility for future phases. Among successful treatment approaches, clearance of Aβ, recovery of cognitive deficits, and control of acute neuroinflammation are widely chosen. It is predicted that some FDA-approved drugs, such as Paracetamol, Risperidone, Escitalopram, Simvastatin, Cilostazoand, and Ritalin-SR, could also be used in off-label ways for AD. This review improves our ability to recognize novel treatments for AD and suggests approaches for the clinical trial design for this devastating disease in the near future.

Within-host mathematical modeling on crucial inflammatory mediators and drug interventions in COVID-19 identifies combination therapy to be most effective and optimal☆

The unprecedented Covid-19 pandemic has resulted in more than 14.75 million infections and 6, 10, 839 deaths in 212 countries. Appropriate interventions can decrease the rate of Covid-19 related mortality. Fast track clinical trials around the world are addressing the efficacy of individual pharmaceutical agent acting at various stages of pathogenesis. However, lessons learnt while dealing with past viral epidemics mandates, simultaneous use of such drugs in combination amongst different populations. Mathematical modelling studies can be extremely helpful in understanding the efficacy of drugs both individually and in combination. The current within-host mathematical model studies the natural history of Covid-19 in terms of complex interplay of virus replication and behaviour of host immune response. Additionally it studies the role of various drugs at various stages of pathogenesis. The model was validated by generating two-parameter heat plots, representing the characteristics of Covid-19, the sensitivity analysis identified the crucial parameters. The efficacy of interventions was assessed by optimal control problem. The model dynamics exhibited disease-free equilibrium and the infected equilibrium with their stability, based on the reproduction number R0, the transcritical bifurcation observed at R0=1. The burst rate and the natural death rate of the virus were observed as most significant parameters in the life-threatening Covid-19 pneumonia. The antiviral drugs affecting viral replication and those modulating the immune response, reduce the infected cells and viral load significantly. However, the yield was optimal and most effective when the combination therapy involving one or more antiviral and one or more immunomodulating drugs were administered together. These findings may help physicians with early decision making in treatment of life-threatening Covid-19 infection.

Toward a Mathematical Modeling of Diseases' Impact on Bone Remodeling: Technical Review

A wide variety of bone diseases have hitherto been discovered, such as osteoporosis, Paget’s disease, osteopetrosis, and metastatic bone disease, which are not well defined in terms of changes in biochemical and mechanobiological regulatory factors. Some of these diseases are secondary to other pathologies, including cancer, or to some clinical treatments. To better understand bone behavior and prevent its deterioration, bone biomechanics have been the subject of mathematical modeling that exponentially increased over the last years. These models are becoming increasingly complex. The current paper provides a timely and critical analysis of previously developed bone remodeling mathematical models, particularly those addressing bone diseases. Besides, mechanistic pharmacokinetic/pharmacodynamic (PK/PD) models, which englobe bone disease and its treatment’s effect on bone health. Therefore, the review starts by presenting bone remodeling cycle and mathematical models describing this process, followed by introducing some bone diseases and discussing models of pathological mechanisms affecting bone, and concludes with exhibiting the available bone treatment procedures considered in the PK/PD models.

Intestinal Microbiota-Associated Metabolites: Crucial Factors in the Effectiveness of Herbal Medicines and Diet Therapies

Although the efficacy of herbal medicines (HMs) and traditional Chinese medicines (TCMs) in human diseases has long been recognized, their development has been hindered in part by a lack of a comprehensive understanding of their mechanisms of action. Indeed, most of the compounds extracted from HMs can be metabolized into specific molecules by host microbiota and affect pharmacokinetics and toxicity. Moreover, HMs modulate the constitution of host intestinal microbiota to maintain a healthy gut ecology. Dietary interventions also show great efficacy in treating some refractory diseases, and the commensal microbiota potentially has significant implications for the high inter-individual differences observed in such responses. Herein, we mainly discuss the contribution of the intestinal microbiota to high inter-individual differences in response to HMs and TCMs, and especially the already known metabolites of the HMs produced by the intestinal microbiota. The contribution of commensal microbiota to the inter-individual differences in response to dietary therapy is also briefly discussed. This review highlights the significance of intestinal microbiota-associated metabolites to the efficiency of HMs and dietary interventions. Our review may help further identify the mechanisms leading to the inter-individual differences in the effectiveness of HM and dietary intervention from the perspective of their interactions with the intestinal microbiota.

Medication safety strategies in hospitals--a systematic review

BACKGROUND

Medication safety is an essential component of patient safety in health care delivery. Providing strategies to effectively prevent medication errors and adverse drug events in hospitals has gained international recognition.

OBJECTIVE

The aim of this paper was to review systematically the research literature on the various interventions for providing medication safety in hospitals.

METHOD

Eight healthcare databases were searched for full research articles written in English. Reference lists of included studies were also searched. Research studies involving delivery of interventions in hospitals with the aim of preventing or reducing medication errors and adverse drug events were examined.

RESULTS

Forty-two studies were selected. Most of the studies were before and after designs without comparative control groups. Forty studies identified interventions contributing to the prevention and reduction of medication errors. Six broad types of interventions were identified: computerized physician order entry with or without clinical decision support systems, automation, computer assisted, barcode technology, pharmacist role, training and system designs.

CONCLUSION

Though studies have provided evidence for individual interventions, there are concerns about the extent of their effectiveness. This has implications for policy makers and clinicians to adopt multifaceted approach in providing medication safety in their hospitals.