Clinical Drug Research Articles

A contemporary review of machine learning to predict adverse pregnancy outcomes from pharmaceuticals, including DDIs.

Those undergoing pregnancy are often excluded from clinical drug trials due to the risk that participation would pose. However, they often require pharmaceuticals to manage health conditions that, if gone untreated, could harm themselves or the fetus. This can mean that such individuals take one or more pharmaceuticals during pregnancy, many of which have unknown reproductive effects. Machine learning models have been used to successfully predict a number of reproductive toxicological outcomes for pharmaceuticals, including transplacental transfer, US Food and Drug Administration safety rating, and drug interactions. Models use quantitative chemical and structural features of active compounds to make predictions concerning the outcome of interest using computational algorithms. Results from these models can be a potential source of valuable information for pregnant people and their medical providers when making decisions regarding therapeutic drug use. This review summarizes current machine learning applications to make predictions about risk and toxicity of medication use during pregnancy. Our review of the recent literature revealed that machine learning quantitative structure-activity relationship models can be used successfully to predict the transplacental transfer and the US Food and Drug Administration pregnancy safety category of pharmaceuticals; such models have also been employed to predict drug interactions, though not specifically during pregnancy. This latter topic is a potential area for future research. In this review, no single algorithm or descriptor-calculation software emerged as the most widely used, and their performances depend on a variety of factors, including outcome of interest and combination of such algorithms and software.

Layered double hydroxide nanozyme (LDHzyme)-assisted high-performance electrochemical analysis of organ transplant therapeutic drug concentration

The variability in mycophenolic acid (MPA) exposure levels among organ transplant patients is substantial and directly influences the drug’s therapeutic efficacy. Therefore, precise monitoring of MPA blood concentrations is imperative to devise personalized diagnostic and treatment plans tailored to individual patient profiles. In this study, we developed a screen-printed carbon electrode (SPCE) incorporating Layered Double Hydroxide-based nanozymes (LDHzymes) and multi-walled carbon nanotubes (MWCNT) to achieve high-sensitivity and stable determination of MPA in blood samples. We synthesized three distinct LDHzymes via a straightforward co-precipitation method, selecting CuMn-LDHzyme for its superior electrochemical properties and laccase activity in the context of MPA detection. The sensor’s performance was enhanced by the amalgamation of CuMn-LDHzyme with MWCNT, leveraging the laccase-like activity of CuMn-LDHzyme and the exceptional conductivity of MWCNT to amplify the oxidation current response to MPA. This integration significantly bolstered the sensor’s detection capabilities. The developed electrochemical sensor exhibited remarkable characteristics, including high selectivity, stability, repeatability, and reproducibility. It demonstrated a notable sensitivity with a detection range of 0.5 µM to 200 µM for MPA, and a detection limit of 0.1 µM, effectively detecting MPA in mouse blood samples. These attributes underscore the sensors as promising tool for clinical drug detection, ensuring fast and precise monitoring of MPA levels in organ transplant patients. This innovative approach holds significant promise for advancing personalized medical care and improving therapeutic outcomes.

Tucaresol: A Clinical Stage Oral Candidate Drug with Two Distinct Antiviral Mechanisms

Globally, approximately 39 million people are living with Human Immunodeficiency Virus, HIV, arising from approximately 86 million infections since this epidemic began in 1981. However, the number of HIV infections is unevenly distributed with two thirds of global infections confined to Sub-Saharan Africa. Due to viral drug resistance, the most effective treatment requires a triple drug combination thereby adding to the complexity and cost of therapy. As such, many people living with HIV or at risk of infection do not have access to prevention or treatment of this potentially fatal disease. There is no cure for HIV [1]. Tucaresol is an orally active clinical stage drug which functions as a host targeted antiviral agent by protection or reconstitution of CD4+ T helper immune cells. We report herein that Tucaresol also displays in-vitro activity against HIV in infected human peripheral blood mononuclear cells. Although this in-vitro antiviral activity is not potent, the excellent safety profile and bioavailability of Tucaresol, along with its low Molecular Weight, support attainment of relevant drug concentrations in man to achieve significant in-vivo activity. This is demonstrated by previously reported stabilization of viremia in a prior proof of concept phase 1b/2a HIV clinical trial [2]. It is possible that the significant in-vivo activity of Tucaresol arises from synergy between co-stimulation of CD4+ T helper cells and the direct activity against virally infected cells. A pan in-vitro viral screen of Tucaresol further revealed a weak, direct antiviral activity against human herpes virus 6B, human papillomavirus 11, measles virus and hepatitis B virus.

Study on Translational toxicology of Senna obtusifolia aqueous extract

In recent years, the clinical adverse drug reactions (ADR) reports of Senna obtusifolia have been constantly emerging, especially hepatotoxicity. However, it is unclear whether the liver is the only or main toxic target organ. In this study, we conducted a repeated administration experiment with the Senna obtusifolia Aqueous Extract (SE) and PCA analysis was used to determine the primary toxic target organs. The results revealed that the liver was the main toxic target organ and we also verifid the hepatotoxicity in vitro. The mechanism of hepatotoxicity was predicted by network toxicology technology, which was verified by ELISA, qPCR, western blotting and other methods.The results showed that SE could increase the serum levels of TNF-α, IL-6, IL-1β, the mRNA expression levels of ACT1, TRAF6, NF-κB P65 and the protein expression levels of TRAF6, NF-κB P65, P-P65 in rat livers and HepG2 cells, which indicated that SE induced hepatotoxicity might be related to inflammatory response.

Clinical drug interactions between voriconazole and 38 other drugs: a retrospective analysis of adverse events.

Voriconazole (VRZ) is involved in a variety of drug‒drug interactions (DDIs), but few studies have reported adverse events (AEs) associated with the DDIs of VRZ. The primary goal of this study was to analyse the potential risk factors for AEs caused by DDIs between VRZ and other drugs via the OpenVigil FDA platform and to provide a reference for preventing VRZ DDIs and monitoring clinically related adverse drug events. A retrospective pharmacovigilance study was conducted to investigate the AEs related to DDIs between VRZ and four categories of drugs: proton pump inhibitors (PPIs), non-steroidal anti-inflammatory drugs (NSAIDs), immunosuppressants, and other antibacterial drugs. AE information for the target drugs from the first quarter of 2004 to the third quarter of 2022 was downloaded from the OpenVigil FDA data platform. Four frequency statistical models-the reporting ratio method, Ω shrinkage measure model, combination risk ratio model, and the chi-square statistics model-were used to analyse the AEs related to DDIs and evaluate the correlation and influence of sex and age between the drug(s) and the target AEs detected. A total of 38 drugs were included, with 262 AEs detected by at least one of the four models and 48 AEs detected by all four models. Some 77 detected AEs were significantly positively correlated with DDIs and were related to higher reporting rates of AEs than when used alone. Graft-versus-host disease was the AE that had the strongest correlation with the drug interaction between VRZ and immunosuppressants (tacrolimus, mycophenolate mofetil, cyclophosphamide, and cyclosporine), and multiple organ dysfunction syndrome was correlated with VRZ in combination with other antibacterial drugs (linezolid, meropenem, cefepime, and vancomycin). Significant sex and age differences in the target AEs were detected for five and nine target drugs, respectively. For VRZ in combination with linezolid, aggravated conditions and respiratory failure should be given more attention in male patients, and mycophenolate mofetil and respiratory failure in female patients. When conditions are aggravated, febrile neutropenia and septic shock should be of particular concern in patients over 18years of age who use VRZ in combination with ceftazidime, ciprofloxacin, or cytarabine. In patients aged under 18, septic shock should be considered when VRZ is used in combination with meropenem and dexamethasone. AEs related to DDIs should receive more attention when VRZ is used in combination with PPIs (renal impairment), NSAIDs (constipation and renal failure), immunosuppressants (graft versus host disease, septic shock) and other antibacterial drugs (multiple organ dysfunction syndrome, febrile neutropenia, and respiratory failure). Considering the influence of sex and age differences in VRZ DDIs, these factors need to be considered when assessing the risk of AEs in patients receiving VRZ and other drugs.

Anti-Schistosomal activity and ADMET properties of 1,2,5-oxadiazinane-containing compound synthesized by visible-light photoredox catalysis.

The incorporation of saturated nitrogen-containing heterocycle 1,2,5-oxadiazinane into small molecules represents a compelling avenue in drug discovery due to its unexplored behavior within biological systems and incomplete protocols for synthesis. In this study, we present 1,2,5-oxadiazinane, an innovative heterocyclic bioisostere of piperizin-2-one and novel chemotype of the anti-schistosomal drug praziquantel (PZQ), which has been the only clinical drug available for three decades. PZQ is associated with significant drawbacks, including poor solubility, a bitter taste, and low metabolic stability. Therefore, the discovery of a new class of anti-schistosomal agents is imperative. To address this challenge, we introduce a pioneering method for the synthesis of 1,2,5-oxadiazinane derivatives through the cycloaddition of nitrones with N,N,N',N'-tetraalkyldiaminomethane in the presence of an IrIII complex photosensitizer. This transformative reaction offers a streamlined route to various kinds of 1,2,5-oxadiazinanes that is characterized by mild reaction conditions and broad substrate scope. Mechanistic investigations suggest that the photoredox pathway underlies the [3 + 3] photocycloaddition process. Thus, based on bioisosteric replacement, we identified a remarkable molecule as a new chemotype of a potent anti-schistosomal compound that not only exhibits superior solubility, but also retains the potent biological activity inherent to PZQ.

Topological indices based VIKOR assisted multi-criteria decision technique for lung disorders.

Lung disorders involve swelling, inflammation, and muscle tightening around the airways, with symptoms such as coughing, wheezing, shortness of breath, and abnormal fluid build-up. The global prevalence of these conditions is rising, highlighting the need for extensive research to alleviate their severity and symptoms. Due to the chronic nature and recurrence of these disorders, the human body often develops immunity and side effects to certain medications. Therefore, developing novel and appropriate drug combinations is crucial. This study analyzes a dataset of lung disorder drugs, characterized by various topological indices. The structures of 16 drugs used to treat lung disorders are correlated with their physical properties using degree-based graph invariants. When considering specific attributes, the VIKOR (VlseKriterijumska Optimizacija I Kompromisno Resenje) method provides an optimal ranking for each drug. The QSPR results highlight the effectiveness of this approach in drug prioritization, offering valuable insights for clinical decision-making and drug development. This methodology can enhance the strategic selection of treatments for lung disorders, leading to improved patient care and better resource allocation.

Viable Bacteria Assay of Helicobacter pylori by RT-qPCR Measurement of cgt Gene Expression Levels: Establishment and Application of a New Method

To establish a viable bacteria assay for Helicobacter pylori (H. pylori) by assessing the cgt gene expression, and to develop accordingly a rapid and novel testing method for clinical precision treatment. Viable bacteria count was determined in bacterial cultures. The transcriptional expression level of cgt (hp0421), the conserved gene that encodes cholesterol-α-glucosyltransferase (CGT) in H. pylori, was measured by RT-PCR. The correlation between the number of colonies and cgt gene transcription expression was analyzed and the regression model was constructed. The linear range, sensitivity, and specificity of the new method were examined accordingly. The bactericidal action of clarithromycin was assessed using this method to verify the performance of the method in determining clinical bacterial drug resistance. The Ct values of cgt for H. pylori colony counts of 102, 104, 106, and 108 CFU/mL were 29.67±0.14, 23.37±0.36, 17.65±0.37, and 11.38±0.39, respectively. In the range of 101-108 CFU/mL, the regression equation for cgt gene expression and viable bacterial counts determined by RT-qPCR was y=-0.3501x+12.49, with the correlation coefficient being R 2=0.9992 and the sensitivity being 101 CFU/mL, showing no cross-reaction with 13 other bacteria. The lg values of live H. pylori bacteria treated with clarithromycin at 0, 5, 10, 20, and 40 μg/mL for 12 h were 2.57±0.02, 2.45±0.01, 2.19±0.02, 1.91±0.07, and 1.33±0.05, respectively. The corresponding cgt gene Ct values were 27.76±0.09, 28.37±0.24, 29.51±0.14, 30.11±0.12, and 31.66±0.11. By applying the cgt gene expression in the equation, the estimated counts of viable bacteria were found to be 2.73±0.03, 2.52±0.08, 2.11±0.05, 1.89±0.02, and 1.33±0.04, showing no significant difference in statistical analysis (P>0.05). The method for assessing viable bacteria account by evaluating cgt gene expression in H. pylori was successfully established, significantly reducing the time required to determine viable bacteria count and providing a new method for clinical viable bacteria testing.

MiRNA375-3p/rapamycin mediates the mTOR pathway by decreasing PS1, enhances microglial cell activity to regulate autophagy in Alzheimer's disease

The clinical prevention, diagnosis, treatment, and drug development of Alzheimer's disease (AD) require urgent detection of novel targets and methods. Autophagy and microglia are significantly associated with the pathogenesis of early AD. This study indicated that microRNA-375-3p can inhibit autophagy by promoting mTOR phosphorylation in normal physiological conditions, while microRNA-375-3p promoted autophagy and enhanced neural repair by inhibiting the expression of presenilin 1 in early AD pathogenesis. Furthermore, co-treatment of rapamycin, and microRNA-375-3p can synergistically promote the autophagy and microglial activation in a neuroprotective manner, clear Aβ accumulation, repair nerve damage, and alleviate cognitive dysfunction and memory defects in APP/PS1 TG mice. This research revealed the impact and mechanism of miR375-3p on the early stage of AD through in vivo and in vitro experiments and provides new ideas and directions for the early treatment of AD.

A Complete Appraisal of Polymeric Micelle-Based Nanocarrier for Targeting Breast Cancer: Recent Strategies and Advancements

Aim/Objective: Polymeric micelle-based drug delivery systems have emerged as a beacon of hope in the challenging landscape of breast cancer therapy. This review aimed to explore the recent advancements and promising developments in the field, offering an in-depth analysis of their potential and challenges. The significance of this study lies in providing a comprehensive examination of the current advances in polymeric micelles technology, which have the potential to improve the efficiency and specificity of breast cancer therapy while minimizing adverse events. Methods: Polymeric micelles offer a revolutionary therapy by encapsulating therapeutic agents, allowing for controlled drug release and the precise targeting of malignant cells, while lowering systemic toxicity. Recent advances have focused on enhancing targeting strategies, including active and passive targeting, to increase the specificity of polymeric micelle-based therapies. A systematic review of literature was carried out using databases, like PubMed, Scopus, and Web of Science, which included papers published between 2010 and 2023. The selection criteria of the literature focused on the drug-loading capabilities and targeting strategies of the polymeric micelles, which could be advantageous for breast cancer treatment. Results: Clinical drug approaches leverage the versatility of micelles to co-deliver multiple agents, addressing the multifaceted nature of breast tumors and combating drug resistance. Additionally, polymeric micelles are finding applications in breast cancer diagnostics and imaging, enabling early detection and precise monitoring. The journey of polymeric micelle-based breast cancer therapy extends to formulation and engineering, preclinical and clinical studies, and confronts regulatory and commercialization challenges. However, the horizon is illuminated by emerging technologies, like personalized medicine, biomarker-driven targeting, and integration with novel therapies, promising a future where breast cancer treatment is tailored to individual patients and marked by improved efficacy and reduced side effects. Conclusion: In conclusion, this review underscores the transformative potential of polymeric micelle- based delivery systems in breast cancer therapy.

Fluorescent Iron-Doped Polymer Dot Nanozyme-Based Cascade System for Dual-Mode Detection of Acetylcholinesterase Activity and Its Inhibitors.

The advancement of acetylcholinesterase (AChE) activity and its inhibitor assays is crucial for clinical diagnosis, drug screening, and environmental monitoring. A nanozyme-mediated cascade reaction system could offer promising prospects for a wide range of applications in such biosensing; however, the creation of nanozyme catalysts with diverse functionalities remains a significant challenge. Herein, we have proposed a multifunctional iron-doped polymer dots (Fe-PDs) nanozyme possessing excellent fluorescence and peroxidase (POD)-mimicking activity. Notably, the Fe-PDs nanozyme is capable of catalyzing H2O2 to produce a series of reactive oxygen species, which can simultaneously quench the fluorescence of Fe-PDs and induce a chromogenic reaction of 3,3',5,5'-tetramethylbenzidine (TMB), enabling the dual-mode detection of H2O2 through both fluorescence turn-off and absorbance turn-on signals. Furthermore, by integrating acetylcholine (ACh) and choline oxidase (ChOx), we have developed a three-enzyme (AChE-ChOx-POD) cascade-based fluorometric and colorimetric dual-mode sensing platform for monitoring AChE activity and its inhibitors. The sensitive and convenient dual-mode sensor has achieved low limits of detection with 0.5 mU/mL (fluorometry) and 0.014 mU/mL (colorimetry) for AChE, respectively, which are superior to the traditional Ellman's assay. More significantly, this sensor can also be extended to detect the reversible and irreversible inhibitors of AChE, such as tacrine (IC50 = 23.3 nM) and carbaryl (LOD = 0.8 nM). We firmly believe that this innovative dual-mode nanozyme-involved multienzyme cascade system-based sensing strategy will stimulate further exploration and serve as a versatile and practical tool for biochemical sensing applications.

In Silico clinical trial to predict the efficacy of hip protectors for preventing hip fractures

Osteoporosis is characterized by loss of bone mineral density and increased fracture risk. Reduction of hip fracture incidence is of major clinical importance. Hip protectors aim to attenuate the impact force transmitted to the femur upon falling, however different conclusions on their efficacy have been reported; some authors suggest this may be due to differences in compliance. The aim of this study was to apply an In Silico trial methodology to predict the effectiveness of hip protectors and its dependence on compliance.A cohort of 1044 virtual patients (Finite Element models of proximal femur) were generated. A Markov chain process was implemented to predict fracture incidence with and without hip protectors, by simulating different levels of compliance. At each simulated follow-up year, a Poisson distribution was randomly sampled to determine the number of falls sustained by each patient. Impact direction and force were stochastically sampled from a range of possible scenarios. The effect of wearing a hip protector was simulated by applying attenuation coefficients to the impact force (12.9 %, 19 % and 33.8 %, as reported for available devices). A patient was considered fractured when impact force exceeded the femur strength.Without hip protector, virtual patients experienced 66 ± 5 fractures in 10 years. Wearing the three devices, fracture incidence was reduced to 43 ± 4, 35 ± 4 and 17 ± 2 respectively, at full compliance. As expected, effectiveness was dependent on compliance.This In Silico trial technology can be applied in the future to test multiple interventions, optimise intervention strategies, improve clinical trial design and drug development.

Blueness, Whiteness, and greenness Appraisal of sensitive chromatographic approach for determination of semaglutide concurrently with Pioglitazone and metformin using green mobile Phase; alongside with pharmacokinetic study

The replacement of hazardous solvents with greener alternatives was under consideration to achieve a sustainable and green approach. The assessment of reliable white analytical method for the determination of semaglutide as a novel member in glucagon-like peptide agonists class is still of a great importance. That is because pharmacological, clinical, and therapeutic drug monitoring purposes. This research proposes and fully validates a simple and sensitive RP-HPLC method for the determination of semaglutide simultaneously with pioglitazone and metformin. The suggested procedures utilizing a green mobile phase of 8 % glycerol in 0.01 M phosphate buffer (pH 6). Separation was achieved using a cyano (5.0 μm, 150 × 4.6 mm) column maintained at a temperature of 40 °C. The mixture was isocratically eluted under a flow rate of 1 mL/min with a total run time of less than 8 min. The UV-detector was adjusted at 215 nm. The method provides low detection (ranging from 0.003 to 0.63 µg/mL) and quantification (ranging from 0.008 to 1.9 µg/mL) limits, with good precision (%RSD ranging from 0.66 % to 0.89 %). The suggested technique has been effectively used to determine each drug in its pharmaceutical preparation and spiked human plasma. Beside the remarkable sensitivity and sustainability of the evolved approach, the relevance of therapeutic drug monitoring motivated us to perform a pharmacokinetics study for both semaglutide and metformin in real human plasma samples. Greenness, whiteness and blueness assessment of the developed method have been carried out using different tools (Green Analytical Procedure Index (GAPI), the analytical GREEnness metric approach (AGREE), RGB-12 model and BAGI). The proven green and white profile of the evolved method could open future prospective for the clinical research and regular quality control examination of the investigated mixture with the least negative environmental impacts.

Pharmacokinetics-pharmacodynamics of first-line antitubercular drugs: a comparative study in tuberculosis patients with and without concomitant diabetes mellitus.

To observe the variability in the plasma concentrations and pharmacokinetic-pharmacodynamic (PK-PD) profiles of first-line antitubercular drugs in pulmonary tuberculosis (TB) patients with and without diabetes mellitus (DM). Newly diagnosed pulmonary TB patients aged 18-60years with or without DM were included in the study. Group I (n = 20) included patients with TB, whereas group II (n = 20) included patients withboth TB and DM. After 2 weeks of therapy, plasma concentrations and other PK-PD parameters were determined. Improvements in clinical features, X-ray findings, sputum conversion, and adverse drug reactions (ADRs) were assessed after 2 months of therapy. Isoniazid displayed non-significantly higher plasma concentrations in diabetic patients, along with a significantly (P < 0.05) longer elimination half-life (t1/2). Rifampicin plasma concentrations at 4, 8, and 12 h were significantly (P < 0.05) lower, and it displayed significantly (P < 0.05) lower area underthe curve (AUC0-12 and AUC0-∞), shorter t1/2, higher clearance (Cl), and a lower AUC0-∞/MIC ratio in diabetic patients. Pyrazinamide and ethambutol showed non-significantly higher plasma concentrations, AUC0-12, AUC0-∞, and t1/2 in diabetic patients. The improvements in clinical features, X-ray findings, sputum conversion, and ADRs were comparable in both groups. The presence of DM in TB patients affects the PK-PD parameters of isoniazid, rifampicin, pyrazinamide, and ethambutol variably in the Indian population. Studies with a larger number of patients are required to further elucidate the role of DM on the PK-PD profile of first-line antitubercular drugs and treatment outcomes in TB patients with concomitant DM. CTRI/2021/08/035578 dated 11/08/2021.

Esterase-Responsive Floxuridine-Tethered Multifunctional Nanoparticles for Targeted Cancer Therapy.

Floxuridine is a potential clinical anticancer drug for the treatment of various cancers. However, floxuridine typically causes unfavorable side effects due to its very poor tumor selectivity, and, hence, there is a high demand for the development of novel approaches that permit the targeted delivery of floxuridine into cancerous cells. Herein, the design and synthesis of an esterase-responsive multifunctional nanoformulation for the targeted delivery of floxuridine in esterase-overexpressed cancer cells is reported. Photopolymerization of floxuridine-tethered lipoic acid results in the formation of amphiphilic floxuridine-tethered poly(disulfide). Self-assembly of the amphiphilic polymer results in the formation of nanoparticles with floxuridine decorated on the surfaces of the particles. Integration of aptamer DNA for nucleolin onto the surface of the nanoparticle is demonstrated by exploring the base-pairing interaction of floxuridine with adenine. Targeted internalization of the aptamer-decorated nanoparticle into nucleolin-expressed cancer cells is demonstrated. Esterase triggered cleavage of the ester bond connecting floxuridine with the polymer backbone, and the subsequent targeted delivery of floxuridine into cancer cells is also shown. Excellent therapeutic efficacy is observed both in vitro and also in the 3D tumor spheroid model. This noncovalent strategy provides a simple yet effective strategy for the targeted delivery of floxuridine into cancer cells in a less laborious fashion.

Structural Models of Human Norepinephrine Transporter Ensemble Reveal the Allosteric Sites and Ligand-Binding Mechanism.

The norepinephrine transporter (NET) plays a pivotal role in recycling norepinephrine (NE) from the synaptic cleft. However, the structures referring to the conformational heterogeneity of NET during the transport cycle remain poorly understood. Here, three structural models of NE bound to the orthosteric site of NET in outward-open (OOholo), outward-occluded (OCholo), and inward-open (IOholo) conformations were first obtained using the multistate structures of serotonin transporter as templates and further characterized through Gaussian-accelerated molecular dynamics and free energy reweighting. Analysis of the structures revealed eight potential allosteric sites on the functional-specific states of NET. One of the pharmacologically relevant pockets located at the extracellular vestibule was further verified by simulating the binding behaviors of a clinical trial drug χ-MrIA that is allosterically regulating NET. These structural and energetic insights into NET advanced our understanding of NE reuptake and paved the way for discovering novel molecules targeting the allosteric sites.

Comparative real-world outcomes between ustekinumab, infliximab, and adalimumab in bio-naïve and bio-experienced Crohn’s disease patients: a retrospective multicenter study

BackgroundNumerous studies have compared the efficacy of ustekinumab (UST) and anti-TNF agents [infliximab (IFX) or adalimumab(ADA)] in moderate to severe Crohn’s disease (CD) patients. This study aims to compare the efficacy of UST, IFX, and ADA while differentiating between bio-naïve and bio-experienced patients, which is an underexplored aspect, particularly in Asia.MethodsWe conducted a retrospective multi-center study from 2012 to 2023, categorizing patients into bio-naïve and bio-experienced groups. We evaluated clinical remission rates after induction therapy and clinical outcomes, including CD-related hospitalization, intestinal resection, and drug discontinuation during maintenance therapy.ResultsAmong the 214 bio-naïve CD patients, 60 received UST, 108 received IFX, and 46 received ADA. After 1:1 propensity score matching between UST and anti-TNF agents groups, 59 patients were analyzed in each group (45 in the IFX group and 14 in the ADA group). We found no significant differences in clinical remission rates (P = 0.071), CD-related hospitalization (P = 0.800), intestinal resection (P = 0.390), or drug discontinuation (P = 0.052) between the UST, IFX, and ADA groups in bio-naïve CD patients. In bio-experienced CD patients, with 35 in the UST group and 13 in the anti-TNF agents group, the UST group showed a lower risk of drug discontinuation (P = 0.004) than the anti-TNF agents group.ConclusionsThis study suggests that UST, IFX, and ADA are equally effective in bio-naïve CD patients, while in bio-experienced patients, mostly with previous exposure to anti-TNF agents, UST may offer superior drug durability.

Identification of genetic association between mitochondrial dysfunction and knee osteoarthritis through integrating multi-omics: a summary data-based Mendelian randomization study

ObjectiveAssociation between mitochondrial dysfunction and osteoarthritis (OA) has been consistently investigated, yet their genetic association remains obscure. In this study, mitochondrial-related genes were used as instrumental variables to proxy for mitochondrial dysfunction, and summary data of knee OA (KOA) were used as outcome to examine their genetic association.MethodsWe obtained 1136 mitochondrial-related genes from the human MitoCarta3.0 database. Genetic proxy instruments for mitochondrial-related genes from studies of corresponding gene expression (n = 31,684) and protein (n = 35,559) quantitative trait locus (eQTLs and pQTLs), respectively. Aggregated data for KOA (62,497 KOA cases and 333,557 controls) were extracted from the largest OA genome-wide association study (GWAS). We integrated QTL data with KOA GWAS data to estimate their genetic association using summary data-based Mendelian randomization analysis (SMR). Additionally, we implemented Bayesian colocalization analysis to reveal whether suggestive mitochondrial-related genes and KOA were driven by a same genetic variant. Finally, to validate the primary findings, replication study (24,955 cases and 378,169 controls) and multi-SNP-based SMR (SMR-multi) test was performed.ResultsThrough SMR analysis, we found that the expression levels of 2 mitochondrial-related genes were associated with KOA risk. Specifically, elevated gene expression levels of the IMMP2L (odds ratio [OR] = 1.056; 95% confidence interval [CI] = 1.030–1.082; P-FDR = 0.004) increased the risk of KOA. Conversely, increased gene expression levels of AKAP10 decreased the risk of KOA (OR = 0.955; 95% CI, 0.934–0.977; P-FDR = 0.019). Colocalization analysis demonstrated that AKAP10 (PP.H4 = 0.84) and IMMP2L (PP.H4 = 0.91) shared the same genetic variant with KOA. In addition, consistent results were found in replication study and SMR-multi test, further demonstrating the reliability of our findings.ConclusionsIn summary, our analyses revealed the genetic association between mitochondrial dysfunction proxied by mitochondrial-related genes and KOA, providing new insight into potential pathogenesis of KOA. Furthermore, these identified candidate genes offer the possibility of clinical drug target development for KOA.Key points• This is the first SMR study to explore the genetic association between mitochondrial dysfunction proxied by mitochondrial-related genes and KOA.• Sufficient evidence to support genetic association between the expression levels of AKAP10 and IMMP2L, and KOA• Our MR analysis may provide novel new insight into potential pathogenesis of KOA.• These identified candidate genes offer the possibility of clinical drug target development for KOA

Implementation of a common data model in Health Data Research Network Canada: Lessons learned

BackgroundThe Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) is a standardized structure for observational data that enables collaborative health research. Health Data Research Network (HDRN Canada) is conducting a pilot study to implement this standard at partner data linkage centers. ObjectiveOur objective is to describe the process used to implement the OMOP CDM, methodological and technical challenges, and the approach to evaluate CDM implementation at multiple sites. ApproachCDM working group members include technical staff from data linkage centers in four provinces and a national data coordinating center, HDRN Canada operational and executive leads, and OMOP CDM consultants. The evaluation aims to collect quantitative and qualitative information on Extract, Transform, and Load (ETL) processes, performance of the CDM in a multi-site observational case study, and data quality. ResultsInitial steps have included collaborative learning about the CDM structure, importing open-source tools and licensed coding standards (i.e., Systematized Nomenclature of Medicine-Clinical Terms [SNOMED-CT], RxNorm) at data linkage centres, and exploring the technical requirements for developing ETL processes and hosting OMOP data. Creation of select OMOP tables has been accompanied by discussions about models for mapping clinical and prescription drug coding standards. A scoping review of evaluation strategies is underway. Conclusions and ImplicationsThe benefits of standardizing health data for multi-site research and supporting the production of findable, accessible, interoperable and reusable (FAIR) national data underscores the importance of HDRN Canada embarking on this OMOP CDM implementation project. The lessons learned will benefit other multi-site data standardization initiatives.

Rationally designed catalytic nanoplatform for enhanced chemoimmunotherapy via deploying endogenous plus exogenous copper and remodeling tumor microenvironment

Chemodynamic therapy represents a novel tumor therapeutic modality via triggering catalytic reactions in tumors to yield highly toxic reactive oxygen species (ROS). Nevertheless, low efficiency catalytic ability, potential systemic toxicity and inefficient tumor targeting, have hindered the efficacy of chemodynamic therapy. Herein, a rationally designed catalytic nanoplatform, composed of folate acid conjugated liposomes loaded with copper peroxide (CP) and chloroquine (CQ; a clinical drug) (denoted as CC@LPF), could power maximal tumor cytotoxicity, mechanistically via maneuvering endogenous and exogenous copper for a highly efficient catalytic reaction. Despite a massive autophagosome accumulation elicited by CP-powered autophagic initiation and CQ-induced autolysosomal blockage, the robust ROS, but not aberrant autophagy, underlies the synergistic tumor inhibition. Otherwise, this combined mode also elicits an early onset, above all, long-term high-level existence of immunogenic cell death markers, associated with ROS and aberrant autophagy -triggered endoplasmic reticulum stress. Besides, CC@LPF, with tumor targeting capability and selective tumor cytotoxicity, could elicit intratumor dendritic cells (mainly attributed to CQ) and tumor infiltrating CD8+ T cells, upon combining with PD-L1 therapeutic antibody, further induce significant anti-tumor effect. Collectively, the rationally designed nanoplatform, CC@LPF, could enhance tumor chemoimmunotherapy via deploying endogenous plus exogenous copper and remodeling tumor microenvironment.Graphical abstract