Safety and efficacy of GP40071 compared with originator insulin aspart (NovoRapid® Penfill®) in Type 1 diabetes mellitus

Aim: To compare safety and efficacy of GP40071 insulin aspart (GP-Asp) and NovoRapid® (NN-Asp). Materials & methods: This randomized open-label, active-controlled, 26-week non-inferiority Phase III clinical trial enrolled 264 Type 1 diabetes mellitus patients (HbA1c: 7.1-12.0%) randomized 1:1 to once daily GP-Asp (n = 132) or NN-Asp (n = 132). The primary safety end point was immune response at week 26. Results: The groups were similar in frequency of immune response (p = 0.323) and in other safety end points. Mean HbA1c change from baseline was -0.57% for GP-Asp and -0.56% for NN-Asp and did not differ between groups (p = 0.955). Intergroup mean difference of HbA1c level change (95% CI) at week 26 from baseline was 0.00 (-0.26, 0.25) %. Insulin doses, fasting plasma glucose levels and seven-point glucose profiles were similar between groups (p > 0.05). The number of patients experiencing hypoglycemic episodes did not differ between the groups (p = 0.497). Conclusion: GP-Asp demonstrated similar safety and efficacy. Trial registration number: NCT04079413 (ClinicalTrials.gov).

[The first Russian multicenter non-interventional registry study to study the incidence of vitamin D deficiency and insufficiency in Russian Federation]

AIM

To assess the incidence of vitamin D deficiency and insufficiency among the adult population living in the regions of the Russian Federation located at latitudes from 45 to 70.

MATERIALS AND METHODS

Russian multicenter non-interventional registry study using the "cross-sectional" method.

RESULTS

In this study, 72.1% of the examined have the status of vitamin D deficiency and insufficiency, while an adequate level was diagnosed in 27.8% of cases. When assessing the degree of vitamin D deficiency depending on the season, statistically significant differences (p0.00001) were found between the periods: vitamin D deficiency or insufficiency was observed in 84.2% of autumn and in 62.4% of spring. The highest incidence of vitamin D deficiency and insufficiency was recorded in males compared with females (p=0.013, 79 and 70.3% respectively). Vitamin D deficiency is observed in young people in the age subgroup of 1825 years (p0.001, 54% in the study as a whole) much more often than in older people Conclusion. The widespread high prevalence of vitamin D deficiency in the Russian Federation is not related to geographic region of residence, but to some extent depends on the season. The high-risk group for vitamin D deficiency and insufficiency is young men. The significant role of vitamin D in the human body justifies the need to supplement and clarify a single concept for the prevention, diagnosis and treatment of conditions associated with deficiency, so higher implementation of National Clinical Guidelines is needed.

[Review of clinical practice guidelines for hypoparathyroidism]

Hypoparathyroidism is a rare disorder characterized by the absent or inappropriately decreased serum parathyroid hormone in the parathyroid glands, which is accompanied by impaired calcium-phosphorus metabolism.The main etiology of hypoparathyroidism remains damage or removal of the parathyroid glands during neck surgery. In view of the incidence of thyroid cancer, primary hyperparathyroidism and other pathologies of the neck organs, which radical treatment can lead to the parathyroid gland impairment, an increased number of patients with hypoparathyroidism is expected. Autoimmune hypoparathyroidism is the second most common form of the disease, usually occurring as part of type 1 autoimmune polyglandular syndrome. Autoimmune hypoparathyroidism usually occurs in childhood and is characterized by a severe course of the disease, especially in the case of concomitant malabsorption syndrome.Chronic hypoparathyroidism of any etiology requires lifelong multicomponent therapy, as well as careful monitoring and an individual approach to choose the optimal treatment strategy. In the absence of adequate follow-up, the risks of long-term complications significantly increase, particularly in the renal, cardiovascular systems; in the soft tissues and in the brain, it could lead to visual disturbances; pathology of the musculoskeletal system with a decreased bone remodeling and a potential risk of fractures, as well as to the neurocognitive disorders and an impaired health-related quality of life.Timely diagnosis, rational medical therapy and management strategy may reduce the risks of short-term and long-term complications, frequency of hospitalizations and disability of patients, as well as improve the prognosis.This review covers the main issues of Russian guidelines for the management of chronic hypoparathyroidism, approved in 2021, including laboratory and instrumental evaluation, treatment approaches and follow-up. This guidelines also include the recommendations for special groups of patients: with acute hypocalcemia, hypoparathyroidism during pregnancy.

Vitamin D deficiency as a factor for immunity stimulation and lower risk of acute respiratory infections and COVID-19

During the COVID-19 pandemic, the efforts of many researchers around the world are aimed at finding preventive and prophylactic measures as well as therapeutic agents against SARS-CoV-2. Recent studies have showed that vitamin D deficiency could be one of many factors associated with the development and severity of acute respiratory infections, and vitamin D could be used for prevention and treatment of these patients. This review summarizes data about the role of vitamin D in the pathogenesis and prevention of respiratory viral infections, including new coronavirus infection as well as mechanisms for reducing the risk of infection with vitamin D therapy. Probably, this review will be of interest for endocrinologists and other specialists.

The efficacy and safety of GP40081 (insulin aspart biphasic 30) compared with NovoMix® 30 in Type 2 diabetes patients

Aim: To evaluate the safety and efficacy of insulin Aspart-Mix biosimilar candidate GP40081 (GP-Asp30) compared with NovoMix® 30 (NN-Asp30). Materials & methods: In a randomized open-label, active-controlled, 26-week non-inferiority clinical trial 264 patients with Type 2 diabetes mellitus were randomized 1:1 to receive once-daily GP-Asp30 or NN-Asp30. The primary safety end point was the immune response rate. Efficacy outcomes were a mean change in HbA1c (primary), frequency of achieving a glycemic g fasting plasma glucose levels, 7-point glucose profiles, and insulin doses. Results: The immune response developed in 10/126 (8%) participants in the GP-Asp30 group and in 10/125 (8%) participants in the NN-Asp30 group (p = 1.000). The mean difference in HbA1c change between groups was 0.12 (95%CI [-0.14, 0.38]). Other secondary efficacy and safety outcomes weren't statistically different between the two groups. Conclusion: GP-Asp30 demonstrated similar safety and efficacy compared with NN-Asp30 and may be considered a biosimilar insulin.

Safety and efficacy of GP40061 compared with originator insulin glargine (Lantus®): a randomized open-label clinical trial

Aim: To compare safety (immunogenicity) and efficacy of GP40061 insulin glargine (GP-Gla) and Lantus® (Sanofi glargine, Sa-Gla) in people with diabetes mellitus. Materials & methods: This randomized open-label, 26-week clinical trial enrolled 180 Type 1 diabetes mellitus patients (HbA1c 6.5-12.0%), randomized 1:1 to once daily GP-Gla (n = 90) or Sa-Gla (n = 90). The primary end point was immune response at 26th week. Results: The frequency of immune response was similar in GP-Gla and Sa-Gla (p = 1.000). Groups were similar in terms of other safety end points. Mean HbA1c change from baseline was -0.66% for GP-Gla and -0.77% for Sa-Gla, and did not differ between groups (p = 0.326). Insulin doses, fasting plasma glucose and seven-point glucose profiles were similar between groups. Conclusion: GP-Gla and Sa-Gla demonstrated similar safety and efficacy. ClinicalTrials.gov Identifier: NCT04022993.

[Common Carotid Intima-Media Thickness, Levels of Total and High-Molecular Weight Adiponectin in Women With Abdominal Obesity]

OBJECTIVE

to investigate influence of different forms of adiponectin on carotid intima-media thickness (CIMT) in women with abdominal obesity (AO) in St.‑Petersburg. It has been recognized before that AO is associated with cardiovascular diseases, including atherosclerosis, but mechanism of this association remains unclear. AO leads to imbalance of adipokines, in particularly decrease of adiponectin, which may lead to atherosclerotic lesion of carotid arteries.

MATERIALS AND METHODS

We investigated 81 women with AO (IDF criteria, 2005) and 21 women with normal waist circumference. СIMT was evaluated by an ultrasound scanner.

RESULTS

Among patients with AO 54.9 % had CIMT >0.9 mm and 38.5 % had atherosclerotic plaques in common carotid arteries. The total adiponectin level (TA) was lower in women with CIMT> 0.9 mm, than in women with normal CIMT (23.20 [2.55; 40.65] and 18.09 [1.60; 38.92] μg/ml, respectively; р0.9 mm, than in women with normal CIMT (2.21 [0.50; 6.85] and 2.88 [1.29; 15.45] μg/ml, respectively; р0.9 mm, than in women with CIMT >0.9 mm and atherosclerotic plaques in carotid arteries (3.09 [1.34; 6.85] and1.82 [0.50; 2.94] mcg/ml, respectively; р0.9 mm depended on waist circumference, diastolic blood pressure and level of C-reactive protein (CRP), while presence of atherosclerotic plaques was associated with levels of HMWA and CRP.

CONCLUSIONS

Factors that make the greatest contribution at early stages of atherosclerosis development in carotid arteries in women with AO can be increased waist circumference, high diastolic blood pressure, and high level of CRP. At later stages of atherosclerosis development lowered HMWA level can contribute to the formation of atherosclerotic plaques.

Role of vitamin D deficiency in type 2 diabetes mellitus and diabetic neuropathy development

Type 2 diabetes mellitus (DM) is a global epidemic associated with severe vascular complications development. Diabetic neuropathy is the most common chronic complication of DM that worsens patients life quality and prognosis. Therefore, studies dealing with DM and diabetic neuropathy underlying mechanisms are extremely relevant. The review discusses current views on vitamin D role in glucose metabolism and inflammatory processes. It is reported that vitamin D deficiency can contribute to insulin resistance development, and change in vitamin D receptor activity or extra- and intracellular calcium concentration due to vitamin D deficiency can affect pancreatic -cells function and lead to decrease in insulin production. Key pathogenic mechanisms of diabetic neuropathy as well as possible relationship between vitamin D deficiency and neuropathy development are in focus of this review. Results of recent clinical trials regarding vitamin D supplementation in patients with DM are also discussed. The presented data suggest that vitamin D deficiency can be considered as a non-classical risk factor for the development of not only DM but its complications as well.

11C-methionine PET/CT and conventional imaging techniques in the diagnosis of primary hyperparathyroidism

BACKGROUND

It is well known that primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders. Precise preoperative adenoma localization is essential for increasing PHPT cure rate. Conventional localization techniques include neck ultrasound, 99m-Tc-sestamibi scintigraphy, and computed tomography (CT). However, all of these methods have limitations. 11C-methionine positron emission tomography/computed tomography (PET/CT) combines both anatomical and functional modalities; it may be useful in terms of lowering the imaging procedures number and improving accuracy.

METHODS

A retrospective diagnostic accuracy study with sensitivity and specificity evaluation was conducted. We studied the data of 91 patients with PHPT, who were hospitalized at Almazov National Medical Research Centre. Medical records, lab results, and CT imaging of all patients were analyzed. All of them underwent ultrasound. 99m-Tc-sestamibi/99m-Tc-pertechnetate subtraction scintigraphy and CT were performed on 56 and 86 patients, respectively. Since 2020 11C-methionine PET/CT has been performed on 45 patients. Then, minimally invasive parathyroidectomy (PTX) was carried out in all patients. Histological results were used as a benchmark in order to evaluate diagnostic accuracy of studied methods. Parathyroid adenoma or hyperplasia was confirmed in all patients. Multiple lesions were found in 5 patients. Nineteen lesions were ectopic. All patients with multiple lesions required at least 3 localization techniques, and 2 of them required 4.

RESULTS

The sensitivity of 11C-methionine PET/CT was 98%, CT, 99m-Tc-sestamibi scintigraphy, and ultrasound showed sensitivity at 75%, 79%, and 67%, respectively. The estimated specificities of 11C-methionine PET/CT, CT, 99m-Tc-sestamibi scintigraphy and ultrasound were 93%, 73%, 75%, and 70%, respectively.

CONCLUSIONS

Our study showed that 11C-methionine PET/CT has higher sensitivity and specificity than conventional techniques in a group of 19 patients. 11C-methionine PET/CT may take a place in the imaging of parathyroid adenomas, it may replace CT and 99m-Tc-sestamibi scintigraphy while simultaneously providing information about lesion topography and function.

Modern glucose-lowering treatment effect on bone remodeling in experimental diabetes mellitus and surgical menopause

BACKGROUND: Diabetes mellitus (DM) is an independent risk factor for low-traumatic fractures. On the other hand, hypoglycemic drugs can have both positive and negative effects on bone remodeling.

THE AIM: Тo investigate bone metabolism parameters during surgical menopause and experimental DM under the treatment with glucagon-like peptide receptor agonist type 1 (arGLP-1) liraglutide (LIRA) and sodium-glucose cotransporter type 2 inhibitor (iSGLT-2) canagliflozin (CANA).

MATERIALS AND METHODS: Female Wistar rats have been subjected to bilateral ovariectomy at the beginning of the experiment. Diabetes mellitus (DM) was modelled using a high-fat diet and streptozotocin+nicotinamide. Four weeks after the following groups were formed: “OE+DM” (females after ovariectomy with DM and without any therapy, n=4) «OE+DM+CANA» (females after ovariectomy with DM under treatment with CANA, n=4), «OE+DM+LIRA» (females after ovariectomy with DM under treatment LIRA, n=5). The treatment or observation period were continuing for 8 weeks. Calcium, phosphorus and bone turnover markers (fibroblast growth factor-23 (FGF-23), osteocalcin, sclerostin, osteoprotegerin (OPG), nuclear factor-kappa-B receptor activator ligand (RANKL), were measured in the end of experiment. Bone histomorphometry was performed after euthanasia.

RESULTS: Treatment with both CANA and LIRA did not significantly affect the phosphorus-calcium metabolism, sclerostin and osteocalcin concentrations. At the same time, the level of OPG was the highest in «OE+DM ‘’ group (9.1 [7.81; 10.045] pmol/l). The differences were significant compared with «OE+DM+CANA’’ (2, 33 [1.84; 5.84] pmol/l, p = 0.003) and «OE+DM+LIRA» (1.7 [1; 2] pmol/l, p = 0.003) groups. There were no differences in OPG levels between animals treated with different drugs. Similarly, the OPG/RANKL ratio was similarly reduced with both types of treatment. In “OE+DM+CANA’’ group the bone trabeculae number of   the femur epiphysis (p=0.042) were decreased in comparison to «OE+DM» group. LIRA did not change the histoarchitectonic parameters.

CONCLUSION: Bone metabolism markers did not differ when using as canagliflozin as liraglutide. Besides, canagliflosin can lead to the activation of bone resorption, which is expressed in the femur epiphyseal trabeculae number decreasing.

Hypokalemia and the renin-angiotensinaldosterone system activity in COVID-19 patients

Background. Hypokalemia is a common electrolyte complication among hospitalized patients with pneumonia caused by a new coronavirus SARS-CoV-2. Hyperactivation of the renin-angiotensin-aldosterone system (RAAS) is suggested as a possible cause of hypokalemia in patients with COVID-19.

Objective. To investigate the RAAS activity in COVID-19 patients with and without hypokalemia and its possible association with treatment outcomes.

Design and methods. The cross-sectional cohort study included 172 patients with COVID-19 pneumonia. Potassium, aldosterone and venous renin were measured in 77 patients. The differences in the levels of acute phase proteins, the degree of lung damage and the severity of COVID-19 were compared between patients with and without hypokalemia.

Results. Hypokalemia was found in 19 of 77 patients (25%): the median potassium level in hypokalemia and eukalemia group was 3,1 [2,8–3,3] and 4,1 [3,9–4,5] mmol/L, respectively (p = 0,001). Plasma aldosterone and renin levels in patients with and without hypokalemia did not differ significantly: aldosterone 76,0 [57,7–121,5] and 70,9 [26,3–113,8] pg/ml (p = 0,23), renin 17,0 [8,5–47,2] and 11,0 [6,5–38,1] pg/ml (p = 0,35), respectively. Differences in the degree of lung tissue damage, acute phase proteins, severity of COVID-19, length of hospitalization and mortality in patients with and without identified electrolyte disturbances were also not significant.

Conclusions. Our results showed that there were no laboratory signs of RAAS hyperactivation in COVID-19 patients with registered hypokalemia. Identification of the cause and clinical significance of hypokalemia among patients with COVID-19 needs to be specified.

PKPD Modeling and Simulations to Support Biosimilar Development of Biphasic Insulin Aspart 30

This paper presents an analysis of data from a comparative study of biosimilarity in terms of pharmacokinetics and pharmacodynamics in healthy volunteers using a hyperinsulinemic euglycemic clamp for reference and test biphasic insulin aspart 30 (BIAsp 30). As a result of the study, one of the secondary pharmacodynamic (PD) endpoints did not satisfy the classical criterion of 80%-125% (the lower limit for PD parameter area under the glucose infusion rate-time curve [AUC GIR 0 - t ${\rm{AUC}}_{{\rm{GIR}}_{0 - {\rm{t}}}}$ ] turned out to be 79.5%). The main hypothesis explaining this result is that the sample size is insufficient to conduct a PD test with 90% statistical power, since the sample size has been calculated based on the coefficient of variation (CV) of pharmacokinetic (PK) parameters. To test this hypothesis, population PKPD (popPKPD) modeling and subsequent simulations of the required number of PD profiles were used. Two popPKPD models were constructed (a one-compartment double simultaneous absorption model for PK and an effect compartment Emax model for PD) to describe the PKPD data of reference and test insulins. As a result, using real data along with model-based simulation data, a biosimilarity test for PD was performed, and the lower limit forAUC GIR 0 - t ${\rm{AUC}}_{{\rm{GIR}}_{0 - {\rm{t}}}}$ became 82.6%, while the CV decreased from 31.7% to 24.1%. Thus, popPKPD modeling and simulations have been shown to be effective in interpreting and supporting the results of clinical biosimilarity trials.

Vitamin D Status and Gestational Diabetes in Russian Pregnant Women in the Period between 2012 and 2021: A Nested Case-Control Study

Several meta-analyses found an association between low maternal serum 25-hydroxyvitamin D (25(OH)D) level and gestational diabetes mellitus (GDM). However, some of them reported significant heterogeneity. We examined the association of serum 25(OH)D concentration measured in the first and in the second halves of pregnancy with the development of GDM in Russian women surveyed in the periods of 2012−2014 and 2018−2021. We conducted a case−control study (including 318 pregnant women) nested on two previous studies. In 2012−2014, a total of 214 women (83 GDM and 131 controls) were enrolled before 15 weeks of gestation and maternal serum 25(OH)D concentrations were measured twice: at 8th−14th week of gestation and simultaneously with two-hour 75 g oral glucose tolerance test (OGTT) at 24th−32nd week of gestation. In the period of 2018−2021, 104 women (56 GDM and 48 controls) were included after OGTT and 25(OH)D concentrations were measured at 24th−32nd week of gestation. Median 25(OH)D levels were 20.0 [15.1−25.7] vs. 20.5 [14.5−27.5] ng/mL (p = 0.565) in GDM and control group in the first half of pregnancy and 25.3 [19.8−33.0] vs. 26.7 [20.8−36.8] ng/mL (p = 0.471) in the second half of pregnancy, respectively. The prevalence rates for vitamin D deficiency (25(OH)D levels < 20 ng/mL) were 49.4% and 45.8% (p = 0.608) in the first half of pregnancy and 26.2% vs. 22.1% (p = 0.516) in the second half of pregnancy in women who developed GDM and in women without GDM, respectively. The frequency of vitamin D supplements intake during pregnancy increased in 2018−2021 compared to 2012−2014 (p = 0.001). However, the third trimester 25(OH)D levels and prevalence of vitamin D deficiency (25.5 vs. 23.1, p = 0.744) did not differ in women examined in the periods of 2012−2014 and 2018−2021. To conclude, there was no association between gestational diabetes risk and maternal 25(OH)D measured both in the first and in the second halves of pregnancy. The increased prevalence of vitamin D supplements intake during pregnancy by 2018−2021 did not lead to higher levels of 25(OH)D.

[SARS-CoV-2 morbidity depending on vitamin D status]

BACKGROUND

The association between vitamin D deficiency and the severity of COVID-19 is currently being actively discussed around the world.

AIM

The aim of this study was to assess the prevalence of vitamin D insufficiency and deficiency and compare it with the incidence rates of SARS-CoV-2 in eight Federal Districts of the Russian Federation.

MATERIALS AND METHODS

We included 304,564 patients (234,716 women; 77,1%) with serum 25(OH)D levels results performed September 2019 through October 2020.

RESULTS

Only 112,877 people (37.1%) had a normal serum 25(OH)D level, others had a deficiency. Vitamin D insufficiency and deficiency was presented with the same frequency in women and men, and no differences were found depending on the geographical location and age in subjects from 18 to 74 years old. However, subjects over 75 years more often had vitamin D deficiency, while subjects under 18 years had normal levels in over 50% cases. In addition, 21,506 patients were tested for SARS-CoV-2 by PCR with further comparison of results with serum 25(OH)D level. The SARS-CoV-2 positivity rate was detected in 3,193 subjects, negative in 18,313. There were no differences in the morbidity in a vitamin D deficiency and a normal level. Thus, 14.8% subjects had positive PCR rates among vitamin D deficiency patients (4,978 tests), 14.9% when 25(OD)D level was from 20 to 30 ng/ml (7,542 tests), 15.0% among those who had 25(OH)D 30- 50 ng/ml (6,622 tests), and 13.9% when vitamin D was more than 50 ng/ml (4,612 tests).

CONCLUSION

There was no association between the COVID-19 incidence and vitamin D status in different regions of Russia. Although the nutrient deficiency persists in all regions and is most often diagnosed in people over 75 years old.

Bioequivalence of Reference and Biosimilar Preparations of Premixed Biphasic Insulin Aspart: A Comparative Clamp Study

Biphasic insulin aspart 30 is a premixed formulation containing a soluble fraction of insulin aspart (30%) and a protamine-crystallized fraction (70%) that was developed to combine the rapid-acting and prolonged advantages of commercially available insulins. The aim of this bioequivalence study was to compare the pharmacokinetics (PKs) of GP-bi-asp and Novo-bi-asp, and evaluate the pharmacodynamic (PD) properties as well as the safety of these drugs in the hyperinsulinemic euglycemic clamp (HEC) procedure. This was a phase 1, randomized, double-blind, 2-sequence, 2-period crossover study. Thirty-four male volunteers who met the inclusion criteria underwent the HEC procedure following a single subcutaneous injection of 0.4 IU/kg of either GP-bi-asp or Novo-bi-asp in the abdomen. After the treatment, the subjects' plasma glucose levels were monitored for 24 hours and the glucose infusion rate (GIR) was adjusted to maintain the target blood glucose level. The PD parameters were calculated using GIR values. Insulin aspart concentrations were measured in blood plasma using validated ELISA assays to evaluate the PK parameters of the investigated drugs. The 90% confidence intervals for the geometric mean ratios of PK (Cins and AUCins-T ) parameters of Gp-bi-asp and Novo-bi-asp were close to 100% and within the 80%-125% limits for establishing bioequivalence. The safety profiles of both drugs were also comparable.

Evaluation of osteogenesis processes against the background of experimental osteoporosis therapy

Background. Osteoporosis is a problem all over the world with important clinical and economic consequences. A significant contribution to solving the problem of the spread of osteoporosis can be the creation of drugs based on unique biologically active compounds. The aim was to evaluate the processes of osteogenesis, according to the formation of an organic matrix of bone tissue, as well as to evaluate markers of bone remodeling in blood serum at the stages of anti-osteoporosis therapy. Materials and methods. The study was performed on an experimental model of osteoporosis using biochemical methods for analyzing markers of osteoporosis in blood serum, as well as atomic absorption spectroscopy and X-ray densitometry. Results. According to the results of the study, the specific anti-osteoporotic activity of the new drug based on succinic acid salts was proved - a significant increase in the organic component the total collagen in bone tissue and the mineral component - the main elements in bone tissue in both young and old senile animals. Evaluation of the dynamics of the content of markers of bone remodeling showed the high effectiveness of the new drug in monotherapy, and in combination with vitamin D3 in the activation of osteogenesis processes in experimental osteoporosis. Conclusion. The effectiveness of the proposed anti-osteoporotic agent is shown, which is more pronounced in senile rats and is due to a proportional increase in the organic and mineral components of bone tissue.

Somatostatin Receptor Imaging in the Diagnosis and Management of Parathyroid Neuroendocrine Neoplasia

BACKGROUND

Parathyroid tumors are classified as parathyroid neuroendocrine neoplasia (NEN) by the IARC-WHO classification. These tumors can occur with NENs from other sites, which often require total-body [68Ga]-DOTA-peptides PET/CT. This study aimed to assess the utility of [68Ga]-DOTA-peptide PET/CT in imaging parathyroid NENs and to evaluate the underlying mechanisms.

METHODS

Fifty patients with primary hyperparathyroidism (PHPT) and parathyroid NENs histologically confirmed as parathyroid adenomas (PAs) were included. PET/CT with [68Ga]-DOTA-peptide was performed in 16 patients with localized PAs, including 10 with MEN1 syndrome. Somatostatin receptor types 2 and 5 (SST2 and SST5) staining was performed on PAs from 48 patients. Somatostatin analogs (SSA) were prescribed in four patients with MEN 1 syndrome and 1 with persistent acromegaly, all with PAs and PHPT. The therapy effects on calcium and parathyroid hormone (iPTH) were evaluated.

RESULTS

[68Ga]-DOTA-peptide PET/CT detected 20 PAs with high radiopharmaceutical uptake. SST2 expression was negative on PA cell membranes in all cases and positive on endothelium in 39 (81%) PAs. Membrane SST5 expression was positive in 25 (52%) PAs and endothelial was positive in 40 (83%). Serum calcium levels decreased in patients on SSA therapy, while iPTH did not.

CONCLUSIONS

PET/CT with [68Ga]-DOTA-peptides can detect parathyroid NENs. The incidental detection of high [68Ga]-DOTA-peptide uptake in the parathyroid region during whole-body PET/CT may prompt biochemical evaluation for PHPT. We suggest that endothelial SST expression mediates high radiopharmaceutical uptake by PAs and that SSA treatment can reduce hypercalcemia in PHPT patients.

COVID-19 Pandemic and Cardiovascular Diseases: Lessons and Prospects

This article is focused on the topicality of assessing complications and mortality from diseases of the circulatory system during the COVID-19 pandemic. The main variants of damage to the cardiovascular system, the mechanisms of their development, and risk factors are given. The long-term consequences of the new coronavirus infection for the heart and blood vessels are considered. In addition, the necessary measures to reduce the burden of disease after the pandemic are discussed.

An artificial intelligence approach for prognosis of COVID-19 course in hospitalized patients

Aim. To create algorithm and risk calculator for predicting the lethal outcome in patients with COVID-19.

Materials and methods. Based on machine learning approach mortality risk calculator was developed in Almazov National Medical Research Centre using data of the hospitalised patients with an established diagnosis of COVID-19 (n=4071).

Results. This mathematical model, which includes 11 significant features, has been proposed for estimation of fatal outcomes in the Clinical Infectious Hospital named after S.P. Botkin. Some key features were not assessed in most hospitals according to accepted standards of care for COVID-19. So systematic analysis of factors affecting the course of disease in patients (n=2876) were conducted and «urea» and «total protein» were replaced with «sex» and «BMI». Modified algorithm demonstrated high sensitivity and specificity. Conclusion. This calculator is able to predict hospitalisation outcome with high accuracy in patients infected with different strains of SARS-CoV-2. This decision support system may be used for risk stratification and following correct patients routing.

Possibilities of in vivo validation of a model of experimental osteoporosis

In this work, the possibilities ofin vivovalidation of an experimental model of osteoporosis are analyzed. Themodel is based on the application of biochemical methodsforanalyzing predictors of osteoporosis inbloodserum,andtheirinformative value in the comparativeanalysis of the assessment of the degree of osteoporosisbasedoninstrumental studies of autopsy of bone tissue usingatomicabsorption spectroscopy and x-ray densitometry.

Metabolic properties of irisin in health and in diabetes mellitus

Irisin is a polypeptide hormone of muscle tissue (myokine), the synthesis and secretion of which increase against the background of physical exertion, which plays a significant role in the metabolism of fat, muscle and bone tissues. It is known that irisin promotes the transformation of white adipose tissue into brown adipose tissue. It has also been experimentally proven that the introduction of irisin contributed to an increase in bone mass and the prevention of osteoporosis and muscular atrophy. There are works indicating a positive effect of irisin in the functioning of bone, fat and muscle tissues in humans. Diabetes mellitus (DM) is an independent risk factor for osteoporotic fractures and the development of specific diabetic myopathy, at the cellular level similar to the aging of muscle tissue, and type 2 diabetes is also associated with the presence of obesity. Thus, it is of particular interest to study the effect of irisin on the state of bone, muscle and adipose tissues and glucose homeostasis in patients with diabetes. This literature review highlights the biological functions of irisin in healthy people and patients with DM.