Therapeutic Potential of Metformin-preconditioned Mesenchymal Stem Cells for Pancreatic Regeneration

BACKGROUND

Diabetes occurs due to insulin deficiency or less insulin. To manage this condition, insulin administration as well as increased insulin sensitivity is required, but exogeneous insulin cannot replace the sensitive and gentle regulation of blood glucose levels same as β cells of healthy individuals. By considering the ability of regeneration and differentiation of stem cells, the current study planned to evaluate the effect of metformin preconditioned buccal fat pad (BFP) derived mesenchymal stem cells (MSCs) on streptozotocin (STZ) induced diabetes mellitus in Wistar rats.

MATERIALS & METHODS

The disease condition was established by using a diabetes-inducing agent STZ in Wistar rats. Then, the animals were grouped into disease control, blank, and test groups. Only the test group received the metformin-preconditioned cells. The total study period for this experiment was 33 days. During this period, the animals were monitored for blood glucose level, body weight, and food-water intake twice a week. At the end of 33 days, the biochemical estimations for serum insulin level and pancreatic insulin level were performed. Also, histopathology of the pancreas, liver and skeletal muscle was performed.

RESULTS

The test groups showed a decline in the blood glucose level and an increase in the serum pancreatic insulin level as compared to the disease group. No significant change in food and water intake was observed within the three groups, while body weight was significantly reduced in the test group when compared with the blank group, but the life span was increased when compared with the disease group.

CONCLUSION

In the present study, we concluded that metformin preconditioned buccal fat pad-derived mesenchymal stem cells have the ability to regenerate damaged pancreatic β cells and have antidiabetic activity, and this therapy is a better choice for future research.

Nanotechnology: Newer Approach in Insulin Therapy

Insulin is a peptide hormone released by pancreatic beta cells. An autoimmune reaction in diabetes mellitus type 1 causes the beta cells to die, preventing insulin from being produced or released into the bloodstream; that impacts 30 million people globally and is linked to shortened lifespan due to acute and chronic repercussions. Insulin therapy aims to replicate normal pancreatic insulin secretion, which includes low levels of insulin that are always present to support basic metabolism, as well as the two-phase secretion of additional insulin in response to high blood sugar - an initial spike in secreted insulin, followed by an extended period of continued insulin secretion. This is performed by combining various insulin formulations at varying rates and lengths of time. Since the beginning of human insulin use, several advances in insulin formulations have been made to help meet these aims as much as possible, resulting in improved glycaemic control while limiting hypoglycemia. In this review, we looked at devices used by patients with type 1 diabetes, such as insulin pumps, continuous glucose monitors, and, more recently, systems that combine a pump with a monitor for algorithm-driven insulin administration automation. We intend to provide insight into supplementary therapies and nanotechnology employed in insulin therapy as a result of our review.

Safety and immunogenicity of an indigenously developed tetanus toxoid, diphtheria toxoid, and acellular pertussis vaccine (Tdap) in adults, adolescents, and children in India

BACKGROUND

This study assessed safety and immunogenicity of Serum Institute of India Pvt Ltd (SIIPL)'s tetanus toxoid (TT), diphtheria toxoid (DT), and acellular pertussis booster vaccine (Tdap).

RESEARCH DESIGN AND METHODS

In this Phase II/III, multicenter, randomized, active-controlled, open-label study, 1500 healthy individuals, aged 4-65 years, were randomized to receive a single dose of SIIPL Tdap or comparator Tdap vaccine (Boostrix®; GlaxoSmithKlines, India). Adverse events (AEs) during initial 30 minutes, 7-day, 30-day post-vaccination were assessed. Blood samples were taken before and 30 days post-vaccination for immunogenicity assessment.

RESULTS

No significant differences in incidence of local and systemic solicited AEs were observed between the two groups; no vaccine-related serious AEs were reported. SIIPL Tdap was non-inferior to comparator Tdap in achieving booster responses to TT and DT in 75.2% and 70.8% of the participants, respectively, and to pertussis toxoid (PT), pertactin (PRN), and filamentous hemagglutinin (FHA) in 94.3%, 92.6%, and 95.0% of the participants, respectively. Anti-PT, anti-PRN, and anti-FHA antibody geometric mean titers in both the groups, were significantly higher post-vaccination compared to pre-vaccination.

CONCLUSIONS

Booster vaccination with SIIPL Tdap was non-inferior to comparator Tdap with respect to immunogenicity against tetanus, diphtheria, and pertussis and was well tolerated.

Managing Type 1 Diabetes from Gynecological Waste: Trash to Treasure

Type 1 diabetes mellitus (T1DM), an autoimmune disease, involves the destruction of pancreatic β cells. β cells maintain glucose homeostasis by identifying blood glucose and accordingly releasing insulin to maintain normal physiologic glucose levels. Human umbilical cord blood (hUCB) cells pose a lesser risk of viral contamination due to low placental transmission during prenatal life. Additionally, they have advantages such as non-invasive harvest procedure gynecological waste, low immunogenicity, easy expansion in-vitro, and easy ethical access compared to deriving stem cells from other sources. According to the published preclinical data, the infusion of autologous cord blood cells is considered safe as they are non-antigenic. Depending on the degree of differentiation, the ability to regenerate themselves and the origin of many stem cell types can be differentiated. The application of stem cells (SCs) has great potential for managing T1DM due to their regenerative capabilities and promising immunological characteristics. Due to lesser ethical complications and easy procedures of isolation, hUCB has become a precious medical intervention.

A novel method for evaluating physician communication: A pilot study testing the feasibility of parent-assisted audio recordings via Zoom

OBJECTIVE

Quality of physician consultations are best assessed via direct observation, but require intensive in-clinic research staffing. To evaluate physician consultation quality remotely, we pilot tested the feasibility of parents using their personal mobile phones to facilitate audio recordings of pediatric visits.

METHODS

Across four academic pediatric primary care clinics, we invited all physicians with a patient panel (n=20). For participating physicians, we identified scheduled patients from medical records. We invited parents to participate via text message and phone calls. During their adolescent's appointment, parents used their mobile phone to connect to Zoom for remote research staff to audio record.

RESULTS

In Spring 2021, five of 20 (25%) physicians participated. During a nine-week period, we invited parents of all 54 patients seen by participating physicians of which 15 (28%) completed adult consent and adolescent assent and 10 (19%) participated. For 9 recordings, at least 45% of the conversation was audible.

CONCLUSIONS

It was feasible and acceptable to directly observe physician consultations virtually with Zoom, although participation rates and potentially audio quality were lower.

INNOVATION

Patients used their cellular phone calling features to connect to Zoom where research staff audio-recorded their physician consultation to evaluate communication quality.

The Building of a Cancer Center for the Rural Folk

The requirement of rural folk differs from the requirements of the well-off urbanites. In developing nations, the onus of their healthcare falls upon the doctors practicing in the periphery. Since public awareness and support are minimal, income has to be generated from the poor folk. Hard work and simple living by the caretakers are the cornerstones to divert all profits for further growth of the hospital. Cancer therapy does not always require big investments. Scientific healthcare can be provided to the poor by doctors with good knowledge, hard work, and good skills.

Narrative Review of Anti-CD3 Antibody and Anti-CD20 Antibody: Immunotherapeutic Strategies to Treat and Prevent Type 1 Diabetes

Background and Objective:

Type 1 diabetes mellitus is a complex disease defined by the loss of pancreatic cells, which leads to complete insulin insufficiency. The Diabetes Control and Problems Trial defines the aims of Type 1 diabetes therapy as achieving adequate glycaemic control, and preventing and avoiding recurrent bouts of hypoglycaemia. Despite ongoing efforts to improve insulin therapy regimens, the actual hormone substitute therapy treats just the symptoms of the disease, with no influence on disease pathology or etiopathogenesis. In recent decades, there has been a lot of interest in preventative techniques in high-risk patients, based on the theory that if a therapeutic intervention is adopted early in the disease, it can help maintain endogenous cell function by protecting the remaining cell reservoir from autoimmune attack.

Methods:

Based on preclinical and clinical data, we have discussed some immunotherapeutic in this meta-analysis. We referred to the preclinical and clinical studies for teplizumab and rituximab from authentic databases and compiled the data. We used statistical analysis to do a meta-analysis.

Results:

In two immunotherapeutic anti-CD3 antibodies and anti-CD20 antibodies examples, teplizumab and rituximab, respectively, shows better efficacy as well as fewer side effects. We have discussed this drug briefly based on their mechanism of action and meta-analysis, which compare clinical efficacy.

Conclusion:

Immunotherapeutic can be a better option for preventing and protecting type one diabetes. Since, the existing literature does not have enough data to support any single drug concluding the same will not be appropriate. Hence further studies are required wherein different drugs can be compared with similar sample sizes for each group of drugs.

Nanobiotechnology-Modified Cellular and Molecular Therapy as a Novel Approach for Autoimmune Diabetes Management

Several cellular and molecular therapies such as stem cell therapy, cell replacement therapy, gene modification therapy, and tolerance induction therapy have been researched to procure a permanent cure for Type 1 Diabetes. However, due to the induction of undesirable side effects, their clinical utility is questionable. These anti-diabetic therapies can be modified with nanotechnological tools for reducing adverse effects by selectively targeting genes and/or receptors involved directly or indirectly in diabetes pathogenesis, such as the glucagon-like peptide 1 receptor, epidermal growth factor receptor, human leukocyte antigen (HLA) gene, miRNA gene and hepatocyte growth factor (HGF) gene. This paper will review the utilities of nanotechnology in stem cell therapy, cell replacement therapy, beta-cell proliferation strategies, immune tolerance induction strategies, and gene therapy for type 1 diabetes management.

Differences in stakeholder-reported barriers and implementation strategies between counties with high, middle, and low HPV vaccine initiation rates: a mixed methods study

BACKGROUND

A greater understanding of the county-level differences in human papillomavirus (HPV) vaccination rates could aid targeting of interventions to reduce HPV-related cancer disparities.

METHODS

We conducted a mixed-methods study to compare the stakeholder-reported barriers and efforts to increase HPV vaccination rates between counties within the highest, middle, and lowest HPV vaccine initiation (receipt of the first dose) rates among 22 northern Florida counties. Between August 2018 and April 2019, we recruited stakeholders (n = 68) through purposeful and snowball sampling to identify potential participants who were most knowledgeable about the HPV vaccination activities within their county and would represent a variety of viewpoints to create a diverse picture of each county, and completed semi-structured interviews. County-level HPV vaccine initiation rates for 2018 were estimated from the Florida Department of Health's immunization registry and population counts. Implementation strategies were categorized by level of importance and feasibility using the Expert Recommendations for Implementing Change (ERIC) taxonomy. We compared the barriers and implementation strategies for HPV vaccination between tercile groups of counties by HPV vaccine initiation rates: highest (18 stakeholders), middle (27 stakeholders), and lowest (23 stakeholders).

RESULTS

The majority of the 68 stakeholders were female (89.7%), non-Hispanic white (73.5%), and represented a variety of clinical and non-clinical occupations. The mentioned barriers represented five themes: healthcare access, clinician practices, community partnerships, targeted populations, and cultural barriers. Within themes, differences emerged between county terciles. Within healthcare access, the highest rate county stakeholders focused on transportation, lowest rate county stakeholders focused on lack of clinicians, and middle county stakeholders mentioned both. The number of ERIC quadrant I strategies, higher feasibility, and importance described decreased with the tercile for HPV vaccination: highest = 6, middle = 5, and lowest =3 strategies.

CONCLUSIONS

The differing barriers and strategies between the highest, middle, and lowest vaccination rate counties suggest that a tailored and targeted effort within the lowest and middle counties to adopt strategies of the highest rate counties may reduce disparities.