Transcriptional landscape of myogenesis from human pluripotent stem cells reveals a key role of TWIST1 in maintenance of skeletal muscle progenitors

Generation of skeletal muscle cells with human pluripotent stem cells (hPSCs) opens new avenues for deciphering essential, but poorly understood aspects of transcriptional regulation in human myogenic specification. In this study, we characterized the transcriptional landscape of distinct human myogenic stages, including OCT4::EGFP+ pluripotent stem cells, MSGN1::EGFP+ presomite cells, PAX7::EGFP+ skeletal muscle progenitor cells, MYOG::EGFP+ myoblasts, and multinucleated myotubes. We defined signature gene expression profiles from each isolated cell population with unbiased clustering analysis, which provided unique insights into the transcriptional dynamics of human myogenesis from undifferentiated hPSCs to fully differentiated myotubes. Using a knock-out strategy, we identified TWIST1 as a critical factor in maintenance of human PAX7::EGFP+ putative skeletal muscle progenitor cells. Our data revealed a new role of TWIST1 in human skeletal muscle progenitors, and we have established a foundation to identify transcriptional regulations of human myogenic ontogeny (online database can be accessed in http://www.myogenesis.net/).

Stratification based on adverse laboratory/pathological features for predicting overall survival in patients undergoing radical prostatectomy: A K-CaP registry-based analysis

When making clinical decisions concerning additional treatment for patients who have undergone radical prostatectomy (RP), adverse laboratory/pathological features are considered major factors. We investigated and compared the prognostic efficacy of adverse laboratory/pathological features in predicting overall survival (OS) and biochemical failure (BCF) in these patients.The Korean Prostate Cancer Database was used to identify patients undergoing RP between May 2001 and April 2013. Patients with incomplete clinicopathological data or positive lymphadenectomy results were excluded. Finally, 4486 patients included in the final analysis were categorized based on their adverse laboratory/pathological features.Adverse pathological features and detectable prostate-specific antigen (PSA) levels 6 weeks after surgery were observed in 1977 (44.1%) and 634 (14.1%) patients, respectively. PSA levels, pathological Gleason score ≥8, adverse pathological features [positive surgical margin (PSM), seminal vesicle invasion (SVI), and extracapsular extension (ECE)], and adverse laboratory features (detectable PSA levels after 6 weeks) together were significant predictors of BCF-free survival (BCFFS). SVI was identified as a predictor of OS. Additionally, patients with ECE, PSM, and detectable PSA levels after 6 weeks, but without SVI, showed similar OS to those without ECE, PSM, and detectable PSA levels after 6 weeks and with SVI (log-rank test, P = .976).We successfully stratified patients based on adverse laboratory/pathological features after RP and demonstrated that these are important prognostic factors for OS and BCFFS. Additionally, we identified the criteria for selecting appropriate patients for undergoing additional treatment based on OS and BCFFS.

Once-Weekly Efpeglenatide Dose-Range Effects on Glycemic Control and Body Weight in Patients With Type 2 Diabetes on Metformin or Drug Naive, Referenced to Liraglutide

OBJECTIVE

To explore the efficacy, safety, and tolerability of once-weekly efpeglenatide, a long-acting glucagon-like peptide 1 receptor agonist (GLP-1 RA), in early type 2 diabetes (T2D) (drug naive or on metformin monotherapy).

RESEARCH DESIGN AND METHODS

EXCEED 203 was a 12-week, randomized, placebo-controlled, double-blind, parallel-group, dose-ranging study of efpeglenatide once weekly referenced to open-label liraglutide 1.8 mg (exploratory analysis). Participants, ∼90% on metformin monotherapy, were randomized to one of five efpeglenatide doses (0.3, 1, 2, 3, or 4 mg q.w.; n = 181), placebo (n = 37), or liraglutide (≤1.8 mg daily; n = 36). The primary efficacy end point was change in HbA_1c from baseline to week 13.

RESULTS

From a baseline HbA_1c of 7.7-8.0% (61.0-63.9 mmol/mol), all efpeglenatide doses ≥1 mg significantly reduced HbA_1c versus placebo (placebo-adjusted least squares [LS] mean changes 0.6-1.2%, P < 0.05 for all) to a final HbA_1c of 6.3-6.8% (45.4-50.6 mmol/mol); masked efpeglenatide 4 mg was noninferior to open-label liraglutide. Greater proportions treated with efpeglenatide ≥1 mg than placebo achieved HbA_1c <7% (61-72% vs. 24%, P < 0.05 for all), and greater reductions in body weight were observed with efpeglenatide 3 and 4 mg versus placebo (placebo-adjusted LS mean differences -1.4 and -2.0 kg, respectively, P < 0.05 for both). Rates of nausea and vomiting were consistent with other GLP-1 RAs and rapidly subsided after the initial 2 weeks. No neutralizing antibodies were detected with efpeglenatide.

CONCLUSIONS

Efpeglenatide once weekly led to significant reductions in HbA_1c and weight, with a safety profile consistent with the GLP-1 RA class in patients with early T2D mostly on metformin monotherapy.

Factors Affecting Smartphone Usage Self-Report Levels

For the treatment of smartphone addiction, it is important to understand users' smartphone usage patterns. Most of the studies are based on self-report surveys. However, there are differences between self-reported usage and real usage. For a better understanding of usage patterns, this study identified demographic and social factors that affect smartphone usage self-report levels. Also, it was confirmed that the influencing factors differ depending on the smartphone usage content by application category.

Development of Integrated Data and Prediction System Platform for the Localized Prostate Cancer

In this study, we built a multi-center integrated database platform of localized prostate cancer and developed biochemical recurrence (BCR) prediction system with Gradient Boosted Regression model using Korean Prostate Cancer Registry (KPCR) database. This platform will facilitate clinical management of patients with prostate cancer, and it will also help develop appropriate treatment of prostate cancer.

Feasibility of using computed tomography texture analysis parameters as imaging biomarkers for predicting risk grade of gastrointestinal stromal tumors: comparison with visual inspection

PURPOSE

To evaluate the feasibility of using computed tomography texture analysis (CTTA) parameters for predicting malignant risk grade and mitosis index of gastrointestinal stromal tumors (GISTs), compared with visual inspection.

METHOD AND MATERIALS

CTTA was performed on portal phase CT images of 145 surgically confirmed GISTs (mean size: 42.9 ± 37.5 mm), using TexRAD software. Mean, standard deviation, entropy, mean of positive pixels (MPP), skewness, and kurtosis of CTTA parameters, on spatial scaling factor (SSF), 2-6 were compared by risk grade, mitosis rate, and the presence or absence of necrosis on visual inspection. CTTA parameters were correlated with risk grade. Diagnostic performance was evaluated with receiver operating characteristic curve analysis. Enhancement pattern, necrosis, heterogeneity, calcification, growth pattern, and mucosal ulceration were subjectively evaluated by two observers.

RESULTS

Three to four parameters at different scales were significantly different according to the risk grade, mitosis rate, and the presence or absence of necrosis (p < 0.041). MPP at fine or medium scale (r = - 0.547 to - 393) and kurtosis at coarse scale (r = 0.424-0.454) correlated significantly with risk grade (p < 0.001). HG-GIST was best differentiated from LG-GIST by MPP at SSF 2 (AUC, 0.782), and kurtosis at SSF 4 (AUC, 0.779) (all p < 0.001). CT features predictive of HG-GIST were density lower than or equal to that of the erector spinae muscles on enhanced images (OR 2.1; p = 0.037; AUC, 0.59), necrosis (OR, 6.1; p < 0.001; AUC, 0.70), heterogeneity (OR, 4.3; p < 0.001; AUC, 0.67), and mucosal ulceration (OR, 3.3; p = 0.002; AUC, 0.62).

CONCLUSION

Using TexRAD, MPP and kurtosis are feasible in predicting risk grade and mitosis index of GISTs. CTTA demonstrated meaningful accuracy in preoperative risk stratification of GISTs.

Isolation and Characterization of a Lytic and Highly Specific Phage against Yersinia enterocolitica as a Novel Biocontrol Agent

The aim of this study was to isolate and characterize a lytic Yersinia enterocolitica-specific phage (KFS-YE) as a biocontrol agent. KFS-YE was isolated and purified with the final concentration of (11.72 ± 0.03) log PFU/ml from poultry. As observed by transmission electron microscopy, KFS-YE consisted of an icosahedral head and a contractile tail, and was classified in the Myoviridae family. KFS-YE showed excellent narrow specificity against Y. enterocolitica only. Its lytic activity was stable at wide ranges of pH (4-11) and temperature (4-50°C). The latent period and burst size of KFS-YE were determined to be 45 min and 38 PFU/cell, respectively. KFS-YE showed relatively robust storage stability at -20, 4, and 22°C for 40 weeks. KFS-YE demonstrated a bactericidal effect in vitro against Y. enterocolitica and provided excellent efficiency with a multiplicity of infection as low as 0.01. This study demonstrated the excellent specificity, stability, and efficacy of KFS-YE as a novel biocontrol agent. KFS-YE may be employed as a practical and promising biocontrol agent against Y. enterocolitica in food.

Types of problematic smartphone use based on psychiatric symptoms

To provide appropriate solutions for problematic smartphone use, we need to first understand its types. This study aimed to identify types of problematic smartphone use based on psychiatric symptoms, using the decision tree method. We recruited 5,372 smartphone users from online surveys conducted between February 3 and February 22, 2016. Based on scores on the Korean Smartphone Addiction Proneness Scale for Adults (S-Scale), 974 smartphone users were assigned to the smartphone-dependent group and 4398 users were assigned to the normal group. The data-mining technique of C5.0 decision tree was applied. We used 15 input variables, including demographic and psychological factors. Four psychiatric variables emerged as the most important predictors: self-control (Sc; 66%), anxiety (Anx; 25%), depression (Dep; 7%), and dysfunctional impulsivities (Imp; 3%). We identified the following five types of problematic smartphone use: (1) non-comorbid, (2) self-control, (3) Sc + Anx, (4) Sc + Anx + Dep, and (5) Sc + Anx + Dep + Imp. We found that 74% of smartphone-dependent users had psychiatric symptoms. The ratio of participants belonging to the non-comorbid and self-control types was 64%. We proposed that these types of problematic smartphone use may be used for the development of an appropriate service for controlling and preventing such behaviors in adults.

Corrigendum: Factors Affecting User Acceptance in Overuse of Smartphones in Mobile Health Services: An Empirical Study Testing a Modified Integrated Model in South Korea

[This corrects the article DOI: 10.3389/fpsyt.2018.00658.].

Factors Affecting User Acceptance in Overuse of Smartphones in Mobile Health Services: An Empirical Study Testing a Modified Integrated Model in South Korea

Smartphones have become crucial in people's everyday lives, including in the medical field. However, as people become close to their smartphones, this leads easily to overuse. Overuse leads to fatigue due to lack of sleep, depressive symptoms, and social relationship failure, and in the case of adolescents, it hinders academic achievement. Self-control solutions are needed, and effective tools can be developed through behavioral analysis. Therefore, the aim of this study was to investigate the determinants of users' intentions to use m-Health for smartphone overuse interventions. A research model was based on TAM and UTAUT, which were modified to be applied to the case of smartphone overuse. The studied population consisted of 400 randomly selected smartphone users aged from 19 to 60 years in South Korea. Structural equation modeling was conducted between variables to test the hypotheses using a 95% confidence interval. Perceived ease of use had a very strong direct positive association with perceived usefulness, and perceived usefulness had a very strong direct positive association with behavioral intention to use. Resistance to change had a direct positive association with behavioral intention to use and, lastly, social norm had a very strong direct positive association with behavioral intention to use. The findings that perceived ease of use influenced perceived usefulness, that perceived usefulness influenced behavioral intention to use, and social norm influenced behavioral intention to use were in accordance with prior related research. Other results that were not consistent with previous research imply that these are unique behavioral findings regarding smartphone overuse. This research identifies the critical factors that need to be considered when implementing systems or solutions in the future for tackling the issue of smartphone overuse.

Effects of age and comorbidity on survival vary according to risk grouping among patients with prostate cancer treated using radical prostatectomy: A retrospective competing-risk analysis from the K-CaP registry

A multicenter Korean Prostate Cancer Database (K-CaP) has been established to provide information regarding Korean patients with prostate cancer (PCa). We used the K-CaP registry to investigate the value of age and comorbidity for predicting cancer-specific mortality (CSM) and other-cause mortality (OCM) according to risk grouping.The K-CaP registry includes 2253 patients who underwent radical prostatectomy (RP) between May 2001 and April 2013 at 5 institutions. Preoperative clinicopathologic data were collected and stratified according to the National Comprehensive Cancer Network risk criteria. Survival was evaluated using Gray's modified log-rank test according to risk category, age (<70 years vs ≥70 years), and Charlson comorbidity index (CCI) (0 vs ≥1).The median follow-up was 55.0 months (interquartile range: 42.0-70.0 months). Competing-risk regression analysis revealed that, independent of CCI, ≥70-year-old high-risk patients had significantly greater CSM than <70-year-old high-risk patients (P = .019). However, <70-year-old high-risk patients with a CCI of ≥1 had similar CSM relative to ≥70-year-old patients. Survival was not affected by age or CCI among low-risk or intermediate-risk patients. Multivariate analysis revealed that a CCI of ≥1 was independently associated with a higher risk of CSM (P = .003), while an age of ≥70 years was independently associated with a higher risk of OCM (P = .005).Age and comorbidity were associated with survival after RP among patients with high-risk PCa, although these associations were not observed among low-risk or intermediate-risk patients. Therefore, older patients with high-risk diseases and greater comorbidity may require alternative multidisciplinary treatment.

Angiopoietin-1 and -2 and vascular endothelial growth factor expression in ovarian grafts after cryopreservation using two methods

Objective

The favored method of preserving fertility in young female cancer survivors is cryopreservation and autotransplantation of ovarian tissue. Reducing hypoxia until angiogenesis takes place is essential for the survival of transplanted ovarian tissue. The aim of this study was to investigate the role of angiopoietin-1 (Angpt-1), angiopoietin-2 (Angpt-2), and vascular endothelial growth factor (VEGF) in ovarian tissue grafts that were cryopreserved using two methods.

Methods

Ovarian tissues harvested from ICR mice were divided into three groups: group I (control), no cryopreservation; group II, vitrification in EFS (ethylene-glycol, ficoll, and sucrose solution)-40; and group III, slow freezing in dimethyl sulfoxide. We extracted mRNA for VEGF, Angpt-1, and Angpt-2 from ovarian tissue 1 week following cryopreservation and again 2 weeks after autotransplantation. We used reverse transcriptase-polymerase chain reaction to quantify the levels of VEGF, Angpt-1, and Angpt-2 in the tissue.

Results

Angpt-1 and Angpt-2 expression decreased after cryopreservation in groups II and III. After autotransplantation, Angpt-1 and Angpt-2 expression in ovarian tissue showed different trends. Angpt-1 expression in groups II and III was lower than in group I, but Angpt-2 in groups II and III showed no significant difference from group I. The vitrified ovarian tissues had higher expression of VEGF and Angpt-2 than the slowfrozen ovarian tissues, but the difference was not statistically significant.

Conclusion

Our results indicate that Angpt-2 may play an important role in ovarian tissue transplantation after cryopreservation although further studies are needed to understand its exact function.

Morphology-Controlled Aluminum-Doped Zinc Oxide Nanofibers for Highly Sensitive NO2 Sensors with Full Recovery at Room Temperature

Room-temperature (RT) gas sensitivity of morphology-controlled free-standing hollow aluminum-doped zinc oxide (AZO) nanofibers for NO2 gas sensors is presented. The free-standing hollow nanofibers are fabricated using a polyvinylpyrrolidone fiber template electrospun on a copper electrode frame followed by radio-frequency sputtering of an AZO thin overlayer and heat treatment at 400 °C to burn off the polymer template. The thickness of the AZO layer is controlled by the deposition time. The gas sensor based on the hollow nanofibers demonstrates fully recoverable n-type RT sensing of low concentrations of NO2 (0.5 ppm). A gas sensor fabricated with Al2O3-filled AZO nanofibers exhibits no gas sensitivity below 75 °C. The gas sensitivity of a sensor is determined by the density of molecules above the minimum energy for adsorption, collision frequency of gas molecules with the surface, and available adsorption sites. Based on finite-difference time-domain simulations, the RT sensitivity of hollow nanofiber sensors is ascribed to the ten times higher collision frequency of NO2 molecules confined inside the fiber compared to the outer surface, as well as twice the surface area of hollow nanofibers compared to the filled ones. This approach might lead to the realization of RT sensitive gas sensors with 1D nanostructures.

Clinical experiences and case review of angiotensin II receptor blocker-related angioedema in Korea

Although angiotensin-converting enzyme inhibitor-related angioedema is well known, angiotensin II receptor blocker (ARB)-related angioedema has not been extensively studied because of its lower incidence. Therefore, ARB-related angioedema is likely to be overlooked in the clinical setting. We analysed the medical records of adults who had been prescribed ARB and diagnosed with angioedema between 2009 and 2015. All adults over the age of 18 years who were initially administered ARB between 1 January 2009 and 31 December 2015 were selected as participants in this study. To confirm whether the angioedema was actually due to the administration of ARB, we conducted a chart review. A total of 35 584 patients were prescribed ARB for the first time when visiting the Seoul St. Mary's Hospital during the study period. Twenty-four patients diagnosed with angioedema for other reasons prior to their first prescription of ARB were excluded from this study. ARB-related angioedema was suspected in six of 35 560 patients (0.02%) who were initially prescribed ARB during the study period. The manifestation of ARB-related angioedema ranged from several days (1/6 case) to several years (3/6 cases). Some patients continued taking ARB with intermittent antihistamine or steroid therapy. In such cases, angioedema symptoms improved but did not completely resolve. Its diagnosis can be delayed and the symptoms may be recurrent as symptoms improve with antihistamine use. In some cases, the same person had different reactions depending on the type of ARB. Definitively diagnosing ARB-related angioedema is difficult, and physicians often overlook angioedema without suspecting that it is an adverse effect of ARB. Close attention of physicians and improved patient education can reduce the incidence of ARB-related angioedema.

Phenotyping of Korean patients with better-than-expected efficacy of moderate-intensity statins using tensor factorization

Several studies have been conducted to evaluate the efficacy of statins in Korean and Asian patients. However, most previous studies only observed the percent reduction in low-density lipoprotein cholesterol (LDL-C) and did not consider the effects of various patient conditions simultaneously, such as abnormal test results, patient demographics, and prescribed drugs before taking a statin. Moreover, the characteristics of the patients whose percent reduction in LDL-C was higher than expected were not provided. Therefore, in this study, we aimed to derive meaningful phenotypes by using tensor factorization to observe the characteristics of the patients whose percent reduction in LDL-C was higher than expected among patients taking moderate-intensity statins. In addition, we used the derived phenotypes to predict how much the LDL-C levels of new patients decreased. We consequently identified eight phenotypes that represented the characteristics of the patients whose percent reduction in LDL-C was higher than expected. Moreover, the latent representations of the derived phenotypes achieved prediction performance similar to that obtained using the raw data. These results demonstrate that the derived phenotypes and latent representations are useful tools for observing the characteristics of patients and predicting LDL-C levels. Additionally, our findings provide direction on how to conduct clinical studies in the future.

Change in ALT levels after administration of HMG-CoA reductase inhibitors to subjects with pretreatment levels three times the upper normal limit in clinical practice

AIM

Prescription of statins to patients with chronic liver disease whose alanine transaminase (ALT) is over three times the upper normal limit (UNL) is not recommended. In this study, we attempted to evaluate patients with baseline ALT levels > 3 ×  UNL who were prescribed statins without ethical problems, using electronic medical records.

METHODS

We enrolled subjects with ALT levels > 3 ×  UNL. The patients were divided into three groups consisting of those who had been taking agents affecting liver function (HEPA) and continued to do so after the statin prescription (HepCon), those who had not previously taken HEPA and began doing so after statin prescription (HepNew), and those who had never taken HEPA (HepNo). All ALT levels were determined within 3 months of statins administration, and changes were monitored.

RESULTS

From January 2009 to December 2012, 61 patients with baseline ALT levels > 3 ×  UNL were prescribed statins for the first time. During the 3-month ALT monitoring, levels of the HepCon, HepNew, and HepNo groups decreased by 45 ± 8%, 64 ± 10%, and 42 ± 8%, respectively; however, intergroup differences were not significant (P = .386). All the subjects who were administered statins showed improvement or maintained their ALT levels, except for two subjects, which showed deterioration. However, the ALT levels of the two subjects subsequently remained stable.

CONCLUSION

It is not clear whether it is safe to prescribe statins to patients with ALT > 3 times the UNL. Our study showed that prescription of statins in combination with HEPA did not cause deleterious effects, suggesting that ALT levels > 3 times the UNL do not have harmful effects.

Prevalence Risk of Metabolic Syndrome Associated with Alcohol Use Behavior in Korean Women

OBJECTIVE

Considerable research has been conducted on the relationship between alcohol consumption and metabolic syndrome. Although various standards for the amount and frequency of alcohol consumption have been suggested, a tool to measure individual alcohol use behavior against a consistent standard is required. Moreover, the association of alcohol use behavior with health should be examined on the basis of such a standard. In this study, we examined the relationships between alcohol use behavior according to the Alcohol Use Disorders Identification Test (AUDIT) and metabolic syndrome and its components in Korean women.

METHODS

This study utilized data from the fifth Korean National Health and Nutrition Examination Survey, which was administered from 2010 through 2012. We investigated the relationships between alcohol use behavior and metabolic syndrome and its components in a sample of 2,906 women by using analysis of covariance and logistic regression analysis.

RESULTS

After adjusting for confounding variables, alcohol use behavior was significantly associated with metabolic syndrome [odds ratio (OR) 2.877; 95% confidence interval (CI) 1.523-5.435 in the problem use group]. AUDIT score also was significantly related to abdominal obesity (OR 2.263; 95% CI 1.704-4.459 in the problem use group), hypertension (OR 3.377; 95% CI 1.871-6.095 in the problem use group), hypertriglyceridemia (OR 3.204; 95% CI 1.800-5.702 in the problem use group), and impaired fasting glucose (OR 3.034; 95% CI 1.721-5.348 in the problem use group).

CONCLUSION

In this study, positive associations were observed between AUDIT score and risk of metabolic syndrome and its components.

Studies on Lytic, Tailed Bacillus cereus-specific Phage for Use in a Ferromagnetoelastic Biosensor as a Novel Recognition Element

This study investigated the feasibility of the lytic, tailed Bacillus cereus-specific phage for use in a ferromagnetoelastic (FME) biosensor as a novel recognition element. The phage was immobilized at various concentrations through either direct adsorption or a combination of 11-mercapto-1-undecanoic acid (11-MUA) and [N-(3-dimethylaminopropyl)-N'-carbodiimide hydrochloride and N-hydroxysuccinimide (EDC/NHS)]. The effects of time and temperature on its lytic properties were investigated through the exposure of B. cereus (4 and 8 logCFU/ml) to the phage (8 logPFU/ml) for various incubation periods at 22°C and at various temperatures for 30 and 60 min. As the phage concentration increased, both immobilization methods also significantly increased the phage density (p < 0.05). SEM images confirmed that the phage density on the FME platform corresponded to the increased phage concentration. As the combination of 11-MUA and EDC/NHS enhanced the phage density and orientation by up to 4.3-fold, it was selected for use. When various incubation was conducted, no significant differences were observed in the survival rate of B. cereus within 30 min, which was in contrast to the significant decreases observed at 45 and 60 min (p < 0.05). In addition, temperature exerted no significant effects on the survival rate across the entire temperature range. This study demonstrated the feasibility of the lytic, tailed B. cereus-specific phage as a novel recognition element for use in an FME biosensor. Thus, the phage could be placed on the surface of foods for at least 30 min without any significant loss of B. cereus, as a result of the inherent lytic activity of the B. cereus-specific phage as a novel recognition element.

Isolation and Characterization of a Novel Broad-host-range Bacteriophage Infecting Salmonella enterica subsp. enterica for Biocontrol and Rapid Detection

Bacteriophages have gained substantial attention as biocontrol and biorecognition agents, substituting antibodies. In this study, a Salmonella Enteritidis-specific bacteriophage, KFS-SE1, was isolated, identified, and characterized. This Siphoviridae phage infects S. Enteritidis with high specificity. This phage is highly stable under various pH (5-11), temperature (4-60°C), and organic solvent conditions. The KFS-SE1 genome consisted of 59,715 bp with 73 predicted open reading frames and 57.14% GC content; it had a complete set of genes required for phage reconstruction. Comparative phylogenetic analysis of KFS-SE1 revealed that it was very similar to the other Salmonella phages in the Siphoviridae family. These characteristics suggest that KFS-SE1 with its high specificity and host lysis activity toward S. Enteritidis may have various potential applications.

LAPS Insulin115: A novel ultra-long-acting basal insulin with a unique action profile

AIMS

To conduct a comprehensive pre-clinical study of the novel ultra-long acting insulin analogue ^LAPS Insulin115.

METHODS

Pharmacokinetic/pharmacodynamic studies comparing ^LAPS Insulin115 with other basal insulins were conducted in genetically diabetic (db/db) mice. Insulin signalling in the major target organs was analysed using Western blot after single subcutaneous injection in wild-type male Wistar rats. Using in vitro assays we analysed transendothelial transport, insulin receptor (IR) interaction, and the mitogenic and metabolic properties of ^LAPS Insulin115. Furthermore, IR downregulation after long-term exposure to high concentrations of ^LAPS Insulin115 was analysed using an in vitro desensitization/resensitization model.

RESULTS

The novel Fc-conjugated insulin derivative ^LAPS Insulin115 showed an extensively prolonged pharmacokinetic and pharmacodynamic profile in rodents. Despite its size of 59 kDa, ^LAPS Insulin115 passes the vascular endothelial barrier and induces insulin signalling in all major target tissues in rats. In vitro, ^LAPS Insulin115 showed a very slow onset of action because of its reduced IR affinity; however, after long-term stimulation it was equipotent in respect to its metabolic potency and showed no increased mitogenic action when compared with regular insulin. Remarkably, under conditions of chronic exposure, ^LAPS Insulin115 does not induce irreversible desensitization of target cells, which is probably attributable to much less prominent IR downregulation.

CONCLUSION

Thus, ^LAPS Insulin115 exhibits a unique in vivo and in vitro profile and thereby represents an excellent candidate for a once-weekly insulin analogue.

Pathological and oncological features of Korean prostate cancer patients eligible for active surveillance: analysis from the K-CaP registry

Background

A web-based multicenter Korean Prostate Cancer Database (K-CaP) was established to provide urologists with information on Korean prostate cancer (PCa) patients treated with radical prostatectomy (RP). We utilized the K-CaP registry to identify pathological features and oncological outcomes of Korean PCa patients eligible for active surveillance (AS).

Methods

The K-CaP registry consisted of 6415 patients who underwent RP from May 2001 to April 2013 at five institutions. Preoperative clinicopathological data were collected to identify patients who were eligible for at least one contemporary AS protocol. Patients who had received neoadjuvant androgen deprivation therapy or a 5α-reductase inhibitor, who had <10 total biopsy cores, or who had incomplete data were excluded. Biochemical recurrence (BCR) was defined as prostate-specific antigen (PSA) level ≥0.2 ng/ml following RP.

Results

A total of 560 patients were identified, and the median follow-up period was 52.0 (interquartile range, 39.0-67.3) months. Pathologically insignificant PCa, defined as organ-confined disease with Gleason score ≤6 was observed in 314 (56.1%) patients. Pathological upgrading (Gleason score ≥7) and upstaging (≥pT3) were observed in 237 (42.3%) and 75 (13.4%) patients, respectively. Unfavorable disease (extracapsular extension, seminal vesicle invasion, or Gleason score ≥8) was observed in 85 (15.2%) patients. PSA density ≤0.2 ng/ml/cc and maximal single core involvement ≤20% were revealed as independent preoperative predictors of pathologically insignificant PCa.

Conclusion

Contemporary Western AS protocols unreliably predict pathologically insignificant PCa in Korean men. Korean men may harbor more aggressive PCa features than Western men, and thus, a more stringent AS protocol is needed.

Nutrition and fasting mimicking diets in the prevention and treatment of autoimmune diseases and immunosenescence

Complex and coordinated signals are necessary to initiate and sustain the activation, proliferation, and differentiation of lymphocytes. These signals, which are known to determine T-cell fate and function, also depend on the metabolic state of the organism. Recent studies indicate that both the type and levels of nutrients can influence the generation, survival and function of lymphocytes and therefore can affect several autoimmune diseases. Here, we review the dysregulation of lymphocytes during autoimmunity and aging, the mechanisms associated with loss of immune function, and how fasting mimicking diets and other dietary interventions affect autoimmunity and immunosenescence.