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Ekhtiari H, Sangchooli A, Carmichael O, Moeller FG, O'Donnell P, Oquendo M, Paulus MP, Pizzagalli DA, Ramey T, Schacht J, Zare-Bidoky M, Childress AR, Brady K. Neuroimaging Biomarkers in Addiction. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.02.24312084. [PMID: 39281741 PMCID: PMC11398440 DOI: 10.1101/2024.09.02.24312084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
As a neurobiological process, addiction involves pathological patterns of engagement with substances and a range of behaviors with a chronic and relapsing course. Neuroimaging technologies assess brain activity, structure, physiology, and metabolism at scales ranging from neurotransmitter receptors to large-scale brain networks, providing unique windows into the core neural processes implicated in substance use disorders. Identified aberrations in the neural substrates of reward and salience processing, response inhibition, interoception, and executive functions with neuroimaging can inform the development of pharmacological, neuromodulatory, and psychotherapeutic interventions to modulate the disordered neurobiology. Based on our systematic search, 409 protocols registered on ClinicalTrials.gov include the use of one or more neuroimaging paradigms as an outcome measure in addiction, with the majority (N=268) employing functional magnetic resonance imaging (fMRI), followed by positron emission tomography (PET) (N=71), electroencephalography (EEG) (N=50), structural magnetic resonance imaging (MRI) (N=35) and magnetic resonance spectroscopy (MRS) (N=35). Furthermore, in a PubMed systematic review, we identified 61 meta-analyses including 30 fMRI, 22 structural MRI, 8 EEG, 7 PET, and 3 MRS meta-analyses suggesting potential biomarkers in addictions. These studies can facilitate the development of a range of biomarkers that may prove useful in the arsenal of addiction treatments in the coming years. There is evidence that these markers of large-scale brain structure and activity may indicate vulnerability or separate disease subtypes, predict response to treatment, or provide objective measures of treatment response or recovery. Neuroimaging biomarkers can also suggest novel targets for interventions. Closed or open loop interventions can integrate these biomarkers with neuromodulation in real-time or offline to personalize stimulation parameters and deliver the precise intervention. This review provides an overview of neuroimaging modalities in addiction, potential neuroimaging biomarkers, and their physiologic and clinical relevance. Future directions and challenges in bringing these putative biomarkers from the bench to the bedside are also discussed.
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Affiliation(s)
- Hamed Ekhtiari
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Arshiya Sangchooli
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Owen Carmichael
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - F Gerard Moeller
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Patricio O'Donnell
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Maria Oquendo
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Martin P Paulus
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Diego A Pizzagalli
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Tatiana Ramey
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Joseph Schacht
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Mehran Zare-Bidoky
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Anna Rose Childress
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Kathleen Brady
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
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Boccardi M, Gold M, Mahant V, Marincola FM, Gunn A. Why should academia care about the Target Product Profile? J Transl Med 2024; 22:716. [PMID: 39095839 PMCID: PMC11295361 DOI: 10.1186/s12967-024-05520-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Affiliation(s)
- Marina Boccardi
- German Center for Neurodegenerative Diseases (DZNE), Rostock-Greifswald site, Rostock, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, University of Medicine Rostock, Rostock, Germany.
| | - Michael Gold
- AriLex Life Sciences LLC, Deerfield, IL 60015, USA
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Leyens L, Batchelor J, De Beuckelaer E, Langel K, Hartog B. Unlocking the full potential of digital endpoints for decision making: a novel modular evidence concept enabling re-use and advancing collaboration. Expert Rev Pharmacoecon Outcomes Res 2024; 24:731-741. [PMID: 38747565 DOI: 10.1080/14737167.2024.2334347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/20/2024] [Indexed: 06/17/2024]
Abstract
INTRODUCTION Over the last decade increasing examples indicate opportunities to measure patient functioning and its relevance for clinical and regulatory decision making via endpoints collected through digital health technologies. More recently, we have seen such measures support primary study endpoints and enable smaller trials. The field is advancing fast: validation requirements have been proposed in the literature and regulators are releasing new guidances to review these endpoints. Pharmaceutical companies are embracing collaborations to develop them and working with academia and patient organizations in their development. However, the road to validation and regulatory acceptance is lengthy. The full value of digital endpoints cannot be unlocked until better collaboration and modular evidence frameworks are developed enabling re-use of evidence and repurposing of digital endpoints. AREAS COVERED This paper proposes a solution by presenting a novel modular evidence framework -the Digital Evidence Ecosystem and Protocols (DEEP)- enabling repurposing of measurement solutions, re-use of evidence, application of standards and also facilitates collaboration with health technology assessment bodies. EXPERT OPINION The integration of digital endpoints in healthcare, essential for personalized and remote care, requires harmonization and transparency. The proposed novel stack model offers a modular approach, fostering collaboration and expediting the adoption in patient care.
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Affiliation(s)
- Lada Leyens
- Regulatory Science, DEEP Measures Oy, Helsinki, Finland
- Product Development Regulatory, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | | | - Kai Langel
- Regulatory, Janssen Cilag S.A, Madrid, Spain
| | - Bert Hartog
- Clinical Operations and Innovation, Janssen-Cilag B.V, DS Breda, The Netherlands
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Pasmooij AMG, Mol PGM, Bot JC, Leufkens HGM. The Evolution of Drug Regulatory Sciences in the Netherlands: More than a Country Report. Clin Pharmacol Ther 2024; 116:64-71. [PMID: 38679943 DOI: 10.1002/cpt.3275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/05/2024] [Indexed: 05/01/2024]
Abstract
In the Netherlands, drug regulatory science is a vibrant national and internationally oriented community. In this review, we present the factors that have contributed to this successful collaboration between relevant stakeholders and that led to a surge of activities around how regulatory science became embedded in the ecosystem of medicines research, clinical pharmacology, policymaking and regulation. We distinguished three pivotal episodes: (i) TI Pharma Escher-project, (ii) Dutch Medicines Evaluation Board as catalyst of the big jump, and (iii) Regulatory Science Network Netherlands and multistakeholder engagement. The research agenda has been influenced by the dynamic evolution of legal frameworks in Europe, such as the EU orphan medicines legislation of 2001 and the EU pharmacovigilance legislation of 2012. All these developments have inspired and have raised pertinent regulatory sciences questions. Furthermore, clinical pharmacology as a discipline has been very influential in shaping regulatory science, contributing to discussions on the level of clinical evidence that is necessary to justify marketing approval of a new medicine. With a growing interest of multiple parties such as academics, European Medicines Agency, national agencies, patient organizations and EFPIA, connecting regulatory science activities is key.
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Affiliation(s)
- Anna M G Pasmooij
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- Regulatory Science Network Netherlands, Utrecht, The Netherlands
| | - Peter G M Mol
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
- Regulatory Science Network Netherlands, Utrecht, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacob Cornelis Bot
- Regulatory Science Network Netherlands, Utrecht, The Netherlands
- Janssen Biologics BV, Leiden, The Netherlands
- Lygature, Utrecht, The Netherlands
| | - Hubert G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- Regulatory Science Network Netherlands, Utrecht, The Netherlands
- Lygature, Utrecht, The Netherlands
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Giannuzzi V, Bertolani A, Torretta S, Reggiardo G, Toich E, Bonifazi D, Ceci A. Innovative research methodologies in the EU regulatory framework: an analysis of EMA qualification procedures from a pediatric perspective. Front Med (Lausanne) 2024; 11:1369547. [PMID: 38606157 PMCID: PMC11007141 DOI: 10.3389/fmed.2024.1369547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction The European Medicines Agency (EMA) offers scientific advice to support the qualification procedure of novel methodologies, such as preclinical and in vitro models, biomarkers, and pharmacometric methods, thereby endorsing their acceptability in medicine research and development (R&D). This aspect is particularly relevant to overcome the scarcity of data and the lack of validated endpoints and biomarkers in research fields characterized by small samples, such as pediatrics. Aim This study aimed to analyze the potential pediatric interest in methodologies qualified as "novel methodologies for medicine development" by the EMA. Methods The positive qualification opinions of novel methodologies for medicine development published on the EMA website between 2008 and 2023 were identified. Multi-level analyses were conducted to investigate data with a hierarchical structure and the effects of cluster-level variables and cluster-level variances and to evaluate their potential pediatric interest, defined as the possibility of using the novel methodology in pediatric R&D and the availability of pediatric data. The duration of the procedure, the type of methodology, the specific disease or disease area addressed, the type of applicant, and the availability of pediatric data at the time of the opinion release were also investigated. Results Most of the 27 qualifications for novel methodologies issued by the EMA (70%) were potentially of interest to pediatric patients, but only six of them reported pediatric data. The overall duration of qualification procedures with pediatric interest was longer than that of procedures without any pediatric interest (median time: 7 months vs. 3.5 months, respectively; p = 0.082). In parallel, qualification procedures that included pediatric data lasted for a longer period (median time: 8 months vs. 6 months, respectively; p = 0.150). Nephrology and neurology represented the main disease areas (21% and 16%, respectively), while endpoints, biomarkers, and registries represented the main types of innovative methodologies (32%, 26%, and 16%, respectively). Discussion Our results underscore the importance of implementing innovative methodologies in regulatory-compliant pediatric research activities. Pediatric-dedicated research infrastructures providing regulatory support and strategic advice during research activities could be crucial to the design of ad hoc pediatric methodologies or to extend and validate them for pediatrics.
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Affiliation(s)
- Viviana Giannuzzi
- Department of Research, Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Arianna Bertolani
- Department of Project Development, Consorzio per Valutazioni Biologiche e Farmacologiche (CVBF), Pavia, Italy
- TEDDY, European Network of Excellence for Paediatric Research, Pavia, Italy
| | - Silvia Torretta
- TEDDY, European Network of Excellence for Paediatric Research, Pavia, Italy
| | - Giorgio Reggiardo
- Department of Project Development, Consorzio per Valutazioni Biologiche e Farmacologiche (CVBF), Pavia, Italy
| | - Eleonora Toich
- Department of Project Development, Consorzio per Valutazioni Biologiche e Farmacologiche (CVBF), Pavia, Italy
| | - Donato Bonifazi
- Department of Project Development, Consorzio per Valutazioni Biologiche e Farmacologiche (CVBF), Pavia, Italy
- TEDDY, European Network of Excellence for Paediatric Research, Pavia, Italy
| | - Adriana Ceci
- Department of Research, Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
- TEDDY, European Network of Excellence for Paediatric Research, Pavia, Italy
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Mészáros L, Guizzaro L. Developing medicines for the pre-symptomatic stage of degenerative neurological conditions: Challenges and opportunities. Rev Neurol (Paris) 2024; 180:141-146. [PMID: 37558575 DOI: 10.1016/j.neurol.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/19/2023] [Indexed: 08/11/2023]
Abstract
Neurodegenerative disorders have a devastating disease course and an increasing prevalence due to prolonged life expectancy. In the last decades, it has become increasingly clear that these diseases often start much earlier, before the onset of symptoms, creating a potential window for pre-symptomatic treatment, a strategy that is desirable from both the biologic and the ethical point of view. However, studying treatments for a pre-symptomatic population presents objective difficulties. This article intends to give a perspective about opportunities and challenges of pre-symptomatic prevention of neurodegenerative diseases. Besides the requirement for biomarkers that would facilitate both the selection of study population and demonstrating a treatment effect, further considerations about balancing benefits, risks and uncertainties pertaining a pre-symptomatic population will be examined.
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Affiliation(s)
- L Mészáros
- Human Medicines, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, Netherlands
| | - L Guizzaro
- Human Medicines, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, Netherlands.
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Van Spall HGC, Bastien A, Gersh B, Greenberg B, Mohebi R, Min J, Strauss K, Thirstrup S, Zannad F. The role of early-phase trials and real-world evidence in drug development. NATURE CARDIOVASCULAR RESEARCH 2024; 3:110-117. [PMID: 39196202 DOI: 10.1038/s44161-024-00420-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/22/2023] [Indexed: 08/29/2024]
Abstract
Phase 3 randomized controlled trials (RCTs), while the gold standard for treatment efficacy and safety, are not always feasible, are expensive, can be prolonged and can be limited in generalizability. Other under-recognized sources of evidence can also help advance drug development. Basic science, proof-of-concept studies and early-phase RCTs can provide evidence regarding the potential for clinical benefit. Real-world evidence generated from registries or observational datasets can provide insights into the treatment of rare diseases that often pose a challenge for trial recruitment. Pragmatic trials embedded in healthcare systems can assess the treatment effects in clinical settings among patient populations sometimes excluded from trials. This Perspective discusses potential sources of evidence that may be used to complement explanatory phase 3 RCTs and to speed the development of new cardiovascular medications. Content is derived from the 19th Global Cardiovascular Clinical Trialists meeting (December 2022), involving clinical trialists, patients, clinicians, regulators, funders and industry representatives.
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Affiliation(s)
- Harriette G C Van Spall
- Department of Medicine, Department of Health Research Methods, Evidence, and Impact; Research Institute of St. Joseph's, McMaster University, Hamilton, Ontario, Canada
- Baim Institute for Clinical Research, Boston, MA, USA
| | | | - Bernard Gersh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Barry Greenberg
- Division of Cardiology, UC San Diego Health, San Diego, CA, USA
| | - Reza Mohebi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Faiez Zannad
- Université de Lorraine, Inserm Clinical Investigation Center at Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy, Nancy, France.
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8
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Kumarasamy G, Mohd Salim NH, Mohd Afandi NS, Hazlami Habib MA, Mat Amin ND, Ismail MN, Musa M. Glycoproteomics-based liquid biopsy: translational outlook for colorectal cancer clinical management in Southeast Asia. Future Oncol 2023; 19:2313-2332. [PMID: 37937446 DOI: 10.2217/fon-2023-0704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Colorectal cancer (CRC) signifies a significant healthcare challenge in Southeast Asia. Despite advancements in screening approaches and treatment modalities, significant medical gaps remain, ranging from prevention and early diagnosis to determining targeted therapy and establishing personalized approaches to managing CRC. There is a need to expand more validated biomarkers in clinical practice. An advanced technique incorporating high-throughput mass spectrometry as a liquid biopsy to unravel a repertoire of glycoproteins and glycans would potentially drive the development of clinical tools for CRC screening, diagnosis and monitoring, and it can be further adapted to the existing standard-of-care procedure. Therefore this review offers a perspective on glycoproteomics-driven liquid biopsy and its potential integration into the clinical care of CRC in the southeast Asia region.
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Affiliation(s)
- Gaayathri Kumarasamy
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Pulau Pinang, 11800, Malaysia
| | - Nurul Hakimah Mohd Salim
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia
| | - Nur Syafiqah Mohd Afandi
- Analytical Biochemistry Research Centre, Universiti Sains Malaysia, Bayan Lepas, Pulau Pinang, 11900, Malaysia
| | - Mohd Afiq Hazlami Habib
- Analytical Biochemistry Research Centre, Universiti Sains Malaysia, Bayan Lepas, Pulau Pinang, 11900, Malaysia
| | - Nor Datiakma Mat Amin
- Analytical Biochemistry Research Centre, Universiti Sains Malaysia, Bayan Lepas, Pulau Pinang, 11900, Malaysia
- Nature Products Division, Forest Research Institute Malaysia, Kepong, Selangor, 52109, Malaysia
| | - Mohd Nazri Ismail
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Pulau Pinang, 11800, Malaysia
- Analytical Biochemistry Research Centre, Universiti Sains Malaysia, Bayan Lepas, Pulau Pinang, 11900, Malaysia
| | - Marahaini Musa
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia
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9
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Bakker E, Starokozhko V, Kraaijvanger JWM, Heerspink HJL, Mol PGM. Precision medicine in regulatory decision making: Biomarkers used for patient selection in European Public Assessment Reports from 2018 to 2020. Clin Transl Sci 2023; 16:2394-2412. [PMID: 37853917 PMCID: PMC10651650 DOI: 10.1111/cts.13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 07/22/2023] [Accepted: 08/21/2023] [Indexed: 10/20/2023] Open
Abstract
Biomarkers can guide precision medicine in clinical trials and practice. They can increase clinical trials' efficiency through selection of study populations more likely to benefit from treatment, thus increasing statistical power and reducing sample size requirements or study duration. We performed a narrative synthesis to explore biomarker utilization for patient selection to guide precision medicine trials in marketing authorization dossiers of centrally approved medicines in Europe between 2018 and 2020 and analyzed in-depth those that eventually included biomarkers in the medicines' indications. From 119 eligible products, 26 included a biomarker in the indication, of which most were oncology products (n = 15). Included biomarkers were often known from literature or from previously approved products in the European Union or the United States. Additionally, 52 dossiers mentioned one or more biomarkers for patient selection in their clinical efficacy and safety information. Although these were not always included in the medicines' indication, they were often implicitly embedded in condition definitions adopted from clinical guidelines or practice. In 15 out of the 26 medicines with a biomarker-guided indication, only biomarker-positive populations were included in the main clinical studies supporting the marketing authorization. These studies were mostly randomized controlled trials or single-arm trials; only two products were studied for multiple indications in an innovative basket trial. Definitions of biomarkers could be subject of debate and needed adaptation after post hoc analyses requested by the assessment committee in four cases, stressing the importance of thorough justification of these definitions to include the right population for an optimal benefit-risk balance, enabling precise medicine.
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Affiliation(s)
- Elisabeth Bakker
- University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Viktoriia Starokozhko
- University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
- Dutch Medicines Evaluation Board, CBG‐MEBUtrechtThe Netherlands
| | - Jet W. M. Kraaijvanger
- Dutch Medicines Evaluation Board, CBG‐MEBUtrechtThe Netherlands
- VU University AmsterdamAmsterdamThe Netherlands
| | | | - Peter G. M. Mol
- University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
- Dutch Medicines Evaluation Board, CBG‐MEBUtrechtThe Netherlands
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10
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Huang HJ, Chou CL, Sandar TT, Liu WC, Yang HC, Lin YC, Zheng CM, Chiu HW. Currently Used Methods to Evaluate the Efficacy of Therapeutic Drugs and Kidney Safety. Biomolecules 2023; 13:1581. [PMID: 38002263 PMCID: PMC10669823 DOI: 10.3390/biom13111581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Kidney diseases with kidney failure or damage, such as chronic kidney disease (CKD) and acute kidney injury (AKI), are common clinical problems worldwide and have rapidly increased in prevalence, affecting millions of people in recent decades. A series of novel diagnostic or predictive biomarkers have been discovered over the past decade, enhancing the investigation of renal dysfunction in preclinical studies and clinical risk assessment for humans. Since multiple causes lead to renal failure, animal studies have been extensively used to identify specific disease biomarkers for understanding the potential targets and nephropathy events in therapeutic insights into disease progression. Mice are the most commonly used model to investigate the mechanism of human nephropathy, and the current alternative methods, including in vitro and in silico models, can offer quicker, cheaper, and more effective methods to avoid or reduce the unethical procedures of animal usage. This review provides modern approaches, including animal and nonanimal assays, that can be applied to study chronic nonclinical safety. These specific situations could be utilized in nonclinical or clinical drug development to provide information on kidney disease.
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Affiliation(s)
- Hung-Jin Huang
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan (C.-L.C.)
| | - Chu-Lin Chou
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan (C.-L.C.)
- Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan City 320, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei 110, Taiwan
| | - Tin Tin Sandar
- Cancer Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Wen-Chih Liu
- Department of Biology and Anatomy, National Defense Medical Center, Taipei 114, Taiwan
- Section of Nephrology, Department of Medicine, Antai Medical Care Corporation Antai Tian-Sheng Memorial Hospital, Pingtung 928, Taiwan
| | - Hsiu-Chien Yang
- Division of Nephrology, Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung 813, Taiwan
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Yen-Chung Lin
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan (C.-L.C.)
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei 110, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - Cai-Mei Zheng
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan (C.-L.C.)
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei 110, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
| | - Hui-Wen Chiu
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei 110, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
- Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, Taipei 110, Taiwan
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11
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Boccardi M. Translational process. J Transl Med 2023; 21:677. [PMID: 37770943 PMCID: PMC10540412 DOI: 10.1186/s12967-023-04507-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Affiliation(s)
- Marina Boccardi
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock-Greifswald Standort, Rostock, Germany.
- Department of Psychosomatic Medicine and Centre for Transdisciplinary Neurosciences, Rostock University of Medicine, Rostock, Germany.
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12
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Manoli I, Gebremariam A, McCoy S, Pass AR, Gagné J, Hall C, Ferry S, Van Ryzin C, Sloan JL, Sacchetti E, Catesini G, Rizzo C, Martinelli D, Spada M, Dionisi-Vici C, Venditti CP. Biomarkers to predict disease progression and therapeutic response in isolated methylmalonic acidemia. J Inherit Metab Dis 2023; 46:554-572. [PMID: 37243446 PMCID: PMC10330948 DOI: 10.1002/jimd.12636] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/28/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023]
Abstract
Methylmalonic Acidemia (MMA) is a heterogenous group of inborn errors of metabolism caused by a defect in the methylmalonyl-CoA mutase (MMUT) enzyme or the synthesis and transport of its cofactor, 5'-deoxy-adenosylcobalamin. It is characterized by life-threatening episodes of ketoacidosis, chronic kidney disease, and other multiorgan complications. Liver transplantation can improve patient stability and survival and thus provides clinical and biochemical benchmarks for the development of hepatocyte-targeted genomic therapies. Data are presented from a US natural history protocol that evaluated subjects with different types of MMA including mut-type (N = 91), cblB-type (15), and cblA-type MMA (17), as well as from an Italian cohort of mut-type (N = 19) and cblB-type MMA (N = 2) subjects, including data before and after organ transplantation in both cohorts. Canonical metabolic markers, such as serum methylmalonic acid and propionylcarnitine, are variable and affected by dietary intake and renal function. We have therefore explored the use of the 1-13 C-propionate oxidation breath test (POBT) to measure metabolic capacity and the changes in circulating proteins to assess mitochondrial dysfunction (fibroblast growth factor 21 [FGF21] and growth differentiation factor 15 [GDF15]) and kidney injury (lipocalin-2 [LCN2]). Biomarker concentrations are higher in patients with the severe mut0 -type and cblB-type MMA, correlate with a decreased POBT, and show a significant response postliver transplant. Additional circulating and imaging markers to assess disease burden are necessary to monitor disease progression. A combination of biomarkers reflecting disease severity and multisystem involvement will be needed to help stratify patients for clinical trials and assess the efficacy of new therapies for MMA.
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Affiliation(s)
- Irini Manoli
- Metabolic Medicine Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Abigael Gebremariam
- Metabolic Medicine Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Samantha McCoy
- Metabolic Medicine Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Alexandra R. Pass
- Metabolic Medicine Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jack Gagné
- Metabolic Medicine Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Camryn Hall
- Metabolic Medicine Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Susan Ferry
- Metabolic Medicine Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Carol Van Ryzin
- Metabolic Medicine Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jennifer L. Sloan
- Metabolic Medicine Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Elisa Sacchetti
- Division of Metabolic Diseases, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Giulio Catesini
- Division of Metabolic Diseases, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Cristiano Rizzo
- Division of Metabolic Diseases, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Diego Martinelli
- Division of Metabolic Diseases, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Marco Spada
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Tranplantation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- European Research Network TransplantChild
| | - Carlo Dionisi-Vici
- Division of Metabolic Diseases, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Charles P. Venditti
- Metabolic Medicine Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
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13
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Bernhardt AM, Tiedt S, Teupser D, Dichgans M, Meyer B, Gempt J, Kuhn PH, Simons M, Palleis C, Weidinger E, Nübling G, Holdt L, Hönikl L, Gasperi C, Giesbertz P, Müller SA, Breimann S, Lichtenthaler SF, Kuster B, Mann M, Imhof A, Barth T, Hauck SM, Zetterberg H, Otto M, Weichert W, Hemmer B, Levin J. A unified classification approach rating clinical utility of protein biomarkers across neurologic diseases. EBioMedicine 2023; 89:104456. [PMID: 36745974 PMCID: PMC9931915 DOI: 10.1016/j.ebiom.2023.104456] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/22/2022] [Accepted: 01/17/2023] [Indexed: 02/07/2023] Open
Abstract
A major evolution from purely clinical diagnoses to biomarker supported clinical diagnosing has been occurring over the past years in neurology. High-throughput methods, such as next-generation sequencing and mass spectrometry-based proteomics along with improved neuroimaging methods, are accelerating this development. This calls for a consensus framework that is broadly applicable and provides a spot-on overview of the clinical validity of novel biomarkers. We propose a harmonized terminology and a uniform concept that stratifies biomarkers according to clinical context of use and evidence levels, adapted from existing frameworks in oncology with a strong focus on (epi)genetic markers and treatment context. We demonstrate that this framework allows for a consistent assessment of clinical validity across disease entities and that sufficient evidence for many clinical applications of protein biomarkers is lacking. Our framework may help to identify promising biomarker candidates and classify their applications by clinical context, aiming for routine clinical use of (protein) biomarkers in neurology.
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Affiliation(s)
- Alexander M Bernhardt
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Neurodegenerative Diseases, Site Munich, Germany
| | - Steffen Tiedt
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Teupser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Martin Dichgans
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Peer-Hendrik Kuhn
- Institute of Pathology, Technische Universität München, Munich, Germany
| | - Mikael Simons
- German Center for Neurodegenerative Diseases, Site Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Institute of Neuronal Cell Biology, Technical University Munich, 80802, Munich, Germany
| | - Carla Palleis
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Neurodegenerative Diseases, Site Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Endy Weidinger
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Neurodegenerative Diseases, Site Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Georg Nübling
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Neurodegenerative Diseases, Site Munich, Germany
| | - Lesca Holdt
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Lisa Hönikl
- Department of Neurosurgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christiane Gasperi
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Pieter Giesbertz
- German Center for Neurodegenerative Diseases, Site Munich, Germany; Neuroproteomics, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan A Müller
- German Center for Neurodegenerative Diseases, Site Munich, Germany; Neuroproteomics, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan Breimann
- German Center for Neurodegenerative Diseases, Site Munich, Germany; Neuroproteomics, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Department of Bioinformatics, Wissenschaftszentrum Weihenstephan, Technical University of Munich, Freising, Germany
| | - Stefan F Lichtenthaler
- German Center for Neurodegenerative Diseases, Site Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; Neuroproteomics, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Kuster
- Chair of Proteomics and Bioanalytics, Technical University of Munich, Freising, Germany; German Cancer Consortium (DKTK), Munich Partner Site, Munich, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias Mann
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Axel Imhof
- Protein Analysis Unit, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-University (LMU) Munich, Großhaderner Straße 9, 82152, Martinsried, Germany
| | - Teresa Barth
- Protein Analysis Unit, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-University (LMU) Munich, Großhaderner Straße 9, 82152, Martinsried, Germany
| | - Stefanie M Hauck
- Research Unit Protein Science and Metabolomics and Proteomics Core, Helmholtz Centre Munich, German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK; UK Dementia Research Institute at UCL, London, UK; Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Markus Otto
- Department of Neurology, Halle University Hospital, Martin Luther University Halle/Wittenberg, Saale, Germany
| | - Wilko Weichert
- Institute of Pathology, Technische Universität München, Munich, Germany
| | - Bernhard Hemmer
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Neurodegenerative Diseases, Site Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
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14
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Kallio MJ, Starokozhko V, Agricola E, Burggraf M, Heß A, Ballensiefen W, Löbker W, Nuevo Y, Pasmooij AMG, Mol PGM. Translating Academic Drug Discovery Into Clinical Development: A Survey of the Awareness of Regulatory Support and Requirements Among Stakeholders in Europe. Clin Pharmacol Ther 2023; 113:349-359. [PMID: 36326573 PMCID: PMC10099080 DOI: 10.1002/cpt.2789] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022]
Abstract
Important discoveries by academic drug developers hold the promise of bringing innovative treatments that address unmet medical needs to the market. However, the drug development process has proved to be challenging and demanding for academic researchers, and regulatory challenges are an important barrier to implementing academic findings in clinical practice. European regulators offer varying degrees of support services to help drug developers meet regulatory standards and requirements. "Strengthening Training of Academia in Regulatory Sciences and Supporting Regulatory Scientific Advice" (STARS) is a European Commission-funded consortium aiming to strengthen the training of academics in regulatory science and requirements. Here, we report the results of four surveys that investigated the awareness and utilization of support tools offered by European regulators and identified the regulatory challenges and support needs of researchers. The surveys targeted four main European stakeholders in academic medicines research: academic research groups (706 respondents), academic research centers (99), funding organizations (49), and regulators (22). The results show that while European regulators provide various regulatory support tools, less than half of the responding academic researchers were aware of these tools and many experienced challenges in reaching a sufficient level of regulatory knowledge. There was a general lack of understanding of the regulatory environment that was aggravated by poor communication between stakeholders. The results of this study form a foundation for an improved European medicines regulatory network, in which regulatory challenges faced by academia are tackled.
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Affiliation(s)
| | - Viktoriia Starokozhko
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | - Anne Heß
- Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - Wolfgang Ballensiefen
- German Aerospace Center, Project Management Agency, Health, Innovation for Disease Related Research and Personalised Medicine, Bonn, Germany
| | - Wiebke Löbker
- Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - Yoana Nuevo
- Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | | | - Peter G M Mol
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,European Medicines Agency, Amsterdam, The Netherlands
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15
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Lutz MW, Khachaturian AS, Zetterberg H, Blennow K, Willette AA, Mielke MM, Hayden KM, Dodge HH, Tang Y, Greenberg BD, Kukull WA, Khachaturian ZS. Biomarkers of Alzheimer syndrome and related dementias: A&D author's guide. Alzheimers Dement 2022; 18:1595-1601. [PMID: 36005812 PMCID: PMC9514317 DOI: 10.1002/alz.12772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Michael W. Lutz
- Department of NeurologyDuke University School of MedicineDurhamNCUSA
| | - Ara S. Khachaturian
- Alzheimer's & Dementia: The Journal of the Alzheimer's AssociationRockvilleMDUSA
| | - Henrik Zetterberg
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and PhysiologyThe Sahlgrenska Academy at the University of GothenburgMölndalSweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University HospitalMölndalSweden
- Department of Neurodegenerative DiseaseUCL Institute of Neurology, Queen SquareLondonUK
- UK Dementia Research Institute at UCLLondonUK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water BayHong KongChina
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of GothenburgGothenburgSweden
| | - Auriel A. Willette
- Department of Food Science and Human NutritionIowa State UniversityAmesIAUSA
- IAC Tracker Inc.AmesIAUSA
| | - Michelle M. Mielke
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNCUSA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health PolicyDivision of Public Health SciencesWake Forest University School of Medicine, Winston‐SalemNCUSA
| | - Hiroko H. Dodge
- Department of NeurologyLayton Aging and Alzheimer's Disease CenterOregon Health & Science UniversityPortlandORUSA
| | - Yi Tang
- Department of Neurology, Innovation Center for Neurological DisordersXuanwu Hospital, Capital Medical UniversityNational Center for Neurological DisordersBeijingChina
| | - Barry D. Greenberg
- Department of Neurology, Director, Alzheimer's Disease Translational CenterJohns Hopkins University School of MedicineBaltimoreMDUSA
- Alzheimer's & Dementia: Translational Research and Clinical InterventionsBaltimoreMDUSA
| | - Walter A Kukull
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Zaven S Khachaturian
- Alzheimer's & Dementia: The Journal of the Alzheimer's AssociationRockvilleMDUSA
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16
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Hendrikse NM, Llinares Garcia J, Vetter T, Humphreys AJ, Ehmann F. Biomarkers in Medicines Development-From Discovery to Regulatory Qualification and Beyond. Front Med (Lausanne) 2022; 9:878942. [PMID: 35559349 PMCID: PMC9086587 DOI: 10.3389/fmed.2022.878942] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Biomarkers are important tools in medicines development and clinical practice. Besides their use in clinical trials, such as for enrichment of patients, monitoring safety or response to treatment, biomarkers are a cornerstone of precision medicine. The European Medicines Agency (EMA) emphasised the importance of the discovery, qualification, and use of biomarkers in their Regulatory Science Strategy to 2025, which included the recommendation to enhance early engagement with biomarker developers to facilitate regulatory qualification. This study explores the journey of biomarkers through the EU regulatory system and beyond, based on a review of interactions between developers and the EMA from 2008 to 2020, as well as the use of qualified biomarkers in clinical trials. Of applicants that used early interaction platforms such as the Innovation Task Force, less than half engaged in fee-related follow-up procedures. Results showed that, as compared to companies, consortia were more likely to opt for the Qualification of Novel Methodologies procedure and engage in follow-up procedures. Our results highlight the importance of early engagement with regulators for achieving biomarker qualification, including pre-submission discussions in the context of the qualification procedure. A review of clinical trials showed that all qualified biomarkers are used in practice, although not always according to the endorsed context of use. Overall, this study highlights important aspects of biomarker qualification, including opportunities to improve the seamless support for developers by EMA. The use of qualified biomarkers in clinical trials underlines the importance of regulatory qualification, which will further enable precision medicine for the benefit of patients.
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Affiliation(s)
- Natalie M Hendrikse
- Regulatory Science and Innovation Task Force, European Medicines Agency, Amsterdam, Netherlands
| | - Jordi Llinares Garcia
- Regulatory Science and Innovation Task Force, European Medicines Agency, Amsterdam, Netherlands
| | - Thorsten Vetter
- Scientific Advice Office, European Medicines Agency, Amsterdam, Netherlands
| | - Anthony J Humphreys
- Regulatory Science and Innovation Task Force, European Medicines Agency, Amsterdam, Netherlands
| | - Falk Ehmann
- Regulatory Science and Innovation Task Force, European Medicines Agency, Amsterdam, Netherlands
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Maliepaard M, Nibi P, Nibi G, Pasmooij AMG. Evaluation of Companion Diagnostics in Scientific Advice and Drug Marketing Authorization Applications by the European Medicines Agency. Front Med (Lausanne) 2022; 9:893028. [PMID: 35602486 PMCID: PMC9120537 DOI: 10.3389/fmed.2022.893028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/11/2022] [Indexed: 12/02/2022] Open
Abstract
With the implementation of the new EU regulation on in vitro diagnostics (IVDR) in May 2022, notified bodies will be required to assess Companion Diagnostics (CDx). The EMA and national medicines agencies will be consulted on the performance and safety of CDx. In this paper, we report on our systematic review on how the EMA has dealt with CDx in dossiers for marketing authorization procedures, in 2017–2019, and in scientific advice procedures in 2016–2020, prior to the implementation of the new IVDR. Out of 167 medicines approved or refused by the EMA, CDx played a role for 20 medicines during assessment. Both European public assessment reports (EPARs) and the internal day 80 and day 120 assessment reports (ARs) of the EMA centralized marketing authorization procedures for these 20 medicines were analyzed in detail to determine how CDx were assessed. Likewise, in 46 of 159 cases in which scientific advice was provided, CDx were mentioned in the question-and-answer section of the scientific advice, and these were analyzed in an analogous manner. Our analysis indicates that clinical performance and analytical performance of the CDx were the most-discussed topics, being discussed 11 and seven times in the 20 EPARs and 59 and 29 times in the ARs, respectively. For scientific advice, clinical and analytical performance was discussed 65 and 22 times in the 46 retrieved mentions of scientific advice. Other aspects in relation to CDx were discussed as well, although at a lower frequency, in assessment reports and scientific advice. Overall, our analysis demonstrates that, despite the absence of an obligation from a legal point of view, EMA has gained experience on the assessment of CDx, most notably regarding its analytical and clinical performance. This experience may be useful in situations in which the EMA and national agencies of EU member states will formally be consulted by notified bodies regarding the performance and safety of CDx. In addition, the issues raised in the EPARs, ARs and scientific advice reports provide insight for applicants on aspects of CDx that need careful consideration.
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Affiliation(s)
- Marc Maliepaard
- Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, Netherlands
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, Netherlands
- *Correspondence: Marc Maliepaard
| | - Priscilla Nibi
- Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, Netherlands
| | - Gabrièlla Nibi
- Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, Netherlands
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