1
|
Soriano JB, Polverino F. Sexual activity and respiratory disease: A systematic review. Respir Med 2024; 228:107665. [PMID: 38768665 DOI: 10.1016/j.rmed.2024.107665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/03/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
CONTEXT Sex and gender are related concepts, but they have distinct meanings and implications. Respiratory diseases are a major driver of morbi-mortality. It is frequent that respirologists, primary care doctors, or other specialists, when dealing with respiratory patients, and aiming for a holistic management of their patients, they all skip any question or matter associated with sexual activity or behavior. OBJECTIVES To review how sexual activity is explored in respiratory patients. METHODS To conduct this review, we endorse PRISMA guidance for reporting systematic reviews, and also the sex and gender equity in research (SAGER) guidelines. RESULTS Compared to other conditions such as heart disease, mental disorders, Alzheimer's, or even COVID-19, to date there is no review focused on sexual activity and respiratory health and disease. Asthma, COPD and other respiratory patients can have their sexual activity and behaviors affected by their disease, but also limitations in sex might be the sentinel event of an incident respiratory disease. Asking on sexual desire and related sex issues should not be considered taboo in any respiratory consultation. Importantly, any marketed stereotypes on cigarettes after any sexual activity should be counteracted. Many clinical trials of respiratory drugs keep recruiting few or no women, so research on women's sexual desire and satisfaction lags behind that of men's. By using the available objective tools and validated questionnaires summarized in this review, these important domains of respiratory patients and their partners can be properly identified and managed. CONCLUSIONS Sexual activity, depending on age and individual specific conditions, is a fundamental driver of overall health, and therefore of lung health.
Collapse
Affiliation(s)
- Joan B Soriano
- Facultat de Medicina, Universitat de les Illes Balears, Palma de Mallorca, Spain; Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, Spain; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Francesca Polverino
- Pulmonary and Critical Care Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.
| |
Collapse
|
2
|
Younes S. The relationship between gender and pharmacology. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2024; 7:100192. [PMID: 39101002 PMCID: PMC11295939 DOI: 10.1016/j.crphar.2024.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/28/2024] [Accepted: 06/11/2024] [Indexed: 08/05/2024] Open
Abstract
The part of sexuality in pharmacology research was not acknowledged, and it was not thought-out to be a determinant that could impact strength and disease. For decades research has mainly contained male, women and animals, leading to a lack of news about syndromes in females. Still, it is critical to guarantee equal likeness so that determine the security, influence, and resistance of healing agents for all individuals. The underrepresentation of female models in preclinical studies over various decades has surpassed to disparities in the understanding, disease, and treatment of ailments 'tween genders. The closeness of sexuality bias has happened recognized as a contributing determinant to the restricted interpretation and replicability of preclinical research. Many demands operation have stressed the significance of including sexuality as a organic changeable, and this view is acquire growing support. Regardless of important progress in incorporating more female models into preclinical studies, differences prevail contemporary. The current review focuses on the part of sexuality and common in biomedical research and, therefore, their potential function in pharmacology and analyze the potential risks guide.
Collapse
Affiliation(s)
- Samer Younes
- Department of Pharmacy, Tartous University, Syria
| |
Collapse
|
3
|
Allegra S, Chiara F, Di Grazia D, Gaspari M, De Francia S. Evaluation of Sex Differences in Preclinical Pharmacology Research: How Far Is Left to Go? Pharmaceuticals (Basel) 2023; 16:786. [PMID: 37375734 DOI: 10.3390/ph16060786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/10/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Until the last quarter of the 20th century, sex was not recognized as a variable in health research, nor was it believed to be a factor that could affect health and illness. Researchers preferred studying male models for a variety of reasons, such as simplicity, lower costs, hormone confounding effects, and fear of liability from perinatal exposure in case of pregnancy. Equitable representation is imperative for determining the safety, effectiveness, and tolerance of therapeutic agents for all consumers. Decades of female models' underrepresentation in preclinical studies has resulted in inequality in the understanding, diagnosis, and treatment of disease between the sexes. Sex bias has been highlighted as one of the contributing factors to the poor translation and replicability of preclinical research. There have been multiple calls for action, and the inclusion of sex as a biological variable is increasingly supported. However, although there has been substantial progress in the efforts to include more female models in preclinical studies, disparities today remain. In the present review, we consider the current standard practice of the preclinical research setting, why the sex bias exists, why there is the need to include female models, and what risks may arise from continuing this exclusion from experimental design.
Collapse
Affiliation(s)
- Sarah Allegra
- Department of Biological and Clinical Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Francesco Chiara
- Department of Biological and Clinical Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Daniela Di Grazia
- Department of Biological and Clinical Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Marco Gaspari
- Department of Biological and Clinical Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Silvia De Francia
- Department of Biological and Clinical Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| |
Collapse
|
4
|
Ratri DMN, Puspitasari AD, Nugroho CW, Suprapti B, Suharjono, Alderman CP. Gender differences in the blood glucose type 2 diabetes patients with combination rapid and long acting insulin therapy. J Basic Clin Physiol Pharmacol 2021; 32:567-570. [PMID: 34214351 DOI: 10.1515/jbcpp-2020-0463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Previous research suggests that there may be intergender differences in the profile of glycemic control achievable during the treatment of type 2 diabetes mellitus. This preliminary study was conducted to determine differences in glycemic outcomes in type 2 diabetes mellitus patients amongst men and women in an Indonesian hospital. METHODS The study was conducted at the outpatient internal medicine polyclinic of Universitas Airlangga Teaching Hospital Surabaya. This observational prospective cohort study examining outcomes for 64 patients (32 men and 32 women) treated with insulin therapy. The primary outcome measure was the extent to which subjects achieved concordance with the target blood glucose parameters based on the American Diabetes Association (ADA) guidance. RESULTS After 3 months of combination basal-bolus insulin treatment, the proportion of subjects who had fasting blood glucose values in the target range did not increase for either gender. For women, there was a significantly higher proportion of subjects who achieved a postprandial glucose value within the target range (p=0.04). CONCLUSIONS In this study, patients achieved postprandial glycemic outcomes for women but not men. More research is required to elucidate the possible intergender difference in results for subjects treated with basal-bolus insulin for type 2 diabetes mellitus.
Collapse
Affiliation(s)
- Dinda M N Ratri
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, East Java, Indonesia.,Department of Pharmacy, Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | - Arina D Puspitasari
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, East Java, Indonesia.,Department of Pharmacy, Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | - Cahyo W Nugroho
- Internal Medicine Department, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia.,Internal Medicine Department, Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | - Budi Suprapti
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, East Java, Indonesia.,Department of Pharmacy, Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | - Suharjono
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Christoper P Alderman
- Faculty of Pharmacy, Universitas Airlangga, Surabaya, East Java, Indonesia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| |
Collapse
|
5
|
Orimadegun AE, Adepoju AA, Myer L. A Systematic Review and Meta-analysis of Sex Differences in Morbidity and Mortality of Acute Lower Respiratory Tract Infections Among African Children. JOURNAL OF PEDIATRICS REVIEW 2020; 8:65-78. [PMID: 33043060 DOI: 10.32598/jpr.8.2.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Context Although biological sex influences Acute Lower Respiratory Tract Infections (ALRIs) morbidity and mortality patterns in children living in sub-Saharan Africa, the exact mechanism about the effect is unknown. Objective We assessed the quality and strength of evidence on the association of sex with incidence, etiology, and outcomes of ALRI in African children. Data Sources Study Selection and Data Extraction We systematically searched electronic databases for publications from 1971-2016 in PubMed, African Journals Online, and Google scholar for ALRI literature in the African children. We used (pneumonia OR bronchiolitis OR "community-acquired pneumonia" OR CAP OR "hospital-acquired pneumonia" OR "nosocomial pneumonia" OR "ventilator-acquired pneumonia" OR "lung abscess" OR "pleural effusion" OR "empyema thoracis") AND (sex OR gender) AND (Africa OR Sub-Saharan) as search terms. We included the published peer-reviewed journal articles reporting on incidence, etiology, and case fatality. We summarized the findings using narrative and meta-analysis methods. Results We included 14 studies with sex-related data; the median (IQR) number of reported pneumonia cases was 148 (87-770) and 114 (56-599) for male and female patients, respectively. Only two studies reported a sex-specific incidence. The odds of sex were in favor of male sex, and the chances of identification of Respiratory Syncytia Virus (RSV) were significantly lower in males than in females (OR=0.60; 95% CI: 0.42, 0.86). Estimates from 9 studies showed that the death rate for males was significantly higher than for females (OR=1.26; 95% CI=1.20-1.33). Conclusions Sex-disaggregated data on incidence, etiology, and case fatality of pneumonia are scarcely reported in studies published in Africa. However, males appear to die more often than females, and females more likely to have RSV infection.
Collapse
Affiliation(s)
- Adebola E Orimadegun
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adedayo A Adepoju
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
6
|
Tozzo P, Zullo S, Caenazzo L. Science Runs and the Debate Brakes: Somatic Gene-Editing as a New Tool for Gender-Specific Medicine in Alzheimer's Disease. Brain Sci 2020; 10:brainsci10070421. [PMID: 32630809 PMCID: PMC7408320 DOI: 10.3390/brainsci10070421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/29/2020] [Indexed: 12/21/2022] Open
Abstract
Gender-specific medicine is a discipline that studies the influence of sex and gender on physiology, pathophysiology, and diseases. One example in light of how a genetic-based disease among other diseases, that impact on sex, can be represented by the risk of developing dementia or Alzheimer's disease. The question that comes into focus is whether gene-editing can represent a new line of investigation to be explored in the development of personalized, gender-specific medicine that guarantees gender equity in health policies. This article aims to discuss the relevance of adopting a gender-specific focus on gene-editing research, considered as a way of contributing to the advance of medicine's understanding, treatment, and prevention of dementia, particularly Alzheimer's disease. The development or improvement of cures could take advantage of the knowledge of the gender diversity in order to ascertain and develop differential interventions also at the genetic level between women and men, and this deserves special attention and deep ethical reflection.
Collapse
Affiliation(s)
- Pamela Tozzo
- Department of Molecular Medicine, Laboratory of Forensic Genetics, University of Padova, Via Falloppio 50, 35121 Padova, Italy;
- Correspondence: ; Tel.: +39-04-9827-2234
| | - Silvia Zullo
- Department of Legal Studies, University of Bologna, 40121 Bologna, Italy;
| | - Luciana Caenazzo
- Department of Molecular Medicine, Laboratory of Forensic Genetics, University of Padova, Via Falloppio 50, 35121 Padova, Italy;
| |
Collapse
|
7
|
" Bridging the Gap" Everything that Could Have Been Avoided If We Had Applied Gender Medicine, Pharmacogenetics and Personalized Medicine in the Gender-Omics and Sex-Omics Era. Int J Mol Sci 2019; 21:ijms21010296. [PMID: 31906252 PMCID: PMC6982247 DOI: 10.3390/ijms21010296] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/21/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023] Open
Abstract
Gender medicine is the first step of personalized medicine and patient-centred care, an essential development to achieve the standard goal of a holistic approach to patients and diseases. By addressing the interrelation and integration of biological markers (i.e., sex) with indicators of psychological/cultural behaviour (i.e., gender), gender medicine represents the crucial assumption for achieving the personalized health-care required in the third millennium. However, ‘sex’ and ‘gender’ are often misused as synonyms, leading to frequent misunderstandings in those who are not deeply involved in the field. Overall, we have to face the evidence that biological, genetic, epigenetic, psycho-social, cultural, and environmental factors mutually interact in defining sex/gender differences, and at the same time in establishing potential unwanted sex/gender disparities. Prioritizing the role of sex/gender in physiological and pathological processes is crucial in terms of efficient prevention, clinical signs’ identification, prognosis definition, and therapy optimization. In this regard, the omics-approach has become a powerful tool to identify sex/gender-specific disease markers, with potential benefits also in terms of socio-psychological wellbeing for each individual, and cost-effectiveness for National Healthcare systems. “Being a male or being a female” is indeed important from a health point of view and it is no longer possible to avoid “sex and gender lens” when approaching patients. Accordingly, personalized healthcare must be based on evidence from targeted research studies aimed at understanding how sex and gender influence health across the entire life span. The rapid development of genetic tools in the molecular medicine approaches and their impact in healthcare is an example of highly specialized applications that have moved from specialists to primary care providers (e.g., pharmacogenetic and pharmacogenomic applications in routine medical practice). Gender medicine needs to follow the same path and become an established medical approach. To face the genetic, molecular and pharmacological bases of the existing sex/gender gap by means of omics approaches will pave the way to the discovery and identification of novel drug-targets/therapeutic protocols, personalized laboratory tests and diagnostic procedures (sex/gender-omics). In this scenario, the aim of the present review is not to simply resume the state-of-the-art in the field, rather an opportunity to gain insights into gender medicine, spanning from molecular up to social and psychological stances. The description and critical discussion of some key selected multidisciplinary topics considered as paradigmatic of sex/gender differences and sex/gender inequalities will allow to draft and design strategies useful to fill the existing gap and move forward.
Collapse
|
8
|
Ortega-Azorín C, Coltell O, Asensio EM, Sorlí JV, González JI, Portolés O, Saiz C, Estruch R, Ramírez-Sabio JB, Pérez-Fidalgo A, Ordovas JM, Corella D. Candidate Gene and Genome-Wide Association Studies for Circulating Leptin Levels Reveal Population and Sex-Specific Associations in High Cardiovascular Risk Mediterranean Subjects. Nutrients 2019; 11:nu11112751. [PMID: 31766143 PMCID: PMC6893551 DOI: 10.3390/nu11112751] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/04/2019] [Accepted: 11/09/2019] [Indexed: 12/13/2022] Open
Abstract
Leptin is a hormone crucial in the regulation of food intake and body-weight maintenance. However, the genes and gene variants that influence its plasma levels are still not well known. Results of studies investigating polymorphisms in candidate genes have been inconsistent, and, in addition, very few genome-wide association studies (GWAS) have been undertaken. Our aim was to investigate the genes and gene variants most associated with plasma leptin concentrations in a high-cardiovascular-risk Mediterranean population. We measured plasma leptin in 1011 men and women, and analyzed the genetic factors associated using three approaches: (1) Analyzing the single nucleotide polymorphisms (SNPs) reported in a GWAS meta-analysis in other populations (including an SNP in/near each of these LEP, SLC32A1, GCKR, CCNL, COBLL1, and FTO genes); (2) Investigating additional SNPs in/near those genes, also including the RLEP gene; and (3) Undertaking a GWAS to discover new genes. We did not find any statistically significant associations between the previously published SNPs and plasma leptin (Ln) in the whole population adjusting for sex and age. However, on undertaking an extensive screening of other gene variants in those genes to capture a more complete set of SNPs, we found more associations. Outstanding among the findings was the heterogeneity per sex. We detected several statistically significant interaction terms with sex for these SNPs in the candidate genes. The gene most associated with plasma leptin levels was the FTO gene in men (specifically the rs1075440 SNP) and the LEPR in women (specifically the rs12145690 SNP). In the GWAS on the whole population, we found several new associations at the p < 1 × 10-5 level, among them with the rs245908-CHN2 SNP (p = 1.6 × 10-6). We also detected a SNP*sex interaction at the GWAS significance level (p < 5 × 10-8), involving the SLIT3 gene, a gene regulated by estrogens. In conclusion, our study shows that the SNPs selected as relevant for plasma leptin levels in other populations, are not good markers for this Mediterranean population, so supporting those studies claiming a bias when generalizing GWAS results to different populations. These population-specific differences may include not only genetic characteristics, but also age, health status, and the influence of other environmental variables. In addition, we have detected several sex-specific effects. These results suggest that genomic analyses, involving leptin, should be estimated by sex and consider population-specificity for more precise estimations.
Collapse
Affiliation(s)
- Carolina Ortega-Azorín
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (C.O.-A.); (E.M.A.); (J.V.S.); (J.I.G.); (O.P.); (C.S.); (A.P.-F.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (O.C.); (R.E.)
| | - Oscar Coltell
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (O.C.); (R.E.)
- Department of Computer Languages and Systems, Universitat Jaume I, 12071 Castellón, Spain
| | - Eva M. Asensio
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (C.O.-A.); (E.M.A.); (J.V.S.); (J.I.G.); (O.P.); (C.S.); (A.P.-F.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (O.C.); (R.E.)
| | - Jose V. Sorlí
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (C.O.-A.); (E.M.A.); (J.V.S.); (J.I.G.); (O.P.); (C.S.); (A.P.-F.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (O.C.); (R.E.)
| | - José I. González
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (C.O.-A.); (E.M.A.); (J.V.S.); (J.I.G.); (O.P.); (C.S.); (A.P.-F.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (O.C.); (R.E.)
| | - Olga Portolés
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (C.O.-A.); (E.M.A.); (J.V.S.); (J.I.G.); (O.P.); (C.S.); (A.P.-F.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (O.C.); (R.E.)
| | - Carmen Saiz
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (C.O.-A.); (E.M.A.); (J.V.S.); (J.I.G.); (O.P.); (C.S.); (A.P.-F.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (O.C.); (R.E.)
| | - Ramon Estruch
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (O.C.); (R.E.)
- Department of Internal Medicine, Hospital Clinic, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel, 170, 08036 Barcelona, Spain
| | | | - Alejandro Pérez-Fidalgo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (C.O.-A.); (E.M.A.); (J.V.S.); (J.I.G.); (O.P.); (C.S.); (A.P.-F.)
- CIBER Cáncer, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jose M Ordovas
- Nutrition and Genomics Laboratory, JM-USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA;
- Department of Cardiovascular Epidemiology and Population Genetics, Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- IMDEA Alimentación, 28049 Madrid, Spain
| | - Dolores Corella
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain; (C.O.-A.); (E.M.A.); (J.V.S.); (J.I.G.); (O.P.); (C.S.); (A.P.-F.)
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain; (O.C.); (R.E.)
- Correspondence: ; Tel.: +34-96-386-4800
| |
Collapse
|
9
|
Franconi F, Campesi I, Colombo D, Antonini P. Sex-Gender Variable: Methodological Recommendations for Increasing Scientific Value of Clinical Studies. Cells 2019; 8:E476. [PMID: 31109006 PMCID: PMC6562815 DOI: 10.3390/cells8050476] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 02/08/2023] Open
Abstract
There is a clear sex-gender gap in the prevention and occurrence of diseases, and in the outcomes and treatments, which is relevant to women in the majority of cases. Attitudes concerning the enrollment of women in randomized clinical trials have changed over recent years. Despite this change, a gap still exists. This gap is linked to biological factors (sex) and psycho-social, cultural, and environmental factors (gender). These multidimensional, entangled, and interactive factors may influence the pharmacological response. Despite the fact that regulatory authorities recognize the importance of sex and gender, there is a paucity of research focusing on the racial/ethnic, socio-economic, psycho-social, and environmental factors that perpetuate disparities. Research and clinical practice must incorporate all of these factors to arrive at an intersectional and system-scenario perspective. We advocate for scientifically rigorous evaluations of the interplay between sex and gender as key factors in performing clinical trials, which are more adherent to real-life. This review proposes a set of 12 rules to improve clinical research for integrating sex-gender into clinical trials.
Collapse
Affiliation(s)
- Flavia Franconi
- Laboratory of Sex-gender Medicine, National Institute of Biostructures and Biosystems, 07100 Sassari, Italy.
| | - Ilaria Campesi
- Laboratory of Sex-gender Medicine, National Institute of Biostructures and Biosystems, 07100 Sassari, Italy.
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy.
| | - Delia Colombo
- Value and Access Head, Novartis Italia, 21040 Origgio, Italy.
| | | |
Collapse
|
10
|
Bernardo BC, Ooi JYY, Weeks KL, Patterson NL, McMullen JR. Understanding Key Mechanisms of Exercise-Induced Cardiac Protection to Mitigate Disease: Current Knowledge and Emerging Concepts. Physiol Rev 2018; 98:419-475. [PMID: 29351515 DOI: 10.1152/physrev.00043.2016] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The benefits of exercise on the heart are well recognized, and clinical studies have demonstrated that exercise is an intervention that can improve cardiac function in heart failure patients. This has led to significant research into understanding the key mechanisms responsible for exercise-induced cardiac protection. Here, we summarize molecular mechanisms that regulate exercise-induced cardiac myocyte growth and proliferation. We discuss in detail the effects of exercise on other cardiac cells, organelles, and systems that have received less or little attention and require further investigation. This includes cardiac excitation and contraction, mitochondrial adaptations, cellular stress responses to promote survival (heat shock response, ubiquitin-proteasome system, autophagy-lysosomal system, endoplasmic reticulum unfolded protein response, DNA damage response), extracellular matrix, inflammatory response, and organ-to-organ crosstalk. We summarize therapeutic strategies targeting known regulators of exercise-induced protection and the challenges translating findings from bench to bedside. We conclude that technological advancements that allow for in-depth profiling of the genome, transcriptome, proteome and metabolome, combined with animal and human studies, provide new opportunities for comprehensively defining the signaling and regulatory aspects of cell/organelle functions that underpin the protective properties of exercise. This is likely to lead to the identification of novel biomarkers and therapeutic targets for heart disease.
Collapse
Affiliation(s)
- Bianca C Bernardo
- Baker Heart and Diabetes Institute , Melbourne , Australia ; Department of Paediatrics, University of Melbourne , Victoria , Australia ; Department of Diabetes, Central Clinical School, Monash University , Victoria , Australia ; Department of Medicine, Central Clinical School, Monash University , Victoria , Australia ; and Department of Physiology, School of Biomedical Sciences , Victoria , Australia
| | - Jenny Y Y Ooi
- Baker Heart and Diabetes Institute , Melbourne , Australia ; Department of Paediatrics, University of Melbourne , Victoria , Australia ; Department of Diabetes, Central Clinical School, Monash University , Victoria , Australia ; Department of Medicine, Central Clinical School, Monash University , Victoria , Australia ; and Department of Physiology, School of Biomedical Sciences , Victoria , Australia
| | - Kate L Weeks
- Baker Heart and Diabetes Institute , Melbourne , Australia ; Department of Paediatrics, University of Melbourne , Victoria , Australia ; Department of Diabetes, Central Clinical School, Monash University , Victoria , Australia ; Department of Medicine, Central Clinical School, Monash University , Victoria , Australia ; and Department of Physiology, School of Biomedical Sciences , Victoria , Australia
| | - Natalie L Patterson
- Baker Heart and Diabetes Institute , Melbourne , Australia ; Department of Paediatrics, University of Melbourne , Victoria , Australia ; Department of Diabetes, Central Clinical School, Monash University , Victoria , Australia ; Department of Medicine, Central Clinical School, Monash University , Victoria , Australia ; and Department of Physiology, School of Biomedical Sciences , Victoria , Australia
| | - Julie R McMullen
- Baker Heart and Diabetes Institute , Melbourne , Australia ; Department of Paediatrics, University of Melbourne , Victoria , Australia ; Department of Diabetes, Central Clinical School, Monash University , Victoria , Australia ; Department of Medicine, Central Clinical School, Monash University , Victoria , Australia ; and Department of Physiology, School of Biomedical Sciences , Victoria , Australia
| |
Collapse
|
11
|
Seeland U, Nauman AT, Cornelis A, Ludwig S, Dunkel M, Kararigas G, Regitz-Zagrosek V. eGender-from e-Learning to e-Research: a web-based interactive knowledge-sharing platform for sex- and gender-specific medical education. Biol Sex Differ 2016; 7:39. [PMID: 27785342 PMCID: PMC5073799 DOI: 10.1186/s13293-016-0101-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sex and Gender Medicine is a novel discipline that provides equitable medical care for society and improves outcomes for both male and female patients. The integration of sex- and gender-specific knowledge into medical curricula is limited due to adequate learning material, systematic teacher training and an innovative communication strategy. We aimed at initiating an e-learning and knowledge-sharing platform for Sex and Gender Medicine, the eGender platform (http://egender.charite.de), to ensure that future doctors and health professionals will have adequate knowledge and communication skills on sex and gender differences in order to make informed decisions for their patients. METHODS The web-based eGender knowledge-sharing platform was designed to support the blended learning pedagogical teaching concept and follows the didactic concept of constructivism. Learning materials developed by Sex and Gender Medicine experts of seven universities have been used as the basis for the new learning tools. The content of these tools is patient-centered and provides add-on information on gender-sensitive aspects of diseases. The structural part of eGender was designed and developed using the open source e-learning platform Moodle. The eGender platform comprises an English and a German version of e-learning modules: one focusing on basic knowledge and seven on specific medical disciplines. Each module consists of several courses corresponding to a disease or symptom complex. Self-organized learning has to be managed by using different learning tools, e.g., texts and audiovisual material, tools for online communication and collaborative work. RESULTS More than 90 users from Europe registered for the eGender Medicine learning modules. The most frequently accessed module was "Gender Medicine-Basics" and the users favored discussion forums. These e-learning modules fulfill the quality criteria for higher education and are used within the elective Master Module "Gender Medicine-Basics" implemented into the accredited Master of Public Health at Charité-Berlin. CONCLUSIONS The eGender platform is a flexible and user-friendly electronical knowledge-sharing platform providing evidence-based high-quality learning material used by a growing number of registered users. The eGender Medicine learning modules could be key in the reform of medical curricula to integrate Sex and Gender Medicine into the education of health professionals.
Collapse
Affiliation(s)
- Ute Seeland
- Institute of Gender in Medicine, Charité-Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany ; DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - Ahmad T Nauman
- Institute of Gender in Medicine, Charité-Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany
| | - Alissa Cornelis
- Institute of Gender in Medicine, Charité-Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany
| | - Sabine Ludwig
- Department of Medical Education and Student Affairs, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mathias Dunkel
- Structural Bioinformatics Group, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Georgios Kararigas
- Institute of Gender in Medicine, Charité-Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany ; Center for Cardiovascular Research (CCR), Charité-Universitätsmedizin Berlin, Berlin, Germany ; DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine, Charité-Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany ; Center for Cardiovascular Research (CCR), Charité-Universitätsmedizin Berlin, Berlin, Germany ; DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
| |
Collapse
|
12
|
Bernardo BC, Ooi JYY, Matsumoto A, Tham YK, Singla S, Kiriazis H, Patterson NL, Sadoshima J, Obad S, Lin RCY, McMullen JR. Sex differences in response to miRNA-34a therapy in mouse models of cardiac disease: identification of sex-, disease- and treatment-regulated miRNAs. J Physiol 2016; 594:5959-5974. [PMID: 27270487 DOI: 10.1113/jp272512] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/24/2016] [Indexed: 12/11/2022] Open
Abstract
KEY POINTS MicroRNA (miRNA)-based therapies are in development for numerous diseases, including heart disease. Currently, very limited basic information is available on the regulation of specific miRNAs in male and female hearts in settings of disease. The identification of sex-specific miRNA signatures has implications for translation into the clinic and suggests the need for customised therapy. In the present study, we found that a miRNA-based treatment inhibiting miRNA-34a (miR-34a) was more effective in females in a setting of moderate dilated cardiomyopathy than in males. Furthermore, the treatment showed little benefit for either sex in a setting of more severe dilated cardiomyopathy associated with atrial fibrillation. The results highlight the importance of understanding the effect of miRNA-based therapies in cardiac disease settings in males and females. ABSTRACT MicroRNA (miRNA)-34a (miR-34a) is elevated in the diseased heart in mice and humans. Previous studies have shown that inhibiting miR-34a in male mice in settings of pathological cardiac hypertrophy or ischaemia protects the heart against progression to heart failure. Whether inhibition of miR-34a protects the female heart is unknown. Furthermore, the therapeutic potential of silencing miR-34a in settings of dilated cardiomyopathy (DCM) and atrial fibrillation (AF) has not been assessed previously. In the present study, we examined the effect of silencing miR-34a in males and females in (1) a model of moderate DCM and (2) a model of severe DCM with AF. The cardiac disease models were administered with a locked nucleic acid-modified oligonucleotide (LNA-antimiR-34a) at 6-7 weeks of age when the models display cardiac dysfunction and conduction abnormalities. Cardiac function and morphology were measured 6 weeks after treatment. In the present study, we show that inhibition of miR-34a provides more protection in the DCM model in females than males. Disease prevention in LNA-antimiR-34a treated DCM female mice was characterized by attenuated heart enlargement and lung congestion, lower expression of cardiac stress genes (B-type natriuretic peptide, collagen gene expression), less cardiac fibrosis and better cardiac function. There was no evidence of significant protection in the severe DCM and AF model in either sex. Sex- and treatment-dependent regulation of miRNAs was also identified in the diseased heart, and may explain the differential response of males and females. These studies highlight the importance of examining the impact of miRNA-based drugs in both sexes and under different disease conditions.
Collapse
Affiliation(s)
| | - Jenny Y Y Ooi
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Aya Matsumoto
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Yow Keat Tham
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Saloni Singla
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Helen Kiriazis
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | - Junichi Sadoshima
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, The State University of New Jersey, Newark, NJ, USA
| | - Susanna Obad
- Roche Innovation Center Copenhagen, Hørsholm, Denmark
| | - Ruby C Y Lin
- Asbestos Diseases Research Institute, Cardiothoracic Genomics, Sydney, Australia and School of Medical Sciences, University of New South Wales, NSW, Australia
| | - Julie R McMullen
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia. .,Department of Medicine, Monash University, Clayton, VIC, Australia. .,Department of Physiology, Monash University, Clayton, VIC, Australia.
| |
Collapse
|