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Izquierdo-García E, Lázaro-Cebas A, Montero Pastor B, Such Díaz A, Álvaro-Alonso EA, López Guerra L, Escobar-Rodríguez I. Design of mobile and website health application devices for drug tolerability in hereditary fructose intolerance. Orphanet J Rare Dis 2024; 19:12. [PMID: 38183105 PMCID: PMC10770908 DOI: 10.1186/s13023-023-03011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Hereditary fructose intolerance (HFI) is a rare metabolic disease caused by aldolase B deficiency. The aim of our study was to analyse excipient tolerability in patients with HFI and other related diseases and to design mobile and website health applications to facilitate the search for drugs according to their tolerance. RESULTS A total of 555 excipients listed in the Spanish Medicines Agency database (July 2023) were classified as suitable for HFI patients, suitable with considerations ((glucose and glucose syrup, intravenous sucrose, oral mannitol, polydextrose, gums and carrageenans, ethanol, sulfite caramel and vanilla), not recommended (intravenous mannitol) and contraindicated (fructose, oral sucrose, invert sugar, sorbitol, maltitol, lactitol, isomaltitol, fruit syrups, honey, sucrose esters and sorbitol esters). Glucose and glucose syrup were classified as suitable with considerations due to its possible fructose content and their potential endogenous fructose production. For other related intolerances, wheat starch was contraindicated and oatmeal was not recommended in celiac disease; oral lactose and lactose-based coprocessed excipient (Cellactose®) were not recommended in lactose intolerance; and glucose, invert sugar and oral sucrose were not recommended in diabetes mellitus. The applications were named IntoMed®. Results are listed in order of tolerability (suitable drugs appear first and contraindicated drugs at the end), and they are accompanied by a note detailing their classified excipients. If a drug contains excipients within different categories, the overall classification will be the most restrictive. The apps are also able to classify substances with the same criteria if they act as active ingredients. The tools exhibited good usability (82.07 ± 13.46 points on the System Usability Scale [range: 0-100]) on a sample of HFI patients, their families and health care professionals. CONCLUSIONS IntoMed® is a tool for finding information about the tolerability of drugs according to excipients for patients with HFI and other related intolerances, with good usability. It is a fast and reliable system that covers the current excipient legislation and expands on it with other specific information: HFI patients should be alert for excipients such as mannitol (especially in intravenous drugs), fruit syrups, honey, sulfite caramel or vanilla. Glucose might contain or produce fructose, and special precaution is needed because of potential errors in their composition.
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Affiliation(s)
- Elsa Izquierdo-García
- Pharmacy Department, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, Madrid, 28031, Spain.
| | - Andrea Lázaro-Cebas
- Pharmacy Department, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Berta Montero Pastor
- Pharmacy Department, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, Madrid, 28031, Spain
| | - Ana Such Díaz
- Pharmacy Department, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, Madrid, 28031, Spain
| | - Elena Alba Álvaro-Alonso
- Pharmacy Department, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, Madrid, 28031, Spain
| | - Laura López Guerra
- Pharmacy Department, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, Madrid, 28031, Spain
| | - Ismael Escobar-Rodríguez
- Pharmacy Department, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, Madrid, 28031, Spain
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Ibuprofen solubility and cytotoxic study of deep eutectic solvents formed by xylitol, choline chloride and water. J Drug Deliv Sci Technol 2023. [DOI: 10.1016/j.jddst.2023.104327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Ramos BCF, Aranda CS, Cardona RSB, Martins AM, Solé D, Clemens SAC, Clemens R. Vaccination strategies for people living with inborn errors of metabolism in Brazil. J Pediatr (Rio J) 2023; 99 Suppl 1:S70-S80. [PMID: 36574955 PMCID: PMC10066440 DOI: 10.1016/j.jped.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Through a literature review, make recommendations regarding immunizations in people living with Inborn Error of Metabolism (IEM) in Brazil, assess the possible impact on metabolic decompensations after immunization, and if this specific population may have an impaired immune response to vaccines. SOURCE OF DATA The MeSH Terms vaccination OR vaccine OR immunization associated with the term inborn error of metabolism AND recommendation were used in combination with search databases. Only articles published after 1990, in the languages English, Spanish, French or Portuguese, human-related were included. SYNTHESIS OF DATA A total of 44 articles were included to make the following recommendations. Individuals with IEMs need to be up to date with their immunizations. Regarding which vaccines should be offered, children and adults should follow the routine immunization schedules locally available, including the COVID-19 vaccines. The only exception is the rotavirus vaccine for hereditary fructose intolerance. The benefit of immunization outweighs the very low risk of metabolic decompensation. Since not all patients will have an adequate immune response, measuring antibody conversion and titers is recommended CONCLUSIONS: All patients should receive age-appropriate immunizations in their respective schedules without delays. The only situation when vaccination may be contraindicated is with oral rotavirus vaccine in hereditary fructose intolerance. Monitoring the levels of antibodies should be done to detect any immune dysfunction or the necessity for boosters. A personalized immunization schedule is ideal for patients with IEMs. The reference organizations could improve their recommendations to address all IEMs, not only some of them.
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Affiliation(s)
| | - Carolina S Aranda
- Universidade Federal de São Paulo, Departamento de Pediatria, Disciplina de Alergia, Imunologia Clínica e Reumatologia, São Paulo, SP, Brazil
| | | | - Ana Maria Martins
- Universidade Federal de São Paulo, Departamento de Pediatria, Erros Inatos do Metabolismo e Instituto de Genética, São Paulo, SP, Brazil
| | - Dirceu Solé
- Universidade Federal de São Paulo, Departamento de Pediatria, Disciplina de Alergia, Imunologia Clínica e Reumatologia, São Paulo, SP, Brazil
| | - Sue Ann C Clemens
- University of Oxford, Pediatric Infectious Disease and Vaccinology, Oxford, United Kingdom; University of Siena, Institute for Global Health, Siena, Italy
| | - Ralf Clemens
- International Vaccine Institute, Seoul, Republic of Korea
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Reply letter to the editor concerning the article 'Safety of Sars-Cov-2 vaccines administration for adult patients with hereditary fructose intolerance'. Hum Vaccin Immunother 2022; 18:2051414. [PMID: 35358012 PMCID: PMC9225529 DOI: 10.1080/21645515.2022.2051414] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
According to the current European medicines legislation, on the labeling is mandatory a warning contraindicating for hereditary fructose intolerance (HFI) patients medicines with oral or parenteral fructose and sorbitol, and oral sucrose, invert sugar, isomaltitol, lactitol and maltitol, but parenteral sucrose is not mentioned. Intravenous administration of sucrose does not increase blood glucose concentrations, because sucrose is poorly oxidized to CO2 and mainly excreted in the urine as a disaccharide; absence of enzimatic activity outside the gut explains why there is not a warning for parenteral sucrose presentations. For this reason, parenteral drugs with sucrose are allowed in HFI patients. Nevertheless, due to interindividual variability and the fact that not all parenterally administered sucrose is recovered in urine, HFI patients need to be closely monitored after parenteral administration of sucrose-containing drugs, especially when the amount exceeds the maximum permissible thresholds.
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Maiorana A, Lepri FR, Novelli A, Dionisi-Vici C. Hypoglycaemia Metabolic Gene Panel Testing. Front Endocrinol (Lausanne) 2022; 13:826167. [PMID: 35422763 PMCID: PMC9001947 DOI: 10.3389/fendo.2022.826167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/21/2022] [Indexed: 12/31/2022] Open
Abstract
A large number of inborn errors of metabolism present with hypoglycemia. Impairment of glucose homeostasis may arise from different biochemical pathways involving insulin secretion, fatty acid oxidation, ketone bodies formation and degradation, glycogen metabolism, fructose and galactose metabolism, branched chain aminoacids and tyrosine metabolism, mitochondrial function and glycosylation proteins mechanisms. Historically, genetic analysis consisted of highly detailed molecular testing of nominated single genes. However, more recently, the genetic heterogeneity of these conditions imposed to perform extensive molecular testing within a useful timeframe via new generation sequencing technology. Indeed, the establishment of a rapid diagnosis drives specific nutritional and medical therapies. The biochemical and clinical phenotypes are critical to guide the molecular analysis toward those clusters of genes involved in specific pathways, and address data interpretation regarding the finding of possible disease-causing variants at first reported as variants of uncertain significance in known genes or the discovery of new disease genes. Also, the trio's analysis allows genetic counseling for recurrence risk in further pregnancies. Besides, this approach is allowing to expand the phenotypic characterization of a disease when pathogenic variants give raise to unexpected clinical pictures. Multidisciplinary input and collaboration are increasingly key for addressing the analysis and interpreting the significance of the genetic results, allowing rapidly their translation from bench to bedside.
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Affiliation(s)
- Arianna Maiorana
- Division of Metabolism, Department of Pediatrics Subspecialties, Ospedale Pediatrico Bambino Gesù, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
- *Correspondence: Arianna Maiorana,
| | - Francesca Romana Lepri
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unity, Ospedale Pediatrico Bambino Gesù, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unity, Ospedale Pediatrico Bambino Gesù, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolism, Department of Pediatrics Subspecialties, Ospedale Pediatrico Bambino Gesù, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
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Urru SAM, Maines E, Campomori A, Soffiati M. Safety of Sars-Cov-2 vaccines administration for adult patients with hereditary fructose intolerance. Hum Vaccin Immunother 2021; 17:4112-4114. [PMID: 34197272 DOI: 10.1080/21645515.2021.1943992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Silvana A M Urru
- Hospital Pharmacy Unit, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Evelina Maines
- Pediatric Unit, Department of Women's and Children's Health, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Annalisa Campomori
- Hospital Pharmacy Unit, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Massimo Soffiati
- Pediatric Unit, Department of Women's and Children's Health, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
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Saborido-Fiaño R, Martinón-Torres N, Crujeiras-Martinez V, Couce ML, Leis R. Letter to the editor concerning the article 'Safety of vaccines administration in hereditary fructose intolerance'. Hum Vaccin Immunother 2021; 17:2593-2594. [PMID: 33653220 DOI: 10.1080/21645515.2021.1891816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The most important approach for the management of hereditary fructose intolerance is a strict avoidance of fructose, sucrose and sorbitol from the diet and medications. A safe threshold of 2.4 mg/kg/dose was recently established by the Instituto Superiore di Sanità of Italy for both oral and parenteral routes, thus shouldering a safe administration of a majority of vaccines in these patients. This would not include, Rotarix® pre-established oral suspension and Rotateq® vaccines, which are indeed contraindicated. Moreover, Rotarix® white powder and solvent for oral suspension would only be safely administered at a weight above 9.3 kg.Overall, these recommendations to avoid rotavirus vaccination are difficult to implement because these vaccines are given during exclusive breastfeeding, prior to fructose-containing food introduction.
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Affiliation(s)
- Rebeca Saborido-Fiaño
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Paediatrics, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Nazareth Martinón-Torres
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Paediatrics, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Vanesa Crujeiras-Martinez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Paediatrics, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria Luz Couce
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, Department of Paediatrics, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rosaura Leis
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Paediatrics, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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