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Chen J, Shantakumar S, Si J, Gowindah R, Parikh R, Chan F, Chan M, Choi WS, Huang E, Huang KC, Huang LM, Kim H, Leong CK, Leong HN, Seo Y, Williams C, Wong ATY. Knowledge, attitude, and practice toward herpes zoster (HZ) and HZ vaccination: Concept elicitation findings from a multi-country study in the Asia Pacific. Hum Vaccin Immunother 2024; 20:2317446. [PMID: 38436584 PMCID: PMC10913700 DOI: 10.1080/21645515.2024.2317446] [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: 11/06/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
Herpes zoster (HZ) is a prevalent disease characterized by a painful rash. A multi‑country study was conducted to elicit public and physician knowledge, attitude, and practice (KAP) toward HZ disease and vaccination for the assessment of local factors influencing HZ vaccine perceptions in four Asian-Pacific countries/territories One-to-one qualitative interviews were conducted in 2022, among the public (people aged ≥ 50 years, adults with parents aged ≥ 50 years, zoster vaccine live-vaccinated individuals aged ≥ 50 years in Republic of Korea, and HZ patients; n = 78) and physicians (general practitioners and specialists; n = 24). Themes surrounding KAP toward HZ and HZ vaccination were summarized using a thematic analysis. A substantial knowledge gap related to HZ was observed among the public, including its causes, long-term impacts, and the at-risk population. There was a low perceived risk of HZ and low general awareness of HZ vaccine availability, although country/territory-specific differences existed. Fear of HZ-associated pain contributed toward vaccination intent among HZ patients and adults with parents aged ≥ 50 years. HZ-naïve adults who were encouraged to receive the vaccine by others were not motivated to do so due to optimism bias. Physicians were perceived to be a reliable source of information. However, physicians did not always proactively discuss HZ vaccination due to time constraints and a perceived need to prioritize other vaccinations including influenza and pneumococcal vaccines. Initiatives are needed to improve public awareness of HZ and its complications, in terms of overall impact on individuals and society, and highlight the important role of physicians in recommending vaccination.
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Affiliation(s)
- Jing Chen
- Epidemiology and Health Outcomes, GSK, Singapore
| | | | | | | | | | - Felix Chan
- Division of Geriatric Medicine, University Department of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | - Won Suk Choi
- Department of Internal Medicine, Korea University College of Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea
| | | | - Kuo-Chin Huang
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Li-Min Huang
- Department of Paediatrics, National Taiwan University Hospital, Taipei City, Taiwan
| | - Hyungwoo Kim
- Early Pipeline Vaccines, GSK, Rockville, MD, USA
| | | | | | - Yubin Seo
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea
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Jeong SK, Ham SJ, Baek SH, Jung EJ, Jo HJ, Cha HR, Lee JM, Ahn BC, Yum JS, Chun E. Lipo-pam™ adjuvanted herpes zoster vaccine induces potent gE-specific cellular and humoral immune responses. NPJ Vaccines 2024; 9:150. [PMID: 39154056 PMCID: PMC11330477 DOI: 10.1038/s41541-024-00939-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 07/30/2024] [Indexed: 08/19/2024] Open
Abstract
Herpes zoster (HZ), also known as shingles, is caused by the reactivation of latent varicella-zoster virus (VZV). Decreased VZV-specific T-cell immune responses significantly contribute to the development of HZ. Shingrix is a recombinant zoster vaccine that is currently used to prevent HZ. However, Shingrix has high reactogenicity and pain at the injection site due to QS21, one of the adjuvant components. In this study, we developed a new herpes zoster vaccine formulation called CVI-VZV-001, containing gE protein and a novel liposome-based adjuvant Lipo-pam™, which consists of two TLR agonists. We evaluated the immunogenicity of CVI-VZV-001 in mouse and rabbit models. CVI-VZV-001 elicited robust gE-specific T-cell immune responses and gE-specific antibody production. Specifically, CVI-VZV-001 induced polyfunctional CD4+ T cell populations that secrete multiple cytokines. Furthermore, CVI-VZV-001 sustained the gE-specific immune responses for up to six months after immunization. To ensure CVI-VZV-001's safety for further development, we conducted a good laboratory practice (GLP) toxicity test, which confirmed that CVI-VZV-001 is safe for use. At present, CVI-VZV-001 is undergoing phase I clinical trials. This study suggests that CVI-VZV-001 can be a potent candidate for the HZ vaccine with high immunogenicity and safety.
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Affiliation(s)
- Soo-Kyung Jeong
- R&D Center, CHA Vaccine Institute, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Su-Jin Ham
- R&D Center, CHA Vaccine Institute, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Seung-Hee Baek
- R&D Center, CHA Vaccine Institute, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Eun-Jung Jung
- R&D Center, CHA Vaccine Institute, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hyun-Jin Jo
- R&D Center, CHA Vaccine Institute, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hye-Ran Cha
- Department of Microbiology and Immunology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Myun Lee
- Department of Microbiology and Immunology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Cheol Ahn
- R&D Center, CHA Vaccine Institute, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jung Sun Yum
- R&D Center, CHA Vaccine Institute, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Eunyoung Chun
- R&D Center, CHA Vaccine Institute, Seongnam-si, Gyeonggi-do, Republic of Korea.
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Aurangzeb A, Chong EY, Yuen PWL, Koh DTS, Kuo CL. Case Report of Herpes Zoster Infection of the Cervical Dermatome - A Rare Cause of Acute Shoulder Pain. J Orthop Case Rep 2024; 14:89-94. [PMID: 39157474 PMCID: PMC11327661 DOI: 10.13107/jocr.2024.v14.i08.4658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/24/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Acute shoulder pain is among the most common presenting complaints in the clinic. Clinicians may find it challenging with the myriad of potential etiologies to explain for the presenting complaint. We present a unique case, where a herpes zoster infection in the C6 dermatome mimicked the presentation of rotator cuff pathology and was admitted to the care of orthopedics. We have also included a detailed literature review on the topic in our study. Case Report The patient was a 38-year-old Chinese female who presented with acute atraumatic right-sided shoulder pain and weakness which was potentially confounded by an attempt of traditional Chinese medicine. Clinical examination revealed that the range of motion was globally reduced and painful in all directions with equivocal impingement testing. Examination of the skin revealed the presence of polymorphous eruption of erythematous papules and vesicles in the right shoulder and C6 region. In this paper, we discuss a possible algorithm to aid clinicians in an acute shoulder pain history with accompanying red flags to look out for. This is accompanied by a detailed literature review on the topic which demonstrates the rarity of this presentation which eventually confounded the initial management of the patient. Conclusion A thorough history and physical examination must remain the cornerstone of a clinician's diagnostic algorithm. Zoster neuropathy at the level of the cervical spine is a rare entity. This case report also emphasizes the need for cognizance of local traditional remedies practiced and their interactions with clinical diagnosis and treatment.
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Affiliation(s)
- Amirzeb Aurangzeb
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore
| | - Elliot Yeung Chong
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore
| | - Paul Wen Loong Yuen
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore
| | - Don Thong Siang Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Chung Liang Kuo
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore
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Kong E, Hua T, Li J, Li Y, Yang M, Ding R, Wang H, Wei H, Feng X, Han C, Yuan H. HSV-1 reactivation results in post-herpetic neuralgia by upregulating Prmt6 and inhibiting cGAS-STING. Brain 2024; 147:2552-2565. [PMID: 38366606 PMCID: PMC11224619 DOI: 10.1093/brain/awae053] [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: 08/03/2023] [Revised: 12/31/2023] [Accepted: 01/19/2024] [Indexed: 02/18/2024] Open
Abstract
Chronic varicella zoster virus (VZV) infection induced neuroinflammatory condition is the critical pathology of post-herpetic neuralgia (PHN). The immune escape mechanism of VZV remains elusive. As to mice have no VZV infection receptor, herpes simplex virus type 1 (HSV-1) infection is a well established PHN mice model. Transcriptional expression analysis identified that the protein arginine methyltransferases 6 (Prmt6) was upregulated upon HSV-1 infection, which was further confirmed by immunofluorescence staining in spinal dorsal horn. Prmt6 deficiency decreased HSV-1-induced neuroinflammation and PHN by enhancing antiviral innate immunity and decreasing HSV-1 load in vivo and in vitro. Overexpression of Prmt6 in microglia dampened antiviral innate immunity and increased HSV-1 load. Mechanistically, Prmt6 methylated and inactivated STING, resulting in reduced phosphorylation of TANK binding kinase-1 (TBK1) and interferon regulatory factor 3 (IRF3), diminished production of type I interferon (IFN-I) and antiviral innate immunity. Furthermore, intrathecal or intraperitoneal administration of the Prmt6 inhibitor EPZ020411 decreased HSV-1-induced neuroinflammation and PHN by enhancing antiviral innate immunity and decreasing HSV-1 load. Our findings revealed that HSV-1 escapes antiviral innate immunity and results in PHN by upregulating Prmt6 expression and inhibiting the cGAS-STING pathway, providing novel insights and a potential therapeutic target for PHN.
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Affiliation(s)
- Erliang Kong
- Department of Anesthesiology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
- Department of Anesthesiology, The 988th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Zhengzhou, Henan 450042, China
| | - Tong Hua
- Department of Anesthesiology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
| | - Jian Li
- Department of Anesthesiology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
| | - Yongchang Li
- Department of Anesthesiology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
| | - Mei Yang
- Department of Anesthesiology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
| | - Ruifeng Ding
- Department of Anesthesiology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
| | - Haowei Wang
- Department of Anesthesiology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
| | - Huawei Wei
- Department of Anesthesiology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
| | - Xudong Feng
- Department of Anesthesiology, The 988th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Zhengzhou, Henan 450042, China
| | - Chaofeng Han
- Department of Histology and Embryology, Naval Medical University, Shanghai 200433, China
| | - Hongbin Yuan
- Department of Anesthesiology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
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Kothapalli Y, Chu CK, Singh US. Enantioselective Synthesis of β-l-5-[( E)-2-Bromovinyl)-1-((2 S,4 S)-2-(hydroxymethyl)-1,3-(dioxolane-4-yl) Uracil)] (l-BHDU) via Chiral Pure l-Dioxolane. J Org Chem 2024; 89:9313-9321. [PMID: 38900839 PMCID: PMC11232004 DOI: 10.1021/acs.joc.4c00399] [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: 02/13/2024] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
β-l-5-((E)-2-Bromovinyl)-1-((2S,4S)-2-(hydroxymethyl)-1,3-(dioxolane-4-yl) uracil (l-BHDU, 17) is a potent and selective inhibitor of the varicella-zoster virus (VZV). l-BHDU (17) has demonstrated excellent anti-VZV activity and is a preclinical candidate to treat chickenpox, shingles (herpes zoster), and herpes simplex virus 1 (HSV-1) infections. Its monophosphate prodrug (POM-l-BHDU-MP, 24) demonstrated an enhanced pharmacokinetic and antiviral profile. POM-l-BHDU-MP (24), in vivo, effectively reduced the VZV viral load and was effective for the topical treatment of VZV and HSV-1 infections. Therefore, a viable synthetic procedure for developing POM-l-BHDU-MP (24) is needed. In this article, an efficient approach for the synthesis of l-BHDU (17) from a readily available starting material is described in 7 steps. An efficient and practical methodology for both chiral pure l- & d-dioxolane 11 and 13 were developed via diastereomeric chiral amine salt formation. Neutralization of the amine carboxylate salt of l-dioxolane 10 provides enantiomerically pure l-dioxane 11 (ee ≥ 99%). Optically pure 11 was utilized to construct the final nucleoside l-BHDU (17) and its monophosphate ester prodrug (POM-l-BHDU-MP, 24). Notably, the reported process eliminates expensive chiral chromatography for the synthesis of chiral pure l- & d-dioxolane, which offers avenues for the development and structure-activity relationship studies of l- & d-dioxolane-derived nucleosides.
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Affiliation(s)
- Yugandhar Kothapalli
- Department of Pharmaceutical and Biomedical
Sciences, College of Pharmacy, University
of Georgia, Athens, Georgia 30602, United States
| | - Chung K. Chu
- Department of Pharmaceutical and Biomedical
Sciences, College of Pharmacy, University
of Georgia, Athens, Georgia 30602, United States
| | - Uma S. Singh
- Department of Pharmaceutical and Biomedical
Sciences, College of Pharmacy, University
of Georgia, Athens, Georgia 30602, United States
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Hanif S, Majeed AI, Faryal R. M2 Genotype of Varicella zoster virus associated with Severe Herpes zoster in Pakistan. Pak J Med Sci 2024; 40:1303-1305. [PMID: 38952536 PMCID: PMC11190426 DOI: 10.12669/pjms.40.6.8764] [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: 09/14/2023] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 07/03/2024] Open
Abstract
This case report is of herpes zoster which is caused by Varicella zoster virus (VZV). The patient was presented with acute renal failure associated with intravenous acyclovir administration for its management. A 50 years old man visited the hospital with rashes on his back. The serum sample was positive for anti-VZV IgM via Enzyme Linked Immunosorbent Assay (ELISA), and vesicular swab for VZV via polymerase chain reaction (PCR). Phylogenetic analysis identified it as M2-genotype. Patient was treated with intravenous acyclovir administration, which led to acute renal failure. Later with shift to oral acyclovir, renal functions were restored. Elderly patients with reactivation of VZV in Pakistan are at risk to contract herpes zoster. Acyclovir is drug of choice via intravenous route was found to be nephrotoxic, however oral acyclovir was safe and effective. This is first report on pathogenic VZV genotype from Pakistan and is presented to highlight that the herpes zoster cases of elderly patients' treatment option need to be revisited.
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Affiliation(s)
- Saba Hanif
- Ms. Saba Hanif, Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Ayesha Isani Majeed
- Prof. Dr. Ayesha Isani Majeed, MBBS, MCPS, FRCR, MPH, MHPE, Ph.D. Department of Radiology and Breast Cancer Screening Programme, Pakistan Institute of Medical Science, Islamabad, Pakistan
| | - Rani Faryal
- Prof. Dr. Rani Faryal, Ph.D., Postdoc Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
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Singer D, Thompson-Leduc P, Ma S, Gupta D, Cheng WY, Sendhil SR, Sundar M, Hagopian E, Stempniewicz N, Duh MS, Poston S. Burden of Herpes Zoster Among Patients with Psoriatic Arthritis in the United States. PSORIASIS (AUCKLAND, N.Z.) 2024; 14:63-78. [PMID: 38939905 PMCID: PMC11208162 DOI: 10.2147/ptt.s430151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/13/2023] [Indexed: 06/29/2024]
Abstract
Purpose Patients with psoriasis (PsO) and psoriatic arthritis (PsA) are at increased risk of herpes zoster (HZ), but healthcare resource use (HRU) and costs relating to HZ in adults with PsA are unknown. We aimed to estimate the incidence of HZ among adults with PsA vs without psoriatic disease and the additional HRU and costs among patients with PsA with vs without HZ. Patients and Methods This retrospective, longitudinal, cohort study estimated HZ incidence in PsA+ vs PsO-/PsA- cohorts and HRU and medical/pharmacy costs among PsA+/HZ+ vs PsA+/HZ- cohorts comprised of adults from Optum's de-identified Clinformatics Data Mart Database during 2015-2020. For the HRU/cost analyses, index was the date of first HZ diagnosis (PsA+/HZ+ cohort) or was randomly assigned (PsA+/HZ- cohort). Generalized linear models were used for adjusted comparisons between cohorts. Results HZ incidence was higher in the PsA+ (n = 57,126) vs PsO-/PsA- (n = 23,837,237) cohort (14.85 vs 7.67 per 1000 person-years; adjusted incidence rate ratio [aIRR]: 1.23; 95% confidence interval [CI]: 1.16-1.30). Numbers of outpatient visits, emergency department visits, and inpatient admissions were significantly higher in the PsA+/HZ+ (n = 1045) vs PsA+/HZ- (n = 36,091) cohorts during the first month after HZ diagnosis (outpatient: aIRR: 1.74; 95% CI: 1.63-1.86; emergency department: 3.14; 95% CI: 2.46-4.02; inpatient: aIRR: 2.61; 95% CI: 1.89-3.61). Mean all-cause per-patient costs were significantly higher in the PsA+/HZ+ vs PsA+/HZ- cohorts during the first month after index ($6493 vs $4521; adjusted cost difference: $2012; 95% CI: $1204-$3007). HRU and costs were numerically higher in the PsA+/HZ+ cohort during the first 3 and 12 months. Conclusion These findings, which provide evidence on the increased incidence and HRU and economic burden associated with HZ among adults with PsA, could be used to inform clinical practice and decision-making.
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Affiliation(s)
- David Singer
- GSK, US Health Economics and Outcomes Research, Philadelphia, PA, USA
| | | | - Siyu Ma
- GSK, US Health Economics and Outcomes Research, Philadelphia, PA, USA
- Tufts Medical Center, Boston, MA, USA
| | - Deepshekhar Gupta
- Analysis Group, Inc., Health Economics and Outcomes Research, Menlo Park, CA, USA
| | - Wendy Y Cheng
- Analysis Group, Inc., Health Economics and Outcomes Research, Boston, MA, USA
| | - Selvam R Sendhil
- Analysis Group, Inc., Health Economics and Outcomes Research, Los Angeles, CA, USA
| | - Manasvi Sundar
- Analysis Group, Inc., Health Economics and Outcomes Research, Los Angeles, CA, USA
| | - Ella Hagopian
- Analysis Group, Inc., Health Economics and Outcomes Research, Boston, MA, USA
| | | | - Mei Sheng Duh
- Analysis Group, Inc., Health Economics and Outcomes Research, Boston, MA, USA
| | - Sara Poston
- GSK, US Health Economics and Outcomes Research, Philadelphia, PA, USA
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Singer D, Thompson-Leduc P, Ma S, Gupta D, Cheng WY, Muthukumar A, Devine F, Sundar M, Bogart M, Hagopian E, Poston S, Duh MS, Oppenheimer JJ. Herpes zoster burden in patients with asthma: real-world incidence, healthcare resource utilisation and cost. BMJ Open Respir Res 2024; 11:e002130. [PMID: 38862238 PMCID: PMC11168123 DOI: 10.1136/bmjresp-2023-002130] [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: 10/13/2023] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Herpes zoster (HZ) is a painful condition caused by reactivation of the varicella-zoster virus. The objectives of this study were to compare HZ incidence in adults with asthma versus adults without asthma and to compare healthcare resource use as well as direct costs in adults with HZ and asthma versus adults with asthma alone in the USA. METHODS This retrospective longitudinal cohort study included adults aged ≥18 years across the USA. Patients were identified from Optum's deidentified Clinformatics Data Mart Database, an administrative claims database, between 1 October 2015 and 28 February 2020, including commercially insured and Medicare Advantage with part D beneficiaries. Cohorts of patients with and without asthma, and separate cohorts of patients with asthma and HZ and with asthma but not HZ, were identified using International Classification of Diseases 10th Revision, Clinical Modification codes. HZ incidence, healthcare resource use and costs were compared, adjusting for baseline characteristics, between the relevant cohorts using generalised linear models. RESULTS HZ incidence was higher in patients with asthma (11.59 per 1000 person-years) than patients without asthma (7.16 per 1000 person-years). The adjusted incidence rate ratio (aIRR) for HZ in patients with asthma, compared with patients without asthma, was 1.34 (95% CI 1.32 to 1.37). Over 12 months of follow-up, patients with asthma and HZ had more inpatient stays (aIRR 1.11; 95% CI 1.02 to 1.21), emergency department visits (aIRR 1.26; 95% CI 1.18 to 1.34) and outpatient visits (aIRR 1.19; 95% CI 1.16 to 1.22), and direct healthcare costs that were US dollars ($) 3058 (95% CI $1671 to $4492) higher than patients with asthma without HZ. CONCLUSION Patients with asthma had a higher incidence of HZ than those without asthma, and among patients with asthma HZ added to their healthcare resource use and costs.
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Affiliation(s)
| | | | - Siyu Ma
- GSK/Tufts Medical Center, Boston, Massachusetts, USA
| | | | | | | | | | | | - Michael Bogart
- GSK, Research Triangle Park, North Carolina, USA
- Gilead Sciences, Foster City, California, USA
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9
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Losa L, Antonazzo IC, Di Martino G, Mazzaglia G, Tafuri S, Mantovani LG, Ferrara P. Immunogenicity of Recombinant Zoster Vaccine: A Systematic Review, Meta-Analysis, and Meta-Regression. Vaccines (Basel) 2024; 12:527. [PMID: 38793778 PMCID: PMC11125663 DOI: 10.3390/vaccines12050527] [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: 03/20/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The adjuvanted recombinant zoster vaccine (RZV), consisting of varicella-zoster virus glycoprotein E (gE) and the AS01B adjuvant system, effectively prevents herpes zoster (HZ). In the absence of a well-defined correlate of protection, it is important to monitor the RZV immune response, as a proxy of clinical effectiveness. METHODS This systematic review examined post-vaccination parameters: humoral and cell-mediated immunity, avidity index, geometric mean concentration of antibody (GMC), and immunity persistence. The meta-analysis used a random-effects model, and subgroup and meta-regression analyses were conducted. RESULTS Among 37 included articles, after one month from RZV-dose 2, the pooled response rate for anti-gE humoral immunity was 95.2% (95%CI 91.9-97.2), dropping to 77.6% (95%CI 64.7-86.8) during immunosuppression. The anti-gE cell-mediated immunity-specific response reached 84.6% (95%CI 75.2-90.9). Varying factors, such as age, sex, coadministration with other vaccines, prior HZ, or live-attenuated zoster vaccine, did not significantly affect response rates. RZV induced a substantial increase in gE avidity. Immunity persistence was confirmed, with more rapid waning in the very elderly. CONCLUSIONS This systematic review indicates that RZV elicits robust immunogenicity and overcomes immunocompromising conditions. The findings underscore the need for further research, particularly on long-term immunity, and have the potential to support HZ vaccination policies and programs.
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Affiliation(s)
- Lorenzo Losa
- Center for Public Health Research, University of Milan–Bicocca, 20900 Monza, Italy
| | - Ippazio Cosimo Antonazzo
- Center for Public Health Research, University of Milan–Bicocca, 20900 Monza, Italy
- Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
| | - Giuseppe Di Martino
- Department of Medicine and Ageing Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
- Unit of Hygiene, Epidemiology and Public Health, Local Health Authority of Pescara, 65100 Pescara, Italy
| | - Giampiero Mazzaglia
- Center for Public Health Research, University of Milan–Bicocca, 20900 Monza, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, 70121 Bari, Italy
| | - Lorenzo Giovanni Mantovani
- Center for Public Health Research, University of Milan–Bicocca, 20900 Monza, Italy
- Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
| | - Pietro Ferrara
- Center for Public Health Research, University of Milan–Bicocca, 20900 Monza, Italy
- Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
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10
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Muttucumaru R, Lau CL, Leeb A, Mills DJ, Wood N, Furuya-Kanamori L. Post-marketing surveillance of 10,392 herpes zoster vaccines doses in Australia. Vaccine 2024; 42:3166-3171. [PMID: 38677792 DOI: 10.1016/j.vaccine.2024.03.066] [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: 12/21/2023] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Immunisation against herpes zoster is recommended for adults aged ≥ 50 years. Two vaccines, a live attenuated (ZVL, Zostavax®) and an adjuvant recombinant subunit (HZ/su, Shingrix®), are available in Australia. Immunisation guidelines are shifting their recommendations towards HZ/su because of higher efficacy in preventing herpes zoster and associated complications. However, there are limited post-marketing data comparing the safety profiles of these vaccines. METHODS Data from SmartVax, an active surveillance system for monitoring adverse events following immunisation (AEFIs) utilised by > 450 clinics throughout Australia, were analysed. Data from patients aged ≥ 50 years, who received ZVL or HZ/su, from 1 June 2021 to 31 May 2022, at clinics that utilised SmartVax were included. The proportion of records where patients who reported any, local, and systemic AEFIs after receiving ZVL or HZ/su were compared using multivariable logistic regression models. RESULTS Data from 10,392 immunisation records (n = 8341 ZVL; n = 2051 HZ/su) were included. The proportion of AEFIs reported was higher with HZ/su (41.9 % [any], 33.8 % [local], 25.2 % [systemic]) than with ZVL (8.7 % [any], 6.2 % [local], 3.5 % [systemic]). After controlling for demographic variables, HZ/su presented a 6-fold increase in the odds (OR 6.44; 95 %CI: 5.57-7.46) of a reported AEFI compared to ZVL. Only 59 (0.6 %) of vaccinations lead to medical attention being sought due to an AEFI. CONCLUSIONS While rates of AEFIs was higher with HZ/su than ZVL, most AEFIs were mild and did not require medical attention. Our findings support the change in vaccine recommendations and the use of HZ/su in immunisation programs.
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Affiliation(s)
- Ramona Muttucumaru
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia; National Centre for Epidemiology and Population Health, College of Health & Medicine, The Australian National University, Canberra, Australia
| | - Colleen L Lau
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Alan Leeb
- Illawarra Medical Centre, Perth, Australia
| | - Deborah J Mills
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia; Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, Australia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Westmead, Australia; University of Sydney's Hospital Westmead Clinical School, Faculty of Medicine and Health, Westmead, Australia
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia.
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George S, Carrico J, Hicks KA, Loukov D, Ng C, Regan J, Giannelos N. Updated Public Health Impact and Cost Effectiveness of Recombinant Zoster Vaccine in Canadian Adults Aged 50 Years and Older. PHARMACOECONOMICS - OPEN 2024; 8:481-492. [PMID: 38605257 PMCID: PMC11058134 DOI: 10.1007/s41669-024-00483-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES The aim of this study was to update previously estimated public health impact and cost effectiveness of recombinant zoster vaccine (RZV) for the prevention of herpes zoster (HZ) in Canadians aged ≥50 years using longer-term RZV efficacy and waning data and real-world coverage and completion. METHODS A multicohort Markov model was used to conduct a cost-utility analysis comparing RZV with no HZ vaccination among Canadians aged ≥50 years. Real-world data were used for first-dose coverage (17.5%) and second-dose completion (65%). Vaccine efficacy and waning data were applied from up to 8-year follow-up from the ZOE-50 and ZOE-70 clinical trials. Incremental costs and benefits were calculated using a lifetime horizon from the healthcare payer (base case) and societal perspectives. A discount rate of 1.5% was applied to costs and quality-adjusted life-years (QALYs). RESULTS The model estimated that RZV would prevent 303,835 HZ cases, 83,256 post-herpetic neuralgia (PHN) cases, 39,653 other complications, and 99 HZ-related deaths compared with no HZ vaccination. Incremental cost-effectiveness ratios (ICERs) were estimated to be $27,486 and $22,097 per QALY (2022 Canadian dollars [CAN$]) from the healthcare payer and societal perspectives, respectively. The base-case ICER was most sensitive to a lower percentage of initial HZ cases with PHN. Almost all probabilistic sensitivity analysis simulations (98.1%) resulted in ICERs CONCLUSIONS RZV is expected to remain a cost-effective option for Canadian adults aged ≥50 years when using longer-term RZV efficacy and waning estimates, although the estimated public health impact was smaller than in the previous analysis (due to lower coverage/completion estimates).
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12
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Xu S, Wang Y. Transient Receptor Potential Channels: Multiple Modulators of Peripheral Neuropathic Pain in Several Rodent Models. Neurochem Res 2024; 49:872-886. [PMID: 38281247 DOI: 10.1007/s11064-023-04087-4] [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: 10/14/2023] [Revised: 11/22/2023] [Accepted: 12/16/2023] [Indexed: 01/30/2024]
Abstract
Neuropathic pain, a prevalent chronic condition in clinical settings, has attracted widespread societal attention. This condition is characterized by a persistent pain state accompanied by affective and cognitive disruptions, significantly impacting patients' quality of life. However, current clinical therapies fall short of addressing its complexity. Thus, exploring the underlying molecular mechanism of neuropathic pain and identifying potential targets for intervention is highly warranted. The transient receptor potential (TRP) receptors, a class of widely distributed channel proteins, in the nervous system, play a crucial role in sensory signaling, cellular calcium regulation, and developmental influences. TRP ion channels are also responsible for various sensory responses including heat, cold, pain, and stress. This review highlights recent advances in understanding TRPs in various rodent models of neuropathic pain, aiming to uncover potential therapeutic targets for clinical management.
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Affiliation(s)
- Songchao Xu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Yun Wang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong'an Road, Xicheng District, Beijing, 100050, China.
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Andoh T, Kikukawa T, Kotani A, Kurokawa Y, Asakura W, Houmoto K, Fukutomi D, Uta D, Okai H, Koike K. Combined effect of Neurotropin® and methylcobalamin on postherpetic neuralgia in mice infected with herpes simplex virus type-1. J Dermatol Sci 2024; 113:138-147. [PMID: 38429137 DOI: 10.1016/j.jdermsci.2024.02.004] [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: 10/10/2023] [Revised: 01/16/2024] [Accepted: 02/09/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Postherpetic pain (PHP) is difficult to control. Although Neurotropin® (NTP) and methylcobalamin (MCB) are often prescribed to treat the pain, the efficacy of combined treatment for PHP remains imcompletely understood. OBJECTIVE In this study, we investigate the combined effects of NTP and MCB on PHP in mice. METHODS NTP and MCB were administered from day 10-29 after herpes simplex virus type-1 (HSV-1) infection. The pain-related responses were evaluated using a paint brush. The expression of neuropathy-related factor (ATF3) and nerve repair factors (GAP-43 and SPRR1A) in the dorsal root ganglion (DRG) and neurons in the skin were evaluated by immunohistochemical staining. Nerve growth factor (NGF) and neurotrophin-3 (NT3) mRNA expression levels were evaluated using real-time PCR. RESULTS Repeated treatment with NTP and MCB after the acute phase inhibited PHP. Combined treatment with these drugs inhibited PHP at an earlier stage than either treatment alone. In the DRG of HSV-1-infected mice, MCB, but not NTP, decreased the number of cells expressing ATF3 and increased the number of cells expressing GAP-43- and SPRR1A. In addition, MCB, but not NTP, also increased and recovered non-myelinated neurons decreased in the lesional skin. NTP increased the mRNA levels of NTF3 in keratinocytes, while MCB increased that of NGF in Schwann cells. CONCLUSION These results suggest that combined treatment with NTP and MCB is useful for the treatment of PHP. The combined effect may be attributed to the different analgesic mechanisms of these drugs.
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Affiliation(s)
- Tsugunobu Andoh
- Department of Applied Pharmacology, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama, Japan; Department of Pharmacology and Pathophysiology, College of Pharmacy, Kinjo Gakuin University, Nagoya, Japan.
| | - Takashi Kikukawa
- Department of Applied Pharmacology, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Atsushi Kotani
- Department of Applied Pharmacology, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Yoko Kurokawa
- Department of Applied Pharmacology, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Wakana Asakura
- Department of Pharmacology and Pathophysiology, College of Pharmacy, Kinjo Gakuin University, Nagoya, Japan
| | - Kengo Houmoto
- Department of Applied Pharmacology, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Daisuke Fukutomi
- Department of Applied Pharmacology, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Daisuke Uta
- Department of Applied Pharmacology, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Hisashi Okai
- Department of Pharmacological Research, Institute of Bio-active Science, Nippon Zoki Pharmaceutical Co., Ltd, Hyogo, Japan
| | - Koji Koike
- Department of Pathophysiology, Institute of Bio-active Science, Nippon Zoki Pharmaceutical Co., Ltd, Hyogo, Japan
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Kui W, Xie L, Li Y, Gu Z, Liu S, Xue C, Wang K. Efficacy and safety of bloodletting puncture and cupping in postherpetic neuralgia: A systematic review and meta‑analysis. Biomed Rep 2024; 20:30. [PMID: 38259587 PMCID: PMC10801353 DOI: 10.3892/br.2023.1718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/09/2023] [Indexed: 01/24/2024] Open
Abstract
The present study aimed to evaluate the efficacy and safety of bloodletting puncture and cupping (BLP-C) in postherpetic neuralgia (PHN) and to provide guidance for clinical treatment. Randomized controlled trials (RCTs) of BLP-C therapy in PHN were systematically searched in eight databases from inception to September 2022. Literature screening, data extraction and quality assessment were performed by two independent researchers. Dichotomous and continuous variables were pooled using the risk ratio (RR) and weighted mean difference (WMD), respectively. A total of 13 studies involving 1,129 patients with PHN (571 in the experimental group and 558 in the control group) were included in the present meta-analysis. Overall efficacy (RR=1.21, 95% CI: 1.15 to 1.28, P<0.00001), VAS score (WMD=-1.10, 95% CI: -1.31 to -0.90, P<0.00001) and PSQI score (WMD=-2.42, 95% CI: -2.87 to -1.96, P<0.0001) were significantly different between the BLP-C group and Western medicine group. Furthermore, subgroup analysis demonstrated that BLP-C alone or combined with other traditional Chinese medicines was more effective than Western medicine in PHN. A total of four RCTs mentioned adverse reactions, most of which were in the Western medicine group and were relieved after treatment discontinuation. In conclusion, BLP-C is superior to Western medicine in relieving pain and improving the sleep quality of patients with PHN with a lower incidence of adverse effects.
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Affiliation(s)
- Wenyun Kui
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Lei Xie
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Yanan Li
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Zhen Gu
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Shuang Liu
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Chunchun Xue
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Kaiqiang Wang
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
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Wang A, Liu N, Zhao J, Niu Y, Chen Y, Zhou J, Liu E, Zhang G. Development of a double-antibody sandwich enzyme-linked immunosorbent assay for rapid detection of VZV. J Virol Methods 2024; 324:114874. [PMID: 38154579 DOI: 10.1016/j.jviromet.2023.114874] [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: 09/07/2023] [Revised: 12/13/2023] [Accepted: 12/25/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Varicella zoster virus (VZV) is the pathogen of varicella and herpes zoster, it is necessary to develop a rapid, sensitive and specific detection method for the prevention and control of related diseases. METHODS We inserted the gB protein extracellular region gene (gB-ex, 1-2208 bp) of VZV into lentivirus vector, and then obtained the recombinant gB protein through mammalian expression system. BALB/c mice were immunized multiple times with purified gB protein as immunogen. Then four strains of high affinity monoclonal antibodies targeting gB protein were prepared by cell fusion technique. Monoclonal antibodies 5G4 and HRP-4E9 were selected as capture and detection antibodies respectively, and a double-antibody sandwich ELISA method was established for detection. RESULTS The detection limit of the DAS-ELISA was 156 PFU/mL, and there was no cross-reaction with Herpes simplex virus-1/Herpes simplex virus-2/Pseudorabies virus. The coefficients of variation of intra-assay and inter-assay repeatability were less than 5%. CONCLUSIONS In this study, a double-antibody sandwich enzyme-linked immunosorbent assay (DAS-ELISA) was established for the detection of VZV. The assay has good sensitivity, specificity and repeatability, which provides strong technical support and product guarantee for the rapid clinical detection of VZV.
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Affiliation(s)
- Aiping Wang
- Longhu Laboratory of Advanced Immunology, Zhengzhou, Henan, China; School of Life Sciences, Zhengzhou University, Zhengzhou, 450001 Henan, China
| | - Na Liu
- School of Life Sciences, Zhengzhou University, Zhengzhou, 450001 Henan, China
| | - Jianguo Zhao
- School of Advanced Agricultural Sciences, Peking University, Beijing, 100871 China
| | - Yan Niu
- School of Life Sciences, Zhengzhou University, Zhengzhou, 450001 Henan, China
| | - Yumei Chen
- Longhu Laboratory of Advanced Immunology, Zhengzhou, Henan, China; School of Life Sciences, Zhengzhou University, Zhengzhou, 450001 Henan, China
| | - Jingming Zhou
- Longhu Laboratory of Advanced Immunology, Zhengzhou, Henan, China; School of Life Sciences, Zhengzhou University, Zhengzhou, 450001 Henan, China
| | - Enping Liu
- Longhu Laboratory of Advanced Immunology, Zhengzhou, Henan, China; School of Life Sciences, Zhengzhou University, Zhengzhou, 450001 Henan, China
| | - Gaiping Zhang
- Longhu Laboratory of Advanced Immunology, Zhengzhou, Henan, China; School of Life Sciences, Zhengzhou University, Zhengzhou, 450001 Henan, China; School of Advanced Agricultural Sciences, Peking University, Beijing, 100871 China.
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Kalava A, Mihaylov SV, Austin HK, Acharya S. Peripheral Nerve Stimulation for a Refractory Case of Postherpetic Neuralgia in the Upper Limb: A Case Report. Cureus 2024; 16:e55168. [PMID: 38558725 PMCID: PMC10979704 DOI: 10.7759/cureus.55168] [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] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Postherpetic neuralgia (PHN) is a chronic neuropathic pain syndrome that is a direct consequence of the reactivation of varicella zoster virus (VZV). It manifests as neuropathic pain, which is pain that occurs because of dysfunction or damage of the nerves that carry sensations to the brain, and this typically persists for months to years after herpes zoster. Current conservative management for PHN includes a combination of topical agents (i.e., lidocaine and capsaicin) and systemic therapy (i.e., serotonin and norepinephrine reuptake inhibitors (SNRIs), gabapentin, pregabalin, and opioids). For refractory cases, with persistent intractable pain, more invasive interventional techniques can be used as pain-relieving measures to improve the patient's quality of life. This report presents a patient with upper limb PHN who responded to peripheral nerve stimulation (PNS) after he failed to obtain sufficient pain relief with conservative management.
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Affiliation(s)
- Arun Kalava
- Anesthesiology, University of Central Florida College of Medicine, Orlando, USA
| | | | - Harriet Kaye Austin
- Anesthesiology, University of Central Florida College of Medicine, Orlando, USA
| | - Saru Acharya
- Anesthesia and Critical Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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Ponticelli D, Antonazzo IC, Losa L, Zampella A, Di Marino F, Mottola G, Fede MN, Gallucci F, Magliuolo R, Rainone A, Del Giudice C, Arcari A, Ferrara P. Knowledge, Attitudes and Practices Survey of Recombinant Zoster Vaccine among Cardiologists and Cardiac Nurses in Italy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:93. [PMID: 38256354 PMCID: PMC10820166 DOI: 10.3390/medicina60010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Cardiac patients are particularly at risk of herpes zoster (HZ), which is associated with a higher risk of major cardiovascular events. This research aimed to analyze the knowledge, attitudes and practices towards recombinant zoster vaccine (RZV) among cardiac healthcare professionals (HPs). Materials and Methods: A cross-sectional survey was conducted in a cardiological hospital in Italy. Multivariate regression models were built to identify factors associated with the outcomes of interest. Results: The response rate was 78.2% (154/197). Overall, age > 50 years and immunosuppression were recognized as risk factors for HZ by 38.3% and 75.3% of respondents, respectively. Regarding RZV, 29.1% of the HPs correctly responded about its schedule and 57.6% about the possibility of administration in immunocompromised individuals. This knowledge was significantly higher in HPs with a higher educational level (odds ratio (OR) = 4.42; 95%CI 1.70-11.47), in those who knew that HZ could cause postherpetic neuralgia (OR = 2.56; 95%CI 1.05-6.25) or major cardiovascular events (OR = 4.23; 95%CI 1.50-11.91), in those who had participated in professional updates on vaccinations (OR = 3.86; 95%CI 1.51-9.87) and in those who stated the need for further information about the RZV (OR = 6.43; 95%CI 1.42-29.98). Younger HPs (coefficient (β) = -0.02; 95%CI -0.04--0.01), those with a positive attitude toward RZV safety (β = 2.92; 95%CI 2.49-3.36) and those who had previously cared for patients with HZ (β = 0.45; 95%CI 0.03-0.88) reported a more positive attitude toward RZV effectiveness. The practice of recommending vaccination was more prevalent in younger HPs (OR = 0.94; 95%CI 0.89-0.99), in those who had a master's degree or higher education (OR = 7.21; 95%CI 1.44-36.08), in those with more positive attitudes toward RZV effectiveness (OR = 7.17; 95%CI 1.71-30.03) and in HPs who had already recommended the vaccine to patients in the past (OR = 4.03; 95%CI 1.08-14.96). Conclusions: Despite being a single-center study, our research brings attention to factors that currently impact cardiac HPs' approaches to RZV. The findings indicate potential measures to enhance HPs' awareness and practices, ultimately aiming to improve vaccination adherence and reduce the burden associated with HZ.
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Affiliation(s)
| | - Ippazio Cosimo Antonazzo
- Center for Public Health Research, University of Milan–Bicocca, 20900 Monza, Italy
- Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, 20165 Milan, Italy
| | - Lorenzo Losa
- Center for Public Health Research, University of Milan–Bicocca, 20900 Monza, Italy
| | | | | | | | | | | | | | | | | | | | - Pietro Ferrara
- Center for Public Health Research, University of Milan–Bicocca, 20900 Monza, Italy
- Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, 20165 Milan, Italy
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Wadhwa S, Jain S, Gemnani R, Madke B. Nasal Herpes Simplex With Infraorbital Neuralgia: A Rare Presentation. Cureus 2023; 15:e49584. [PMID: 38156122 PMCID: PMC10753150 DOI: 10.7759/cureus.49584] [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: 09/21/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Facial herpes is a form of herpes simplex type I infection and presents with characteristic vesicular lesion around the perioral region. Nasal herpes, a form of facial herpes is a rare presentation with only a few cases reported in the literature. Neuralgic pain in herpes simplex is usually experienced at the site of the lesion during or before the eruptive stage. Here, we are reporting a case where the patient with a herpes simplex lesion over the tip of her nose presented with pain over the infraorbital region, which is a region supplied by the infraorbital nerve, a branch of the maxillary division of the trigeminal nerve. Initially confused as a bacterial infection due to its unusual presentation and rarity of the condition, the patient was given anti-bacterial therapy, but on showing no relief in symptoms, the patient was treated with appropriate antiviral drugs, following which complete remission of the lesion was observed. The case highlights a rare site for a common condition and atypical presentation.
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Affiliation(s)
- Smriti Wadhwa
- Department of Otorhinolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shraddha Jain
- Department of Otorhinolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rinkle Gemnani
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhushan Madke
- Department of Dermatology, Venereology, and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Bruno F, Abondio P, Bruno R, Ceraudo L, Paparazzo E, Citrigno L, Luiselli D, Bruni AC, Passarino G, Colao R, Maletta R, Montesanto A. Alzheimer's disease as a viral disease: Revisiting the infectious hypothesis. Ageing Res Rev 2023; 91:102068. [PMID: 37704050 DOI: 10.1016/j.arr.2023.102068] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
Alzheimer's disease (AD) represents the most frequent type of dementia in elderly people. Two major forms of the disease exist: sporadic - the causes of which have not yet been fully understood - and familial - inherited within families from generation to generation, with a clear autosomal dominant transmission of mutations in Presenilin 1 (PSEN1), 2 (PSEN2) or Amyloid Precursors Protein (APP) genes. The main hallmark of AD consists of extracellular deposits of amyloid-beta (Aβ) peptide and intracellular deposits of the hyperphosphorylated form of the tau protein. An ever-growing body of research supports the viral infectious hypothesis of sporadic forms of AD. In particular, it has been shown that several herpes viruses (i.e., HHV-1, HHV-2, HHV-3 or varicella zoster virus, HHV-4 or Epstein Barr virus, HHV-5 or cytomegalovirus, HHV-6A and B, HHV-7), flaviviruses (i.e., Zika virus, Dengue fever virus, Japanese encephalitis virus) as well as Human Immunodeficiency Virus (HIV), hepatitis viruses (HAV, HBV, HCV, HDV, HEV), SARS-CoV2, Ljungan virus (LV), Influenza A virus and Borna disease virus, could increase the risk of AD. Here, we summarized and discussed these results. Based on these findings, significant issues for future studies are also put forward.
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Affiliation(s)
- Francesco Bruno
- Regional Neurogenetic Centre (CRN), Department of Primary Care, Azienda Sanitaria Provinciale Di Catanzaro, Viale A. Perugini, 88046 Lamezia Terme, CZ, Italy; Association for Neurogenetic Research (ARN), Lamezia Terme, CZ, Italy
| | - Paolo Abondio
- Laboratory of Ancient DNA, Department of Cultural Heritage, University of Bologna, Via degli Ariani 1, 48121 Ravenna, Italy.
| | - Rossella Bruno
- Sudent at the Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88050 Catanzaro, Italy
| | - Leognano Ceraudo
- Sudent at the Department of Medical and Surgical Sciences, University of Parma, 43121 Parma, Italy
| | - Ersilia Paparazzo
- Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende 87036, Italy
| | - Luigi Citrigno
- National Research Council (CNR) - Institute for Biomedical Research and Innovation - (IRIB), 87050 Mangone, Cosenza, Italy
| | - Donata Luiselli
- Laboratory of Ancient DNA, Department of Cultural Heritage, University of Bologna, Via degli Ariani 1, 48121 Ravenna, Italy
| | - Amalia C Bruni
- Regional Neurogenetic Centre (CRN), Department of Primary Care, Azienda Sanitaria Provinciale Di Catanzaro, Viale A. Perugini, 88046 Lamezia Terme, CZ, Italy; Association for Neurogenetic Research (ARN), Lamezia Terme, CZ, Italy
| | - Giuseppe Passarino
- Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende 87036, Italy
| | - Rosanna Colao
- Regional Neurogenetic Centre (CRN), Department of Primary Care, Azienda Sanitaria Provinciale Di Catanzaro, Viale A. Perugini, 88046 Lamezia Terme, CZ, Italy
| | - Raffaele Maletta
- Regional Neurogenetic Centre (CRN), Department of Primary Care, Azienda Sanitaria Provinciale Di Catanzaro, Viale A. Perugini, 88046 Lamezia Terme, CZ, Italy; Association for Neurogenetic Research (ARN), Lamezia Terme, CZ, Italy
| | - Alberto Montesanto
- Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende 87036, Italy.
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Singer D, Thompson-Leduc P, Ma S, Gupta D, Cheng WY, Sendhil SR, Sundar M, Hagopian E, Stempniewicz N, Duh MS, Poston S. Burden of Herpes Zoster Among Patients with Psoriasis in the United States. Dermatol Ther (Heidelb) 2023; 13:2649-2668. [PMID: 37740149 PMCID: PMC10613173 DOI: 10.1007/s13555-023-00988-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/18/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Patients with psoriasis (PsO) are at increased risk of herpes zoster (HZ), but recent data on the incidence of HZ among patients with PsO and the impact of HZ on healthcare resource use (HRU) and costs for patients with PsO have not been described. METHODS This retrospective, longitudinal, cohort study estimated HZ incidence in cohorts of adults with vs without PsO (PsO + vs PsO-) and HRU and costs among those with PsO, with vs without HZ (PsO + /HZ + vs PsO + /HZ-) using Optum's de-identified Clinformatics Data Mart Database during 2015-2020. Patients with psoriatic arthritis were excluded from all four cohorts. Comparisons between cohorts used generalized linear models to adjust outcomes based on various baseline characteristics. RESULTS The incidence rate of HZ was significantly higher in the PsO + (n = 144,115) vs PsO- (n = 23,837,237) cohorts at 11.35 vs 7.67 per 1000 patient-years; adjusted incidence rate ratio (aIRR): 1.21, 95% confidence interval (CI): 1.16-1.25. HRU (outpatient, emergency department, and inpatient) was significantly higher in the PsO + /HZ + (n = 1859) vs PsO + /HZ- (n = 78,664) cohorts during 1 month and 3 months after HZ diagnosis (e.g., outpatient visits during month: 2.83 vs 1.30 per patient; aIRR: 1.96; 95% CI 1.86-2.06). Mean all-cause costs were also significantly higher in the PsO + /HZ + vs PsO + /HZ- cohort during both month ($5020 vs $2715 per patient; adjusted cost difference: $1390; 95% CI $842-$1964) and 3 months ($12,305 vs $8256; adjusted cost difference: $1422; 95% CI $280-$2889) after HZ diagnosis. CONCLUSION These findings show the increased incidence of HZ among patients with PsO and the clinical and economic burdens of HZ in this population. Considering the high prevalence of PsO, insights into the impact of HZ in these patients provide valuable evidence to inform clinical decision-making.
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Affiliation(s)
- David Singer
- GSK, US Health Outcomes and Epidemiology, Vaccines, FMC Tower Suite 1700, 2929 Walnut Street, Philadelphia, PA19104, USA
| | | | - Siyu Ma
- GSK, US Health Outcomes and Epidemiology, Vaccines, FMC Tower Suite 1700, 2929 Walnut Street, Philadelphia, PA19104, USA
- Tufts Medical Center, Boston, MA, USA
| | | | | | | | | | | | - Nikita Stempniewicz
- GSK, US Health Outcomes and Epidemiology, Vaccines, FMC Tower Suite 1700, 2929 Walnut Street, Philadelphia, PA19104, USA.
| | | | - Sara Poston
- GSK, US Health Outcomes and Epidemiology, Vaccines, FMC Tower Suite 1700, 2929 Walnut Street, Philadelphia, PA19104, USA
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Wen SY, Ou-Yang C, Chang C, Chen CC, Chang HY. Impact of Type 1 Versus Type 2 Diabetes on Developing Herpes Zoster and Post-herpetic Neuralgia: A Population-based Cohort Study. Acta Derm Venereol 2023; 103:adv9400. [PMID: 37787418 PMCID: PMC10561104 DOI: 10.2340/actadv.v103.9400] [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: 02/04/2023] [Accepted: 07/14/2023] [Indexed: 10/04/2023] Open
Abstract
Type 2 diabetes is associated with an increased risk of herpes zoster and postherpetic neuralgia. However, the association of type 1 diabetes with herpes zoster or postherpetic neuralgia remains unclear. This retrospective cohort study using Taiwan's Health Insurance Research Database included 199,566 patients with type 1 diabetes and 1,458,331 with type 2 diabetes, identified during the period 2000 to 2012. Patients with type 1 diabetes had a significantly higher risk of developing herpes zoster than those with type 2 diabetes (p < 0.001). Across all age groups, the impact of diabetes on herpes zoster was greater in type 1 than in type 2 diabetes. Patients with both type 1 and type 2 diabetes had a 1.45-fold higher risk of post-herpetic neuralgia than those without diabetes (hazard ratio 1.45, 95% confidence interval 1.28-1.65; hazard ratio 1.45, 95% confidence interval 1.37-1.52, respectively), and there was no difference between the 2 types of diabetes (hazard ratio 1.06; 95% confidence interval 0.93-1.21). The results recommend consideration of herpes zoster vaccination at an earlier age in patients with type 1 diabetes.
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Affiliation(s)
- Su-Ying Wen
- School of Management, National Taiwan University of Science and Technology, Taipei, Taiwan; Department of Dermatology, Taipei City Hospital, Renai Branch, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Science, Taipei, Taiwan; Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Department of Health and Welfare, University of Taipei, Taipei, Taiwan,
| | - Chao Ou-Yang
- Department of Industrial Management, National Taiwan University of Science and Technology, Taipei 106, Taiwan
| | | | - Chu-Chieh Chen
- National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Hung-Yu Chang
- Division of Endocricrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Health Care Center, Chang Gung Memorial Hospital, Taoyuan Branch, Taiwan.
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22
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de Oliveira Gomes J, Gagliardi AM, Andriolo BN, Torloni MR, Andriolo RB, Puga MEDS, Canteiro Cruz E. Vaccines for preventing herpes zoster in older adults. Cochrane Database Syst Rev 2023; 10:CD008858. [PMID: 37781954 PMCID: PMC10542961 DOI: 10.1002/14651858.cd008858.pub5] [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] [Indexed: 10/03/2023]
Abstract
BACKGROUND Herpes zoster, commonly known as shingles, is a neurocutaneous disease caused by the reactivation of the virus that causes varicella (chickenpox). After resolution of the varicella episode, the virus can remain latent in the sensitive dorsal ganglia of the spine. Years later, with declining immunity, the varicella zoster virus (VZV) can reactivate and cause herpes zoster, an extremely painful condition that can last many weeks or months and significantly compromise the quality of life of the affected person. The natural process of ageing is associated with a reduction in cellular immunity, and this predisposes older adults to herpes zoster. Vaccination with an attenuated form of the VZV activates specific T-cell production avoiding viral reactivation. Two types of herpes zoster vaccines are currently available. One of them is the single-dose live attenuated zoster vaccine (LZV), which contains the same live attenuated virus used in the chickenpox vaccine, but it has over 14-fold more plaque-forming units of the attenuated virus per dose. The other is the recombinant zoster vaccine (RZV) which does not contain the live attenuated virus, but rather a small fraction of the virus that cannot replicate but can boost immunogenicity. The recommended schedule for the RZV is two doses two months apart. This is an update of a Cochrane Review first published in 2010, and updated in 2012, 2016, and 2019. OBJECTIVES To evaluate the effectiveness and safety of vaccination for preventing herpes zoster in older adults. SEARCH METHODS For this 2022 update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL 2022, Issue 10), MEDLINE (1948 to October 2022), Embase (2010 to October 2022), CINAHL (1981 to October 2022), LILACS (1982 to October 2022), and three trial registries. SELECTION CRITERIA We included studies involving healthy older adults (mean age 60 years or older). We included randomised controlled trials (RCTs) or quasi-RCTs comparing zoster vaccine (any dose and potency) versus any other type of intervention (e.g. varicella vaccine, antiviral medication), placebo, or no intervention (no vaccine). Outcomes were cumulative incidence of herpes zoster, adverse events (death, serious adverse events, systemic reactions, or local reaction occurring at any time after vaccination), and dropouts. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included two new studies involving 1736 participants in this update. The review now includes a total of 26 studies involving 90,259 healthy older adults with a mean age of 63.7 years. Only three studies assessed the cumulative incidence of herpes zoster in groups that received vaccines versus placebo. Most studies were conducted in high-income countries in Europe and North America and included healthy Caucasians (understood to be white participants) aged 60 years or over with no immunosuppressive comorbidities. Two studies were conducted in Japan and one study was conducted in the Republic of Korea. Sixteen studies used LZV. Ten studies tested an RZV. The overall certainty of the evidence was moderate, which indicates that the intervention probably works. Most data for the primary outcome (cumulative incidence of herpes zoster) and secondary outcomes (adverse events and dropouts) came from studies that had a low risk of bias and included a large number of participants. The cumulative incidence of herpes zoster at up to three years of follow-up was lower in participants who received the LZV (one dose subcutaneously) than in those who received placebo (risk ratio (RR) 0.49, 95% confidence interval (CI) 0.43 to 0.56; risk difference (RD) 2%; number needed to treat for an additional beneficial outcome (NNTB) 50; moderate-certainty evidence) in the largest study, which included 38,546 participants. There were no differences between the vaccinated and placebo groups for serious adverse events (RR 1.08, 95% CI 0.95 to 1.21) or deaths (RR 1.01, 95% CI 0.92 to 1.11; moderate-certainty evidence). The vaccinated group had a higher cumulative incidence of one or more adverse events (RR 1.71, 95% CI 1.38 to 2.11; RD 23%; number needed to treat for an additional harmful outcome (NNTH) 4.3) and injection site adverse events (RR 3.73, 95% CI 1.93 to 7.21; RD 28%; NNTH 3.6; moderate-certainty evidence) of mild to moderate intensity. These data came from four studies with 6980 participants aged 60 years or older. Two studies (29,311 participants for safety evaluation and 22,022 participants for efficacy evaluation) compared RZV (two doses intramuscularly, two months apart) versus placebo. Participants who received the new vaccine had a lower cumulative incidence of herpes zoster at 3.2 years follow-up (RR 0.08, 95% CI 0.03 to 0.23; RD 3%; NNTB 33; moderate-certainty evidence), probably indicating a favourable profile of the intervention. There were no differences between the vaccinated and placebo groups in cumulative incidence of serious adverse events (RR 0.97, 95% CI 0.91 to 1.03) or deaths (RR 0.94, 95% CI 0.84 to 1.04; moderate-certainty evidence). The vaccinated group had a higher cumulative incidence of adverse events, any systemic symptom (RR 2.23, 95% CI 2.12 to 2.34; RD 33%; NNTH 3.0), and any local symptom (RR 6.89, 95% CI 6.37 to 7.45; RD 67%; NNTH 1.5). Although most participants reported that their symptoms were of mild to moderate intensity, the risk of dropouts (participants not returning for the second dose, two months after the first dose) was higher in the vaccine group than in the placebo group (RR 1.25, 95% CI 1.13 to 1.39; RD 1%; NNTH 100, moderate-certainty evidence). Only one study reported funding from a non-commercial source (a university research foundation). All other included studies received funding from pharmaceutical companies. We did not conduct subgroup and sensitivity analyses AUTHORS' CONCLUSIONS: LZV (single dose) and RZV (two doses) are probably effective in preventing shingles disease for at least three years. To date, there are no data to recommend revaccination after receiving the basic schedule for each type of vaccine. Both vaccines produce systemic and injection site adverse events of mild to moderate intensity. The conclusions did not change in relation to the previous version of the systematic review.
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Affiliation(s)
| | - Anna Mz Gagliardi
- Department of Geriatrics and Gerontology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Brenda Ng Andriolo
- Cochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
| | - Maria Regina Torloni
- Cochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
| | - Regis B Andriolo
- Department of Public Health, Universidade do Estado do Pará, Belém, Brazil
| | - Maria Eduarda Dos Santos Puga
- Cochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
| | - Eduardo Canteiro Cruz
- Department of Geriatrics and Gerontology, Universidade Federal de São Paulo, São Paulo, Brazil
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Tang J, Zhang Y, Liu C, Zeng A, Song L. Therapeutic Strategies for Postherpetic Neuralgia: Mechanisms, Treatments, and Perspectives. Curr Pain Headache Rep 2023; 27:307-319. [PMID: 37493871 DOI: 10.1007/s11916-023-01146-x] [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] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE OF REVIEW Postherpetic neuralgia is an annoying pain that mainly affects older people. In order to give patients more options, this review summarizes the pharmacological and interventional treatments for postherpetic neuralgia and updates the research on the efficacy, thereby providing doctors with more treatment options. The adverse effects and effective doses of its various treatments are also presented so that the therapy can be prescribed according to their concrete physical conditions. In a word, this review is dedicated to providing a comprehensive overview of the treatment options for postherpetic neuralgia and offering patients more choices. RECENT FINDINGS Combinational therapy is more excellent than monotherapy. The local anesthesia and gabapentin comprised outstanding compatibility. In addition, two therapeutic tools for PHN patients, especially for the intractable ones, electroacupuncture (EA), and osteopathic manipulative treatment (OMT), show their efficacy and become potential options to alleviate pain. In terms of treatment, guidelines recommend patients use tricyclic antidepressants (TCAs), gabapentin, pregabalin, and 5% lidocaine patches as the first-line medications, and gabapentin is investigated most, especially the gabapentin enacarbil (GEn). And drug efficacy can be limited by adverse effects and tolerated doses. Interventional treatments, with their invasiveness and operational difficulty, are usually considered for intractable patients. Combinational therapies may be used when a single therapy cannot achieve the desired effect. Therapies such as OMT and EA have also been proposed to palliate pain in some cases, and future directions of treatment may be investigated in Chinese medicine and acupuncture.
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Affiliation(s)
- Jiayu Tang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China
| | - Yunchao Zhang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China
| | - Chenxin Liu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China
| | - Anqi Zeng
- Institute of Translational Pharmacology and Clinical Application, Sichuan Academy of Chinese Medical Science, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Linjiang Song
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China.
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Huerta MÁ, Garcia MM, García-Parra B, Serrano-Afonso A, Paniagua N. Investigational Drugs for the Treatment of Postherpetic Neuralgia: Systematic Review of Randomized Controlled Trials. Int J Mol Sci 2023; 24:12987. [PMID: 37629168 PMCID: PMC10455720 DOI: 10.3390/ijms241612987] [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: 07/25/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
The pharmacological treatment of postherpetic neuralgia (PHN) is unsatisfactory, and there is a clinical need for new approaches. Several drugs under advanced clinical development are addressed in this review. A systematic literature search was conducted in three electronic databases (Medline, Web of Science, Scopus) and in the ClinicalTrials.gov register from 1 January 2016 to 1 June 2023 to identify Phase II, III and IV clinical trials evaluating drugs for the treatment of PHN. A total of 18 clinical trials were selected evaluating 15 molecules with pharmacological actions on nine different molecular targets: Angiotensin Type 2 Receptor (AT2R) antagonism (olodanrigan), Voltage-Gated Calcium Channel (VGCC) α2δ subunit inhibition (crisugabalin, mirogabalin and pregabalin), Voltage-Gated Sodium Channel (VGSC) blockade (funapide and lidocaine), Cyclooxygenase-1 (COX-1) inhibition (TRK-700), Adaptor-Associated Kinase 1 (AAK1) inhibition (LX9211), Lanthionine Synthetase C-Like Protein (LANCL) activation (LAT8881), N-Methyl-D-Aspartate (NMDA) receptor antagonism (esketamine), mu opioid receptor agonism (tramadol, oxycodone and hydromorphone) and Nerve Growth Factor (NGF) inhibition (fulranumab). In brief, there are several drugs in advanced clinical development for treating PHN with some of them reporting promising results. AT2R antagonism, AAK1 inhibition, LANCL activation and NGF inhibition are considered first-in-class analgesics. Hopefully, these trials will result in a better clinical management of PHN.
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Affiliation(s)
- Miguel Á. Huerta
- Department of Pharmacology, University of Granada, 18016 Granada, Spain;
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain
| | - Miguel M. Garcia
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Unidad Asociada I+D+i Instituto de Química Médica (IQM) CSIC-URJC, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- High Performance Experimental Pharmacology Research Group, Universidad Rey Juan Carlos (PHARMAKOM), 28922 Alcorcón, Spain
| | - Beliu García-Parra
- Clinical Neurophysiology Section—Neurology Service, Hospital Universitari de Bellvitge, Universitat de Barcelona-Health Campus, IDIBELL, 08907 L’Hospitalet de Llobregat, Spain;
| | - Ancor Serrano-Afonso
- Department of Anesthesia, Reanimation and Pain Clinic, Hospital Universitari de Bellvitge, Universitat de Barcelona-Health Campus, IDIBELL, 08907 L’Hospitalet de Llobregat, Spain;
| | - Nancy Paniagua
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Unidad Asociada I+D+i Instituto de Química Médica (IQM) CSIC-URJC, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- High Performance Experimental Pharmacology Research Group, Universidad Rey Juan Carlos (PHARMAKOM), 28922 Alcorcón, Spain
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25
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Fan HR, Zhang EM, Fei Y, Huang B, Yao M. Early Diagnosis of Herpes Zoster Neuralgia: A Narrative Review. Pain Ther 2023; 12:893-901. [PMID: 37129752 PMCID: PMC10289968 DOI: 10.1007/s40122-023-00510-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/30/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Early intervention reduces the incidence of postherpetic neuralgia (PHN). Typical shingles are easy to diagnose; however, there is no clear diagnostic method for neuralgia symptoms manifested before the onset of the rash, which can easily cause misdiagnosis. This not only increases the patient's pain, medical expenses, and mental burden, but more importantly, delays the valuable time for early treatment of shingles, and increases the probability of complications and PHN. OBJECTIVE In this paper, the diagnostic methods of preherpetic neuralgia were summarized and analyzed, and the current challenges were put forward to provide directions for the early diagnosis of herpes zoster (HZ) in the future. METHODS PubMed, and China National Knowledge Infrastructure (CNKI) libraries were searched using the terms "herpes zoster," "before the blistering," "diagnosis," and "neuralgia." Clinical trials, reviews, and case reports were collected and reviewed. The period of literature search is from 1 January 1980 to 1 October 2022. RESULTS The early diagnosis of herpes zoster neuralgia can reduce misdiagnosis and mistreatment, and timely and effective intervention can significantly reduce the incidence of PHN. The body may possess a mechanism that limits the local breakthrough of the virus in the skin, causing blistering later than the onset of pain. Changes in the plasma proteins of patients with varicella-zoster virus shingles neuralgia may be used as an early diagnostic indicator in patients with HZ neuralgia before eruption. CONCLUSION Early diagnosis of HZ neuralgia before eruption can facilitate timely targeted treatment, thereby reducing the incidence of PHN. Proteomic quantitative analysis and validation results can serve as a simple, micro, rapid, and accurate diagnostic method.
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Affiliation(s)
- Han-Rui Fan
- Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - En-Ming Zhang
- Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Yong Fei
- Department of Anesthesiology and Pain, The Affiliated Hospital of Jiaxing University, 1882 Zhong-Huan-South Road, Jiaxing, 314000, People's Republic of China.
| | - Bing Huang
- Department of Anesthesiology and Pain, The Affiliated Hospital of Jiaxing University, 1882 Zhong-Huan-South Road, Jiaxing, 314000, People's Republic of China
| | - Ming Yao
- Department of Anesthesiology and Pain, The Affiliated Hospital of Jiaxing University, 1882 Zhong-Huan-South Road, Jiaxing, 314000, People's Republic of China
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Hass RM, Sturgill FL, Young NP. Sensory and Motor Neurologic Presentations of Herpes Zoster (Shingles). Mayo Clin Proc 2023; 98:1128-1130. [PMID: 37536802 DOI: 10.1016/j.mayocp.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Reece M Hass
- Department of Neurology, Mayo Clinic, Rochester, MN
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Gao N, Li M, Wang W, Wang L, Liu Z, Guo Y. Top 100 Most-Cited Papers in Herpes Zoster from 2000 to 2022: A Bibliometric Study. J Pain Res 2023; 16:1779-1797. [PMID: 37273270 PMCID: PMC10237222 DOI: 10.2147/jpr.s409616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023] Open
Abstract
Background In recent years, the incidence of herpes zoster has risen steeply, the exact pathogenesis of the acute pain and the transformation into postherpetic neuralgia are still obscure, and the absence of effective management remains a major therapeutic challenge. The purpose of this study was to perform a qualitative and quantitative bibliometric analysis of the 100 most cited papers on herpes zoster. Materials and methods Related literature were retrieved from the Web of Science Core Collection. Excel and VOSviewer software were applied to quantitatively analyze, and construct the bibliometric network charts. Results The Top 100 most-cited papers published between 2000 and 2018 showed a fluctuating downward trend. The most studies were published in the year of 2000 (n = 12). The article entitled "A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults" from Oxman MN, was the most-cited publication. The United States was the most contributing country, followed by the United Kingdom, and Italy. Finland occupied the highest citations per publication (CPP). The University of Colorado topped the list of institutions with the most publications with 18 articles and also had the most citations (average citations: 281.78 per article). Myron J Levin from the University of Colorado School of Medicine is the most published and most cited researcher overall, whereas Duke University's John W Gnann tops the list in terms of average CPP. Conclusion In terms of the quantity of T100 articles, researchers, and organizations, the US is the predominant country. The most T100 papers were published in the special journal Clinical Infectious Diseases. The most academic focus remain the remedies for postherpetic neuralgia and vaccine development for individualized groups.
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Affiliation(s)
- Ning Gao
- Department of Acupuncture and Moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
| | - Meng Li
- Department of Gastroenterology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
| | - Weiming Wang
- Department of Acupuncture and Moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
| | - Lei Wang
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, 100020, People’s Republic of China
| | - Zhen Liu
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, People’s Republic of China
| | - Yufeng Guo
- Department of Acupuncture and Moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
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28
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Singh US, Konreddy AK, Kothapalli Y, Liu D, Lloyd MG, Annavarapu V, White CA, Bartlett MG, Moffat JF, Chu CK. Prodrug Strategies for the Development of β-l-5-(( E)-2-Bromovinyl)-1-((2 S,4 S)-2-(hydroxymethyl)-1,3-(dioxolane-4-yl))uracil (l-BHDU) against Varicella Zoster Virus (VZV). J Med Chem 2023; 66:7038-7053. [PMID: 37140467 DOI: 10.1021/acs.jmedchem.3c00545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Varicella zoster virus (VZV) establishes lifelong infection after primary disease and can reactivate. Several drugs are approved to treat VZV diseases, but new antivirals with greater potency are needed. Previously, we identified β-l-5-((E)-2-bromovinyl)-1-((2S,4S)-2-(hydroxymethyl)-1,3-(dioxolane-4-yl))uracil (l-BHDU, 1), which had significant anti-VZV activity. In this communication, we report the synthesis and evaluation of numerous l-BHDU prodrugs: amino acid esters (14-26), phosphoramidates (33-34), long-chain lipids (ODE-l-BHDU-MP, 38, and HDP-l-BHDU-MP, 39), and phosphate ester prodrugs (POM-l-BHDU-MP, 41, and POC-l-BHDU-MP, 47). The amino acid ester l-BHDU prodrugs (l-phenylalanine, 16, and l-valine, 17) had a potent antiviral activity with EC50 values of 0.028 and 0.030 μM, respectively. The phosphate ester prodrugs POM-l-BHDU-MP and POC-l-BHDU-MP had a significant anti-VZV activity with EC50 values of 0.035 and 0.034 μM, respectively, and no cellular toxicity (CC50 > 100 μM) was detected. Out of these prodrugs, ODE-l-BHDU-MP (38) and POM-l-BHDU-MP (41) were selected for further evaluation in future studies.
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Affiliation(s)
- Uma S Singh
- Department of Pharmaceutical and Biomedical Science, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Ananda K Konreddy
- Department of Pharmaceutical and Biomedical Science, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Yugandhar Kothapalli
- Department of Pharmaceutical and Biomedical Science, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Dongmei Liu
- State University of New York, Upstate Medical University, Syracuse, New York 13210, United States
| | - Megan G Lloyd
- State University of New York, Upstate Medical University, Syracuse, New York 13210, United States
| | - Vidya Annavarapu
- Department of Pharmaceutical and Biomedical Science, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Catherine A White
- Department of Pharmaceutical and Biomedical Science, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Michael G Bartlett
- Department of Pharmaceutical and Biomedical Science, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Jennifer F Moffat
- State University of New York, Upstate Medical University, Syracuse, New York 13210, United States
| | - Chung K Chu
- Department of Pharmaceutical and Biomedical Science, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
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Kim JH, Johnson R, Kovac M, Cunningham AL, Amakrane M, Sullivan KM, Dagnew AF, Curran D, Schuind A. Adjuvanted recombinant zoster vaccine decreases herpes zoster-associated pain and the use of pain medication across 3 randomized, placebo-controlled trials. Pain 2023; 164:741-748. [PMID: 36066965 PMCID: PMC10026829 DOI: 10.1097/j.pain.0000000000002760] [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: 11/18/2021] [Revised: 07/26/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Herpes zoster (HZ) and HZ-associated pain greatly affect patients' quality of life, particularly in older and immunocompromised adults, for whom comorbidities and polypharmacy are often reported. Three phase III, randomized, placebo-controlled clinical trials have reported the adjuvanted recombinant zoster vaccine (RZV) as highly efficacious in preventing HZ and reducing pain severity in healthy adults ≥50 years old (Zoster Efficacy Study [ZOE]-50 study, NCT01165177) and ≥70 years old (ZOE-70; NCT01165229) and in immunocompromised adults ≥18 years old undergoing autologous hematopoietic stem cell transplantation (ZOE-HSCT; NCT01610414). Here, we investigated efficacy of RZV in reducing (i) the duration of clinically significant pain (Zoster Brief Pain Inventory pain score ≥3) and (ii) HZ-associated pain medication use and duration of use in participants with confirmed HZ ("breakthrough cases") from the 3 studies. Recombinant zoster vaccine effectively reduced the duration of clinically significant HZ-associated pain during HZ episodes by 38.5% ( P -value: 0.010) in the ZOE-HSCT study. Although a similar trend was observed in the ZOE-50 and ZOE-70 studies, the results were not statistically significant because of the high vaccine efficacy (VE) against HZ resulting in rare breakthrough cases. VE in reducing pain medication use (39.6%; P -value: 0.008) and duration of medication use (49.3%, P -value: 0.040) was reported in the ZOE-70 study; corresponding positive VE estimates were observed in the ZOE-50 and ZOE-HSCT studies but were not statistically significant. Data reported here demonstrate efficacy of RZV in reducing HZ-associated pain duration and pain medication use in breakthrough cases, thereby improving quality of life of those with HZ.
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Affiliation(s)
- Joon Hyung Kim
- GSK, Rockville, MD, United States, Martina Kovac is now with the PPD, Bethesda, MD, United States. Alemnew F. Dagnew is now with the Bill & Melinda Gates Medical Research Institute, Cambridge, MA, United States. Anne Schuind is now with the PATH, Washington, DC, United States
| | - Robert Johnson
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Martina Kovac
- GSK, Rockville, MD, United States, Martina Kovac is now with the PPD, Bethesda, MD, United States. Alemnew F. Dagnew is now with the Bill & Melinda Gates Medical Research Institute, Cambridge, MA, United States. Anne Schuind is now with the PATH, Washington, DC, United States
| | - Anthony L. Cunningham
- The Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | | | | | - Alemnew F. Dagnew
- GSK, Rockville, MD, United States, Martina Kovac is now with the PPD, Bethesda, MD, United States. Alemnew F. Dagnew is now with the Bill & Melinda Gates Medical Research Institute, Cambridge, MA, United States. Anne Schuind is now with the PATH, Washington, DC, United States
| | | | - Anne Schuind
- GSK, Rockville, MD, United States, Martina Kovac is now with the PPD, Bethesda, MD, United States. Alemnew F. Dagnew is now with the Bill & Melinda Gates Medical Research Institute, Cambridge, MA, United States. Anne Schuind is now with the PATH, Washington, DC, United States
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Patterns and Trends in Pharmacological Treatment for Outpatients with Postherpetic Neuralgia in Six Major Areas of China, 2015-2019. Healthcare (Basel) 2023; 11:healthcare11050764. [PMID: 36900769 PMCID: PMC10000853 DOI: 10.3390/healthcare11050764] [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: 12/12/2022] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
The aim of this study was to assess the patterns and trends of pharmacological treatment for outpatients with postherpetic neuralgia (PHN) in China in the period 2015-2019. Prescription data for outpatients with PHN were extracted from the database of the Hospital Prescription Analysis Program of China according to the inclusion criteria. The trends in yearly prescriptions and corresponding costs were analyzed and stratified by drug class and specific drugs. A total of 19,196 prescriptions from 49 hospitals in 6 major regions of China were included for analysis. The yearly prescriptions increased from 2534 in 2015 to 5676 in 2019 (p = 0.027), and the corresponding expenditures increased from CNY 898,618 in 2015 to CNY 2,466,238 in 2019 (p = 0.027). Gabapentin and pregabalin are the most commonly used drugs for PHN, and more than 30% of these two drugs were combined with mecobalamin. Opioids were the second most frequently prescribed drug class, and oxycodone accounted for the largest share of the cost. Topical drugs and TCAs are rarely used. The frequent use of pregabalin and gabapentin was in accordance with current guidelines; however, the use of oxycodone raised concerns about rationality and economic burden. The results of this study may benefit the allocation of medical resources and management for PHN in China and other countries.
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Pan D, Wang W, Cheng T. Current Methods for the Detection of Antibodies of Varicella-Zoster Virus: A Review. Microorganisms 2023; 11:microorganisms11020519. [PMID: 36838484 PMCID: PMC9965970 DOI: 10.3390/microorganisms11020519] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Infection with the varicella-zoster virus (VZV) causes chickenpox and shingles, which lead to significant morbidity and mortality globally. The detection of serum VZV-specific antibodies is important for the clinical diagnosis and sero-epidemiological research of VZV infection, and for assessing the effect of VZV vaccine immunization. Over recent decades, a variety of methods for VZV antibody detection have been developed. This review summarizes and compares the current methods for detecting VZV antibodies, and discussed future directions for this field.
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Chung WC, Ravichandran S, Park D, Lee GM, Kim YE, Choi Y, Song MJ, Kim KK, Ahn JH. G-quadruplexes formed by Varicella-Zoster virus reiteration sequences suppress expression of glycoprotein C and regulate viral cell-to-cell spread. PLoS Pathog 2023; 19:e1011095. [PMID: 36630443 PMCID: PMC9873165 DOI: 10.1371/journal.ppat.1011095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/24/2023] [Accepted: 01/02/2023] [Indexed: 01/12/2023] Open
Abstract
G-quadruplex (G4) formed by repetitive guanosine-rich sequences plays important roles in diverse cellular processes; however, its roles in viral infection are not fully understood. In this study, we investigated the genome-wide distribution of G4-forming sequences (G4 motifs) in Varicella-Zoster virus (VZV) and found that G4 motifs are enriched in the internal repeat short and the terminal repeat short regions flanking the unique short region and also in some reiteration (R) sequence regions. A high density of G4 motifs in the R2 region was found on the template strand of ORF14, which encodes glycoprotein C (gC), a virulent factor for viral growth in skin. Analyses such as circular dichroism spectroscopy, thermal difference spectra, and native polyacrylamide gel electrophoresis with oligodeoxynucleotides demonstrated that several G4 motifs in ORF14 form stable G4 structures. In transfection assays, gC expression from the G4-disrupted ORF14 gene was increased at the transcriptional level and became more resistant to suppression by G4-ligand treatment. The recombinant virus containing the G4-disrupted ORF14 gene expressed a higher level of gC mRNA, while it showed a slightly reduced growth. This G4-disrupted ORF14 virus produced smaller plaques than the wild-type virus. Our results demonstrate that G4 formation via reiteration sequences suppresses gC expression during VZV infection and regulates viral cell-to-cell spread.
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Affiliation(s)
- Woo-Chang Chung
- Department of Microbiology, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Subramaniyam Ravichandran
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Daegyu Park
- Department of Microbiology, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Gwang Myeong Lee
- Department of Microbiology, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Young-Eui Kim
- Department of Microbiology, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Youngju Choi
- Department of Microbiology, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Moon Jung Song
- Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea
| | - Kyeong Kyu Kim
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
- Biomedical Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Jin-Hyun Ahn
- Department of Microbiology, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
- Biomedical Research Institute, Samsung Medical Center, Seoul, Republic of Korea
- * E-mail:
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Kumar PS, Radhakrishnan A, Mukherjee T, Khamaru S, Chattopadhyay S, Chattopadhyay S. Understanding the role of Ca 2+ via transient receptor potential (TRP) channel in viral infection: Implications in developing future antiviral strategies. Virus Res 2023; 323:198992. [PMID: 36309316 PMCID: PMC10194134 DOI: 10.1016/j.virusres.2022.198992] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
Transient receptor potential (TRP) channels are a superfamily of cation-specific permeable channels primarily conducting Ca2+ions across various membranes of the cell. The perturbation of the Ca2+ homeostasis is the hallmark of viral infection. Viruses hijack the host cell Ca2+ signaling, employing tailored Ca2+ requirements via TRP channels to meet their own cellular demands. This review summarizes the importance of Ca2+ across diverse viruses based on the Baltimore classification and focuses on the associated role of Ca2+-conducting TRP channels in viral pathophysiology. More emphasis has been given to the role of the TRP channel in viral life-cycle events such as viral fusion, viral entry, viral replication, virion maturation, and egress. Additionally, this review highlights the TRP channel as a store-operated channel which has been discussed vividly. The TRP channels form an essential aspect of host-virus interaction by virtue of its Ca2+ permeability. These channels are directly involved in regulating the viral calcium dynamics in host cells and thereby affect the viral infection. Considering its immense potential in regulating viral infection, the TRP channels may act as a target for antiviral therapeutics.
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Affiliation(s)
- P Sanjai Kumar
- School of Biological Sciences, National Institute of Science Education & Research, an OCC of Homi Bhabha National Institute, Bhubaneswar, Jatni, Khurda, Odisha 752050, India; Infectious Disease Biology, Institute of Life Sciences, Autonomous Institute of Department of Biotechnology, Government of India, Nalco Square, Bhubaneswar, Odisha 751023, India
| | - Anukrishna Radhakrishnan
- School of Biological Sciences, National Institute of Science Education & Research, an OCC of Homi Bhabha National Institute, Bhubaneswar, Jatni, Khurda, Odisha 752050, India
| | - Tathagata Mukherjee
- School of Biological Sciences, National Institute of Science Education & Research, an OCC of Homi Bhabha National Institute, Bhubaneswar, Jatni, Khurda, Odisha 752050, India
| | - Somlata Khamaru
- School of Biological Sciences, National Institute of Science Education & Research, an OCC of Homi Bhabha National Institute, Bhubaneswar, Jatni, Khurda, Odisha 752050, India
| | - Soma Chattopadhyay
- Infectious Disease Biology, Institute of Life Sciences, Autonomous Institute of Department of Biotechnology, Government of India, Nalco Square, Bhubaneswar, Odisha 751023, India.
| | - Subhasis Chattopadhyay
- School of Biological Sciences, National Institute of Science Education & Research, an OCC of Homi Bhabha National Institute, Bhubaneswar, Jatni, Khurda, Odisha 752050, India.
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Wan CF, Song T. Comparison of Two Different Pulsed Radiofrequency Modes for Prevention of Postherpetic Neuralgia in Elderly Patients With Acute/Subacute Trigeminal Herpes Zoster. Neuromodulation 2022; 25:1364-1371. [PMID: 34008278 DOI: 10.1111/ner.13457] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Trigeminal postherpetic neuralgia (PHN) is often refractory to treatment. Pulsed radiofrequency (PRF) neuromodulation can help in preventing PHN after herpes zoster. This study aimed to compare the efficacy and safety of two different PRF modes on gasserian ganglion neuromodulation in elderly patients with acute/subacute trigeminal herpes zoster. MATERIALS AND METHODS A total of 120 elderly patients with acute or subacute (within past three months) trigeminal herpes zoster were randomized to receive either a single cycle of high-voltage, long-duration PRF (HL-PRF group; N = 60) or three cycles of standard PRF (S-PRF group; N = 60). Patients were followed up for six months after treatment. Visual analog scale (VAS) pain score, 36-Item Short Form Health Survey (SF-36) score, and pregabalin at baseline and at different time points during follow-up were recorded. RESULTS VAS and SF-36 scores declined significantly from baseline levels in both groups (p < 0.001). The scores were significantly lower in the HL-PRF group than in the S-PRF group at some time points (p < 0.05). The mean dose of pregabalin was significantly lower in the HL-PRF group than in the S-PRF group on days 3, 14, and 28 after treatment (p < 0.05). No serious adverse events occurred in either group. CONCLUSION HL-PRF neuromodulation of the gasserian ganglion appears to be more effective than S-PRF for preventing PHN in the elderly. CLINICAL TRIAL REGISTRATION ChiCTR2000038775.
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Affiliation(s)
- Cheng-Fu Wan
- Department of Pain Medicine, the First Affiliated Hospital to China Medical University, Shenyang, China
| | - Tao Song
- Department of Pain Medicine, the First Affiliated Hospital to China Medical University, Shenyang, China.
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Gliagias V, Denisova K, Kang JJ. A child with dendritiform eye lesions and developmental delay. Am J Ophthalmol Case Rep 2022; 28:101701. [PMID: 36118278 PMCID: PMC9471959 DOI: 10.1016/j.ajoc.2022.101701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Tyrosinemia Type II (Richner-Hanhart syndrome) is a rare autosomal recessive disease that occurs due to deficiency in the enzyme tyrosine aminotransferase and can result in an ulcerated keratitis. We present a case of a young patient with oculocutaneous tyrosinemia despite a negative newborn screen. Observations A 15 month old boy with an uncomplicated birth history and negative newborn screen presented with a unilateral central irregular epithelial defect and hyperkeratotic lesions on his fingertips and soles. A month later, the patient developed bilateral dendritiform epithelial erosions. Following a series of antiviral, antibiotic, and lubricating treatments, there was a waxing and waning course of epithelial healing. After the patient was lost to follow up for one year, the patient presented with a new global developmental delay prompting further workup. Tyrosine and phenylalanine levels were ordered which confirmed a diagnosis of Tyrosinemia Type II, and the patient was started on a low-protein diet. A month later, the patient's epithelial defects and ocular symptoms were resolved. Conclusion and Importance Presentation of a dendritiform epithelial erosion, whether unilateral or bilateral, accompanied by symptoms of developmental delay and palmoplantar hyperkeratotic lesions should prompt measurement of tyrosine and phenylalanine levels. As dermatologic lesions and variable developmental delay may not appear until later in the course of disease, diagnosis may depend on early recognition of ocular signs and symptoms even with negative newborn screening. Prompt diagnosis and diet modification is necessary to prevent developmental delay in this disease. To our knowledge, this is the first Tyrosinemia Type II case in the literature manifesting as an asynchronous bilateral eye disease.
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Affiliation(s)
- Vasiliki Gliagias
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Ksenia Denisova
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joann J. Kang
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Corresponding author.
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Eid MM, Hamed NS, Abdelbasset WK, Elkholi SM, Eladl HM, Bahey El-Deen HA. A comparative study between transcutaneous electrical nerve stimulation and pulsed electromagnetic field therapy in the management of post-herpetic neuralgia of the sciatic nerve. Medicine (Baltimore) 2022; 101:e31433. [PMID: 36343068 PMCID: PMC9646515 DOI: 10.1097/md.0000000000031433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To compare the efficacy of pulsed electromagnetic field therapy (PEMFT) versus transcutaneous electrical nerve stimulation (TENS) in the treatment of post-herpetic neuralgia of the sciatic nerve. METHODS A double-blinded randomized clinical study has included 56 patients (18 males and 38 females). Participants were randomly and equally assigned into 2 groups. Both groups received conventional physical therapy treatment. Moreover, group (A) has an additional TENS, and group (B) had PEMFT. Both modalities were applied once daily, 3 times a week for 20 minutes for 8 successive weeks. Visual analog scale (VAS) and carbamazepine intake (CMI) dose have been assessed before and after interventions. RESULTS There was a significant decrease in VAS and CMI post-treatment in group A and B compared with that pretreatment (P > .001). The percent decrease in VAS and CMI in group A were 72.44% and 69.47% respectively and that for group B was 68.95% and 67.94% respectively. The findings revealed a non-significant difference in VAS and CMI (P > .05) between groups. The Means of VAS and CMI were (2.4 ± 0.78, 204.5 ± 16.76 and 2.67 ± 0.9, 210.57 ± 16.5) in group A and group B respectively. The mean difference for VAS and CMI was (-0.27 and -6.07) between groups post-treatment respectively. CONCLUSION Both TENS and PEMFT were effective and nearly equivalent in improving the post-herpetic neuralgia of the sciatic nerve as measured by in VAS and CMI. Clinical recommendations should be highlighted to instigate the using of TENS and PEMFT in the management of post-herpetic neuralgia of the sciatic nerve.
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Affiliation(s)
- Marwa M. Eid
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Nashwa Sayed Hamed
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
- Department of Physical Therapy for Neuromuscular Disorders & Its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Walid Kamal Abdelbasset
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
- * Correspondence: Walid Kamal Abdelbasset, Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia (e-mail: )
| | - Safaa Mostafa Elkholi
- Department of Rehabilitation Sciences, Faculty of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hadaya M. Eladl
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Science, Jouf University, Saudi Arabia
| | - Heba A. Bahey El-Deen
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Science, Jouf University, Saudi Arabia
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Misr University for Science and Technology, Egypt
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Zhou R, Li J, Zhang Y, Xiao H, Zuo Y, Ye L. Characterization of plasma metabolites and proteins in patients with herpetic neuralgia and development of machine learning predictive models based on metabolomic profiling. Front Mol Neurosci 2022; 15:1009677. [PMID: 36277496 PMCID: PMC9583257 DOI: 10.3389/fnmol.2022.1009677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Herpes zoster (HZ) is a localized, painful cutaneous eruption that occurs upon reactivation of the herpes virus. Postherpetic neuralgia (PHN) is the most common chronic complication of HZ. In this study, we examined the metabolomic and proteomic signatures of disease progression in patients with HZ and PHN. We identified differentially expressed metabolites (DEMs), differentially expressed proteins (DEPs), and key signaling pathways that transition from healthy volunteers to the acute or/and chronic phases of herpetic neuralgia. Moreover, some specific metabolites correlated with pain scores, disease duration, age, and pain in sex dimorphism. In addition, we developed and validated three optimal predictive models (AUC > 0.9) for classifying HZ and PHN from healthy individuals based on metabolic patterns and machine learning. These findings may reveal the overall metabolomics and proteomics landscapes and proposed the optimal machine learning predictive models, which provide insights into the mechanisms of HZ and PHN.
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Affiliation(s)
- Ruihao Zhou
- Department of Pain Management and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Li
- Department of Pain Management and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yujun Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Xiao
- Department of Pain Management and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Yunxia Zuo,
| | - Ling Ye
- Department of Pain Management and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ling Ye,
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Wilms L, Weßollek K, Peeters TB, Yazdi AS. Infektionen mit Herpes‐simplex‐ und Varizella‐zoster‐Virus. J Dtsch Dermatol Ges 2022; 20:1327-1353. [DOI: 10.1111/ddg.14917_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 08/18/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Larissa Wilms
- Klinik für Dermatologie und Venerologie Helios Klinikum Krefeld
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Wilms L, Weßollek K, Peeters TB, Yazdi AS. Infections with Herpes simplex and Varicella zoster virus. J Dtsch Dermatol Ges 2022; 20:1327-1351. [DOI: 10.1111/ddg.14917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 08/18/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Larissa Wilms
- Department of Dermatology and Venereology Helios Klinikum Krefeld Germany
| | - Katharina Weßollek
- Department of Dermatology and Allergology University Hospital RWTH Aachen Germany
| | | | - Amir Sadegh Yazdi
- Department of Dermatology and Allergology University Hospital RWTH Aachen Germany
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Gandhi R, Vilke GM, Castillo EM. Intermittent Transient Flaring Rash Post Herpes Zoster. J Emerg Med 2022; 63:e37-e39. [PMID: 35914988 DOI: 10.1016/j.jemermed.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/04/2022] [Accepted: 04/23/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Rushika Gandhi
- University of California San Diego Medical Center, San Diego, California.
| | - Gary M Vilke
- University of California San Diego Medical Center, San Diego, California
| | - Edward M Castillo
- University of California San Diego Medical Center, San Diego, California
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Sun R, Li S, Ren L, Xia Y, Wang Y, Bian Z, Fang J, Zhang Z. Efficacy of Electroacupuncture for the Treatment of Postherpetic Neuralgia: Study Protocol for a Multicenter Randomized Controlled Trial. J Pain Res 2022; 15:959-968. [PMID: 35411183 PMCID: PMC8994622 DOI: 10.2147/jpr.s357435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/19/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ruohan Sun
- Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Shimin Li
- Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Leilei Ren
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yunfan Xia
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yiyi Wang
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhiyuan Bian
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Jianqiao Fang
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
- Jianqiao Fang, The Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 23 Qinchun Road, Hangzhou, Zhejiang, People’s Republic of China, Email
| | - Zuyong Zhang
- Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
- Correspondence: Zuyong Zhang, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, No. 38 West Lake Road, Hangzhou, Zhejiang, People’s Republic of China, Email
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Xue S, Yang WJ, Cao ZX, Sun T. Comparing the efficacy and safety of short-term spinal cord stimulation and pulsed radiofrequency for zoster-related pain: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29073. [PMID: 35356934 PMCID: PMC10684147 DOI: 10.1097/md.0000000000029073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/24/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Pulsed radiofrequency (PRF) is a commonly used method for the treatment of zoster-related pain in the clinic. However, PRF therapy has a high recurrence rate and many adverse reactions. Recent studies have shown that short-term spinal cord stimulation (stSCS) can effectively alleviate zoster-related pain. Due to the lack of evidence, it is unclear whether stSCS is superior to PRF in the efficacy of treating zoster-related pain. OBJECTIVE This study aimed to compare the efficacy and safety of stSCS and PRF for zoster-related pain. METHODS We searched seven electronic databases from the establishment of the database to January 2021. Related randomized controlled trials were included in this meta-analysis. After extracting the data and evaluating the methodological quality of the included trials, the outcome indicators were statistically analyzed by using RevManV.5.3. RESULTS This meta-analysis included 6 trials with a total of 509 patients. Compared with PRF group, stSCS group showed lower pain intensity (standardized mean difference=-0.83, 95%CI [-1.37, -0.30], P=.002), better sleep quality (mean difference=-1.43, 95%CI [-2.29, -0.57], P=.001), lower pain rating index scores, and less incidence of adverse events (RR=0.32, 95%CI [0.12, 0.83], P<.05). However, the efficacies of PRF and stSCS for treating postherpetic neuralgia were consistent in the response rate (RR= 1.10, 95% CI [0.82, 1.48], P=.51) and the complete remission rate (RR=1.05, 95% CI [0.66, 1.68], P=.84). CONCLUSIONS In this study, stSCS showed a better analgesic effect and higher safety than PRF. Our meta-analysis results suggested that stSCS may be a feasible and safe invasive treatment for zoster-related pain. However, high-quality, randomized controlled trials with large sample sizes are needed to further verify our conclusions.
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Affiliation(s)
| | | | | | - Tao Sun
- Correspondence: Tao Sun, Department of Pain Management, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324 Jingwu Road, Jinan, 250021, China (e-mail: ).
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43
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External Therapy of Chinese Medicine for Herpes Zoster: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3487579. [PMID: 35310025 PMCID: PMC8930213 DOI: 10.1155/2022/3487579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/11/2022] [Indexed: 11/17/2022]
Abstract
Background. Herpes zoster (HZ) is a common skin disease that has a huge impact on the quality of life of sufferers. Antiviral therapy is a conventional treatment, but it still has limitations. This review evaluates the safety and efficacy of acupuncture in the treatment of HZ. Methods. We identified randomized controlled trials from multiple electronic sources (including Embase, PubMed, Cochrane, Web of Knowledge, China National Knowledge Infrastructure (CNKI), and China Biology Medicine Disc (CBM)) and reference lists of relevant articles and extracted data and assessed risk of bias (Cochrane’s Risk of Bias tool). Pooled data are expressed as standardized mean differences (SMDs), with 95% confidence intervals (CI) (random-effects model). Results. We included 15 trials (1811 participants) comparing acupuncture to medicine. Ten studies involving 1424 patients provided these data for the meta-analysis. The results showed that acupuncture as a control group had a higher clinical cure rate than Western medicine therapy (n = 1424, 95% Cl 2.19–3.14, I2 = 0%). Eleven studies used the visual analog scale (VAS), but only nine provided specific data, which we used as a continuous variable for data extraction. The meta-analysis also showed an SMD of −2.64 (n = 646, 95% CI −3.79–1.48, I2 = 97%) which showed great heterogeneity. Meta-analysis showed a significant reduction in the incidence of PHN in those who received acupuncture compared to pharmacotherapy (OR = 0.35, 95% CI 0.04–2.86, I2 = 52%) which showed moderate heterogeneity. Economic indicators suggest that acupuncture costs less and has fewer adverse reactions. Conclusions. This review compares acupuncture therapy with conventional treatment and finds that the curative effects of acupuncture are exact, with fewer side effects. However, with the risk of bias and imprecision of the studies included, a concrete conclusion is difficult to draw. Thus, well-designed, rigorous studies are warranted in the future.
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44
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Luo G, Chen L, Kostich WA, Hamman B, Allen J, Easton A, Bourin C, Gulianello M, Lippy J, Nara S, Pattipati SN, Dandapani K, Dokania M, Vattikundala P, Sharma V, Elavazhagan S, Verma MK, Lal Das M, Wagh S, Balakrishnan A, Johnson BM, Santone KS, Thalody G, Denton R, Saminathan H, Holenarsipur VK, Kumar A, Rao A, Putlur SP, Sarvasiddhi SK, Shankar G, Louis JV, Ramarao M, Conway CM, Li YW, Pieschl R, Tian Y, Hong Y, Bristow L, Albright CF, Bronson JJ, Macor JE, Dzierba CD. Discovery and Optimization of Biaryl Alkyl Ethers as a Novel Class of Highly Selective, CNS-Penetrable, and Orally Active Adaptor Protein-2-Associated Kinase 1 (AAK1) Inhibitors for the Potential Treatment of Neuropathic Pain. J Med Chem 2022; 65:4534-4564. [PMID: 35261239 DOI: 10.1021/acs.jmedchem.1c02132] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent mouse knockout studies identified adapter protein-2-associated kinase 1 (AAK1) as a viable target for treating neuropathic pain. BMS-986176/LX-9211 (4), as a highly selective, CNS-penetrable, and potent AAK1 inhibitor, has advanced into phase II human trials. On exploring the structure-activity relationship (SAR) around this biaryl alkyl ether chemotype, several additional compounds were found to be highly selective and potent AAK1 inhibitors with good druglike properties. Among these, compounds 43 and 58 showed very good efficacy in two neuropathic pain rat models and had excellent CNS penetration and spinal cord target engagement. Both compounds also exhibited favorable physicochemical and oral pharmacokinetic (PK) properties. Compound 58, a central pyridine isomer of BMS-986176/LX-9211 (4), was 4-fold more potent than 4 in vitro and showed lower plasma exposure needed to achieve similar efficacy compared to 4 in the CCI rat model. However, both 43 and 58 showed an inferior preclinical toxicity profile compared to 4.
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Affiliation(s)
- Guanglin Luo
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Ling Chen
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Walter A Kostich
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Brian Hamman
- Lexicon Pharmaceuticals, 8800 Technology Forest Place, The Woodlands, Texas 77381, United States
| | - Jason Allen
- Lexicon Pharmaceuticals, 8800 Technology Forest Place, The Woodlands, Texas 77381, United States
| | - Amy Easton
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Clotilde Bourin
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Michael Gulianello
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Jonathan Lippy
- Department of Lead Evaluation, Bristol Myers Squibb Company, Route 206 & Province Line Rd, Princeton, New Jersey 08543, United States
| | - Susheel Nara
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Sreenivasulu Naidu Pattipati
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Kumaran Dandapani
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manoj Dokania
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Pradeep Vattikundala
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Vivek Sharma
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Saravanan Elavazhagan
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manoj Kumar Verma
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manish Lal Das
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Santosh Wagh
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Anand Balakrishnan
- Department of Pharmaceutical Candidate Optimization, Bristol Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Benjamin M Johnson
- Department of Pharmaceutical Candidate Optimization, Bristol Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Kenneth S Santone
- Department of Pharmaceutical Candidate Optimization, Bristol Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - George Thalody
- Discovery Toxicology, Bristol Myers Squibb Company, Route 206 & Province Line Rd, Princeton, New Jersey 08543, United States
| | - Rex Denton
- Discovery Toxicology, Bristol Myers Squibb Company, Route 206 & Province Line Rd, Princeton, New Jersey 08543, United States
| | - Hariharan Saminathan
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Vinay K Holenarsipur
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Anoop Kumar
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Abhijith Rao
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Siva Prasad Putlur
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Sarat Kumar Sarvasiddhi
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Ganesh Shankar
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Justin V Louis
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manjunath Ramarao
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Charles M Conway
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Yu-Wen Li
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Rick Pieschl
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Yuan Tian
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Yang Hong
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Linda Bristow
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Charles F Albright
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Joanne J Bronson
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - John E Macor
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Carolyn D Dzierba
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
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45
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Luo G, Chen L, Kostich WA, Hamman B, Allen J, Easton A, Bourin C, Gulianello M, Lippy J, Nara S, Maishal TK, Thiyagarajan K, Jalagam P, Pattipati SN, Dandapani K, Dokania M, Vattikundala P, Sharma V, Elavazhagan S, Verma MK, Das ML, Wagh S, Balakrishnan A, Johnson BM, Santone KS, Thalody G, Denton R, Saminathan H, Holenarsipur VK, Kumar A, Rao A, Putlur SP, Sarvasiddhi SK, Shankar G, Louis JV, Ramarao M, Conway CM, Li YW, Pieschl R, Tian Y, Hong Y, Ditta J, Mathur A, Li J, Smith D, Pawluczyk J, Sun D, Yip S, Wu DR, Vetrichelvan M, Gupta A, Wilson A, Gopinathan S, Wason S, Bristow L, Albright CF, Bronson JJ, Macor JE, Dzierba CD. Discovery of ( S)-1-((2',6-Bis(difluoromethyl)-[2,4'-bipyridin]-5-yl)oxy)-2,4-dimethylpentan-2-amine (BMS-986176/LX-9211): A Highly Selective, CNS Penetrable, and Orally Active Adaptor Protein-2 Associated Kinase 1 Inhibitor in Clinical Trials for the Treatment of Neuropathic Pain. J Med Chem 2022; 65:4457-4480. [PMID: 35257579 DOI: 10.1021/acs.jmedchem.1c02131] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Recent mouse knockout studies identified adapter protein-2 associated kinase 1 (AAK1) as a viable target for treating neuropathic pain. Potent small-molecule inhibitors of AAK1 have been identified and show efficacy in various rodent pain models. (S)-1-((2',6-Bis(difluoromethyl)-[2,4'-bipyridin]-5-yl)oxy)-2,4-dimethylpentan-2-amine (BMS-986176/LX-9211) (34) was identified as a highly selective, CNS penetrant, potent AAK1 inhibitor from a novel class of bi(hetero)aryl ethers. BMS-986176/LX9211 (34) showed excellent efficacy in two rodent neuropathic pain models and excellent central nervous system (CNS) penetration and target engagement at the spinal cord with an average brain to plasma ratio of 20 in rat. The compound exhibited favorable physicochemical and pharmacokinetic properties, had an acceptable preclinical toxicity profile, and was chosen for clinical trials. BMS-986176/LX9211 (34) completed phase I trials with good human pharmacokinetics and minimum adverse events and is currently in phase II clinical trials for diabetic peripheral neuropathic pain (ClinicalTrials.gov identifier: NCT04455633) and postherpetic neuralgia (ClinicalTrials.gov identifier: NCT04662281).
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Affiliation(s)
- Guanglin Luo
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Ling Chen
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Walter A Kostich
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Brian Hamman
- Lexicon Pharmaceuticals, 8800 Technology Forest Place, The Woodlands, Texas 77381, United States
| | - Jason Allen
- Lexicon Pharmaceuticals, 8800 Technology Forest Place, The Woodlands, Texas 77381, United States
| | - Amy Easton
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Clotilde Bourin
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Michael Gulianello
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Jonathan Lippy
- Department of Lead Evaluation, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Susheel Nara
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Tarun Kumar Maishal
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Kamalraj Thiyagarajan
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Prasadrao Jalagam
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Sreenivasulu Naidu Pattipati
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Kumaran Dandapani
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manoj Dokania
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Pradeep Vattikundala
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Vivek Sharma
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Saravanan Elavazhagan
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manoj Kumar Verma
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manish Lal Das
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Santosh Wagh
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Anand Balakrishnan
- Department of Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Benjamin M Johnson
- Department of Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Kenneth S Santone
- Department of Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - George Thalody
- Discovery Toxicology, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Rex Denton
- Discovery Toxicology, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Hariharan Saminathan
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Vinay K Holenarsipur
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Anoop Kumar
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Abhijith Rao
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Siva Prasad Putlur
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Sarat Kumar Sarvasiddhi
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Ganesh Shankar
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Justin V Louis
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manjunath Ramarao
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Charles M Conway
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Yu-Wen Li
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Rick Pieschl
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Yuan Tian
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Yang Hong
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Jonathan Ditta
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Arvind Mathur
- Department of Discovery Synthesis, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Jianqing Li
- Department of Discovery Synthesis, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Daniel Smith
- Department of Discovery Synthesis, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Joseph Pawluczyk
- Department of Discovery Synthesis, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Dawn Sun
- Department of Discovery Synthesis, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Shiuhang Yip
- Department of Discovery Synthesis, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Dauh-Rurng Wu
- Department of Discovery Synthesis, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Muthalagu Vetrichelvan
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Anuradha Gupta
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Alan Wilson
- Lexicon Pharmaceuticals, 8800 Technology Forest Place, The Woodlands, Texas 77381, United States
| | - Suma Gopinathan
- Lexicon Pharmaceuticals, 8800 Technology Forest Place, The Woodlands, Texas 77381, United States
| | - Suman Wason
- Lexicon Pharmaceuticals, 8800 Technology Forest Place, The Woodlands, Texas 77381, United States
| | - Linda Bristow
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Charles F Albright
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Joanne J Bronson
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - John E Macor
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Carolyn D Dzierba
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
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46
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The efficient development of a novel recombinant adenovirus zoster vaccine perfusion production process. Vaccine 2022; 40:2036-2043. [PMID: 35216843 PMCID: PMC8863426 DOI: 10.1016/j.vaccine.2022.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 11/20/2022]
Abstract
The adenovirus vector vaccines induce humoral and cellular immune responses and have been used to develop vaccines for effective prevention of life-threating viruses, such as Ebola and Coronaviruses. High demand of vaccines worldwide requires optimization of the production process. Perfusion process increases cell concentration and volumetric productivity, so that it becomes the commonly used strategy in vaccine production In this study, we optimized and developed a perfusion process for the adenovirus-based zoster vaccine production efficiently. We first tested different perfusion strategies in shake flasks, showing semi-continuous strategies for optimal HEK 293 cell growth. We then evaluated three empirical key process parameters (cell concentration at the time of infection (VCC), multiplicity of infection (MOI), virus production pH) by the design of experiment (DoE) method, from which the robust setpoint (VCC 1.04 × 107 cells/mL, MOI 9, and virus production pH 7.17) was confirmed in both shake flask and 2 L benchtop bioreactor. In the bioreactor, we compared the performances of two perfusion systems, the commercially-available XCell ATF® system and a novel peristaltic pump-driven alternating tangential flow perfusion system (PATFP system) that we developed. During cell cultivation stage, both perfusion systems have comparable performances regarding viable cell concentration and cell viability. At 2 dpi, the PATFP system resulted in an adenovirus titer of 2.1 × 1010 IFU/mL and cell-specific virus yield of 2,062 IFU/cell, reaching 75% and 77% of values for XCell ATF® system. This study demonstrates the perfusion process to be superior strategy for adenovirus-based vaccine production compared to the batch-mode strategy (1,467 IFU/cell). Furthermore, our PATFP system shows potential to be comparable to the XCell ATF® system, and it would become an alternative perfusion strategy for the vaccine production.
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Wei M, Liao Y, Liu J, Li L, Huang G, Huang J, Li D, Xiao L, Zhang Z. EEG Beta-Band Spectral Entropy Can Predict the Effect of Drug Treatment on Pain in Patients With Herpes Zoster. J Clin Neurophysiol 2022; 39:166-173. [PMID: 32675727 DOI: 10.1097/wnp.0000000000000758] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Medication is the main approach for early treatment of herpes zoster, but it could be ineffective in some patients. It is highly desired to predict the medication responses to control the degree of pain for herpes zoster patients. The present study is aimed to elucidate the relationship between medication outcome and neural activity using EEG and to establish a machine learning model for early prediction of the medication responses from EEG. METHODS The authors acquired and analyzed eye-closed resting-state EEG data 1 to 2 days after medication from 70 herpes zoster patients with different drug treatment outcomes (measured 5-6 days after medication): 45 medication-sensitive pain patients and 25 medication-resistant pain patients. EEG power spectral entropy of each frequency band was compared at each channel between medication-sensitive pain and medication-resistant pain patients, and those features showing significant difference between two groups were used to predict medication outcome with different machine learning methods. RESULTS Medication-sensitive pain patients showed significantly weaker beta-band power spectral entropy in the central-parietal regions than medication-resistant pain patients. Based on these EEG power spectral entropy features and a k-nearest neighbors classifier, the medication outcome can be predicted with 80% ± 11.7% accuracy, 82.5% ± 14.7% sensitivity, 77.7% ± 27.3% specificity, and an area under the receiver operating characteristic curve of 0.85. CONCLUSIONS EEG beta-band power spectral entropy in the central-parietal region is predictive of the effectiveness of drug treatment on herpes zoster patients, and it could potentially be used for early pain management and therapeutic prognosis.
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Affiliation(s)
- Mengying Wei
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China
| | - Yuliang Liao
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, The Affiliated Shenzhen Sixth Hospital of Guangdong Medical University, Shenzhen, China; and
| | - Jia Liu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China
| | - Linling Li
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China
| | - Gan Huang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China
| | - Jiabin Huang
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, The Affiliated Shenzhen Sixth Hospital of Guangdong Medical University, Shenzhen, China; and
| | - Disen Li
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, The Affiliated Shenzhen Sixth Hospital of Guangdong Medical University, Shenzhen, China; and
| | - Lizu Xiao
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, The Affiliated Shenzhen Sixth Hospital of Guangdong Medical University, Shenzhen, China; and
| | - Zhiguo Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen University, Shenzhen, China
- Peng Cheng Laboratory, Shenzhen, China
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Jay GW, Barkin RL. Trigeminal neuralgia and persistent idiopathic facial pain (atypical facial pain). Dis Mon 2022; 68:101302. [PMID: 35027171 DOI: 10.1016/j.disamonth.2021.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gary W Jay
- Department of Neurology, Division: Headache/Pain, University of North Carolina, Chapel Hill, USA.
| | - Robert L Barkin
- Departmentts of Anesthesilogy, Family Medicine, Pharrmacology, Rush University Medical College, Chicago Illinois, USA
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Schnier C, Janbek J, Lathe R, Haas J. Reduced dementia incidence after varicella zoster vaccination in Wales 2013-2020. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12293. [PMID: 35434253 PMCID: PMC9006884 DOI: 10.1002/trc2.12293] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/14/2022] [Accepted: 03/03/2022] [Indexed: 01/23/2023]
Abstract
Introduction Chronic infection with herpes viruses is a potential contributing factor to the development of dementia. The introduction of nationwide shingles (varicella zoster) vaccination in Wales might therefore be associated with reduced incident dementia. Methods We analyzed the association of shingles vaccination with incident dementia in Wales between 2013 and 2020 using retrospectively collected national health data. Results Vaccinated individuals were at reduced risk of dementia (adjusted hazard ratio: 0.72; 95% confidence interval: 0.69 to 0.75). The association was not modified by a reduction in shingles diagnosis and was stronger for vascular dementia than for Alzheimer's disease. Vaccination was also associated with a reduction in several other diseases and all-cause mortality. Discussion Our study shows a clear association of shingles vaccination with reduced dementia, consistent with other observational cohort studies. The association may reflect selection bias with people choosing to be vaccinated having a higher healthy life expectancy.
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Affiliation(s)
- Christian Schnier
- Division of Infection MedicineUniversity of Edinburgh Medical SchoolEdinburghUK
| | - Janet Janbek
- Danish Dementia Research CentreRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Richard Lathe
- Division of Infection MedicineUniversity of Edinburgh Medical SchoolEdinburghUK
| | - Jürgen Haas
- Division of Infection MedicineUniversity of Edinburgh Medical SchoolEdinburghUK
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Xu R, Xie ME, Jackson CM. Trigeminal Neuralgia: Current Approaches and Emerging Interventions. J Pain Res 2021; 14:3437-3463. [PMID: 34764686 PMCID: PMC8572857 DOI: 10.2147/jpr.s331036] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022] Open
Abstract
Trigeminal neuralgia (TN) has been described in the literature as one of the most debilitating presentations of orofacial pain. This review summarizes over 150 years of collective clinical experience in the medical and surgical treatment of TN. Fundamentally, TN remains a clinical diagnosis that must be distinguished from other types of trigeminal neuropathic pain and/or facial pain associated with other neuralgias or headache syndromes. What is increasingly clear is that there is no catch-all medical or surgical intervention that is effective for all patients with trigeminal neuralgia, likely reflective of the fact that TN is likely a heterogenous group of disorders that jointly manifests in facial pain. The first-line treatment for TN remains anticonvulsant medical therapy. Patients who fail this have a range of surgical options available to them. In general, microvascular decompression is a safe and effective procedure with immediate and durable outcomes. Patients who are unable to tolerate general anesthesia or whose medical comorbidities preclude a suboccipital craniectomy may benefit from percutaneous methodologies including glycerol or radiofrequency ablation, or both. For patients with bleeding diathesis due to blood thinning medications who are ineligible for invasive procedures, or for those who are unwilling to undergo open surgical procedures, radiosurgery may be an excellent option-provided the patient understands that maximum pain relief will take on the order of months to achieve. Finally, peripheral neurectomies continue to provide an inexpensive and resource-sparing alternative to pain relief for patients in locations with limited economic and medical resources. Ultimately, elucidation of the molecular mechanisms underlying trigeminal neuralgia will pave the way for novel, more effective and less invasive therapies.
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Affiliation(s)
- Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael E Xie
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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