Assessing the performance of the Cell Painting assay across different imaging systems

Quantitative microscopy is a powerful method for performing phenotypic screens from which image-based profiling can extract a wealth of information, termed profiles. These profiles can be used to elucidate the changes in cellular phenotypes across cell populations from different patient samples or following genetic or chemical perturbations. One such image-based profiling method is the Cell Painting assay, which provides morphological insight through the imaging of eight cellular compartments. Here, we examine the performance of the Cell Painting assay across multiple high-throughput microscope systems and find that all are compatible with this assay. Furthermore, we determine independently for each microscope system the best performing settings, providing those who wish to adopt this assay an ideal starting point for their own assays. We also explore the impact of microscopy setting changes in the Cell Painting assay and find that few dramatically reduce the quality of a Cell Painting profile, regardless of the microscope used.

Assessing the performance of the Cell Painting assay across different imaging systems

Quantitative microscopy is a powerful method for performing phenotypic screens from which image-based profiling can extract a wealth of information, termed profiles. These profiles can be used to elucidate the changes in cellular phenotypes across cell populations from different patient samples or following genetic or chemical perturbations. One such image-based profiling method is the Cell Painting assay, which provides morphological insight through the imaging of eight cellular compartments. Here, we examine the performance of the Cell Painting assay across multiple high-throughput microscope systems and find that all are compatible with this assay. Furthermore, we determine independently for each microscope system the best performing settings, providing those who wish to adopt this assay an ideal starting point for their own assays. We also explore the impact of microscopy setting changes in the Cell Painting assay and find that few dramatically reduce the quality of a Cell Painting profile, regardless of the microscope used.

Practical segmentation of nuclei in brightfield cell images with neural networks trained on fluorescently labelled samples

Identifying nuclei is a standard first step when analysing cells in microscopy images. The traditional approach relies on signal from a DNA stain, or fluorescent transgene expression localised to the nucleus. However, imaging techniques that do not use fluorescence can also carry useful information. Here, we used brightfield and fluorescence images of fixed cells with fluorescently labelled DNA, and confirmed that three convolutional neural network architectures can be adapted to segment nuclei from the brightfield channel, relying on fluorescence signal to extract the ground truth for training. We found that U-Net achieved the best overall performance, Mask R-CNN provided an additional benefit of instance segmentation, and that DeepCell proved too slow for practical application. We trained the U-Net architecture on over 200 dataset variations, established that accurate segmentation is possible using as few as 16 training images, and that models trained on images from similar cell lines can extrapolate well. Acquiring data from multiple focal planes further helps distinguish nuclei in the samples. Overall, our work helps to liberate a fluorescence channel reserved for nuclear staining, thus providing more information from the specimen, and reducing reagents and time required for preparing imaging experiments.

Functional Recovery in Schizophrenia and Schizoaffective Disorder: Results from the Risperidone Long-acting Injectable Versus Quetiapine Relapse Prevention Trial (constatre)

Objective:

To report the functional recovery results from an open-label, randomized-controlled, relapse prevention trial (ConstaTRE) in stable patients with schizophrenia or schizoaffective disorder treated with risperidone long-acting injectable (RLAI) or the oral atypical antipsychotic quetiapine.

Methods:

Clinically stable adults with schizophrenia or schizoaffective disorder previously treated with oral risperidone, olanzapine, or oral conventional antipsychotics were randomized to treatment with either RLAI (25 mg every-two-weeks) or quetiapine (300-400 mg/day) for 24 months. Functional recovery was assessed using the Social and Occupational Functioning Assessment Scale (SOFAS) and two quality-of-life (QoL) measures (Short -Form 12 [SF-12] and Schizophrenia Quality-of-Life Scale Revision 4 [SQLS-R4]).

Results:

710 subjects were randomized to treatment with RLAI or quetiapine (n=355 patients/group). Baseline demographics were similar between treatment groups. Relapse occurred in 16.5% RLAI and 31.3% quetiapine patients. A total of 105 RLAI and 107 quetiapine patients dropped out of the study for other reasons than relapse, most commonly due to withdrawal of consent. A significant improvement in SOFAS, SF-12, and SQLS-R4 scores was observed from baseline to month-24 with both RLAI and quetiapine. at months 6, 12, and endpoint, SOFAS had significantly increased more for RLAI than quetiapine (p< 0.05).

Conclusions:

Among stable patients with schizophrenia or schizoaffective disorder, the likelihood of functional recovery appears to be higher in those switching to RLAI. Improvement in functional status and QoL from baseline was observed with both RLAI and quetiapine.

Survey of Safety and Efficacy of Long-acting Injectable Risperidone in Daily Practice: An Open-label, Non-interventional Prospective Study

Objective:

This post-authorization safety survey evaluated the long-term safety, tolerability, and efficacy of risperidone long-acting injectable (RLAI) in routine clinical practice.

Methods:

In this 6-month, multicenter, European, naturalistic survey, patients were included if, during routine clinical practice, long-term antipsychotic therapy with RLAI was deemed necessary by the treating physician. Efficacy measures (at baseline and after 1, 3, 6 months) included Clinical Global Impression-Severity (CGI-S) and Global Assessment of Functioning (GAF). Safety was evaluated by recording treatment-emergent adverse events (TEAEs) at every visit.

Results:

RLAI was initiated in 5,134 predominantly male (58.6%) patients (aged 14-94 years) with a diagnosis of paranoid schizophrenia (69.8%). RLAI initial doses were 25 mg every-two-weeks in 37.0%, or 50 mg in 44.4% of patients. at endpoint, RLAI dosages were 50 mg in 49.3% of patients, 25 mg in 27.0%, and 37.5 mg in 22.1%. Six-month treatment with RLAI was completed by 4,314 patients (84.0%). RLAI was discontinued due to loss to follow-up (n=346;6.7%), insufficient response (n=116;2.3%), and AEs (n=106;2.1%). CGI-S significantly improved from baseline to endpoint (p< 0.001). Patient functioning in the GAF scale also significantly improved from baseline to endpoint (45.4±16.0 versus 62.4±17.7, respectively, p< 0.001). TEAEs were recorded by 20% of patients. AEs occurring in ≥5% of patients were akathisia, extrapyramidal disorders, depression, psychotic disorder, anxiety, and weight gain. Serious AEs were reported by 384 (8%) patients.

Conclusions:

This large prospective survey confirms the good safety, tolerability, and efficacy of RLAI as reported in previous controlled clinical trials when used in routine clinical practice.

Long-term Remission in Schizophrenia and Schizoaffective Disorder: Results from the Risperidone Long-acting Injectable Versus Quetiapine Relapse Prevention Trial (constatre)

Objective:

To report the long-term remission results from the relapse prevention trial (ConstaTRE) in stable patients treated either with risperidone long-acting injectable (RLAI) or the oral atypical antipsychotic quetiapine.

Methods:

Clinically stable adults with schizophrenia or schizoaffective disorder treated with oral risperidone, olanzapine, or oral conventional antipsychotics were randomized to treatment with RLAI or oral quetiapine. Dosing was according to package-insert recommendation. Efficacy and tolerability were recorded for up to 24 months of treatment. Remission was defined as achieving and maintaining mild or less symptoms of schizophrenia over a 6-month period as defined by Andreasen et al, (2005).

Results:

710 patients were randomized (n=355 per group) to either RLAI or quetiapine. Demographics were similar between treatment groups. Relapse occurred in 54 RLAI (16.5%) and 102 quetiapine (31.3%) patients (p< 0.001). Full remission was achieved by 51% RLAI and 39% of quetiapine-treated patients (p=0.003) and was maintained until the end of the trial by 44% of RLAI and 31% of quetiapine patients. Mean duration of full remission was 540.8±181.4 and 508.1±188.0 days for RLAI and quetiapine groups, respectively (p=0.1325). Tolerability was similar between treatment groups. Most adverse events (AEs) were transient. Six RLAI and 10 quetiapine patients discontinued study treatment due to AEs.

Conclusions:

Among stable patients with schizophrenia or schizoaffective disorder, remission was more likely to occur in patients switching to RLAI when compared with quetiapine. both RLAI and quetiapine treatments were well tolerated.

Early schizophrenia patients treated with once-monthly paliperidone palmitate over a 12-month period - a retrospective observational study

Introduction

Little is known about patient characteristics and rehospitalization in newly diagnosed patients with schizophrenia treated with long-acting antipsychotics.

Objectives

To retrospectively explore hospitalizations, drug utilization and clinical outcomes from medical records of young, newly diagnosed schizophrenia patients during the first 12 months of treatment with once-monthly paliperidone palmitate (PP).

Methods

International, multicenter, retrospective, observational study. Outcomes presented are patient characteristics, reason for PP initiation and hospitalization data.

Results

Eighty-four patients were analyzed: mean age (years) at first psychotic episode was 23.8 (SD2.6), 23.9 (SD2.6) at first antipsychotic treatment and 24.1 (SD2.7, range 19-29) at PP initiation. Time between first antipsychotic treatment and PP initiation was 4.8 (SD: 3.4, range: 0-12) months. At PP initiation, 42.9% of patients were in hospital, primarily for the management of the first episode/relapse (97.2%). Reason for PP initiation was: LAT favored over oral treatment for relapse prevention (56%), partial/non adherence with previous oral medication (20.0%), convenience (15.5%) or limited access to health care systems (2.4%). Mean time (days) between admission and initiation of PP, and between initiation of PP and discharge from hospital was 28.8 (SD23.0) and 23.2 (SD24.5), respectively. 96.4% of patients were not hospitalized during the 12-month PP treatment period. 3/84 patients (3.6%) had a single hospitalization of 15.7 (SD: 8.1) days for management of episode/relapse.

Conclusions

In this young, newly diagnosed schizophrenia population, the number of hospitalizations following PP initiation was low. Main reason to initiate PP was clinicians favoring LAT over oral antipsychotic treatment for relapse prevention or due to partial/non adherence with previous oral treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Expert Systems for the Prediction of Ovulation: Comparison of an Expert System Shell (Expertech Xi Plus) with a Program Written in a Traditional Language (BASIC)

The use of an expert system shell (EXPERTECH Xi Plus) in the construction of an expert system for the diagnosis of infertility has been evaluated. A module was devised for predicting ovulation from the medical history alone. Two versions of this system were constructed, one using the expert system shell, and the other using QuickBASIC. The two systems have been compared with respect to: (1) ease of construction; (2) ease of knowledge base update; (3) help and explanation facilities; (4) diagnostic accuracy; (5) acceptability to patients and clinicians; (6) user-friendliness and ease of use; (7) use of memory space; and (8) run time. The responses of patients and clinicians were evaluated by questionnaires. The predictions made by the computer systems were compared to the conclusions reached by clinicians and to the “gold standard” of day 21 progesterone.

The conclusions of this pilot study are: (1) the construction of this expert system was NOT facilitated by the use of this expert system shell; (2) update of the knowledge base was not facilitated either; (3) the expert system shell offered built-in help and explanation facilities, but as the system increased in complexity these became less useful; (4) after initial adjustment of decision thresholds the diagnostic accuracy of the system equalled that of the clinician; (5) the patient response to computer history-taking was very favorable but much less favorable to computer diagnosis; (6) the clinicians took a positive attitude to computer diagnosis; (7) the systems were easy to use; (8) the expert systems shell required much more memory space and had a much slower response time than the system written in BASIC.

Fumarate Hydratase Loss Causes Combined Respiratory Chain Defects

Fumarate hydratase (FH) is an enzyme of the tricarboxylic acid (TCA) cycle mutated in hereditary and sporadic cancers. Despite recent advances in understanding its role in tumorigenesis, the effects of FH loss on mitochondrial metabolism are still unclear. Here, we used mouse and human cell lines to assess mitochondrial function of FH-deficient cells. We found that human and mouse FH-deficient cells exhibit decreased respiration, accompanied by a varying degree of dysfunction of respiratory chain (RC) complex I and II. Moreover, we show that fumarate induces succination of key components of the iron-sulfur cluster biogenesis family of proteins, leading to defects in the biogenesis of iron-sulfur clusters that affect complex I function. We also demonstrate that suppression of complex II activity is caused by product inhibition due to fumarate accumulation. Overall, our work provides evidence that the loss of a single TCA cycle enzyme is sufficient to cause combined RC activity dysfunction.

Mathematical imaging methods for mitosis analysis in live-cell phase contrast microscopy

In this paper we propose a workflow to detect and track mitotic cells in time-lapse microscopy image sequences. In order to avoid the requirement for cell lines expressing fluorescent markers and the associated phototoxicity, phase contrast microscopy is often preferred over fluorescence microscopy in live-cell imaging. However, common specific image characteristics complicate image processing and impede use of standard methods. Nevertheless, automated analysis is desirable due to manual analysis being subjective, biased and extremely time-consuming for large data sets. Here, we present the following workflow based on mathematical imaging methods. In the first step, mitosis detection is performed by means of the circular Hough transform. The obtained circular contour subsequently serves as an initialisation for the tracking algorithm based on variational methods. It is sub-divided into two parts: in order to determine the beginning of the whole mitosis cycle, a backwards tracking procedure is performed. After that, the cell is tracked forwards in time until the end of mitosis. As a result, the average of mitosis duration and ratios of different cell fates (cell death, no division, division into two or more daughter cells) can be measured and statistics on cell morphologies can be obtained. All of the tools are featured in the user-friendly MATLAB®Graphical User Interface MitosisAnalyser.

Once-monthly paliperidone palmitate in recently diagnosed and chronic non-acute patients with schizophrenia

Objective: To explore the treatment response, tolerability and safety of once-monthly paliperidone palmitate (PP1M) in non-acute patients switched from oral antipsychotics, stratified by time since diagnosis as recently diagnosed (≤3 years) or chronic patients (>3 years).

Research design and methods: Post hoc analysis of a prospective, interventional, single-arm, multicentre, open-label, 6-month study performed in 233 recently diagnosed and 360 chronic patients.

Main outcome measures: The proportion achieving treatment response (defined as ≥20% improvement in Positive and Negative Syndrome Scale [PANSS] total score from baseline to endpoint) and maintained efficacy (defined as non-inferiority in the change in PANSS total score at endpoint [Schuirmann’s test]).

Results: 71.4% of recently diagnosed and 59.2% of chronic patients showed a ≥20% decrease in PANSS total score (p = 0.0028 between groups). Changes in PANSS Marder factors, PANSS subscales, and the proportion of patients with a Personal and Social Performance scale (PSP) total score of 71–100 were significantly greater in recently diagnosed compared with chronic patients. PP1M was well tolerated, presenting no unexpected safety findings.

Conclusion: These data show that recently diagnosed patients treated with PP1M had a significantly higher treatment response and improved functioning, as assessed by the PSP total score, than chronic patients.

Sécurité d’emploi, tolérance et efficacité du palmitate de palipéridone à doses flexibles chez des patients schizophrènes hospitalisés pour une décompensation psychotique

Objectif

Explorer sécurité d’emploi, tolérance et efficacité du palmitate de palipéridone (PP) à doses flexibles chez des patients adultes schizophrènes hospitalisés pour une décompensation.

Méthodes

Étude internationale, prospective, en ouvert, non-interventionnelle de 6 semaines.

Évaluation

Échelles BPRS (Brief Psychiatric Rating Scale), CGI-S (Clinical Global Impression-Severity), PSP (Personal and Social Performance Scale), questionnaire de satisfaction sur le traitement (MSQ-Medication Satisfaction Questionnaire), ESRS (Extrapyramidal Symptom Rating Scale) et évènements indésirables sous traitement (EIST), entre début d’étude (baseline) et dernière observation rapportée.

Résultats

Trois cent soixante-sept patients analysés (65,9% hommes, âge moyen (± écart-type) 39,8 ± 12,1 ans, 85,8% schizophrénie paranoïde). Au total, 91,6% des patients ont terminé l’étude de 6 semaines. Le délai moyen entre l’admission à l’hôpital et l’initiation du PP était de 9,4 ± 7,7 jours. Le score initial BPRS (50,2 ± 13,6) s’est amélioré de–6,5 ± 8,6 au jour 8 et de–19,3 ± 12,6 à la fin de l’étude (IC 95% = –20,7;–18,0; deux critères avec p < 0,0001). En fin d’étude, 93,6% des patients étaient évalués comme améliorés sur l’échelle CGI-S. Le score de fonctionnement PSP s’est amélioré de 49,4 ± 14,7 à baseline à 14,3 ± 12,4 en fin d’étude (IC 95% = 12,9; 15,8, p < 0,0001). Le score ESRS moyen a diminué de manière significative de 3,7 ± 5,9 (baseline) à 2,0 ± 4,7 en fin d’étude (p < 0,0001). Le pourcentage de patients très ou extrêmement satisfaits par leur traitement antipsychotique est passé de 6,0% à baseline (traitement précédent) à 46,1% en fin d’étude (PP). EIST rapportés chez ≥ 2% des patients: tremblements (2,5%) et schizophrénie (2,2%).

Conclusions

Ces données chez des patients schizophrènes hospitalisés pour décompensation confirment les résultats d’études contrôlées randomisées montrant que le PP à doses flexibles est bien toléré, induit une réponse au traitement rapide et cliniquement significative et une amélioration du fonctionnement. Traduction de l’abstract résumé présenté au congrès EPA 2015 (European Congress of Psychiatry – Vienna, Austria, 28–31 March 2015).

Effets du palmitate de palipéridone sur les symptômes négatifs, la dépression/anxiété, le fonctionnement et les symptômes extrapyramidaux chez des patients souffrant d’une schizophrénie non-aiguë, en échec du traitement par aripiprazole oral

Objectif

Évaluer l’effet du palmitate de palipéridone (PP) à doses flexibles sur les symptômes négatifs, la dépression/anxiété, le fonctionnement et les symptômes extrapyramidaux chez des patients adultes souffrant de schizophrénie non-aiguë, en échec à un traitement par aripiprazole oral.

Méthodes

Étude internationale, prospective, en ouvert de 6 mois.

Évaluations

Variations entre début d’étude (baseline) et dernière observation rapportée sur la PANSS (Positive and Negative Syndrome Scale), la sous-échelle négative de la PANSS, les facteurs de Marder de la PANSS « symptômes négatifs » et « anxiété/dépression », les échelles de fonctionnement PSP (Personal and Social Performance) et Mini-ICF (Mini International Classification of Functioning) et l’échelle ESRS (Extrapyramidal Symptom Rating Scale).

Résultats

Quarante-six patients analysés (73,9 % hommes, âge moyen 34,4 ± 9,4 ans, 78,3 % schizophrénie paranoïde). Parmi les patients, 67,4 % ont terminé l’étude. Avant l’inclusion, la dose moyenne d’aripiprazole oral était de 22,7 ± 10,7 mg/jour. Le score de la sous-échelle négative de PANSS s’est significativement amélioré de 20,3 ± 5,0 (baseline) à 17,3 ± 6,1 (fin d’étude) (variation moyenne = −3,0 ± 5,0 ; IC 95 % = −4,4 ; −1,5 ; p < 0,0001), ainsi que les scores des facteurs de Marder « symptômes négatifs » (de 19,5 ± 5,8 à 16,6 ± 5,9 ; IC95 % = −4,5 ; −1,3, p < 0,0001) et « anxiété/dépression » (de 10,3 ± 3,6 à,5 ± 2,9 ; IC95 % = −3,0 ; −0,6, p = 0,0031). Le score ESRS s’est aussi amélioré de manière significative (de −0,6 ± 3,4 ; IC 95 % = −1,6 ; 0,4, p = 0,0456). Le fonctionnement du patient s’est amélioré de manière significative sur les échelles PSP (de 58,9 ± 13,4 à 62,9 ± 15,2, p = 0,041) et Mini-ICF (de 19,0 ± 7,78 à 16,1 ± 9,84 ; IC 95 % −5,1, −0,7 ; p = 0,0079). Le seul événement indésirable sous traitement rapporté chez ≥ 5 patients a été l’anxiété (n = 6).

Conclusions

La transition d’un échec au traitement par aripiprazole oral à un traitement par PP à doses flexibles chez des patients souffrant de schizophrénie non-aiguë a été bien tolérée et s’est traduit par une amélioration significative des symptômes négatifs, dépressifs, anxieux et des symptômes extrapyramidaux, ainsi que du fonctionnement du patient.

Traduction de l’abstract résumé présenté au congrès EPA 2015 (European Congress of Psychiatry, Vienna, Austria, 28–31 March 2015)

Schizophrenia through the carers' eyes: results of a European cross-sectional survey

Schizophrenia is a serious mental disorder affecting approximately 29 million people worldwide. The ideal treatment and care of patients with schizophrenia should be provided by a multidisciplinary 'team' involving psychiatrists, nurses and other healthcare professionals, together with carers and patients. In light of the key role carers play in the care of patients with schizophrenia, the present survey was designed to assess the opinions of family members and friends of patients with schizophrenia across Europe and to ascertain their attitudes towards the illness, medication and adherence to medication. Among carers participating in this survey, there was widespread awareness of the issues involved in supporting patients with schizophrenia and the importance of their role in improving poor adherence to medication. Three differences in opinion emerged between the views of carers and psychiatrists; psychiatrists rely more on the patient themselves when assessing adherence than carers would recommend; in contrast to psychiatrists, many carers believe the illness itself contributes to non-adherence; two thirds of carers think that schizophrenia medication damages health (higher than estimated by psychiatrists). The findings from the present survey, taken together with the results from the Adherencia Terapéutica en la Esquizofrenia surveys of psychiatrists and nurses, support the need for a collaborative approach to the issue of treatment nonadherence. In particular, healthcare professionals should recognize the valuable contribution that family carers can make to improve treatment adherence and consequently clinical outcomes for patients with schizophrenia. Schizophrenia carries a significant burden for families providing care. The Adherencia Terapéutica en la Esquizofrenia (ADHES) carers' survey was designed to assess the opinions of family and friends of patients with schizophrenia across Europe and ascertain their attitudes towards the illness, medication and adherence to medication. A questionnaire-based cross-sectional survey of 138 carers across 16 European countries. Interpretation of results was based on a descriptive comparison of responses. Carers recognized the importance of medication to help patients get better (76%) and improve their quality of life (76%) and relationships (74%). Sixty-seven per cent believed medication damages general health. Sixty-five per cent reported that treatment adherence was a burden for patients. Thirty-eight per cent indicated that it was a daily struggle to get patients to take their medication. Fifty per cent perceived that medication administered every few weeks rather than daily was quite/very important. Ninety-three per cent agreed on the importance of family support to boost adherence, with education and information deemed important for families and patients. Carers rely less on the patient themselves when assessing adherence than psychiatrists. The burden faced by carers and patients in taking medication provides an opportunity for healthcare professionals to provide support in a multidisciplinary 'team' involving psychiatrists, nurses and carers.

Paliperidone palmitate in non-acute patients with schizophrenia previously unsuccessfully treated with risperidone long-acting therapy or frequently used conventional depot antipsychotics

PALMFlexS, a prospective multicentre, open-label, 6-month, phase IIIb interventional study, explored tolerability, safety and treatment response in adults (n = 231) with non-acute but symptomatic schizophrenia switching to flexibly dosed paliperidone palmitate (PP) after unsuccessful treatment with risperidone long-acting injectable therapy (RLAT) or conventional depot antipsychotics (APs). Treatment response was measured by change in Positive and Negative Syndrome Scale (PANSS) total score from baseline (BL) to last-observation-carried-forward (LOCF) endpoint (EP). Safety and tolerability assessments included Extrapyramidal Symptom Rating Scale (ESRS) total score and treatment-emergent adverse events. Significant reductions in mean PANSS total score were observed for all groups (-7.5 to -10.6; p ⩽ 0.01 [BL to LOCF EP]). After switching to PP, more than 50% of all patients achieved ⩾20% and one-third of RLAT-treated patients even achieved ⩾50% improvement in PANSS total score. Across groups, there were significant improvements (p < 0.05) in symptom severity as measured by Clinical Global Impression-Severity (CGI-S; trend for improvement with RLAT; p = 0.0568), subjective well-being, medication satisfaction, and patient functioning with PP. PP was generally well tolerated. Clinically relevant benefits were observed in non-acute patients with schizophrenia switched from RLAT or conventional depot APs to PP.

Salt-inducible kinase 2 regulates mitotic progression and transcription in prostate cancer

Salt-inducible kinase 2 (SIK2) is a multifunctional kinase of the AMPK family that plays a role in CREB1-mediated gene transcription and was recently reported to have therapeutic potential in ovarian cancer. The expression of this kinase was investigated in prostate cancer clinical specimens. Interestingly, auto-antibodies against SIK2 were increased in the plasma of patients with aggressive disease. Examination of SIK2 in prostate cancer cells found that it functions both as a positive regulator of cell-cycle progression and a negative regulator of CREB1 activity. Knockdown of SIK2 inhibited cell growth, delayed cell-cycle progression, induced cell death, and enhanced CREB1 activity. Expression of a kinase-dead mutant of SIK2 also inhibited cell growth, induced cell death, and enhanced CREB1 activity. Treatment with a small-molecule SIK2 inhibitor (ARN-3236), currently in preclinical development, also led to enhanced CREB1 activity in a dose- and time-dependent manner. Because CREB1 is a transcription factor and proto-oncogene, it was posited that the effects of SIK2 on cell proliferation and viability might be mediated by changes in gene expression. To test this, gene expression array profiling was performed and while SIK2 knockdown or overexpression of the kinase-dead mutant affected established CREB1 target genes; the overlap with transcripts regulated by forskolin (FSK), the adenylate cyclase/CREB1 pathway activator, was incomplete.

IMPLICATIONS

This study demonstrates that targeting SIK2 genetically or therapeutically will have pleiotropic effects on cell-cycle progression and transcription factor activation, which should be accounted for when characterizing SIK2 inhibitors.

CARS based label-free assay for assessment of drugs by monitoring lipid droplets in tumour cells

Coherent anti-Stokes Raman scattering (CARS) is becoming an established tool for label-free multi-photon imaging based on molecule specific vibrations in the sample. The technique has proven to be particularly useful for imaging lipids, which are abundant in cells and tissues, including cytoplasmic lipid droplets (LD), which are recognized as dynamic organelles involved in many cellular functions. The increase in the number of lipid droplets in cells undergoing cell proliferation is a common feature in many neoplastic processes [1] and an increase in LD number also appears to be an early marker of drug-induced cell stress and subsequent apoptosis [3]. In this paper, a CARS-based label-free method is presented to monitor the increase in LD content in HCT116 colon tumour cells treated with the chemotherapeutic drugs Etoposide, Camptothecin and the protein kinase inhibitor Staurosporine. Using CARS, LDs can easily be distinguished from other cell components without the application of fluorescent dyes and provides a label-free non-invasive drug screening assay that could be used not only with cells and tissues ex vivo but potentially also in vivo.

Clinical effectiveness and resource utilization of paliperidone ER for schizophrenia: Pharmacoepidemiologic International Longitudinal Antipsychotic Registry (PILAR)

OBJECTIVE

To document prescribing patterns in clinical practice and assess long-term outcomes related to initiation of paliperidone ER and other oral antipsychotics among patients with schizophrenia in a naturalistic setting.

RESEARCH DESIGN AND METHODS

An international, non-interventional, naturalistic study of adult patients (≥18 years) with schizophrenia. Patients were assigned to the relevant treatment group (paliperidone ER or 'all other oral antipsychotics') after switching to, or initiating, oral antipsychotic treatment. Retrospective 12 month data collection was followed by 12 month prospective data collection, with 3-monthly assessments. The primary endpoint was time to all-cause discontinuation of new medication. Secondary endpoints included Clinical Global Impression-Severity (CGI-S) score, Clinical Global Impression-Schizophrenia (CGI-SCH) score, Personal and Social Performance (PSP) score, health-related quality of life (HR-QoL) and quality of sleep, evaluation of healthcare resource utilization and patient's treatment satisfaction.

RESULTS

A total of 4051 patients were included in the intent-to-treat (ITT) analysis set. All-cause study discontinuation rates were comparable between the paliperidone ER group (16.8%) and the 'all other oral antipsychotics' group (15.5%). There was no difference in the time to discontinuation of newly initiated antipsychotic treatments between paliperidone ER and 'all other oral antipsychotics' groups. Paliperidone ER was associated with greater improvements from baseline to endpoint in both the PSP scale score (+14.2 vs +13.1, p = 0.041) and the physical component of quality of life (SF-12 Physical scores; +3.9 vs +2.9, p = 0.003) compared to 'all other oral antipsychotics'. Improvements in mean CGI-S score, CGI-SCH score, HR-QoL, quality of sleep and daytime drowsiness, as well as patients' treatment satisfaction were comparable between treatment groups. The incidence of adverse events was comparable between groups.

CONCLUSIONS

This study provides valuable data on the prescribing habits and treatment outcomes associated with use of paliperidone ER in everyday clinical practice, and supports previous findings of the favorable functional improvement and treatment satisfaction associated with paliperidone ER.

CLINICAL TRIAL REGISTRATION

NCT00696813; R076477SCH4015 (Register of German Association of Research-based Pharmaceutical Companies [VFA] http://www.vfa.de/de/arzneimittel-forschung/datenbanken-zu-arzneimitteln/nisdb).

Amélioration fonctionnelle sous palmitate de paliperidone à doses flexibles chez des patients aigus ou non aigus atteints de schizophrénie, après échec d’un traitement par antipsychotiques oraux

Objectifs

Évaluer l’amélioration fonctionnelle chez des patients atteints de schizophrénie sous palmitate de paliperidone (PP) à doses flexibles après échec d’un traitement par antipsychotiques oraux.

Méthodes

Analyse menée dans deux sous-groupes de patients atteints de schizophrénie : aigus (n = 202) et non aigus (n = 593) après échec d’un traitement par antipsychotiques oraux, inclus dans une étude internationale, prospective, de six mois.

Critères d’évaluation

Changement du score total à la PANSS (Positive and Negative Syndrome Scale), à la PSP (Personal and Psychosocial Performance scale), et à la Mini-ICF-APP (Mini International Classification of Functionality, Disability and Health Rating for Activity and Participation Disorders in Psychological Illnesses).

Résultats

Les deux sous-groupes ont présenté une amélioration significative du score total à la PANSS : de 98,5 ± 20,1 à l’inclusion à 67,4 ± 24,0 à la fin de l’étude (diminution moyenne = −31,0 ± 29,0) chez les patients aigus et de 71,5 ± 14,6 à 59,7 ± 18,1 (diminution moyenne = −11,7 ± 15,9) chez les patients non aigus. Cette réponse thérapeutique était associée à une augmentation significative du score total à la PSP de 43,9 ± 15,0 à 62,9 ± 17,1 (amélioration moyenne = 19,0 ± 18,7, p <0,0001) chez les patients aigus, et de 58,1 ± 13,4 à 66,1 ± 15,7 (amélioration moyenne =8,0 ± 14,0, p < 0,0001) chez les patients non aigus. Il existait une amélioration significative du score à la Mini-ICF-APP qui diminuait de 26,8 ± 8,5 à 18,5 ± 9,8 (diminution moyenne = −8,0 ± 10,4, p < 0,0001) chez les patients aigus et de 19,8 ± 7,9 à 15,9 ± 8,8 (diminution moyenne = −4,0 ± 7,5, p < 0,0001) chez les patients non aigus.

Conclusions

L’amélioration symptomatique sous PP à doses flexibles chez des patients aigus ou non-aigus atteints de schizophrénie après échec d’un traitement par antipsychotique oral s’est accompagnée d’une amélioration fonctionnelle cliniquement significative.

Palmitate de palipéridone à doses flexibles – Réponse thérapeutique, tolérance et sécurité d’emploi: une étude prospective chez des patients en période d’exacerbation aiguë d’un trouble schizophrénique après échec d’un traitement par antipsychotiques oraux

Objectifs

Évaluer la tolérance, la sécurité d’emploi et l’efficacité de doses flexibles de PP chez des patients adultes en période d’exacerbation aiguë d’une schizophrénie, après échec d’un traitement par antipsychotiques oraux.

Méthodes

Étude internationale, prospective, ouverte, de six mois.

Critères d’évaluation

Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), événements indésirables (EI), changement de poids.

Résultats

Deux cent douze patients (population en intention de traiter) : âge moyen 36,4 ± 12,1 ans, 59,0 % d’hommes, 85,4 % souffrant de schizophrénie paranoïde ont été inclus. La principale raison de la substitution d’un antipsychotique oral par le PP était un manque d’efficacité (45,8 %). 70,3 % des patients ont terminé l’étude de six mois. Les raisons les plus fréquentes d’arrêt précoce ont été : le choix du patient (9,4 %), des EI (9,0 %), les perdus de vue (4,7 %), le manque d’efficacité (2,8 %). Le score total moyen à la PANSS initiale (98,5 ± 20,1) a diminué, et ce dès j8, pour atteindre 67,4 ± 24,0 à la fin de l’étude (diminution de −31,0 ± 29,0, p < 0,0001). 66,7 % des patients ont eu une amélioration de plus de 30 % du score PANSS total et le pourcentage de patients jugés manifestement malades ou pire (CGI-S) a diminué de 75,1 % à 20,5 %. Les EIs (≥ 5 % patients) : douleur au site d’injection (13,7 %), insomnie (10,8 %), trouble psychotique (10,4 %), céphalées (6,1 %) et anxiété (6,1 %). Le changement moyen de poids a été de 2,6 ± 5,6 kg (IC 95 % [1,8; 3,4]).

Conclusions

Ces résultats confirment que le PP à doses flexibles est bien toléré et permet une réponse clinique précoce et cliniquement significative chez des patients en période d’exacerbation aiguë de leur trouble schizophrénique, après échec d’un traitement par antipsychotiques oraux.

Differential proteomic analysis of abnormal intramyoplasmic aggregates in desminopathy

Desminopathy is a subtype of myofibrillar myopathy caused by desmin mutations and characterized by protein aggregates accumulating in muscle fibers. The aim of this study was to assess the protein composition of these aggregates. Aggregates and intact myofiber sections were obtained from skeletal muscle biopsies of five desminopathy patients by laser microdissection and analyzed by a label-free spectral count-based proteomic approach. We identified 397 proteins with 22 showing significantly higher spectral indices in aggregates (ratio >1.8, p<0.05). Fifteen of these proteins not previously reported as specific aggregate components provide new insights regarding pathomechanisms of desminopathy. Results of proteomic analysis were supported by immunolocalization studies and parallel reaction monitoring. Three mutant desmin variants were detected directly on the protein level as components of the aggregates, suggesting their direct involvement in aggregate-formation and demonstrating for the first time that proteomic analysis can be used for direct identification of a disease-causing mutation in myofibrillar myopathy. Comparison of the proteomic results in desminopathy with our previous analysis of aggregate composition in filaminopathy, another myofibrillar myopathy subtype, allows to determine subtype-specific proteomic profile that facilitates identification of the specific disorder.

BIOLOGICAL SIGNIFICANCE

Our proteomic analysis provides essential new insights in the composition of pathological protein aggregates in skeletal muscle fibers of desminopathy patients. The results contribute to a better understanding of pathomechanisms in myofibrillar myopathies and provide the basis for hypothesis-driven studies. The detection of specific proteomic profiles in different myofibrillar myopathy subtypes indicates that proteomic analysis may become a useful tool in differential diagnosis of protein aggregate myopathies.

Criteria and suspension levels in diagnostic radiology

The EC (European Council) Directive on radiation protection of patients requires that criteria for acceptability of equipment in diagnostic radiology, nuclear medicine and radiotherapy be established throughout the member states. This study reviews the background to this requirement and to its implementation in practice. It notes and considers parallel requirements in the EC medical devices directive and International Electrotechnical Commission standards that it is also important to consider and that both sets of requirements should ideally be harmonised due to the global nature of the equipment industry. The study further reviews the types of criteria that can be well applied for the above purposes, and defines qualitative criteria and suspension levels suitable for application. Both are defined and relationships with other acceptance processes are considered (including acceptance testing at the time of purchase, commissioning and the issue of second-hand equipment). Suspension levels are divided into four types, A, B, C and D, depending on the quality of evidence and consensus they are based on. Exceptional situations involving, for example, new or rapidly evolving technology are also considered. The publication and paper focuses on the role of the holder of the equipment and related staff, particularly the medical physics expert and the practitioner. Advice on how the criteria should be created and implemented is provided for these groups and how this might be coordinated with the supplier. Additional advice on the role of the regulator is provided.

The EMEA ADHES survey in schizophrenia, an initiative to raise awareness of non-adherence to medication. demographics and methodology

Introduction

Rates of non-adherence of up to 72% have being reported, in schizophrenia, depending on the method used and the patient population. Rates of approximately 59% over 1 year have been reported for individuals with a first episode. Patients who stop medication are almost five times more likely to experience relapse than adherent patients. Failure to adhere to medication can have a major impact on the course of illness and treatment outcomes.

Objectives

The EMEA (Europe, Middle East and Africa) ADHES schizophrenia survey was a survey of psychiatrists across the region, treating patients with schizophrenia, designed to canvas their perceptions of assessment, potential reasons and management for partial or non-adherence to medication amongst their patients.

Aims

To present methodology and demographics of the EMEA ADHES survey in schizophrenia.

Methods

The EMEA ADHES survey comprised 20 questions and was conducted in 36 countries across EMEA. In addition to recording the gender, age and practice setting of the respondents, questions related directly to the issue of partial-/non-adherence in patients with schizophrenia.

Results

The survey was conducted amongst psychiatrists (including neurologists with psychiatric background in Germany) from January - March 2010. Results were obtained from 4722 respondents. Psychiatrists perceived that during the previous month more than half of their patients (53%) were partially or non-adherent across all EMEA regions

Discussion

The EMEA ADHES schizophrenia survey is a large and geographically broad survey providing insight on psychiatrists’ perceptions of the assessment, causes and management of partial and non-adherence to medication.

The EMEA ADHES survey in schizophrenia: psychiatrists’ perceptions of the extent of assessment and management of partial and non-adherence to medication

Introduction

Partial or non-adherence to medication is high amongst patients with schizophrenia. Rates of non-adherence of up to 72% have being reported depending on the method used and the patient population. Adherence is essential for optimal long-term patient outcomes in schizophrenia and failure to adhere to medication can have a major impact on the course of illness and treatment outcomes.

Objectives

The objective of the EMEA (Europe, Middle east and Africa) ADHES survey was to collect psychiatrist's perceptions of the assessment, reasons and management of partial and non-adherence to medication.

Aims

The aim of this poster is to present psychiatrist's perceptions collected in the EMEA ADHES survey.

Methods

The survey was devised to ascertain psychiatrists’ preferred methods of assessing adherence, their perceptions of the level of adherence, reasons for non-adherence and on strategies to improve adherence.

Results

Psychiatrists estimated that during the previous month more than half of their patients (53%) were partially or non-adherent. They estimated that as few as a third of patients who deteriorated after stopping medication was able to attribute this to their non-adherence. 76% of psychiatrists assessed adherence most frequently by asking their patient explicitly. Use of long-acting treatment was the preferred choice to address adherence problems for 62% of respondents.

Discussion

This EMEA-wide survey illustrates that while respondents recognised the relevance and importance of partial and non-adherence to medication, there remains a need for more proactive management of treatment adherence of patients with schizophrenia to reduce the frequency and consequences of relapse.

Tolerability and treatment response in patients with recently diagnosed vs. chronic schizophrenia treated with paliperidone ER

Objective

To explore tolerability and treatment response in adult patients with recently diagnosed (≤5 years) and chronic (>5 years) schizophrenia treated with flexible doses of paliperidone ER.

Methods

International prospective open-label 6-month study. Endpoints were the Positive and Negative Syndrome Scale (PANSS), patient functioning and treatment-emergent adverse events (TEAEs).

Results

Of 713 recently diagnosed patients, most were male (60.9%), mean age was 33.6 ± 11.2 years and mean time since diagnosis was 2.3 ± 1.7 years. Chronic patients (n = 1003) were predominantly male (59.2%) with a mean age of 43.8 ± 11.4 and mean time since diagnosis of 15.6 ± 9.2 years. 70.4% and 71.7% of patients completed the study, respectively. Mean mode doses of paliperidone ER were similar between recently diagnosed and chronic patients (7.0 ± 2.9 mg/day and 7.2 ± 2.9 mg/day). 63.1% of recently diagnosed and 60.8% of chronic patients switching due to lack of efficacy with their previous antipsychotic had a ≥20% improvement in PANSS total score at endpoint, and improvement with other switching reasons was consistently numerically higher in recently diagnosed patients. The rate of patients with mild or no functional impairment increased from 17.7% to 39.8% in recently diagnosed and from 14.4% to 32.9% in chronic patients. TEAEs reported in ≥5% were insomnia (10.7% and 8.1%), anxiety (8.6% and 6.0%) and somnolence (5.8% and 3.4%), respectively.

Conclusion

These data suggest that both recently diagnosed and chronic patients previously unsuccessfully treated with other oral antipsychotics may benefit from paliperidone ER, with a tendency for recently diagnosed patients showing some higher treatment response in psychotic symptoms and patient functioning.

Functioning in patients with recently diagnosed vs. chronic schizophrenia treated with paliperidone ER

Objective

To explore functioning in adult patients with recently diagnosed (< 5 years) and more chronic (> 5 years) schizophrenia treated with flexible doses of paliperidone ER.

Methods

International prospective open-label 6-month study. Endpoints were the Positive and Negative Syndrome Scale (PANSS), patient functioning (Personal and Social Performance Scale; PSP) and treatment-emergent adverse events (TEAEs).

Results

Of 713 recently diagnosed patients, most were male (60.9%), mean age was 33.6 ± 11.2 years and mean time since diagnosis was 2.3 ± 1.7 years. Chronic patients (n = 1003) were predominantly male (59.2%) with a mean age of 43.8 ± 11.4 and mean time since diagnosis of 15.6 ± 9.2 years. Mean mode doses of paliperidone ER were similar between recently diagnosed and chronic patients (7.0 ± 2.9 mg/day and 7.2 ± 2.9 mg/day). At endpoint PANSS total scores were improved by 13.7 and 12.9 points, respectively, in recently diagnosed and chronic patients. The rate of patients with mild or less functional impairment increased from 17.7% to 39.8% in recently diagnosed and from 14.4% to 32.9% in chronic patients. Major functional improvements were observed for socially useful activities and personal and social relationships. TEAEs reported in >5% of recently diagnosed or chronic patients were insomnia (10.7% and 8.1%), anxiety (8.6% and 6.0%) and somnolence (5.8% and 3.4%), respectively.

Conclusion

These data suggest that both recently diagnosed and chronic patients previously unsuccessfully treated with other oral antipsychotics may benefit from paliperidone ER, with a tendency for recently diagnosed patients showing some higher treatment response in psychotic symptoms and patient functioning, particularly in socially useful activities and personal and social relationships.

Seizure and cognitive outcomes in children and adolescents with epilepsy treated with topiramate

This 12-week open label study explored cognitive and seizure outcomes of 53 children treated with topiramate (TPM). The digit symbol test and verbal learning memory test were administered at baseline and study endpoint. Topiramate was started either in monotherapy or add-on therapy. Overall, 57% of children experienced a ≥50% seizure reduction, 36% became seizure free and cognitive testing revealed no significant changes during TPM therapy. Due to the heterogeneity of the study population, post hoc analyses were added to compare patients in initial or conversion to TPM monotherapy as well as patients who continued add-on therapy. Verbal learning memory test parameters showed neither significant differences within any subgroup comparing baseline with endpoint nor significant differences between described subgroups except for one finding. The digit symbol test revealed no differences between each subgroup between baseline and endpoint. Comparing pre-post differences, TPM monotherapy was associated with better cognitive outcomes than treatment in add-on therapy. These results have to be interpreted with caution given the short study duration and the heterogeneity of the study population. Despite these limitations, our overall results suggest that treatment with topiramate is associated with improved seizure control without significant changes in cognitive functions at the low doses tested.