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DuMont M, Agostinis A, Singh K, Swan E, Buttle Y, Tropea D. Sex representation in neurodegenerative and psychiatric disorders' preclinical and clinical studies. Neurobiol Dis 2023:106214. [PMID: 37385457 DOI: 10.1016/j.nbd.2023.106214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/10/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023] Open
Abstract
Many studies show the importance of biological sex for the onset, progression, and response to treatment in brain disorders. In line with these reports, health agencies have requested that all trials, both at the clinical and preclinical level, use a similar number of male and female subjects to correctly interpret the results. Despite these guidelines, many studies still tend to be unbalanced in the use of male and female subjects. In this review we consider three neurodegenerative disorders: Alzheimer's disease, Parkinson's disease, Amyotrophic lateral sclerosis, and three psychiatric disorders: Depression, Attention Deficit Hyperactivity Disorder, and Schizophrenia. These disorders were chosen because of their prevalence and their recognized sex-specific differences in onset, progression, and response to treatment. Alzheimer's disease and Depression demonstrate higher prevalence in females, whereas Parkinson's Disease, Amyotrophic lateral sclerosis, Attention Deficit Hyperactivity Disorder, and schizophrenia show higher prevalence in males. Results from preclinical and clinical studies examining each of these disorders revealed sex-specific differences in risk factors, diagnostic biomarkers, and treatment response and efficacy, suggesting a role for sex-specific therapies in neurodegenerative and neuropsychiatric disorders. However, the qualitative analysis of the percentage of males and females enrolled in clinical trials in the last two decades shows that for most of the disorders, there is still a sex bias in the patients' enrolment.
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Affiliation(s)
- Mieke DuMont
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Kiran Singh
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Evan Swan
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Yvonne Buttle
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Daniela Tropea
- Department of Psychiatry and Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin 2, Dublin, Ireland; FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases.
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Agostinis A, Heffernan C, Long R, Beckon A, Cockburn S, Ahmed R. Interferon-gamma release assays for latent tuberculosis infection screening in Canadian federal correctional facilities. Int J Tuberc Lung Dis 2021; 25:447-452. [PMID: 34049606 DOI: 10.5588/ijtld.20.0801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: The correctional setting presents an opportunity for latent TB infection (LTBI) screening in an otherwise difficult to reach demographic. We evaluate factors associated with the fidelity of the tuberculin skin test (TST) and interferon-gamma release assay (IGRA), specifically the QuantiFERON®-TB Gold In-Tube assay (QFT-GIT), explain factors associated with discordance, and report LTBI treatment outcomes.METHODS: We describe the association between demographic and clinical variables, and predictors of concordance with IGRA using univariate logistic regression in a population of TST-positive inmates. We report outcomes among those offered LTBI treatment.RESULTS: We observed concordance between TST and QFT-GIT in 90 of 306 (29.4%) inmates. Persons with TST+/QFT-GIT+ results were less likely to be male (OR 3.94, 95% CI 1.73-8.97) or have a BCG vaccination history (OR 0.34, 95% CI 0.12-0.95), and more likely to be foreign-born (P < 0.001). Of the 108 inmates offered LTBI treatment, 65 (60.1%) accepted and 51 (78.0%) completed. TST/QFT-GIT discordance has not been associated with disease during follow-up.CONCLUSION: Our findings suggest that TST/QFT-GIT discordance in Canadian federal inmates is common; however, low-risk of disease progression in those with discordance suggests that a shift towards IGRA-based screening is warranted and feasible.
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Affiliation(s)
- A Agostinis
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - C Heffernan
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - R Long
- Department of Medicine, University of Alberta, Edmonton, AB, Canada, TB Services, Alberta Health Services, Edmonton, AB, Canada
| | - A Beckon
- TB Services, Alberta Health Services, Edmonton, AB, Canada
| | - S Cockburn
- TB Services, Alberta Health Services, Edmonton, AB, Canada
| | - R Ahmed
- Department of Medicine, University of Alberta, Edmonton, AB, Canada, TB Services, Alberta Health Services, Edmonton, AB, Canada
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Lother SA, Abassi M, Agostinis A, Bangdiwala AS, Cheng MP, Drobot G, Engen N, Hullsiek KH, Kelly LE, Lee TC, Lofgren SM, MacKenzie LJ, Marten N, McDonald EG, Okafor EC, Pastick KA, Pullen MF, Rajasingham R, Schwartz I, Skipper CP, Turgeon AF, Zarychanski R, Boulware DR. Post-exposure prophylaxis or pre-emptive therapy for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): study protocol for a pragmatic randomized-controlled trial. Can J Anaesth 2020; 67:1201-1211. [PMID: 32383125 PMCID: PMC7205369 DOI: 10.1007/s12630-020-01684-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 causing the coronavirus disease (COVID-19) pandemic. Currently, there is a lack of evidence-based therapies to prevent COVID-19 following exposure to the virus, or to prevent worsening of symptoms following confirmed infection. We describe the design of a clinical trial of hydroxychloroquine for post-exposure prophylaxis (PEP) and pre-emptive therapy (PET) for COVID-19. METHODS We will conduct two nested multicentre international double-blind randomized placebo-controlled clinical trials of hydroxychloroquine for: 1) PEP of asymptomatic household contacts or healthcare workers exposed to COVID-19 within the past four days, and 2) PET for symptomatic outpatients with COVID-19 showing symptoms for less than four days. We will recruit 1,500 patients each for the PEP and PET trials. Participants will be randomized 1:1 to receive five days of hydroxychloroquine or placebo. The primary PEP trial outcome will be the incidence of symptomatic COVID-19. The primary PET trial outcome will be an ordinal scale of disease severity (not hospitalized, hospitalized without intensive care, hospitalization with intensive care, or death). Participant screening, informed consent, and follow-up will be exclusively internet-based with appropriate regulatory and research ethics board approvals in Canada and the United States. DISCUSSION These complementary randomized-controlled trials are innovatively designed and adequately powered to rapidly answer urgent questions regarding the effectiveness of hydroxychloroquine to reduce virus transmission and disease severity of COVID-19 during a pandemic. In-person participant follow-up will not be conducted to facilitate social distancing strategies and reduce risks of exposure to study personnel. Innovative trial approaches are needed to urgently assess therapeutic options to mitigate the global impact of this pandemic. TRIALS REGISTRATION clinicaltrials.gov (NCT04308668); registered 16 March, 2020.
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Affiliation(s)
- Sylvain A Lother
- Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada.
- Section of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Mahsa Abassi
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Alyssa Agostinis
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ananta S Bangdiwala
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Matthew P Cheng
- Divisions of Infectious Diseases & Medical Microbiology, McGill University Health Centre, Montreal, QC, Canada
- McGill Interdisciplinary Initiative in Infection and Immunity, Montreal, QC, Canada
| | - Glen Drobot
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Engen
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kathy H Hullsiek
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Lauren E Kelly
- Department of Pediatrics and Child Health, Department of Pharmacology, University of Manitoba, Winnipeg, MB, Canada
| | - Todd C Lee
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Sarah M Lofgren
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Lauren J MacKenzie
- Section of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Marten
- Critical Care Research, St-Boniface Hospital, Winnipeg, MB, Canada
| | - Emily G McDonald
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - Katelyn A Pastick
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Matthew F Pullen
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Radha Rajasingham
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Ilan Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Caleb P Skipper
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit Trauma - Emergency - Critical Care Medicine, Université Laval, Quebec, QC, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Section of Hematology and Oncology, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - David R Boulware
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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