The development of HTA collaboration at European level and the challenge of the EU regulation

Issue

The establishment of HTA has been an important topic in Europe for many years. The engagement of HTA agencies, scientists, politicians and many other stakeholders throughout more than 20 years lead to the EU-HTA regulation, which came into force beginning of 2022. Now it is time to prepare for a sustainable European Network for HTA.

Description

The implementation of HTA in Europe is of high importance of the EU-commission for more than 20 years. Started with the first projects in 1994 (EUR-ASSESS) it needed quite a bunch of different projects and, in the end, three joint actions for finally providing legal ground for HTA with the EU-HTA regulation. This journey seemed a long one. However, referring to the need of addressing the requirements of Health Care of 27 Member States combined with the demand of reliable high methodological quality and applicability, investing all the time and effort for a sustainable European Network of HTA was definitely worthwhile. Joint Scientific Consultation (JSC) and Joint Clinical Assessments (JCA) will play a central role for national HTA and decision making in health care. But for understanding role, content, national uptake and further development of means, products and results of a European Network for HTA it is quite important to get a perception of the development of HTA collaboration in Europe. Based on this the challenge of the EU-HTA regulation and its implementation will be tackled easier.

Effects

Through provision of the main pillars of the previous EU-HTA collaboration the appreciation and understanding of the differences and complexities behind the HTA processes in the EU-healthcare systems will made aware. Based on this understanding the challenges of the implementation of the EU-HTA regulation will be discussed.

Genetic association of DLG5 R30Q with familial and sporadic inflammatory bowel disease in men

BACKGROUND

The association of DLG5 R30Q with IBD has been replicated in several populations, but is not statistically significant in others. We studied the incidence of DLG5 alleles in a population of IBD patients from Pennsylvania.

METHODS

DLG5 R30Q (rs1248696) and G1066G (rs1248634) were analyzed with PCR-based RFLP methods in a total of 521 subjects, that included 105 individuals with IBD and 139 without IBD from a familial IBD registry, 107 with sporadic IBD, and 170 unrelated healthy controls. R30Q was further analyzed with SNPlex Genotyping System in 473 samples.

RESULTS

RFLP genotyping data showed that, DLG5 R30Q was significantly associated with IBD overall (p=0.006), and separately with CD (p=0.009) and UC (p=0.024). The association of R30Q with IBD was entirely due to a male-associated effect (male vs female p=0.015 vs 0.241 (IBD), p=0.024 vs 0.190 (CD), and p=0.019 vs 0.575 (UC)). The frequency of the A allele carriage was elevated in both affected and unaffected members in the familial IBD cohort compared to healthy controls (p=0.037). In the family pedigrees, we observed differences in the expression of IBD in individuals carrying the A allele between families.

CONCLUSIONS

In the studied population, DLG5 R30Q was associated with all forms of IBD. An elevated presence of the R30Q variant was observed in all members of a familial IBD registry. This association of the R30Q variant with IBD was male-specific.

Interleukin-18 is increased only in a minority of patients with active Crohn's disease

BACKGROUND AND AIMS

It has been suggested that Crohn's Disease (CD) is associated with an elevated T helper 1 response as manifested by increased production of interleukin-18 (IL-18). Local concentrations of neutralizing IL-18 binding proteins (IL-18 bp) may counteract biological functions of mature IL-18 in mucosal inflammation. Therefore, we investigated the IL-18/IL-18 bp system in a large group of patients with active inflammatory bowel disease (IBD) to identify patients that could respond theoretically to IL-18 neutralizing treatment strategies.

PATIENT/METHODS

IL-18 and IL-18 bp messenger RNA (mRNA) expression in colonic mucosa from patients with active CD (n = 72), active ulcerative colitis (UC; n = 32), and non-IBD controls (infectious colitis or diverticulitis; n = 19) and normal, non-diseased controls (n = 20) were measured by reverse-transcribed real-time polymerase chain reaction. Mature IL-18 protein and IL-18 bp expression in inflamed mucosa were assessed by Western blotting.

RESULTS/FINDINGS

Although IL-18 mRNA was increased in some patients with CD, the increase was not statistically significant. Densitometric evaluation of IL-18/alpha-actin ratio in patients with active CD (n = 20) and patients with UC (n = 10) demonstrated an increased ratio of IL-18 protein in CD when compared to UC (1.04 vs 0.72 [median]). On closer inspections, only 7/20 CD patients had an increased IL-18 protein expression in inflamed areas compared to noninflamed mucosa.

INTERPRETATION/CONCLUSION

IL-18 expression in active CD is heterogeneous, only a minority of patients expresses elevated levels. Further treatment strategies targeting IL-18 expression in active CD should be concentrated on this subgroup of patients.

Functional P2X7Receptor Polymorphisms (His155Tyr, Arg307Gln, Glu496Ala) in Patients with Crohn's Disease

Genetic factors contribute to inflammatory bowel diseases. Recently, the P2X(7) receptor was found to be a key player in caspase-1-mediated processing of the proinflammatory cytokines, interleukin-1beta and interleukin-18. We therefore aimed to determine whether the gain-of-function single nucleotide polymorphism (SNP) His155Tyr and the loss-of-function SNP Arg307Gln and Glu496Ala were associated with susceptibility to Crohn's disease (CD). For association analysis, 681 unrelated CD patients and 736 healthy controls were enrolled. Furthermore, 490 CD trios were included for segregation analysis. Genotyping was performed by the application of the TaqMan(R) MGB biallelic discrimination system. The Arg307Gln polymorphism revealed a borderline significant difference in genotype frequencies between CD patients and controls (P = 0.06) without implying any pathological significance because of low case numbers. Case-control statistics for the variants His155Tyr and Glu496Ala showed no association with CD phenotype (P = 0.19 and 0.99). Subsequent family-based transmission disequilibrium test did not prove an association of the investigated single-nucleotide polymorphisms with CD. In conclusion, the analysed intragenetic variants of the P2X(7) receptor may not be a susceptibility factor for CD.