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Moorthy V, Hamel MJ, Smith PG. Malaria vaccines for children: and now there are two. Lancet 2024; 403:504-505. [PMID: 38310911 DOI: 10.1016/s0140-6736(23)02743-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/02/2023] [Indexed: 02/06/2024]
Affiliation(s)
- Vasee Moorthy
- Department of Research for Health, Science Division, World Health Organization, Geneva 1211, Switzerland.
| | - Mary J Hamel
- Department of Immunization, Vaccines & Biologicals, Universal Health Coverage, Life Course, World Health Organization, Geneva, Switzerland
| | - Peter G Smith
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
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Kivuyo S, Birungi J, Okebe J, Wang D, Ramaiya K, Ainan S, Tumuhairwe F, Ouma S, Namakoola I, Garrib A, van Widenfelt E, Mutungi G, Jaoude GA, Batura N, Musinguzi J, Ssali MN, Etukoit BM, Mugisha K, Shimwela M, Ubuguyu OS, Makubi A, Jeffery C, Watiti S, Skordis J, Cuevas L, Sewankambo NK, Gill G, Katahoire A, Smith PG, Bachmann M, Lazarus JV, Mfinanga S, Nyirenda MJ, Jaffar S. Integrated management of HIV, diabetes, and hypertension in sub-Saharan Africa (INTE-AFRICA): a pragmatic cluster-randomised, controlled trial. Lancet 2023; 402:1241-1250. [PMID: 37805215 DOI: 10.1016/s0140-6736(23)01573-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND In sub-Saharan Africa, health-care provision for chronic conditions is fragmented. The aim of this study was to determine whether integrated management of HIV, diabetes, and hypertension led to improved rates of retention in care for people with diabetes or hypertension without adversely affecting rates of HIV viral suppression among people with HIV when compared to standard vertical care in medium and large health facilities in Uganda and Tanzania. METHODS In INTE-AFRICA, a pragmatic cluster-randomised, controlled trial, we randomly allocated primary health-care facilities in Uganda and Tanzania to provide either integrated care or standard care for HIV, diabetes, and hypertension. Random allocation (1:1) was stratified by location, infrastructure level, and by country, with a permuted block randomisation method. In the integrated care group, participants with HIV, diabetes, or hypertension were managed by the same health-care workers, used the same pharmacy, had similarly designed medical records, shared the same registration and waiting areas, and had an integrated laboratory service. In the standard care group, these services were delivered vertically for each condition. Patients were eligible to join the trial if they were living with confirmed HIV, diabetes, or hypertension, were aged 18 years or older, were living within the catchment population area of the health facility, and were likely to remain in the catchment population for 6 months. The coprimary outcomes, retention in care (attending a clinic within the last 6 months of study follow-up) for participants with either diabetes or hypertension (tested for superiority) and plasma viral load suppression for those with HIV (>1000 copies per mL; tested for non-inferiority, 10% margin), were analysed using generalised estimating equations in the intention-to-treat population. This trial is registered with ISCRTN 43896688. FINDINGS Between June 30, 2020, and April 1, 2021 we randomly allocated 32 health facilities (17 in Uganda and 15 in Tanzania) with 7028 eligible participants to the integrated care or the standard care groups. Among participants with diabetes, hypertension, or both, 2298 (75·8%) of 3032 were female and 734 (24·2%) of 3032 were male. Of participants with HIV alone, 2365 (70·3%) of 3365 were female and 1000 (29·7%) of 3365 were male. Follow-up lasted for 12 months. Among participants with diabetes, hypertension, or both, the proportion alive and retained in care at study end was 1254 (89·0%) of 1409 in integrated care and 1457 (89·8%) of 1623 in standard care. The risk differences were -0·65% (95% CI -5·76 to 4·46; p=0·80) unadjusted and -0·60% (-5·46 to 4·26; p=0·81) adjusted. Among participants with HIV, the proportion who had a plasma viral load of less than 1000 copies per mL was 1412 (97·0%) of 1456 in integrated care and 1451 (97·3%) of 1491 in standard care. The differences were -0·37% (one-sided 95% CI -1·99 to 1·26; pnon-inferiority<0·0001 unadjusted) and -0·36% (-1·99 to 1·28; pnon-inferiority<0·0001 adjusted). INTERPRETATION In sub-Saharan Africa, integrated chronic care services could achieve a high standard of care for people with diabetes or hypertension without adversely affecting outcomes for people with HIV. FUNDING European Union Horizon 2020 and Global Alliance for Chronic Diseases.
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Affiliation(s)
- Sokoine Kivuyo
- National Institutes for Medical Research, Dar es Salaam, Tanzania; Barcelona Institute for Global Health Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Josephine Birungi
- The AIDS Support Organisation, Mulago Hospital Complex, Kampala, Uganda; Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda; School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Joseph Okebe
- Institute for Global Health, University College London, London, UK
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kaushik Ramaiya
- Tanzania NCDs Alliance, Dar es Salaam, Tanzania; Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - Samafilan Ainan
- National Institutes for Medical Research, Dar es Salaam, Tanzania
| | - Faith Tumuhairwe
- The AIDS Support Organisation, Mulago Hospital Complex, Kampala, Uganda
| | - Simple Ouma
- The AIDS Support Organisation, Mulago Hospital Complex, Kampala, Uganda
| | - Ivan Namakoola
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - Anupam Garrib
- Institute for Global Health, University College London, London, UK; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Gerald Mutungi
- Non-Communicable Diseases Control Programme, Ministry of Health, Kampala, Uganda
| | | | - Neha Batura
- Institute for Global Health, University College London, London, UK
| | | | | | | | - Kenneth Mugisha
- The AIDS Support Organisation, Mulago Hospital Complex, Kampala, Uganda
| | | | | | | | - Caroline Jeffery
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Stephen Watiti
- The National Forum of People Living with HIV Networks in Uganda, Kampala, Uganda
| | - Jolene Skordis
- Institute for Global Health, University College London, London, UK
| | - Luis Cuevas
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Geoff Gill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Anne Katahoire
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Peter G Smith
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Max Bachmann
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health Hospital Clinic, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Sayoki Mfinanga
- National Institutes for Medical Research, Dar es Salaam, Tanzania; Institute for Global Health, University College London, London, UK
| | - Moffat J Nyirenda
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - Shabbar Jaffar
- Institute for Global Health, University College London, London, UK; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
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Sparrow E, Adetifa I, Chaiyakunapruk N, Cherian T, Fell DB, Graham BS, Innis B, Kaslow DC, Karron RA, Nair H, Neuzil KM, Saha S, Smith PG, Srikantiah P, Were F, Zar HJ, Feikin D. WHO preferred product characteristics for monoclonal antibodies for passive immunization against respiratory syncytial virus (RSV) disease in infants - Key considerations for global use. Vaccine 2022; 40:3506-3510. [PMID: 35184927 PMCID: PMC9176315 DOI: 10.1016/j.vaccine.2022.02.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/03/2021] [Accepted: 02/09/2022] [Indexed: 12/14/2022]
Abstract
World Health Organization (WHO) preferred product characteristics describe preferences for product attributes that would help optimize value and use to address global public health needs, with a particular focus on low- and middle-income countries. Having previously published preferred product characteristics for both maternal and paediatric respiratory syncytial virus (RSV) vaccines, WHO recently published preferred product characteristics for monoclonal antibodies to prevent severe RSV disease in infants. This article summarizes the key attributes from the preferred product characteristics and discusses key considerations for future access and use of preventive RSV monoclonal antibodies.
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Affiliation(s)
- Erin Sparrow
- World Health Organization, Switzerland; School of Public Health and Community Medicine, UNSW Sydney, Australia.
| | - Ifedayo Adetifa
- KEMRI-Wellcome Trust Research Programme, Kenya; London School of Hygiene & Tropical Medicine, UK
| | | | | | - Deshayne B Fell
- School of Epidemiology & Public Health, University of Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Canada
| | | | | | | | - Ruth A Karron
- Johns Hopkins Bloomberg School of Public Health, USA
| | - Harish Nair
- Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, UK
| | | | - Samir Saha
- Child Health Research Foundation and Bangladesh Institute of Child Health, Bangladesh
| | | | | | - Fred Were
- School of Medicine, University of Nairobi, Kenya
| | - Heather J Zar
- Department of Paediatrics and Child Health, and SA-MRC unit on Child and Adolescent Health, University of Cape Town, South Africa
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Feikin DR, Higdon MM, Abu-Raddad LJ, Andrews N, Araos R, Goldberg Y, Groome MJ, Huppert A, O'Brien KL, Smith PG, Wilder-Smith A, Zeger S, Deloria Knoll M, Patel MK. Duration of effectiveness of vaccines against SARS-CoV-2 infection and COVID-19 disease: results of a systematic review and meta-regression. Lancet 2022; 399:924-944. [PMID: 35202601 PMCID: PMC8863502 DOI: 10.1016/s0140-6736(22)00152-0] [Citation(s) in RCA: 597] [Impact Index Per Article: 298.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Knowing whether COVID-19 vaccine effectiveness wanes is crucial for informing vaccine policy, such as the need for and timing of booster doses. We aimed to systematically review the evidence for the duration of protection of COVID-19 vaccines against various clinical outcomes, and to assess changes in the rates of breakthrough infection caused by the delta variant with increasing time since vaccination. METHODS This study was designed as a systematic review and meta-regression. We did a systematic review of preprint and peer-reviewed published article databases from June 17, 2021, to Dec 2, 2021. Randomised controlled trials of COVID-19 vaccine efficacy and observational studies of COVID-19 vaccine effectiveness were eligible. Studies with vaccine efficacy or effectiveness estimates at discrete time intervals of people who had received full vaccination and that met predefined screening criteria underwent full-text review. We used random-effects meta-regression to estimate the average change in vaccine efficacy or effectiveness 1-6 months after full vaccination. FINDINGS Of 13 744 studies screened, 310 underwent full-text review, and 18 studies were included (all studies were carried out before the omicron variant began to circulate widely). Risk of bias, established using the risk of bias 2 tool for randomised controlled trials or the risk of bias in non-randomised studies of interventions tool was low for three studies, moderate for eight studies, and serious for seven studies. We included 78 vaccine-specific vaccine efficacy or effectiveness evaluations (Pfizer-BioNTech-Comirnaty, n=38; Moderna-mRNA-1273, n=23; Janssen-Ad26.COV2.S, n=9; and AstraZeneca-Vaxzevria, n=8). On average, vaccine efficacy or effectiveness against SARS-CoV-2 infection decreased from 1 month to 6 months after full vaccination by 21·0 percentage points (95% CI 13·9-29·8) among people of all ages and 20·7 percentage points (10·2-36·6) among older people (as defined by each study, who were at least 50 years old). For symptomatic COVID-19 disease, vaccine efficacy or effectiveness decreased by 24·9 percentage points (95% CI 13·4-41·6) in people of all ages and 32·0 percentage points (11·0-69·0) in older people. For severe COVID-19 disease, vaccine efficacy or effectiveness decreased by 10·0 percentage points (95% CI 6·1-15·4) in people of all ages and 9·5 percentage points (5·7-14·6) in older people. Most (81%) vaccine efficacy or effectiveness estimates against severe disease remained greater than 70% over time. INTERPRETATION COVID-19 vaccine efficacy or effectiveness against severe disease remained high, although it did decrease somewhat by 6 months after full vaccination. By contrast, vaccine efficacy or effectiveness against infection and symptomatic disease decreased approximately 20-30 percentage points by 6 months. The decrease in vaccine efficacy or effectiveness is likely caused by, at least in part, waning immunity, although an effect of bias cannot be ruled out. Evaluating vaccine efficacy or effectiveness beyond 6 months will be crucial for updating COVID-19 vaccine policy. FUNDING Coalition for Epidemic Preparedness Innovations.
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Affiliation(s)
- Daniel R Feikin
- Department of Immunisations, Vaccines, and Biologicals, WHO, Geneva, Switzerland.
| | - Melissa M Higdon
- International Vaccine Access Center, Department of International Health, John Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Rafael Araos
- Instituto de Ciencias e Innovacion en Medicina, Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile; Advanced Centre for Chronic Diseases, Santiago, Chile
| | - Yair Goldberg
- Technion Israel Institute of Technology, Haife, Israel
| | - Michelle J Groome
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amit Huppert
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Katherine L O'Brien
- Department of Immunisations, Vaccines, and Biologicals, WHO, Geneva, Switzerland
| | - Peter G Smith
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Scott Zeger
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Maria Deloria Knoll
- International Vaccine Access Center, Department of International Health, John Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Minal K Patel
- Department of Immunisations, Vaccines, and Biologicals, WHO, Geneva, Switzerland
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Birungi J, Kivuyo S, Garrib A, Mugenyi L, Mutungi G, Namakoola I, Mghamba J, Ramaiya K, Wang D, Maongezi S, Musinguzi J, Mugisha K, Etukoit BM, Kakande A, Niessen LW, Okebe J, Shiri T, Meshack S, Lutale J, Gill G, Sewankambo N, Smith PG, Nyirenda MJ, Mfinanga SG, Jaffar S. Integrating health services for HIV infection, diabetes and hypertension in sub-Saharan Africa: a cohort study. BMJ Open 2021; 11:e053412. [PMID: 34728457 PMCID: PMC8565555 DOI: 10.1136/bmjopen-2021-053412] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND HIV, diabetes and hypertension have a high disease burden in sub-Saharan Africa. Healthcare is organised in separate clinics, which may be inefficient. In a cohort study, we evaluated integrated management of these conditions from a single chronic care clinic. OBJECTIVES To determined the feasibility and acceptability of integrated management of chronic conditions in terms of retention in care and clinical indicators. DESIGN AND SETTING Prospective cohort study comprising patients attending 10 health facilities offering primary care in Dar es Salaam and Kampala. INTERVENTION Clinics within health facilities were set up to provide integrated care. Patients with either HIV, diabetes or hypertension had the same waiting areas, the same pharmacy, were seen by the same clinical staff, had similar provision of adherence counselling and tracking if they failed to attend appointments. PRIMARY OUTCOME MEASURES Retention in care, plasma viral load. FINDINGS Between 5 August 2018 and 21 May 2019, 2640 patients were screened of whom 2273 (86%) were enrolled into integrated care (832 with HIV infection, 313 with diabetes, 546 with hypertension and 582 with multiple conditions). They were followed up to 30 January 2020. Overall, 1615 (71.1%)/2273 were female and 1689 (74.5%)/2266 had been in care for 6 months or more. The proportions of people retained in care were 686/832 (82.5%, 95% CI: 79.9% to 85.1%) among those with HIV infection, 266/313 (85.0%, 95% CI: 81.1% to 89.0%) among those with diabetes, 430/546 (78.8%, 95% CI: 75.4% to 82.3%) among those with hypertension and 529/582 (90.9%, 95% CI: 88.6 to 93.3) among those with multimorbidity. Among those with HIV infection, the proportion with plasma viral load <100 copies/mL was 423(88.5%)/478. CONCLUSION Integrated management of chronic diseases is a feasible strategy for the control of HIV, diabetes and hypertension in Africa and needs evaluation in a comparative study.
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Affiliation(s)
- Josephine Birungi
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- The AIDS Support Organization, Kampala, Uganda
| | - Sokoine Kivuyo
- Muhimbili Medical Research Centre, National Institute for Medical Research Muhimbili Research Centre, Dar Es Salaam, Tanzania
| | - Anupam Garrib
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Gerald Mutungi
- Non-Communicable Diseases Control Programme, Ministry of Health, Kampala, Uganda
| | - Ivan Namakoola
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Janneth Mghamba
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | | | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sarah Maongezi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | | | | | | | - Ayoub Kakande
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Louis Wihelmus Niessen
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joseph Okebe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tinevimbo Shiri
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Janet Lutale
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Geoff Gill
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Peter G Smith
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Moffat J Nyirenda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe and Karonga, Malawi
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sayoki Godfrey Mfinanga
- Muhimbili Medical Research Centre, National Institute for Medical Research Muhimbili Research Centre, Dar Es Salaam, Tanzania
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Shabbar Jaffar
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Mfinanga SG, Nyirenda MJ, Mutungi G, Mghamba J, Maongezi S, Musinguzi J, Okebe J, Kivuyo S, Birungi J, van Widenfelt E, Van Hout MC, Bachmann M, Garrib A, Bukenya D, Cullen W, Lazarus JV, Niessen LW, Katahoire A, Shayo EH, Namakoola I, Ramaiya K, Wang D, Cuevas LE, Etukoit BM, Lutale J, Meshack S, Mugisha K, Gill G, Sewankambo N, Smith PG, Jaffar S. Integrating HIV, diabetes and hypertension services in Africa: study protocol for a cluster randomised trial in Tanzania and Uganda. BMJ Open 2021; 11:e047979. [PMID: 34645657 PMCID: PMC8515479 DOI: 10.1136/bmjopen-2020-047979] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION HIV programmes in sub-Saharan Africa are well funded but programmes for diabetes and hypertension are weak with only a small proportion of patients in regular care. Healthcare provision is organised from stand-alone clinics. In this cluster randomised trial, we are evaluating a concept of integrated care for people with HIV infection, diabetes or hypertension from a single point of care. METHODS AND ANALYSIS 32 primary care health facilities in Dar es Salaam and Kampala regions were randomised to either integrated or standard vertical care. In the integrated care arm, services are organised from a single clinic where patients with either HIV infection, diabetes or hypertension are managed by the same clinical and counselling teams. They use the same pharmacy and laboratory and have the same style of patient records. Standard care involves separate pathways, that is, separate clinics, waiting and counselling areas, a separate pharmacy and separate medical records. The trial has two primary endpoints: retention in care of people with hypertension or diabetes and plasma viral load suppression. Recruitment is expected to take 6 months and follow-up is for 12 months. With 100 participants enrolled in each facility with diabetes or hypertension, the trial will provide 90% power to detect an absolute difference in retention of 15% between the study arms (at the 5% two-sided significance level). If 100 participants with HIV infection are also enrolled in each facility, we will have 90% power to show non-inferiority in virological suppression to a delta=10% margin (ie, that the upper limit of the one-sided 95% CI of the difference between the two arms will not exceed 10%). To allow for lost to follow-up, the trial will enrol over 220 persons per facility. This is the only trial of its kind evaluating the concept of a single integrated clinic for chronic conditions in Africa. ETHICS AND DISSEMINATION The protocol has been approved by ethics committee of The AIDS Support Organisation, National Institute of Medical Research and the Liverpool School of Tropical Medicine. Dissemination of findings will be done through journal publications and meetings involving study participants, healthcare providers and other stakeholders. TRIAL REGISTRATION NUMBER ISRCTN43896688.
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Affiliation(s)
- Sayoki Godfrey Mfinanga
- Muhimbili Medical Research Centre, National Institute for Medical Research Muhimbili Research Centre, Dar Es Salaam, Tanzania
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Gerald Mutungi
- Non-Communicable Diseases Control Programme, Republic of Uganda Ministry of Health, Kampala, Uganda
| | - Janneth Mghamba
- Directors office, Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania
| | - Sarah Maongezi
- Non-Communicable Diseases Control Programme, Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania
| | - Joshua Musinguzi
- AIDS Control Programme, Republic of Uganda Ministry of Health, Kampala, Uganda
| | - Joseph Okebe
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sokoine Kivuyo
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | | | | | - Max Bachmann
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Anupam Garrib
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Walter Cullen
- School of Medicine, University College Dublin School of Medicine, Dublin, Ireland
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Anne Katahoire
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Elizabeth Henry Shayo
- Policy Analysis and Advocacy, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Ivan Namakoola
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - L E Cuevas
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Janet Lutale
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Geoff Gill
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Peter G Smith
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
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7
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Patel MK, Bergeri I, Bresee JS, Cowling BJ, Crowcroft NS, Fahmy K, Hirve S, Kang G, Katz MA, Lanata CF, L'Azou Jackson M, Joshi S, Lipsitch M, Mwenda JM, Nogareda F, Orenstein WA, Ortiz JR, Pebody R, Schrag SJ, Smith PG, Srikantiah P, Subissi L, Valenciano M, Vaughn DW, Verani JR, Wilder-Smith A, Feikin DR. Evaluation of post-introduction COVID-19 vaccine effectiveness: Summary of interim guidance of the World Health Organization. Vaccine 2021; 39:4013-4024. [PMID: 34119350 PMCID: PMC8166525 DOI: 10.1016/j.vaccine.2021.05.099] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/27/2021] [Indexed: 01/07/2023]
Abstract
Phase 3 randomized-controlled trials have provided promising results of COVID-19 vaccine efficacy, ranging from 50 to 95% against symptomatic disease as the primary endpoints, resulting in emergency use authorization/listing for several vaccines. However, given the short duration of follow-up during the clinical trials, strict eligibility criteria, emerging variants of concern, and the changing epidemiology of the pandemic, many questions still remain unanswered regarding vaccine performance. Post-introduction vaccine effectiveness evaluations can help us to understand the vaccine's effect on reducing infection and disease when used in real-world conditions. They can also address important questions that were either not studied or were incompletely studied in the trials and that will inform evolving vaccine policy, including assessment of the duration of effectiveness; effectiveness in key subpopulations, such as the very old or immunocompromised; against severe disease and death due to COVID-19; against emerging SARS-CoV-2 variants of concern; and with different vaccination schedules, such as number of doses and varying dosing intervals. WHO convened an expert panel to develop interim best practice guidance for COVID-19 vaccine effectiveness evaluations. We present a summary of the interim guidance, including discussion of different study designs, priority outcomes to evaluate, potential biases, existing surveillance platforms that can be used, and recommendations for reporting results.
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Affiliation(s)
- Minal K Patel
- World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland.
| | - Isabel Bergeri
- World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
| | - Joseph S Bresee
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, USA
| | - Benjamin J Cowling
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong, China
| | | | - Kamal Fahmy
- World Health Organization Regional Office for the Eastern Mediterranean, Monazamet El Seha El Alamia Str, Extension of Abdel Razak El Sanhouri Street, P.O. Box 7608, Nasr City, Cairo 11371, Egypt
| | | | - Gagandeep Kang
- Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India
| | - Mark A Katz
- World Health Organization Regional Office of Europe, UN City, Marmorvej 51, Copenhagen DK-2100, Denmark
| | - Claudio F Lanata
- Instituto de Investigación Nutricional, Av. la Molina 1885, La Molina 15024, Peru
| | - Maïna L'Azou Jackson
- The Coalition for Epidemic Preparedness Innovations (CEPI), Gibbs building, 215 Euston Rd, Bloomsbury, London NW1 2BE, United Kingdom
| | - Sudhir Joshi
- World Health Organization Regional Office for South-East Asia, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Cité du Djoué, P.O. Box 06, Brazzaville, Republic of Congo
| | - Francisco Nogareda
- Consultant to the Pan American Health Organization, 525 23rd Street NW, Washington, DC 20037, USA
| | | | - Justin R Ortiz
- Center for Vaccine Development & Global Health, University of Maryland School of Medicine, 685 W. Baltimore St., Room #480, Baltimore, MD 21201, USA
| | - Richard Pebody
- World Health Organization Regional Office of Europe, UN City, Marmorvej 51, Copenhagen DK-2100, Denmark
| | - Stephanie J Schrag
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, USA
| | - Peter G Smith
- MRC International Epidemiology & Statistics Group, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | | | - Lorenzo Subissi
- World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
| | | | - David W Vaughn
- Bill & Melinda Gates Foundation, 500 5th Ave N., Seattle, WA 98109, USA
| | - Jennifer R Verani
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, USA
| | | | - Daniel R Feikin
- World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
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8
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Salmon DA, Lambert PH, Nohynek HM, Gee J, Parashar UD, Tate JE, Wilder-Smith A, Hartigan-Go KY, Smith PG, Zuber PLF. Novel vaccine safety issues and areas that would benefit from further research. BMJ Glob Health 2021; 6:bmjgh-2020-003814. [PMID: 34011502 PMCID: PMC8137224 DOI: 10.1136/bmjgh-2020-003814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/01/2020] [Accepted: 01/06/2021] [Indexed: 12/20/2022] Open
Abstract
Vaccine licensure requires a very high safety standard and vaccines routinely used are very safe. Vaccine safety monitoring prelicensure and postlicensure enables continual assessment to ensure the benefits outweigh the risks and, when safety problems arise, they are quickly identified, characterised and further problems prevented when possible. We review five vaccine safety case studies: (1) dengue vaccine and enhanced dengue disease, (2) pandemic influenza vaccine and narcolepsy, (3) rotavirus vaccine and intussusception, (4) human papillomavirus vaccine and postural orthostatic tachycardia syndrome and complex regional pain syndrome, and (5) RTS, S/adjuvant system 01 malaria vaccine and meningitis, cerebral malaria, female mortality and rebound severe malaria. These case studies were selected because they are recent and varied in the vaccine safety challenges they elucidate. Bringing these case studies together, we develop lessons learned that can be useful for addressing some of the potential safety issues that will inevitably arise with new vaccines.
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Affiliation(s)
- Daniel A Salmon
- Global Disease Epidemiology and Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Hanna M Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
| | - Julianne Gee
- Division of Healthcare Quality Promotion, National Center of Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia, USA
| | - Umesh D Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | - Jacqueline E Tate
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | | | | | - Peter G Smith
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Patrick Louis F Zuber
- Essential Medicines and Health Products, Organisation Mondiale de la Sante, Geneve, Switzerland
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9
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Butkeviciute E, Prudden HJ, Jit M, Smith PG, Kang G, Riddle MS, Lopman BA, Pitzer VE, Lanata CF, Platts-Mills JA, Breiman RF, Giersing BK, Hasso-Agopsowicz M. Global diarrhoea-associated mortality estimates and models in children: Recommendations for dataset and study selection. Vaccine 2021; 39:4391-4398. [PMID: 34134905 DOI: 10.1016/j.vaccine.2021.05.086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multiple factors contribute to variation in disease burden, including the type and quality of data, and inherent properties of the models used. Understanding how these factors affect mortality estimates is crucial, especially in the context of public health decision making. We examine how the quality of the studies selected to provide mortality data, influence estimates of burden and provide recommendations about the inclusion of studies and datasets to calculate mortality estimates. METHODS To determine how mortality estimates are affected by the data used to generate model outputs, we compared the studies used by The Institute of Health Metrics and Evaluation (IHME) and Maternal and Child Epidemiology Estimation (MCEE) modelling groups to generate enterotoxigenic Escherichia coli (ETEC) and Shigella-associated mortality estimates for 2016. Guided by an expert WHO Working Group, we applied a modified Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies used by both modelling groups. RESULTS IHME and MCEE used different sets of ETEC and Shigella studies in their models and the majority of studies were high quality. The distribution of the NOS scores was similar between the two modelling groups. We observed an overrepresentation of studies from some countries in SEAR, AFR and WPR compared to other WHO regions. CONCLUSION We identified key differences in study inclusion and exclusion criteria used by IHME and MCEE and discuss their impact on datasets used to generate diarrhoea-associated mortality estimates. Based on these observations, we provide a set of recommendations for future estimates of mortality associated with enteric diseases.
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Affiliation(s)
- Egle Butkeviciute
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Holly J Prudden
- Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Peter G Smith
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Gagandeep Kang
- The Wellcome Trust Research Laboratory Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Mark S Riddle
- University of Nevada Reno School of Medicine, Reno, Nevada, United States
| | - Benjamin A Lopman
- Department of Epidemiology, Emory University, Atlanta, United States
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, United States
| | | | - James A Platts-Mills
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, United States
| | - Robert F Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, United States
| | - Birgitte K Giersing
- Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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10
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Affiliation(s)
- Nir Eyal
- Center for Population-Level Bioethics, and Departments of Health Behavior, Society & Policy (SPH) and Philosophy (SAS), Rutgers University, New Brunswick, New Jersey, USA
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, and Departments of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Peter G Smith
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
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11
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Affiliation(s)
- Nir Eyal
- Center for Population-Level Bioethics, Rutgers University, New Brunswick, New Jersey, USA.,Department of Philosophy, Rutgers University, New Brunswick, New Jersey, USA.,Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Peter G Smith
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
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12
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Jamrozik E, Littler K, Bull S, Emerson C, Kang G, Kapulu M, Rey E, Saenz C, Shah S, Smith PG, Upshur R, Weijer C, Selgelid MJ. Key criteria for the ethical acceptability of COVID-19 human challenge studies: Report of a WHO Working Group. Vaccine 2020; 39:633-640. [PMID: 33341309 PMCID: PMC7598752 DOI: 10.1016/j.vaccine.2020.10.075] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 12/13/2022]
Abstract
This report of the WHO Working Group for Guidance on Human Challenge Studies in COVID-19 outlines ethical standards for COVID-19 challenge studies. It includes eight Key Criteria related to scientific justification, risk-benefit assessment, consultation and engagement, co-ordination of research, site selection, participant selection, expert review, and informed consent. The document aims to provide comprehensive guidance to scientists, research ethics committees, funders, policymakers, and regulators in deliberations regarding SARS-CoV-2 challenge studies by outlining criteria that would need to be satisfied in order for such studies to be ethically acceptable.
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Affiliation(s)
- Euzebiusz Jamrozik
- The Ethox Centre & Wellcome Centre for Ethics and the Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK; Monash Bioethics Centre, Monash University, Clayton, Victoria, Australia; Royal Melbourne Hospital Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Katherine Littler
- Global Health Ethics Unit, World Health Organization, Geneva, Switzerland
| | - Susan Bull
- The Ethox Centre & Wellcome Centre for Ethics and the Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Claudia Emerson
- Institute on Ethics & Policy for Innovation, Department of Philosophy, McMaster University, Hamilton, Ontario, Canada
| | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Melissa Kapulu
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elena Rey
- Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM. Cali, Colombia; Universidad Icesi. Cali, Colombia
| | - Carla Saenz
- Department of Health Systems and Services, Pan American Health Organization, USA
| | - Seema Shah
- Lurie Children's Hospital & Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Peter G Smith
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, Toronto, Canada
| | - Charles Weijer
- Departments of Medicine, Epidemiology & Biostatistics, and Philosophy, Western University, London, Canada
| | - Michael J Selgelid
- Monash Bioethics Centre, Monash University, Clayton, Victoria, Australia
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13
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Eyal N, Lipsitch M, Smith PG. Reply to Hasford and to Spinola et al. J Infect Dis 2020; 222:1574-1575. [PMID: 32845306 PMCID: PMC7529012 DOI: 10.1093/infdis/jiaa458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Nir Eyal
- Center for Population-Level Bioethics, Rutgers University, New Brunswick, New Jersey, USA
- Department of Philosophy, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Peter G Smith
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
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14
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Shayo E, Van Hout MC, Birungi J, Garrib A, Kivuyo S, Mfinanga S, Nyrienda MJ, Namakoola I, Okebe J, Ramaiya K, Bachmann MO, Cullen W, Lazarus JV, Gill G, Shiri T, Bukenya D, Snell H, Nanfuka M, Cuevas LE, Shimwela M, Mutungi G, Musinguzi J, Mghamba J, Mugisha K, Jaffar S, Smith PG, Sewankambo NK. Ethical issues in intervention studies on the prevention and management of diabetes and hypertension in sub-Saharan Africa. BMJ Glob Health 2020; 5:bmjgh-2019-002193. [PMID: 32636311 PMCID: PMC7342469 DOI: 10.1136/bmjgh-2019-002193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Elizabeth Shayo
- National Institutes for Medical Research, Dar es Salaam, United Republic of Tanzania
| | - Marie Claire Van Hout
- Faculty of Education, Health & Community, Liverpool John Moores University, Liverpool, Merseyside, UK
| | | | - Anupam Garrib
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sokoine Kivuyo
- National Institutes for Medical Research, Dar es Salaam, United Republic of Tanzania
| | - Sayoki Mfinanga
- National Institutes for Medical Research, Dar es Salaam, United Republic of Tanzania
| | - Moffat J Nyrienda
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda.,Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Joseph Okebe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Max Oscar Bachmann
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Walter Cullen
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jeffrey V Lazarus
- Hospital Clinic, University of Barcelona, Instituto de Salud Global de Barcelona, Barcelona, Spain.,CHIP, Rigshospitalet, Kobenhavn, Denmark
| | - Geoff Gill
- Emeritus Professor of International Medicine, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tinevimbo Shiri
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Hazel Snell
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Luis E Cuevas
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Gerald Mutungi
- Non-communicable Disease Control Programme, Ministry of Health, Kampala, Uganda
| | | | - Janneth Mghamba
- Department of Preventive Services, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | | | - Shabbar Jaffar
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Peter G Smith
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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15
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Abstract
Controlled human challenge trials of SARS-CoV-2 vaccine candidates could accelerate the testing and potential rollout of efficacious vaccines. By replacing conventional phase 3 testing of vaccine candidates, such trials may subtract many months from the licensure process, making efficacious vaccines available more quickly. Obviously, challenging volunteers with this live virus risks inducing severe disease and possibly even death. However, we argue that such studies, by accelerating vaccine evaluation, could reduce the global burden of coronavirus-related mortality and morbidity. Volunteers in such studies could autonomously authorize the risks to themselves, and their net risk could be acceptable if participants comprise healthy young adults, who are at relatively low risk of serious disease following natural infection, if they have a high baseline risk of natural infection, and if during the trial they receive frequent monitoring and, following any infection, the best available care.
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Affiliation(s)
- Nir Eyal
- Center for Population-Level Bioethics, Rutgers University, New Brunswick, New Jersey, USA
- Department of Philosophy, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Peter G Smith
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
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16
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Prudden HJ, Hasso-Agopsowicz M, Black RE, Troeger C, Reiner RC, Breiman RF, Jit M, Kang G, Lamberti L, Lanata CF, Lopman BA, Ndifon W, Pitzer VE, Platts-Mills JA, Riddle MS, Smith PG, Hutubessy R, Giersing B. Meeting Report: WHO Workshop on modelling global mortality and aetiology estimates of enteric pathogens in children under five. Cape Town, 28-29th November 2018. Vaccine 2020; 38:4792-4800. [PMID: 32253097 PMCID: PMC7306158 DOI: 10.1016/j.vaccine.2020.01.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/15/2020] [Indexed: 12/22/2022]
Abstract
Investment in vaccine product development should be guided by up-to-date and transparent global burden of disease estimates, which are also fundamental to policy recommendation and vaccine introduction decisions. For low- and middle-income countries (LMICs), vaccine prioritization is primarily driven by the number of deaths caused by different pathogens. Enteric diseases are known to be a major cause of death in LMICs. The two main modelling groups providing mortality estimates for enteric diseases are the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle and the Maternal Child Epidemiology Estimation (MCEE) group, led by Johns Hopkins Bloomberg School of Public Health. Whilst previous global diarrhoea mortality estimates for under five-year-olds from these two groups were closely aligned, more recent estimates for 2016 have diverged, particularly with respect to numbers of deaths attributable to different enteric pathogens. This has impacted prioritization and investment decisions for vaccines in the development pipeline. The mission of the Product Development for Vaccines Advisory Committee (PDVAC) at the World Health Organisation (WHO) is to accelerate product development of vaccines and technologies that are urgently needed and ensure they are appropriately targeted for use in LMICs. At their 2018 meeting, PDVAC recommended the formation of an independent working group of subject matter experts to explore the reasons for the difference between the IHME and MCEE estimates, and to assess the respective strengths and limitations of the estimation approaches adopted, including a review of the data on which the estimates are based. Here, we report on the proceedings and recommendations from a consultation with the working group of experts, the IHME and MCEE modelling groups, and other key stakeholders. We briefly review the methodological approaches of both groups and provide a series of proposals for investigating the drivers for the differences in enteric disease burden estimates.
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Affiliation(s)
- H J Prudden
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland
| | - M Hasso-Agopsowicz
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland
| | - R E Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - C Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA
| | - R C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA
| | - R F Breiman
- Global Health Institute, Emory University, Atlanta, GA, USA
| | - M Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom; Modelling and Economics Unit, National Infections Service, Public Health England, United Kingdom; School of Public Health, University of Hong Kong, Hong Kong
| | - G Kang
- Translational Health Science and Technology Institute, Faridabad, India
| | - L Lamberti
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - C F Lanata
- Instituto de Investigacion Nutricional, Lima, Peru; Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, TN 37027, USA
| | - B A Lopman
- Global Health Institute, Emory University, Atlanta, GA, USA
| | - W Ndifon
- African Institute for Mathematical Sciences, Cape Town, South Africa
| | - V E Pitzer
- Department of Epidemiology and Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - J A Platts-Mills
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA 22908, USA
| | - M S Riddle
- Uniformed Services University, Bethesda, MD 120814, USA
| | - P G Smith
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom
| | - R Hutubessy
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland
| | - B Giersing
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland.
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17
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Dean NE, Gsell PS, Brookmeyer R, Crawford FW, Donnelly CA, Ellenberg SS, Fleming TR, Halloran ME, Horby P, Jaki T, Krause PR, Longini IM, Mulangu S, Muyembe-Tamfum JJ, Nason MC, Smith PG, Wang R, Henao-Restrepo AM, De Gruttola V. Creating a Framework for Conducting Randomized Clinical Trials during Disease Outbreaks. N Engl J Med 2020; 382:1366-1369. [PMID: 32242365 PMCID: PMC7490833 DOI: 10.1056/nejmsb1905390] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Natalie E Dean
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Pierre-Stéphane Gsell
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Ron Brookmeyer
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Forrest W Crawford
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Christl A Donnelly
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Susan S Ellenberg
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Thomas R Fleming
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - M Elizabeth Halloran
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Peter Horby
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Thomas Jaki
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Philip R Krause
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Ira M Longini
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Sabue Mulangu
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Jean-Jacques Muyembe-Tamfum
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Martha C Nason
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Peter G Smith
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Rui Wang
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Ana M Henao-Restrepo
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
| | - Victor De Gruttola
- From the Department of Biostatistics, University of Florida, Gainesville (N.E.D., I.M.L.); the World Health Organization, Geneva (P.-S.G., A.M.H.-R.); the Department of Biostatistics, University of California, Los Angeles (R.B.); the Department of Biostatistics, Yale University, New Haven, CT (F.W.C.); the Department of Statistics (C.A.D.) and the Centre for Tropical Medicine and Global Health (P.H.), University of Oxford, Oxford, the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London (C.A.D.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (P.G.S.), London, and the Department of Mathematics and Statistics, Lancaster University, Lancaster (T.J.) - all in the United Kingdom; the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia (S.S.E.); the Department of Biostatistics, University of Washington (T.R.F., M.E.H.), and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (M.E.H.) - both in Seattle; the Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring (P.R.K.), and the Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda (M.C.N.) - both in Maryland; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo (S.M., J.-J.M.-T.); and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (R.W.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (R.W., V.D.G.) - both in Boston
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Driscoll AJ, Arshad SH, Bont L, Brunwasser SM, Cherian T, Englund JA, Fell DB, Hammitt LL, Hartert TV, Innis BL, Karron RA, Langley GE, Mulholland EK, Munywoki PK, Nair H, Ortiz JR, Savitz DA, Scheltema NM, Simões EAF, Smith PG, Were F, Zar HJ, Feikin DR. Does respiratory syncytial virus lower respiratory illness in early life cause recurrent wheeze of early childhood and asthma? Critical review of the evidence and guidance for future studies from a World Health Organization-sponsored meeting. Vaccine 2020; 38:2435-2448. [PMID: 31974017 PMCID: PMC7049900 DOI: 10.1016/j.vaccine.2020.01.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/20/2019] [Accepted: 01/07/2020] [Indexed: 12/21/2022]
Abstract
Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI) and hospitalization in infants and children globally. Many observational studies have found an association between RSV LRTI in early life and subsequent respiratory morbidity, including recurrent wheeze of early childhood (RWEC) and asthma. Conversely, two randomized placebo-controlled trials of efficacious anti-RSV monoclonal antibodies (mAbs) in heterogenous infant populations found no difference in physician-diagnosed RWEC or asthma by treatment group. If a causal association exists and RSV vaccines and mAbs can prevent a substantial fraction of RWEC/asthma, the full public health value of these interventions would markedly increase. The primary alternative interpretation of the observational data is that RSV LRTI in early life is a marker of an underlying predisposition for the development of RWEC and asthma. If this is the case, RSV vaccines and mAbs would not necessarily be expected to impact these outcomes. To evaluate whether the available evidence supports a causal association between RSV LRTI and RWEC/asthma and to provide guidance for future studies, the World Health Organization convened a meeting of subject matter experts on February 12-13, 2019 in Geneva, Switzerland. After discussing relevant background information and reviewing the current epidemiologic evidence, the group determined that: (i) the evidence is inconclusive in establishing a causal association between RSV LRTI and RWEC/asthma, (ii) the evidence does not establish that RSV mAbs (and, by extension, future vaccines) will have a substantial effect on these outcomes and (iii) regardless of the association with long-term childhood respiratory morbidity, severe acute RSV disease in young children poses a substantial public health burden and should continue to be the primary consideration for policy-setting bodies deliberating on RSV vaccine and mAb recommendations. Nonetheless, the group recognized the public health importance of resolving this question and suggested good practice guidelines for future studies.
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Affiliation(s)
- Amanda J Driscoll
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore St, Suite 480, Baltimore, MD, USA
| | - S Hasan Arshad
- The David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport PO30 5TG, Isle of Wight, UK; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Louis Bont
- The ReSViNET Foundation, Zeist, the Netherlands; Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht, the Netherlands; Department of Translational Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht, the Netherlands
| | - Steven M Brunwasser
- Center for Asthma Research, Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 450, Nashville, TN 37203, USA
| | - Thomas Cherian
- MM Global Health Consulting, Chemin Maurice Ravel 11C, 1290 Versoix, Switzerland
| | - Janet A Englund
- Seattle Children's Hospital, 4800 Sand Point Way NE Seattle, WA 98105, USA; Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, CPCR, Room L-1154, Ottawa, Ontario K1H 8L1, Canada
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA
| | - Tina V Hartert
- Center for Asthma Research, Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 450, Nashville, TN 37203, USA
| | - Bruce L Innis
- Center for Vaccine Innovation and Access, PATH, 455 Massachusetts Avenue NW, Suite 1000, WA, DC 20001, USA
| | - Ruth A Karron
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Suite 217, Baltimore, MD 21205, USA
| | - Gayle E Langley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - E Kim Mulholland
- Murdoch Children's Research Institute, Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Flemington Rd, Parkville, VIC 3052, Australia; Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Patrick K Munywoki
- Division of Global Health Protection, US Centers for Disease Control and Prevention, PO Box 606-00621, Nairobi, Kenya
| | - Harish Nair
- The ReSViNET Foundation, Zeist, the Netherlands; Centre for Global Health Research, Usher Institute, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, Scotland, United Kingdom
| | - Justin R Ortiz
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore St, Suite 480, Baltimore, MD, USA
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02903, USA
| | - Nienke M Scheltema
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht, the Netherlands
| | - Eric A F Simões
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, and Children's Hospital Colorado 13123 E. 16th Ave, B065, Aurora, CO 80045, USA; Department of Epidemiology, Center for Global Health Colorado School of Public Health, 13001 E 17th Pl B119, Aurora, CO 80045, USA
| | - Peter G Smith
- Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Fred Were
- Department of Pediatrics and Child Health, University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; SA-Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, 5th Floor ICH Building, Klipfontein Road, Cape Town, South Africa
| | - Daniel R Feikin
- Department of Immunizations, Vaccines and Biologicals, World Health Organization, 20 Avenue Appia, Geneva, Switzerland
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Rioux N, Smith S, Colombo F, Kim A, Lai WG, Nix D, Siu YA, Schindler J, Smith PG. Metabolic disposition of H3B-8800, an orally available small-molecule splicing modulator, in rats, monkeys, and humans. Xenobiotica 2020; 50:1101-1114. [PMID: 31902291 DOI: 10.1080/00498254.2019.1709134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
H3B-8800, a novel orally available modulator of the SF3b complex, which potently and preferentially kills spliceosome-mutant tumor cells, is in clinical development for the treatment of advanced myeloid malignancies. We characterized the pharmacokinetics, metabolism and disposition of H3B-8800 in rats, monkeys and humans.In vitro, H3B-8800 is a substrate of CYP3A4/5, flavin-containing monooxygenases (FMOs) and P-glycoprotein (P-gp), and showed a favorable drug-drug interaction profile as a perpetrator.Following oral dosing of 14C-H3B-8800 in bile-duct cannulated SD rats, 54.7% of the dosed radioactivity was excreted in the bile, with less found in feces (36.8%). The low amount in urine (3.7%), suggests that renal elimination is a minor pathway of clearance for H3B-8800.In Long-Evans rats, radioactivity derived from 14C-H3B-8800 was rapidly absorbed, with the highest distribution in the ocular, metabolic/excretory, and gastrointestinal tract tissues. No radioactivity was detected in the central nervous system.Seven metabolites were observed in human plasma following 4 daily doses of 40 mg H3B-8800. H3B-68736 (N-desmethyl), H3B-77176 (N-oxide), and unchanged H3B-8800 were the prominent components in human plasma, at 27.3%, 18.1%, and 33.2%, respectively, of the total drug-related material in a pooled AUC0-24h sample. The same 7 metabolites were observed in monkey plasma.
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Affiliation(s)
- Nathalie Rioux
- Integrated Drug Development, Certara Strategic Consulting, Princeton, NJ, USA
| | | | | | - Amy Kim
- H3 Biomedicine, Cambridge, MA, USA
| | | | - Darrell Nix
- Integrated Drug Development, Certara Strategic Consulting, Princeton, NJ, USA
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Affiliation(s)
| | - Stefan Flasche
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Peter G Smith
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Kobayashi M, Schrag SJ, Alderson MR, Madhi SA, Baker CJ, Sobanjo-Ter Meulen A, Kaslow DC, Smith PG, Moorthy VS, Vekemans J. WHO consultation on group B Streptococcus vaccine development: Report from a meeting held on 27-28 April 2016. Vaccine 2019; 37:7307-7314. [PMID: 28017431 PMCID: PMC6892266 DOI: 10.1016/j.vaccine.2016.12.029] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/17/2016] [Indexed: 11/29/2022]
Abstract
Globally, group B Streptococcus (GBS) remains a leading cause of sepsis and meningitis in infants in the first 90days of life. Intrapartum antibiotic prophylaxis (IAP) for women at increased risk of transmitting GBS to their newborns has been effective in reducing part, but not all, of the GBS disease burden in many high income countries (HICs). In low- and middle-income countries (LMICs), IAP use is low. Immunization of pregnant women with a GBS vaccine represents an alternative strategy to protecting newborns and young infants, through transplacental antibody transfer and potentially by reducing new vaginal colonization. This vaccination strategy was first suggested in the 1970s and several potential GBS vaccines have completed phase I/II clinical trials. During the 2015 WHO Product Development for Vaccines Advisory Committee meeting, GBS was identified as a high priority for the development of a vaccine for maternal immunization because of the major public health burden posed by GBS in LMICs, and the high technical feasibility for successful development. Following this meeting, the first WHO technical consultation on GBS vaccines was held on the 27th and 28th of April 2016, to consider development pathways for such vaccines, focused on their potential role in reducing newborn and young infant deaths and possibly stillbirths in LMICs. Discussion topics included: (1) pathophysiology of disease; (2) current gaps in the knowledge of global disease burden and serotype distribution; (3) vaccine candidates under development; (4) design considerations for phase III trials; and (5) pathways to licensure, policy recommendations and use. Efforts to address gaps identified in each of these areas are needed to establish the public health need for, the development and deployment of, efficacious GBS vaccines. In particular, more work is required to understand the global disease burden of GBS-associated stillbirths, and to develop quality-assured standardized antibody assays to identify correlates of protection.
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Affiliation(s)
- Miwako Kobayashi
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Stephanie J Schrag
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
| | - Mark R Alderson
- Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA
| | - Shabir A Madhi
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, and Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Carol J Baker
- Department of Pediatrics, Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - David C Kaslow
- Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA
| | - Peter G Smith
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Vasee S Moorthy
- Initiative for Vaccine Research, World Health Organization, CH-1211 Geneva 27, Switzerland
| | - Johan Vekemans
- Initiative for Vaccine Research, World Health Organization, CH-1211 Geneva 27, Switzerland.
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22
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Hosangadi D, Smith PG, Kaslow DC, Giersing BK. WHO consultation on ETEC and Shigella burden of disease, Geneva, 6–7th April 2017: Meeting report. Vaccine 2019; 37:7381-7390. [DOI: 10.1016/j.vaccine.2017.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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23
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Flasche S, Wilder-Smith A, Hombach J, Smith PG. Estimating the proportion of vaccine-induced hospitalized dengue cases among Dengvaxia vaccinees in the Philippines. Wellcome Open Res 2019; 4:165. [PMID: 31815190 PMCID: PMC6880258 DOI: 10.12688/wellcomeopenres.15507.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 01/06/2023] Open
Abstract
Background: Dengvaxia was used in the Philippines to vaccinate 9-10-year-old school children, living in areas highly endemic for dengue. After about 830,000 had received at least 1 of 3 recommended doses, risks of enhanced disease in dengue-naïve vaccinees were reported. Methods: We used Phase 3 trial data to derive the proportions of cases of hospitalised and severe dengue that might have been prevented by the Philippines vaccination programme and, among those cases that may occur in vaccinees, what proportions are likely to arise in those who were seropositive or seronegative for dengue at the time of first vaccination and what proportion in the latter group may be enhanced disease attributable to the vaccine. Results: Assuming about 15% of vaccinees were dengue naïve at vaccination and the effects of the vaccine are independent of the number of doses received, we estimate that, in the 5 years following vaccination, the number of cases of severe disease in the vaccinated population will be reduced by about 70%. Among vaccinees who do develop severe disease, about half the cases will be due to vaccine breakthrough in seropositive vaccinees, and about a quarter will be excess cases in seronegative vaccinees that will have occurred as a consequence of vaccination. Conclusions: Overall, the Philippine dengue vaccination programme will likely prevent a substantial number of severe dengue cases and, among those that do occur, the majority are likely to be breakthrough disease in seropositive vaccinees and a minority attributable to the excess risk of enhanced disease in seronegative vaccinees.
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Affiliation(s)
- Stefan Flasche
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Peter G. Smith
- London School of Hygiene & Tropical Medicine, London, UK
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24
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Pebody R, Moyes J, Hirve S, Campbell H, Jackson S, Moen A, Nair H, Simões EAF, Smith PG, Wairagkar N, Zhang W. Approaches to use the WHO respiratory syncytial virus surveillance platform to estimate disease burden. Influenza Other Respir Viruses 2019; 14:615-621. [PMID: 31595655 PMCID: PMC7578280 DOI: 10.1111/irv.12667] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/11/2019] [Accepted: 06/14/2019] [Indexed: 12/01/2022] Open
Abstract
The World Health Organization (WHO) recently completed the first phase of a RSV surveillance pilot study in fourteen countries (two to three in each WHO region) building on the Global Influenza Surveillance and Response System (GISRS). This active surveillance strategy had several objectives including understanding RSV-related health burden in a variety of settings. A range of approaches can be used to estimate disease burden; most approaches could not be applied by participating countries in the WHO surveillance pilot. This article provides the recommendations made by WHO for strengthening and expanding the scope of the RSV surveillance in the next phase to enable burden estimation.
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Affiliation(s)
| | - Jocelyn Moyes
- Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | | | - Harry Campbell
- Usher Institute of Population Health Research and Informatics, University of Edinburgh, Edinburgh, UK
| | - Sandra Jackson
- Global Influenza Program, World Health Organization, Geneva, Switzerland
| | - Ann Moen
- Global Influenza Program, World Health Organization, Geneva, Switzerland
| | - Harish Nair
- Usher Institute of Population Health Research and Informatics, University of Edinburgh, Edinburgh, UK
| | - Eric A F Simões
- Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
| | - Peter G Smith
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Wenqing Zhang
- Global Influenza Program, World Health Organization, Geneva, Switzerland
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Nguyen TV, Yao S, Wang Y, Rolfe A, Selvaraj A, Darman R, Ke J, Warmuth M, Smith PG, Larsen NA, Yu L, Zhu P, Fekkes P, Vaillancourt FH, Bolduc DM. The R882H DNMT3A hot spot mutation stabilizes the formation of large DNMT3A oligomers with low DNA methyltransferase activity. J Biol Chem 2019; 294:16966-16977. [PMID: 31582562 DOI: 10.1074/jbc.ra119.010126] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 07/09/2019] [Revised: 09/27/2019] [Indexed: 01/04/2023] Open
Abstract
DNMT3A (DNA methyltransferase 3A) is a de novo DNA methyltransferase responsible for establishing CpG methylation patterns within the genome. DNMT3A activity is essential for normal development, and its dysfunction has been linked to developmental disorders and cancer. DNMT3A is frequently mutated in myeloid malignancies with the majority of mutations occurring at Arg-882, where R882H mutations are most frequent. The R882H mutation causes a reduction in DNA methyltransferase activity and hypomethylation at differentially-methylated regions within the genome, ultimately preventing hematopoietic stem cell differentiation and leading to leukemogenesis. Although the means by which the R882H DNMT3A mutation reduces enzymatic activity has been the subject of several studies, the precise mechanism by which this occurs has been elusive. Herein, we demonstrate that in the context of the full-length DNMT3A protein, the R882H mutation stabilizes the formation of large oligomeric DNMT3A species to reduce the overall DNA methyltransferase activity of the mutant protein as well as the WT-R882H complex in a dominant-negative manner. This shift in the DNMT3A oligomeric equilibrium and the resulting reduced enzymatic activity can be partially rescued in the presence of oligomer-disrupting DNMT3L, as well as DNMT3A point mutations along the oligomer-forming interface of the catalytic domain. In addition to modulating the oligomeric state of DNMT3A, the R882H mutation also leads to a DNA-binding defect, which may further reduce enzymatic activity. These findings provide a mechanistic explanation for the observed loss of DNMT3A activity associated with the R882H hot spot mutation in cancer.
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Affiliation(s)
| | - Shihua Yao
- H3 Biomedicine Inc., Cambridge, Massachusetts 02139
| | - Yahong Wang
- ChemPartner Co., Ltd., 998 Halei Road, Shanghai 201203, China
| | - Alan Rolfe
- H3 Biomedicine Inc., Cambridge, Massachusetts 02139
| | | | | | - Jiyuan Ke
- H3 Biomedicine Inc., Cambridge, Massachusetts 02139
| | | | | | | | - Lihua Yu
- H3 Biomedicine Inc., Cambridge, Massachusetts 02139
| | - Ping Zhu
- H3 Biomedicine Inc., Cambridge, Massachusetts 02139
| | - Peter Fekkes
- H3 Biomedicine Inc., Cambridge, Massachusetts 02139
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Seiler M, Peng S, Agrawal AA, Palacino J, Teng T, Zhu P, Smith PG, Buonamici S, Yu L. Somatic Mutational Landscape of Splicing Factor Genes and Their Functional Consequences across 33 Cancer Types. Cell Rep 2019; 23:282-296.e4. [PMID: 29617667 DOI: 10.1016/j.celrep.2018.01.088] [Citation(s) in RCA: 264] [Impact Index Per Article: 52.8] [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: 07/21/2017] [Revised: 11/12/2017] [Accepted: 01/29/2018] [Indexed: 12/21/2022] Open
Abstract
Hotspot mutations in splicing factor genes have been recently reported at high frequency in hematological malignancies, suggesting the importance of RNA splicing in cancer. We analyzed whole-exome sequencing data across 33 tumor types in The Cancer Genome Atlas (TCGA), and we identified 119 splicing factor genes with significant non-silent mutation patterns, including mutation over-representation, recurrent loss of function (tumor suppressor-like), or hotspot mutation profile (oncogene-like). Furthermore, RNA sequencing analysis revealed altered splicing events associated with selected splicing factor mutations. In addition, we were able to identify common gene pathway profiles associated with the presence of these mutations. Our analysis suggests that somatic alteration of genes involved in the RNA-splicing process is common in cancer and may represent an underappreciated hallmark of tumorigenesis.
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Affiliation(s)
- Michael Seiler
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA 02139, USA
| | - Shouyong Peng
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA 02139, USA
| | - Anant A Agrawal
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA 02139, USA
| | - James Palacino
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA 02139, USA
| | - Teng Teng
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA 02139, USA
| | - Ping Zhu
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA 02139, USA
| | - Peter G Smith
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA 02139, USA
| | | | - Silvia Buonamici
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA 02139, USA.
| | - Lihua Yu
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA 02139, USA.
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Broor S, Campbell H, Hirve S, Hague S, Jackson S, Moen A, Nair H, Palekar R, Rajatonirina S, Smith PG, Venter M, Wairagkar N, Zambon M, Ziegler T, Zhang W. Leveraging the Global Influenza Surveillance and Response System for global respiratory syncytial virus surveillance-opportunities and challenges. Influenza Other Respir Viruses 2019; 14:622-629. [PMID: 31444997 PMCID: PMC7578328 DOI: 10.1111/irv.12672] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/04/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV)-associated acute lower respiratory infection is a common cause for hospitalization and hospital deaths in young children globally. There is urgent need to generate evidence to inform immunization policies when RSV vaccines become available. The WHO piloted a RSV surveillance strategy that leverages the existing capacities of the Global Influenza Surveillance and Response System (GISRS) to better understand RSV seasonality, high-risk groups, validate case definitions, and develop laboratory and surveillance standards for RSV. METHODS The RSV sentinel surveillance strategy was piloted in 14 countries. Patients across all age groups presenting to sentinel hospitals and clinics were screened all year-round using extended severe acute respiratory infection (SARI) and acute respiratory infection (ARI) case definitions for hospital and primary care settings, respectively. Respiratory specimens were tested for RSV at the National Influenza Centre (NIC) using standardized molecular diagnostics that had been validated by an External Quality Assurance program. The WHO FluMart data platform was adapted to receive case-based RSV data and visualize interactive visualization outputs. RESULTS Laboratory standards for detecting RSV by RT-PCR were developed. A review assessed the feasibility and the low incremental costs for RSV surveillance. Several challenges were addressed related to case definitions, sampling strategies, the need to focus surveillance on young children, and the data required for burden estimation. CONCLUSIONS There was no evidence of any significant adverse impact on the functioning of GISRS which is primarily intended for virologic and epidemiological surveillance of influenza.
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Affiliation(s)
- Shobha Broor
- Medicine and Health Sciences, Shree Guru Gobind Singh Tricentenary University, Gurugram, India
| | - Harry Campbell
- Usher Institute of Population Health Research and Informatics, University of Edinburgh, Edinburgh, UK
| | - Siddhivinayak Hirve
- Global Influenza Program, Influenza Preparedness and Response, World Health Organization, Geneva, Switzerland
| | - Siri Hague
- Department of Influenza, Norwegian Institute of Public Health, Oslo, Norway
| | - Sandra Jackson
- Global Influenza Program, Influenza Preparedness and Response, World Health Organization, Geneva, Switzerland
| | - Ann Moen
- Global Influenza Program, Influenza Preparedness and Response, World Health Organization, Geneva, Switzerland
| | - Harish Nair
- Usher Institute of Population Health Research and Informatics, University of Edinburgh, Edinburgh, UK
| | | | | | - Peter G Smith
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Marietjie Venter
- Center for Viral Zoonosis, Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | | | - Maria Zambon
- Virus Reference Department, Public Health England, London, UK
| | - Thedi Ziegler
- Research Center for Child Psychiatry, University of Turku, Turku, Finland
| | - Wenqing Zhang
- Global Influenza Program, Influenza Preparedness and Response, World Health Organization, Geneva, Switzerland
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Colombo F, Smith S, Lai GW, Nix D, Smith PG, Schindler J, Rioux N. Correlation of the in vitro biotransformation of H3B-6527 in dog and human hepatocytes with the in vivo metabolic profile of 14C-H3B-6527 in a dog mass balance study. Xenobiotica 2019; 50:458-467. [PMID: 31305210 DOI: 10.1080/00498254.2019.1643941] [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] [Indexed: 10/26/2022]
Abstract
1. H3B-6527 is an orally available covalent small molecule inhibitor of FGFR4 undergoing evaluation in adults with hepatocellular carcinoma. Absorption, metabolism, transport and elimination of H3B-6527 were investigated in vitro and in a 14C-H3B-6527 beagle dog mass balance study.2. Following intravenous dosing in dogs, unchanged 14C-H3B-6527 represents only 1.6% of the total dose in excreta. The low amount of radioactivity in the dog urine (4.9% of the administered dose), suggests that renal elimination is a minor pathway of clearance for H3B-6527. A majority of the radioactivity was observed in the feces up to 5 days after dose administration, suggesting that drug-related material was secreted in the bile, and that H3B-6527 clearance was mostly driven by metabolism.3. In vitro, H3B-6527 is a substrate of GSTs, CYP3A and P-glycoprotein.4. The major pathways of metabolism were similar in human and dog hepatocytes, and occurred via glutathione (GSH) conjugations and sequential hydrolysis, N-deethylation and hydroxylation.5. The metabolic profile of H3B-6527 was qualitatively similar in dog hepatocytes and plasma/excreta.
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Affiliation(s)
| | - S Smith
- H3 Biomedicine, Cambridge, MA, USA.,Relay Therapeutics, Cambridge, MA, USA
| | | | - D Nix
- IDD, Certara Strategic Consulting, Princeton, NJ, USA
| | | | | | - N Rioux
- IDD, Certara Strategic Consulting, Princeton, NJ, USA
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Flasche S, Smith PG. Sensitivity and negative predictive value for a rapid dengue test. Lancet Infect Dis 2019; 19:465-466. [PMID: 31034385 DOI: 10.1016/s1473-3099(19)30167-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/20/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Stefan Flasche
- Vaccine Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Peter G Smith
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
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Smith PG, Racey PA. The Itinerant Natterer: Dynamics of Summer Roost Occupancy by Myotis nattereri (Chiroptera, Vespertilionidae). Acta Chiropterologica 2019. [DOI: 10.3161/15081109acc2018.20.2.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter G. Smith
- School of Biological Sciences, University of Aberdeen, Tillydrone Avenue, Aberdeen, Scotland AB24 2TZ, United Kingdom
| | - Paul A. Racey
- School of Biological Sciences, University of Aberdeen, Tillydrone Avenue, Aberdeen, Scotland AB24 2TZ, United Kingdom
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31
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Mangtani P, Nguipdop-Djomo P, Keogh RH, Sterne JAC, Abubakar I, Smith PG, Fine PEM, Vynnycky E, Watson JM, Elliman D, Lipman M, Rodrigues LC. The duration of protection of school-aged BCG vaccination in England: a population-based case-control study. Int J Epidemiol 2019; 47:193-201. [PMID: 29025083 DOI: 10.1093/ije/dyx141] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/12/2022] Open
Abstract
Background Evidence of protection from childhood Bacillus Calmette-Guerin (BCG) against tuberculosis (TB) in adulthood, when most transmission occurs, is important for TB control and resource allocation. Methods We conducted a population-based case-control study of protection by BCG given to children aged 12-13 years against tuberculosis occurring 10-29 years later. We recruited UK-born White subjects with tuberculosis and randomly sampled White community controls. Hazard ratios and 95% confidence intervals (CIs) were estimated using case-cohort Cox regression, adjusting for potential confounding factors, including socio-economic status, smoking, drug use, prison and homelessness. Vaccine effectiveness (VE = 1 - hazard ratio) was assessed at successive intervals more than 10 years following vaccination. Results We obtained 677 cases and 1170 controls after a 65% response rate in both groups. Confounding by deprivation, education and lifestyle factors was slight 10-20 years after vaccination, and more evident after 20 years. VE 10-15 years after vaccination was 51% (95% CI 21, 69%) and 57% (CI 33, 72%) at 15-20 years. Subsequently, BCG protection appeared to wane; 20-25 years VE = 25% (CI -14%, 51%) and 25-29 years VE = 1% (CI -84%, 47%). Based on multiple imputation of missing data (in 17% subjects), VE estimated in the same intervals after vaccination were similar [56% (CI 33, 72%), 57% (CI 36, 71%), 25% (-10, 48%), 21% (-39, 55%)]. Conclusions School-aged BCG vaccination offered moderate protection against tuberculosis for at least 20 years, which is longer than previously thought. This has implications for assessing the cost-effectiveness of BCG vaccination and when evaluating new TB vaccines.
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Affiliation(s)
- Punam Mangtani
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Patrick Nguipdop-Djomo
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Jonathan A C Sterne
- School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, WC1N 1EH, UK
| | - Peter G Smith
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Paul E M Fine
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Emilia Vynnycky
- Statistics Modelling and Economics Department, Public Health England, Colindale, London, NW9 5HT.,TB Modelling Group, Centre for Mathematical Modelling In Infectious Diseases and TB Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - John M Watson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - David Elliman
- Whittington Health, St Anns Hospital, Tottenham, N15 3TD, UK
| | - Marc Lipman
- Royal Free London NHS Foundation Trust, London & UCL Respiratory, Division of Medicine, University College London, London, NW3 2QG, UK
| | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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32
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Rioux N, Smith S, Korpal M, O’Shea M, Prajapati S, Zheng GZ, Warmuth M, Smith PG. Nonclinical pharmacokinetics and in vitro metabolism of H3B-6545, a novel selective ERα covalent antagonist (SERCA). Cancer Chemother Pharmacol 2018; 83:151-160. [DOI: 10.1007/s00280-018-3716-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/25/2018] [Indexed: 10/28/2022]
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Rioux N, Kim A, Nix D, Bowser T, Warmuth M, Smith PG, Schindler J. Effect of a high-fat meal on the relative bioavailability of H3B-6527, a novel FGFR4 inhibitor, in healthy volunteers. Cancer Chemother Pharmacol 2018; 83:91-96. [DOI: 10.1007/s00280-018-3708-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/22/2018] [Indexed: 01/27/2023]
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34
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Lee SCW, North K, Kim E, Jang E, Obeng E, Lu SX, Liu B, Inoue D, Yoshimi A, Ki M, Yeo M, Zhang XJ, Kim MK, Cho H, Chung YR, Taylor J, Durham BH, Kim YJ, Pastore A, Monette S, Palacino J, Seiler M, Buonamici S, Smith PG, Ebert BL, Bradley RK, Abdel-Wahab O. Synthetic Lethal and Convergent Biological Effects of Cancer-Associated Spliceosomal Gene Mutations. Cancer Cell 2018; 34:225-241.e8. [PMID: 30107174 PMCID: PMC6373472 DOI: 10.1016/j.ccell.2018.07.003] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 04/25/2018] [Accepted: 07/12/2018] [Indexed: 02/07/2023]
Abstract
Mutations affecting RNA splicing factors are the most common genetic alterations in myelodysplastic syndrome (MDS) patients and occur in a mutually exclusive manner. The basis for the mutual exclusivity of these mutations and how they contribute to MDS is not well understood. Here we report that although different spliceosome gene mutations impart distinct effects on splicing, they are negatively selected for when co-expressed due to aberrant splicing and downregulation of regulators of hematopoietic stem cell survival and quiescence. In addition to this synthetic lethal interaction, mutations in the splicing factors SF3B1 and SRSF2 share convergent effects on aberrant splicing of mRNAs that promote nuclear factor κB signaling. These data identify shared consequences of splicing-factor mutations and the basis for their mutual exclusivity.
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Affiliation(s)
- Stanley Chun-Wei Lee
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA
| | - Khrystyna North
- Computational Biology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Mailstop: M1-B514, Seattle, WA 98109-1024, USA; Basic Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Eunhee Kim
- School of Life Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Eunjung Jang
- School of Life Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Esther Obeng
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sydney X Lu
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA
| | - Bo Liu
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA
| | - Daichi Inoue
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA
| | - Akihide Yoshimi
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA
| | - Michelle Ki
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA
| | - Mirae Yeo
- School of Life Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Xiao Jing Zhang
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA
| | - Min Kyung Kim
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA
| | - Hana Cho
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA
| | - Young Rock Chung
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA
| | - Justin Taylor
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA
| | - Benjamin H Durham
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA
| | - Young Joon Kim
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA
| | - Alessandro Pastore
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA
| | - Sebastien Monette
- Laboratory of Comparative Pathology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, The Rockefeller University, New York, NY, USA
| | | | | | | | | | - Benjamin L Ebert
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Robert K Bradley
- Computational Biology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Mailstop: M1-B514, Seattle, WA 98109-1024, USA; Basic Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Genome Sciences, University of Washington, Seattle, WA, USA.
| | - Omar Abdel-Wahab
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Zuckerman 701, 408 East 69(th) Street, New York, NY 10065, USA; Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Abstract
In a Policy Forum, Marc Lipsitch and colleagues discuss trial design issues in infectious disease outbreaks.
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Affiliation(s)
- Rebecca Kahn
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Annette Rid
- Department of Global Health & Social Medicine, King’s College London, London, United Kingdom
| | - Peter G. Smith
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nir Eyal
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Puyang X, Furman C, Zheng GZ, Wu ZJ, Banka D, Aithal K, Agoulnik S, Bolduc DM, Buonamici S, Caleb B, Das S, Eckley S, Fekkes P, Hao MH, Hart A, Houtman R, Irwin S, Joshi JJ, Karr C, Kim A, Kumar N, Kumar P, Kuznetsov G, Lai WG, Larsen N, Mackenzie C, Martin LA, Melchers D, Moriarty A, Nguyen TV, Norris J, O'Shea M, Pancholi S, Prajapati S, Rajagopalan S, Reynolds DJ, Rimkunas V, Rioux N, Ribas R, Siu A, Sivakumar S, Subramanian V, Thomas M, Vaillancourt FH, Wang J, Wardell S, Wick MJ, Yao S, Yu L, Warmuth M, Smith PG, Zhu P, Korpal M. Discovery of Selective Estrogen Receptor Covalent Antagonists for the Treatment of ERα WT and ERα MUT Breast Cancer. Cancer Discov 2018; 8:1176-1193. [PMID: 29991605 DOI: 10.1158/2159-8290.cd-17-1229] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/11/2018] [Accepted: 06/19/2018] [Indexed: 11/16/2022]
Abstract
Mutations in estrogen receptor alpha (ERα) that confer resistance to existing classes of endocrine therapies are detected in up to 30% of patients who have relapsed during endocrine treatments. Because a significant proportion of therapy-resistant breast cancer metastases continue to be dependent on ERα signaling, there remains a critical need to develop the next generation of ERα antagonists that can overcome aberrant ERα activity. Through our drug-discovery efforts, we identified H3B-5942, which covalently inactivates both wild-type and mutant ERα by targeting Cys530 and enforcing a unique antagonist conformation. H3B-5942 belongs to a class of ERα antagonists referred to as selective estrogen receptor covalent antagonists (SERCA). In vitro comparisons of H3B-5942 with standard-of-care (SoC) and experimental agents confirmed increased antagonist activity across a panel of ERαWT and ERαMUT cell lines. In vivo, H3B-5942 demonstrated significant single-agent antitumor activity in xenograft models representing ERαWT and ERαY537S breast cancer that was superior to fulvestrant. Lastly, H3B-5942 potency can be further improved in combination with CDK4/6 or mTOR inhibitors in both ERαWT and ERαMUT cell lines and/or tumor models. In summary, H3B-5942 belongs to a class of orally available ERα covalent antagonists with an improved profile over SoCs.Significance: Nearly 30% of endocrine therapy-resistant breast cancer metastases harbor constitutively activating mutations in ERα. SERCA H3B-5942 engages C530 of both ERαWT and ERαMUT, promotes a unique antagonist conformation, and demonstrates improved in vitro and in vivo activity over SoC agents. Importantly, single-agent efficacy can be further enhanced by combining with CDK4/6 or mTOR inhibitors. Cancer Discov; 8(9); 1176-93. ©2018 AACR.This article is highlighted in the In This Issue feature, p. 1047.
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Affiliation(s)
| | | | | | | | | | - Kiran Aithal
- Aurigene Discovery Technologies Ltd., Bangalore, Karnataka, India
| | | | | | | | | | | | | | | | | | | | - René Houtman
- PamGene International, Den Bosch, the Netherlands
| | - Sean Irwin
- H3 Biomedicine, Inc., Cambridge, Massachusetts
| | | | - Craig Karr
- H3 Biomedicine, Inc., Cambridge, Massachusetts
| | - Amy Kim
- H3 Biomedicine, Inc., Cambridge, Massachusetts
| | | | - Pavan Kumar
- H3 Biomedicine, Inc., Cambridge, Massachusetts
| | | | | | | | | | - Lesley-Ann Martin
- Breast Cancer Now, Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | | | | | | | | | | | - Sunil Pancholi
- Breast Cancer Now, Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | | | | | | | | | | | - Ricardo Ribas
- Breast Cancer Now, Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Amy Siu
- Eisai Inc., Andover, Massachusetts
| | | | | | | | | | - John Wang
- H3 Biomedicine, Inc., Cambridge, Massachusetts
| | | | | | - Shihua Yao
- H3 Biomedicine, Inc., Cambridge, Massachusetts
| | - Lihua Yu
- H3 Biomedicine, Inc., Cambridge, Massachusetts
| | | | | | - Ping Zhu
- H3 Biomedicine, Inc., Cambridge, Massachusetts.
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Finci LI, Zhang X, Huang X, Zhou Q, Tsai J, Teng T, Agrawal A, Chan B, Irwin S, Karr C, Cook A, Zhu P, Reynolds D, Smith PG, Fekkes P, Buonamici S, Larsen NA. The cryo-EM structure of the SF3b spliceosome complex bound to a splicing modulator reveals a pre-mRNA substrate competitive mechanism of action. Genes Dev 2018; 32:309-320. [PMID: 29491137 PMCID: PMC5859971 DOI: 10.1101/gad.311043.117] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/07/2018] [Indexed: 12/16/2022]
Abstract
In this study, Finci et. al. present the cryo-EM structure of the SF3b subcomplex (SF3B1, SF3B3, PHF5A, and SF3B5), part of the U2 snRNP, bound to E7107 at 3.95 A. The structure suggests a model in which splicing modulators interfere with branch point adenosine recognition and supports a substrate competitive mechanism of action. Somatic mutations in spliceosome proteins lead to dysregulated RNA splicing and are observed in a variety of cancers. These genetic aberrations may offer a potential intervention point for targeted therapeutics. SF3B1, part of the U2 small nuclear RNP (snRNP), is targeted by splicing modulators, including E7107, the first to enter clinical trials, and, more recently, H3B-8800. Modulating splicing represents a first-in-class opportunity in drug discovery, and elucidating the structural basis for the mode of action opens up new possibilities for structure-based drug design. Here, we present the cryogenic electron microscopy (cryo-EM) structure of the SF3b subcomplex (SF3B1, SF3B3, PHF5A, and SF3B5) bound to E7107 at 3.95 Å. This structure shows that E7107 binds in the branch point adenosine-binding pocket, forming close contacts with key residues that confer resistance upon mutation: SF3B1R1074H and PHF5AY36C. The structure suggests a model in which splicing modulators interfere with branch point adenosine recognition and supports a substrate competitive mechanism of action (MOA). Using several related chemical probes, we validate the pose of the compound and support their substrate competitive MOA by comparing their activity against both strong and weak pre-mRNA substrates. Finally, we present functional data and structure–activity relationship (SAR) on the PHF5AR38C mutation that sensitizes cells to some chemical probes but not others. Developing small molecule splicing modulators represents a promising therapeutic approach for a variety of diseases, and this work provides a significant step in enabling structure-based drug design for these elaborate natural products. Importantly, this work also demonstrates that the utilization of cryo-EM in drug discovery is coming of age.
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Affiliation(s)
- Lorenzo I Finci
- Beijing Advanced Innovation Center for Structural Biology, Tsinghua-Peking Joint Center for Life Sciences, School of Life Sciences, Tsinghua University, Beijing 100084, China
| | - Xiaofeng Zhang
- Beijing Advanced Innovation Center for Structural Biology, Tsinghua-Peking Joint Center for Life Sciences, School of Life Sciences, Tsinghua University, Beijing 100084, China
| | - Xiuliang Huang
- Beijing Advanced Innovation Center for Structural Biology, Tsinghua-Peking Joint Center for Life Sciences, School of Life Sciences, Tsinghua University, Beijing 100084, China
| | - Qiang Zhou
- Beijing Advanced Innovation Center for Structural Biology, Tsinghua-Peking Joint Center for Life Sciences, School of Life Sciences, Tsinghua University, Beijing 100084, China
| | - Jennifer Tsai
- H3 Biomedicine, Inc., Cambridge, Massachusetts 02139, USA
| | - Teng Teng
- H3 Biomedicine, Inc., Cambridge, Massachusetts 02139, USA
| | - Anant Agrawal
- H3 Biomedicine, Inc., Cambridge, Massachusetts 02139, USA
| | - Betty Chan
- H3 Biomedicine, Inc., Cambridge, Massachusetts 02139, USA
| | - Sean Irwin
- H3 Biomedicine, Inc., Cambridge, Massachusetts 02139, USA
| | - Craig Karr
- H3 Biomedicine, Inc., Cambridge, Massachusetts 02139, USA
| | - Andrew Cook
- H3 Biomedicine, Inc., Cambridge, Massachusetts 02139, USA
| | - Ping Zhu
- H3 Biomedicine, Inc., Cambridge, Massachusetts 02139, USA
| | | | - Peter G Smith
- H3 Biomedicine, Inc., Cambridge, Massachusetts 02139, USA
| | - Peter Fekkes
- H3 Biomedicine, Inc., Cambridge, Massachusetts 02139, USA
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Vannice KS, Wilder-Smith A, Barrett ADT, Carrijo K, Cavaleri M, de Silva A, Durbin AP, Endy T, Harris E, Innis BL, Katzelnick LC, Smith PG, Sun W, Thomas SJ, Hombach J. Clinical development and regulatory points for consideration for second-generation live attenuated dengue vaccines. Vaccine 2018; 36:3411-3417. [PMID: 29525283 PMCID: PMC6010224 DOI: 10.1016/j.vaccine.2018.02.062] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/05/2018] [Accepted: 02/15/2018] [Indexed: 01/05/2023]
Abstract
Licensing and decisions on public health use of a vaccine rely on a robust clinical development program that permits a risk-benefit assessment of the product in the target population. Studies undertaken early in clinical development, as well as well-designed pivotal trials, allow for this robust characterization. In 2012, WHO published guidelines on the quality, safety and efficacy of live attenuated dengue tetravalent vaccines. Subsequently, efficacy and longer-term follow-up data have become available from two Phase 3 trials of a dengue vaccine, conducted in parallel, and the vaccine was licensed in December 2015. The findings and interpretation of the results from these trials released both before and after licensure have highlighted key complexities for tetravalent dengue vaccines, including concerns vaccination could increase the incidence of dengue disease in certain subpopulations. This report summarizes clinical and regulatory points for consideration that may guide vaccine developers on some aspects of trial design and facilitate regulatory review to enable broader public health recommendations for second-generation dengue vaccines.
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Affiliation(s)
- Kirsten S Vannice
- World Health Organization, Department of Immunizations, Vaccines and Biologicals, Geneva, Switzerland
| | - Annelies Wilder-Smith
- World Health Organization, Department of Immunizations, Vaccines and Biologicals, Geneva, Switzerland; Lee Kong Chian School of Medicine, Singapore
| | - Alan D T Barrett
- Sealy Center for Vaccine Development and World Health Organization Collaborating Center for Vaccine Research, Evaluation and Training for Emerging Infectious Diseases, University of Texas Medical Branch, Galveston, TX, USA
| | - Kalinka Carrijo
- Brazilian Health Regulatory Agency - Anvisa, Brasília, DF, Brazil
| | | | - Aravinda de Silva
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Anna P Durbin
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tim Endy
- State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Bruce L Innis
- Respiratory Infections and Maternal Immunizations, PATH Center for Vaccine Innovation and Access, Washington, DC, USA
| | - Leah C Katzelnick
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Peter G Smith
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Stephen J Thomas
- State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Joachim Hombach
- World Health Organization, Department of Immunizations, Vaccines and Biologicals, Geneva, Switzerland.
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Yang FC, Draper J, Smith PG, Vivian JL, Shapiro SM, Stanford JA. Short Term Development and Fate of MGE-Like Neural Progenitor Cells in Jaundiced and Non-Jaundiced Rat Brain. Cell Transplant 2018; 27:654-665. [PMID: 29845869 PMCID: PMC6041884 DOI: 10.1177/0963689718766327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Neonatal hyperbilirubinemia targets specific brain regions and can lead to kernicterus.
One of the most debilitating symptoms of kernicterus is dystonia, which results from
bilirubin toxicity to the globus pallidus (GP). Stem cell transplantation into the GP to
replace lost neurons and restore basal ganglia circuits function is a potential
therapeutic strategy to treat dystonia in kernicterus. In this study we transplanted human
medial ganglionic eminence (MGE)-like neural progenitor cells (NPCs) that we
differentiated into a primarily gamma-aminobutyric acid (GABA)ergic phenotype, into the GP
of non-immunosuppressed jaundiced (jj) and non-jaundiced (Nj) rats. We assessed the
survival and development of graft cells at three time-points post-transplantation. While
grafted MGE-like NPCs survived and generated abundant fibers in both jj and Nj brains, NPC
survival was greater in the jj brain. These results were consistent with our previous
finding that excitatory spinal interneuron-like NPCs exhibited a higher survival rate in
the jj brain than in the Nj brain. Our findings further support our hypothesis that
slightly elevated bilirubin levels in the jj brain served as an antioxidant and
immunosuppressant to protect the transplanted cells. We also identified graft fibers
growing toward brain regions that receive projections from the GP, as well as host fibers
extending toward the graft. These promising findings suggest that MGE-like NPCs may have
the capacity to restore the circuits connecting GP and other nuclei.
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Affiliation(s)
- Fu-Chen Yang
- 1 Department of Molecular & Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Julia Draper
- 2 Transgenic and Gene Targeting Institutional Facility, University of Kansas Medical Center, Kansas City, KS, USA
| | - Peter G Smith
- 1 Department of Molecular & Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA.,3 Kansas Intellectual & Developmental Disabilities Research Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jay L Vivian
- 4 Department of Pathology & Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Steven M Shapiro
- 5 Division of Child Neurology, Department of Pediatrics, Children's Mercy Hospital & Clinics, Kansas City, MO, USA
| | - John A Stanford
- 1 Department of Molecular & Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA.,3 Kansas Intellectual & Developmental Disabilities Research Center, University of Kansas Medical Center, Kansas City, KS, USA
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Mangtani P, Nguipdop-Djomo P, Keogh RH, Trinder L, Smith PG, Fine PE, Sterne J, Abubakar I, Vynnycky E, Watson J, Elliman D, Lipman M, Rodrigues LC. Observational study to estimate the changes in the effectiveness of bacillus Calmette-Guérin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK. Health Technol Assess 2018; 21:1-54. [PMID: 28738015 DOI: 10.3310/hta21390] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Until recently, evidence that protection from the bacillus Calmette-Guérin (BCG) vaccination lasted beyond 10 years was limited. In the past few years, studies in Brazil and the USA (in Native Americans) have suggested that protection from BCG vaccination against tuberculosis (TB) in childhood can last for several decades. The UK's universal school-age BCG vaccination programme was stopped in 2005 and the programme of selective vaccination of high-risk (usually ethnic minority) infants was enhanced. OBJECTIVES To assess the duration of protection of infant and school-age BCG vaccination against TB in the UK. METHODS Two case-control studies of the duration of protection of BCG vaccination were conducted, the first on minority ethnic groups who were eligible for infant BCG vaccination 0-19 years earlier and the second on white subjects eligible for school-age BCG vaccination 10-29 years earlier. TB cases were selected from notifications to the UK national Enhanced Tuberculosis Surveillance system from 2003 to 2012. Population-based control subjects, frequency matched for age, were recruited. BCG vaccination status was established from BCG records, scar reading and BCG history. Information on potential confounders was collected using computer-assisted interviews. Vaccine effectiveness was estimated as a function of time since vaccination, using a case-cohort analysis based on Cox regression. RESULTS In the infant BCG study, vaccination status was determined using vaccination records as recall was poor and concordance between records and scar reading was limited. A protective effect was seen up to 10 years following infant vaccination [< 5 years since vaccination: vaccine effectiveness (VE) 66%, 95% confidence interval (CI) 17% to 86%; 5-10 years since vaccination: VE 75%, 95% CI 43% to 89%], but there was weak evidence of an effect 10-15 years after vaccination (VE 36%, 95% CI negative to 77%; p = 0.396). The analyses of the protective effect of infant BCG vaccination were adjusted for confounders, including birth cohort and ethnicity. For school-aged BCG vaccination, VE was 51% (95% CI 21% to 69%) 10-15 years after vaccination and 57% (95% CI 33% to 72%) 15-20 years after vaccination, beyond which time protection appeared to wane. Ascertainment of vaccination status was based on self-reported history and scar reading. LIMITATIONS The difficulty in examining vaccination sites in older women in the high-risk minority ethnic study population and the sparsity of vaccine record data in the later time periods precluded robust assessment of protection from infant BCG vaccination > 10 years after vaccination. CONCLUSIONS Infant BCG vaccination in a population at high risk for TB was shown to provide protection for at least 10 years, whereas in the white population school-age vaccination was shown to provide protection for at least 20 years. This evidence may inform TB vaccination programmes (e.g. the timing of administration of improved TB vaccines, if they become available) and cost-effectiveness studies. Methods to deal with missing record data in the infant study could be explored, including the use of scar reading. FUNDING The National Institute for Health Research Health Technology Assessment programme. During the conduct of the study, Jonathan Sterne, Ibrahim Abubakar and Laura C Rodrigues received other funding from NIHR; Ibrahim Abubakar and Laura C Rodrigues have also received funding from the Medical Research Council. Punam Mangtani received funding from the Biotechnology and Biological Sciences Research Council.
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Affiliation(s)
- Punam Mangtani
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Patrick Nguipdop-Djomo
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth H Keogh
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lucy Trinder
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter G Smith
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Paul Em Fine
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jonathan Sterne
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | | | - John Watson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Marc Lipman
- Royal Free London NHS Foundation Trust, London, UK.,University College London Respiratory, Division of Medicine, University College London, London, UK
| | - Laura C Rodrigues
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Seiler M, Yoshimi A, Darman R, Chan B, Keaney G, Thomas M, Agrawal AA, Caleb B, Csibi A, Sean E, Fekkes P, Karr C, Klimek V, Lai G, Lee L, Kumar P, Lee SCW, Liu X, Mackenzie C, Meeske C, Mizui Y, Padron E, Park E, Pazolli E, Peng S, Prajapati S, Taylor J, Teng T, Wang J, Warmuth M, Yao H, Yu L, Zhu P, Abdel-Wahab O, Smith PG, Buonamici S. H3B-8800, an orally available small-molecule splicing modulator, induces lethality in spliceosome-mutant cancers. Nat Med 2018; 24:497-504. [PMID: 29457796 PMCID: PMC6730556 DOI: 10.1038/nm.4493] [Citation(s) in RCA: 330] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 01/10/2018] [Indexed: 12/19/2022]
Abstract
Genomic analyses of cancer have identified recurrent point mutations in the RNA splicing factor-encoding genes SF3B1, U2AF1, and SRSF2 that confer an alteration of function. Cancer cells bearing these mutations are preferentially dependent on wild-type (WT) spliceosome function, but clinically relevant means to therapeutically target the spliceosome do not currently exist. Here we describe an orally available modulator of the SF3b complex, H3B-8800, which potently and preferentially kills spliceosome-mutant epithelial and hematologic tumor cells. These killing effects of H3B-8800 are due to its direct interaction with the SF3b complex, as evidenced by loss of H3B-8800 activity in drug-resistant cells bearing mutations in genes encoding SF3b components. Although H3B-8800 modulates WT and mutant spliceosome activity, the preferential killing of spliceosome-mutant cells is due to retention of short, GC-rich introns, which are enriched for genes encoding spliceosome components. These data demonstrate the therapeutic potential of splicing modulation in spliceosome-mutant cancers.
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Affiliation(s)
| | - Akihide Yoshimi
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Betty Chan
- H3 Biomedicine Inc., Cambridge, Massachusetts, USA
| | - Gregg Keaney
- H3 Biomedicine Inc., Cambridge, Massachusetts, USA
| | | | | | | | | | | | - Peter Fekkes
- H3 Biomedicine Inc., Cambridge, Massachusetts, USA
| | - Craig Karr
- H3 Biomedicine Inc., Cambridge, Massachusetts, USA
| | - Virginia Klimek
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Linda Lee
- H3 Biomedicine Inc., Cambridge, Massachusetts, USA
| | - Pavan Kumar
- H3 Biomedicine Inc., Cambridge, Massachusetts, USA
| | - Stanley Chun-Wei Lee
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Xiang Liu
- H3 Biomedicine Inc., Cambridge, Massachusetts, USA
| | | | - Carol Meeske
- H3 Biomedicine Inc., Cambridge, Massachusetts, USA
| | | | - Eric Padron
- Department of Hematologic Malignancies and Immunology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Eunice Park
- H3 Biomedicine Inc., Cambridge, Massachusetts, USA
| | | | | | | | - Justin Taylor
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Teng Teng
- H3 Biomedicine Inc., Cambridge, Massachusetts, USA
| | - John Wang
- H3 Biomedicine Inc., Cambridge, Massachusetts, USA
| | | | - Huilan Yao
- H3 Biomedicine Inc., Cambridge, Massachusetts, USA
| | - Lihua Yu
- H3 Biomedicine Inc., Cambridge, Massachusetts, USA
| | - Ping Zhu
- H3 Biomedicine Inc., Cambridge, Massachusetts, USA
| | - Omar Abdel-Wahab
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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42
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Cretu C, Agrawal AA, Cook A, Will CL, Fekkes P, Smith PG, Lührmann R, Larsen N, Buonamici S, Pena V. Structural Basis of Splicing Modulation by Antitumor Macrolide Compounds. Mol Cell 2018; 70:265-273.e8. [DOI: 10.1016/j.molcel.2018.03.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/07/2018] [Accepted: 03/07/2018] [Indexed: 12/22/2022]
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43
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Wichmann O, Vannice K, Asturias EJ, de Albuquerque Luna EJ, Longini I, Lopez AL, Smith PG, Tissera H, Yoon IK, Hombach J. Live-attenuated tetravalent dengue vaccines: The needs and challenges of post-licensure evaluation of vaccine safety and effectiveness. Vaccine 2018; 35:5535-5542. [PMID: 28893477 DOI: 10.1016/j.vaccine.2017.08.066] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 05/27/2017] [Revised: 08/18/2017] [Accepted: 08/24/2017] [Indexed: 11/16/2022]
Abstract
Since December 2015, the first dengue vaccine has been licensed in several Asian and Latin American countries for protection against disease from all four dengue virus serotypes. While the vaccine demonstrated an overall good safety and efficacy profile in clinical trials, some key research questions remain which make risk-benefit-assessment for some populations difficult. As for any new vaccine, several questions, such as very rare adverse events following immunization, duration of vaccine-induced protection and effectiveness when used in public health programs, will be addressed by post-licensure studies and by data from national surveillance systems after the vaccine has been introduced. However, the complexity of dengue epidemiology, pathogenesis and population immunity, as well as some characteristics of the currently licensed vaccine, and potentially also future, live-attenuated dengue vaccines, poses a challenge for evaluation through existing monitoring systems, especially in low and middle-income countries. Most notable are the different efficacies of the currently licensed vaccine by dengue serostatus at time of first vaccination and by dengue virus serotype, as well as the increased risk of dengue hospitalization among young vaccinated children observed three years after the start of vaccination in one of the trials. Currently, it is unknown if the last phenomenon is restricted to younger ages or could affect also seronegative individuals aged 9years and older, who are included in the group for whom the vaccine has been licensed. In this paper, we summarize scientific and methodological considerations for public health surveillance and targeted post-licensure studies to address some key research questions related to live-attenuated dengue vaccines. Countries intending to introduce a dengue vaccine should assess their capacities to monitor and evaluate the vaccine's effectiveness and safety and, where appropriate and possible, enhance their surveillance systems accordingly. Targeted studies are needed, especially to better understand the effects of vaccinating seronegative individuals.
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Affiliation(s)
- Ole Wichmann
- World Health Organization, Department of Immunizations, Vaccines and Biologicals, Geneva, Switzerland; Robert Koch Institute, Berlin, Germany
| | - Kirsten Vannice
- World Health Organization, Department of Immunizations, Vaccines and Biologicals, Geneva, Switzerland
| | - Edwin J Asturias
- University of Colorado School of Medicine, Aurora, CO, United States; Colorado School of Public Health, Aurora, CO, United States
| | | | - Ira Longini
- University of Florida, Gainesville, FL, United States
| | - Anna Lena Lopez
- University of the Philippines Manila - National Institutes of Health, Manila, Philippines
| | - Peter G Smith
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hasitha Tissera
- National Dengue Control Unit, Ministry of Health, Colombo, Sri Lanka
| | - In-Kyu Yoon
- International Vaccine Institute, Seoul, South Korea
| | - Joachim Hombach
- World Health Organization, Department of Immunizations, Vaccines and Biologicals, Geneva, Switzerland.
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44
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McCarson KE, Winter MK, Abrahamson DR, Berman NE, Smith PG. Assessing complex movement behaviors in rodent models of neurological disorders. Neurobiol Learn Mem 2018; 165:106817. [PMID: 29476821 DOI: 10.1016/j.nlm.2018.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/14/2017] [Revised: 02/12/2018] [Accepted: 02/20/2018] [Indexed: 01/24/2023]
Abstract
Behavioral phenotyping is a crucial step in validating animal models of human disease. Most traditional behavioral analyses rely on investigator observation of animal subjects, which can be confounded by inter-observer variability, scoring consistency, and the ability to observe extremely rapid, small, or repetitive movements. Force-Plate Actimeter (FPA)-based assessments can quantify locomotor activity and detailed motor activity with an incredibly rich data stream that can reveal details of movement unobservable by the naked eye. This report describes four specific examples of FPA analysis of behavior that have been useful in specific rat or mouse models of human neurological disease, which show how FPA analysis can be used to capture and quantify specific features of the complex behavioral phenotypes of these animal models. The first example quantifies nociceptive behavior of the rat following injection of formalin into the footpad as a common model of persistent inflammatory pain. The second uses actimetry to quantify intense, rapid circling behaviors in a transgenic mouse that overexpresses human laminin α5, a basement membrane protein. The third example assesses place preference behaviors in a rat model of migraine headache modeling phonophobia and photophobia. In the fourth example, FPA analysis revealed a unique movement signature emerged with age in a digenic mutant mouse model of Tourette Syndrome. Taken together, these approaches demonstrate the power and usefulness of the FPA in the examination and quantification of minute details of motor behaviors, greatly expanding the scope and detail of behavioral phenotyping of preclinical models of human disease.
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Affiliation(s)
- Kenneth E McCarson
- Kansas Intellectual and Developmental Disabilities Research Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Michelle K Winter
- Kansas Intellectual and Developmental Disabilities Research Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Dale R Abrahamson
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Nancy E Berman
- Kansas Intellectual and Developmental Disabilities Research Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; Department of Anatomy and Cell Biology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Peter G Smith
- Kansas Intellectual and Developmental Disabilities Research Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; Department of Molecular and Integrative Physiology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
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45
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Korpal M, Puyang X, Furman C, Zheng GZ, Banka D, Wu J, Zhang Z, Thomas M, Mackenzie C, Yao H, Rimkunas V, Kumar P, Caleb B, Karr C, Subramanian V, Irwin S, Larsen N, Vaillancourt F, Nguyen TV, Davis A, Chan B, Hao MH, O'Shea M, Prajapati S, Agoulnik S, Kuznetsov G, Kumar N, Yu Y, Lai G, Hart A, Eckley S, Fekkes P, Bowser T, Joshi JJ, Selvaraj A, Wardell S, Norris J, Smith S, Reynolds D, Mitchell L, Wang J, Yu L, Kim A, Rioux N, Sahmoud T, Warmuth M, Smith PG, Zhu P. Abstract P1-10-08: Development of a first-in-class oral selective ERα covalent antagonist (SERCA) for the treatment of ERαWT and ERαMUT breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-10-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Mutations in estrogen receptor alpha (ERα) are detected in up to 30% of breast cancer patients who have relapsed during endocrine therapy. ERα mutations functionally confer resistance to existing classes of endocrine therapies, likely through gaining constitutive activity. The fact that current ER-directed therapies are only partially effective in the ERα mutant setting, and that a significant proportion of resistant breast cancer metastases continue to remain dependent on ERα signaling for growth/survival, highlights the critical need to develop the next generation of ERα antagonists that can overcome aberrant ERα activity. Using structure-based drug design approaches we have identified a novel class of ERα antagonist referred to as Selective ERα Covalent Antagonist (SERCA) that inactivate both wild-type and mutant ERα by targeting a unique cysteine residue that is not conserved among other steroid hormone receptors. Biophysical, biochemical and cellular analyses confirm the covalent mechanism of action, specific binding to ER and selective inhibition of ERα-dependent transcription of SERCAs. H3B-6545 is a highly selective SERCA that potently antagonizes wild-type and mutant ERα in biochemical and cell based assays demonstrating increased potency over standard of care and other experimental agents. In vivo, H3B-6545 shows superior efficacy to fulvestrant in the MCF-7 xenograft model with once daily oral dosing, achieving maximal antitumor activity at doses >10x below the maximum tolerated dose in mice. In addition, H3B-6545 shows superior antitumor activity to both tamoxifen and fulvestrant in patient derived xenograft models of breast cancer carrying estrogen receptor mutations. In summary, H3B-6545 is a first-in-class, orally available and selective ER covalent antagonist with a compelling pre-clinical profile that is being developed for the treatment of ERα positive breast cancer.
Citation Format: Korpal M, Puyang X, Furman C, Zheng GZ, Banka D, Wu J, Zhang Z, Thomas M, Mackenzie C, Yao H, Rimkunas V, Kumar P, Caleb B, Karr C, Subramanian V, Irwin S, Larsen N, Vaillancourt F, Nguyen T-V, Davis A, Chan B, Hao MH, O'Shea M, Prajapati S, Agoulnik S, Kuznetsov G, Kumar N, Yu Y, Lai G, Hart A, Eckley S, Fekkes P, Bowser T, Joshi JJ, Selvaraj A, Wardell S, Norris J, Smith S, Reynolds D, Mitchell L, Wang J, Yu L, Kim A, Rioux N, Sahmoud T, Warmuth M, Smith PG, Zhu P. Development of a first-in-class oral selective ERα covalent antagonist (SERCA) for the treatment of ERαWT and ERαMUT breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-10-08.
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Affiliation(s)
- M Korpal
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - X Puyang
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - C Furman
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - GZ Zheng
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - D Banka
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - J Wu
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - Z Zhang
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - M Thomas
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - C Mackenzie
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - H Yao
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - V Rimkunas
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - P Kumar
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - B Caleb
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - C Karr
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - V Subramanian
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - S Irwin
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - N Larsen
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - F Vaillancourt
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - T-V Nguyen
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - A Davis
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - B Chan
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - MH Hao
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - M O'Shea
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - S Prajapati
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - S Agoulnik
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - G Kuznetsov
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - N Kumar
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - Y Yu
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - G Lai
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - A Hart
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - S Eckley
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - P Fekkes
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - T Bowser
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - JJ Joshi
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - A Selvaraj
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - S Wardell
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - J Norris
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - S Smith
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - D Reynolds
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - L Mitchell
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - J Wang
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - L Yu
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - A Kim
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - N Rioux
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - T Sahmoud
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - M Warmuth
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - PG Smith
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
| | - P Zhu
- H3 Biomedicine, Inc., 300 Technology Square, Cambridge, MA; Eisai Inc., 4 Corporate Drive, Andover, MA; Duke University, Research Drive, LSRC Bldg, C251, Durham, NC
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46
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Vekemans J, Moorthy V, Giersing B, Friede M, Hombach J, Arora N, Modjarrad K, Smith PG, Karron R, Graham B, Kaslow DC. Respiratory syncytial virus vaccine research and development: World Health Organization technological roadmap and preferred product characteristics. Vaccine 2018; 37:7394-7395. [PMID: 29395536 DOI: 10.1016/j.vaccine.2017.09.092] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 09/19/2017] [Accepted: 09/28/2017] [Indexed: 11/27/2022]
Abstract
The respiratory syncytial virus causes a considerable respiratory disease burden globally, most markedly in young infants, in low and middle income countries. A diverse product pipeline illustrates the recent intensification of research and development activities for vaccines and monoclonal antibodies against RSV. With the aim to ensure that product development activities are directed to address the public health needs, the World Health Organization has developed a research and development technical roadmap and articulated product characteristics preferences.
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Affiliation(s)
| | | | | | | | | | | | | | - Peter G Smith
- London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Karron
- John Hopkins Bloomberg School of Public Health, Baltimore, USA
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47
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Joshi JJ, Coffey H, Corcoran E, Tsai J, Huang CL, Ichikawa K, Prajapati S, Hao MH, Bailey S, Wu J, Rimkunas V, Karr C, Subramanian V, Kumar P, MacKenzie C, Hurley R, Satoh T, Yu K, Park E, Rioux N, Kim A, Lai WG, Yu L, Zhu P, Buonamici S, Larsen N, Fekkes P, Wang J, Warmuth M, Reynolds DJ, Smith PG, Selvaraj A. H3B-6527 Is a Potent and Selective Inhibitor of FGFR4 in FGF19-Driven Hepatocellular Carcinoma. Cancer Res 2018; 77:6999-7013. [PMID: 29247039 DOI: 10.1158/0008-5472.can-17-1865] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/23/2017] [Accepted: 10/10/2017] [Indexed: 01/18/2023]
Abstract
Activation of the fibroblast growth factor receptor FGFR4 by FGF19 drives hepatocellular carcinoma (HCC), a disease with few, if any, effective treatment options. While a number of pan-FGFR inhibitors are being clinically evaluated, their application to FGF19-driven HCC may be limited by dose-limiting toxicities mediated by FGFR1-3 receptors. To evade the potential limitations of pan-FGFR inhibitors, we generated H3B-6527, a highly selective covalent FGFR4 inhibitor, through structure-guided drug design. Studies in a panel of 40 HCC cell lines and 30 HCC PDX models showed that FGF19 expression is a predictive biomarker for H3B-6527 response. Moreover, coadministration of the CDK4/6 inhibitor palbociclib in combination with H3B-6527 could effectively trigger tumor regression in a xenograft model of HCC. Overall, our results offer preclinical proof of concept for H3B-6527 as a candidate therapeutic agent for HCC cases that exhibit increased expression of FGF19. Cancer Res; 77(24); 6999-7013. ©2017 AACR.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jeremy Wu
- H3 Biomedicine, Cambridge, Massachusetts
| | | | - Craig Karr
- H3 Biomedicine, Cambridge, Massachusetts
| | | | | | | | | | | | - Kun Yu
- H3 Biomedicine, Cambridge, Massachusetts
| | | | | | - Amy Kim
- H3 Biomedicine, Cambridge, Massachusetts
| | | | - Lihua Yu
- H3 Biomedicine, Cambridge, Massachusetts
| | - Ping Zhu
- H3 Biomedicine, Cambridge, Massachusetts
| | | | | | | | - John Wang
- H3 Biomedicine, Cambridge, Massachusetts
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48
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Bhattacherjee A, Winter MK, Eggimann LS, Mu Y, Gunewardena S, Liao Z, Christianson JA, Smith PG. Motor, Somatosensory, Viscerosensory and Metabolic Impairments in a Heterozygous Female Rat Model of Rett Syndrome. Int J Mol Sci 2017; 19:ijms19010097. [PMID: 29286317 PMCID: PMC5796047 DOI: 10.3390/ijms19010097] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 10/03/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 12/12/2022] Open
Abstract
Rett Syndrome (RTT), an autism-related disorder caused by mutation of the X-linked Methyl CpG-binding Protein 2 (MECP2) gene, is characterized by severe cognitive and intellectual deficits. While cognitive deficits are well-documented in humans and rodent models, impairments of sensory, motor and metabolic functions also occur but remain poorly understood. To better understand non-cognitive deficits in RTT, we studied female rats heterozygous for Mecp2 mutation (Mecp2−/x); unlike commonly used male Mecp2−/y rodent models, this more closely approximates human RTT where males rarely survive. Mecp2−/x rats showed rapid, progressive decline of motor coordination through six months of age as assessed by rotarod performance, accompanied by deficits in gait and posture. Mecp2−/x rats were hyper-responsive to noxious pressure and cold, but showed visceral hyposensitivity when tested by colorectal distension. Mecp2−/x rats ate less, drank more, and had more body fat resulting in increased weight gain. Our findings reveal an array of progressive non-cognitive deficits in this rat model that are likely to contribute to the compromised quality of life that characterizes RTT.
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Affiliation(s)
- Aritra Bhattacherjee
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- Kansas Intellectual and Developmental Disabilities Research Center, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Michelle K Winter
- Kansas Intellectual and Developmental Disabilities Research Center, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Linda S Eggimann
- Kansas Intellectual and Developmental Disabilities Research Center, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Ying Mu
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- Kansas Intellectual and Developmental Disabilities Research Center, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Sumedha Gunewardena
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- Kansas Intellectual and Developmental Disabilities Research Center, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Zhaohui Liao
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- Kansas Intellectual and Developmental Disabilities Research Center, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Julie A Christianson
- Kansas Intellectual and Developmental Disabilities Research Center, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Peter G Smith
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- Kansas Intellectual and Developmental Disabilities Research Center, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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49
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Chakrabarty A, Liao Z, Mu Y, Smith PG. Inflammatory Renin-Angiotensin System Disruption Attenuates Sensory Hyperinnervation and Mechanical Hypersensitivity in a Rat Model of Provoked Vestibulodynia. J Pain 2017; 19:264-277. [PMID: 29155208 DOI: 10.1016/j.jpain.2017.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 12/20/2022]
Abstract
Vestibulodynia is characterized by perivaginal mechanical hypersensitivity, hyperinnervation, and abundant inflammatory cells expressing renin-angiotensin system proteins. We developed a tractable rat model of vestibulodynia to further assess the contributions of the renin-angiotensin system. Complete Freund's adjuvant injected into the posterior vestibule induced marked vestibular hypersensitivity throughout a 7-day test period. Numbers of axons immunoreactive for PGP9.5, calcitonin gene-related peptide, and GFRα2 were increased. Numbers of macrophages and T cells were also increased whereas B cells were not. Renin-angiotensin-associated proteins were abundant, with T cells as well as macrophages contributing to increased renin and angiotensinogen. Media conditioned with inflamed vestibular tissue promoted neurite sprouting by rat dorsal root ganglion neurons in vitro, and this was blocked by the angiotensin II receptor type 2 receptor antagonist PD123319 or by an angiotensin II function blocking antibody. Sensory axon sprouting induced by inflamed tissue was dependent on activity of angiotensin-converting enzyme or chymase, but not cathepsin G. Thus, vestibular Complete Freund's adjuvant injection substantially recapitulates changes seen in patients with provoked vestibulodynia, and shows that manipulation of the local inflammatory renin-angiotensin system may be a useful therapeutic strategy. PERSPECTIVE This study provides evidence that inflammation of the rat vestibule induces a phenotype recapitulating behavioral and cytological features of human vestibulodynia. The model confirms a crucial role of the local inflammatory renin-angiotensin system in hypersensitivity and hyperinnervation. Targeting this system holds promise for developing new nonopioid analgesic treatment strategies.
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Affiliation(s)
- Anuradha Chakrabarty
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Zhaohui Liao
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Ying Mu
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Peter G Smith
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas.
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50
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Agrawal AA, Yu L, Smith PG, Buonamici S. Targeting splicing abnormalities in cancer. Curr Opin Genet Dev 2017; 48:67-74. [PMID: 29136527 DOI: 10.1016/j.gde.2017.10.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/19/2017] [Accepted: 10/13/2017] [Indexed: 01/11/2023]
Abstract
Recently splicing has been recognized as a key pathway in cancer. Although aberrant splicing has been shown to be a consequence of mutations or the abnormal expression of splicing factors (trans-effect changes) or mutations in the splicing sequences (cis-effect mutations), the connections between aberrant splicing and cancer initiation or progression are still not well understood. Here we review the mutational landscape of splicing factors in cancer and associated splicing consequences, along with the most important examples of the therapeutic approaches targeting the spliceosome currently being investigated in oncology.
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Affiliation(s)
| | - Lihua Yu
- H3 Biomedicine, Inc., Cambridge, MA, USA
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