Natalizumab Treatment Continuum in RRMS: A Systematic Review and Meta-Analysis of Cessation Risks and Dosing Strategies

- Posted by system in English

Significance of the Topic:

The topic of Natalizumab therapy in Relapsing-Remitting Multiple Sclerosis (RRMS) is crucial for patients and clinicians alike. Natalizumab is a high-efficacy therapy for RRMS, but its discontinuation poses significant risks. Understanding the post-cessation outcomes and the risks associated with relapse and disability progression is vital for making informed treatment decisions.

Importance:

The importance of this topic lies in its potential to impact the lives of thousands of patients with RRMS. By highlighting the risks associated with Natalizumab discontinuation, clinicians can better counsel patients and make informed decisions about treatment continuation or transition. This is especially critical for patients who have been on Natalizumab for extended periods.

Timeliness:

The text is relevant and timely as RRMS patients are constantly seeking effective treatment options. With the rising popularity of Natalizumab and other disease-modifying therapies, clinicians must be aware of the potential risks and benefits associated with these treatments, particularly in the context of discontinuation.

Relevance:

This study is relevant to clinicians, researchers, and patients, providing valuable insights into the efficacy and safety of Natalizumab in RRMS. The findings highlight the need for prompt therapy transition and patient counseling, underlining the importance of a comprehensive treatment approach that encompasses the entire continuum from initiation to discontinuation.

Examination of Text Items:

  • Background: The introduction sets the context for the study, emphasizing the importance of understanding post-cessation outcomes in RRMS patients.
  • Objectives: The study objectives are clearly outlined, focusing on comparing the efficacy and safety of Natalizumab administered via Single-Infusion Dosing (SID) versus Extended-Interval Dosing (EID), as well as quantifying relapse and disability risk after cessation.
  • Methods: The study design, data sources, and statistical analysis are thoroughly explained, ensuring transparency and reproducibility.
  • Results: The key findings are presented, including the substantial relapse risk within 12 months of Natalizumab cessation and the lack of significant difference between SID and EID in terms of ARR and PML risk.
  • Conclusion: The conclusion highlights the clinical implications of the study, emphasizing the need for prompt therapy transition and patient counseling.

Usefulness for Disease Management or Drug Discovery:

This study provides valuable insights into the management of RRMS patients on Natalizumab therapy. By quantifying the relapse risk after cessation, clinicians can better counsel patients and make informed decisions about treatment continuation or transition. The study also highlights the importance of a comprehensive treatment approach that encompasses the entire continuum from initiation to discontinuation. From a drug discovery perspective, this study underscores the need for further research into the mechanisms of Natalizumab discontinuation and the development of alternative treatments that can mitigate the risks associated with relapse and disability progression.

Original Information Beyond the Obvious:

While the study's findings are not entirely novel, the comprehensive meta-analysis and narrative synthesis provide a unique perspective on the topic. The study's key finding of a substantial relapse risk within 12 months of Natalizumab cessation is a critical contribution to the field, emphasizing the need for prompt therapy transition and patient counseling.

Comparison with State-of-the-Art:

This study aligns with the current state of knowledge in the field, building upon previous research that has highlighted the risks associated with Natalizumab discontinuation. The study's findings are consistent with existing evidence, reinforcing the importance of a comprehensive treatment approach that encompasses the entire continuum from initiation to discontinuation.

In conclusion, this study provides valuable insights into the management of RRMS patients on Natalizumab therapy, underscoring the need for prompt therapy transition and patient counseling. The findings highlight the importance of a comprehensive treatment approach that encompasses the entire continuum from initiation to discontinuation, emphasizing the need for continued research into the mechanisms of Natalizumab discontinuation and the development of alternative treatments.

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TAS2R38-Linked MGAM Expression in Alzheimer's Disease: A Novel Target for Precision Drug Repurposing

- Posted by system in English

Significance, Importance, Timeliness, and Relevance:

The topic of this text revolves around the genetic connection between TAS2R38, a taste receptor implicated in innate immunity, and Alzheimer's disease (AD). The significance of this research lies in its potential to aid in the development of new treatments or repurpose existing ones for AD management. This is crucial as AD remains a leading cause of dementia worldwide, with limited treatment options available.

The importance of this study is twofold: it explores a novel relationship between a taste receptor and AD risk, which could lead to new therapeutic targets. The timeliness of this research is also evident, given the growing understanding of the role of genetics in disease susceptibility and the increasing emphasis on precision medicine.

In terms of relevance, the study leverages existing databases (ADNI and ROSMAP) and utilizes established methodologies (linear mixed-effects models and RNA-seq analysis), making it a valuable contribution to the field of AD research.

Relationship between items in the text:

  • The genetic connection between TAS2R38 and AD biomarkers was identified using linear mixed-effects models, utilizing data from the ADNI study (n = 2,342).
  • The molecular mechanisms underlying this association were explored using eQTL analysis, which connected the nontaster allele to increased expression of the gene MGAM in AD-affected brain regions.
  • The expression of MGAM was also associated with more severe Tau burdens, suggesting a link between MGAM expression and AD pathology.
  • A cohort study using the NACC dataset found that individuals taking MGAM-inhibiting diabetes drugs (Acarbose and Miglitol) had slower CDR progression compared to non-takers.

Usefulness for disease management or drug discovery:

This study suggests that TAS2R38 haplotypes could guide precision drug repurposing strategies for AD. Specifically, the identification of MGAM as a novel drug target with existing FDA-approved inhibitors (Acarbose and Miglitol) provides a valuable lead for future research.

Originality:

While the study builds upon existing knowledge in the field, it presents novel connections between TAS2R38, MGAM, and AD pathology. The identification of MGAM as a potential therapeutic target is a notable finding, as it suggests a new avenue for AD treatment.

Comparison to the state of the art:

This study contributes to our understanding of the genetic and molecular mechanisms underlying AD susceptibility. However, it should be noted that the sample sizes used in this study are relatively small compared to other AD research studies.

In conclusion, this study provides a valuable addition to the growing body of evidence on the genetic and molecular mechanisms of AD. The identification of MGAM as a potential therapeutic target with existing FDA-approved inhibitors holds promise for future research and potential clinical applications.

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Feasibility of Bilateral Auricular Vagus Nerve Stimulation Combined with Exercise for Improving Cardiovascular and Motor Outcomes in Parkinsons Disease

- Posted by system in English

Background and PurposeNeuromodulation and physical therapy (PT) can both mitigate motor and non-motor symptoms of Parkinsons Disease (PD). There are a lack of studies examining the integration of transcutaneous auricular vagus nerve stimulation (taVNS) with PT or exercise for improving Parkinsonian symptoms. The study was designed to investigate the safety, tolerability, and feasibility of combining bilateral taVNS with PT to enhance the therapeutic benefits of exercise as medicine in a clinical setting.

MethodsThis pilot study was a randomized, sham-controlled clinical trial. Participants were randomly assigned to receive active or sham bilateral taVNS in combination with physical therapy for 12 visits over 6 weeks. We quantified safety, tolerability, and feasibility outcomes, and explored changes in cardiovascular and motor function over time.

ResultsWe observed taVNS was well tolerated without reported adverse events. We observed taVNS administered prior to physical therapy significantly decreased heart rate and blood pressure at rest. We observed the active taVNS treatment group exhibited more sustained improvements in motor function and balance compared to baseline. Due to the small size of the feasibility study, we did not detect between-group differences.

Discussion and ConclusionsCombining taVNS with physical therapy was safe, feasible, and well-tolerated. Preliminary results suggest taVNS has the potential to enhance rehabilitation outcomes by modulating cardiovascular function prior to and during PT and exercise. These findings support the need for larger clinical trials and real-world studies investigating the integration of taVNS into PT and exercise methods for improving PD symptomology.

Trial RegistrationClinicalTrials.gov NCT05871151

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Biomarkers of LRRK2 and lysosomal dysfunction in Progressive Supranuclear Palsy

- Posted by system in English

Significance, Importance, Timeliness, and Relevance:

The topic of the text revolves around the discovery of biochemical and genetic markers of Parkinson's disease (PD) and progressive supranuclear palsy (PSP), two neurodegenerative disorders. The study sheds light on the potential role of LRRK2, a gene linked to both sporadic and familial PD, in PSP. This research has significant implications for disease management and drug discovery.

The importance of this study lies in its ability to identify biomarkers for PSP, which is a rare and incurable disorder. The findings provide a potential avenue for targeted therapies, particularly those targeting LRRK2, which could lead to improved treatment options for PSP patients.

The study is timely as the field of neurodegenerative disease research is rapidly evolving, and the need for effective biomarkers and therapeutic targets is growing. The relevance of the study is evident in its potential to contribute to the development of novel treatments for PSP and PD, two disorders with a significant impact on public health.

Items of the Text and Their Relationship:

  1. Genetic Variants and PSP Survival: The study investigated the association between genetic variants in the LRRK2 gene and PSP survival. The findings suggest that carriers of the alternate allele at the LRRK2 PD risk variant, rs76904798, had higher levels of CSF total LRRK2, which is a potential biomarker for PSP.

  2. Lysosomal Dysfunction and PSP: The study measured lysosomal dysfunction markers in PSP patients using immunoblotting and multiplexed assays. The results showed that total urine 22:6-BMP levels were higher in PSP vs. control samples, indicating lysosomal dysfunction.

  3. LRRK2 and Rab10 Phosphorylation: The study examined LRRK2-dependent Rab10 phosphorylation at Threonine73 (pRab10Thr73) in neutrophil and monocyte samples from PSP and control participants. The findings suggest that LRRK2-dependent phosphorylation is a potential biomarker for PSP.

  4. Biomarkers and Treatment Stratification: The study's conclusions highlight the potential for biochemical and genetic stratification to identify PSP patients that would benefit from LRRK2-targeting therapies.

Usefulness for Disease Management and Drug Discovery:

The study provides valuable insights into the biochemical and genetic mechanisms underlying PSP, which could lead to the development of novel treatments for the disorder. The identification of biomarkers, such as total LRRK2 and pRab10Thr73 levels, could facilitate the stratification of PSP patients for targeted therapies. This could ultimately lead to improved treatment outcomes for PSP patients.

Original Information and Comparison with State of Art:

The study contributes to our understanding of the role of LRRK2 in PSP, which is a relatively understudied area. The findings suggest that LRRK2-targeting therapies may be beneficial for PSP patients, which is a novel and promising area of research. While the study does not present breakthrough findings, it provides valuable insights into the biochemical and genetic mechanisms underlying PSP, which could lead to the development of novel treatments.

In comparison with the state of art, this study builds upon previous research that has investigated the role of LRRK2 in neurodegenerative disorders. The study's findings provide a more comprehensive understanding of the relationship between LRRK2 and PSP, which could lead to the development of novel treatments for the disorder.

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IsomiR Utility in ALS Prognostication

- Posted by system in English

Significance of the Topic:

Amyotrophic Lateral Sclerosis (ALS) is a devastating neurodegenerative disease with limited treatment options. Early diagnosis and prognostication are critical in managing ALS, as they can significantly impact the quality of life for patients and their caregivers. The discovery of reliable biomarkers for ALS can provide valuable insights into disease progression and enable clinicians to develop more effective treatment strategies.

Importance:

The identification of plasma isomiRs as potential biomarkers for ALS is significant because it opens up new avenues for non-invasive monitoring of disease progression and response to treatment. IsomiRs are microRNA isoforms that are distinct from their parent microRNAs, and their presence in the plasma can be indicative of cellular stress or damage. The potential utility of isomiRs as biomarkers for neurodegenerative diseases is an area of active research, and this study contributes to our understanding of their role in ALS.

Timeliness:

The study's focus on plasma isomiRs as biomarkers for ALS is timely, given the growing interest in using liquid biopsies for disease diagnosis and monitoring. Liquid biopsies offer a non-invasive and cost-effective way to monitor disease progression and response to treatment, making them an attractive option for clinicians and researchers.

Relevance:

The study's findings are relevant to ALS research and clinical practice because they provide evidence that plasma isomiRs can be used to predict survival in ALS patients. The identified isomiR, let-7g-5p.t, has prognostic utility comparable to that of established biomarkers, such as neurofilament light chain (NfL) and miR-181. This suggests that plasma isomiRs could be used as a novel class of biomarkers for ALS, potentially refining prognostication in clinical trials and improving patient outcomes.

Items of the text and their relationships:

  1. Background: The text provides context on ALS and isomiRs, explaining that while isomiRs have distinct biological and clinical relevance, their potential as cell-free biomarkers in neurodegeneration remains largely unexplored.
  2. Method: The researchers used next-generation sequencing and two orthogonal statistical approaches to investigate the prognostic utility of plasma isomiRs in ALS.
  3. Findings: The study identified higher levels of let-7g-5p.t in ALS patients, which was associated with longer survival and independently validated in an international ALS cohort.
  4. Conclusion: The results establish isomiRs as a novel class of blood-based biomarkers in ALS, with potential to refine prognostication in clinical trials for neurodegenerative diseases.

Usefulness for disease management or drug discovery:

The study's findings are useful for disease management and drug discovery because they:

  1. Provide new biomarkers: The identified isomiR, let-7g-5p.t, can be used as a biomarker for ALS, potentially improving prognostication and patient outcomes.
  2. Inform treatment strategies: The study's findings can inform the development of new treatment strategies for ALS, such as targeted therapies that modulate the expression of isomiRs.

Originality:

The study provides original information beyond the obvious because it:

  1. Investigates a novel biomarker: The study investigates the use of plasma isomiRs as biomarkers for ALS, which is a new area of research.
  2. Provides evidence: The study provides evidence that plasma isomiRs can be used to predict survival in ALS patients, which is a significant finding in the field of neurodegenerative diseases.

Comparison with the state of art:

The study's findings are comparable to existing biomarkers for ALS, such as neurofilament light chain (NfL) and miR-181. However, the study's focus on plasma isomiRs as biomarkers for ALS is a new area of research that contributes to our understanding of the potential utility of isomiRs in neurodegenerative diseases.

Read the original article on medRxiv


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