Vaccination in liver diseases and liver Transplantation: Recommendations, implications and opportunities in the post-covid era

The interest in vaccination efficacy and toxicity has surged following the Covid-19 pandemic. Immune responses to several vaccines have been shown to be suboptimal in patients with chronic liver disease (CLD) or post-liver transplant (LT), as a consequence of cirrhosis-associated immune dysfunction (CAID) or post-LT immunosuppression respectively. Accordingly, vaccine-preventable infections may be more common or severe than in the general population. The Covid-19 pandemic has greatly accelerated research and development into vaccination technology and platforms, which will have spillover benefits for liver patients. The aims of this review are: (i) to discuss the impact of vaccine-preventable infections on CLD and post-LT patients, (ii) to appraise current evidence supporting vaccination strategies, and (iii) to provide some insight into recent developments relevant for liver patients

Extracorporeal liver support and liver transplantation for acute-on-chronic liver failure

Acute-on-chronic liver failure (ACLF) is defined by acute decompensation, organ failure and a high risk of short-term mortality. This condition is characterized by an overwhelming systemic inflammatory response. Despite treating the precipitating event, intensive monitoring and organ support, clinical deterioration can occur with very poor outcomes. During the last decades, several extracorporeal liver support systems have been developed to try to reduce ongoing liver injury and provide an improved environment for the liver to regenerate or as a bridging therapy until liver transplantation. Several clinical trials have been performed to evaluate the clinical efficacy of extracorporeal liver support systems, but no clear impact on survival has been proven. DIALIVE is a novel extracorporeal liver support device that has been built to specifically address the pathophysiological derangements responsible for the development of ACLF by replacing dysfunctional albumin and removing pathogen and damage-associated molecular patterns (PAMPs and DAMPs). In phase II clinical trial, DIALIVE appears to be safe, and it seems to be associated with a faster time to the resolution of ACLF compared with standard medical treatment. Even in patients with severe ACLF, liver transplantation saves lives and there is clear evidence of transplant benefit. Careful selection of patients is required to attain good results from liver transplantation, but many questions remain unanswered. In this review, we describe the current perspectives on the use of extracorporeal liver support and liver transplantation for ACLF patients

SARS-CoV-2 infection and liver involvement

The COVID-19 pandemic is the largest public health challenge in living memory. Patients with underlying liver disease have been disproportionately affected, experiencing high morbidity and mortality. In addition, elevated liver enzymes appear to be a risk factor for disease progression, even in the absence of underlying liver disease. Nevertheless, the mechanism of liver injury in SARS-CoV-2 infection remains largely unknown. This review aims to provide an overview of the mechanisms by which SARS-CoV-2 induces liver injury, and the impact of COVID-19 on cirrhosis, alcohol-related liver disease, autoimmune liver disease, non-alcoholic fatty liver disease, hepatitis B and C virus infection, liver-transplant recipients and patients with hepatocellular carcinoma. Finally, emerging data on vaccination in liver diseases is discussed, to help inform public health policy

Rare diseases from the community pharmacy

Introduction: the visibility of Rare Diseases at a multidisciplinary level and their humanization are one of the challenges set out in the 2030 Agenda of the United Nations. Community pharmacists need to renew themselves and promote skills, such as individualized pharmaceutical care techniques, which are essential for the support of these patients. The aim of this research is to identify the socio-health needs of families belonging to rare disease associations who go to the community pharmacy in Spain. Method: Observational and transversal study by a digital questionnaire to users of the Association of Rare Diseases D'genes, through the Association and the Official Associations of Pharmacists, n=253. Results: Rare diseases are distributed throughout the territory with a high dispersion. Most patients or relatives usually visit the community pharmacy more than twice a month. These families usually trust their pharmacy for more than three years and do not encounter difficulties in obtaining their treatment. The profile of the patients who visit the pharmacy is very heterogeneous, but the majority of family members claim to know and focus only on their social and health needs. In relation to their levels of satisfaction, the reception, discretion in treatment, time of attention and farewell are the best valued factors. Conclusions: The professional pharmacist must possess, scientific and technical skills, needs to promote values such as empathy, social skills or listening skills, to be able to provide personalized pharmaceutical care to families with rare diseases and manage to humanize the community pharmacy of the 21st century.Introducción: la visibilidad de las Enfermedades Raras a nivel multidisciplinar y su humanización, son uno de los retos planteados en la Agenda 2030 de Naciones Unidas. El farmacéutico comunitario necesita renovarse y promover habilidades, como técnicas de atención farmacéutica individualizada, imprescindibles para el apoyo de estos pacientes. El objetivo de esta investigación es identificar las necesidades socio-sanitarias de las familias pertenecientes a asociaciones de enfermedades raras que acude a la farmacia comunitaria en España. Método: Estudio observacional y transversal mediante cuestionario digital enviado a usuarios de la Asociación de Enfermedades Raras D´genes, a través de la Asociación y de los Colegios Oficiales de Farmacéuticos, n=253. Resultados: las enfermedades raras se distribuyen por todo el territorio con una alta dispersión. La mayoría de pacientes o familiares suelen visitar la farmacia comunitaria más de dos veces al mes. Estas familias suelen confiar en su farmacia desde hace más de tres años y no encuentran dificultades para obtener su tratamiento. El perfil de los pacientes que acuden a la farmacia es muy heterogéneo, pero la mayoría de familiares afirman conocer y centrarse únicamente en sus necesidades sociosanitarias. En relación a sus niveles de satisfacción, el recibimiento, la discreción en el trato, el tiempo de atención y la despedida son los factores mejor valorados. Conclusiones: El profesional farmacéutico debe poseer, habilidades científicas y técnicas, necesita promover valores como empatía, habilidades sociales o capacidad de escucha, para poder prestar una atención farmacéutica personalizada a familias con enfermedades raras y conseguir humanizar la farmacia comunitaria del siglo XXI

Enfermedades raras desde la farmacia comunitaria

Introducción: la visibilidad de las Enfermedades Raras a nivel multidisciplinar y su humanización, son uno de los retos planteados en la Agenda 2030 de Naciones Unidas. El farmacéutico comunitario necesita renovarse y promover habilidades, como técnicas de atención farmacéutica individualizada, imprescindibles para el apoyo de estos pacientes. El objetivo de esta investigación es identificar las necesidades socio-sanitarias de las familias pertenecientes a asociaciones de enfermedades raras que acude a la farmacia comunitaria en España. Método: Estudio observacional y transversal mediante cuestionario digital enviado a usuarios de la Asociación de Enfermedades Raras D´genes, a través de la Asociación y de los Colegios Oficiales de Farmacéuticos, n=253. Resultados: las enfermedades raras se distribuyen por todo el territorio con una alta dispersión. La mayoría de pacientes o familiares suelen visitar la farmacia comunitaria más de dos veces al mes. Estas familias suelen confiar en su farmacia desde hace más de tres años y no encuentran dificultades para obtener su tratamiento. El perfil de los pacientes que acuden a la farmacia es muy heterogéneo, pero la mayoría de familiares afirman conocer y centrarse únicamente en sus necesidades sociosanitarias. En relación a sus niveles de satisfacción, el recibimiento, la discreción en el trato, el tiempo de atención y la despedida son los factores mejor valorados. Conclusiones: El profesional farmacéutico debe poseer, habilidades científicas y técnicas, necesita promover valores como empatía, habilidades sociales o capacidad de escucha, para poder prestar una atención farmacéutica personalizada a familias con enfermedades raras y conseguir humanizar la farmacia comunitaria del siglo XXI.

Enfermedades raras desde la farmacia comunitaria

Introducción: la visibilidad de las Enfermedades Raras a nivel multidisciplinar y su humanización, son uno de los retos planteados en la Agenda 2030 de Naciones Unidas. El farmacéutico comunitario necesita renovarse y promover habilidades, como técnicas de atención farmacéutica individualizada, imprescindibles para el apoyo de estos pacientes. El objetivo de esta investigación es identificar las necesidades socio-sanitarias de las familias pertenecientes a asociaciones de enfermedades raras que acude a la farmacia comunitaria en España. Método: Estudio observacional y transversal mediante cuestionario digital enviado a usuarios de la Asociación de Enfermedades Raras D´genes, a través de la Asociación y de los Colegios Oficiales de Farmacéuticos, n=253. Resultados: las enfermedades raras se distribuyen por todo el territorio con una alta dispersión. La mayoría de pacientes o familiares suelen visitar la farmacia comunitaria más de dos veces al mes. Estas familias suelen confiar en su farmacia desde hace más de tres años y no encuentran dificultades para obtener su tratamiento. El perfil de los pacientes que acuden a la farmacia es muy heterogéneo, pero la mayoría de familiares afirman conocer y centrarse únicamente en sus necesidades sociosanitarias. En relación a sus niveles de satisfacción, el recibimiento, la discreción en el trato, el tiempo de atención y la despedida son los factores mejor valorados. Conclusiones: El profesional farmacéutico debe poseer, habilidades científicas y técnicas, necesita promover valores como empatía, habilidades sociales o capacidad de escucha, para poder prestar una atención farmacéutica personalizada a familias con enfermedades raras y conseguir humanizar la farmacia comunitaria del siglo XXI.

The CSN3 subunit of the COP9 signalosome interacts with the HD region of Sos1 regulating stability of this GEF protein

Sos1 is an universal, widely expressed Ras guanine nucleotide-exchange factor (RasGEF) in eukaryotic cells. Its N-terminal HD motif is known to be involved in allosteric regulation of Sos1 GEF activity through intramolecular interaction with the neighboring PH domain. Here, we searched for other cellular proteins also able to interact productively with the Sos1 HD domain. Using a yeast two-hybrid system, we identified the interaction between the Sos1 HD region and CSN3, the third component of the COP9 signalosome, a conserved, multi-subunit protein complex that functions in the ubiquitin-proteasome pathway to control degradation of many cellular proteins. The interaction of CSN3 with the HD of Sos1 was confirmed in vitro by GST pull-down assays using truncated mutants and reproduced in vivo by co-immunoprecipitation with the endogenous, full-length cellular Sos1 protein. In vitro kinase assays showed that PKD, a COP9 signalosome-associated-kinase, is able to phosphorylate Sos1. The intracellular levels of Sos1 protein were clearly diminished following CSN3 or PKD knockdown. A sizable fraction of the endogenous Sos1 protein was found ubiquitinated in different mammalian cell types. A significant reduction of RasGTP formation upon growth factor stimulation was also observed in CSN3-silenced as compared with control cells. Our data suggest that the interaction of Sos1 with the COP9 signalosome and PKD plays a significant role in maintenance of cellular Sos1 protein stability and homeostasis under physiological conditions and raises the possibility of considering the CSN/PKD complex as a potential target for design of novel therapeutic drugs.We thank R Brent for the pJG45-HeLa library and R. Jorge for help with yeast two-hybrid screening. J.M.R. received grant support from MINECO-FEDER (SAF2016-78852-R), ISCIII-MINECO (FIS-Intrasalud PI13/00703) and Spanish Association against Cancer (AECC). E.S. and A.F.M. were supported by grants from ISCIII-MINECO (FIS PI16/02137), JCyL (SA043U16-UIC 076) and Solorzano Foundation. E.S. and J.M.R. were also supported by ISCIII-RETIC (groups RTICC-RD12/0036/0001 and RTICC-RD12/0036/0021, respectively) and by CIBERONC (groups CB16/12/00352 and CB16/12/00273, respectively). Research co-financed by FEDER funds.S

Medical deserts in Spain—Insights from an international project

Introduction Medical deserts are a growing phenomenon across many European countries. They are usually defined as (i) rural areas, (ii) underserved areas or (iii) by applying a measure of distance/time to a facility or a combination of the three characteristics. The objective was to define medical deserts in Spain as well as map their driving factors and approaches to mitigate them. Methods A mixed methods approach was applied following the project “A Roadmap out of medical deserts into supportive health workforce initiatives and policies” work plan. It included the following elements: (i) a scoping literature review; (ii) a questionnaire survey; (iii) national stakeholders' workshop; (iv) a descriptive case study on medical deserts in Spain. Results Medical deserts in Spain exist in the form of mostly rural areas with limited access to health care. The main challenge in their identification and monitoring is local data availability. Diversity of both factors contributing to medical deserts and solutions applied to eliminate or mitigate them can be identified in Spain. They can be related to demand for or supply of health care services. More national data, analyses and/or initiatives seem to be focused on the health care supply dimension. Conclusions Addressing medical deserts in Spain requires a comprehensive and multidimensional approach. Effective policies are needed to address both the medical staff education and planning system, working conditions, as well as more intersectoral approach to the population health management.© 2024 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.fi=vertaisarvioitu|en=peerReviewed

Measuring intellectual ability in cerebral palsy: The comparison of three tests and their neuroimaging correlates

Standard intelligence scales require both verbal and manipulative responses, making it difficult to use in cerebral palsy and leading to underestimate their actual performance. This study aims to compare three intelligence tests suitable for the heterogeneity of cerebral palsy in order to identify which one(s) could be more appropriate to use. Forty-four subjects with bilateral dyskinetic cerebral palsy (26 male, mean age 23 years) conducted the Raven's Coloured Progressive Matrices (RCPM), the Peabody Picture Vocabulary Test -3rd (PPVT-III) and the Wechsler Nonverbal Scale of Ability (WNV). Furthermore, a comprehensive neuropsychological battery and magnetic resonance imaging were assessed. The results show that PPVT-III gives limited information on cognitive performance and brain correlates, getting lower intelligence quotient scores. The WNV provides similar outcomes as RCPM, but cases with severe motor impairment were unable to perform it. Finally, the RCPM gives more comprehensive information on cognitive performance, comprising not only visual but also verbal functions. It is also sensitive to the structural state of the brain, being related to basal ganglia, thalamus and white matter areas such as superior longitudinal fasciculus. So, the RCPM may be considered a standardized easy-to-administer tool with great potential in both clinical and research fields of bilateral cerebral palsy

PKD phosphorylation and COP9/Signalosome modulate intracellular Spry2 protein stability

Spry2 is a molecular modulator of tyrosine kinase receptor signaling pathways that has cancer-type-specific effects. Mammalian Spry2 protein undergoes tyrosine and serine phosphorylation in response to growth factor stimulation. Spry2 expression is distinctly altered in various cancer types. Inhibition of the proteasome functionality results in reduced intracellular Spry2 degradation. Using in vitro and in vivo assays, we show that protein kinase D (PKD) phosphorylates Spry2 at serine 112 and interacts in vivo with the C-terminal half of this protein. Importantly, missense mutation of Ser112 decreases the rate of Spry2 intracellular protein degradation. Either knocking down the expression of all three mammalian PKD isoforms or blocking their kinase activity with a specific inhibitor contributes to the stabilization of Spry2 wild-type protein. Downregulation of CSN3, a component of the COP9/Signalosome that binds PKD, significantly increases the half-life of Spry2 wild-type protein but does not affect the stability of a Spry2 after mutating Ser112 to the non-phosphorylatable residue alanine. Our data demonstrate that both PKD and the COP9/Signalosome play a significant role in control of Spry2 intracellular stability and support the consideration of the PKD/COP9 complex as a potential therapeutic target in tumors where Spry2 expression is reduced.JMR-C received grant support from MINECO-FEDER (SAF2016-78852-R), AESI-ISCIII (PI20CIII/00029) and Spanish Association against Cancer (AECC, CGB14143035THOM). ES group was supported by grants from ISCIII-MCUI (FIS PI19/00934), JCyL (SA264P18-UIC-076), Areces Foundation (CIVP19A5942), Solorzano-Barruso Foundation (FS/32–2020) and by ISCIII-CIBERONC (group CB16/12/00352). Funding to AM group was provided by the Agencia Estatal de Investigación (PID2019-104867RB-I00/AEI/10.13039/501100011033) and by ISCIII-CIBERONC (group CB16/12/00273). TI was supported by grant PID2020-115218RB-I00 funded by MCIN/AEI/ 10.13039/501100011033 and by “ERDF A way of making Europe” and by ISCIII-CIBERNED. RB received grant support from AESI-ISCIII (PI20CIII/00019). Finally, DP-J and MY groups were supported by grants 1.012.022 (to DP-J), 1.010.929 and 1.400.002 (both to MY) from Fundación Universidad Alfonso X el Sabio (FUAX). All research co-financed by FEDER funds.S