Short-Term Therapies for Treatment of Acute and Advanced Heart Failure—Why so Few Drugs Available in Clinical Use, Why Even Fewer in the Pipeline?

Both acute and advanced heart failure are an increasing threat in term of survival, quality of life and socio-economical burdens. Paradoxically, the use of successful treatments for chronic heart failure can prolong life but—per definition—causes the rise in age of patients experiencing acute decompensations, since nothing at the moment helps avoiding an acute or final stage in the elderly population. To complicate the picture, acute heart failure syndromes are a collection of symptoms, signs and markers, with different aetiologies and different courses, also due to overlapping morbidities and to the plethora of chronic medications. The palette of cardio- and vasoactive drugs used in the hospitalization phase to stabilize the patient’s hemodynamic is scarce and even scarcer is the evidence for the agents commonly used in the practice (e.g., catecholamines). The pipeline in this field is poor and the clinical development chronically unsuccessful. Recent set backs in expected clinical trials for new agents in acute heart failure (AHF) (omecamtiv, serelaxine, ularitide) left a field desolately empty, where only few drugs have been approved for clinical use, for example, levosimendan and nesiritide. In this consensus opinion paper, experts from 26 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, The Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, Turkey, U.K. and Ukraine) analyse the situation in details also by help of artificial intelligence applied to bibliographic searches, try to distil some lesson-learned to avoid that future projects would make the same mistakes as in the past and recommend how to lead a successful development project in this field in dire need of new agents

Short-Term Therapies for Treatment of Acute and Advanced Heart Failure—Why so Few Drugs Available in Clinical Use, Why Even Fewer in the Pipeline?

Both acute and advanced heart failure are an increasing threat in term of survival, quality of life and socio-economical burdens. Paradoxically, the use of successful treatments for chronic heart failure can prolong life but—per definition—causes the rise in age of patients experiencing acute decompensations, since nothing at the moment helps avoiding an acute or final stage in the elderly population. To complicate the picture, acute heart failure syndromes are a collection of symptoms, signs and markers, with different aetiologies and different courses, also due to overlapping morbidities and to the plethora of chronic medications. The palette of cardio- and vasoactive drugs used in the hospitalization phase to stabilize the patient’s hemodynamic is scarce and even scarcer is the evidence for the agents commonly used in the practice (e.g., catecholamines). The pipeline in this field is poor and the clinical development chronically unsuccessful. Recent set backs in expected clinical trials for new agents in acute heart failure (AHF) (omecamtiv, serelaxine, ularitide) left a field desolately empty, where only few drugs have been approved for clinical use, for example, levosimendan and nesiritide. In this consensus opinion paper, experts from 26 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, The Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, Turkey, U.K. and Ukraine) analyse the situation in details also by help of artificial intelligence applied to bibliographic searches, try to distil some lesson-learned to avoid that future projects would make the same mistakes as in the past and recommend how to lead a successful development project in this field in dire need of new agents

Quantification of neonicotinoid pesticides in six cultivable fish species from the River Owena in Nigeria and a template for food safety assessment

The Owena River Basin in Nigeria is an area of agricultural importance for the production of cocoa. To optimise crop yield, the cocoa trees require spraying with neonicotinoid insecticides (Imidacloprid, Thiacloprid Acetamiprid and Thiamethoxam). It is proposed that rainwater runoff from the treated area may pollute the Owena River and that these pesticides may thereby enter the human food chain via six species of fish (Clarias gariepinus, Clarias anguillaris, Sarotherodon galilaeus, Parachanna obscura, Oreochromis niloticus and Gymnarchus niloticus) which are cultured in the river mostly for local consumption. This work aims to establish a working method to quantify the likely levels of the insecticides in the six species of fish, firstly by undertaking a laboratory-based study employing the QuEChERS method to extract the four neonicotinoids from fish purchased in marketplace in the UK, spiked with known quantities of the pesticide and using liquid chromatography coupled with tandem mass spectrometry (LC-MS-MS) as the detection method; secondly, by using these samples to optimise the detection method for very low levels of pesticides, then applying the optimised techniques to the analysis of three of each six species of fish taken from the Owena River. A significant benefit of this combined technique is that only small samples of fish are required. Success with this part of the study showed that very low concentrations of the insecticides could be detected in fish muscle. The third aim is to apply a simple quantitative risk assessment model using the data sets obtained, together with information about daily diet, human body weight and recommended safety limits of pesticides in food to illustrate how human health may be affected by the consumption of these fish. The multiple determinations of neonicotinoids in edible fishes in Nigeria are pioneer research and fill a gap in addressing the relationship between waterborne pesticides and food quality in the country. Fundamentally, this work is an exercise to demonstrate the applicability of the aforementioned instrumental method of analysis to fish muscle, which requires only a small sample size of fish; a large number of fish is not required for a proof of concept, in this case. Although not a monitoring programme for the whole Owena River Basin ecosystem per se, this work successfully demonstrates the technical feasibility of a system of chemical analysis and establishes the foundation for ecological surveys in the immediate future. Parameters involving exposures to xenobiotics in ecotoxicological modelling can now be expressed in terms of both mass and molar concentrations of a chemical in animal tissues if so desired

Exploitation and destabilization of a warm, freshwater ecosystem through engineered hydrological change

Exploitation of freshwater resources is having catastrophic effects on the ecological dynamics, stability, and quality of those water resources on a global scale, especially in arid and semiarid regions. Lake Kinneret, Israel (the Biblical Sea of Galilee), the only major natural freshwater lake in the Middle East, has been transformed functionally into a reservoir over the course of ∼70 years of hydrological alterations aimed mostly at producing electrical power and increasing domestic and agricultural water supply. Historical changes in lake chemistry and biology were reconstructed using analysis of sedimentary nutrient content, stable and radioisotope composition, biochemical and morphological fossils from algae, remains of aquatic invertebrates, and chemical indices of past light regimes. Together, these paleolimnological analyses of the lake's bottom sediments revealed that this transformation has been accompanied by acceleration in the rate of eutrophication, as indicated by increased accumulation rates of phosphorus, nitrogen, organic matter, phytoplankton and bacterial pigments, and remains of phytoplankton and zooplankton. Substantial increases in these indices of eutrophication coincide with periods of increased water‐level fluctuations and drainage of a major upstream wetland in the early to middle 20th century and suggest that management of the lake for increased water supply has degraded water quality to the point that ecosystem stability and sustainability are threatened. Such destabilization may be a model for eutrophication of freshwater lakes in other arid regions of the world in which management emphasizes water quantity over quality.Peer reviewedZoolog