7 research outputs found
Plasma Soluble Urokinase Plasminogen Activator Receptor in Children with Urinary Tract Infection
Objective In this prospective study we investigated the role of plasma levels of soluble urokinase plasminogen activator receptor (suPAR) in children with urinary tract infection. Material and Methods We measured the levels of plasma suPAR during admission in 42 children with suspected acute pyelonephritis and compared the results to acute DMSA scintigraphy. Results The mean level of plasma suPAR at admission was significantly elevated in children with renal involvement (7.3 ng/ml) assessed by the DMSA scintigraphy compared to children without renal involvement (4.4 ng/ml, P = 0.010). The positive predictive value of suPAR seems high, since all patients without renal involvement had low suPAR values. During treatment the mean level of plasma suPAR decreased. Conclusion We conclude that plasma suPAR could be of clinical use for the diagnosis of acute pyelonephritis and that high levels of plasma suPAR might reflect the level of renal involvement and could therefore be a new indicator for renal scarring
Formulation, stabilisation and encapsulation of bacteriophage for phage therapy
Against a backdrop of global antibiotic resistance and increasing awareness of the importance of the
human microbiota, there has been resurgent interest in the potential use of bacteriophages for
therapeutic purposes, known as phage therapy. A number of phage therapy phase I and II clinical
trials have concluded, and shown phages don’t present significant adverse safety concerns. These
clinical trials used simple phage suspensions without any formulation and phage stability was of
secondary concern. Phages have a limited stability in solution, and undergo a significant drop in
phage titre during processing and storage which is unacceptable if phages are to become regulated
pharmaceuticals, where stable dosage and well defined pharmacokinetics and pharmacodynamics
are de rigueur. Animal studies have shown that the efficacy of phage therapy outcomes depend on
the phage concentration (i.e. the dose) delivered at the site of infection, and their ability to target and
kill bacteria, arresting bacterial growth and clearing the infection. In addition, in vitro and animal
studies have shown the importance of using phage cocktails rather than single phage preparations to
achieve better therapy outcomes. The in vivo reduction of phage concentration due to interactions
with host antibodies or other clearance mechanisms may necessitate repeated dosing of phages, or
sustained release approaches. Modelling of phage-bacterium population dynamics reinforces these
points. Surprisingly little attention has been devoted to the effect of formulation on phage therapy
outcomes, given the need for phage cocktails, where each phage within a cocktail may require
significantly different formulation to retain a high enough infective dose.
This review firstly looks at the clinical needs and challenges (informed through a review of key animal
studies evaluating phage therapy) associated with treatment of acute and chronic infections and the
drivers for phage encapsulation. An important driver for formulation and encapsulation is shelf life and
storage of phage to ensure reproducible dosages. Other drivers include formulation of phage for
encapsulation in micro- and nanoparticles for effective delivery, encapsulation in stimuli responsive
systems for triggered controlled or sustained release at the targeted site of infection. Encapsulation of
phage (e.g. in liposomes) may also be used to increase the circulation time of phage for treating
systemic infections, for prophylactic treatment or to treat intracellular infections. We then proceed to
document approaches used in the published literature on the formulation and stabilisation of phage for
storage and encapsulation of bacteriophage in micro- and nanostructured materials using freeze
drying (lyophilization), spray drying, in emulsions e.g. ointments, polymeric microparticles,
nanoparticles and liposomes. As phage therapy moves forward towards Phase III clinical trials, the
review concludes by looking at promising new approaches for micro- and nanoencapsulation of
phages and how these may address gaps in the field
Drug survival of biologics and novel immunomodulators for rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, and psoriasis - A nationwide cohort study from the DANBIO and DERMBIO registries
Additional file 1 of Understanding what matters most to patients in acute care in seven countries, using the flash mob study design
Additional file 1: Figure S1. Developmental process of framework. Table S1. Framework for coding. Table S2. Top ten answers to the question ‘what matters most’. Table S3. Top ten answers to the question ‘why is this important’. Table S4. Differences in what matters and why between sex, age groups, length of stay and if patients feel the doctor knows what matters or not. Table S5. Differences in what matters and why to patients between countries. List of local collaborators