Clinical development innovation in rare diseases: lessons learned and best practices from the DevelopAKUre consortium

New opportunities have arisen for development of therapies for rare diseases with the increased focus and progress in the field. However, standardised framework integrating individual initiatives has not been formed. We present lessons learned and best practice from a collaborative success case in developing a treatment for a rare genetic disease. Our unique consortium model incorporated several of the identified developments under one project, DevelopAKUre, truly bringing together academia, industry and patient organisations in clinical drug development. We found that the equal partnership between all parties in our consortium was a key success factor creating a momentum based on a strong organisational culture where all partners had high engagement and taking ownership of the entire programme. With an agreed mutual objective, this provided synergies through connecting the strengths of the individual parties. Another key success factor was the central role of the patient organisation within the management team, and their unique study participants’ advocacy role securing the understanding and meeting the needs of the clinical study participants in real-time. This resulted in an accelerated enrolment into the clinical studies with a high retention rate allowing for delivery of the programme with significantly improved timelines. Our project was partly funded through an external EU research grant, enabling our model with equal partnership. Further attention within the community should be given to establishing a functional framework where sustainable funding and risk sharing between private and public organisations allow for our model to be replicated

Suitability Of Nitisinone In Alkaptonuria 1 (SONIA 1): an international, multicentre, randomised, open-label, no-treatment controlled, parallel-group, dose-response study to investigate the effect of once daily nitisinone on 24-h urinary homogentisic acid excretion in patients with alkaptonuria after 4 weeks of treatment.

BACKGROUND: Alkaptonuria (AKU) is a serious genetic disease characterised by premature spondyloarthropathy. Homogentisate-lowering therapy is being investigated for AKU. Nitisinone decreases homogentisic acid (HGA) in AKU but the dose-response relationship has not been previously studied. METHODS: Suitability Of Nitisinone In Alkaptonuria 1 (SONIA 1) was an international, multicentre, randomised, open-label, no-treatment controlled, parallel-group, dose-response study. The primary objective was to investigate the effect of different doses of nitisinone once daily on 24-h urinary HGA excretion (u-HGA24) in patients with AKU after 4 weeks of treatment. Forty patients were randomised into five groups of eight patients each, with groups receiving no treatment or 1 mg, 2 mg, 4 mg and 8 mg of nitisinone. FINDINGS: A clear dose-response relationship was observed between nitisinone and the urinary excretion of HGA. At 4 weeks, the adjusted geometric mean u-HGA24 was 31.53 mmol, 3.26 mmol, 1.44 mmol, 0.57 mmol and 0.15 mmol for the no treatment or 1 mg, 2 mg, 4 mg and 8 mg doses, respectively. For the most efficacious dose, 8 mg daily, this corresponds to a mean reduction of u-HGA24 of 98.8% compared with baseline. An increase in tyrosine levels was seen at all doses but the dose-response relationship was less clear than the effect on HGA. Despite tyrosinaemia, there were no safety concerns and no serious adverse events were reported over the 4 weeks of nitisinone therapy. CONCLUSIONS: In this study in patients with AKU, nitisinone therapy decreased urinary HGA excretion to low levels in a dose-dependent manner and was well tolerated within the studied dose range. TRIAL REGISTRATION NUMBER: EudraCT number: 2012-005340-24. Registered at ClinicalTrials.gov: NCTO1828463

The production and consumption of Make Poverty History's communications : a case study

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Copper, zinc and lead isotope signatures of sediments from a mediterranean coastal bay impacted by naval activities and urban sources

Toulon bay is severely impacted by metal contamination induced by past and recent naval activities. In this work, Cu, Zn and Pb isotope compositions and elemental concentrations of fifty-five surface sediments were determined in order to map the spatial distribution of anthropogenic and natural sources along this land-sea continuum. Two sub-systems of Toulon Bay, the Small and Large bays, showed well-marked patterns on metal contamination levels and isotope signatures for Cu and Pb. The Small bay had the highest metal concentrations, and displayed average Pb and Cu isotope compositions of 1.1664 ± 0.0043 (1s, expressed as 206Pb/207Pb ratios) and −0.17 ± 0.19‰ (1s, expressed as δ65CuNIST values), respectively. It contrasted with the Large bay, with moderate to pristine metal concentrations and average Pb and Cu isotope compositions of 1.1763 ± 0.0079 (1s) and +0.08 ± 0.23‰ (1s), respectively. Lead isotope systematics indicated a binary source mixing process involving industrial and natural sources, while Cu isotope systematics showed a ternary mixing process involving two distinct anthropogenic signatures, interpreted as associated to new diffuse anthropogenic sources and old warfare material. In contrast, Zn isotope compositions in the Small and Large bays were practically the same: +0.06 ± 0.05‰ and +0.06 ± 0.11‰ (1s, expressed δ66ZnJMC values), respectively, denoting an overlap between isotope signatures of natural and anthropogenic sources. This study presents the first detailed spatial distributions of Cu and Zn isotope compositions for an aquatic system, and demonstrates the feasibility to use Cu isotopes as tracers of anthropogenic sources in coastal environments

Assessment of the metal contamination evolution in the Loire estuary using Cu and Zn stable isotopes and geochemical data in sediments

International audienc

Can cu isotope composition in oysters improve marine biomonitoring and seafood traceability?

This study provides the first geographic and temporal large-scale analysis of Cu stable isotope compositions in indigenous oysters to biomonitor anthropogenic Cu inputs in aquatic systems. It includes oyster samples from French marine environments with distinct Cu-pollution levels and histories and extends over several decades of biomonitoring. Sample series composed of oysters from the same season and similar size/age intended to avoid biological biases. Oysters in macrotidal estuaries (Loire and Gironde, Western France) display fluctuating Cu concentrations without clear temporal trends, challenging to infer anthropogenic influence. Conversely, the time series of their Cu isotope ratios indicate a constant proportion of natural and anthropogenic Cu sources since the 1980s. In contrast, Cu isotope compositions in oysters from the progressively developing locales (urbanization and recreational boating) of Arcachon and Vilaine bays shift positively over time, along with increasing Cu concentrations. This finding suggests a gradual augmentation in the bioaccumulation of anthropogenic Cu over time. Thus, the time series of Cu isotope compositions in oysters is an unambiguous and robust approach to pinpoint anthropogenic Cu contamination. Furthermore, Cu concentrations combined with isotope compositions yield site-specific fingerprints allowing geographic discrimination among oysters. This two-dimensional Cu signature is promising as a tool for seafood traceability

Differences in Copper Isotope Fractionation Between Mussels (Regulators) and Oysters (Hyperaccumulators): Insights from a Ten-Year Biomonitoring Study

Copper (Cu) isotope compositions in bivalve mollusks used in marine-monitoring networks is a promising tool to monitor anthropogenic Cu contamination in coastal and marine ecosystems. To test this new biomonitoring tool, we investigated Cu isotope variations of two bivalves—the oyster Crassostrea gigas and the mussel Mytilus edulis—over 10 years (2009–2018) in a French coastal site contaminated by diffuse Cu anthropogenic sources. Each species displayed temporal concentration profiles consistent with their bioaccumulation mechanisms, that is, the Cu-regulating mussels with almost constant Cu concentrations and the Cu-hyperaccumulating oysters with variable concentrations that track Cu bioavailability trends at the sampling site. The temporal isotope profiles were analogous for both bivalve species, and an overall shift toward positive δ65Cu values with the increase of Cu bioavailabilities was associated with anthropogenic Cu inputs. Interestingly, mussels showed wider amplitudes in the isotope variations than oysters, suggesting that each species incorporates Cu isotopes in their tissues at different rates, depending on their bioaccumulation mechanisms and physiological features. This study is the first to demonstrate the potential of Cu isotopes in bivalves to infer Cu bioavailability changes related to anthropogenic inputs of this metal into the marine environment

Cu and Zn stable isotopes in suspended particulate matter sub-fractions from the Northern Bay of Biscay help identify biogenic and geogenic particle pools

Marine suspended particulate matter (SPM) plays a pivotal role in the marine biogeochemical cycling of trace elements. This study investigates metal distributions and copper (Cu) and zinc (Zn) stable isotope ratios in different size fractions of SPM from two sampling stations on the inner continental shelf of northern Bay of Biscay (NE Atlantic), a zone highly influenced by the macrotidal Loire estuary, the outlet of a major European river. The objective of this study is to test stable isotopes as tools to infer the origins of particles and their formation processes, and to infer relevant Cu and Zn biogenic pools involved in marine trophic transfers of these metals. SPM samples were nearly quantitatively mineralized (i.e., without HF) to determine metals and Cu and Zn isotopes in their more labile and reactive phases. Their δ65CuSRM-976 values ranged from −0.45 to +0.51‰, with higher Cu concentrations accompanying particle size decreasing. The δ66ZnJMC-Lyon values in SPM sub-fractions varied from +0.14 to +0.76‰, and were uncorrelated to both Zn concentrations and particle size. Compared to larger size fractions, increased Al and Fe levels (proxies for terrigenous materials) and enrichments in lighter Cu and Zn isotopes observed in the smaller size SPM sub-fractions suggest that a major proportion of SPM Cu and Zn is associated with geogenic particles. Conversely, the relative enrichment of heavy isotopes in coarser particles is attributable to an increase of Cu and Zn metabolically incorporated into biogenic organic particles (e.g., plankton), and by surface adsorption onto organic detrital particles. The higher δ-values attributed to biogenic particles likely represents the isotope composition of the local marine organic matter available to primary consumers like filter-feeders (oysters). Thus, this study shows that targeting particles of specific size classes allows to identify relative dominances of biogenic and geogenic carrier phases. Identifying these pools and their isotopic composition may help track Cu and Zn transfers through marine food-web metal in future studie