Long-acting somatostatin analogue treatments in autosomal dominant polycystic kidney disease and polycystic liver disease : a systematic review and meta-analysis

Objectives A number of randomised control trials (RCTs) investigating the effects of long-acting somatostatin analogues in autosomal dominant polycystic kidney disease (ADPKD) and polycystic liver disease (PLD) have been recently reported. We sought to evaluate all available RCTs investigating the efficacy of somatostatin analogues treatment in ADPKD and PLD. Data sources Electronic databases; Pubmed, Clincaltrials.gov and Cochrane Central Register of Controlled Trials Eligibility criteria for selecting studies RCTs and randomised cross-over trials comparing the effects of somatostatin analogue treatment with controls in patients with ADPKD or PLD. Data extraction and synthesis Data extraction and bias assessments were performed by two independent reviewers between January and May 2019. Outcomes assessed included estimated glomerular filtration rate (eGFR), total kidney volume (TKV), total liver volume (TLV), progression to end stage renal failure (ESRF) and adverse effects. Data were pooled using a random-effects model and reported as relative risk or mean difference with 95% CIs. Results Meta-analysis was performed of six RCTs or randomised cross-over trials and three secondary analyses. A total of 592 patients were included. Compared with controls, somatostatin analogue treatment significantly reduced TLV (mean difference −0.15 L, 95% CI −0.26 to −0.03, p=0.01). There was no significant effect on TKV (mean difference −0.19 L, 95% CI −0.50 to 0.12, p=0.23) or eGFR (mean difference 0.27 mL/min/1.73 m2, 95% CI −2.03 to 2.57, p=0.82). There was no effect on progression to ESRF. Somatostatin analogues were associated with known adverse effects such as gastrointestinal symptoms. Conclusions The available RCT data show improvement in TLV with somatostatin analogue treatment. There was no benefit to TKV or eGFR in patients with ADPKD, while being associated with various side effects. Further studies are needed to assess potential benefit in reducing cyst burden in patients with PLD

A conceptual model of factors potentially influencing prescribing decisions for chronic conditions: an overview of systematic reviews

Background Nearly half of all adults are affected by chronic conditions with long-term medications often being the primary intervention. Although models like that of Murshid and Mohaidin contribute to our understanding of prescribing behaviours, they are not specific to chronic conditions and may not reflect the full range of influencing factors relevant to long-term care. Better understanding the factors that may influence healthcare professionals’ decision-making could help inform policy and guidelines as well as identify targets for future research and interventions. Methods An overview of systematic reviews was undertaken, following the 2020 PRISMA guidelines. PubMed, Embase, Web of Science, Cochrane Library and Google Scholar were searched from 01/01/2013 to 7/11/2023. Quality assessment was undertaken using the AMSTAR 2 tool. Screening, data extraction and synthesis were conducted. Confidence in findings was assessed using the GRADE-CERQual tool. An existing generic conceptual model of prescribing was adjusted to specifically reflect chronic conditions. Results Twenty-six reviews published between 2013 and 2023 were included, synthesising 689 primary studies. Patient factors that may influence prescribers’ decisions included age, ethnicity, education and level of rurality of residence. Prescribers describe assessing individual patient characteristics when weighing the risks and benefits, with a tendency to prioritise risks—especially for patients with multiple comorbidities or complex needs. Prescribers’ approach to risk may be influenced by their clinical experience, care setting and assessment tools. High workload and competing priorities may lead to clinical inertia in terms of delaying or preventing medication initiation. Shared decision-making may not always be shared equally between patients and prescribers. Beyond direct medication costs, prescribers may also consider broader healthcare costs, such as the need for monitoring and use of support staff for monitoring. External factors such as guidelines may be helpful in navigating risks, with their effectiveness potentially enhanced when they offer specific recommendations tailored to prescribers’ population characteristics. Conclusions Prescribers may need to navigate multiple challenges when making prescribing decisions for people with chronic conditions. This overview of systematic reviews suggests possible interrelated factor categories influencing prescribing decisions. The conceptual model may be used as a framework for future research and development of interventions

Assessing associations between the AURKAHMMR-TPX2-TUBG1 functional module and breast cancer risk in BRCA1/2 mutation carriers

While interplay between BRCA1 and AURKA-RHAMM-TPX2-TUBG1 regulates mammary epithelial polarization, common genetic variation in HMMR (gene product RHAMM) may be associated with risk of breast cancer in BRCA1 mutation carriers. Following on these observations, we further assessed the link between the AURKA-HMMR-TPX2-TUBG1 functional module and risk of breast cancer in BRCA1 or BRCA2 mutation carriers. Forty-one single nucleotide polymorphisms (SNPs) were genotyped in 15,252 BRCA1 and 8,211 BRCA2 mutation carriers and subsequently analyzed using a retrospective likelihood appr

Associations of common breast cancer susceptibility alleles with risk of breast cancer subtypes in BRCA1 and BRCA2 mutation carriers

Introduction: More than 70 common alleles are known to be involved in breast cancer (BC) susceptibility, and several exhibit significant heterogeneity in their associations with different BC subtypes. Although there are differences in the association patterns between BRCA1 and BRCA2 mutation carriers and the general population for several loci, no study has comprehensively evaluated the associations of all known BC susceptibility alleles with risk of BC subtypes in BRCA1 and BRCA2 carriers. Methods: We used data from 15,252 BRCA1 and 8,211 BRCA2 carriers to analyze the associations between approximately 200,000 genetic variants on the iCOGS array and risk of BC subtypes defined by estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and triple-negative- (TN) status; morphologic subtypes; histological grade; and nodal involvement. Results: The estimated BC hazard ratios (HRs) for the 74 known BC alleles in BRCA1 carriers exhibited moderate correlations with the corresponding odds ratios from the general population. However, their associations with ER-positive BC in BRCA1 carriers were more consistent with the ER-positive as

Genome-Wide Association Study in BRCA1 Mutation Carriers Identifies Novel Loci Associated with Breast and Ovarian Cancer Risk

BRCA1-associated breast and ovarian cancer risks can be modified by common genetic variants. To identify further cancer risk-modifying loci, we performed a multi-stage GWAS of 11,705 BRCA1 carriers (of whom 5,920 were diagnosed with breast and 1,839 were diagnosed with ovarian cancer), with a further replication in an additional sample of 2,646 BRCA1 carriers. We identified a novel breast cancer risk modifier locus at 1q32 for BRCA1 carriers (rs2290854, P = 2.7×10-8, HR = 1.14, 95% CI: 1.09-1.20). In addition, we identified two novel ovarian cancer risk modifier loci: 17q21.31 (rs17631303, P = 1.4×10-8, HR = 1.27, 95% CI: 1.17-1.38) and 4q32.3 (rs4691139, P = 3.4×10-8, HR = 1.20, 95% CI: 1.17-1.38). The 4q32.3 locus was not associated with ovarian cancer risk in the general population or BRCA2 carriers, suggesting a BRCA1-specific associat

Total absorption spectroscopy of the β decay of Zr 101,102 and Tc 109

20 pags., 9 figs., 5 tabs.The β decay of Zr101,102 and Tc109 was studied using the technique of total absorption spectroscopy. The experiment was performed at the National Superconducting Cyclotron Laboratory using the Summing NaI(Tl) (SuN) detector in the first-ever application of total absorption spectroscopy with a fast beam produced via projectile fragmentation. The β-decay feeding intensity and Gamow-Teller transition strength distributions were extracted for these three decays. The extracted distributions were compared to three different quasiparticle random-phase approximation (QRPA) models based on different mean-field potentials. A comparison with calculations from one of the QRPA models was performed to learn about the ground-state shape of the parent nucleus. For Zr101 and Zr102, calculations assuming a pure shape configuration (oblate or prolate) were not able to reproduce the extracted distributions. These results may indicate that some type of mixture between oblate and prolate shapes is necessary to reproduce the extracted distributions. For Tc109, a comparison of the extracted distributions with QRPA calculations suggests a dominant oblate configuration. The other two QRPA models are commonly used to provide β-decay properties in r-process network calculations. This work shows the importance of making comparisons between the experimental and theoretical β-decay distributions, rather than just half-lives and β-delayed neutron emission probabilities, as close to the r-process path as possible.A.A. acknowledges support from the Spanish Ministerio de Economía y Competitividad under Grants No. FPA2011-24553, No. FPA2014-52823-C2-1-P, and No. FPA2017-83946-C2-1-P and the program Severo Ochoa (SEV-2014-0398). P.S. acknowledges support from MCIU/AEI/FEDER,UE (Spain) under Contract No. PGC2018-093636-B-I00. S.V. acknowledges support from Czech Science Foundation Project No. 19-14048 and the Charles University Project No. UNCE/SCI/013. This work was supported by the National Science Foundation under Grants No. PHY 1565546 (NSCL), No. PHY 1430152 (JINA-CEE), and No. PHY 1350234 (CAREER). This material is based upon work supported by the Department of Energy National Nuclear Security Administration through the Nuclear Science and Security Consortium under Awards No. DE-NA0003180 and/or No. DE-NA000097

Identifying patient-important outcomes in polycystic kidney disease: An international nominal group technique study

AIM: Patients with autosomal dominant polycystic kidney disease (ADPKD) are at increased risk of premature mortality, morbidities and complications, which severely impair quality of life. However, patient-centered outcomes are not consistently reported in trials in ADPKD, which can limit shared decision-making. We aimed to identify outcomes important to patients and caregivers and the reasons for their priorities. METHODS: Nominal group technique was adopted involving patients with ADPKD and caregivers who were purposively selected from eight centres across Australia, France and the Republic of Korea. Participants identified, ranked and discussed outcomes for trials in ADPKD. We calculated an importance score (0-1) for each outcome and conducted thematic analyses. RESULTS: Across 17 groups, 154 participants (121 patients, 33 caregivers) aged 19 to 78 (mean 54.5 years) identified 55 outcomes. The 10 highest ranked outcomes were: kidney function (importance score 0.36), end-stage kidney disease (0.32), survival (0.21), cyst size/growth (0.20), cyst pain/bleeding (0.18), blood pressure (0.17), ability to work (0.16), cerebral aneurysm/stroke (0.14), mobility/physical function (0.12), and fatigue (0.12). Three themes were identified: threatening semblance of normality, inability to control and making sense of diverse risks. CONCLUSION: For patients with ADPKD and their caregivers, kidney function, delayed progression to end-stage kidney disease and survival were the highest priorities, and were focused on achieving normality, and maintaining control over health and lifestyle. Implementing these patient-important outcomes may improve the meaning and relevance of trials to inform clinical care in ADPKD

Clinical spectrum, prognosis and estimated prevalence of DNAJB11-kidney disease

Monoallelic mutations of DNAJB11 were recently described in seven pedigrees with atypical clinical presentations of autosomal dominant polycystic kidney disease. DNAJB11 encodes one of the main cofactors of the endoplasmic reticulum chaperon BiP, a heat-shock protein required for efficient protein folding and trafficking. Here we conducted an international collaborative study to better characterize the DNAJB11-associated phenotype. Thirteen different loss-of-function variants were identified in 20 new pedigrees (54 affected individuals) by targeted next-generation sequencing, whole-exome sequencing or whole-genome sequencing. Amongst the 77 patients (27 pedigrees) now in total reported, 32 reached end stage kidney disease (range, 55-89 years, median age 75); without a significant difference between males and females. While a majority of patients presented with non-enlarged polycystic kidneys, renal cysts were inconsistently identified in patients under age 45. Vascular phenotypes, including intracranial aneurysms, dilatation of the thoracic aorta and dissection of a carotid artery were present in four pedigrees. We accessed Genomics England 100,000 genomes project data, and identified pathogenic variants of DNAJB11 in nine of 3934 probands with various kidney and urinary tract disorders. The clinical diagnosis was cystic kidney disease for eight probands and nephrocalcinosis for one proband. No additional pathogenic variants likely explaining the kidney disease were identified. Using the publicly available GnomAD database, DNAJB11 genetic prevalence was calculated at 0.85/10.000 individuals. Thus, establishing a precise diagnosis in atypical cystic or interstitial kidney disease is crucial, with important implications in terms of follow-up, genetic counseling, prognostic evaluation, therapeutic management, and for selection of living kidney donors