The design and development of a personalized medicine support system

The use of a patient\u27s genetic data to aid clinical diagnosis and drug treatment represents a major milestone in the contribution of genomic research to healthcare practices. Initial implementation of a personalized medicine system is currently possible, uniting the areas of medicine, genomics, and informatics, built upon a foundation of the latest advances in information technology. The aim of a clinical application of pharmacogenomics is to tailor therapeutic drug regimens to an individual\u27s genetic profile, thereby maximizing the effectiveness of drug therapy and minimizing the likelihood of an adverse drug response (ADR). The fulfillment of these goals is of the utmost importance. Only half of all patients treated with conventional blockbuster drugs respond adequately and ADRs currently rank as the fourth leading cause of death in the US with more than 50% classified as dose-related (Olivier, Williams-Jones, Godard, Mikalson, & Ozdemir, 2008; Brockmöller & Tzvetkov, 2008). This represents a major financial and social burden. Though the link between allelic variants and altered drug metabolism is well established, the technology for implementing such considerations toward individualized dose adjustments does not currently exist. In order to leverage current advances in pharmacogenomics and assume a proactive role for the more rapid adoption of future technologies and advancements, a societal-scale personalized medicine system has been designed and developed. Given the very recent nature of the advances in human genomic knowledge and biotechnology methods as well as the lack of formal pharmacogenomics education, the system has been developed to serve as an education tool for physicians and pharmacists. The system represents a fully operational software system and incorporates development methodologies and technology that a business organization would use in order to implement a commercially viable product. This in particular allows the system to contribute toward the development of current data standards, exemplify an interface between genotypic analysis and its practical application to clinical decision support, allow for an analysis of current gaps within the supporting infrastructure, and enable the final dissemination of a best practices report with regard to real-world design, development, and implementation

Improving reuse in software development for the life sciences

The last several years have seen unprecedented advancements in the application of technology to the life sciences, particularly in the area of data generation. Novel scientific insights are now often driven primarily by software development supporting new multidisciplinary and increasingly multifaceted data analysis. However, despite the availability of tools such as best practice frameworks, the current rate of software development is not able to keep up with the needs of scientists. This bottleneck in software development is largely due to code reuse generally not being applied in practice. This dissertation presents Legwork, a class library of reuse-optimized design pattern implementations for desktop applications written in the C# programming language using Microsoft\u27s .NET Framework. Two case studies were used to evaluate the effect of Legwork on improving code reusability as compared to Microsoft\u27s best practices Prism framework. First, a collection of six established web service-based workflows leveraging the National Center for Biotechnology\u27s Entrez database retrieval system. Second, a modular genomics data analysis and visualization application based on the open source .NET Bio bioinformatics toolkit. Employing quantitative and qualitative methods, code reusability was evaluated at the class, subsystem, and system levels of software design through comparing established class metrics for code reuse, code control flow, and code composition, respectively. The results from both case studies demonstrate that using Legwork provides a consistent improvement in code reusability over Microsoft\u27s Prism framework across all three levels of program design evaluated

Ipatasertib plus paclitaxel versus placebo plus paclitaxel as first-line therapy for metastatic triple-negative breast cancer (LOTUS): a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial

BackgroundThe oral AKT inhibitor ipatasertib is being investigated in cancers with a high prevalence of PI3K/AKT pathway activation, including triple-negative breast cancer. The LOTUS trial investigated the addition of ipatasertib to paclitaxel as first-line therapy for triple-negative breast cancer.MethodsIn this randomised, placebo-controlled, double-blind, phase 2 trial, women aged 18 years or older with measurable, inoperable, locally advanced or metastatic triple-negative breast cancer previously untreated with systemic therapy were recruited from 44 hospitals in South Korea, the USA, France, Spain, Taiwan, Singapore, Italy, and Belgium. Enrolled patients were randomly assigned (1:1) to receive intravenous paclitaxel 80 mg/m2 (days 1, 8, 15) with either ipatasertib 400 mg or placebo once per day (days 1-21) every 28 days until disease progression or unacceptable toxicity. Randomisation was by stratified permuted blocks (block size of four) using an interactive web-response system with three stratification criteria: previous (neo)adjuvant therapy, chemotherapy-free interval, and tumour PTEN status. The co-primary endpoints were progression-free survival in the intention-to-treat population and progression-free survival in the PTEN-low (by immunohistochemistry) population. This ongoing trial is registered with ClinicalTrials.gov (NCT02162719).FindingsBetween Sept 2, 2014, and Feb 4, 2016, 166 patients were assessed for eligibility and 124 patients were enrolled and randomly assigned to paclitaxel plus ipatasertib (n=62) or paclitaxel plus placebo (n=62). Median follow-up was 10·4 months (IQR 6·5-14·1) in the ipatasertib group and 10·2 months (6·0-13·6) in the placebo group. Median progression-free survival in the intention-to-treat population was 6·2 months (95% CI 3·8-9·0) with ipatasertib versus 4·9 months (3·6-5·4) with placebo (stratified hazard ratio [HR] 0·60, 95% CI 0·37-0·98; p=0·037) and in the 48 patients with PTEN-low tumours, median progression-free survival was 6·2 months (95% CI 3·6-9·1) with ipatasertib versus 3·7 months (1·9-7·3) with placebo (stratified HR 0·59, 95% CI 0·26-1·32, p=0·18). The most common grade 3 or worse adverse events were diarrhoea (14 [23%] of 61 ipatasertib-treated patients vs none of 62 placebo-treated patients), neutrophil count decreased (five [8%] vs four [6%]), and neutropenia (six [10%] vs one [2%]). No colitis, grade 4 diarrhoea, or treatment-related deaths were reported with ipatasertib. One treatment-related death occurred in the placebo group. Serious adverse events were reported in 17 (28%) of 61 patients in the ipatasertib group and nine (15%) of 62 patients in the placebo group.InterpretationProgression-free survival was longer in patients who received ipatasertib than in those who received placebo. To our knowledge, these are the first results supporting AKT-targeted therapy for triple-negative breast cancer. Ipatasertib warrants further investigation for the treatment of triple-negative breast cancer.FundingF Hoffmann-La Roche

Wittig derivatization of sesquiterpenoid polygodial leads to cytostatic agents with activity against drug resistant cancer cells and capable of pyrrolylation of primary amines

Many types of cancer, including glioma, melanoma, non-small cell lung cancer (NSCLC), among others, are resistant to proapoptotic stimuli and thus poorly responsive to current therapies based on the induction of apoptosis in cancer cells. The current investigation describes the synthesis and anticancer evaluation of unique C12-Wittig derivatives of polygodial, a sesquiterpenoid dialdehyde isolated from Persicaria hydropiper (L.) Delabre. These compounds were found to undergo an unprecedented pyrrole formation with primary amines in a chemical model system, a reaction that could be relevant in the biological environment and lead to the pyrrolation of lysine residues in the target proteins. The anticancer evaluation of these compounds revealed their promising activity against cancer cells displaying various forms of drug resistance, including resistance to proapoptotic agents. Mechanistic studies indicated that compared to the parent polygodial, which displays fixative general cytotoxic action against human cells, the C12-Wittig derivatives exerted their antiproliferative action mainly through cytostatic effects explaining their activity against apoptosis-resistant cancer cells. The possibility for an intriguing covalent modification of proteins through a novel pyrrole formation reaction, as well as useful activities against drug resistant cancer cells, make the described polygodial-derived chemical scaffold an interesting new chemotype warranting thorough investigation.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection.

IMPORTANCE: SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals. OBJECTIVE: To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections. DESIGN, SETTING, AND PARTICIPANTS: Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling. EXPOSURE: SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES: PASC and 44 participant-reported symptoms (with severity thresholds). RESULTS: A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months. CONCLUSIONS AND RELEVANCE: A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC