Expert opinion on biological therapy
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Five percent of asthmatics have severe symptoms despite high doses of inhaled (ICS) or additional oral corticosteroids (OCS): these patients have high morbidity, risk for asthma death, and account for half of asthma healthcare spending. A subgroup (20 - 40%) of these has persistent airway eosinophilia and frequent exacerbations. Mepolizumab is a humanized monoclonal antibody that blocks binding of the key cytokine implicated specifically in eosinophil maturation and survival, interleukin-5, to its receptor. ⋯ Mepolizumab can reduce exacerbation rates in the severe asthma cohort who have eosinophilic airway inflammation despite corticosteroid treatment. This may be 30% of severe asthmatics and represents a new and important treatment option. Further studies need to confirm efficacy and indications for asthma (and other eosinophilic airway disease), and to examine clinical consequences of reducing remodeling.
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Expert Opin Biol Ther · Dec 2012
ReviewAn update on vaccines for tuberculosis - there is more to it than just waning of BCG efficacy with time.
Apart from better diagnostics and new anti-microbial drugs, an effective vaccine for tuberculosis is urgently needed to halt this poverty-related disease, afflicting millions of people worldwide. ⋯ It is argued that the variable protection conferred by the existing BCG vaccine against reactivation of latent TB is caused not only by waning of its efficacy with time but also by its weak induction of MHC class I restricted responses. Prime-boost strategies based on the actual BCG vaccine may not be sufficient to overcome this hurdle. The use of plasmid DNA vaccination might offer a solution.
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Expert Opin Biol Ther · Dec 2012
Bone marrow-derived mononuclear cell therapy for patients with ischemic heart disease and ischemic heart failure.
This meta-analysis aimed to assess whether bone marrow-derived mononuclear cells (BMMNCs) therapy may improve cardiac functional parameters in patients with ischemic heart disease (IHD) or ischemic heart failure (IHF). ⋯ BMMNCs therapy is associated with moderate but significant improvement over regular therapy in LVEF in patients with IHD and IHF. This observation, therefore, supports further RCTs conducting safety and efficiency of BMMNCs therapy with longer-term follow-up.
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Expert Opin Biol Ther · Nov 2012
ReviewNabiximols in the treatment of spasticity, pain and urinary symptoms due to multiple sclerosis.
Over the last two decades, experimental and clinical data suggest a therapeutic benefit of cannabis-based medicines for a variety of multiple sclerosis (MS) symptoms. Clinical trials, both with synthetic or plant-derived cannabinoids, have demonstrated clinical efficacy of cannabinoids for the treatment of spasticity, neuropathic pain and bladder dysfunction. Nabiximols, a 1:1 mix of delta-9-tetrahydrocanabinol and cannabidiol extract from cloned chemovars, was licensed in the UK in 2010 and has also been approved in other European countries and Canada. The European Federation of Neurological Societies recommends that cannabis should be used only as a second or third line treatment in central neuropathic pain. ⋯ Despite a number of trials with very promising results, there are still concerns related to relative paucity of data on long-term safety. Also, the long-term efficacy information in terms of the control of symptoms of a disease in which the natural history is progression is sparse. Therefore, further studies are required to improve the current knowledge of nabiximols.
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Expert Opin Biol Ther · Sep 2012
ReviewDecoy activity through microRNAs: the therapeutic implications.
microRNAs (miRNAs), small noncoding RNAs, are deregulated in several diseases including cancer. miRNAs regulate gene expression at a posttranscriptional level by binding to 5'UTR, coding regions or 3'UTR of messenger RNAs (mRNA), inhibiting mRNA translation or causing mRNA degradation. The same miRNA can have multiple mRNA targets, and the same mRNA can be regulated by various miRNAs. ⋯ The miRNA decoy functions have implications for the design of therapeutic approaches in human diseases, including specific ways to overcome resistance to drug therapy and future miRNA-based clinical trials design.