Latest ArticlesAs the first dual receptor agonist of glucose-dependent insulin-stimulating polypeptide and glucagon-like peptide-1 used for chronic weight management, tirzepatide achieves weight loss by delaying gastric emptying and reducing energy intake, and its therapeutic effect on obesity is significant and its safety is high. Tirzepatide can also improve a variety of cardiometabolic risk factors, such as reducing blood sugar, lowering blood pressure, and improving blood lipids. In the future,it is expected to treat obesity with cardiovascular and cerebrovascular diseases, respiratory diseases, liver diseases, etc, with broad application prospects. This article reviewed the pharmacokinetics, mechanism of weight loss, clinical application and safety of tirzepatide.
The diversity of clinical trial population is the key to ensure the generalizability of drug safety and efficacy assessment results obtained from clinical trials, and plays an important role in advancing research on new drugs and strengthening the regulation of marketed drugs to improve the quality of life for patients. The United States has accumulated rich experience in improving the diversity of clinical trial population. Regulatory authorities have established a policy system for improving research practice, reducing patient participation barriers, and promoting data collection and sharing, and have provided diversified clinical trial information to the public. Clinical trial institutions have promoted the participation of patients from different backgrounds in clinical trials by strengthening inter-agency cooperation, facilitating community involvement, and improving the cultural inclusiveness of employees. China can learn from the relevant experience of the United States, improve the supervision system of clinical trial population diversity, promote the capacity building of clinical trial institutions to serve diverse populations, and strengthen the publicity and education of clinical trials, so as to improve the diversity of clinical trial population.
To explore the research hotspots and development trends of global drug regulatory science, and to provide reference for promoting the sustainable development of drug regulatory science in China.
The literatures related to drug regulatory science published from 1991 to 2023 was searched from Web of Science database, and the contents of time distribution, author, institution, country / region and keywords were analyzed by CiteSpace 5.8.R3.
A total of 540 papers were included, and the annual number of published papers showed a stable growth trend. Foreign regulatory scientific research started early, and now it has formed a relatively complete regulatory scientific development system, and formed a relatively close cooperative relations among countries and institutions. Drug regulatory science research has evolved from an initial stage to a stage of refined research around new tools, standards, and methods; research hotspots include drug development, risk assessment, biomarkers, etc.
China’s drug regulatory authorities can increase policy guidance, strengthen basic theoretical research and applied capacity building, promote interdisciplinary joint research, and build a multidisciplinary academic exchange platform in order to accelerate the development of drug regulatory science.
To explore the effect of cyclosporin blood drug concentration on the efficacy and safety of cyclosporin on patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the transplant bin.
Clinical medical records of 94 allo-HSCT patients were collected. The first day of stem cell infusion was +1 day (d), and the transplantation time was divided into four groups: group A (-9 d to -1 d), group B (+1 d to +7 d,) group C (+8 d to +14 d) and group D (+15 d to +21 d). The plasma concentration of cyclosporin and its influencing factors,cell implantation, liver and kidney function indexes, acute graft-versus-host disease (aGVHD), and the occurrence of cyclosporin-related adverse reactions were observed in different periods and their relationships with the plasma concentration of cyclosporin were analysed. Receiver operating characteristic (ROC) curve was used to analyze the value of serum concentration of cyclosporin at different time periods in predicting safety.
The concentration of cyclosporin in allo-HSCT patients was 128 (99,160) ng·mL-1, with statistically significant differences between different time periods (P<0.001). In allo-HSCT patients, the implantation rate of leukocyte, platelet, and neutrophil in +21 d was 94%, 64%, and 51%, respectively. The incidence of liver injury, kidney injury, and aGVHD was 47% (44/94), 71% (67/94), and 16% (15/94), respectively. ROC analysis showed that the warning value of cyclosporin blood concentration in the group A for liver injury and kidney injury was 128.5 ng·mL-1 and 113.5 ng·mL-1, respectively, while the area under the curve was 0.712 (95%CI：0.578 to 0.847，P=0.002) and 0.752 (95%CI：0.637 to 0.868，P<0.001), respectively.
There are many factors affecting the blood concentration of cyclosporin which can affect the clinical efficacy and safety. Timely and accurate monitoring of cyclosporin blood concentration can better guide the clinical treatment of allo-HSCT patients in the transplant bin.
To evaluate the efficacy and safety of anlotinib combined with gemcitabine + docetaxel as second-line or later therapy in patients with lung metastasis of osteosarcoma.
Case data of 23 patients with lung metastasis of osteosarcoma received anlotinib combined with gemcitabine + docetaxel as second-line or later therapy in the department of oncology of Shanghai Sixth People’s Hospital from January 2016 to December 2022 were analysed retrospectively. The primary endpoint was progression-free survival (PFS). Secondary endpoints included objective response rate, disease control rate (DCR) and safety.
In the 23 patients with lung metastasis of osteosarcoma, 17 patients (74%)achieved stable disease and 6 patients (26%) achieved progress disease, with DCR 74%. Median PFS was 10.8 months (95% CI: 1.4 to 20.2 months). All 23 patients experienced adverse reactions. Grade 3 or 4 adverse reactions included thrombocytopenia (17%)，hypothyroidism (9%), hypertension (4%), hand-foot reaction (4%), fatigue (4%), diarrhea (4%), leukopenia (4%), and pneumothorax (4%).
Anlotinib combined with gemcitabine + docetaxel as second-line or later therapy can be used as an effective treatment with manageable toxicities for patients with lung metastasis of osteosarcoma.
To investigate the effects of cordycepin on cartilage repair, serum inflammatory factors and oxidative stress in rats with osteoarthritis.
Forty-five rats were randomly divided into control group, model group and low-,medium-, and high-dose cordycepin groups (10, 20, and 50 mg·kg·d-1 by gavage) . The knee osteoarthritis model has been established using Hulth method. One week after modeling, rats in each group were administered the corresponding doses of cordycepin by gavage for 28 days. HE staining and Alcian blue staining were used to observe and compare the cartilage morphology of each group. MicroCT was used to detect and calculate the bone volume fraction, bone area fraction, trabecular bone thickness and trabecular bone number. The expression of cartilage matrix protein was detected by Western blot. The contents of interleukin (IL)-6, tumor necrosis factor (TNF)-α, monocyte chemotactic protein (MCP)-1 and IL-10 in serum of rats were determined by ELISA. The levels of oxidative stress markers in serum were detected by the kits.
Compared with the control group, cartilage tissue were showed significant pathological damage in the model group, bone volume fraction and bone area fraction were increased, and trabecular thickness and number were decreased (P<0.05); the protein expression levels of sex determining region Y-frame protein 9 (SOX-9), aggrecan, and collagenⅡ were decreased (P<0.05); the levels of IL-6, TNF-α, and MCP-1 in serum were increased, SOD and GSH activity were decreased, and MDA content was increased (all P<0.05). Compared with the model group, the pathological damage of knee cartilage tissue were significantly alleviated in the medium- and high-dose cordycepin groups, the bone volume fraction and bone area fraction were decreased, and trabecular thickness and number were increased ( P<0.05); the protein expression levels of SOX-9, aggrecan, and collagen Ⅱ were increased (P<0.05); serum IL-6, TNF-α, MCP-1 contents were decreased, IL-10 content was increased, MDA content was decreased, and SOD and GSH activity were increased (all P<0.05), showing a dose-dependent trend.
Cordycepin can reduce cartilage damage in rats with osteoarthritis by reducing inflammation and oxidative stress.
To investigate the impact of erianin on the development of pancreatic cancer by regulating cyclic GMP-AMP synthase-stimulator of interferon gene (cGAS-STING) signal pathway.
SW1990 cells were divided into control group, low-, medium- and high-concentration erianin groups (10, 20, 40 nmol·L-1), RU.521 (cGAS inhibitor)group (1 μmol·L-1), and erianin (40 nmol·L-1) +RU.521 (1 μmol·L-1) group. The proliferation was detected by CCK-8 method, and apoptosis was detected by flow cytometry. The migration and invasion of SW1990 cells were detected by scratch test and Transwell test, respectively. Western blot was applied to detect the protein expressions of cyclin D1, Bcl-2 associated X protein (Bax), matrix metalloproteinase (MMP)-2, MMP-9, cGAS and STING in SW1990 cells. SW1990 cells were co-cultured with NK cells for 48 hours, the levels of granzyme B and perforin (PF) in co-culture supernatant were detected by ELISA, and NK cell killing activity was detected.
Compared with the control group, the cell proliferation rate,the rate of scratch healing, the number of invasive cells were decreased in the low-, medium- and high-concentration erianin groups, the protein expressions of cyclin D1, MMP-2, MMP-9 were decreased, the apoptosis rate was increased, and the protein expressions of Bax, cGAS and STING were decreased in a concentration-dependent manner (P<0.05), while the change trends of the above indexes in the RU.521 group were opposite (P<0.05). Compared with the high-concentration erianin group, the cell proliferation rate, scratch healing rate, the number of invasive cells, and the protein expressions of cyclin D1,MMP-2, MMP-9, Bax, cGAS and STING in the erianin +RU.521 group were increased, and the apoptosis rate was decreased (P<0.05). In the co-culture experiment, compared with the control group, the levels of granzyme B and PF and NK cell killing activity in the cell supernatant of the low-, medium- and high-concentration erianin groups were increased in a concentration-dependent manner (P<0.05), while the change trends of corresponding indexes in the RU.521 group were opposite (P<0.05).Compared with the high-concentration erianin group, the levels of granzyme B and PF and NK cell killing activity in the erianin+RU.521 group were decreased (P<0.05).
Erianin may inhibit the proliferation, migration, invasion,and immune escape of pancreatic cancer cells and promote cell apoptosis by activating cGAS-STING signaling pathway.
Isavuconazole is the latest triazole broad-spectrum antifungal drug that has been approved for the treatment of invasive aspergillosis and mucormycosis in adults. When isavuconazole was initially marketed abroad, many international guidelines did not recommend or weakly recommended it for routine therapeutic drug monitoring. However, a number of recent studies and expert consensus have emphasized that specific populations can be monitored for the use of isavuconazole based on clinical needs. Based on domestic and international real-world studies, this article provided a review of the specific situations leading to therapeutic drug monitoring of isavuconazole, including liver insufficiency, abnormal body mass index, children, CYP3A5*1/*3 genotypes, multi-drug therapy, long-term medication, and receiving special treatment or medication regimens, in order to provide reference for the clinical rational application of isavuconazole.
Eravacycline is a new class of fully synthetic fluortetracycline antibiotics with broad-spectrum antibacterial activity. The existing clinical trials have shown that eravacycline has good efficacy and safety in the treatment of various complex infections, especially in the application of multi-drug resistant bacteria. In this paper, the chemical structure, mechanism of action, antibacterial spectrum, pharmacokinetics/pharmacodynamics, clinical application, and drug resistance of eravacycline were reviewed in order to provide basis and reference for clinical drug use.
Chronic kidney disease is a global public health problem, which can progress to end-stage kidney disease. Podocyte injury is a common pathological type of various glomerular diseases, and the incidence of proteinuria can increase with the decrease of podocyte number. The treatment of podocyte injury is still limited by complex etiology, significant side effects of immunotherapy, and late initiation of targeted non-immunosuppressive therapy. In recent years, the research on the mechanism of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in chronic kidney disease had become increasingly extensive and in-depth, but there were still few reports on targeting podocytes. In this paper, the mechanism of SGLT2i against podocyte injury is reviewed, which provides a more sufficient theoretical foundation for the application of SGLT2i in the treatment of podocyte injury-related diseases.
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