Medical Pharmacology Commons^™

Identifying Current Barriers And Optimization Opportunities Of Rapid Access Pathway To Outpatient Care For High-Cost Biologics In An Academic Health System, Avani Topiwala Pharmd, Vincent Do Pharmd, Bcps, Bctxp, Joseph Rosano Bs, Pharmd

Posters

• Inpatient administration of specialty biologic agents can have significant financial impacts on a healthcare system.
• The “Never Administer Inpatient List” (NAIL) is an established reference which contains biologic infusions that should be administered in an outpatient setting when clinically appropriate.
• While outpatient administration may be clinically appropriate, there are many barriers to coordinating outpatient infusions that result in unnecessary inpatient administration. This can result in a prolonged length of stay and increased medication cost.

Exercise Therapy Rescues Skeletal Muscle Dysfunction And Exercise Intolerance In Cardiometabolic Hfpef, Heather Quiriarte, Robert C. Noland, James E. Stampley, Gregory Davis, Zhen Li, Eunhan Cho, Youyoung Kim, Jake Doiron, Guillaume Spielmann, Sujoy Ghosh, Sanjiv J. Shah, Brian A. Irving, David J. Lefer, Timothy D. Allerton

School of Graduate Studies Faculty Publications

Exercise intolerance, a hallmark of heart failure with preserved ejection fraction (HFpEF) exacerbated by obesity, involves unclear mechanisms related to skeletal muscle metabolism. In a “2-hit” model of HFpEF, we investigated the ability of exercise therapy (voluntary wheel running) to reverse skeletal muscle dysfunction and exercise intolerance. Using state-of-the-art metabolic cages and a multiomic approach, we demonstrate exercise can rescue dysfunctional skeletal muscle lipid and branched-chain amino acid oxidation and restore exercise capacity in mice with cardiometabolic HFpEF. These results underscore the importance of skeletal muscle metabolism to improve exercise intolerance in HFpEF.

Recent Developments In Tirzepatide's Role In Reducing Cardiovascular Disease Risk Factors In Adults With Type 2 Diabetes, Talaya Jones, Zaneh Kahook, Carina Bryan, Mayur Parmar

HCA-NSU MD Research Day

Objective: This literature review aims to investigate recent developments in tirzepatide’s ability to lessen CVD risk factors for adults with increased risk of major adverse cardiovascular events. Background: Tirzepatide is an FDA - approved medication primarily used to treat adults with type 2 diabetes mellitus (T2DM) by reducing A1C and chronic weight management, however its efficacy for reducing CVD risk factors is under examination. Methods: This review synthesizes data from recent early findings published by the pharmaceutical company, which has not yet undergone peer review, alongside existing literature on tirzepatide. Additional sources were identified through a systematic search of PubMed, …

Impact Of Multifactorial Interventions With Medication And Lifestyle Optimization On Patients With Type 2 Diabetes: A Randomised Controlled Trial, Marwan M. El Deyarbi

Thesis/ Dissertation Defenses

The incidence of diabetes is increasing worldwide, consequently increasing mortality rates due to complications such as diabetic kidney disease. Clinical evidence on the protective effect of balanced diet, exercise and medication adherence with glucose-lowering intensification therapies on the progression of diabetes is insufficient, and interventions that are most effective in slowing cardiorenal metabolic complications in patients with type 2 diabetes mellitus (T2DM), especially in the UAE population diabetes remain to be elucidated. Several studies have shown that patient-related factors and limited medication adherence in patients with chronic diseases, are associated with poor clinical outcomes, long-term complications, and increased overall disease …

Mechanisms Of Extracellular Vesicle Uptake And Implications For The Design Of Cancer Therapeutics, Stephanie R Jackson Cullison, Joseph P Flemming, Kubra Karagoz, Peter J Wermuth, Mỹ G Mahoney

Rowan-Virtua School of Osteopathic Medicine Departmental Research

The translation of pre-clinical anti-cancer therapies to regulatory approval has been promising, but slower than hoped. While innovative and effective treatments continue to achieve or seek approval, setbacks are often attributed to a lack of efficacy, failure to achieve clinical endpoints, and dose-limiting toxicities. Successful efforts have been characterized by the development of therapeutics designed to specifically deliver optimal and effective dosing to tumour cells while minimizing off-target toxicity. Much effort has been devoted to the rational design and application of synthetic nanoparticles to serve as targeted therapeutic delivery vehicles. Several challenges to the successful application of this modality as …

Riluzole Attenuates Acute Neural Injury And Reactive Gliosis, Hippocampal-Dependent Cognitive Impairments And Spontaneous Recurrent Generalized Seizures In A Rat Model Of Temporal Lobe Epilepsy, Thomas Kyllo, Dominic Allocco, Laine Vande Hei, Heike Wulff, Jeffrey D. Erickson

School of Medicine Faculty Publications

Background: Riluzole exhibits neuroprotective and therapeutic effects in several neurological disease models associated with excessive synaptic glutamate (Glu) release. We recently showed riluzole prevents acute excitotoxic hippocampal neural injury at 3 days in the kainic acid (KA) model of temporal lobe epilepsy (TLE). Currently, it is unknown if preventing acute neural injury and the neuroinflammatory response is sufficient to suppress epileptogenesis. Methods: The KA rat model of TLE was used to determine if riluzole attenuates acute hippocampal neural injury and reactive gliosis. KA was administered to adult male Sprague-Dawley (250 g) rats at 5 mg/kg/hr until status epilepticus (SE) was …

Identification Of The N-Terminal Residues Responsible For The Differential Microdomain Localization Of Cyp1a1 And Cyp1a2, Robert M. Fuchs, James R. Reed, J. Patrick Connick, Markéta Paloncýová, Martin Šrejber, Petra Čechová, Michal Otyepka, Marilyn K. Eyer, Wayne L. Backes

School of Graduate Studies Faculty Publications

The endoplasmic reticulum is organized into ordered regions enriched in cholesterol and sphingomyelin, and disordered microdomains characterized by more fluidity. Rabbit CYP1A1 and CYP1A2 localize into disordered and ordered microdomains, respectively. Previously, a CYP1A2 chimera containing the first 109 amino acids of CYP1A1 showed altered microdomain localization. The goal of this study was to identify specific residues responsible for CYP1A microdomain localization. Thus, CYP1A2 chimeras containing substitutions from homologous regions of CYP1A1 were expressed in HEK 293T/17 cells, and the localization was examined after solubilization with Brij 98. A CYP1A2 mutant with the three amino acids from CYP1A1 (VAG) at …

Prevalence And Prognostication Of Cd5+ Mature T-Cell Lymphomas, Omar Elghawy, Miao Cao, Jason Xu, Daniel J. Landsburg, Jakub Svoboda, Sunita D. Nasta, Elise A. Chong, Stephen J. Schuster, Colin J. Thomas, Jordan S. Carter, Montreh Tavakkoli, Marco Ruella, Stefan K. Barta

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

Background: T-cell lymphomas (TCLs) are a group of heterogenous cancers with poor rates and duration of response. There remains a great challenge in risk stratification of these cancers. Cluster of differentiation (CD) 5 has shown prognostic implication in many subtypes of B-cell lymphoma; however, its role in TCLs is not known. Methods: We performed a single-institution retrospective analysis of newly diagnosed patients with TCL. CD5 positivity was determined based on positive results via immunohistochemistry and/or flow cytometry. We used univariate and multivariable analysis of biological factors to assess their association with survival outcomes. Results: A total of 194 patients with …

Risk Of Stroke In Patients With Left Ventricular Thrombosis Who Undergo Coronary Angiography: A System-Wide Retrospective Analysis, Ashraf Ahmed, Shaun Abid Md, Abhinav Aggarwal, Samdish Sethi, Ilia Ryzhkov, Nur Rahman Md, Assad Ur Rehman Md, Mohamed A. Badheeb, Isaac Opoku Md, Rasha Kaddoura, Rajvir Singh Md, Sandeep S. Nayak, Gilead Lancaster

Posters

Left ventricular thrombus (LVT) has been associated with an increased risk of cardioembolic stroke. However, it has not been established if coronary angiography (CAG) or percutaneous intervention (PCI) would enhance that risk. This study aims to determine the risk of cardioembolic stroke among patients with LVT who underwent CAG or PCI.

A Rare Case Of Neuroleptic Malignant Syndrome, Farrah R. Khan Md, Salman Ayaz Md, Rasha Saleth Md, Aysha Rana Md, Bryan Schaf Md, Zahra Khan Md

Posters

This case highlights the importance of identifying the signs of NMS in patients who are on antipsychotics. Although it is an uncommon phenomenon, heightened awareness is important to prevent delays or worsening conditions.

Knee Osteoarthritis: Disease Burden, Available Treatments, And Emerging Options, Michael Langworthy, Vinod Dasa, Andrew I. Spitzer

School of Medicine Faculty Publications

Osteoarthritis (OA) is a prevalent condition that affects nearly 528 million people worldwide, including 23% of the global population aged ⩾40, and is characterized by progressive damage to articular cartilage, which often leads to substantial pain, stiffness, and reduced mobility for affected patients. Pain related to OA is a barrier to maintaining physical activity and a leading cause of disability, accounting for 2.4% of all years lived with disability globally, reducing the ability to work in 66% of US patients with OA and increasing absenteeism in 21% of US patients with OA. The joint most commonly involved in OA is …

Curcumin Alleviates Inflammatory Effects Of Ketamine Anesthesia In Postnatal Rats, Soroush Afshar Ghahremani, Abbas Raisi, Sohrab Minaei Beirami, Houman Kahroba, Mahnaz Mardani, Omid Dezfoulian, Vahideh Tarhriz

School of Graduate Studies Faculty Publications

Curcumin has been employed in traditional medicine for over a millennium to treat various ailments, and its global use is now widespread. Chinese medicine relies heavily on curcumin as a primary element and uses it to cure infectious diseases, skin disorders, depression, and stress. It has cardioprotective, neuroprotective, and anti-diabetic properties, as well as pharmacological effects on disorders like type II diabetes, atherosclerosis, and human immunodeficiency virus replication. The anti-cancer activity of curcumin has been studied extensively with notable improvements in gastrointestinal, melanoma, urogenital, breast, and lung malignancies. We investigated the anti-inflammatory effects of curcumin on expression of tumor necrosis …

Characterizing The Monomer-Dimer Equilibrium Of Ubch8/Ube2l6: A Combined Saxs And Nmr Study, Kerem Kahraman, Scott A. Robson, Oktay Göcenler, Cansu M. Yenici, Cansu D. Tozkoparan Ceylan, Jennifer M. Klein, Volker Dötsch, Emine Sonay Elgin, Arthur L. Haas, Joshua J. Ziarek, Çağdaş Dağ

School of Medicine Faculty Publications

Interferon-stimulated gene-15 (ISG15) is an interferon-induced protein with two ubiquitin-like (Ubl) domains linked by a short peptide chain and is a conjugated protein of the ISGylation system. Similar to ubiquitin and other Ubls, ISG15 is ligated to its target proteins through a series of E1, E2, and E3 enzymes known as Uba7, Ube2L6/UbcH8, and HERC5, respectively. Ube2L6/UbcH8 plays a central role in ISGylation, underscoring it as an important drug target for boosting innate antiviral immunity. Depending on the type of conjugated protein and the ultimate target protein, E2 enzymes have been shown to function as monomers, dimers, or both. UbcH8 …

Clinical Practice Guideline-Inconsistent Chemotherapy-Induced Vomiting Prophylaxis In Pediatric Cancer Patients In Community Settings: A Children's Oncology Group Study, Aaron J. Sugalski, Allison C. Grimes, Michelle M. Nuño, Subhash Ramakrishnan, Melissa P. Beauchemin, Paula D. Robinson, Nancy Santesso, Alexandra M. Walsh, Andrea R. Wrightson, Lolie C. Yu, Susan K. Parsons, Lillian Sung, L. Lee Dupuis

School of Medicine Faculty Publications

Background: This study aimed to determine the proportion of patients receiving clinical practice guideline (CPG)-inconsistent care related to chemotherapy-induced vomiting (CIV) prophylaxis, and to describe the association between CPG-inconsistent care and site size. The association between delivery of CPG-inconsistent care and patient outcomes (CIV control, admission prolongation, and unplanned healthcare visits) was also described. Methods: This was a retrospective study conducted at Children's Oncology Group (COG) National Cancer Institute Community Oncology Research Program (NCORP) sites. Eligible patients received highly (HEC) or moderately emetogenic chemotherapy (MEC) as inpatients from January 2014 through December 2015, and were previously enrolled in a COG …

The Il-6 Hypothesis In Covid-19: A Phase 2, Randomised, Double-Blind, Placebo-Controlled Study To Evaluate The Efficacy And Safety Of Free Il-6 Sequestration By The Monoclonal Antibody Sirukumab In Severe And Critical Covid-19, Robert L. Gottlieb, Meredith Clement, Paul Cook, Audra Deveikis, Kap Sum Foong, Philip Robinson, Jihad Slim, Cedric W. Spak, Annemie Buelens, Katleen Callewaert, Sandra De Meyer, Wai Ling Mo, Inge Verbrugge, Liesbeth Van Wesenbeeck, Yanli Zhuang, Jason W. Chien, Magda Opsomer, Erika Van Landuyt

School of Medicine Faculty Publications

Background: Upregulation of IL-6 has been associated with worse prognosis in COVID-19 patients. Impact on IL-6 signalling has mostly been limited to clinical outcomes in IL-6 receptor antagonist trials. Methods: We performed a phase 2, randomised, double-blind, placebo-controlled trial (NCT04380961) of US-based hospitalised adults (< 85 years) with laboratory-confirmed SARS-CoV-2 infection and severe (low levels of supplemental oxygen) or critical disease (high levels of oxygen supplementation). Patients received sirukumab 5 mg/kg or placebo single dose IV on Day 1 plus standard of care. The primary endpoint was time to sustained clinical improvement up to Day 28 based on an ordinal scale. Secondary endpoints included clinical improvement, all-cause mortality, and safety. Following an interim analysis, the protocol was amended to only recruit patients with critical COVID-19. Findings: From May 2020 to March 2021, 209 patients were randomised; 112 had critical disease (72 sirukumab, 40 placebo) at baseline. Median time to sustained clinical improvement in critical patients was 17 and 23 days in the sirukumab and placebo groups (HR, 1∙1; 95% CI, 0∙66–1∙88; p > 0∙05). At Day 28, 59∙4% versus 55∙0% of patients achieved clinical improvement with sirukumab versus placebo and rates of all-cause mortality were 24∙6% versus 30∙0%, respectively. Rates of grade ≥ 3 adverse events were comparable between the sirukumab and placebo groups (25∙9% vs 32∙9%; all patients). Interpretation: In critical COVID-19 patients who received sirukumab, there …

Microrna-532-3p Modulates Colorectal Cancer Cell Proliferation And Invasion Via Suppression Of Foxm1, Ketakee Mahajan, Ani V. Das, Suresh K. Alahari, Ramesh Pothuraju, S. Asha Nair

School of Graduate Studies Faculty Publications

Colorectal cancer (CRC) is a heterogeneous disease and classified into various subtypes, among which transcriptional alterations result in CRC progression, metastasis, and drug resistance. Forkhead-box M1 (FOXM1) is a proliferation-associated transcription factor which is overexpressed in CRC and the mechanisms of FOXM1 regulation have been under investigation. Previously, we showed that FOXM1 binds to promoters of certain microRNAs. Database mining led to several microRNAs that might interact with FOXM1 3’UTR. The interactions between shortlisted microRNAs and FOXM1 3’UTR were quantitated by a dual-luciferase reporter assay. MicroRNA-532-3p interacted with the 3’UTR of the FOXM1 mRNA transcript most efficiently. MicroRNA-532-3p was ectopically …

Hydroxyurea In The Sickle Cell Disease Modern Era, Chazmyn Riley, Walter K. Kraft, Robin Miller

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

INTRODUCTION: Sickle cell disease is an inherited disorder characterized by hemoglobin S polymerization leading to vaso-occlusion and hemolytic anemia. These result in a variety of pathological events, causing both acute and chronic complications. Millions around the world are affected by sickle cell disease with predominance in sub-Saharan Africa. Hydroxyurea was the first drug approved for use in sickle cell disease to reduce the occurrence of painful crises and blood transfusions in patients with frequent, moderate to severe painful crises.

AREAS COVERED: With the development of new therapeutics, the role of hydroxyurea is evolving. This narrative review aims to provide clinical …

Epigenetic Mechanisms Differentially Regulate Blood Pressure And Renal Dysfunction In Male And Female Npr1 Haplotype Mice, Prerna Kumar, Kandasamy Neelamegam, Chandramohan Ramasamy, Ramachandran Samivel, Huijing Xia, Daniel R. Kapusta, Kailash N. Pandey

School of Graduate Studies Faculty Publications

We determined the epigenetic mechanisms regulating mean arterial pressure (MAP) and renal dysfunction in guanylyl cyclase/natriuretic peptide receptor-A (GC-A/NPRA) gene-targeted mice. The Npr1 (encoding NPRA) gene-targeted mice were treated with class 1 specific histone deacetylase inhibitor (HDACi) mocetinostat (MGCD) to determine the epigenetic changes in a sex-specific manner. Adult male and female Npr1 haplotype (1-copy; Npr1+/−), wild-type (2-copy; Npr1+/+), and gene-duplicated heterozygous (3-copy; Npr1++/+) mice were intraperitoneally injected with MGCD (2 mg/kg) for 14 days. BP, renal function, histopathology, and epigenetic changes were measured. One-copy male mice showed significantly increased MAP, renal dysfunction, and fibrosis than 2-copy and 3-copy mice. …

Antibiotic Resistance In Livestock: A Literature Review Of Its Consequences And International Effort On Human Antimicrobial Agents Resistant Crisis, Ha Nguyen

Theses and Graduate Projects

Background: Despite their benefits, the overuse of antibiotics in livestock has resulted in negative consequences to human health and the augmenting of an antibiotic-resistant crisis. Countries worldwide have conducted analyses and confirmed the growth of bacterial strains immune to most antibiotics. The widespread use of antibiotics is shown in various sectors, including human medicine and agriculture, leading to the emergence of antibiotic-resistant bacterial strains.

Purpose: This comprehensive literature review focuses on finding the connection between the usage of antibiotics in livestock, the transfer of antibiotic resistance to humans through consumption and exposure, and international efforts to find solutions to antimicrobial …

Podocyte Cell-Specific Npr1 Is Required For Blood Pressure And Renal Homeostasis In Male And Female Mice: Role Of Sex-Specific Differences, Chandramohan Ramasamy, Kandasamy Neelamegam, Samivel Ramachandran, Huijing Xia, Daniel R. Kapusta, Farhad R. Danesh, Kailash N. Pandey

School of Graduate Studies Faculty Publications

Atrial and brain natriuretic peptides (ANP and BNP) bind to guanylyl cyclase A/natriuretic peptide receptor A (GC-A/NPRA), stimulating natriuresis and diuresis and reducing blood pressure (BP), but the role of ANP/NPRA signaling in podocytes (highly specialized epithelial cells covering the outer surfaces of renal glomerular capillaries) remains unclear. This study aimed to determine the effect of conditional deletion of podocyte-specific Npr1 (encoding NPRA) gene knockout (KO) in male and female mice. Tamoxifen-treated wild-type control (PD Npr1 f/f; WT), heterozygous (PD-Cre-Npr1 f/+; HT), and KO (PD-Cre-Npr1 f/-) mice were fed a normal-, low-, or high-salt diet for 4 wk. Podocytes isolated …