Showing posts with label failure. Show all posts
Showing posts with label failure. Show all posts

Saturday, 21 September 2013

Despite MAGE-A3 Failure, William Blair And Maxim Analysts Are Still Bullish On Agenus

Agenus Inc (AGEN): Despite MAGE-A3 Failure, William Blair And Maxim Analysts Are Still Bullish On Agenus - Seeking Alpha (function(_,e,rr,s){_errs=[s];var c=_.onerror;_.onerror=function(){var a=arguments;_errs.push(a); c&&c.apply(this,a)};var b=function(){var c=e.createElement(rr),b=e.getElementsByTagName(rr)[0]; c.src="//beacon.errorception.com/"+s+".js";c.async=!0;b.parentNode.insertBefore(c,b)}; _.addEventListener?_.addEventListener("load",b,!1):_.attachEvent("onload",b)}) (window,document,"script","4ffae9d6f05d1da630000008"); if (SA.Data && SA.Data.Cache) { var adata = SA.Data.Cache.get('campaign_content'); }.market_currents_list li .ticker_date_left .mc_list_tickers a{font-weight: normal} var ms_slug = ''; var article_dashboards = '@investing-ideas@sectors@'; var article_sectors_themes = '@long-ideas@us@biotechnology@healthcare@article@'; var ratings_hash={}; var ARTICLE_ID = 1676012; var ARTICLE_TYPE = "standard"; var ARTICLE_LOCK = ""; var author_slug = "ben-yoffe"; var pticker_for_ads = "agen"; var time_left; var lock_comments = false; var machine_cookie = readCookie('machine_cookie'); var middle_version = ABTest.identity%10; try { window.sessionStorage.setItem("/article/"+ARTICLE_ID, '1'); } catch (error) {}var mone_article_tags = "{gsk,agen};;;{healthcare};;;{long-ideas,us,biotechnology,investing-ideas,sa-exclusive};;;{ben-yoffe}"var ord = Math.floor(Math.random()*1000000000);Seeking Alpha Seeking Alpha Portfolio App for iPad Finance (1) var ipadData; SeekingAlpha.Initializer.AddAfterLoad(function(){ if (SA.Utils.Env.isIPad && !/3/.test(SA.Data.Cookies.get("user_devices"))){ Mone.event("ipad_promotion_top","top_ipad_banner_large","ipad_promotion_displayed"); ipadData = new SA.Data.iPad(); ipadData.instanceName = "ipadData"; var responseHandler = new Object(); responseHandler.handleResponse = function(data){ if (!data.averageUserRating) return; var stars = data.averageUserRating Home | Portfolio | Market Currents | Investing Ideas | Dividends & Income | ETFs | Macro View | ALERTS | PRO   This article was sent to 1,203 people who get email alerts on  . Which cover: new articles | breaking news | earnings results | dividend announcements Get email alerts on   » This article was sent to 338,826 people who get the Investing Ideas newsletter. Get the Investing Ideas newsletter » Despite MAGE-A3 Failure, William Blair And Maxim Analysts Are Still Bullish On Agenus Sep 5 2013, 14:35 by: Ben Yoffe  |  about: AGEN, includes: GSK BOOKMARKED / READ LATER Bookmarked

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Early this morning, GlaxoSmithKline (GSK) reported negative top-line results from its Phase III DERMA trial with its MAGE-A3 vaccine in melanoma. The Phase III trial was designed to assess disease-free survival in GlaxoSmithKline's MAGE-A3 vaccine versus placebo in roughly 1,300 stage IIIb/c melanoma patients. Agenus' (AGEN) QS-21 adjuvant is a central component of the vaccine and is being studied in 18 other investigational vaccines through a partnership with GlaxoSmithKline. While the MAGE-A3 vaccine has failed in melanoma, the trial continues and data from a subpopulation is expected in 2015.

Despite the vaccine not meeting the primary endpoint, no major safety signals have been observed thus far, which is being viewed by William Blair analysts as a positive sign for Agenus given that GlaxoSmithKline has 18 other ongoing programs containing Agenus' QS-21 adjuvant. Therefore, today's news, while disappointing, does not diminish the enthusiasm for the partnership with GlaxoSmithKline. Moreover, Agenus has no cost associated with the partnership with GlaxoSmithKline, thereby limiting the downside risk to the company.

The analysts point out that despite the failure in melanoma, they do not believe it is prudent to read through to the other programs, and they remain encouraged about the trials in non-small cell lung cancer and shingles. They believe that the Phase III MAGRIT trial with the MAGE-A3 vaccine in non-small-cell lung cancer is the most attractive of the late-stage programs. Therefore, they reiterated their Outperform rating on Agenus shares in a research report sent to investors this morning.

There are three major reasons for continued enthusiasm: First, the Phase II trial data were encouraging, with a trend demonstrated between the MAGE-A3 vaccine and the control arm. Second, the Phase III trial is the largest of its kind in non-small-cell lung cancer, which gives confidence that the trial is powered to determine the effect of the drug. Third, a more potent vaccine is being used in the Phase III trial than the one in the Phase II trial that produced encouraging results. The top-line results are expected in the first half of 2014, and GlaxoSmithKline will pay Agenus a low-single-digit royalty on worldwide commercial sales.

Additionally, Maxim analyst Jason Kolbert believes that today's drop is an overreaction and gives us four reasons:

1. The study did not meet disease free survival endpoint in these advanced melanoma patients (3B/3C) but melanoma is not lung cancer and the lung cancer patients are earlier stage (1B-3A). These cancers have drastically different times to relapse with melanoma being faster than lung cancer (9 months vs. 3 years). Immune-therapy may need time to work, time that melanoma patients just don't have. So it's erroneous to assume that QS21 is a failure yet, just because advanced melanoma patients did not broadly benefit, i.e. this does not mean that QS-21 does not work in earlier stage lung cancer patients or gene signature sub-group or patients.

2. Gene Signature is also a primary endpoint and has yet to report. Gene signature patients (those patients who may be more likely to benefit from immune therapy) were pre-specified as a sub-group with a co-primary endpoint. This group has not yet reported and the trial is still ongoing in these patients, i.e. this group may still benefit from QS-21.

3. Both cancer trials, do not necessarily portend negative results in herpes or Malaria trials, again, different disease, different patients, and very different immune systems.

4. The real upside to the Agenus story was never QS-21, it's Glioblastoma.

Conclusion:

Agenus has a number of upcoming catalysts, each of which could have a meaningful impact on the stock given current price levels. In addition to the collaboration with GlaxoSmithKline, Agenus has two wholly owned programs that are making significant clinical progress. The herpes program consists of an immunotherapeutic vaccine designed to suppress the virus in infected patients. A Phase II trial is underway and results are expected in the fourth quarter. The brain cancer program consists of two immunotherapeutic vaccines designed to target cancer cells in newly diagnosed and recurrent patients. A potentially registration enabling trial with G-200 in recurrent brain cancer recently initiated, and top-line results may be possible as early as 2015. The non-small cell lung cancer and shingles trials in collaboration with GlaxoSmithKline will read out in 2014. If any of these trials are positive, the stock could reverse from current levels.

Source: Despite MAGE-A3 Failure, William Blair And Maxim Analysts Are Still Bullish On Agenus

Disclosure: I have no positions in any stocks mentioned, and no plans to initiate any positions within the next 72 hours. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article. (More...)

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Tuesday, 20 August 2013

Physician continuity after patients leave hospital for heart failure can help survival rates

Main Category: Primary Care / General Practice
Also Included In: Cardiovascular / Cardiology
Article Date: 19 Aug 2013 - 9:00 PDT Current ratings for:
Physician continuity after patients leave hospital for heart failure can help survival rates
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Patients with heart failure who see a physician in the first month after leaving hospital are more likely to survive than those who do not see a doctor, reports a new study in CMAJ (Canadian Medical Association Journal). The effect is slightly more pronounced in patients who see their regular physician rather than an unfamiliar physician.

In the United States and Canada, more than $20 billion is spent every year on patients who are readmitted to hospital within 30 days after discharge. Heart failure is one of the most common reasons for hospitalization and has a high risk of readmission and early death.

To determine whether continuity of care resulted in better outcomes for patients with heart failure, researchers looked at data on all adults aged 20 years and over in Alberta who were discharged after hospitalization for heart failure. Patients were elderly with various health issues and had used the health care system in the year before their hospitalization for heart failure.

"Intuitively, one might consider physician continuity important for heart-failure patients discharged from hospital, given their age, high comorbidity burdens and complex therapy regimens," writes Dr. Finlay McAlister, University of Alberta, Edmonton, with coauthors. "However, a robust evidence base and multiple guidelines with consistent messaging on key management principles have made physician continuity potentially less important."

Of the total 24 373 discharged patients, 5336 (22%) did not see a physician within the first month, 16 855 (69%) saw a familiar physician (one they had seen at least twice in the year prior) and 2182 (9%) saw an unfamiliar physician. The researchers found that patients who saw a familiar physician had a lower risk of urgent readmission and death compared with patients who saw an unfamiliar physician or who did not visit a doctor.

"Early follow-up was associated with a lower risk of death or urgent readmission over 6 months, compared with no visits in the first month after discharge, regardless of whether the follow-up was with familiar or unfamiliar physicians. However, when we examined follow-up patterns throughout the 6 months after discharge, continuity with a familiar physician was associated with a significantly lower risk of death or readmission than follow-up with an unfamiliar physician, with similar effect estimates for specialist and nonspecialist follow-up," the authors write.

"The absolute reduction of 3% to 8% in risk of death or urgent readmission ... observed over 3?"12 months in association with follow-up in the first month after discharge was in the same range as the absolute benefits seen in placebo-controlled randomized trials of angiotensin-converting-enzyme inhibitor or b-blocker therapy. ... Thus, we believe that physicians should strive to optimize continuity with their heart-failure patients after discharge and that strategies are needed in the health care system to ensure early follow-up after discharge with the patient's regular physician," the authors conclude.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Thursday, 15 August 2013

Earlier surgical correction of heart valve disorder associated with greater long-term survival, lower risk of heart failure risk

Main Category: Cardiovascular / Cardiology
Article Date: 13 Aug 2013 - 13:00 PDT Current ratings for:
Earlier surgical correction of heart valve disorder associated with greater long-term survival, lower risk of heart failure risk
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In a study that included patients with mitral valve regurgitation due to a condition known as flail mitral valve leaflets, performance of early surgical correction compared with initial medical management was associated with greater long-term survival and lower risk of heart failure, according to a study in the August 14 issue of JAMA.

"Degenerative mitral regurgitation [backflow of blood from the left ventricle to the left atrium due to mitral valve insufficiency] is common and can be surgically repaired in the vast majority of patients, improving symptoms and restoring normal life expectancy. Despite the safety and efficacy of contemporary surgical correction, an ongoing international debate persists regarding the need for early intervention in patients without American College of Cardiology (ACC)/American Heart Association (AHA) guideline class I triggers (no or minimal symptoms and absence of left ventricular dysfunction). This is in part propagated by discordant views of the prognostic consequences of uncorrected severe mitral regurgitation; considered as benign by those supporting medical watchful waiting (nonsurgical observation until a distinct event is encountered) vs. conveying excess mortality and morbidity (including heart failure and atrial fibrillation) by those advocating early surgical intervention," according to background information in the article.

To understand the comparative effectiveness of early surgery vs. initial medical management strategies, Rakesh M. Suri, M.D., D.Phil., of the Mayo Clinic College of Medicine, Rochester, Minn., and colleagues conducted a study to ascertain the comparative effectiveness of initial medical management (nonsurgical observation) vs. early mitral valve surgery following the diagnosis of mitral regurgitation due to flail leaflets (an abnormality of the mitral valve in which a portion of the valve has lost its normal support). For the study, the researchers used data from the Mitral Regurgitation International Database (MIDA) registry, which includes 2,097 patients with flail mitral valve regurgitation (1980-2004) receiving routine cardiac care from 6 tertiary centers (France, Italy, Belgium, and the United States). Of 1,021 patients with mitral regurgitation without ACC and AHA guideline class I triggers, 575 patients were initially medically managed and 446 underwent mitral valve surgery within 3 months following detection.

Within 3 months following diagnosis, 8 patients died, 5 (1.1 percent) after early surgery vs. 3 (0.5 percent) during initial medical management; 9 patients developed heart failure, 4 (0.9 percent) after early surgery vs. 5 (0.9 percent) during initial medical management; and 30 patients developed new-onset atrial fibrillation, 6.2 percent after early surgery vs. 1.2 percent during initial medical management.

Ninety-eight percent of patients were followed up from diagnosis until death or at least 5 years. A total of 319 deaths were observed during an average follow-up time of 10.3 years. "Survival among the entire unmatched cohort for early surgery was 95 percent at 5 years, 86 percent at 10 years, 63 percent at 20 years vs. 84 percent at 5 years, 69 percent at 10 years, and 41 percent at 20 years for initial medical management, favoring early surgery," the authors write. Early surgical correction of mitral valve regurgitation was associated with a 5-year reduction in mortality of 53 percent.

With class II triggers (atrial fibrillation or pulmonary hypertension), survival was again better with early surgery, both overall and in the matched cohort at 10 years.

During follow-up, 167 patients incurred at least 1 incident episode of heart failure representing a rate of 16 percent at 10 years and 27 percent at 20 years. In the overall cohort, heart failure was less frequent after early surgery (7 percent for early surgery vs. 23 percent for initial medical management at 10 years and 10 percent for early surgery vs. 35 percent for initial medical management at 20 years), with a heart failure risk reduction of approximately 60 percent.

Reduction in late-onset atrial fibrillation was not observed.

"These findings emanate from institutions that together provide a very high rate of mitral valve repair (>90 percent) with low operative mortality, emphasizing that such results might also be achieved in routine practice at many advanced repair centers," the authors write. "The advantages associated with early surgical correction of mitral valve regurgitation were confirmed in both unmatched and matched populations, using multiple statistical methods."

In an accompanying editorial, Catherine M. Otto, M.D., of the University of Washington School of Medicine, Seattle, comments on how the findings of this study may influence patient care.

"The study group is atypical compared with most patients with chronic severe mitral regurgitation seen in clinical practice who are referred for surgical intervention at symptom onset or when serial imaging shows early left ventricular (LV) dysfunction. In patients with severe mitral regurgitation due to mitral valve prolapse, early surgery is reasonable if surgical risk is low and the likelihood of successful valve repair is high, which is often the case for patients with a flail leaflet; the new data support this recommendation."

"However, if surgical risk is high or if the likelihood of valve repair is low, it remains uncertain whether early surgical intervention is appropriate in the asymptomatic patient with severe mitral regurgitation due to a flail leaflet when LV size and systolic function are normal. Although the majority of these patients will develop clear indications for valve surgery within 2 years, it may be reasonable to postpone the risks of having an intervention and having a prosthetic valve as long as possible."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cardiovascular / cardiology section for the latest news on this subject.

Article - JAMA. 2013;310(6):609-616

Editorial - JAMA. 2013;310(6):587-588

JAMA

Please use one of the following formats to cite this article in your essay, paper or report:

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Study identifies characteristics of heart failure patients more likely to benefit from implantation of cardiac resynchronization device

Main Category: Cardiovascular / Cardiology
Also Included In: Medical Devices / Diagnostics
Article Date: 13 Aug 2013 - 13:00 PDT Current ratings for:
Study identifies characteristics of heart failure patients more likely to benefit from implantation of cardiac resynchronization device
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In a large population of Medicare beneficiaries with heart failure who underwent implantation of a cardiac resynchronization therapy defibrillator, patients who had the cardiac characteristics of left bundle-branch block and longer QRS duration had the lowest risks of death and all-cause, cardiovascular, and heart failure readmission, according to a study in the August 14 issue of JAMA.

"Clinical trials have shown that cardiac resynchronization therapy (CRT) improves symptoms and reduces mortality and readmission among selected patients with heart failure and left ventricular systolic dysfunction. Following broad implementation of CRT, it was recognized that one-third to one-half of patients receiving the therapy for heart failure do not improve. Identification of patients likely to benefit from CRT is particularly important, because CRT defibrillator (CRT-D) implantation is expensive, invasive, and associated with important procedural risks. A primary question regarding optimal patient selection for CRT is whether patients with longer QRS duration or left bundle-branch block (LBBB) morphology derive greater benefit than others," according to background information in the article. QRS duration is a measurement of the electrical conducting time of the heart on an electrocardiogram. Left bundle-branch block is a cardiac conduction abnormality.

Pamela N. Peterson, M.D., M.S.P.H., of Denver Health Medical Center, Denver, and colleagues conducted a study to determine the long-term outcomes of patients undergoing CRT-D implantation and associations between combinations of QRS duration and presence of LBBB and outcomes, including all-cause mortality; all-cause, cardiovascular, and heart failure readmission; and complications. The study included Medicare beneficiaries in the National Cardiovascular Data Registry's ICD Registry between 2006 and 2009 who underwent CRT-D implantation. Patients were stratified according to whether they were admitted for CRT-D implantation or for another reason, then categorized as having either LBBB or no LBBB and QRS duration of either 150 ms or greater or 120 to 149 ms. Patients underwent follow-up for up to 3 years, through December 2011.

Mortality rates in the primary overall study cohort were 0.8 percent at 30 days, 9.2 percent at 1 year, and 25.9 percent at 3 years. Rates of all-cause readmission were 10.2 percent at 30 days and 43.3 percent at 1 year. The researchers found that after adjustment for demographic and clinical factors, compared with patients with LBBB and QRS duration of 150 ms or greater, the other 3 groups had significantly higher risks of mortality and all-cause, cardiovascular, and heart failure readmission. The adjusted risk of 3-year mortality was lowest among patients with LBBB and QRS duration of 150 ms or greater (20.9 percent), compared with LBBB and QRS duration of 120 to 149 ms (26.5 percent), no LBBB and QRS duration of 150 ms or greater (30.7 percent), and no LBBB and QRS duration of 120 to 149 ms (32.3 percent). The adjusted risk of l-year all-cause readmission were also lowest among patients with LBBB and QRS duration of 150 ms or greater (38.6 percent), compared with LBBB and QRS duration of 120 to 149 ms (44.8 percent), no LBBB and QRS duration of 150 ms or greater (45.7 percent), and no LBBB and QRS duration of 120 to 149 ms (49.6 percent).

There were no observed associations with complications.

"Although prior data regarding the effects of CRT as a function of QRS duration are largely limited to meta-analyses of clinical trials, this study provides an important perspective on the role of QRS duration in outcomes after CRT implantation in clinical practice," the authors write.

"These findings support the use of QRS morphology and duration to help identify patients who will have the greatest benefit from CRT-D implantation."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cardiovascular / cardiology section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:

MLA

JAMA. "Study identifies characteristics of heart failure patients more likely to benefit from implantation of cardiac resynchronization device." Medical News Today. MediLexicon, Intl., 13 Aug. 2013. Web.
14 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.


'Study identifies characteristics of heart failure patients more likely to benefit from implantation of cardiac resynchronization device'

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Monday, 5 August 2013

Promising compound could offer new treatment for heart failure

Main Category: Cardiovascular / Cardiology
Article Date: 03 Aug 2013 - 0:00 PDT Current ratings for:
Promising compound could offer new treatment for heart failure
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Heart failure occurs when the heart cannot pump enough blood to meet the body's needs. It's a very common condition, affecting about six million people in the United States, but current therapies are not adequately effective at improving health and preventing deaths. A study published by Cell Press August 1st in the journal Cell reveals the key role of a family of molecules known as bromodomain and extraterminal domain (BET) proteins in activating genes that contribute to heart failure. The study also demonstrates that a BET-inhibiting drug can protect against heart failure in mice, opening up promising new avenues for the treatment of this devastating condition.

"New insights into the biology of heart failure are desperately needed to prompt new types of targeted therapeutic agents," says senior study author James Bradner of the Dana-Farber Cancer Institute and Harvard Medical School. "Our findings comprise significant progress toward fulfilling this clinical need, which is great news for heart failure patients."

Heart failure is a debilitating condition that causes fatigue, shortness of breath, organ damage, and early death. It is triggered by the activation of a large set of genes that cause the walls of the heart to thicken and develop scar tissue, impairing the organ's ability to pump blood normally. BET proteins can have a huge impact on gene activity because they belong to a class of molecules called epigenetic readers, which recognize special marks on DNA-protein complexes and attract gene-activating proteins to those spots. Bradner and his collaborators recently developed a potent BET inhibitor called JQ1, which shows promise as a potential anticancer therapy. But until now, nothing was known about the role of BET proteins in heart function.

To address this question, Bradner teamed up with study senior author Saptarsi Haldar of Case Western Reserve University School of Medicine and University Hospitals Case Medical Center. They found that BET proteins regulate the growth of heart muscle cells and activate a broad set of genes involved in heart failure. Treatment with JQ1 inhibited this abnormal pattern of gene activity and protected against heart-wall thickening, the formation of scar tissue, and pump failure in a mouse model of cardiac disease.

"Based on our findings, we are highly motivated to bring a drug-like derivative of JQ1 forward as a new type of heart failure drug for humans," Haldar says. "These compounds will shortly enter the clinic for therapeutic development in cancer, and we expect they can also be immediately developed into therapies for heart failure."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Cell, Anand et al.: "BET Bromodomains Mediate Transcriptional Pause Release in Heart Failure."

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Tuesday, 30 July 2013

Liver function regenerated and survival extended in mice with hepatic failure using human stem cell-derived hepatocytes

Main Category: Liver Disease / Hepatitis
Also Included In: Stem Cell Research
Article Date: 30 Jul 2013 - 0:00 PDT Current ratings for:
Liver function regenerated and survival extended in mice with hepatic failure using human stem cell-derived hepatocytes
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Researchers have generated functional hepatocytes from human stem cells, transplanted them into mice with acute liver injury, and shown the ability of these stem-cell derived human liver cells to function normally and increase survival of the treated animals. This promising advance in the development of cell-based therapies to treat liver failure resulting from injury or disease relied on the development of scalable, reproducible methods to produce stem cell-derived hepatocytes in bioreactors, as described in an article in Stem Cells and Development, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free on the Stem Cells and Development website.

Massoud Vosough and coauthors demonstrate a large-scale, integrated manufacturing strategy for generating functional hepatocytes in a single suspension culture grown in a scalable stirred bioreactor. In the article "Generation of Functional Hepatocyte-Like Cells from Human Pluripotent Stem Cells in a Scalable Suspension Culture" the authors describe the method used for scale-up, differentiation of the pluripotent stem cells into liver cells, and characterization and purification of the hepatocytes based on their physiological properties and the expression of liver cell biomarkers.

David C. Hay, MRC Centre for Regenerative Medicine, University of Edinburgh, U.K., comments on the importance of Vosough et al.'s contribution to the scientific literature in his editorial in Stem Cells and Development entitled "Rapid and Scalable Human Stem Cell Differentiation: Now in 3D." The researchers "developed a system for mass manufacture of stem cell derived hepatocytes in numbers that would be useful for clinical application," creating possibilities for future "immune matched cell based therapies," says Hay. Such approaches could be used to correct mutated genes in stem cell populations prior to differentiation and transplantation, he adds.

"The elephant in the room for stem cell therapy rarely even acknowledged let alone addressed in the literature is that of scalable production of cells for translational application," says Editor-in-Chief Graham C. Parker, PhD, research professor, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine. "Baharvand's groups' landmark publication not only demonstrates but exquisitely describes the methodology required to scale up stem cell populations for clinical application with a rigor to satisfy necessary manufacturing standards."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Adolescent kidney transplant recipients appear to be at higher risk of transplant failure

Main Category: Transplants / Organ Donations
Article Date: 29 Jul 2013 - 13:00 PDT Current ratings for:
Adolescent kidney transplant recipients appear to be at higher risk of transplant failure
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Patients who received their first kidney transplant at ages 14 to 16 years appear to be at increased risk for transplant failure, with black adolescents having a disproportionately higher risk of graft failure, according to a report published by JAMA Internal Medicine, a JAMA Network publication.

Existing medical literature does not adequately describe the risks of graft failure among kidney transplant recipients by age. Organ losses by adolescents are partly due to physiologic or immunologic changes with age but psychological and sociological factors play a role, especially when they affect medication adherence, according to the study background.

Kenneth A. Andreoni, M.D., of the University of Florida, Gainesville, and colleagues analyzed 168,809 first kidney-only transplants from October 1987 through October 2010. Age at transplant was the primary factor studied.

"Adolescent recipients aged 14 to 16 years had the highest risk of any age group of graft loss ... starting at one year after transplant, and amplifying at three, five and 10 years after transplant," according to the study results. "Black adolescents are at a disproportionate risk of graft failure at these time points compared with nonblack adolescents."

In the study, researchers also note that donor type (deceased vs. living) and insurance type (government vs. private) also had an impact along with a kidney transplant recipient's age.

"Among 14-year-old recipients, the risk of death was 175 percent greater in the deceased donor-government insurance group vs. the living donor-private insurance group (hazard ratio, 0.92 vs. 0.34), whereas patient survival rates in the living donor-government insurance and deceased donor-private insurance groups were nearly identical (hazard ratio, 0.61 vs. 0.54)," the study results indicate.

Researchers suggest that comprehensive programs are needed for adolescent transplant recipients.

"The realization that this age group is at an increased risk of graft loss as they are becoming young adults should prompt providers to give specialized care and attention to these adolescents in the transition from pediatric to adult-focused care. Implementing a structured health care transition preparation program from pediatric to adult-centered care in transplant centers may improve outcomes," the study concludes.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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JAMA Intern Med. Published online July 29, 2013. doi:10.1001/jamainternmed.2013.8495.

The Organ Procurement and Transplantation Network (OPTN) is supported by a Health Resources and Services Administration contract. The Ohio State University Comprehensive Transplant Center supported expenses for statistical evaluation of data. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Friday, 26 July 2013

Obese kidney failure patients receive survival benefit from transplantation

Main Category: Transplants / Organ Donations
Also Included In: Urology / Nephrology;  Obesity / Weight Loss / Fitness
Article Date: 25 Jul 2013 - 0:00 PDT Current ratings for:
Obese kidney failure patients receive survival benefit from transplantation
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Most obese individuals with kidney failure can prolong their lives by receiving a kidney transplant, although this survival benefit is lower in severely obese individuals. That's the conclusion of a new study published in the American Journal of Transplantation. The findings will hopefully decrease differences in access to transplantation for obese patients.

Obesity is increasing in patients with kidney failure. In some studies, obese kidney failure patients who are on dialysis have a lower risk of dying prematurely than non-obese patients. In contrast, obese kidney transplant recipients have a higher risk of dying prematurely than non-obese recipients. Therefore determining the survival benefit of transplantation in obese transplant recipients is an important issue.

Using data from the United States between 1995 and 2007, John Gill, MD, MS, of the University of British Columbia, in Vancouver, and his colleagues determined the risk of premature death in transplant recipients grouped by body mass index (BMI) compared with transplant candidates with the same BMI who were on the transplant waiting list. The analysis included 208,498 patients, and obesity was defined as a BMI of 30 kg/m2 or higher.

Among the major findings:

Obese patients with a BMI of 30 to 39 kg/m2 derived a similar survival advantage from transplantation as non-obese patients, which equated to more than a 66 percent reduced risk of dying within one year of transplantation.Obese patients with a BMI of 40 or higher derived a lower survival advantage from transplantation (a 48 percent reduced risk of dying within one year), and a survival advantage was uncertain in Black patients with a BMI of 40 or higher.Differences in obese compared with non-obese patients were not as profound with transplantations using kidneys from live donors.

The risk of dying early after transplantation was greater in obese compared with non-obese patients.

"Our study shows that obese patients derive a survival advantage from transplantation, and obesity should not exclude patients from consideration of transplantation," said Dr. Gill. "Also, improved early post-transplant care may help reduce the early risk of death in obese patients, and living donor transplantation may be a useful strategy to mitigate the risks of transplantation in obese transplant candidates."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our transplants / organ donations section for the latest news on this subject.

Gill et al. The Survival Benefit of Kidney Transplantation in Obese Patients, American Journal of Transplantation; Published Online: July 25, 2013 (DOI: 10.1111/ajt.12331).

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