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Browsing by Author "Rahnasto, Johanna"

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  • Rahnasto, Johanna (2019)
    Preeclampsia is a vascular pregnancy disorder characterized by new-onset hypertension and proteinuria and/or new-onset preeclampsia associated symptoms during the second half of pregnancy. The pathophysiology of the disorder is not fully understood, but incomplete placentation and maternal tolerance towards fetal tissue are known to play a part in the disease pathogenesis. Predisposing factors include nulliparity, obesity, diabetes, chronic hypertension and autoimmune diseases. Furthermore, women who have experienced preeclampsia are more susceptible to cardiovascular disease later in life. One established biomarker for preeclampsia is the increased concentration of the soluble Fms-like tyrosine kinase 1 (sFlt1) in the maternal serum. sFlt1 is frequently overexpressed in preeclampsia and it is linked with angiogenic imbalance and endothelial dysfunction, although its role in the disorder is not completely clear. Preeclampsia has a genetic background. There are protective and predisposing variants in and near the Fms related tyrosine kinase 1 gene (FLT1; coding for sFlt1) that have been associated with preeclampsia either in the mother or in the fetus. In this study, five genetic polymorphisms over a 2.3 kb region in the 3’ untranslated region of FLT1 were genotyped by Sanger sequencing and fragment analysis in altogether 1200 individuals consisting of case and control mother–child pairs of the Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) cohort. These polymorphisms were tested for association with various preeclampsia-related phenotypes by Fisher’s exact test. In the maternal genome, the minor alleles of rs17086497 and rs57760154 were associated with extreme hypertension (systolic blood pressure >180 mmHg) (p=0.004, OR=1.77) and obesity (p=0.023, OR=1.63). Homozygosity for these minor alleles was associated with pregnancy complications in general (p=0.026, OR=2.53) and the early-onset form of preeclampsia (p=0.004, OR=3.34). Additionally, the minor alleles of rs9554314, rs3138582 and rs149279513 were associated with extreme hypertension (p=0.045, OR=1.63) and obesity (p=0.023, OR=1.78). Moreover, a suggestive association to severe proteinuria (> 5 g/24h) was found in the maternal genome. In the fetal genome, significant negative associations were reached for rs17086497 and rs57760154 in terms of the serum concentration of sFlt1 in the preeclampsia group (p=0.008, OR=0.23). Overall, the results seem to link the studied region in the maternal genome to preeclampsia with severe features. This supports the idea of preeclampsia as a heterogeneous disorder with varying etiology and mechanisms and thus highlights the importance of differentiating between the various sub-phenotypes. For example, the association of the same allele in the fetal genome with lower maternal sFlt1 levels and in the maternal genome with severe symptoms of preeclampsia suggests that the sFlt1 level might not be a good measure in all patients. Additionally, the observed associations with extreme hypertension and obesity point to the possibility that this region might be relevant for the endothelial damage that is thought to be a central factor in creating the later-in-life disease susceptibility.
  • Rahnasto, Johanna (2018)
    The research discusses whether health rights can be used as a discretionary limitation in the grant of permanent injunctions for pharmaceutical patents in the EU. The method is predominantly legal dogmatic with some comparative law as well as law and politics. The research contributes to the discussions of what the role of the right to exclude is, whether courts should have discretion in granting injunctions after infringement has been established and what the relationship of intellectual property and human rights is. The traditional starting point of patent law is a strong right to exclude. This means that injunctions are issued as a matter of course when infringement has been established. In the case of pharmaceuticals the exercise of the right to exclude can sometimes result in a socially valuable product becoming unavailable to patients. It is therefore reasonable to ask whether the right to exclude should sometimes be overridden by public health concerns. Health rights refer to these public health concerns, including access to medicine and right to highest attainable level of health, as provided in various human rights instruments. The EU Enforcement Directive provides that courts must have authority to grant injunctions. It also says that remedies must be effective, proportionate and dissuasive. To fulfil all these requirements any particular remedy should be selected based on the facts at hand. In the USA, the Supreme Court's eBay judgment made granting injunctions entirely discretionary. Courts have kept issuing injunctions for pharmaceutical patents in most cases, but consideration of public interest factors has become more routine. Injunctive relief might be denied if the injunction would make a medically important product unavailable to a substantial patient population, for example if the infringing product were not entirely substitutable with other products. Taking into account the human rights framework of the EU, it seems that EU courts would have the authority to take into account these kinds of facts and exercise similar discretion. Health rights could in individual cases weigh more than the patentee's right to exclude. Despite this, the current practices are unlikely to change without the emergence of a landmark case that might be referred to the Court of Justice of the EU. As a conclusion, no legislative changes would be needed in the EU in order to adopt discretion in granting permanent injunctions. The lenient wording of the enforcement provisions, the principle of proportionality and the various human rights commitments of EU Member States provide sufficient legal grounds for exercising this kind of judicial discretion. In the light of the EU health rights framework the possibility to balance competing interest according to individual circumstances seems justified. Yet, the threshold for intervening with normal exercise of patent rights should be set quite high. In standard cases there would be no reason not to prioritize interests of the patentee. In the long run these interests also support public interests indirectly. Therefore the existence of discretion would not necessarily undermine exclusivity-based business models or incentives for pharmaceutical research and development.