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(2017)Increasing number of companion animals and market for companion animal drug products will bring about new challenges to the companion animal drug product marketing. Thus animal health companies have to rethink determinants of companion animal drug launch success so that their products could differ from other similar products. The aim of this study was to examine if the dominant approach of the new product launch (product-centered-, traditional sales and marketing- and strategic orientations approach) also more popular than relationship approach in the animal drug product marketing. The approach was chosen because big differences exist between the animal- and the human drug marketing. In addition it was researched how the recent changes of the animal health field has been effected to animal drug product marketing. The study was addressed to animal health marketing experts in Finland, the United Kingdom, Germany, France, Spain and Italy by electronic questionnaire. A previously generated questionnaire was employed. It was used after slight modifications and repiloting. According to the study it was found that there is dominating the same procedures as generally in industries in the launch of veterinary drug products. However, relationship approach, which emphasizes the importance of customer relationships, is quite important in the launch of a new veterinary drug product. Based on the results, relationship approach complements dominant approach in the launch of veterinary drug product. Based on answers given to the open-ended questions, veterinary drug companies consider current chances positive and aim to take advantage of the changes. Based on this study at least the senior management of veterinary drug companies seems to be aware the importance of relationship activities. From the results it can be seen that the relationship activities have not been utilized in the launches as much as it would be potential. Veterinary drug companies lean too much on that the company's products will be succeed with very low relationship activities because veterinary drug market is small and they have much less competitors than the human drug companies has. In addition there is working primarily high experienced people in the veterinary pharmaceutical industry, which has an impact that marketing practices are not updated easily.
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(2019)Despite the long history of skin grafting, there is no standardized treatment for split-thickness skin graft donor sites. These sites cause a notable amount of pain and discomfort to the patients and open wounds also introduce a risk for infection. There is an extensive need for treatment options promoting the fastest and least painful healing possible while also being infection-free. The treatment of split-thickness skin graft donor sites is constantly studied and there is plenty of scientific literature available about this topic. In the theory section of this Master’s thesis, the structure of skin, the process of wound healing, skin grafting surgery and wound care products for split-thickness skin graft donor sites are briefly introduced. Additionally, the method of systematic review is described. In the empirical section, a systematic review is performed to compare animal- and non-animal-based wound care products in the treatment of split skin graft donor sites. The methodological quality of the included studies is reviewed. In the literature search, 3552 references were found. In this systematic review a total of 23 articles were included comprising of 21 comparative clinical studies and two previous literature reviews. Of the original studies, 20 reviewed healing, 14 infection and 17 pain of the split-thickness skin graft donor sites. Based on the results of the systematic review, animal-based wound care products might promote healing and reduce pain experienced by patients in the treatment of split-thickness skin graft donor sites when compared with non-animal-based wound care products. The results concerning infection were inconsistent. Generally, the reporting of the clinical original studies was not comprehensive enough for proper evaluation of methodological quality. Some defects, mostly in the blinding of the patients, study personnel and the assessors of outcomes, were also found. Moreover, the studies were heterogeneous in their definitions and measuring of the reported outcomes. Therefore, there is substantial uncertainty in the results of this systematic review. The systematic and transparent way of conducting the literature search, the review of the methodological quality and the reporting of the outcomes can be considered as a strength of this thesis. The main weakness is, that only one person performed the critical steps of this study, which might increase the risk of bias and reduce the repeatability of the study.
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(2022)There is a growing need for antibiotic stewardship since antibiotic resistance is a global and increasing problem. One option would be outpatient parenteral antibiotic therapy (OPAT) which has evolved globally since 1970s. In Helsinki, it has been applied in hospital-at-home units since 2018 with elastomeric antibiotic infusion pumps that enable 24-hour continuous infusion and normal daily life for the patient. The continuous infusion via infusion pumps enables the use of first-line antibiotics whereas with intermittent infusions broad-spectrum antibiotics, that require doses less frequently, are a more likely choice. Thus, antibiotic therapy with elastomeric infusion pumps is likely to enhance antibiotic stewardship. The aim of the study was to analyse if treatment with elastomeric infusion pumps in hospital-at-home unit is cheaper than theoretical hospital stay and to compare the costs. An economic evaluation was performed with the assumption that hospital-at-home care and hospital stay are equal when it comes to the outcomes of the therapy. The economic evaluation was made with cost-minimization analysis. Data were collected manually by nurses in three hospital-at-home units in Helsinki between September 2021 and March 2022. Patients’ age, gender, indication and length of the antibiotic infusion pump therapy, distance from the hospital-at-home unit and problems with the therapy were collected. Cost information were received personally from City of Helsinki and taken from a paper of Finnish Institute for Health and Welfare. The data included 57 patients, of whom one had two treatment periods. The mean age was 60 years. Thirty-two percent of patients were female and 68% were male. The most common indications were bacteremia (n=24) and erysipelas (n=18). A total of 625 hospital bed days were saved, which is 10,8 days per patient on average. Cost savings with elastomeric infusion pump therapy were 89 000–116 000 euros compared to the theoretical treatment in a hospital ward depending on the cost information being used, which is 37–48% of the theoretical hospital stay costs. An economic evaluation was made separately for the treatment of bacteremia. The cost savings were 47 600–150 700 euros or 37–69% of the theoretical costs. Savings in travel costs were 2 300–3 800 euros when elastomeric pump therapy was compared to the conventional hospital-at-home intermittent infusion therapy of 4-6 nurse visits per day per patient. In conclusion, elastomeric infusion pump therapy in hospital-at-home units in Helsinki results in cost savings of 37–48% compared to theoretical hospital stay costs from the perspective of the entity responsible for the costs of the treatment.
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(2019)Literature review part: The enteric nervous system (ENS) often called “the second brain” is considered its own autonomic division that can independently regulate gut function. The ENS is derived from enteric neural crest-derived cells (ENCCs), which colonize the gut during development. Development of the ENS is a complex process, and many signalling pathways are required for a properly functioning ENS, especially GDNF/Gfrα1/RET signalling controlling survival, proliferation, migration, and differentiation of ENCCs. Hirschsprung’s disease (HSCR) is the most common congenital disease affecting gut motility. The prevalence of HSCR is 1:5000, and it is characterized by a complete lack of enteric neurons (aganglionosis) in the distal colon. Due to impaired intestinal motility, infants may have constipation, emesis, abdominal pain or distention, and, in some cases, diarrhea. The most life-threatening symptom is HSCR-associated enterocolitis (HAEC), which occurs in 30-50% of patients. Routine treatment for HSCR is a surgical operation called “pull through” in which the aganglionic segment is removed, and the remaining ganglionic segment is joined to the anus. However, the risk of developing HAEC after successful surgery still exists. Histopathological analysis has revealed that HAEC is accompanied by various changes in the gut epithelium, especially in mucin-producing goblet cells. These changes include hyperplasia of the goblet cells, altered mucin profile, retention of mucin, damaged and disorganized epithelium structure, inflammation, and bacterial adherence to the epithelium. However, a lack of suitable postnatal HSCR mouse models has partially hindered the progress of pinpointing the exact order of these events. A RET mutation found in half of the patients is overwhelmingly the biggest risk factor for HSCR. RET is a receptor on the cell membrane that mediates the effects in GDNF/Gfrα1/RET signaling pathway. of Knock-out mice of Gdnf, Gfra1 and Ret all have intestinal aganglionosis, resembling HSCR. However, to date, no mouse models of HSCR affecting GDNF/Gfrα1/RET signalling exist because pups are born without kidneys and die soon after birth. Experimental part: The GFRa1 hypomorphic mouse line (Gfra1hypo/hypo) created by Dr. Jaan-Olle Andressoo is the first successful model that survives past birth while manipulating GDNF-Gfrα1-RET signalling and phenocopying HSCR. These mice have 70-80% reduction in the expression of Gfrα1 in the developing gut and kidneys, which is sufficient to cause aganglionosis in the distal colon, yet not enough to impair kidney development.These mice are sacrificed between P7-P25 because of welfare problems yet giving a time window for analysis of the development of HAEC. Histological analyses revealed that Gfra1hypo/hypo mice had goblet cell hyperplasia and a shift away from acidic mucin production in the distal colon. Goblet cell hyperplasia was first observed at P10, but the shift in mucin profile already appeared at P5. It is not known what causes goblet cells to change their mucin production, but it seems to be the earliest histopathological change in HAEC preceding goblet cell hyperplasia. qPCR-analysis revealed that Muc2, the main secreted mucin that protects epithelium from invading pathogens, was upregulated at both P5 and P10. mRNA levels of Tnfa were also upregulated at P10. The aforementioned changes were not observed in the duodenum where the ENS had developed normally despite the reduction in Gfra1 expression. This indicates that the changes observed in the colon are likely due to the lack of ENS innervation, rather than a direct effect from GDNF-GFRa1-RET signalling itself. Finally, serum analysis indicated that systemic inflammation did not occur from P10-P16, although one Gfra1hypo/hypo animal had high levels of IL6 and TNFa at P14-16. This indicates that inflammation is not an early stage event and it is preceded by goblet cells related changes. In conclusion, changes in goblet cells seems to be earliest histopathological findings preceeding HAEC.
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(2013)Amphetamine and its derivatives are widely used as medicines but also abused as psychostimulant drugs. The most important action of amphetamine in the central nervous system is to release dopamine to the extracellular space which leads to enhanced dopaminergic neurotransmission. Amphetamine also releases serotonin and norepinephrine by similar mechanisms and it affects indirectly other neurotransmitter systems too. It still remains partly unsolved how amphetamine exactly releases monoamines but it is known to have multiple sites of action. Amphetamine is a substrate for dopamine transporter (DAT) and it acts as a competitive inhibitor of the transporter reducing uptake of dopamine. Amphetamine enters the cell mainly through DAT and partly by diffusing through the cell membrane. The drug induces changes in DAT leading to reverse transport of dopamine from the cytoplasm into the synaptic cleft through DAT. Amphetamine is also substrate for vesicular monoamine transporter 2 (VMAT2) preventing the uptake of dopamine into storage vesicles and promoting its release from the vesicles to cytoplasm. Additionally, amphetamine inhibits monoamine oxidase (MAO), enzyme which degrades monoamines. It also enhances dopamine synthesis and according to recent studies amphetamine augments exocytotic dopamine release. Drug addiction is a chronic disorder related to structural and functional adaptive changes of neurons, called neuronal plasticity. GDNF (glial cell line-derived neurotrophic factor) is one of the many molecules regulating plasticity. It is especially important to the dopaminergic system and some investigations have suggested that it has potential as a protective agent against addiction. The aim of this study was to investigate how the overexpression of endogenic GDNF affects dopaminergic system and how it changes drug responses. A hypermorphic mouse strain (GDNFh), which is overexpressing physiological GDNF, was used. Their wild-type littermates were used as controls. Using brain microdialysis it was measured how the extracellular dopamine concentration changes in striatum and nucleus accumbens (NAcc) after amphetamine stimulation. Amphetamine was administered straight to the brain through the microdialysis probe. Microdialysis was performed on days 1 and 4, and on days 2 and 3 the mice were given amphetamine intraperitoneally. This was done to find out if the response to amphetamine changed after repeated dosing. In addition to these experiments, the biological activity of three small-molecule GDNF mimetics in intact brains was tested by microdialysis. On the first day amphetamine increased striatal dopamine output more in the heterozygous GDNFh mouse than in the wild-type mice. This stronger reaction to amphetamine may be explained by the enhanced activity of DAT in the GDNFh-het mice leading to higher intracellular amphetamine concentration. Also the striatal dopamine levels are increased in the GDNFh-het. On the fourth day no differences were detected between the genotypes. In the NAcc no significant difference was found between the genotypes. Instead in NAcc amphetamine caused a smaller increase in the dopamine output on day 4 than on day 1 in both genotypes suggesting that tolerance was developed. These results confirm that endogenic GDNF has a remarkable role in the regulation of the dopamine system and hence addiction but further investigations are needed to clarify its versatile actions. The small-molecule GDNF mimetics increased striatal dopamine output thus showing biological activity and encouraging to further investigations.
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(2020)Lääkevaihto ja sitä täydentävä viitehintajärjestelmä ovat laskeneet lääkekustannuksia Suomessa. Epilepsialääkkeet eivät ole aiemmin kuuluneet lääkevaihdon piiriin, sillä epilepsian hoidossa eri valmisteet eivät välttämättä ole terapeuttisesti tarpeeksi samanarvoisia, ja pienikin muutos hoitotasapainossa voi altistaa epilepsiakohtauksille. Nykyisin epilepsialääkkeitä käytetään kuitenkin usein muihinkin käyttöaiheisiin, kuten psykiatrisiin sairauksiin ja kivun hoitoon. Vuonna 2017 lääkekorvausjärjestelmään tehtiin säästötoimenpiteitä, joiden yhteydessä epilepsialääkkeet sisällytettiin lääkevaihdon piiriin muissa käyttöaiheissa kuin epilepsian hoidossa. Lisäksi otettiin käyttöön poikkeava viitehintaryhmä, joka koski epilepsialääkkeistä pregabaliinia neuropaattisen kivun käyttöaiheessa. Tutkimuksen tavoitteena oli tarkastella epilepsialääkkeiden (pregabaliinin, gabapentiinin, topiramaatin, lamotrigiinin ja valproiinihapon) vaihtamista sekä hintojen kehitystä lääkevaihtoon ja viitehintajärjestelmään sisällyttämisen jälkeen vuoden 2017 alusta vuoden 2019 puoliväliin. Lisäksi tarkasteltiin näiden lääkeaineiden kustannusten, korvausmenojen sekä käyttäjä- ja reseptimäärien kehitystä. Aineistona käytettiin Kansaneläkelaitoksen reseptirekisteriin pohjautuvia tilastoja epilepsialääkkeiden lääkeostoista sekä lääkkeiden hintalautakunnan päätöksiä epilepsialääkkeiden viitehintaryhmistä ja viitehinnoista. Epilepsialääkkeiden vaihtaminen yleistyi tarkastelujakson aikana kaikilla lääkevaihdon piirissä olleilla viidellä lääkeaineella, ja vaihtokieltojen osuus resepteistä laski useimmilla lääkeaineista. Viitehinnat laskivat useimmissa tarkastelluista viitehintaryhmistä, mutta lähes yhtä usein viitehinta ei muuttunut. Viitehinnat laskivat enemmän viitehintaryhmissä, joissa oli useampia vaihtokelpoisia valmisteita. Lääkevaihdon ensimmäisenä vuonna 2017 lääkevaihtoon kuuluvien epilepsialääkkeiden kustannukset ja korvausmenot pääosin laskivat, vaikka lääkkeiden käyttö ei vähentynyt. Lääkevaihdon toisena vuonna kustannukset eivät juuri laskeneet. Pregabaliinin poikkeavan viitehintaryhmän vuoksi vaihtamatta jääneet reseptit aiheuttivat merkittävän osan lääkevaihtoon kuuluvien epilepsialääkkeiden kustannuksista. Pregabaliinille jäi siten todennäköisesti yhä säästöpotentiaalia poikkeavan viitehintaryhmän voimassaolon päätyttyä vuoden 2019 heinäkuussa, mitä on syytä tarkastella jatkotutkimuksissa.
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(2020)Erenumab (Aimovig®) is a first-in-class calcitonin gene-related peptide (CGRP) inhibitor approved for the preventive treatment of migraine by the FDA in May 2018 and by European Commission (EC) in July 2018. It is a human monoclonal antibody (mAb) binding to the CGRP receptor, antagonizing the effect of CGRP. The marketing authorization of Aimovig® was based on two phase II and two phase III clinical trials. In all trials, erenumab with doses 70 mg/mL and 140 mg/mL was found to have a significantly superior effect compared to placebo, with a similar safety profile between all groups. These conclusions are mainly in line with studies conducted post marketing authorization. However, questions about the optimal dose, and the frequency and types of adverse events in larger patient populations remain to be studied. A European Public Assessment Report (EPAR) and Summary of Product Characteristics (SmPC) are required by the European Commission for each human medicine with a marketing authorization within the European Union. The SmPC is produced by the applicant and it should contain all relevant information of the medicinal product as distilled during the assessment process. The SmPC can thus be viewed as a kind of summarized version of the EPAR. The aim of this study was to investigate the post-marketing efficacy and safety information of erenumab from three perspectives: 1) the EPAR was compared with recent systematic reviews and meta-analyses assessing the efficacy and safety of erenumab, 2) all existing literature on the efficacy and safety of erenumab on different subgroups of migraine patients was assessed and summarized, and 3) the efficacy and safety information of the EPAR was compared to those of the SmPC, to resolve whether important information is missing. This review found several points regarding the efficacy and safety of erenumab. First, the status of erenumab was further established as a safe and effective treatment for the prevention of migraine. Second, meta-analyses (n=3) with more extensive cohorts compared to those of the EPAR and SmPC, present a further case for the superiority of the 140 mg dose compared to the 70 mg dose. The difference in dose effect is addressed in the EPAR but its assessment may be based on limited information. Third, different subgroups seem to respond differently to erenumab treatment. This aspect should be further investigated by head-to-head studies. Lastly, the safety information of the SmPC seems insufficient due to lack of mention of upper respiratory infections. This adverse event was among the most common in all of the four clinical trials and has since been observed in a real-world study. Based on these findings, neither the EPAR nor the SmPC of erenumab seem to be fully up to date and information related to the dose and upper respiratory infections as a risk should be reconsidered.
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(2010)The objective of the research was to study the effects of different polymers, sugars, and cell handlings on the viabilities of ARPE-19 and ARPE-19-SEAP-2-neo cells after freeze-drying. Also the residual moisture content of the freeze-dried samples and the amount of intracellular sugar after incubation in trehalose medium were measured. The mixtures used in the study contained different polymers (e.g. polyvinylpyrrolidone, alginate, polyethylene glycol) and sugars (sucrose, trehalose and mannitol). Some cells were incubated or heated in trehalose medium before freeze-drying in order to increase the amount of intracellular sugar. The aim of the heating was also to increase the heat shock protein formation in the cells. The samples were mainly freeze-dried in 24 well plates. The same freeze-drying parameters were used in all freeze-drying runs. The freeze-drying cycle lasted 38.5 hours (freezing 2.5 h, primary drying 32 h, and secondary drying 4 h). In the freezing stage the samples were froze to -40 °C and the freezing rate was 1 °C/minute. In the primary drying stage the shelf temperature was mainly -35 °C and the pressure was 150 mTorr. The viabilities of the samples after freeze-drying were determined by measuring the fluorescence after 3 and 6 hours from addition of the Alamar Blue indicator dye. The residual moisture contents were measured by thermogravimeter. According to the results, mixture containing glycerol (9%) and PEG 10 000 (18%) was the best lyoprotectant in the study (70% viability after 3 hours). However, the viability decreased significantly (24% viability) in the measurement after 6 hours. Similar viability decrease was observed among all lyoprotectant mixtures used in the study. Extracellular sugars rarely had positive effect on the viability results. The 12 days incubation in 150 mM trehalose medium before freeze-drying affected positively to the post freeze-drying viability. Shorter incubation time or heating did not induce the same effect. Intracellular sugar measurements revealed, that the amount of intracellular trehalose was multiple after 12 days of incubation in 150 mM trehalose medium compared to the cells that were not incubated. The residual moisture contents of the samples varied between 0-7%. The residual moisture content of the sample containing glycerol 9% and PEG 10 000 18% was 1,5%.
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(2012)In pharmaceuticals amorphous state can be obtained either intentionally or unintentionally. Intentional production is used, for example, to improve the dissolution of poorly soluble compounds, to stabilize the structure of proteins, or to improve the mechanical properties of excipients (e.g., lactose). Unintentional introduction of amorphous phases can result from general manufacturing procedures of pharmaceuticals, such as coating, granulation, drying, milling, and compression. The presence of amorphous regions, even in small quantities, can exhibit a significant influence on the physical and chemical stability of pharmaceutical products. Molecular mobility in formulation with amorphous content is believed to be the key factor of their stability. Therefore, evaluating of molecular mobility is an important step in pharmaceutical product development. The aim of this study was to estimate molecular motions in amorphous disaccharides using calorimetric approach at temperatures below the glass transition temperature (Tg), where relaxation process is very slow as compared to the time of experiment. When temperature is low enough, the initial relaxation time parameter (τi) can be used as an estimate for relaxation process on the timescale of pharmaceutical product shelf life. The results of the present study revealed similar trend in stability of amorphous forms for the disaccharides (sucrose experiencing the fastest structural relaxation), which can be assumed on the basis of Tg alone, where higher Tg would result in more stable glassy state (Tg of sucrose is the lowest). Storage temperature of Tg - 55oC or lower would suffice for amorphous trehalose, melibiose and cellobiose to achieve at least 2 year's relaxation time, while for sucrose the temperature is Tg - 70oC. Fragility has been used as a helpful mean for classifying amorphous materials. All the compounds can be classified as fragile. Fragility ranking in the present study contains some degree of uncertainty, while 3 different approaches revealed somewhat different results for ranking the disaccharides. The variation in the results can be attributed to the overall sensitivity of DSC. The method described in the present study is quite difficult to apply without supportive information from other techniques. The results, obtained with the method, are very dependent on the slope in plotting ln q vs. 1/Tg, and even small fluctuations in the estimation can lead to different fragility values and consequently to different relaxation times. However, the final results reveal values for relaxation times well below Tg, which are in reasonable agreement with modern theoretical understanding of glassy state dynamics.
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(2022)Etätyö yleistyi maaliskuussa 2020 äkillisesti COVID-19 pandemian seurauksena maailman terveysjärjestö WHO:n suosituksesta. Etätyö on ollut ennen koronapandemiaa harvinaista lääketeollisuudessa, joten etätyötä lääketeollisuudessa on tutkittu hyvin vähän. Etätyön on arvioitu jäävän pysyväksi ratkaisuksi, joten on ajankohtaista tutkia etätyön soveltuvuutta ja tehokkuutta lääketeollisuudessa. Etätyöntekijöiden tuottavuus kasvaa yleensä huomattavasti. Työpaikalla koetaan jatkuvasti keskeytyksiä, melua ja muita häiriötekijöitä, joiden lisäksi työmatkat kuormittavat työntekijöitä. Etätyöntekijät säästyvät suurimmalta osalta näistä ongelmista, jolloin suurempi osa heidän työpäivästään kuluu varsinaiseen työntekoon. Valtaosa etätyöntekijöistä tekee etätyötä osan työajastaan. Tutkimuksen tavoitteena oli selvittää kokemuksia etätyöstä, etätyön soveltuvuutta ja etätyön tehokkuuteen vaikuttavia tekijöitä lääketeollisuudessa. Tutkimus on toteutettu Orion Oyj:n Suomen toimipisteissä. Tutkimuksen toteuttamistapa oli kvantitatiivisen ja kvalitatiivisen kyselytutkimuksen yhdistelmä. Yhdistämällä kvantitatiivisia ja kvalitatiivisia kysymyksiä pyrittiin saamaan tarkempia tietoja kuin pelkällä kvantitatiivisella tutkimuksella voitaisiin saada. Kysely oli avoinna 15.11.–26.11.2021. Vastausprosentiksi saatiin 34,9 %. Etätyön merkittävimmiksi hyödyiksi havaittiin työ- ja vapaa-ajan joustavampi yhteensovittaminen ja se, että etätyössä keskittyminen on parempaa. Kommunikaation koetaan onnistuvan hyvin etätyössä, mutta kasvokkain tapahtuvaa kommunikaatiota pidetään myös tärkeänä. Esimerkiksi kehitys- ja ideointipalaverit olisi hyvä järjestää mahdollisuuksien mukaan kasvokkain. Lisäksi hiljaisen tiedon siirtyminen on vähäisempää etätyössä. Etätyö soveltuu hyvin tutkimus- ja tuotekehitystyöhön, eikä sen koeta heikentävän merkittävästi kykyä innovoida. Tulosten perusteella etätyötä haluttaisiin tehdä enemmän kuin 40 % työajasta ja etätyötä pidetään tehokkaana työskentelytapana. Kyselyssä ei selvitetty, minkälaisia etätyömääriä vastaajat ovat tehneet vahvan etätyösuosituksen aikana. Osa vastaajista on saattanut olla muita enemmän lähitöissä, mikä voi vaikuttaa tuloksiin. Saadut tulokset olivat kuitenkin samansuuntaisia kuin aikaisemmissa tutkimuksissa. Suurin osa tähän kyselyyn osallistuneista oli erittäin kokeneita ja työnsä hyvin osaavia työntekijöitä, mikä voi lisätä etätyömyönteisyyttä tuloksissa.
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(2022)Municipal case management is an activity that assesses various functional capacity indicators, utilizing the elderly’s state of health and coping in everyday life. The goal of case management is to refer clients to suitable services, such as home care or a doctor's visit. The problems related to drug treatments are only superficially reviewed. The involvement of a pharmacist in the assessment of case management would provide an opportunity to address the problems of pharmacotherapy and to provide adequate support for the implementation of pharmacotherapy. In this thesis, a remote service of a pharmacist was piloted for new clients over the age of 65 living at home as part of case management. Pharmacist reviewed medications remotely using medication risk management checklist LOTTA. The study examined the suitability of the LOTTA for medication reviews and the problems associated with medications of the elderly participating in case management. In addition, the suitability of pharmacovigilance assessments as a remote service as part of a comprehensive assessment of functional capacity and coping with everyday life was examined. The research material was collected at the case management unit of the city of Turku. The study involved 50 volunteer Finnish-speaking customers over the age of 65, for whom were assessed for a case management at Turku's case management unit. In addition to the assessment of normal case management, two pharmacists with comprehensive medication review qualifications reviewed medications using the medication risk management checklist LOTTA. Subjects were interviewed by telephone. If the pharmacist estimates that the subject will benefit from a multi-professional comprehensive medication review, the physician and pharmacist collaborated to conduct a review using a videophone application. Subjects background information, responses, observations made by pharmacists, and actions taken by physicians were recorded on an electronic form and analyzed. The mean age of the study participants (n = 50) was 82 years (range 67–98). Of these, 36 were women (72%) and 14 were men (28%). Most subjects were multidrug-treated (average medication 10.3, range 3–28). Each subject had at least one drug can be used with consideration for use in the elderly, as defined in the Fimea Drug 75 + database (Class C). 30% of subjects did not have a medication list and 34% reported lack of regular medication monitoring. 96% of the subjects had experienced a symptom on the LOTTA list that repeatedly interferes with their lives. The most common of these were problems such as constipation (54%). Pharmacists proposed changes for medication for 96 % of subjects. The most common proposed change was a change in the time of dosing (46%). Pharmacists estimated that 14 (28%) subjects would benefit from a multi-professional comprehensive medication review. In these cases, pharmacists made an average of 8.1 proposed changes for the physician, and the physician made an average of 6.9 changes for each subject. The most common challenges in coping with medication were symptom, which may be due to adverse drug reactions, a lack of follow-up to medication, and the absence of a treating physician. The results suggest that medication should be reviewed during the case management. The LOTTA list made it possible to identify and address the pharmacological problems of the elderly. The participation of a pharmacist in the assessment of the need for a multi-professional service remotely was possible, but it must be further developed. More research is needed on the benefits of multi-professional case management with a larger sample size.
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(2018)Appetite regulation is a complex process involving regulation of energy homeostasis and the rewarding nature of food. Abnormalities in appetite regulation lead to obesity and eating disorders which are challenging to treat with medicines. Especially obesity is an increasing public health problem and drug development against it is a current subject in research. Hypothalamus is the most important brain area related to appetite regulation. Also, the basal forebrain and the amygdala which are part of the reward system in the brain, contribute to the appetite regulation. There is cholinergic innervation from the basal forebrain to the amygdala and most of the cholinergic activity in the amygdala is originating from the basal forebrain. It is known that the cholinergic system inhibits appetite but there is still no research about impact of cholinergic projections between these two brain areas. Aim of this study was to find out if the cholinergic projections from the basal forebrain to the amygdala effect on appetite regulation. The study included two stereotactic surgery. In the first surgery the mice (n=14) received injections to the basal forebrain that contained genetic materials for DREADDs in AAV. DREADDs appeared in the cholinergic cells of the basal forebrain and emanated within their axons to the amygdala. In the second surgery cannulas were placed to the amygdala. CNO was injected through the cannulas to the amygdala to cause the DREADDs activate or inhibit the cholinergic cells. As a control, mice received vehicle. The feeding experiments were performed in normal conditions or after food restriction and there were either food or sugar pellets available. The pellet dispenser monitored how many pellets mice ate during the six hours after the CNO or vehicle treatment. The success of virus injections was checked after the feeding experiments by antibody dyeing. In any conditions there was no significant differences in the results due to DREADDs and treatment. Because of the small group sizes and dispersion of the results no final conclusions can be made but the additional research about this topic is needed.
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(2013)Prostate cancer is the most common cancer among men in Finland. Today, new prostate cancers are diagnosed in an early phase of the disease when the cancer is still local and effectiveness of the treatments good. There are many effective treatment options for localised prostate cancer but all of them cause multiple side effects. No comprehensive information about prostate cancer patients' experiences, treatment consequences and outcomes has been available. National Institute for Health and Welfare (THL) carried out a nationwide survey to prostate cancer patients diagnosed in 2004. The questionnaire was sent by mail in 2009. Patients were asked to report their experiences during the diagnosis and treatment selection (prostatectomy, hormone therapy, external beam radiation, brachytherapy, surveillance). They were asked about amount and harmfulness of side effects and satisfaction with outcome of the treatment. An association between the side effects and satisfaction with the treatment outcome was also studied. A total of 1239 responses were accepted for the study (response rate 73%). All treatments caused several side effects, and up to half of the patients had some adverse effect still present at the time of the survey. Most of the side effects concerned urinary or sexual dysfunction, in external beam radiation also bowel dysfunction. All treatments caused sexual dysfunction, but radiation therapy less than the other treatments. Side effects caused by hormone therapy were specific for this treatment, like hot flashes and mood disturbances. Patients treated with prostatectomy were least satisfied with the outcome of the treatment and dissatisfaction was mostly associated with sexual and urinary dysfunction. Patients treated with radiation therapy were most satisfied with the outcome. Urinary and bowel dysfunction impaired the satisfaction in patients treated with external beam radiation. All prostate cancer treatments cause plenty of potentially harmful side effects that may be challenging for psychological and psychosocial well-being of the patients. Thus, both treatment modalities and means to support well-being of the patients should be developed further. Actions that enhance well-being and prevent and relieve side effects should be an essential part of standard clinical procedures for every prostate cancer patient.
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(2010)Prostate cancer is one of the most common cancers in the developed countries. Prostate cancer is slowly progressing cancer but can transform into aggressive disease and metastasize. Metastases are the major cause of mortality. Androgens play an important role in the pathogenesis of prostate cancer and prostate tumors are usually dependent on androgens. Thus the aim of the treatment is to eliminate testicular androgens by surgical or medical castration and/or block the effect of androgens on the prostate with antiandrogens. Prostate cancer and new therapies to treat the disease are being investigated vigorously. Numerous in vivo models of prostate cancer have been developed. Androgen responsive animal models mimic prostate cancer more closely. There are many animal species that may be used to model prostate cancer but mouse is no doubt the most useful. Tumor models can be created by inoculating human cancer cells or solid parts of tumors into immune deficient mice. Orthotopic prostate tumor models reflect the abnormal cancer cell-stroma interactions occuring in prostate cancer. Transgenic mouse models are becoming more and more common in the research of prostate cancer. Transgenic models are able to model the initiation and progression of the disease more realistically. Growth of the orthotopic tumor is difficult to monitor without measuring serum prostate specific antigen (PSA) concentrations or using specific imaging methods. Imaging techniques, such as optical imaging, are being utilized in different in vivo models of prostate cancer. The objective of the experimental part of this thesis was to optimize bioluminescence imaging method in androgen responsive cell line LNCaP-luc2 in orthotopic model of prostate cancer. Bioluminescence imaging is based on a reaction catalyzed by a luciferase which is expressed by the tumor cells. In the ATP-dependent reaction luciferase enzyme oxidizes its substrate, luciferin, and produces light. In addition, the purpose of this study was to examine the effects of medical therapy and castration on tumor growth. Bioluminescence imaging enabled noninvasive, real-time and longitudinal monitoring of the growth of prostate tumors in this model. Quantification of the tumors with bioluminescence measurement was faster than with ultrasound sonography. It was also possible to monitor the growth of the tumors more often with bioluminescence imaging than with PSA measurements. Bioluminescence imaging was found to correlate better with serum PSA concentrations than with the actual size of the tumor. However prostate tumor size was noted to correlate better with PSA concentrations than with bioluminescence imaging in this study. Medical treatment or castration was found to have no effect on the size of the tumors when measured with bioluminescence imaging. The larger size of the tumors than expected was the probable reason for this. Bioluminescence imaging is not suitable for large or necrotic tumors because this imaging method can only be applied in living cells. In addition, a successful luciferin injection is essential for the proper utilization of bioluminescence imaging in this model. More studies are needed to validate the model for example in proving the effects of the medical therapies.
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(2023)Microcrystalline cellulose (MCC) is a purified, partially depolymerized cellulose, which is obtained by treating α-cellulose with mineral acids. Ever since the first microcrystalline cellulose was commercialized, different grades of microcrystalline cellulose have widely been used in the manufacture of solid dosage forms, such as tablets. MCC obtained from different sources will exhibit different physico-chemical properties, including moisture content, degree of polymerization, crystallinity, and particle morphology. In wet granulation, microcrystalline cellulose can be used as a filler, binder, and disintegrant. Recently, Aalto University has introduced a novel microcrystalline cellulose obtained from renewable raw materials by an integrated process, which has a short retention time, low energy and chemical consumption. However, very few studies have evaluated the use of AaltoCellTM as an excipient in solid dosage forms. The objective of this study was to evaluate the filler properties of three grades of AaltoCellTM to prepare paracetamol tablets with 50% (w/w) drug load and compare AaltoCellTM with a commercial microcrystalline cellulose, Vivapur 101. Due to the poor flowability of paracetamol and the experimental microcrystalline celluloses, it is challenging to direct compress tablets from paracetamol and microcrystalline mixtures. Thus, the powder mixtures were granulated by high-shear wet granulation method to improve the flowability. After the granulation, the formulations were characterized for particle size distribution, morphology and powder flow. Carr’s index Hausner ratio and angle of repose were calculated to evaluate the flowability of the formulations. In addition, an image-based analysis of powder flow was performed. A rotary tablet press equipped with single punches of 9 mm diameter was used to compress tablets. To evaluate the quality of tablets, European Pharmacopoeia tests of friability, disintegration, uniformity of mass, uniformity of content and dissolution were conducted. The AaltoCellTM A and Vivapur 101 formulations had the smallest particle size, whereas the AaltoCellTM B had the largest particle size. According to Carr’s index and Hausner ratio, the flowability of AaltoCellTM powders and Vivapur 101 varied from poor to very, very poor. After the granulation, the flowability of AaltoCellTM B and AaltoCellTM C were classified as good, while AaltoCellTM A and Vivapur 101 formulations had fair flowability. However, the results were conflicting with the flowability index values obtained in the image-based analysis. According to the results, the AaltoCellTM tablets complied with all criteria of European Pharmacopoeia and were comparable with Vivapur 101 tablets. The average tablet weight deviated ± 3.2% from the target weight. The variations in weight and drug content were small, as indicated by low RSD values. The disintegration time of the AaltoCellTM tablets was between 1-8.5 minutes. In addition, the AaltoCellTM tablets had fast dissolution with 78-84% of paracetamol released within 1 minute. Overall, AaltoCellTM is a promising excipient for use as a filler in tablets. In further studies, characterizing the powder properties, such as morphology, surface properties and hygroscopicity, would provide a better understanding of the properties of AaltoCellTM.
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(2016)The field of stem cell research is hotter than ever, because still today, the goal for easily achievable stem cells for the use of tissue engineering and stem cell therapies, is yet to be achieved. Also, human stem cell based test systems are potential replacements of present animal test models. The ongoing obesity epidemic creates pressure for scientists to resolve the causes behind it. One way of approaching the problem, is the study of adipogenesis with the use of a in-vitro cell model. This have already been done for a while, with rodent based cell models, but the present study took the human obesity research a bit closer to its subject by using humane adipose tissue derived mesenchymal stem cells (hASC). Also, the adipogenic induction is executed with a human adipose tissue extract (ATE). Epidemiologically, the rise in obesity rates correlates at some level, with the occurrence of known endocrine disrupting chemicals in our environment. These include e.g. some pesticides and plasticizers, such as tributyltin (TBT), bis(2-ethylhexyl)phthalate (DEHP) and bisphenol A (BPA). In the present study, the effects of a variety of concentrations, ranging from 50nM to 100µM of BPA, on ATE induced adipogenesis of hASCs, was studied. The accumulation of triglycerides - a key parameter for adipogenesis - is evaluated with the use of oil-red-o (ORO) staining and photometric measurements. A set of tests was executed to find out if BPA possesses adipogenic, synergistic or antiadipogenic properties in this particular test system. No significant antiadipogenic, nor synergistic effects were seen. Some antiadipogenic effects were seen throughout the study, but without any dose-dependence. This study also showed need for further development of the test. ORO staining needs to be further standardized to increase accuracy, different batches of ATE may cause variation in the results. All and all the test system is relatively easily modified and when fully functional, it is a great tool for screening for substances affecting our adipose tissue, and also for enhancing our knowledge on human adipogenesis in whole.
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(2023)Immune checkpoint inhibitor (ICI) therapy aims to enhance the endogenous immune response against tumour cells, and it has become a potent treatment option for various types of cancers. Despite the promise of ICIs, most patients do not respond to the treatment. The primary limitation of ICI therapy is the immunosuppressive tumour microenvironment (TME), which is characterised by the lack of tumour- infiltrating cytotoxic T cells (CTLs) and the presence of immunosuppressive cells, such as tumour- associated macrophages (TAMs). A promising immunotherapeutic strategy that can promote antitumor immunity is oncolytic virus (OV) therapy. OVs can selectively replicate in and kill cancer cells, leading to the release of immunostimulatory molecules. These molecules can induce local inflammation and prime and recruit CTLs to the tumour site. In addition, OVs can also be used as a delivery platform for immunostimulatory transgenes that can further enhance the activation of anti-tumour immune response and help to overcome the immunosuppressive TME. Another strategy used to support anti-tumour immune responses and overcome immunosuppressive TME is epigenetic therapy. Epigenetic therapy can reprogram both cancer and immune cells towards a less immunosuppressive phenotype, thus helping to overcome the limitation of immune checkpoint therapy. The aim of this study was to generate a novel oncolytic adenovirus armed with epigenetic modifying transgene (EpiCRAd) to overcome the immunosuppressive TME and enhance the anti-tumour immune response. We tested its efficacy and immunogenicity in vitro and in vivo using a murine triple-negative breast cancer model. We demonstrated that EpiCRAd was able to modulate the epigenome of cancer cells without affecting viruses’ infectivity. Upon examining the potential effect of EpiCRAd on cancer cells, we observed that epigenetic regulation did not notably influence the expression of MHC class I and PD- L1 proteins, both of which play a role in the immune evasion mechanism of tumour cells. In addition, the in vivo experiments show that EpiCRAd controls tumour growth the best, especially together with an immune checkpoint inhibitor, suggesting that the virus was able to create an immune microenvironment more favourable for anti-tumour response. Interestingly, the TAM infiltration in the TME seems to reduce after treatment with EpiCRAd. Overall, the combination of epigenetic therapy with oncolytic virotherapy has shown promising results in converting immunotherapy-resistant tumours into immunotherapy-responsive tumours. Our findings provide valuable insights into the effect of EpiCRAd on cancer and immune cells. This study encourages exploring the use of epigenetic cancer remodelling and oncolytic viruses for cancer immunotherapy.
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(2020)There are significant inter-individual differences in the effects of drugs. These differences can be caused by, for example, other diseases, adherence to treatment, or drug-drug interactions. A drug-drug interaction can lead to an increase in the concentration of the active substance in the circulation (pharmacokinetic interactions) or a change in the effect of the drug without changes in plasma concentration (pharmacodynamic interactions). A drug-drug interaction can change the efficacy of a drug or affect the adverse drug reaction profile. The individual’s genetic background, such as diversity in drug-modifying enzymes (polymorphism), also has an effect on the efficacy and the risk for adverse drug reactions of some drugs. A pharmacogenetic test can be used to study how genetic factors affect drug treatments. The aim of this master's thesis was to examine the possibilities of personalized migraine pharmacotherapy from the perspective of pharmacogenomics and drug-drug interactions. Four online drug-drug interaction databases available in Finland were compared. Inxbase is the most widely used interaction database by physicians in Finland and it is also integrated into Finnish pharmacy systems. Other databases used in this study were the international professional database Micromedex as well as Medscape Drug Interaction Checker and Drugs.com Drug Interactions Checker. The latter two are open-access databases available for healthcare professionals and patients. Interaction searches were conducted in the selected databases between acute and prophylactic drugs used for the treatment of migraine (e.g. bisoprolol-sumatriptan). Fourteen acute and 12 prophylactic drugs were selected for this study based on the Current Care Guidelines in Finland (Käypä hoito), and the data were collected in Excel spreadsheets. The first search was completed in December 2019 and the second search in March 2020. In this study, many potential interactions were found between acute and prophylactic drugs used to treat migraine in Finland. For more than half of the drug pairs studied, a potential interaction was found in at least one of the databases. There were significant differences between the interaction databases regarding which interactions the database contains and how the severity of the interactions was classified. Of the interactions found, only 45% were found in all four databases, and each database contained interactions that were not found in the other databases. Even very serious interactions or drug pairs classified as contraindicated were not found to be consistently presented across all four databases. When selecting drug treatment for a migraine patient, potential drug-drug interactions between acute and prophylactic drugs as well as the patient's genetic background should be considered. Individualizing migraine treatment to achieve the best efficacy and to reduce the risk for adverse drug reactions is important because migraine as a disease causes a heavy burden on individuals, healthcare, and society. Pharmacogenetic tests particularly developed to help choosing migraine treatment are not yet available, but tests are available for few other indications in both public and private healthcare. The use of these tests in clinical practice will increase as physicians’ pharmacogenetic knowledge and scientific evidence on pharmacogenetic tests increase. Utilization of pharmacogenetic data requires that test results are stored in electronic health records so that they are available in the future, when changes are made to drug treatment of individuals. More studies are warranted to better understand the clinical impact of pharmacogenomics and drug-drug interactions in migraine care.
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(2023)Parkinson’s disease is a progressive neurodegenerative disorder which is commonly treated with Levodopa (L-dopa) and Dopa Decarboxylase (DDC)/ Catechol-O-methyltransferase (COMT) inhibitors. The main problem with this treatment is the intestinal conversion of L-dopa to dopamine despite DDC and COMT inhibition which probably occurs by the Tyrosine Decarboxylase (TyrDC) of intestinal bacteria. This study aims to find new inhibitor molecules that would have dual inhibitory effects towards both DDC and TyrDC enzymes. Currently, available DDC inhibitors cannot inhibit the bacterial TyrDC enzyme. A recently found TyrDC inhibitor (S)-α-Fluoromethyltyrosine (AFMT) is not able to inhibit the human DDC enzyme, respectively. The dual inhibition of both decarboxylases could reduce the dosing frequency and side effects related to L-dopa. In addition, the object of this study is to produce the human DDC enzyme by DNA recombinant technique as well as develop and optimize a biochemical DDC inhibition assay to study the effect of selected small molecule compounds towards inhibition of DDC and L-dopa conversion in E. faecalis model by previously developed cell-based assay. The human DDC was successfully produced in a TB medium with a yield of 1.8 mg/mL. The Km value of DDC for L-dopa was found to be 34 μM which indicates a high affinity for L-dopa. In the optimization of the DDC inhibition assay, the sample volume of 80 μL and incubation time of 3 h with detection reagent was found to give the highest fluorometric signal with sufficient robustness. In the initial screening of test compounds, 14 % of the compounds (n=59) were classified as active towards human DDC, while 31 % of the compounds were active towards L-dopa conversion in the E. faecalis model. Of those compounds, five were having dose-dependent dual inhibitory effects, but the IC50 values of them were higher compared to either carbidopa or AFMT. The most effective compounds were 8009-2501 (IC50 37 μM in E. faecalis model and 19 % inhibition at 1000 μM towards DDC enzyme) and 8012-3386 (IC50 248 μM in E. faecalis model and 37 % inhibition at 1000 μM towards DDC enzyme). However, this study confirms the possibility to find dual decarboxylase inhibitors. By optimizing the structures as well as investigating the mechanism of action, selectivity, and structure-activity relationships of the most active compounds, it is possible to find more effective dual inhibitors in the future.
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(2016)Oncolytic viruses have been extensively studied for the treatment of cancer. They are genetically engineered viruses, which are able to selectively infect and kill the cancer cells causing no harm to normal cells. Adenoviruses are the most commonly used viruses in the gene therapy field and their oncolytic variants are currently under evaluation in many clinical trials. The cell killing properties of oncolytic adenoviruses against the cancer cells have been known for a long time. In addition, it is known that they can activate immune system. To achieve more selective and effective antitumor effects several modifications of oncolytic adenoviruses have been studied. During my internship I worked on the development of a new cancer vaccine platform based on peptide-coated conditionally replicating adenovirus (PeptiCRAd). The PeptiCRAd technology consists of a serotype 5 adenoviruses which are coated with tumorderived peptides. The aim of the thesis was to evaluate the antitumor efficacy of the PeptiCRAd. The cytopathic effects of the PeptiCRAd were studied in vitro using human adenocarcinoma cell line, A549. In this experiment three different treatments were used to study the cytopathic effects of the PeptiCRAd and Ad5Δ24-CpG- virus or polyK-SIINFEKL- peptide alone. The cell viability was assayed using MTS reagent and quantified by spectrophotometer. The antitumor effects were also studied in vivo using immunocompetent C57BL/6 mice bearing B16-OVA melanoma tumors. Tumor-bearing mice were treated with Ad5Δ24-CpG- virus, SIINFEKL- peptide or the PeptiCRAd. To evaluate the antitumor effects, tumor volume was observed after the treatments. In this study, I show that PeptiCRAd and Ad5Δ24-CpG- virus both have oncolytic effects in vitro against A549 cells. In vitro Ad5Δ24-CpG- virus showed significantly better cytopathic effects at high concentration compared to PeptiCRAd. In vivo the PeptiCRAd showed strongest antitumor effect on the growth of established tumors. At the end of the experiment the volume of the tumor was significantly smallest in the PeptiCRAd group.
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