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Virtual Care Market to Witness Exponential Growth by 2031 – BioSpace

Global Virtual Care Market: Snapshot

Virtual care refers to a technique that allows for the treatment of patients dealing with different health issues with the help of advanced technologies such as audio, video, or written communication. Moreover, it also includes virtual visits performed using communication devices held by patients as well as physicians from diverse places.

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TMRs upcoming research report provides comprehensive study of all factors influencing the development of the global virtual care market. Thus, it gives inclusive assessment of important facets such as drivers, trends, restraints, challenges, and growth opportunities in the market. In addition, this assessment document offers dependable statistics on sales, volume, revenues, and shares of the market for virtual care.

The report analysts have performed segmentation of the global virtual care market on the basis of several important parameters such as consultation type, end-user, and region. On the basis of consultation type, the market is classified into audio consultation, kiosks, and video consultation.

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Key Drivers of Virtual Care Market Growth

In the healthcare sector, there is notable growth in the application of different advanced technologies such as virtual care owing to the flexibility provided by the connected devices. Moreover, people today are inclining toward the use of virtual care services as they get an opportunity to gain second opinions from qualified healthcare professionals through online channels.

Virtual care is utilized by patients for performing varied activities such as consultations, meetings, check-ins, and checking the status of their reports. In addition, this technique can be utilized in the management of diseases that need continual follow ups. Thus, increased number of individuals suffering from critical health issues such as hypertension and diabetes is expected to support in the rapid expansion of the global virtual care market in the years to come.

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Virtual care solutions are increasingly adopted across major parts of the globe as they offer a wide range of advantages such as accessibility to doctors or healthcare providers with the help of video conferencing, which can be a prominent option in case of medical emergencies in remote areas.

The virtual care technique is adopted by healthcare specialists as they can focus on critical cases, as the technology gives them direct access to the patient medication room or to the hospital even if they are not physically present at that particular place.

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What Key Strategies are Utilized by Companies in Global Virtual Care Market to Stay Ahead in Competition

The global virtual care market is fragmented in nature and its competitive landscape is highly intense. Players are utilizing diverse strategies to maintain their prominent market positions. Some of the key strategies utilized by market enterprises are partnerships, collaborations, and mergers and acquisitions.

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North America Demand Outlook for Virtual Care

In terms of region, the global virtual care market shows existence in many regions such as Europe, Asia Pacific, North America, South America, and Middle East and Africa. Among all regions, North America is one of the dominant regions of the market for virtual care.

The North America virtual care market is estimated to maintain its dominant position in the forthcoming years due to early adoption of advanced technologies in the region.

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Virtual Care Market to Witness Exponential Growth by 2031 - BioSpace

The translatome of neuronal cell bodies, dendrites, and axons – pnas.org

Significance

Proteins are the key drivers of neuronal synaptic function. The regulation of gene expression is important for the formation and modification of synapses throughout the lifespan. The complexity of dendrites and axons imposes unique challenges for protein supply at remote locations. The discovery of messenger RNAs (mRNAs) and ribosomes near synapses has shown that local protein synthesis represents an important solution to this challenge. Here we used RNA sequencing and ribosome sequencing to determine directly the population of mRNAs that is present and in the process of translation in neuronal cell bodies, dendrites, and axons. Thousands of transcripts were differentially translated between the cell body and synaptic regions with over 800 mRNAs exhibiting more translation in the dendriticaxonal compartment.

To form synaptic connections and store information, neurons continuously remodel their proteomes. The impressive length of dendrites and axons imposes logistical challenges to maintain synaptic proteins at locations remote from the transcription source (the nucleus). The discovery of thousands of messenger RNAs (mRNAs) near synapses suggested that neurons overcome distance and gain autonomy by producing proteins locally. It is not generally known, however, if, how, and when localized mRNAs are translated into protein. To investigate the translational landscape in neuronal subregions, we performed simultaneous RNA sequencing (RNA-seq) and ribosome sequencing (Ribo-seq) from microdissected rodent brain slices to identify and quantify the transcriptome and translatome in cell bodies (somata) as well as dendrites and axons (neuropil). Thousands of transcripts were differentially translated between somatic and synaptic regions, with many scaffold and signaling molecules displaying increased translation levels in the neuropil. Most translational changes between compartments could be accounted for by differences in RNA abundance. Pervasive translational regulation was observed in both somata and neuropil influenced by specific mRNA features (e.g., untranslated region [UTR] length, RNA-binding protein [RBP] motifs, and upstream open reading frames [uORFs]). For over 800 mRNAs, the dominant source of translation was the neuropil. We constructed a searchable and interactive database for exploring mRNA transcripts and their translation levels in the somata and neuropil [MPI Brain Research, The mRNA translation landscape in the synaptic neuropil. https://public.brain.mpg.de/dashapps/localseq/. Accessed 5 October 2021]. Overall, our findings emphasize the substantial contribution of local translation to maintaining synaptic protein levels and indicate that on-site translational control is an important mechanism to control synaptic strength.

At neuronal synapses, more than 2,500 proteins (1, 2) (the synaptic proteome) act as sensors and effectors to control neuronal excitability, synaptic strength, and plasticity. The elaborate morphology and functional compartmentalization of the individual neuron imposes unique logistical challenges to maintain and modify the synaptic proteome at locations remote from the transcription source (i.e., the nucleus). To fulfill the local demand for new protein, neurons localize messenger RNAs (mRNAs) and ribosomes near synapses to produce proteins directly where they are needed (1). Using high-throughput sequencing, several groups have reported the localization of thousands of transcripts to axons and dendrites (the local transcriptome) (37). In many cell types, however, it has been shown that the transcript levels do not always predict protein levels (8), suggesting that mRNA translation is a highly regulated process. Since proteins, rather than mRNAs, drive cellular function, it is imperative to determine directly which transcripts are translated into proteins in dendrites and/or axons in vivo (the local translatome). Importantly, it remains unknown which transcripts exhibit differential levels of translation between somatic and synaptic regions.

A given transcripts translation level is determined by the rate of ribosome recruitment to the start codon during initiation and the velocity of ribosome translocation during polypeptide elongation. For most mRNAs, translation initiation is considered rate limiting (9): Initiation is regulated by elements within the mRNAs untranslated regions (UTRs) that bind RNA-binding proteins (RBPs) or miRNAs (1012). In addition, the elongation rate also plays a regulatory role in determining the amount of protein produced from a transcript (13). Although disrupted translational control has been linked to a number of neurological disorders (14), little is known about the magnitude and mechanisms for transcript-specific translational regulation in neuronal compartments.

In this study, we combined deep sequencing of ribosome-protected fragments (ribosome sequencing [Ribo-seq]) and RNA sequencing (RNA-seq) of microdissected hippocampal rodent brain sections to provide a comprehensive analysis of the mRNA translational landscape both in the somata (enriched in cell bodies) and the neuropil (enriched in neuronal dendrites/axons). Thousands of mRNAs were translated in the somatic and synaptic regions. Many transcripts exhibited differential translation levels between somatic and synaptic regions. Many of these translational changes likely resulted from differences in the RNA levels between the somata and neuropil. Furthermore, we found evidence for pervasive translational regulation of synaptic proteins in both neuronal compartments. We provide a dynamic query-based web interface for exploring mRNA transcripts and their translation in neuronal compartments (15). Together, our results reveal an unprecedented capacity for local protein production in vivo to maintain and modify the pre- and postsynaptic proteome.

To discover the mRNA species localized and translated in cell bodies as well as dendrites and axons we carried out a genome-wide analysis of the transcriptome and translatome of the somata and neuropil from microdissected hippocampal slices (16). Ribosome footprints were obtained from somata and neuropil lysates to assess the number and position of translating ribosomes on a transcript (Ribo-seq) (17). In parallel, transcript levels were quantified by performing RNA-seq from the somata and neuropil (Fig. 1A) (16). The RNA- and Ribo-seq libraries from the somata and neuropil were highly reproducible among the three biological replicates (SI Appendix, Fig. S1 A and B). Furthermore, the Ribo-seq samples exhibited the expected depletion of footprint read densities in the UTRs and introns of transcripts (SI Appendix, Fig. S1 C and D), as well as three-nucleotide phasing (SI Appendix, Fig. S1 E and F) (17).

Many transcripts display differential translation between the somata and neuropil. (A) Experimental workflow. Microdissection of the CA1 region of the rat hippocampus. RNA-seq and Ribo-seq were conducted simultaneously for the somata (enriched in pyramidal neuron cell bodies) and the neuropil (enriched in dendrites and axons) layers. A neuronal filter was applied to enrich for excitatory neuron transcripts in downstream analyses. (B) Volcano plot comparing the translational level of 7,850 transcripts between compartments (neuropil:somata Ribo-seq ratio [log2FC]). FDR < 0.05 using DESeq2 (Experimental Procedures). Colored dots highlight the transcripts significantly more translated in the somata (somata [smt]-translation-up, n = 2,945, orange) or neuropil (neuropil [npl]-translation-up, n = 807, teal). (C) Coverage tracks representing the average neuropil (Top) or somata (Bottom) ribosome footprint coverage for candidate smt-translation-up (Gria2, Neurod6, and Hpca) and npl-translation-up (Shank1, Map2, and Dgkz) transcripts. The y axis indicates the number of normalized reads. (D) Schematic depicting in vivo ribosome run-off following harringtonine incubation of rat hippocampal cultures. (E) Elongation rates for smt-translation-up (orange), npl-translation-up (teal), and other (gray) transcripts inferred from the slope of the linear fit shown in SI Appendix, Fig. S4 are plotted with their SE (n = 3). P = 0.5738, One-way ANOVA. Har, harringtonine; Chx, cycloheximide; ns, not significant.

We detected 13,055 and 12,371 transcripts with one count per million (CPM) in two of three neuropil (SI Appendix, Fig. S2A) or somata (SI Appendix, Fig. S2B) Ribo-seq replicates, respectively. Using the Ribo-seq datasets, we found substantial overlap between our translatome data and a previously published neuropil (SI Appendix, Fig. S2A) and somata (SI Appendix, Fig. S2B) transcriptome (3). The somata and neuropil of the hippocampus contain excitatory neuron cell bodies and their processes, as well as glia and interneurons. We created a pipeline to focus on excitatory neuron genes by minimizing the contribution of other cell types via bioinformatic filtering. To obtain a comprehensive set of glia-enriched transcripts, we prepared hippocampal neuron- and glia-enriched cultures (SI Appendix, Fig. S2C and Dataset S1). Because the somata and neuropil do not only contain glia but also interneurons, we additionally compiled lists of transcripts enriched in nonexcitatory neuron cell types in the hippocampus. To do so, we identified the transcripts significantly deenriched in the hippocampi of two different RiboTag mouse lines that target primarily excitatory neurons: Camk2Cre::RiboTag mice (SI Appendix, Fig. S2D), as well as the microdissected somata (SI Appendix, Fig. S2E) and neuropil (SI Appendix, Fig. S2F) from Wfs1Cre::RiboTag mice (16). Combining these datasets, we obtained a list of contaminant nonexcitatory neuron genes (SI Appendix, Fig. S2G).

The number of ribosomes loaded on a transcript indicates how much it is translated. To identify transcripts that exhibit differential translation between the somata and neuropil, we computed neuropil:somata Ribo-seq ratios (DESeq2) (18) (Experimental Procedures). After subtraction of the contaminant genes, we detected 7,850 neuronal transcripts (SI Appendix, Fig. S2H) (19) that were translated in both the somata and neuropil (Fig. 1B). Of these, 807 transcripts exhibited significantly increased translation levels in the neuropil compared to the somata (neuropil-translation-up) (Fig. 1B and Dataset S2). The neuropil-translation-up transcripts included, for example, Shank1, Map2, and Dgkz (Fig. 1 B and C). In contrast, 2,945 transcripts showed increased translation in the somata, including Gria2, Neurod6, and Hpca (somata-translation-up) (Fig. 1 B and C and Dataset S2). Both neuropil- and somata-translation-up transcripts exhibited three-nucleotide periodicity arising from the codon-by-codon translocation of ribosomes along mRNAs during translation in the neuropil and somata, respectively (SI Appendix, Fig. S3 A and B). Consistent with previous findings (12), the neuropil-translation-up transcripts displayed significantly longer 3 UTRs (SI Appendix, Fig. S3C).

Previous studies suggested that mRNAs present in dendrites and/or axons might be translationally silenced, via the pausing of ribosomes at the level of elongation (13, 20). To address this, we asked whether the neuropil- and somata-translation-up transcripts exhibited differences in the speed of translation elongation. We performed a time series of ribosome run-off by incubating cultured hippocampal neurons for 15, 30, 45, or 90 s with harringtonine, a drug that immobilizes ribosomes immediately after translation initiation, resulting in a progressive run-off of ribosomes over time (Fig. 1D and SI Appendix, Fig. S4). We analyzed the rate of ribosome progression (elongation) from the 5 end of neuropil- and somata-translation-up transcripts (SI Appendix, Fig. S4). The neuropil- and somata-translation-up transcript subsets displayed a similar elongation rate of 4 codons per second (Fig. 1E and SI Appendix, Fig. S4), a value that is within the range measured in other cell types (3 to 10 codons per second) (2124). Together, these findings indicate that neuropil-translation-up mRNAs are globally not significantly more paused than other transcripts.

To examine whether particular protein function groups are encoded by transcripts that exhibit increased translation levels in either compartment, we performed a gene ontology (GO) analysis (Fig. 2 A and B). An enrichment of terms associated with synaptic function was found for both somata- and neuropil-translation-up transcripts (Fig. 2 A and B). For the somata-translation-up transcripts, we observed a significant overrepresentation of the term perikaryon as well as many membrane-related terms such as integral component of postsynaptic density membrane, presynaptic membrane, or synaptic vesicle membrane (Fig. 2A). On the other hand, mostly postsynaptic functions were significantly associated with the neuropil-translation-up transcripts, including for example dendritic spine and postsynaptic density (Fig. 2B). To understand better the synaptic function of the neuropil- and somata-translation-up transcripts, we analyzed the neuropil:somata Ribo-seq fold changes of excitatory synaptic proteins (Fig. 2C). We noted that ionotropic and metabotropic glutamate receptor subunits (AMPARs, NMDARs, and mGluRs) mostly displayed greater translation levels in the somata (Fig. 2C). In contrast, many glutamate receptor-associated accessory (e.g., Cnih2) or scaffold proteins (e.g., Shank1, Dlg4, and Homer2) exhibited increased translation levels in the neuropil (Fig. 2C). Also, we found that many presynaptic proteins exhibited greater protein synthesis rates in the somata (Fig. 2C). Interestingly, we identified several nuclear-encoded mRNAs related to mitochondrial function that exhibited enhanced translation levels in the neuropil (e.g., Timm8a1 and Mrpl40) (Fig. 2C).

Functional segregation of transcripts differentially translated between the somata and neuropil. (A and B) GO terms representing the top five highest significantly enriched (FDR < 0.05) protein function groups for somata-translation-up (A) and neuropil-translation-up (B) transcripts. (C) Scheme depicting proteins of glutamatergic synapses. Ribo-seq neuropil:somata ratios (log2FC) are color coded from orange (more somata-translated) to teal (more neuropil-translated). Interacting proteins are displayed in closer proximity. Proteins with similar functions are grouped together and the synaptic vesicle cycle is indicated by arrows.

The mRNA transcript and translation profiles in the somata and neuropil are available for download and exploration at a searchable web interface (https://public.brain.mpg.de/dashapps/localseq/). This interactive database allows viewers to compare transcript and mRNA translation levels between neuronal compartments.

The translation level of a given transcript is proportional to its abundance and its ribosome density. We thus asked whether differential translation of somata- and neuropil-translation-up transcripts was associated with between-compartment changes in RNA levels (Dataset S3). Indeed, neuropil-translation-up transcripts displayed significantly higher neuropil:somata RNA-seq ratios compared to somata-translation-up genes (Fig. 3A). In order to validate these observations in situ in hippocampal slices, we performed high-resolution fluorescence in situ hybridization (FISH) for 14 candidate transcripts with significantly different translation levels between the somata and neuropil (Fig. 3 BD). The in situ hybridization signal detected was highest in expected compartment (i.e., somata for somata-translation-up, Fig. 3 B and D, and neuropil for neuropil-translation-up, Fig. 3 C and D). Taken together, both the RNA-seq and FISH analyses revealed that increased translation in the somata or neuropil was accompanied by higher RNA levels in the same neuronal compartment.

Differential translation of neuropil- and somata-translation-up genes is accompanied by between-compartment changes in RNA levels. (A) Box plot representing the neuropil:somata RNA-seq ratio (log2FC) for somata (smt)-translation-up (orange) and neuropil (npl)-translation-up (teal) genes (DESeq2; Experimental Procedures). (B and C) (Top) Neuropil:somata RNA-and Ribo-seq ratios (log2FC) for candidate smt-translation-up genes (Gria2, Cacng8, Uchl1, Sv2b, Syp1, Gria1, and Snap25) (B) and npl-translation-up genes (Aco2, Dlg4, Hpcal4, Cnih2, Ddn, Eef2, and Camk2a) (C). (Bottom) FISH signal in the CA1 region of rat hippocampal slices using probes against smt- (B) and npl-translation-up (C) candidate genes. The dendrites were immunostained with an anti-MAP2 antibody (purple). (Scale bar, 50 m.) (D) Neuropil:somata ratio of mRNA puncta relative to the mean neuropil:somata ratio of the smt-translation-up genes (***P < 2.2e-16, MannWhitney U Test between all smt-translation-up and all npl-translation-up genes).

We next compared gene-level translation efficiencies (TEs) between the neuropil and somata by computing the ratio of ribosome footprints (from Ribo-seq) to mRNA fragments (from RNA-seq) (17) in both compartments (Fig. 4A and Dataset S4). We observed a good correlation between the somata and neuropil TE values, indicating that most transcripts exhibit similar translational regulation in both neuronal compartments (Fig. 4A, R2 = 0.92, P < 2.2e-16). For instance, Syngap1 exhibited low footprint-to-mRNA ratios in both somata and neuropil, indicating the relatively poor translational efficiency of this transcript (Fig. 4 A and B). In contrast, Camk2a was found translated with high efficiency (high footprint-to-mRNA ratio) in both neuronal compartments (Fig. 4 A and B). We also identified a handful of mRNAs that displayed significantly higher TE values in the somata, including, for example, Kif5c (Fig. 4 A and B). Thus, many but not all of the between-compartment differences in ribosome footprint levels can be accounted for by differences in the amount of mRNA present.

Most transcripts exhibit similar translational efficiency in the somata and neuropil. (A) Correlation of the translational efficiencies (TE; log2Ribo-Seq/RNA-seq) in the neuropil and somata (R2 = 0.92, P < 2.2e-16). Highlighted are genes with significantly higher (TEhigh, yellow) or lower (TElow, blue) TE than log2 1.5 (FDR < 0.05, DESeq2) in both somata and neuropil. Genes with significantly differential TE between somata and neuropil are shown in red. DESeq2 with FDR <0.05. Marginal rug (gray) represents the distribution of the TE values in the somata (x axis) and neuropil (y axis). (B) Coverage tracks representing the average ribosome footprint or RNA coverage for candidate genes (Syngap1, Kif5c, and Camk2a) in the neuropil and somata. The y axis indicates reads per million (RPM). (C and D) GO terms representing significantly enriched (FDR < 0.05) protein function groups for TElow (C) and TEhigh (D) transcripts. (E) Empirical cumulative distribution frequency (Ecdf) of the TE (log2FC) of SFARI autism associated (yellow) and other (black) genes. P = 2.579e-05, KolmogorovSmirnov test.

In both neuronal compartments, we observed a wide distribution of translation efficiencies, with a greater than 1,000-fold difference between the most and least efficiently translated transcripts in the neuropil (Fig. 4A). We identified 730 and 592 transcripts exhibiting significantly high or low translational efficiencies, respectively, in both somata and neuropil (Fig. 4A and Dataset S4). We identified gene features associated with these two groups which we call TElow and TEhigh. GO analysis revealed an enrichment of terms such as spindle and microtubule organizing center for TElow genes (Fig. 4C). In contrast, TEhigh genes were associated with terms such as intrinsic component of synaptic vesicle membrane and intrinsic component of postsynaptic membrane (Fig. 4D). As a group, TElow transcripts had longer coding sequences (CDS), consistent with previous observations (2527) (SI Appendix, Fig. S5A). Because autism risk factor genes have been described to be exceptionally long (2830), we analyzed the TE values of Simons Foundation Autism Research Initiative (SFARI) transcripts. We found that SFARI transcripts displayed overall lower TE values compared to other genes (Fig. 4E). The efficiency of mRNA translation is also influenced by elements within the UTRs that serve as binding platforms for regulatory RBPs (10, 12). Because longer UTRs harbor more cis-acting elements (10, 12), we examined the 5 and 3 UTR length of the translationally regulated transcripts. We found that TElow genes exhibited significantly longer 5 and 3 UTRs (Fig. 5 A and B). To identify potential RBPs for the neuropil UTRs, we searched for known RBP consensus motifs (31) and determined whether transcript groups sharing the same motifs were associated with higher or lower TE values in the neuropil (Experimental Procedures). A total of 131 3 UTR motifs targeted by 52 RBPs (Dataset S5) were associated with transcripts displaying significantly higher TE values in the neuropil (Fig. 5C; for somata see SI Appendix, Fig. S5B and Dataset S6). For example, consistent with their described role as translational enhancers (3234), HNRNPK and MBNL1 motifs were detected in transcripts exhibiting significantly higher TE values (Fig. 5C). On the other hand, 155 3 UTR motifs targeted by 90 RBPs (Dataset S5) were associated with transcripts exhibiting significantly lower neuropil TE values in the neuropil (Fig. 5C). Among these, we identified, for example, the CPEB, Hu (Elav), and PUF/Pumilio RBP families, all known for their repressive action on translation in neuronal processes (35). We note that none of the RBP motifs we detected within neuropil 5 UTRs were associated with transcripts displaying significantly higher or lower neuropil or somata TE (Datasets S7 and S8). Our results thus reveal the identity of potentially novel regulators that bind the 3 UTR and control translation, either directly or indirectly for example via the regulation of polyadenylation (34) or mRNA decay (35).

Features of translationally regulated transcripts in the somata and neuropil. (A and B) Box plots of 5 UTR (A) and 3 UTR (B) length (log10 nucleotides (nts) for TEhigh (yellow), TElow (blue), and other (gray) genes. Bars indicate 1.5*IQR. *P < 0.05, ****P < 0.0001; one-way ANOVA test followed by pairwise t test with BenjaminiHochberg P value adjustment. (C) Shown are RBP motifs within 3 UTRs associated with significantly lower (blue) or higher (yellow) neuropil TE values (q values < 0.05; Wilcoxon rank sum test) (Experimental Procedures). (D) Detection of translated uORFs in hippocampal neurons. Translation initiation sites were mapped using the drug harringtonine (har), which accumulates ribosomes at start codons. A total of 766 uORF-containing neuronal transcripts were detected in the somata and neuropil. (E) Coverage tracks representing the average ribosome footprint reads along the UTRs (gray), detected uORFs (orange), or the main protein coding sequence (blue) of Dlg4, Gria2, Taok1, and Ppp1r9b in the neuropil. The y axis indicates reads per million (RPM). (F) Observed-to-expected ratio of TEhigh (teal), TElow (blue), and other (gray) transcripts containing uORFs. **P < 0.01, ***P < 0.001, ****P < 0.0001; hypergeometric test. (G) Neuropil TE (log2FC) measurements of transcripts containing translated uORFs (uORF) or not (no uORF). ****P < 0.0001; Welch two-sample t test. (H) GO terms representing the top eight significantly (FDR < 0.05) enriched protein function groups for uORF-containing transcripts in the neuropil.

Upstream open reading frames (uORFs) also play an important role in regulating the translation of the main protein coding sequence (36). While most uORFs are believed to exert a negative effect on the translation of downstream ORFs (36), a few examples of positive-acting uORFs have been reported (37, 38). We identified translated uORFs in neuronal compartments using an integrated experimental and computational approach. To map upstream translation initiation sites within neuronal transcripts, we performed Ribo-seq on neurons treated with the drug harringtonine, which causes the accumulation of ribosomes at start codons (21) (Fig. 5D and Experimental Procedures). We then used the ORF-RATER pipeline to identify and quantify translated uORFs in the neuropil- and somata Ribo-seq data (Experimental Procedures) (39). In total, we identified 766 uORF-containing mRNAs in neuronal compartments (Fig. 5D and Dataset S9), including novel (e.g., Gria2, Taok1, Dlg4, and Ppp1r9b) (Fig. 5E and SI Appendix, Fig. S5C) and previously described (e.g., Atf4 and Ppp1r15b) (38, 40) (SI Appendix, Fig. S5D) transcripts. A comparison of TElow and TEhigh transcripts revealed an overrepresentation of uORF-containing transcripts in the TElow group and an underrepresentation of uORF-containing transcripts in the TEhigh group (Fig. 5F). Additionally, uORF-containing transcripts displayed a significantly lower neuropil median TE value when compared with non-uORF-containing mRNAs (Fig. 5G and SI Appendix, Fig. S5E for the somata). Using the neuropil Ribo-seq data, we next computed a relative uORF to CDS ribosome density for each uORF. Of interest, the relative uORF:CDS ribosome densities ranged from 0.1 to 1,000, indicating a wide spread in the uORF-mediated translational repression in the neuropil (SI Appendix, Fig. S5F). Many uORFs displayed uORF:CDS ribosome density ratios greater than 1, indicating that uORFs often act as CDS translational repressors. A GO analysis indicated that above described uORF-containing neuropil and somata mRNAs were significantly enriched for terms like positive regulation of synapse assembly, regulation of membrane potential, and behavior (Fig. 5H). These findings highlight uORFs as an important translational regulatory element present in many transcripts in somatic and synaptic regions.

Using ribosome profiling, we detected thousands of mRNA species that are translated in synaptic regions, dramatically expanding the contribution of ongoing local protein synthesis to the protein pool detected in dendrites, axons, or synapses (4144). Indeed, among the locally translated mRNAs, we identified most protein families, including signaling molecules (kinases or phosphatases), ion channels, metabotropic and ionotropic receptors, cell adhesion molecules, scaffold proteins, as well as regulators of cytoskeleton remodeling or translation.

Many transcripts were found differentially translated between neuronal compartments. An open question in the field has concerned the contribution of local synthesis to the total pool of a particular protein. Our data indicate that most proteins are synthesized in both compartments. We note that over 800 mRNAs displayed enhanced translation levels in the neuropil, suggesting that most of these proteins arise from a local source. For many transcripts, the abundance of the mRNA was positively associated with the translation level differences between somata and neuropil, as observed previously in developing neurons derived from mouse embryonic stem cells (45). Notably, the neuropil-translation-up transcripts often encoded signaling and scaffold proteins that play an important role in the maintenance and modification of synaptic strength. Of interest, we detected several mitochondrial mRNAs that displayed enhanced neuropil translation. Recently, it has been shown that endosomes can act as platforms for the local translation of candidate mitochondrial mRNAs (46). It is thus tempting to hypothesize that local translation plays a role in sustaining mitochondria, which in turn fuel protein synthesis near synapses during plasticity (47). Together, our results suggest that the increased translation levels of a specific transcript subset in the neuropil likely provide a means to ensure the efficient production of key synaptic proteins at very remote locations from the cell body.

In contrast the transcripts with increased translation levels in the somata often encoded transmembrane proteins. This protein class is typically processed through multiple membrane-bound organelles (including the endoplasmic reticulum [ER] and Golgi apparatus [GA]), where they are folded, assembled, and biochemically modified prior to their delivery to the neuronal cell surface (48). However, recent studies reported that hundreds of neuronal surface proteins (e.g., the AMPAR subunit GluA1) bypass GA maturation and likely travel directly from the ER to the neuronal cell surface (49, 50). Thus, although the bulk synthesis and posttranslational modification of transmembrane proteins might occur in the somatic ER and GA, a small residual fraction of this protein class could undergo on demand local translation to fine tune synaptic strength.

Using a combination of microdissection with Ribo-and RNA-seq, we found that most transcripts exhibit similar translational regulation in the somata and neuropil. In both neuronal compartments, we detected widespread translational regulation, with an unexpectedly high dynamic range in the translation efficiencies of transcripts. Among the mechanisms that regulate the synthesis of proteins in somatic and synaptic regions, we identified uORF-mediated translational control. This finding is in good agreement with previous studies revealing the role of uORFs in the translational regulation of two candidate transcripts in neuronal processes (51, 52). uORF-mediated translational control is often fine tuned by the phosphorylation of eukaryotic initiation factor 2 (eIF2) (53). The phosphorylation of eIF2 inhibits global translation while leading to a paradoxical increase in the translation of a subset of uORF-bearing transcripts (54). Many manipulations of cellular and synaptic activity modulate the phosphorylation status of eIF2 in neurons in vivo and in vitro (5457). Thus, activity-driven eIF2 phosphorylation could act as a switch to enhance the local translational efficiency of uORF-containing transcripts encoding key plasticity-related proteins. It is noteworthy that the translational regulation of some uORF-containing transcripts is insensitive to changes in the eIF2 phosphorylation status (e.g., the protein phosphatase 1 regulatory subunit CReP [Ppp1r15b]) (40).

Electron microscopy (EM) studies have shown that the distribution of the ribosomes along neuronal processes is heterogeneous, with a selective localization of protein-making machines (i.e., polyribosomes, more than three ribosomes per mRNA) beneath synapses, while only a few polyribosomes could be observed in CA1 dendritic shafts (58, 59). Dendritic shafts could be mostly populated by monosomes (i.e., single ribosome per mRNA) that cannot be visualized by EM but also represent active protein making machines in synaptic regions (16). Indeed, a recent superresolution study which likely detects both monosomes and polysomes identified a greater ribosome density in dendrites compared to EM studies (60). These observations raise intriguing questions about the definition of local translation compartments: Are different protein species synthesized within distinct subregions of neuronal processes (e.g., spines vs. dendritic shafts)? And: Could the translation efficiency of the same transcript vary depending on whether it is localized beneath synapses or in other dendritic regions? These questions set the stage for future studies characterizing the translational landscape in neuronal subregions with greater spatial resolution using, for example, proximity-specific ribosome profiling.

Timed pregnant specific-pathogen-free (Charles River Laboratories) female rats were housed in Max Planck Institute for Brain Research animal facility for 1 wk on a 12/12-h light/dark cycle with food and water ad libitum until the litter was born. Cultured neurons were derived from P0 (postnatal day 0) Sprague-Dawley rat pups (both male and female, research resource identifier: 734476). Pups were killed by decapitation. The housing and killing procedures involving animal treatment and care were conducted in conformity with the institutional guidelines that are in compliance with national and international laws and policies (Directive 2010/63/EU; German animal welfare law; Federation of European Laboratory Animal Science Associations guidelines). The animals were killed according to annex 2 of 2 Abs. 2 Tierschutz-Versuchstier-Verordnung. Animal numbers were reported to the local authority (Regierungsprsidium Darmstadt, approval numbers: V54-19c20/15-F126/1020 and V54-19c20/15-F126/1023).

Total Ribo-seq (including monosomes and polysomes) and RNA-seq libraries from microdissected rat somata and neuropil of three biological replicates were generated previously (16) (SI Appendix, Table S1). In short, somata and neuropil were microdissected from 4-wk-old male rats. The tissue samples were homogenized in polysome lysis buffer (20 mM Tris pH 7.5, 150 mM NaCl, 5 mM MgCl2, 24 U/mL TurboDNase, 100 g/mL cycloheximide, 1 mM dithiothreitol (DTT), 1% Triton X-100, and protease inhibitor mixture [Roche]) by douncing in a glass homogenizer. After triturating the lysate 10 times using a 23-gauge syringe, samples were chilled on ice for 10 min and cleared by two centrifugations at 16,100 g for 6 min. From the somata and neuropil lysates Ribo-seq and RNA-seq libraries were prepared simultaneously. For Ribo-seq, neuropil and somata lysates containing equal amounts of total RNA were digested with 0.5 U/g RNase I (Epicentre), shaking for 45 min at 400 rpm at 24C. Nuclease digestion reactions were promptly cooled and spun, and 10 L of SUPERaseIN*RNase inhibitor was added. Samples were then layered onto a 34% sucrose cushion, prepared wt/vol in gradient buffer supplemented with 20 U/L of SUPERaseIN*RNase inhibitor. 80S particles were pelleted by centrifugation in a SW55Ti rotor for 3 h 30 min at 55,000 rpm at 4C. Ribo-seq libraries were prepared according to ref. 61 with the modifications described in ref. 16. Total RNA was isolated from tissue lysates using the Direct-zol RNA micro prep kit (Zymo). RNA integrity was assessed using the Agilent RNA 6000 Nano kit. Rat neuropil and somata total RNA-seq libraries were prepared from an equal amount of total RNA using the TruSeq stranded total RNA library prep gold kit (Illumina) (16). Libraries were sequenced on an Illumina NextSeq500, using a single-end 52- and 75-bp run for Ribo-seq and RNA-seq, respectively.

Neuron-enriched and glia-enriched cultures were prepared from the same litter as described previously (12). The hippocampi of P0-d-old rat pups were isolated and triturated after digestion with papain. Both cultures were plated on 60-mm cell culture dishes. For the preparation of hippocampal neuron-enriched cultures, cells were plated onto poly-d-lysine-coated 60-mm cell culture dishes and treated as described above with Ara-C (Sigma) at a final concentration of 5 M for 48 h. After 48 h, the medium was replaced with preconditioned growth medium and cells were cultured until 21 d in vitro (DIV). For the preparation of glia-enriched cultures, cells were plated onto uncoated 60-mm cell culture dishes in conditioned minimal essential medium (minimal essential medium, 10% horse serum, 0.6% glucose [wt/vol]). At 7 DIV, the medium was replaced with preconditioned growth medium and cells were cultured until 21 DIV. Four independent biological replicates were prepared. RNA was isolated using the Direct-zol RNA micro prep kit (Zymo). RNA integrity was assessed using the Agilent RNA 6000 Nano kit. mRNA-seq libraries were prepared starting from 200 ng of total RNA, using the TruSeq stranded mRNA library prep kit (Illumina). Libraries were sequenced on an Illumina NextSeq500, using a single-end, 75-bp run.

The input- and translating ribosome affinity purification (TRAP)-seq libraries from hippocampi of Camk2a-Cre-RiboTag or somata/neuropil sections of Wfs1-Cre-RiboTag mice were generated previously (16) (SI Appendix, Table S1).

Dissociated rat hippocampal neurons were prepared from P0-d-old rat pups as described previously (62). Hippocampal neurons were plated at a density of 31,250 cells/cm2 onto poly-d-lysine-coated 100-mm dishes and cultured in preconditioned growth medium (Neurobasal-A, B27, GlutaMAX, 30% glia-culture supernatant, 15% cortex-culture supernatant) for 21 DIV. At 1 DIV, cells were treated with Ara-C (Sigma) at a final concentration of 5 M to prevent the overgrowth of nonneuronal cells. After 48 h, the medium was replaced with preconditioned growth medium and cells were cultured until 21 DIV. Cells were fed with 1 mL of preconditioned medium every 7 d. Three independent biological replicates were prepared. At 24 h before drug treatment, cell medium was adjusted to 8 mL per dish. In appropriate experiments, harringtonine (LKT Laboratories) was added to a final concentration of 2 g/mL from a 5 mg/mL stock in 100% ethanol. Cells were returned to the incubator at 37C for 15, 30, 45, 90, or 150 s. Cycloheximide was added to a final concentration of 100 g/mL from a stock of 50 mg/mL in 100% ethanol. After drug addition, cells were returned to the incubator at 37C for 1 min. After the incubation with cycloheximide, the cells were immediately placed on ice and washed twice with ice-cold phosphate-buffered saline (PBS) plus 100 g/mL cycloheximide and scraped in polysome lysis buffer (20 mM Tris pH 7.5, 150 mM NaCl, 5 mM MgCl2, 24 U/mL TurboDNase, 100 g/mL cycloheximide, 1 mM DTT, 1% Triton-X-100, and protease inhibitor mixture [Roche]) (21). After scraping, the lysates were triturated 10 times using a 23-gauge syringe; samples were chilled on ice for 10 min and then cleared by centrifugation at 16,100 g for 10 min. Ribo-seq libraries from rat hippocampal neuron cultures treated for 0, 15, 30, 45, 90, and 150 s with harringtonine were prepared as described above. The 0-, 30-, and 90-s datasets were previously published in ref. 16 (SI Appendix, Table S1).

Four-week-old male rats were perfused with 1 RNase-free PBS and fixative solution (4% (vol/vol) paraformaldehyde (PFA), 4% (wt/vol) sucrose in 1 RNase-free PBS). Brains were dissected and fixed for another hour at room temperature. Brains were cryoprotected for two consecutive days at 4C. In 15% (wt/vol) sucrose in RNase-free 1 PBS on day 1, followed by 30% (wt/vol) sucrose in RNase-free 1 PBS on day 2. Hippocampi were cryosectioned at 30-m thickness.

Fluorescence in situ hybridization was performed using the QuantiGene ViewRNA kit (Thermo Fisher) mostly following the manufacturers instructions. In brief, hippocampal slices were postfixed for 10 min at room temperature in fixative solution (4% [vol/vol] PFA, 5.4% [wt/vol] glucose, 0.01 M sodium metaperiodate in 1 lysine-phosphate buffer). The manufacturer recommended proteinase K treatment was omitted to preserve the integrity of the dendrites. Slices were permeabilized for 20 min using the kits detergent buffer. Detection probes were incubated overnight at 40C. Preamplification, amplification, and label probes were incubated for 60 min at 40C, respectively, washing three times for 5 min between each step. After completion of in situ hybridization, slices were washed with 1 PBS and incubated in blocking buffer (4% [vol/vol] goat serum 1 PBS) for 1 h at room temperature. The primary antibody (gp-anti-MAP2, SYSY 188004, 1:1,000) was incubated overnight in blocking buffer at 4C. Slices were washed five times for 10 min in 1 PBS and the secondary antibody (gt-anti-gp Alexa 647, Thermo Fisher A21450, 1:500) was incubated in blocking buffer for 5 h at room temperature. Slices were washed in 1 PBS and nuclei were stained with DAPI for 3 min at room temperature. Slices were mounted in AquaPolyMount.

Slices were imaged using a Zeiss LSM780 confocal microscope and a 40 oil objective (numerical aperture [NA] 1.3). Z stacks spanning the entire slice volume were obtained using appropriate excitation laser lines and spectral detection windows. The mRNA signal was dilated for better visualization. The raw, nondilated images were used for analysis.

An in-house Python script was used to count mRNA puncta in the somata and the neuropil layer, respectively. In the neuropil, puncta colocalizing with DAPI signal (arising from glia or interneurons) were excluded from the analysis. Counts were normalized by area and a neuropil-to-somata ratio was computed for each slice. The mean neuropil-to-somata ratio was calculated for somata-translation-up target genes. All neuropil-to-somata ratios were divided by this average.

Sequencing adapters were trimmed using the Cutadapt software version 1.15 (63) with the following arguments: cut 1minimum-length 22 discard-untrimmed overlap 3 -e 0.2. An extended unique molecular identifier (UMI) was constructed from the two random nucleotides (nts) of the reverse transcription primer and the five random nucleotides of the linker and added to the FASTQ description line using a custom Perl script. To remove reads originating from noncoding RNA (ncRNA, i.e., rRNA), trimmed reads were aligned to rat ncRNA using Bowtie2 version 2.3.5.1 (very-sensitive) (64) and aligned reads were discarded. The remaining reads were aligned to the rat genome (rn6) with the split-aware aligner STAR version 2.7.3.a (65) with the following arguments: twopassMode Basic twopass1readsN -1 seedSearchStartLmax 15 outSJfilterOverhangMin 15 8 8 8 outFilterMismatchNoverReadLmax 0.1. To retrieve transcript coordinates, STARs quant mode (quantMode) was used. Throughout the study, genome alignments were used for differential expression analyses and genomic feature analyses. Transcriptome alignments were used for all other analyses. The STAR genome index was built using annotation downloaded from the University of California Santa Cruz (UCSC) table browser (66). PCR duplicates were suppressed using a custom Perl script and alignments flagged as secondary alignment were discarded before analysis. Only footprints with sizes between 24 and 34 nts were used for analyses.

Sequencing adapters and low-quality nucleotides were trimmed using the Cutadapt software version 1.15 (63) with the following arguments: minimum-length 25nextseq-trim = 20. The trimmed reads were aligned to the rat (rn6) or the mouse (mm10) genome with STAR version 2.7.3a (65).

The coordinates of genomic features (CDS, 3 UTR, 5 UTR, intron) were downloaded from the UCSC table browser in BED format (66). Bedtools version 2.26.0 (67) was used to convert BAM into BED files and to identify reads overlapping with the individual features.

P-site offsets were defined for different footprint lengths. Each footprint start position defined the footprint frame in reference to the annotated start codon. The footprint reads were virtually back projected over the start codon and the offsets from the start and the end of the read were calculated. We used every read of a given length and accumulated the most probable offset and frame. Next, the P-site position per footprint read was deduced from its length and the previously determined offset. All P-site positions were plotted for 100 nucleotides around the start and stop codons, and the center of a transcript. To correct for differences in translation rates between genes, the P-site coverage of each gene was normalized to its mean footprint coverage. The nucleotide coverage at the 0, 1, and 2 frame positions were assessed. A one-way analysis of variance (ANOVA) was used to determine if the observed frame fraction was different from the expected frame fraction. A significant P value rejected the null hypothesis that all frames featured the expected P-site coverage.

Footprint alignments were converted into the BedGraph file format using Bedtools version 2.26.0 and visualized as custom tracks on the UCSC Genome Browser (68). Footprint coverages were corrected for sequencing depth.

For both total RNA sequencing and ribosome footprint libraries from the somata and neuropil, the software featureCounts version 2.0.0 (69) was used to calculate counts per gene from reads that were aligned to the rat genome. All annotated transcript isoforms were considered. Raw counts were fed into DESeq2 version 1.30.1 and log fold change (LFC) shrinkage was used (18). Only genes with an adjusted P value are displayed in Fig. 1B.

The software featureCounts version 2.0.0 (69) was used to calculate counts per gene from reads mapped to the genome (mm10, rn6). All annotated transcript isoforms were considered. Raw counts were fed into DESeq2 version 1.30.1 and LFC shrinkage was used (18).

Gene ontology analysis was performed for neuropil- and somata-translation-up genes. All detected genes (baseMean greater than zero and with an adjusted P value), without the contaminants, were used as background. GO enrichment analysis was performed for the complete cellular component annotation using the PANTHER overrepresentation test (70, 71). The Fisher exact test was used and only GO terms with a false discovery rate (FDR) smaller than 0.05 were considered. The most specific GO terms per branch were retained. The top five GO terms with the highest enrichment scores were visualized.

Gene ontology analysis was performed for uORF-containing transcripts. All detected genes in the neuropil and the somata (baseMean greater than zero), without the contaminants, were used as background. GO enrichment analysis was performed for the complete biological process annotation using the PANTHER overrepresentation test (70, 71). The Fisher exact test was used and only GO terms with an FDR smaller than 0.05 were considered. The most specific GO terms per branch were retained. All significant GO terms were visualized.

Gene ontology analysis was performed for TEhigh and TElow transcripts. All detected genes in the neuropil and the somata (baseMean greater than zero), without the contaminants, were used as background. GO enrichment analysis was performed for the complete cellular component annotation using the PANTHER overrepresentation test (70, 71). Only GO terms with at least 50 genes in the background set were used in the analysis. The Fisher exact test was used and only GO terms with an FDR smaller than 0.05 were considered. The most specific GO terms per branch were retained. All significant GO terms were visualized.

The number of ribosomes per transcript was estimated by integrating Ribo-seq and RNA-seq libraries to calculate TE values in the neuropil. Raw Ribo-seq and RNA-seq counts, falling into gene CDS, were fed into DESeq2 version 1.30.1 and LFC shrinkage was used (18). TE values that were either significantly higher than log2(1.5) in the neuropil and the somata or smaller than log2(1.5) in the neuropil and the somata were assigned to TEhigh and TElow, respectively [lfcThreshold = log2(1.5) with an FDR < 0.05]. Only genes with a baseMean greater than 10 in the neuropil and the somata were considered. An interaction term was added to the experimental design to compare TE values between the neuropil and the somata (72).

Genes known to be associated with autism spectrum disorders were downloaded from the SFARI Gene database (https://www.sfari.org). Human gene symbols were converted into rat gene symbols. Genes with an SFARI score of 1 and 2 were considered as autism genes.

RBP motifs (human, rat, and mouse) were downloaded as position weighted matrices from the public ATtRACT database (31). The FIMO tool from the MEME suite version 5.1.1 was used to scan 5 and 3 UTRs for motif occurrences, using the default threshold (P value = 1e-4) and a precalculated nucleotide background model derived from query sequences (73). Only genes with an RBP motif occurrence were considered for analysis. For each identified RBP motif, the motif-containing genes were grouped and a median TE value was calculated. A Wilcoxon rank sum test was conducted to test if the median TE of a given RBP motif group differed from the median TE of all genes that do not contain the motif.

The ORF-RATER pipeline (https://github.com/alexfields/ORF-RATER) was run as previously described (39), starting with the harringtonine 150 s as well as the neuropil and somata BAM files. Note, that it is possible that a translated uORF may be assigned a low score, as ORF-RATER is tuned to indicate the highest-confidence sites of translation, at the expense of an increased false negative rate (74). The following parameters were used: --codons NTG for ORF types, --minrdlen 28 --maxrdlen 34 for harringtonine-treated samples, --minrdlen 27 --maxrdlen 34 for neuropil and somata samples. Only uORFs with a score of at least 0.7, a length of at least three codons, and at least one count in each of the neuropil and the somata replicates were considered.

The ribosome density of a uORF or CDS was computed as the number of ribosome footprints divided by the uORF or CDS length, respectively. The relative ribosome density was computed as the uORF ribosome density divided by the CDS ribosome density.

The 5 and 3 UTR lengths were calculated based on the Rattus norvegicus annotation version 6 (rn6). The 3 UTR lengths were corrected in accordance with newly identified 3 UTR isoforms described in ref. 12. For genes with multiple 5 UTR isoforms the longest 5 UTR sequence was chosen, giving priority to curated isoforms. For genes with multiple 3 UTRs, the most-expressed 3 UTR isoform was chosen (12).

For the comparison of 5 UTR lengths between TEhigh, TElow, and others only 5 UTRs with a minimum length of 10 nts and a maximum length of 5,000 nts were considered. For the comparison of 3 UTR lengths between TEhigh, TElow, and others, only 3 UTRs with a minimum length of 50 nts and a maximum length of 10,000 nts were considered.

For the comparison of 3 UTR lengths between neuropil-translation-up and somata-translation-up genes, the 3 UTR isoform with the highest expression in the hippocampus per gene family was considered (12).

The coverage of each gene was projected along the CDS in transcript coordinates (only exons). Genes with CDS lengths shorter than 440 codons were omitted from analysis. Each metagene profile was scaled by the average coverage between codon 400 and 20 codons before the stop codon. For each time point, the metagene profiles were smoothed with a running average window of 30 codons. For each group, the coverage tracks were accumulated, averaged, and normalized to the 0-s condition. A baseline coverage track was defined as 85% of the nontreated sample coverage track. The first positive crossing between the harringtonine-treated coverage track and the baseline coverage track determined the crossing position in codons. Elongation rates were calculated as the slope of a linear regression between the harringtonine incubation times for each track and the crossing position in codons.

Statistical significance and the tests performed are indicated in the figure legends. Statistical analysis was performed using MATLAB and R.

Details about data availability can be found in SI Appendix, Table S1. The accession number for the raw sequencing data published previously in ref. 16 is National Center for Biotechnology Information (NCBI) BioProject: PRJNA550323. The accession number for the raw sequencing data reported in this paper is NCBI BioProject: PRJNA634994. All bioinformatic tools used in this study are contained in one modular C++ program called RiboTools. The source code and further notes on the algorithms can be found on our GitHub repository (DOI: 10.5281/zenodo.3579508). Other analysis scripts and codes are available upon request.

We thank Elena Ciirdaeva for help with mRNA library preparation. A.B. is supported by a European Molecular Biology Organization (EMBO) long-term postdoctoral fellowship (EMBO ALTF 331-2017). E.M.S. is funded by the Max Planck Society, an Advanced Investigator award from the European Research Council (Grant 743216), Deutsche Forschungsgemeinschaft (DFG) Collaborative Research Centre (CRC) 1080: Molecular and Cellular Mechanisms of Neural Homeostasis, and DFG CRC 902: Molecular Principles of RNA-Based Regulation.

Author contributions: C.G., A.B., and E.M.S. designed research; C.G., A.B., B.N.-A., A.K., I.B., and S.t.D. performed research; C.G., A.B., and G.T. analyzed data; and A.B. and E.M.S. wrote the paper.

Reviewers: C.M.A., The University of Edinburgh Centre for Genomic and Experimental Medicine; and E.K., New York University.

The authors declare no competing interest.

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This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.2113929118/-/DCSupplemental.

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The translatome of neuronal cell bodies, dendrites, and axons - pnas.org

COVID-19: Researchers warn against overhyping early-stage therapies – Medical News Today

The COVID-19 pandemic has created a sense of urgency to generate new drugs and vaccines. In many cases, this urgency became a regulatory opportunity to bypass established regulatory pathways for new drugs.

While this has led to the fast emergence of many useful drugs and vaccines for COVID-19, it has also led to a general reduction in the quality of medical research from which to derive conclusions.

For example, according to Janet Woodcock, former director of the Food and Drug Administrations (FDA) Center for Drug Evaluation and Research, an FDA analysis found that 6% of clinical trials are yielding results the agency deems actionable.

The lack of regulation coupled with a sense of urgency has also led to overhype and rushed development of certain treatments, including cell-based therapies often sold as stem cell treatments.

While some of these products have undergone well-designed, adequately controlled trials, most are in the early stages. Some clinics are nevertheless offering these unproven and unlicensed treatments to people, promising to boost their immune system or overall health to protect against COVID-19.

Promoting and selling unproven and unlicensed treatments can harm public health and could lead many to undergo untested and potentially harmful treatments.

Recently, a group of researchers from the University of California, Irvine, the Georgia Institute of Technology, the University at Buffalo, NY, and the University of Melbourne in Australia, published a report outlining misinformation around cell-based treatments for COVID-19, calling for their stronger regulation.

Efforts to rapidly develop therapeutic interventions should never occur at the expense of the ethical and scientific standards that are at the heart of responsible clinical research and innovation, said Dr. Laertis Ikonomou, assistant professor of Oral Biology at the University at Buffalo, and co-author of the study.

Scientists, regulators, and policymakers must guard against the proliferation of poorly designed, underpowered, and duplicative studies that are launched with undue haste because of the pandemic, but are unlikely to provide convincing, clinically meaningful safety and efficacy data, said co-author Dr. Leigh Turner, professor of Health, Society and Behavior at the University of California, Irvine.

The researchers published their report in Stem Cell Reports.

Researchers conducted a study in August 2020 of 70 clinical trials involving cell-based treatments for COVID-19. They found that most were small, with an average of 51.8 participants, and only 22.8% were randomized, double-blinded, and controlled experiments.

The authors concluded that the cell-based interventions for COVID-19 were likely to have a relatively small collective clinical impact.

Cell-based treatments for COVID-19 are still at an experimental stage, Dr. Ikonomou told Medical News Today. There are tens of clinical trials, of varied complexity and rigor, that evaluate various cell types, such as mesenchymal stromal cells, for COVID-19 treatment.

Expanded or compassionate use of cell-based interventions has also been reported, but these individual cases are unlikely to tell us whether and how cell therapies could help with COVID-19 and do not substitute for the systematic clinical evaluation of cell-based products, he added.

A few completed phase 1/2 trials have shown a favorable safety profile, but larger size trials are required. Eventually, properly-powered, controlled, randomized, double-blinded clinical trials will help determine whether cell-based treatments are a viable therapeutic option for COVID-19 and its complications, he explained.

The urgency of the pandemic has made it easy to exaggerate early-stage research. The scientists highlight this is especially the case in press releases, where media professionals can over-hype findings and understate or omit limitations to gain more media coverage.

The researchers also say that even when online media include limitations and key aspects of studies, other communication channels can strip these away easily. What is left then gets amplified, as the public is desperate to see positive news.

To address this, the researchers say science communicators should ensure they have an accurate understanding of the information they report and highlight the required steps for the science to advance without exaggerating its speed.

The researchers also say that simply feeding the public more information in what is known as the information deficit model alone is insufficient. They also suggest science communicators should strive for an engaged or dialogue-based communication approach.

Over-hyping of promising treatments and in particular cell-based treatments has been a longstanding problem, and it did not first emerge with the COVID-19 pandemic, said Dr. Ikonomou. It has become a salient issue during these times due to the global nature of this health emergency and the resulting devastation and health toll.

Therefore, it is even more important to communicate promising developments in COVID-19-related science and clinical management [responsibly]. Key features of good communication are an accurate understanding of new findings, including study limitations and avoidance of sensationalist language, he explained.

Realistic timeframes for clinical translation are equally important as is the realization that promising interventions at preliminary stages may not always translate to proven treatments following rigorous testing, he added.

The researchers say that commercial investments by biotechnology companies to develop cell-based therapies for COVID-19 have led to well-designed and rigorous clinical trials.

However, some other businesses have overlooked the demanding process of pre-marketing authorization of their products. Instead, they made unsubstantiated and inaccurate claims about their stem cell products for COVID-19 based on hyperbolic reporting of cell-based therapies in early testing.

Some clinics advertise unproven and unlicensed mesenchymal stem cell treatments or exosome therapies as immune boosters that prevent COVID-19 and repair and regenerate lungs.

Often, these businesses make their treatments available via infusion or injection. However, one anti-aging clinic in California shipped its kits to clients, where they were to self-administer with a nebulizer and mask.

Such companies often market stem cell treatments via online and social media. In an initial review of many of these brands, the researchers could not find published findings from preclinical studies and clinical trials to support their commercial activities.

Instead, they found that these companies drew from uncritical news media reports, preliminary clinical studies, or case reports in which those diagnosed with COVID-19 received stem cell interventions.

Promoting such therapies that have not undergone proper tests for safety and efficacy have the potential for significant physical and financial harm.

Health experts have documented adverse events due to unlicensed stem cell products, including vision loss and autoimmune, infectious, neurological, and cardiovascular complications.

Early in the pandemic, scientific and professional societies, including the Alliance for Regenerative Medicine and the International Society for Stem Cell Research, have warned the public against businesses engaged in the marketing of cell-based treatments that have not undergone adequate testing.

The researchers highlight that it is unclear whether these warnings reached individuals and their loved ones or significantly affected public understanding of the risks of receiving unlicensed and unproven stem cell treatments for COVID-19.

They also indicate that it is unclear whether these societies and organizations have an important role in convincing regulatory bodies to increase enforcement in this space. Nevertheless, at the time of writing, the FDA and Federal Trade Commission have issued 22 letters to businesses selling unproven and unlicensed cell-based therapies.

And while many of these companies have ceased market activity, the presence of other companies continuing to pedal the same claims makes it clear that regulatory bodies must increase their enforcement.

Additionally, the researchers question whether warning letters are sufficient to disincentivize clinicians and others to sell unlicensed products. They write:

If companies and affiliated clinicians are not fined, forced to return to patients whatever profits they have made, confronted with criminal charges, subject to revocation of medical licensure, or otherwise subject to serious legal and financial consequences, it is possible that more businesses will be drawn to this space because of the profits that can be generated from selling unlicensed and unproven cell-based products in the midst of a pandemic.

The researchers conclude that regulators should increase enforcement against unproven and unlicensed therapies for COVID-19.

They also say that science communicators should report on scientific claims more realistically and include the public in more discourse.

In the U.S. and elsewhere, there are regulations and enforcement mechanisms that deal with harms caused by unproven and unlicensed cell-based interventions and false advertising claims, said Dr. Ikonomou. It may be preferable to implement existing regulations more vigorously than introduce new ones.

Stakeholders, such as scientific, professional, and medical associations, can contribute towards this goal with reporting and monitoring of cell therapy misinformation. There is a shared responsibility to combat cell-therapy related misinformation and disinformation that undercuts legitimate research and clinical efforts and portrays unproven interventions as silver bullets for COVID-19, he concluded.

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COVID-19: Researchers warn against overhyping early-stage therapies - Medical News Today

Albert Einstein Cancer Center researcher receives NCI Outstanding Investigator Award to study two deadly blood diseases – EurekAlert

image:Dr. Ulrich G. Steidl view more

Credit: Albert Einstein College of Medicine

October 27, 2021(BRONX, NY)Ulrich G. Steidl, M.D., Ph.D., co-director of the Blood Cancer Institute and associate director of basic science at the Albert Einstein Cancer Center (AECC), has received a prestigious Outstanding Investigator Award from the National Cancer Institute (NCI). This award is accompanied by a seven-year, $7 million grant to study the molecular and cellular mechanisms that lead to two related blood diseases, myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). Dr. Steidl is one of only 17 recipients of this award in 2021, which is given to accomplished leaders in cancer research who provide significant contributions in their field. The ultimate goal of this research is to develop new treatments and cures for these usually fatal disorders.

Clinical outcomes in MDS and AML have not significantly improved over the past half-century, and cure rates remain below 15% for most patients, said Dr. Steidl, who is also professor of cell biology and of medicine and the Diane and Arthur B. Belfer Faculty Scholar in Cancer Research at Einstein. There is an urgent need to improve our understanding of how these diseases develop and to devise more effective therapies.

MDS and AML Explained

MDS occurs when blood-forming (hematopoietic) stem cells in the bone marrow acquire genetic and non-genetic irregularities, leading to the production of abnormal, dysfunctional blood cells, which out-compete healthy cells. Common symptoms include anemia, infections, and bleeding.

The incidence of MDS in the United States is unclear, with estimates ranging from 10,000 to 40,000 new cases annually; about one-third of MDS patients will go on to develop AML. Treatment for MDS is generally limited to preventing or reducing complications, particularly severe anemia. The only cure is a bone-marrow transplanta therapy not easily tolerated and therefore often reserved for the youngest, most resilient patients. However, most people diagnosed with MDS are elderly.

AML, like MDS, begins with abnormal bone marrow stem cells. But in AML, those cells, after becoming cancerous, proliferate rapidly and quickly spread to the blood and other hematopoietic organs, such as the bone marrow and spleen, and sometimes to other tissues, causing many of the same symptoms seen in MDS, plus others. AML is often fatal within just a few months and afflicts about 21,000 Americans each year. It is usually treated with chemotherapy. Bone-marrow transplantation can cure AML in some patients.

From Stem Cells to Cancer

Recent studies led by Dr. Steidl and his research team have shown that both MDS and AML arise from pre-leukemic stems cells (pre-LSCs), a subpopulation of blood-forming stem cells that have genetic and non-genetic aberrations. Certain varieties (clones) of these pre-LSCs go on to develop into leukemic stem cells (LSCs)cancer cells that are capable of self-renewal. These LSCs lead to sustained leukemia growth and are particularly resistant to drugs. We now know that the considerable diversity of pre-LSC clones affects the development, progression, and treatment resistance of both MDS and AML, said Dr. Steidl, one of the nations leading authorities on both diseases.

What causes some pre-LSCs but not others to become leukemic is not clear, but transcription factors are thought to play a key role. Transcription factors are proteins that turn specific genes on or off, determining a cells function by regulating the activity of genes. In the case of stem cells, transcription factors guide their differentiation into mature cells. Our recent work has shown that the actions of key transcription factors are dysregulated in pre-LSCs and LSCs, meaning that the transcription factors and the molecular programs they govern behave abnormally, he added.

Thanks to his new NCI grant, Dr. Steidl hopes to:

To accomplish these goals, Dr. Steidls research team will employ novel tools for analyzing stem cell clones in patients, as well as newly developed mouse models of pre-LSC progression to MDS and AML.

Developing New Cancer Therapies

The knowledge we gain from this research should enable us to develop drugs that target pre-LSCs and their aberrant transcription factors, said Dr. Steidl. Such an approach holds the promise of achieving lasting remissions and, ultimately, even cures. Hopefully, our understanding of the early events in the progression of MDS and AML may even allow us in the future to prevent these diseases by interrupting the transformation of pre-LSCs to LSCs before overt leukemia can occur.

The grant (R35CA253127) is titled Molecular and Cellular Regulation of Pre-Leukemic Stem Cells and their Therapeutic Targeting.

***

About Albert Einstein College of Medicine

Albert Einstein College of Medicine is one of the nations premier centers for research, medical education and clinical investigation. During the 2020-21 academic year, Einstein is home to 721 M.D. students, 178 Ph.D. students, 109 students in the combined M.D./Ph.D. program, and 265 postdoctoral research fellows. The College of Medicine has more than 1,900 full-time faculty members located on the main campus and at its clinical affiliates. In 2020, Einstein received more than $197 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States through Montefiore and an affiliation network involving hospitals and medical centers in the Bronx, Brooklyn and on Long Island. For more information, please visit einsteinmed.org, read our blog, followus on Twitter, like us on Facebook, and view us on YouTube.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

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Albert Einstein Cancer Center researcher receives NCI Outstanding Investigator Award to study two deadly blood diseases - EurekAlert

San Diego research centers receive $15 million to train next generation of scientists – Three San Diego research institutions have been awarded nearly…

San Diego research centers receive $15 million to train next generation of scientists

San Diego Community News Group

Three San Diego research institutions have been awarded nearly $15 million from the California Institute of Regenerative Medicine (CIRM) to train the next generation of scientists in regenerative medicine, a field of research that holds great promise for generating transformative medicines.

Scripps Research, University of California San Diego, and Sanford Burnham Prebys each received grants of around $5 million from CIRM to support the training of graduate students, postdoctoral trainees, and clinical trainees.

The CIRM awards will also foster interdisciplinary regenerative medicine collaborations among the three San Diego recipient institutions and support outreach science activities in the broader San Diego community. The funding also will support educational programs for K-12 students and undergraduates on topics related to regenerative medicine that are intended to reduce disparities and disproportionate access to science.

"CIRM has provided critical leadership spearheading regenerative medicine and stem cell research," says Peter Schultz, president and CEO of Scripps Research. "This forward-looking investment in training the next generation of scientists will help ensure continued progress toward realizing the tremendous promise of regenerative medicine."

Schultz will head the Scripps Research program which received $4,931,353 to train scientists in disciplines and techniques central to stem cell biology and regenerative medicine. These include cellular processes involved in human embryonic and adult stem cell self-renewal and differentiation and the development of novel drugs to target related pathways.

University of California San Diego received $4,992,446 to train the next generation of stem cell biologists, driving advances ranging from the unraveling of fundamental mechanisms of cell function to the development of new therapies. The UC San Diego training program will be led by Alysson R. Muotri, PhD, professor of pediatrics and cellular and molecular medicine at UC San Diego School of Medicine, and Sheldon Morris, MD, primary care physician at UC San Diego Health.

This grant comes at a time when stem cell research in San Diego has matured, thanks to strong support over the years from visionaries such as CIRM and philanthropist T. Denny Sanford, Muotri said. The only way to keep up this momentum is to have professionals that understand how to use and apply stem cell and gene therapies. We are building the next generation of researchers and clinicians to do this.

Sanford Burnham Prebys received $4,931,353 to launch a multidisciplinary stem cell training program. The grant will provide funds for competitive awards for PhD students, postdocs and clinical fellows in stem cell, gene therapy and regenerative medicine fields at the institute. The training program will be led by Evan Snyder, MD, PhD, professor and director of the Center for Stem Cells & Regenerative Medicine, as well as professors/directors Pier Lorenzo Puri, MD, and Alessandra Sacco, PhD, in the Development, Aging and Regeneration Program Center at Sanford Burnham Prebys.

Sacco says stem cell research holds tremendous promise for medical treatments, and that CIRMs support will allows scientists to learn more about the process through which science becomes medicine.

We are exceptionally grateful that CIRM is supporting this important program, says Sacco. This award helps the next generation of stem cell and regenerative medicine scientists who will work across boundaries and between disciplines to become capable of translating basic discovery science into clinical research for patient benefit.

This years awards build on an earlier Research Training program through which CIRM supported training in regenerative medicines from 2006-2016 and trained 940 CIRM Scholars including 321 doctoral students, 453 postdocs and 166 MDs.

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San Diego research centers receive $15 million to train next generation of scientists - Three San Diego research institutions have been awarded nearly...

Medical Innovation In Pet Healthcare Is Taking Things Up a Notch – Entrepreneur

Opinions expressed by Entrepreneur contributors are their own.

You're reading Entrepreneur India, an international franchise of Entrepreneur Media.

India is currently home to over 10-plus million pets. Over time, pet parents have realized the importance of medicine and innovation and the change it can bring about in a pets life. Pet innovation today is booming across treats, food, grooming, wearables, insurance, online veterinary services, genetic testing, stem cell therapy, diagnostics and much more. According to PETEX INDIA 2021, the pet food market alone is projected to cross $310 million by FY22. The pet care industry is globally expanding horizontally and vertically with innovative and challenging minds at work. Medical innovation has brought about effective growth thus making way for new products, services and medicines for pets. Medical procedures such as lasers for joint pains and joint care have helped pet owners make the lives of their furry babies a little less painful.

Unsplash

A few medical innovations in India have particularly taken the Indian pet care sector a notch higher:

CBD & Hemp Seed Oil For Overall Health & Wellness

CBD, or cannabidiol, is a chemical found in the cannabis sativa plant and is known to have wonderful pain-relieving properties. CBD is one of the most effective natural therapies for dogs suffering from arthritis and many other diseases. It is safe and has no side effects. CBD oil interacts with the cells in the muscle, skin and nerves of pets thereby reducing their pain. CBD and hemp seed oils are now available in the form of oil, shampoos and treats. It also benefits pets with anxiety issues triggered due to loud noises, people or travel and keeps them calm and relaxed. CBD oil is finding an innovative use in health and wellness based products for pets and its multiple visible benefits.

Omega 3 and Omega 6 fatty acids in hemp seed oil help control skin breakouts and protect the skin.

They are responsible for creating a healthy cell membrane and help to avoid excessive fur shedding. Hemp serves as the optimum plant-based nutrition that is easily digestible and includes antioxidants that aid elevated health in pets. Hemp seed oil has recently been added to pet food and treats and is also being used in healing balms for dry paws and skin.

Prebiotics & Probiotics For Gut Health

Probiotics are the billions of good bacteria that live in the gastrointestinal tract of animals. Pets respond to supplements in the form of immunity boosters and probiotic strips are easy dissolving strips unlike pills, powders or tablets which the pet might refuse to intake. Probiotics treat diarrhoea, stomach related issues, irritable bowel syndrome, improve digestive health, prevent anxiety, reduce stress and improve general health and well-being. Given its health benefits, prebiotics and probiotics have found their way in pet food as they help to maintain the pH balance in the gut and keep the digestive tract healthy. Probiotics have also recently been introduced in shampoos as they help in supporting a healthy microbiome and defend against common skin problems such as itching dryness, dandruff, hot spots, excessive shedding and yeast in pets.

Assistive Devices To Aid Mobility

Harnesses and slings for dogs suffering from hip dysplasia are gaining popularity among vets and pet parents. These act as a wheel-chair and support the pets rear body and enable them to move around. They also help pets who have lost their hind legs in accidents. Harnesses for pets who are blind have been created such that they form a halo around their head and this will alert the pet if they happen to bump against any object. These innovations may alter the pets appearance but what is important is that it helps pets to live a normal life. The same goes for pets afflicted with arthritis. Elevated feeding stations, ramps to reduce the stress on joints have also become common to households who have aging pets.

Veterinary Diagnostics

Innovation in the use of technology that equips veterinarians to view real-time information on internal bone and muscle structure is in the fray. This will help to speed up the prototype required to create an animal bone model that is generated using the tomography scan technology. This technology is building steam though still in its nascent stage. Two new blood types, Langereis and Junior, have been identified in pets apart from the 12 dog blood types. New diagnostic techniques through tests which can help to diagnose the possibility of diseases in pets, confirm or even classify disease status in pets, is the need of the hour.

According to a study by Grand View Research on veterinary medicine, the global veterinary medicine market size was estimated at $29.2 billion in 2020 and is expected to expand at a CAGR of 7.4 per cent from 2021 to 2028. Steady medical innovation is solving unsolved and unattended problems that pets have faced since decades. While the offline gap has been filled in by the online D2C revolution in pet care and wellness, advancements in medical innovation remain unhindered despite the pandemic.

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Medical Innovation In Pet Healthcare Is Taking Things Up a Notch - Entrepreneur

UC Davis Medical Center faculty respond to the rise of treatments like Merck’s anti-COVID pill – The Aggie – The Aggie

Mercks pill, molnupiravir, shows reductions of hospitalizations and deaths by 50%

By BRANDON NGUYEN science@theaggie.org

Over a year and a half into the pandemic, with sweeping changes to the standard of living along with distressing upward trends of illness, hospitalizations and deaths, recent developments of treatments such as Mercks anti-COVID pill offer hope toward a return to the status quo.

According to an article in The Sacramento Bee, Pharmaceutical company Merck took the internet by storm when it announced Friday morning that findings from a recent study showed its experimental oral pill molnupiravir reduced COVID-19 related hospitalizations and deaths by 50%.

Dr. Christian Sandrock, a trained infectious disease pulmonary critical care doctor at the UC Davis Medical Center, discussed the current state of the pandemic as being dominated by downward trends in new cases by about 20% from where it was two weeks ago. However, he highlighted that hot spots of cases remain in certain states and areas within the U.S. where vaccination rates are not as high as in California.

With the advent of continuing trials for new treatments against COVID-19, a multi-faceted approach is necessary to reduce the impact of the pandemic, according to Dr. Rachael Callcut, the division chief of trauma and acute care surgery at the UC Davis Medical Center. Part of this approach, aside from initial prevention of the disease and treating the virus itself, includes risk mitigation and decreasing the chances of hospitalization by preventing the development of severe illness arising from the coronavirus.

This particular oral agent is targeted at people who are at risk of developing severe illness from the virus, and it is something to be given early in the course of illness to try to prevent the development of complications, Callcut said. I would say that this is sort of analogous to the approaches that you see with things like pills that we give to patients who have influenza to try to prevent them from developing complications of influenza.

Mercks study is important to altering the current landscape of the pandemic and its ferocious impact on the global population in the past year. In the same vein, Sandrock summarized the promising results of the pill and its significance proceeding toward a hopeful end to the pandemic.

The data looks promising: the trial had just about a little over 350 people in each arm so, not whopping numbers but still reasonably high, and the key is the major endpoints of hospitalization and death were certainly down, Sandrock said. So I think that the big thing is it can be taken orally, and this changes the landscape to something that is a single pill.

Other current treatments include the administration of monoclonal antibodies to the patient to combat the virus, and maintaining a steady supply of this product is relatively more costly in terms of price and time, according to Sandrock. For individuals who live further away and have little to no access to healthcare, reducing hospitalizations is key to facilitating a return to the status quo. With Mercks anti-COVID pill, it has the potential to drastically reduce the burdens of both the patient and the medical professional.

Fighting the COVID-19 pandemic has fostered collaboration among drug developers, academic medical and research centers as well as supportive funding agencies, Dr. Allison Brashear, the dean of the UC Davis School of Medicine, said. UC Davis School of Medicine, renowned for its research expertise, is a trusted partner on many COVID-19 clinical trials at the forefront of efforts to cure this terrible disease.

Callcuts lab is also involved in one of the many ongoing clinical trials, working with mesenchymal stromal cells, cells that are stem-cell like that aid in regeneration of damaged lung cells and reducing inflammation associated with acute respiratory disorders caused by viruses like COVID-19.

Hope is on the horizon for individuals actively fighting the pandemic with the race toward developing treatments attacking all realms of the virus. Callcut echoed this sentiment, encouraging the continual efforts in enforcing public health safety and support.

Theres got to be a multi-faceted approach that resides on the principles of our public health initiatives, and the first is prevention of illness, Callcut said. One of the most effective strategies for that is vaccinations, specifically investing in increasing vaccination education and administering vaccines. These types of measures will be our most important defenses in leading to the end of the pandemic. Written by: Brandon Nguyen science@theaggie.org

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UC Davis Medical Center faculty respond to the rise of treatments like Merck's anti-COVID pill - The Aggie - The Aggie

Managing superficial pyoderma with light therapy – DVM 360

Phovia is highly effective for treating superficial and deep skin infections.

This article is sponsored by Vetoquinol.

Superficial bacterial folliculitis, also called superficial pyoderma, is a commonly diagnosed dermatological condition in dogs.1,2 These infections are secondary to primary conditions affecting normal skin barrier function (eg, allergic skin disease, trauma, burns), keratinization (eg, nutritional deficiency, liver disease), and immune regulation (eg, neoplasia, autoimmunity, endocrinopathy).2 Cats less commonly develop superficial pyoderma perhaps because of decreased adhesion of staphylococci to feline corneocytes, but the primary issues causing infection are similar to those seen in dogs.3-8

The primary pathogen associated with superficial pyoderma in dogs and cats is a normal resident of the skin, Staphylococcus pseudintermedius, but other flora may be involved.2,8-12 As the normal homeostasis of this organism is disrupted from a primary disease, these gram-positive cocci invade deeper regions of the epidermis and hair follicle epithelium, increase in number, and enhance inflammation.

Classical clinical lesions of superficial pyoderma include papules and pustules that may eventually progress to alopecia, epidermal collarettes, scales, and crusts. Often the skin is erythematous and pruritic. Chronic cases may demonstrate lichenification, hyperpigmentation, and scarring alopecia from long-standing inflammation and infection.2 Cats may develop even more unique cutaneous reaction patterns and skin lesionsespecially when allergic skin disease is presentincluding miliary dermatitis, eosinophilic plaques, rodent ulcers, and eosinophilic granulomas.5

Identifying and addressing the primary disease is paramount in achieving complete, permanent resolution of the superficial pyoderma. Therefore, treatment is multifactorial and aimed at addressing the primary disease, reducing skin inflammation, and treating the infection directly. Current guidelines for the treatment of superficial pyoderma in dogs recommend the use of topical antimicrobials as sole therapy whenever possible; however, overuse of systemic antibiotics remains common.2,13-16

Topical therapy has many benefits including direct antimicrobial effects without use of an antibiotic, reduction in antibiotic-resistant bacterial populations, restoration of the normal skin barrier, enhancement of skin hydration, physical removal of keratinous debris, and removal of offending allergens from the haircoat.2,14 However, topical therapy is met with challenges that impede clinical application. Adherence is the biggest concern when recommending topical therapy to pet owners. Frequent bathing or application of medicated solutions to the skin can be difficult when busy owner lifestyles combine with a nonadherent patient. Skin inflammation can be painful and animals may be resistant to topical therapy. Cats are fastidious groomers and may lick away a medicated topical therapy before it can achieve appropriate contact time. Additionally, some topical agents can cause oral erosions and ulcerations or even gastrointestinal disturbance when groomed off. For these reasons, systemic antibiotics continue to be a common prescribing practice for superficial pyoderma.

All antibiotic use, despite duration or frequency, contributes to the development of antibiotic-resistant bacterial populations on the animal and in the environment.17-19 From that very first dose, bacteria are constantly evolving to implement inherent and acquired resistance mechanisms necessary for survival. One well-recognized mechanism is oxacillin resistance through the mecA gene, which produces a penicillin-binding protein receptor with poor affinity for -lactam antibiotics.2,14,15,20-23 Even more concerning than these oxacillin-resistant strains are those that develop multidrug resistance, which is defined as resistance to 3 or more antibiotic drug classes. This may happen over time with repeated antibiotic exposure or after a single dose of certain antibiotics such as fluorinated quinolones.2,20,23-25 The continued emergence of antibiotic-resistant bacteria inhibits the successful treatment of bacterial infections in pets and humans. As veterinarians consider how their antibiotic use contributes to this growing pandemic, they must look for alternative, safe, effective, affordable, and convenient antibacterial treatment modalities.

Phovia as a solution

Investigation into the photobiological effects of light therapy has been ongoing for the past 50 years. Photobiomodulation (PBM) therapy is a type of light treatment that uses visible or near infrared light to promote therapeutic benefits including induction of tissue healing and regeneration and inhibition of biological responses that induce pain or inflammation. The treatment distance, wavelength, fluence, pulse parameters, spot size, and irradiation time influence the effects of light energy on tissue. Visible light with wavelengths ranging from 400 to 700 nm can stimulate positive photobiomodulatory effects that promote wound healing, reduce inflammation and pain, modulate stem cell populations, and reduce bacterial contamination of wounds.26,27

Once visible light enters the skin, it is absorbed by the cells and initiates chemical changes dependent on the wavelength (or color) of light and the chromophore within the skin.27 Within each cell, membrane-bound organelles called mitochondria contain chromophores that absorb the light energy and begin making energy (adenosine triphosphate; ATP) via activation of cytochrome c oxidase. Outcomes of the mitochondrial respiratory pathway activation include stimulation of secondary messenger pathways, production of transcription factors and growth factors, and increased ATP production. However, excessive light energy exposure will overstimulate mitochondrial respiration and cause expenditure of all ATP reserves, which creates oxidative stress resulting in damaging elevations of nitric oxide, production of harmful free radicals, and activation of cytotoxic mitochondrial-signaling pathways leading to apoptosis.27,28 This is why creating PBM therapy protocols is important for targeting the beneficial effects while avoiding unintended harm.

Specific benefits of light energy within the visible light spectrum can be broken down into each color of light. Blue light (400-500 nm) has a lower penetration depth and primarily interacts with keratinocytes, reduces bacterial adhesion and growth, and increases intracellular calcium and osteoblast differentiation.29-31 Green light (495-570 nm) affects the superficial tissue and alters melanogenesis, reduces hyperpigmentation of the skin, and reduces tissue swelling.29,30 Red light (600-750 nm) penetrates deeper into the dermis and subcutis where it acts on cellular mitochondria to reduce inflammation and promote collagen synthesis through fibroblast proliferation and production of transforming growth factor-, fibroblast growth factor, platelet derived growth factor, and others.26-28,32,33 Red light has proliferative effects on mesenchymal stem cells and induces proliferation of epithelial colony forming units important for tissue repair and regeneration.34,35

Phovia, sold by Vetoquinol, is a form of fluorescent PBM therapy utilizing a blue light emitting diode (LED lamp, 400-460 nm) and topical photoconverter gel that emits low-energy fluorescent light (510-600 nm) when illuminated by the LED lamp.36,37 This interaction results in the formation of multiple wavelengths of visible light, each with a unique depth of penetration and effect on the tissue as described above. Application is fast and simple. The affected skin may be clipped free of hair and cellular debris removed with gentle cleaning. The skin is allowed to dry before application of the photoconverter gel. Just prior to application, 1 ampule of fluorescence chromophore gel is added to 1 container of photoconverter carrier gel and mixed thoroughly. The mixture is applied in a 2-mm layer to the affected skin, and the LED lamp is held 5 cm above the lesion and used to illuminate the area for 2 minutes. The gel is wiped away using saline-soaked gauze. The application can be repeated immediately after 5 to 10 minutes of rest or a second application can occur a few days later. Twice-weekly applications are continued until the wound is healed. Appropriate eyewear is required to protect the operator from the intensely bright light. Application is pain free and stress free for the patient, so sedation is not typically required.

Benefits of Phovia

Phovia shows great promise as a safe, effective therapy for treatment of numerous inflammatory dermatoses in dogs including superficial pyoderma,38 deep pyoderma,39 perianal fistula,40 interdigital dermatitis,41 calcinosis cutis,42 acute traumatic wounds,43 chronic wounds,37 surgical wounds,44 and otitis externa.45 Phovia as a sole therapy speeds time to healing by 36% in canine superficial pyoderma as compared with dogs receiving oral antibiotics alone.38 In one study, dogs with superficial pyoderma were treated with Phovia alone or with an oral antibiotic alone. Dogs treated twice weekly with Phovia demonstrated complete clinical healing in about 2.3 weeks (P < .05)whereas dogs receiving oral antibiotic healed in about 3.75 weeks.38 Additionally, Phovia speeds time to healing by nearly 50% in deep pyoderma when used with an oral antibiotic (5.7 weeks of treatment) compared with dogs receiving only oral antibiotic (11.7 weeks of treatment).39 The ability of this fluorescent PBM therapy to eliminate or significantly reduce duration of exposure to antibiotics will decrease the spread of antibiotic-resistant bacterial strains within pets and humans.

Phovias high safety profile makes it a beneficial tool to implement in everyday practice. Training the veterinary team to communicate therapy benefits with clients as well as to perform treatments is fast and easy. Training the veterinary technicians to perform treatments will give the veterinarian time to examine other patients. A single back-to-back application takes about 15 minutes, so pet owners can be in and out of the clinic quickly; however, the 2 weekly treatments can be separated by a few days if the veterinarian prefers to evaluate the patient more frequently. Additionally, when used as a sole therapy, clients are not required to administer oral or topical medications at home. This greatly improves treatment adherence and success. Instruct clients to use once-daily smartphone photos to document improvement at home. This can be useful when deciding how many treatments to perform. Most cases of superficial pyoderma will resolve completely by the third treatment.38 It is a good idea to communicate to clients that 3 to 4 weekly treatments may be required.

Conclusion

Phovia is a versatile, innovative therapeutic approach to numerous types of dermatitis.36 It is easy to implement in general practice, and is safe, pain free, and affordable. Phovia is highly effective for superficial and deep skin infections and eliminates the need for clients to administer numerous at-home treatments. This greatly improves the pet-owner bond and treatment outcomes by promoting adherence. Phovia accelerates time to wound healing, which decreases duration of antibiotic exposure and may reduce risk of antibiotic resistance development in these cases.2,13,36-39 Phovias efficacy against antibiotic-susceptible and antibiotic-resistant bacteria shows promise as an alternative therapeutic approach that promotes the principles of antimicrobial stewardship.36 If you are interested in purchasing this medical device for your practice, contact your Vetoquinol service representative.

Amelia G. White, DVM, MS, DACVD is an associate clinical professor of dermatology at Auburn University College of Veterinary Medicine.

REFERENCES

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Managing superficial pyoderma with light therapy - DVM 360

Completion of Enrollment in Phase III Comparative Study for Investigational Regenerative Cellular Medicine (gMSC1) for Knee Chondrogenesis Using…

Chugai Pharmaceutical Co., Ltd.

TWOCELLS Co., Ltd.

Completion of Enrollment in Phase III Comparative Study for

Investigational Regenerative Cellular Medicine (gMSC1) for Knee Chondrogenesis Using Allogeneic 3D Artificial Tissue of MSC

TOKYO, October 27, 2021 --Chugai Pharmaceutical Co., Ltd.(TOKYO: 4519) and TWOCELLS Co., Ltd.

(Head Office: Hiroshima City, Hiroshima; President and CEO: Toshiki Hiura; hereafter, TWOCELLS) announced completion of target enrollment into a Phase III comparative study for an investigational regenerative cellular medicine for chondrogenesis in the knee (development number "gMSC1"), with surgery on the 70th patient.

This study examines the safety and efficacy of transplanting gMSC1, a three-dimensional artificial tissue of allogeneic MSCs, in comparison with microfracture surgery for patients with symptomatic traumatic cartilage defects or osteochondritis dissecans in the knee. The enrollment had started on November 29, 2017 and completed with the 70th surgery, fully enrolling the target number of patients. Going forward, the primary endpoints of histological evaluation of the cartilage and subjective symptoms will be analyzed at week 52 after surgery.

"The articular cartilage in the knee plays an important role in assisting with smooth leg movement. It has a very limited regenerative capacity, and various methods of treatment are under investigation for damages on the cartilage. gMSC1 aims to repair the cartilage in the knee as a regenerative cell therapy which does not require the patient's own tissue taken from their joint, potentially paving the way for solving unmet medical needs in existing treatments. We hope that the assessment ahead will prove the value of gMSC1, Chugai's first regenerative medicine project, and its benefit for patients," said Dr. Osamu Okuda, President and CEO of Chugai.

Toshiki Hiura, President and CEO of TWOCELLS, said, "Despite significant impact from COVID-19 pandemic, we have successfully completed enrollment in the study. Supported by the partnership with Chugai, we, here in Hiroshima, are smoothly advancing the development of basic technologies required for allogenic tissues, the provision of tissues from donors and establishing a GCTP-compatible facility to manufacture final products in Japan for the first time. We will build commercial production capacity as early as possible and strive to make regenerative medicine a familiar treatment option."

Chugai and TWOCELLS concluded a licensing agreement for gMSC1 in 2016. Under the agreement, TWOCELLS is conducting the clinical trial, and responsible for manufacture and supply of gMSC1. Chugai has joint development and exclusive distribution rights for gMSC1 in Japan and is responsible for regulatory application.

To provide more patients with an innovative treatment option as soon as possible, Chugai and TWOCELLS will work on the practical application of the cartilage regenerative therapy using allogenic synovium-derived mesenchymal stem cell, which is the first of its kind in the world.

TWOCELLS and Chugai Announce Performing Surgery of the First Patient in Phase III Trial for "gMSC1," a Regenerative Cellular Medicine for Chondrogenesis in the Knee (press release on November 29, 2017) https://www.chugai-pharm.co.jp/english/news/detail/20171129170000_50.html

Chugai and TWO CELLS Announce a License Agreement for "gMSC1" a Regenerative Cellular Medicine for Chondrogenesis in the Knee (press release on April 25, 2016) https://www.chugai-pharm.co.jp/english/news/detail/20160425150000_144.html

Sources of reference for the study:

Japan Pharmaceutical Information Center (JAPIC) Drug Information Database

http://www.clinicaltrials.jp/user/cteSearch.jsp

About gMSC

gMSC1 is a tissue-engineered medical product currently developed by TWOCELLS and was prepared for the regenerative chondrogenesis using synovium-derived mesenchymal stem cell (MSC) in collaboration with Osaka University and Hiroshima University. This product is a scaffold-free allogeneic 3D artificial tissue of MSC provided by TWOCELLS with their own technologies and serum-free medium (STK1 and STK2), which is expected to provide an effective treatment for cartilage regeneration. Development of gMSC1 has been supported by JST (Japan Science and Technology Agency), NEDO (New Energy and Industrial Technology Development Organization), the Ministry of Economy, Trade and Industry, and AMED (Japan Agency for Medical Research and Development).

About Chugai

Chugai Pharmaceutical is one of Japan's leading research-based pharmaceutical companies with strengths in biotechnology products. Chugai, based in Tokyo, specializes in prescription pharmaceuticals and is listed on the 1st section of the Tokyo Stock Exchange. As an important member of the Roche Group, Chugai is actively involved in R&D activities in Japan and abroad. Specifically, Chugai is working to develop innovative products which may satisfy the unmet medical needs.

About TWOCELLS

TWOCELLS is a bio-venture company established in Hiroshima in 2003, aiming to promote regenerative medicine so that patients may have a new treatment option. By particularly targeting MSC (mesenchymal stem cell), it is engaging in the development of cellular medicine with MSC, peri-MSC culturing technique and a system for regenerative medicine.

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Completion of Enrollment in Phase III Comparative Study for Investigational Regenerative Cellular Medicine (gMSC1) for Knee Chondrogenesis Using...

Stem Cell Therapy Market Research Report by Cell Source, by Type, by Therapeutic Application, by End-User, by Region – Global Forecast to 2026 -…

Stem Cell Therapy Market Research Report by Cell Source (Adipose tissue-derived MSCs (mesenchymal stem cells),, Bone marrow-derived MSCs,, and Placental/umbilical cord-derived MSCs), by Type (Allogeneic Stem Cell Therapy and Autologous Stem Cell Therapy), by Therapeutic Application, by End-User, by Region (Americas, Asia-Pacific, and Europe, Middle East & Africa) - Global Forecast to 2026 - Cumulative Impact of COVID-19

New York, Oct. 13, 2021 (GLOBE NEWSWIRE) -- Reportlinker.com announces the release of the report "Stem Cell Therapy Market Research Report by Cell Source, by Type, by Therapeutic Application, by End-User, by Region - Global Forecast to 2026 - Cumulative Impact of COVID-19" - https://www.reportlinker.com/p06175517/?utm_source=GNW

The Global Stem Cell Therapy Market size was estimated at USD 202.87 million in 2020 and expected to reach USD 240.88 million in 2021, at a CAGR 19.07% to reach USD 578.27 million by 2026.

Market Statistics: The report provides market sizing and forecast across five major currencies - USD, EUR GBP, JPY, and AUD. It helps organization leaders make better decisions when currency exchange data is readily available. In this report, the years 2018 and 2019 are considered historical years, 2020 as the base year, 2021 as the estimated year, and years from 2022 to 2026 are considered the forecast period.

Market Segmentation & Coverage: This research report categorizes the Stem Cell Therapy to forecast the revenues and analyze the trends in each of the following sub-markets:

Based on Cell Source, the market was studied across Adipose tissue-derived MSCs (mesenchymal stem cells),, Bone marrow-derived MSCs,, and Placental/umbilical cord-derived MSCs.

Based on Type, the market was studied across Allogeneic Stem Cell Therapy and Autologous Stem Cell Therapy.

Based on Therapeutic Application, the market was studied across Cardiovascular Diseases Surgeries, Inflammatory & Autoimmune Diseases, Musculoskeletal Disorders, Neurological Disorders, Other Therapeutic Applications, and Wounds & Injuries.

Based on End-User, the market was studied across Academic and Research Centers, Ambulatory Surgical Centers (ASCs), and Hospitals & Clinics.

Based on Region, the market was studied across Americas, Asia-Pacific, and Europe, Middle East & Africa. The Americas is further studied across Argentina, Brazil, Canada, Mexico, and United States. The United States is further studied across California, Florida, Illinois, New York, Ohio, Pennsylvania, and Texas. The Asia-Pacific is further studied across Australia, China, India, Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan, and Thailand. The Europe, Middle East & Africa is further studied across France, Germany, Italy, Netherlands, Qatar, Russia, Saudi Arabia, South Africa, Spain, United Arab Emirates, and United Kingdom.

Cumulative Impact of COVID-19: COVID-19 is an incomparable global public health emergency that has affected almost every industry, and the long-term effects are projected to impact the industry growth during the forecast period. Our ongoing research amplifies our research framework to ensure the inclusion of underlying COVID-19 issues and potential paths forward. The report delivers insights on COVID-19 considering the changes in consumer behavior and demand, purchasing patterns, re-routing of the supply chain, dynamics of current market forces, and the significant interventions of governments. The updated study provides insights, analysis, estimations, and forecasts, considering the COVID-19 impact on the market.

Competitive Strategic Window: The Competitive Strategic Window analyses the competitive landscape in terms of markets, applications, and geographies to help the vendor define an alignment or fit between their capabilities and opportunities for future growth prospects. It describes the optimal or favorable fit for the vendors to adopt successive merger and acquisition strategies, geography expansion, research & development, and new product introduction strategies to execute further business expansion and growth during a forecast period.

FPNV Positioning Matrix: The FPNV Positioning Matrix evaluates and categorizes the vendors in the Stem Cell Therapy Market based on Business Strategy (Business Growth, Industry Coverage, Financial Viability, and Channel Support) and Product Satisfaction (Value for Money, Ease of Use, Product Features, and Customer Support) that aids businesses in better decision making and understanding the competitive landscape.

Market Share Analysis: The Market Share Analysis offers the analysis of vendors considering their contribution to the overall market. It provides the idea of its revenue generation into the overall market compared to other vendors in the space. It provides insights into how vendors are performing in terms of revenue generation and customer base compared to others. Knowing market share offers an idea of the size and competitiveness of the vendors for the base year. It reveals the market characteristics in terms of accumulation, fragmentation, dominance, and amalgamation traits.

Competitive Scenario: The Competitive Scenario provides an outlook analysis of the various business growth strategies adopted by the vendors. The news covered in this section deliver valuable thoughts at the different stage while keeping up-to-date with the business and engage stakeholders in the economic debate. The competitive scenario represents press releases or news of the companies categorized into Merger & Acquisition, Agreement, Collaboration, & Partnership, New Product Launch & Enhancement, Investment & Funding, and Award, Recognition, & Expansion. All the news collected help vendor to understand the gaps in the marketplace and competitors strength and weakness thereby, providing insights to enhance product and service.

Company Usability Profiles: The report profoundly explores the recent significant developments by the leading vendors and innovation profiles in the Global Stem Cell Therapy Market, including Advanced Cell Technology, Inc., AlloSource, Inc., Anterogen Co., Ltd., Bioheart Inc., BioTime, Inc., BrainStorm Cell Therapeutics Inc., Celgene Corporation, Cellartis AB, CellGenix GmbH, Cellular Engineering Technologies Inc., Gamida Cell Ltd, Gilead Sciences, Inc., Holostem Terapie Avanzate Srl, JCR Pharmaceuticals Co., Ltd., Lonza Group AG, Medipost Co., Ltd., Nuvasive, Inc., Osiris Therapeutics, Inc., Pharmicell Co., Ltd., Pluristem Therapeutics Inc., PromoCell GmbH, RTI Surgical, Inc., STEMCELL Technologies, Inc., Takeda Pharmaceutical Company Limited, Vericel Corporation, and VistaGen Therapeutics, Inc..

The report provides insights on the following pointers: 1. Market Penetration: Provides comprehensive information on the market offered by the key players 2. Market Development: Provides in-depth information about lucrative emerging markets and analyze penetration across mature segments of the markets 3. Market Diversification: Provides detailed information about new product launches, untapped geographies, recent developments, and investments 4. Competitive Assessment & Intelligence: Provides an exhaustive assessment of market shares, strategies, products, certification, regulatory approvals, patent landscape, and manufacturing capabilities of the leading players 5. Product Development & Innovation: Provides intelligent insights on future technologies, R&D activities, and breakthrough product developments

The report answers questions such as: 1. What is the market size and forecast of the Global Stem Cell Therapy Market? 2. What are the inhibiting factors and impact of COVID-19 shaping the Global Stem Cell Therapy Market during the forecast period? 3. Which are the products/segments/applications/areas to invest in over the forecast period in the Global Stem Cell Therapy Market? 4. What is the competitive strategic window for opportunities in the Global Stem Cell Therapy Market? 5. What are the technology trends and regulatory frameworks in the Global Stem Cell Therapy Market? 6. What is the market share of the leading vendors in the Global Stem Cell Therapy Market? 7. What modes and strategic moves are considered suitable for entering the Global Stem Cell Therapy Market? Read the full report: https://www.reportlinker.com/p06175517/?utm_source=GNW

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Stem Cell Therapy Market Research Report by Cell Source, by Type, by Therapeutic Application, by End-User, by Region - Global Forecast to 2026 -...