Device-based treatment for hypertension

Autonomic imbalance is thought to play an important role in the pathophysiology of hypertension. Despite the availability of diverse pharmacological options, non-adherence to medication or inability to tolerate current pharmacological therapies has led to the development of various device-based therapy options. Inhibiting components of the sympathetic nervous system offers a unique opportunity to target the ‘neural’ component of the neurohormonal axis. Combining novel drug-, device-, and procedure-based strategies with improved utilization of existing therapies (including appropriate attention to diet, exercise, and weight control) may result in improved outcomes. This chapter discusses the rationale and current experimental and clinical data of several novel device-based treatment options—renal nerve ablation, carotid body ablation, carotid baroreceptor stimulation, and central arteriovenous anastomosis.

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Autonomic cardiovascular alterations as therapeutic targets in chronic kidney disease

Clinical Autonomic Research ◽

10.1007/s10286-021-00786-6 ◽

2021 ◽

Author(s):

Gino Seravalle ◽

Fosca Quarti-Trevano ◽

Jennifer Vanoli ◽

Chiara Lovati ◽

Guido Grassi

Keyword(s):

Chronic Kidney Disease ◽

Renal Failure ◽

Kidney Transplantation ◽

Kidney Disease ◽

Therapeutic Interventions ◽

Renal Nerve ◽

Carotid Baroreceptor ◽

Renal Nerve Ablation ◽

Baroreceptor Stimulation ◽

Carotid Baroreceptor Stimulation

Abstract Purpose The present paper will review the impact of different therapeutic interventions on the autonomic dysfunction characterizing chronic renal failure. Methods We reviewed the results of the studies carried out in the last few years examining the effects of standard pharmacologic treatment, hemodialysis, kidney transplantation, renal nerve ablation and carotid baroreceptor stimulation on parasympathetic and sympathetic control of the cardiovascular system in patients with renal failure. Results Drugs acting on the renin–angiotensin system as well as central sympatholytic agents have been documented to improve autonomic cardiovascular control. This has also been shown for hemodialysis, although with more heterogeneous results related to the type of dialytic procedure adopted. Kidney transplantation, in contrast, particularly when performed together with the surgical removal of the native diseased kidneys, has been shown to cause profound sympathoinhibitory effects. Finally, a small amount of promising data are available on the potential favorable autonomic effects (particularly the sympathetic ones) of renal nerve ablation and carotid baroreceptor stimulation in chronic kidney disease. Conclusions Further studies are needed to clarify several aspects of the autonomic responses to therapeutic interventions in chronic renal disease. These include (1) the potential to normalize sympathetic activity in uremic patients by the various therapeutic approaches and (2) the definition of the degree of sympathetic deactivation to be achieved during treatment.

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Faculty Opinions recommendation of Catheter-based renal nerve ablation and centrally generated sympathetic activity in difficult-to-control hypertensive patients: prospective case series.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717961246.793465903 ◽

2012 ◽

Author(s):

Andrea Semplicini

Keyword(s):

Sympathetic Activity ◽

Case Series ◽

Renal Nerve ◽

Hypertensive Patients ◽

Renal Nerve Ablation ◽

Prospective Case Series

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4E Interacting Protein as a Potential Novel Drug Target for Nucleoside Analogues in Trypanosoma Brucei

Microorganisms ◽

10.3390/microorganisms9040826 ◽

2021 ◽

Vol 9 (4) ◽

pp. 826

Author(s):

Dorien Mabille ◽

Camila Cardoso Santos ◽

Rik Hendrickx ◽

Mathieu Claes ◽

Peter Takac ◽

...

Keyword(s):

Mode Of Action ◽

Drug Target ◽

Drug Targets ◽

De Novo ◽

Treatment Options ◽

Adenosine Kinase ◽

Nucleoside Analogues ◽

Purine Salvage ◽

Interacting Protein ◽

Novel Drug

Human African trypanosomiasis is a neglected parasitic disease for which the current treatment options are quite limited. Trypanosomes are not able to synthesize purines de novo and thus solely depend on purine salvage from the host environment. This characteristic makes players of the purine salvage pathway putative drug targets. The activity of known nucleoside analogues such as tubercidin and cordycepin led to the development of a series of C7-substituted nucleoside analogues. Here, we use RNA interference (RNAi) libraries to gain insight into the mode-of-action of these novel nucleoside analogues. Whole-genome RNAi screening revealed the involvement of adenosine kinase and 4E interacting protein into the mode-of-action of certain antitrypanosomal nucleoside analogues. Using RNAi lines and gene-deficient parasites, 4E interacting protein was found to be essential for parasite growth and infectivity in the vertebrate host. The essential nature of this gene product and involvement in the activity of certain nucleoside analogues indicates that it represents a potential novel drug target.

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Effectiveness of web-based feedback interventions for people with overweight and obesity: systematic review and network meta-analysis of randomized controlled trials

Journal of Eating Disorders ◽

10.1186/s40337-021-00432-6 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Carmen Varela ◽

Camila Oda-Montecinos ◽

Ana Andrés ◽

Carmina Saldaña

Keyword(s):

Systematic Review ◽

Confidence Interval ◽

Weight Control ◽

Meta Analysis ◽

Treatment Options ◽

Overweight And Obesity ◽

Mean Difference ◽

Effective Treatment Option ◽

Web Based ◽

Self Help

Abstract Background Web-based delivered interventions have become an innovative option to treat health problems, like obesity. The aim of this systematic review and network meta-analysis was to analyze the effectiveness of web-based behavioral treatments for adults with overweight and obesity. Web-based interventions and comparison interventions (traditional weight control programs) were classified according to the following feedback characteristics: frequency, personalization, and provider (human versus machine). Method From the initial 1789 studies, 15 were included in this review. A network meta-analysis was conducted to analyze the efficacy of web-based programs with traditional interventions, considering direct and indirect comparisons. The main outcome was the weight loss mean difference (kg) between baseline and post-treatment. Heterogeneity and consistency assumptions were validated to conduct the network meta-analysis. Results Network meta-analysis showed comparisons between different treatment options. The main results were that Intensive Contact Web-based programs were more effective than wait-list (Mean Difference − 1.86 kg; 95% Confidence Interval: − 3.61, − 0.12). Moreover, Intensive Contact Web-based programs were more effective than the other web-based options and self-help traditional interventions. However, the only significant comparison was Intensive Contact Web-based programs versus Guided Self-Help Web-based programs (Mean Difference − 4.31 kg; 95% Confidence Interval: − 5,22, − 3,41). Intensive Contact Web-based programs were the most effective treatment option according the obtained results, achieving the first place in the ranking provided by the network meta-analysis with 98.5% of probabilities. Conclusions Intensive Contact Web-based interventions have obtained the first position in the ranking, proving the relevance of frequent, personalized, and professional feedback and their association with a better prognosis for people with overweight and obesity. These results provide relevant information to design more effective treatments for people with overweight and obesity, in a new format especially appropriate for the current situation.

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Renal Nerve Ablation in Nephritis and Beyond

Journal of the American Society of Nephrology ◽

10.1681/asn.2021060748 ◽

2021 ◽

Vol 32 (10) ◽

pp. 2393-2395

Author(s):

Kristina Rodionova ◽

Tilmann Ditting ◽

Roland Veelken

Keyword(s):

Renal Nerve ◽

Renal Nerve Ablation

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Advances in the treatment of opioid use disorders

F1000Research ◽

10.12688/f1000research.10184.1 ◽

2017 ◽

Vol 6 ◽

pp. 87 ◽

Cited By ~ 7

Author(s):

George E. Woody

Keyword(s):

Treatment Options ◽

Geographical Location ◽

Psychosocial Problems ◽

Psychosocial Treatment ◽

Prescription Opioid ◽

Opioid Use ◽

Improved Outcomes ◽

Opioid Use Disorders ◽

The Many ◽

Prescription Opioid Use

The development of medications for treating persons with opioid use disorders has expanded the number of evidence-based treatment options, particularly for persons with the most severe disorders. It has also improved outcomes compared to psychosocial treatment alone and expanded treatment availability by increasing the number of physicians involved in treatment and the settings where patients can be treated. The medications include methadone, buprenorphine, buprenorphine/naloxone, and extended-release injectable naltrexone. Studies have shown that they are most effective when used over an extended, but as-yet-unspecified, period of time and with counseling and other services, particularly for the many with psychosocial problems. Though controversial in some cultures, well-designed studies in Switzerland, the Netherlands, Germany, and Canada have demonstrated the efficacy of supervised heroin injecting for persons who responded poorly to other treatments, and this treatment option has been approved by Switzerland and a few other E.U. countries. The degree to which medication-assisted therapies are available is dependent on many variables, including national and local regulations, preferences of individual providers and their geographical location, treatment costs, and insurance policies. Greater availability of medication-assisted therapies has become a major focus in the U.S. and Canada, where there has been a marked increase in deaths associated with heroin and prescription opioid use. This paper provides a brief summary of these developments.

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