The Cleveland Clinic Foundation

WEDNESDAY, Nov. 27, 2024 -- The blood-brain barrier is a natural membrane that protects your brain from toxins and germs. Unfortunately, this barrier also hampers the delivery of important medicines and therapies into the brain. But researchers now think they’ve figured out a way to get drugs past the blood-brain barrier. A Mount Sinai research team delivered genetic therapies into the brains of mice by taking advantage of a natural transport function of cells, researchers report in the journal Nature Biotechnology . The therapies successfully reduced the activity of harmful genes in lab mouse brains that contribute to ALS, Alzheimer’s disease and dementia, researchers said. “The blood-brain barrier is an essential defense mechanism, but it also presents a significant challenge for delivering drugs to the brain,” senior researcher Yizhou Dong , professor of immunology and immunotherapy with the Icahn School of Medicine at Mount Sinai, said in a news release. The new technique, called the blood-brain barrier-crossing conjugate (BCC) system, “breaks this barrier,” Dong said, allowing medications “to reach the central nervous system safely and efficiently.” The blood-brain barrier is a tight layer of cells that line the inner surfaces of blood vessels inside the brain, according to the Cleveland Clinic. The barrier filters out larger molecules that might otherwise enter the brain through the bloodstream. This keeps bacteria, viruses and toxic substances from invading the brain, but also makes it tough to deliver medications into the brain. The new technique involves a process called transcytosis, in which cells transport substances through themselves. The substance is engulfed by the cell, moved through its interior, and then released on the other side. Researchers were able to get gene-based drugs injected into the bloodstream of mice by linking the medication to a compound called BCC10, their paper says. The BCC10 compound uses transcytosis to prompt cells in the blood-brain barrier to transport the drugs across the barrier from within, researchers said. The treatment was well-tolerated in the mice, causing little or no damage to any major organs, researchers said. “Our platform could potentially solve one of the biggest hurdles in brain research — getting large therapeutic molecules past the blood-brain barrier safely and efficiently,” senior researcher Dr. Eric Nestler , director of the Friedman Brain Institute and dean for academic affairs at Icahn Mount Sinai, said in a news release. “This development has the potential to advance treatments for a broad range of brain diseases.” Researchers next plan to test their BCC system on larger animals, to validate its function and develop its potential to treat disease. Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

Medtronic has announced it has received CE Mark approval for its next generation Endoflip 300 system to measure pressure and dimensions in the oesophagus and pylorus in adults. The Endoflip 300 System will help thousands of patients across Europe with oesophageal motility disorders achieve a diagnosis. Research suggests these disorders are missed in up to 50% of endoscopies and patients can wait years to receive a diagnosis. Endoflip can be performed under sedation in around five minutes and can be utilised from the very first endoscopy. Timely diagnosis of these conditions is key to improving patient outcomes. As pinpointing the underlying cause of patient symptoms can be very difficult, Endoflip represents a valuable tool as a convenient, well tolerated method for assessment. The device uses a balloon catheter to display diameter estimates of the measurement area in real-time. It can measure and display diameter estimates at up to 16 points within the balloon while also displaying balloon pressure. This may allow for a more precise diagnosis and treatment planning from the very first endoscopy, preventing unnecessary distress for patients. “Medtronic is committed to transforming oesophageal care for patients by providing physicians with cutting-edge solutions to their clinical challenges,” comments Darin Wilson, Medtronic Endoscopy Business Unit Leader, Western Europe. “We are excited to have received CE Mark approval for Endoflip 300, which will help gastroenterologists & GI surgeons across Europe diagnose oesophageal motility disorders much earlier, plan and implement precise and effective treatment and, ultimately, improve patient outcomes. We are fuelled by our resolve to change each individual’s life for the better and strive to achieve this through continued technological innovation.” Dr. Rehan Haidry, Clinical Lead of Endoscopy and Consultant Gastroenterologist at the Cleveland Clinic, London adds: “Endoflip is a game changer for us. Oesophageal motility disorders, like achalasia and gastroparesis, are notorious for being hard to spot and patients are often given the wrong diagnosis. I've seen patients with symptoms for over a decade, undergoing numerous inconclusive endoscopies. Endoflip provides us with a significant advantage: by guiding diagnosis and treatment early on, Endoflip can drastically improve patient outcomes.” Professor Silvana Perretta, Upper gastro-intestinal surgeon, from the Nouvel Hôpital Civil (NHC) University Hospital, Strasbourg concludes: “Incorporating EndoflipTM technology for perioperative use provides an additional functional tool that enhances diagnostic accuracy and helps prevent misdiagnosis and therefore mistreatment. In surgery there is no room for approximation. This innovation is pivotal in delivering more precise care, particularly in the era of precision surgery and treatment. A smart imaging probe for smart diagnosis can save health care dollars and improve patient’s lives.” Oesophageal motility disorders affect the normal functioning of the oesophagus. They can disrupt the normal swallowing process (peristalsis) causing symptoms such as difficulty swallowing (dysphagia), chest pain, regurgitation, and heartburn. The best-defined oesophageal motility disorder, achalasia, is rare with a prevalence of up to 15.7 per 100,000, while gastroparesis has a prevalence of 13.8 per 100,000 in Europe. But these conditions are misdiagnosed in up to 50% of endoscopies meaning, in Europe alone, there could be thousands more people living with these conditions that haven’t been diagnosed. This is because symptoms can overlap with more common conditions such as gastro-oesophageal reflux disease (GORD). Misdiagnosis can lead to unnecessary tests which can cause distress and cost money. Depending on the healthcare system and whether procedures are performed publicly or privately costs can vary, however, upper GI endoscopies typically cost €2,000 - €4,000 in Western Europe, and sometimes as much as €7,000. Meanwhile, patients deteriorate and they suffer reduced quality of life due to ongoing symptoms.

WEDNESDAY, Nov. 20, 2024 -- Disparities exist in telemedicine utilization for neurologic conditions, according to a study published online Nov. 20 in Neurology: Clinical Practice . Marisa Patryce McGinley, D.O., from the Cleveland Clinic, and colleagues characterized outpatient telemedicine utilization for neurologic conditions and identified potential disparities at an academic medical health care system. Patients completing in-person visits were compared to those completing telemedicine visits. Telemedicine utilization was compared prepandemic (before March 2020), early pandemic (March to June 2020), and late pandemic (July 2020 to July 2022). During the study time frame, 242,273 patients completed 752,174 visits. The researchers found that telemedicine utilization differed significantly between time frames, with the highest utilization early in the pandemic. The odds of a telemedicine visit were significantly lower for individuals who were older (odds ratio, 0.97), were Black or Hispanic (odds ratios, 0.84 and 0.70, respectively), had a higher Area Deprivation Index (odds ratios, 0.85, 0.80, 0.78, and 0.65 for 20 to 40, 40 to 60, 60 to 80, and ≥80 percent, respectively), had nonprivate insurance (odds ratios, 0.78, 0.84, and 0.60 for Medicaid, Medicare, and self-pay, respectively), and had non-English preferred language (odds ratio, 0.61) in the late pandemic time frame. Significantly higher odds of a telemedicine visit were seen for individuals who were female (odds ratio, 1.25) and lived outside of the greater Cleveland area (odds ratios, 2.33 and 3.32 for other Ohio and out of state, respectively). No difference was seen for visits completed by rural patients versus metropolitan patients. "Telemedicine has the potential to improve access to neurologic care and the disparities in utilization identified in this study may aid researchers and institutions in creating strategies to ensure equitable implementation," the authors write. Several authors disclosed ties to biopharmaceutical companies, including Genentech, which partially funded the study.