Endocrinology and Diabetes

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Endocrinology and Diabetes

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VANCOUVER, British Columbia and CAMBRIDGE, Mass., May 05, 2017 (GLOBE NEWSWIRE) -- Novelion Therapeutics Inc. (NASDAQ:NVLN) (TSX:NVLN), a biopharmaceutical company dedicated to developing new standards of care for individuals living with rare diseases, today announced the presentation of data by academic researchers at the American Association of Clinical Endocrinology taking place in Austin, TX. The study titled “Impact of Metreleptin on Hepatomegaly in Patients with Generalized Lipodystrophy” suggests treatment with metreleptin may reduce liver volume in patients with enlarged liver (hepatomegaly) resulting from complications of generalized lipodystrophy (GL). The study also demonstrated improvements from baseline of key metabolic parameters, including hemoglobin A1c (HbA1c), liver enzymes and triglycerides. The post-hoc analysis of an open-label, prospective study in patients with GL assessed both the impact on liver volume and key metabolic parameters when patients were treated with metreleptin as leptin replacement therapy. Of the 34 evaluable patients, 22 had baseline liver volumetric measurements using MRI; all 22 patients had an enlarged liver. Normal liver volume was defined as less than 25 mL/kg of body weight. The post-hoc analysis completed by Elif Oral, M.D., Associate Professor of Medicine, Michigan Medicine, reviewed patients who participated in a prospective, open-label study conducted at National Institutes of Health between 2000-2008, with study drug provided by Novelion Therapeutics’ subsidiary. For patients assessed within one year of initiating treatment with metreleptin (N=21), liver volume decreased an average of 25 percent. The mean treatment duration was 10 months. Among these same patients who had additional follow ups after one year (N=14) and had a mean duration of metreleptin treatment of 46 months, liver volume decreased by 35 percent. The most commonly reported adverse events occurring in more than 10 percent of patients were abdominal pain, hypoglycemia, ear infection, fatigue, proteinuria, back pain, diarrhea, headache, menorrhagia, nausea, ovarian cyst, upper respiratory tract infection and weight decline. “GL patients lack fat cells and the absence of adipocytes can lead to the accumulation of fat in the liver that can potentially progress to various forms of liver disease,” said Dr. Oral.  “We were pleased to see a continued treatment effect in patients who had a longer duration of therapy.” Patients treated with metreleptin also experienced clinically meaningful reductions from baseline in HbA1c, liver enzymes (both AST and ALT) and triglycerides, a type of fat in the blood. Novelion believes that metreleptin may demonstrate clinical results in a wide range of low leptin-mediated rare and metabolic diseases. John Orloff, MD, executive vice president and head of research and development for Novelion, stated, “Analysis like this, combined with 14 years of additional patient data, provides evidence supporting the implications of low leptin levels on various physiologic functions. We are currently evaluating conducting clinical trials to investigate the use of metreleptin in multiple other low leptin-mediated conditions.” Lipodystrophy syndromes (LD) are ultra-rare disorders characterized by the irreversible loss of adipose tissue. In patients with lipodystrophy syndromes, levels of leptin are often very low. Leptin is a naturally occurring hormone produced in adipose tissue and is an important regulator of energy homoeostasis, fat and glucose metabolism, reproductive capacity, and other diverse physiological functions. With GL, the loss of fat affects the whole body. With partial lipodystrophy, the loss of fat typically occurs in the arms, legs, head and trunk regions, while accumulation of fat may occur in other areas of the body, including the neck, face and intra-abdominal regions. Metreleptin is approved in the U.S. to treat GL and is not approved to treat partial lipodystrophy. MYALEPT® (metreleptin) for injection is a leptin analog indicated as an adjunct to diet as replacement therapy to treat the complications of leptin deficiency in patients with congenital or acquired generalized lipodystrophy. LIMITATIONS OF USE: The safety and effectiveness of MYALEPT for the treatment of complications of partial lipodystrophy or for the treatment of liver disease, including nonalcoholic steatohepatitis (NASH), have not been established. MYALEPT is not indicated for use in patients with HIV-related lipodystrophy. MYALEPT is not indicated for patients with metabolic disease, including diabetes mellitus and hypertriglyceridemia, without concurrent evidence of generalized lipodystrophy. Anti-metreleptin antibodies with neutralizing activity have been identified in patients treated with MYALEPT. T-cell lymphoma has been reported in patients with acquired generalized lipodystrophy, both treated and not treated with MYALEPT. For more detailed information, please see additional Important Safety Information and the Prescribing Information, including boxed warning, for MYALEPT. MYALEPT is available only through a restricted program called the MYALEPT REMS PROGRAM. About University of Michigan, Metabolism, Endocrinology and Diabetes Division The University of Michigan, Metabolism, Endocrinology and Diabetes Division and Brehm Center for Diabetes collectively house a major referral for the study of lipodystrophy syndromes. For more information, contact Adam Neidert at (734) 615-0539. About Novelion Therapeutics Novelion Therapeutics is a biopharmaceutical company dedicated to developing new standards of care for individuals living with rare diseases. The company seeks to advance its portfolio of rare disease therapies by investing in science and clinical development. Novelion has a diversified commercial portfolio through its indirect subsidiary, Aegerion Pharmaceuticals, Inc. (Aegerion), and is also developing zuretinol acetate for the potential treatment of inherited retinal disease caused by underlying mutations in RPE65 or LRAT genes. Certain statements in this press release constitute "forward-looking statements" of Novelion within the meaning of applicable laws and regulations and constitute "forward-looking information" within the meaning of applicable Canadian securities laws, including the statement regarding expectations as to label expansion for metreleptin. Forward-looking statements are based on estimates and assumptions made by Novelion in light of current conditions and expected future developments, as well as other factors that Novelion believes are appropriate in the circumstances, including but not limited to, our financial position and execution of our business strategy, receipt of regulatory approvals, indication prevalence, and product competition, market acceptance, sales, pricing, reimbursement and side effects. These forward-looking statements are neither promises nor guarantees of future performance, and are subject to a variety of risks and uncertainties, many of which are beyond our control, which could cause actual results to differ materially from those contemplated in these forward-looking statements. Many such risks, uncertainties and other factors are taken into account as part of our assumptions underlying these forward-looking statements and include, among others, the following: the risks that metreleptin may not obtain regulatory approval for additional indications; that, if approved, metreleptin may not obtain reimbursement approvals on a timely basis or at all or at the levels necessary to support commercialization; that the prevalence estimates for a desired indication may be inaccurate; the risk that orphan drug, data and marketing exclusivity or the patent protection for metreleptin may not be sufficient or may be invalidated; and the other risks common to seeking regulatory approval for, developing and commercializing orphan drugs. For additional disclosure regarding these and other risks we face, see the disclosure contained in the "Risk Factors" section of our Annual Report on Form 10-K filed on March 30, 2017, and our other public filings with the SEC, available on the SEC's website at www.sec.gov. Except as required by law, we undertake no obligation to update or revise the information contained in this press release, whether as a result of new information, future events or circumstances or otherwise. Investors and others should note that we communicate with our investors and the public using our company website www.novelion.com, including, but not limited to, company disclosures, investor presentations and FAQs, SEC filings, press releases, public conference calls transcripts and webcast transcripts. The information that we post on these websites could be deemed to be material information. As a result, we encourage investors, the media and others interested to review the information that we post there on a regular basis. The contents of our website shall not be deemed incorporated by reference in any filing under the Securities Act of 1933, as amended.

Spencer-Segal J.L.,Endocrinology and Diabetes | Spencer-Segal J.L.,Molecular and Behavioral Neuroscience Institute | Hyzy R.C.,University of Michigan | Iwashyna T.J.,University of Michigan | And 2 more authors.
Annals of the American Thoracic Society | Year: 2017

Rationale: Psychiatric morbidity after acute respiratory distress syndrome (ARDS) is common, and our current ability to predict psychiatric symptoms based on patient- and illness-specific factors is limited. Objectives: We assessed symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) in long-term survivors of ARDS, as well as the associated changes in cortisol levels. Methods: The participants were enrolled in a randomized, double-blind, placebo-controlled trial of granulocyte macrophage-colony stimulating factor (GM-CSF) or placebo conducted at three academic medical centers. There were 132 patients enrolled, and 44 patients completed 6-month follow-up questionnaires (45% of survivors). Results: Six months after enrollment, survivors completed the Post-Traumatic Stress Syndrome 10 Questions Inventory, Impact of Event Scale, and Hospital Anxiety and Depression Scale to assess psychiatric symptoms. Plasma cortisol levels during treatment were measured by immunoassay. Thirty-six percent of patients reported significant psychiatric symptoms on at least one scale. GM-CSF-treated patients reported more severe posttraumatic stress and depression symptoms than patients in the placebo group. In multiple regression analyses, younger age, female sex, higher severity of illness, fewer steroid treatment days, and GM-CSF treatment were all independently associated with more severe psychiatric symptoms on at least one scale. Conclusions: 6months after ARDS, age, sex, illness severity, steroids, and GM-CSF treatment were associated with psychiatric symptom scores. These associations should be confirmed in a larger population. © 2017 by the American Thoracic Society.

Sivaprasad S.,King's College | Gupta B.,King's College | Gulliford M.C.,King's College London | Mann S.,St Thomas Hospital Nhs Foundation Trust | And 2 more authors.
PLoS ONE | Year: 2012

Purpose: To provide estimates of visual impairment in people with diabetes attending screening in a multi-ethnic population in England (United Kingdom). Methods: The Diabetic Retinopathy In Various Ethnic groups in UK (DRIVE UK) Study is a cross-sectional study on the ethnic variations of the prevalence of DR and visual impairment in two multi-racial cohorts in the UK. People on the diabetes register in West Yorkshire and South East London who were screened, treated or monitored between April 2008 to July 2009 (London) or August 2009 (West Yorkshire) were included in the study. Data on age, gender, ethnic group, visual acuity and diabetic retinopathy were collected. Ethnic group was defined according to the 2011 census classification. The two main ethnic minority groups represented here are Blacks ("Black/African/Caribbean/Black British") and South Asians ("Asians originating from the Indian subcontinent"). We examined the prevalence of visual impairment in the better eye using three cut-off points (a) loss of vision sufficient for driving (approximately <6/9) (b) visual impairment (<6/12) and (c) severe visual impairment (<6/60), standardising the prevalence of visual impairment in the minority ethnic groups to the age-structure of the white population. Results: Data on visual acuity and were available on 50,331individuals 3.4% of people diagnosed with diabetes and attending screening were visually impaired (95% confidence intervals (CI) 3.2% to 3.5%) and 0.39% severely visually impaired (0.33% to 0.44%). Blacks and South Asians had a higher prevalence of visual impairment (directly age standardised prevalence 4.6%, 95% CI 4.0% to 5.1% and 6.9%, 95% CI 5.8% to 8.0% respectively) compared to white people (3.3%, 95% CI 3.1% to 3.5%). Visual loss was also more prevalent with increasing age, type 1 diabetes and in people living in Yorkshire. Conclusions: Visual impairment remains an important public health problem in people with diabetes, and is more prevalent in the minority ethnic groups in the UK. © 2012 Sivaprasad et al.

Haymart M.R.,Endocrinology and Diabetes | Haymart M.R.,University of Michigan | Haymart M.R.,North Campus Research Complex | Banerjee M.,University of Michigan | And 4 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2013

Context: Little is known about practice patterns in thyroid cancer, a cancer that is increasing in incidence. Objective: Wesought to identify aspects of thyroid cancer management that have the greatest variation. Design/Setting/Participants: We surveyed 944 physicians involved in thyroid cancer care from 251 hospitals affiliated with the US National Cancer Database. Physicians were asked questions in the following four domains: thyroid surgery, radioactive iodine use, thyroid hormone replacement postsurgery, and long-term thyroid cancer management. We calculated the ratio of observed variation to hypothetical maximum variation under the assumed distribution of the response. Ratios closer to 1 indicate greater variation. Results: We had a 66% response rate. We found variation in multiple aspects of thyroid cancer management, including the role of central lymph node dissections (variation, 0.99; 95% confidence interval [CI], 0.98-1.00), the role of pretreatment scans before radioactive iodine treatment (variation, 1.00; 95% CI, 0.98-1.00), and all aspects of long-term thyroid cancer management, including applications of ultrasound (variation, 0.97; 95% CI, 0.93-0.99) and radioactive iodine scans (variation, 0.99; 95% CI, 0.97-1.00). For the management of small thyroid cancers, variation exists in all domains, including optimal extent of surgery (variation, 0.91; 95% CI, 0.88-0.94) and the role of both radioactive iodine treatment (variation, 0.91; 95% CI, 0.89-0.93) and suppressive doses of thyroid hormone replacement (variation, 1.00; 95% CI, 0.99-1.00). Conclusion: We identified areas of variation in thyroid cancer management. To reduce the variation and improve the management of thyroid cancer, there is a need for more research and more research dissemination. Copyright © 2013 by The Endocrine Society.

The International Association of HealthCare Professionals is pleased to welcome Jorge A. Pino, MD, Endocrinologist, to their prestigious organization with his upcoming publication in The Leading Physicians of the World. Dr. Jorge A. Pino is a highly trained and qualified physician with an extensive expertise in all facets of his work, especially in endocrinology, internal medicine, diabetes, and metabolism. Dr. Pino has been in practice for more than 35 years and is currently serving patients within Diabetes and Endocrinology Associates in Birmingham, Alabama. He is also affiliated with St. Joseph Hospital. Dr. Jorge A. Pino graduated with his Medical Degree in 1964 from the Universidad del Valle in Cali, Columbia. Upon relocating to the United States, Dr. Pino completed his Endocrinology and Diabetes residency at the Southeast Louisiana Veterans Health Care System, before undertaking an additional residency at the University of Alabama at Birmingham. Dr. Pino is double board certified in Endocrinology and Internal Medicine, and in addition to his clinical practice, he serves as a Clinical Professor at the University of Alabama at Birmingham. He attributes his success to his great education, constantly learning, and his excellent mentors. In his free time, Dr. Pino likes to relax by reading and traveling. Learn more about Dr. Pino by reading his upcoming publication in The Leading Physicians of the World. FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics.  Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review.  FindaTopDoc.com features each doctor’s full professional biography highlighting their achievements, experience, patient reviews and areas of expertise.  A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life.  For more information about FindaTopDoc, visit http://www.findatopdoc.com

Rubio D.M.,University of Pittsburgh | Schoenbaum E.E.,Yeshiva University | Lee L.S.,Duke University | Schteingart D.E.,Endocrinology and Diabetes | And 6 more authors.
Academic Medicine | Year: 2010

Because translational research is not clearly defined, developers of translational research programs are struggling to articulate specific program objectives, delineate the knowledge and skills (competencies) that trainees are expected to develop, create an appropriate curriculum, and track outcomes to assess whether program objectives and competency requirements are being met. Members of the Evaluation Committee of the Association for Clinical Research Training (ACRT) reviewed current definitions of translational research and proposed an operational definition to use in the educational framework. In this article, the authors posit that translational research fosters the multidirectional and multidisciplinary integration of basic research, patient-oriented research, and population-based research, with the long-term aim of improving the health of the public. The authors argue that the approach to designing and evaluating the success of translational training programs must therefore be flexible enough to accommodate the needs of individual institutions and individual trainees within the institutions but that it must also be rigorous enough to document that the program is meeting its short-, intermediate-, and long-term objectives and that its trainees are meeting preestablished competency requirements. A logic model is proposed for the evaluation of translational research programs. © 2010 Association of American Medical Colleges.

Yoshimoto F.K.,Endocrinology and Diabetes | Peng H.-M.,Endocrinology and Diabetes | Zhang H.,University of Michigan | Anderson S.M.,Endocrinology and Diabetes | And 2 more authors.
Biochemistry | Year: 2014

Some cytochrome P450 enzymes epoxidize unsaturated substrates, but this activity has not been described for the steroid hydroxylases. Physiologic steroid substrates, however, lack carbon-carbon double bonds in the parts of the pregnane molecules where steroidogenic hydroxylations occur. Limited data on the reactivity of steroidogenic P450s toward olefinic substrates exist, and the study of occult activities toward alternative substrates is a fundamental aspect of the growing field of combinatorial biosynthesis. We reasoned that human P450c17 (steroid 17-hydroxylase/17,20-lyase, CYP17A1), which 17- and 16α-hydroxylates progesterone, might catalyze the formation of the 16α,17-epoxide from 16,17-dehydroprogesterone (pregna-4,16-diene-3,20-dione). CYP17A1 catalyzed the novel 16α, 17-epoxidation and the ordinarily minor 21-hydroxylation of 16,17-dehydroprogesterone in a 1:1 ratio. CYP17A1 mutation A105L, which has reduced progesterone 16α -hydroxylase activity, gave a 1:5 ratio of epoxide:21-hydroxylated products. In contrast, human P450c21 (steroid 21-hydroxylase, CYP21A2) converted 16,17-dehydroprogesterone to the 21-hydroxylated product and only a trace of epoxide. CYP21A2 mutation V359A, which has significant 16α-hydroxylase activity, likewise afforded the 21-hydroxylated product and slightly more epoxide. CYP17A1 wild-type and mutation A105L do not 21- or 16α-hydroxylate pregnenolone, but the enzymes 21-hydroxylated and 16α,17-epoxidized 16,17-dehydropregnenolone (pregna-5,16-diene-3β-ol-20-one) in 4:1 or 12:1 ratios, respectively. Catalase and superoxide dismutase did not prevent epoxide formation. The progesterone epoxide was not a time-dependent, irreversible CYP17A1 inhibitor. Our substrate modification studies have revealed occult epoxidase and 21-hydroxylase activities of CYP17A1, and the fraction of epoxide formed correlated with the 16α-hydroxylase activity of the enzymes. (Chemical Equation Presented). © 2014 American Chemical Society.

Moraitis A.G.,endocrinology and Diabetes | Rainey W.E.,endocrinology and Diabetes | Rainey W.E.,University of Michigan | Auchus R.J.,endocrinology and Diabetes
Application of Clinical Genetics | Year: 2014

Primary aldosteronism (PA) is the most common form of secondary hypertension, found in about 5% of all hypertension cases, and up to 20% of resistant hypertension cases. The most common forms of PA are an aldosterone-producing adenoma and idiopathic (bilateral) hyperaldosteronism. Rare genetic forms of PA exist and, until recently, the only condition with a known genetic mechanism was familial hyperaldosteronism type 1, also known as glucocorticoid-remediable aldosteronism (FHA1/GRA). FHA type 3 has now been shown to derive from germline mutations in the KCNJ5 gene, which encodes a potassium channel found on the adrenal cells. Remarkably, somatic mutations in KCNJ5 are found in about one-third of aldosterone-producing adenomas, and these mutations are likely to be involved in their pathogenesis. Finally, mutations in the genes encoding an L-type calcium channel (CACNA1D) and in genes encoding a sodium-potassium adenosine triphosphatase (ATP1A1) or a calcium adenosine triphosphatase (ATP2B3) are found in other aldosterone-producing adenomas. These fndings provide a working model, in which adenoma formation and/or aldosterone production in many cases derives from increased calcium entry, which drives the pathogenesis of primary aldosteronism. © 2014 Moraitis et al.

Else T.,Endocrinology and Diabetes | Williams A.R.,University of Michigan | Sabolch A.,University of Michigan | Jolly S.,University of Michigan | And 2 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2014

Context: Adrenocortical carcinoma is a rare malignant endocrine neoplasia. Studies regarding outcomeandprognostic factors relyonfairly small studies. Herewesummarize the experience with patients with a diagnosis of adrenocortical carcinoma from a large tertiary referral center. Objective: The objective of the study was to identify prognostic factors in patients with adrenocortical carcinoma and evaluate adjuvant treatment strategies. Design: Patient datawerecollected in a retrospective single-center study. Epidemiological, patient, and tumor characteristics were analyzed for prognostic factors regarding overall and recurrencefree survival in Cox regression models (multivariable and univariable). Results: Three hundred ninety-one adult patients with the diagnosis of adrenocortical carcinoma were identified. Median overall survival was 35.2 months. Cortisol production [hazard ratio (HR) 1.4, HR 1.5], tumor stage (HR stage 3 of 2.1 and 2.1, HR stage 4 of 4.8), and tumor grade (HR 2.4 and 2.0) were identified as negative prognostic factors (HR for death, HR for recurrence). Mitotane therapy increases recurrence-free survival, an effect that was significantly further improved by adjuvant radiation therapy but did not impact overall survival. Patients with open adrenalectomy had improved overall survival. Conclusions: This study increases the evidence for adverse risk factors (cortisol production, high tumor stage, and high tumor grade) and suggests the following therapy approach: adrenocortical carcinoma patients should be treated with open adrenalectomy. Adjuvant therapy, particularly mitotane therapy in conjunction with radiation, should be considered to delay tumor recurrence. Copyright © 2014 by the Endocrine Society.

Papaleontiou M.,Endocrinology and Diabetes | Haymart M.R.,Endocrinology and Diabetes and Hematology Oncology
Current Opinion in Oncology | Year: 2014

PURPOSE OF REVIEW: Numerous staging and scoring systems exist for differentiated thyroid cancer (DTC), but all harbor limitations. This has prompted investigation for new factors with prognostic implications for DTC. RECENT FINDINGS: Several new factors that may be involved in DTC risk stratification have emerged, such as thyroid stimulating hormone and molecular markers. In addition, others are controversial and being challenged, such as age, sex and lymph node involvement. SUMMARY: The purpose of this review is to present recent updates in the literature on new potential risk stratification predictors for DTC. © Lippincott Williams & Wilkins.

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