Informing a national rare disease registry strategy in Australia: a mixed methods study.

BACKGROUND: Rare disease registries (RDRs) facilitate monitoring of rare diseases by pooling small datasets to increase clinical and epidemiological knowledge of rare diseases and promote patient centred best practice. The aim of this study was to understand the current state of RDRs in Australia, data captured, impact on patient outcomes, funding models, and barriers and enablers regarding their establishment and maintenance. METHODS: An exploratory sequential mixed methods study design was adopted. First, a list of Australian RDRs, primary contacts and data custodians was generated through online and consumer group (Rare Voices Australia (RVA)) contacts. A cross-sectional, anonymous online survey was distributed to registry custodians, managers, or principal investigators of 74 identified Australian RDRs, 88 RVA Partners, 17 pharmaceutical organizations and 12 RVA Scientific and Medical Advisory Committee members. Next, managers and coordinators of RDRs and databases who participated in the survey were invited to participate in semi-structured interviews. Quantitative and qualitative data were analysed using basic descriptive statistics and content analysis, respectively. RESULTS: Forty RDRs responded to the survey; nine were national, five were based in Australia and New Zealand, and the remaining were global. Of the 40 survey respondents, eight were interviewed. Most of the RDRs captured similar information regarding patient characteristics, comorbidities and clinical features, diagnosis, family history, genetic testing, procedures or treatment types, response to treatments and complications of treatments. Better treatment outcomes, changes in process of care and changes in quality of care were the most frequently reported benefits of the RDRs. The main challenges proved to be cost/funding of data collection, data completeness, and patient consent. When asked, the participants identified opportunities and challenges regarding potential options to streamline RDRs in Australia in the future. CONCLUSION: Findings from this study highlighted significant dataset heterogeneity based on the individual disease, and current lack of interoperability and coordination between different existing RDRs in Australia. Nevertheless, a nationally coordinated approach to RDRs should be investigated given the particular benefits RDRs offer, such as access to research and the monitoring of new disease-modifying treatments.

Current state of rare disease registries and databases in Australia: a scoping review.

BACKGROUND: Rare diseases (RDs) affect approximately 8% of all people or > 400 million people globally. The Australian Government's National Strategic Action Plan for Rare Diseases has identified the need for a national, coordinated, and systematic approach to the collection and use of RD data, including registries. Rare disease registries (RDRs) are established for epidemiological, quality improvement and research purposes, and they are critical infrastructure for clinical trials. The aim of this scoping review was to review literature on the current state of RDRs in Australia; to describe how they are funded; what data they collect; and their impact on patient outcomes. METHODS: We conducted a literature search on MEDLINE, EMBASE, CINAHL and PsychINFO databases, in addition to Google Scholar and grey literature. Dissertations, government reports, randomised control trials, conference proceedings, conference posters and meeting abstracts were also included. Articles were excluded if they did not discuss RDs or if they were written in a language other than English. Studies were assessed on demographic and clinical patient characteristics, procedure or treatment type and health-related quality of life captured by RDRs or databases that have been established to date. RESULTS: Seventy-four RDRs were identified; 19 were global registries in which Australians participated, 24 were Australian-only registries, 10 were Australia and New Zealand based, and five were Australian jurisdiction-based registries. Sixteen "umbrella" registries collected data on several different conditions, which included some RDs, and thirteen RDRs stored rare cancer-specific information. Most RDRs and databases captured similar types of information related to patient characteristics, comorbidities and other clinical features, procedure or treatment type and health-related quality of life measures. We found considerable heterogeneity among existing RDRs in Australia, especially with regards to data collection, scope and quality of registries, suggesting a national coordinated approach to RDRs is required. CONCLUSION: This scoping review highlights the current state of Australian RDRs, identifying several important gaps and opportunities for improvement through national coordination and increased investment.

Response rates in clinical quality registries and databases that collect patient reported outcome measures: a scoping review.

BACKGROUND: Patient Reported Outcome Measures (PROMs) are being increasingly introduced in clinical registries, providing a personal perspective on the expectations and impact of treatment. The aim of this study was to describe response rates (RR) to PROMs in clinical registries and databases and to examine the trends over time, and how they change with the registry type, region and disease or condition captured. METHODS: We conducted a scoping literature review of MEDLINE and EMBASE databases, in addition to Google Scholar and grey literature. All English studies on clinical registries capturing PROMs at one or more time points were included. Follow up time points were defined as follows: baseline (if available), < 1 year, 1 to < 2 years, 2 to < 5 years, 5 to < 10 years and 10 + years. Registries were grouped according to regions of the world and health conditions. Subgroup analyses were conducted to identify trends in RRs over time. These included calculating average RRs, standard deviation and change in RRs according to total follow up time. RESULTS: The search strategy yielded 1,767 publications. Combined with 20 reports and four websites, a total of 141 sources were used in the data extraction and analysis process. Following the data extraction, 121 registries capturing PROMs were identified. The overall average RR at baseline started at 71% and decreased to 56% at 10 + year at follow up. The highest average baseline RR of 99% was observed in Asian registries and in registries capturing data on chronic conditions (85%). Overall, the average RR declined as follow up time increased. CONCLUSION: A large variation and downward trend in PROMs RRs was observed in most of the registries identified in our review. Formal recommendations are required for consistent collection, follow up and reporting of PROMs data in a registry setting to improve patient care and clinical practice. Further research studies are needed to determine acceptable RRs for PROMs captured in clinical registries.

Hydrophobic deep eutectic solvents in the food sector: Focus on their use for the extraction of bioactive compounds.

Hydrophobic Deep Eutectic Solvents (HDESs) represent a novel kind of solvent. While several studies investigated their properties, just a few dealt with their use for extracting and recovering bioactive compounds from raw materials, wastes and by-products, even if HDESs might represent an interesting alternative when producing pharmaceuticals, foodstuffs and cosmetics. Furthermore, their use may contribute to realizing more sustainable green processes. This review focuses on HDESs, with particular emphasis on Natural HDESs, discussing their properties and uses, highlighting their role as extractants in food applications, both from an analytical and processing point of view, and underlining the positive and negative aspects. While of prospective interest, currently the use of HDESs at industrial level remains a challenge, with several aspects needing further investigation. In order to scale-up the process, more research should focus on key issues, such as solute recovery, solvent recycling and extraction yields, as well as potential health hazards.

Extraction Kinetics of Total Polyphenols, Flavonoids, and Condensed Tannins of Lentil Seed Coat: Comparison of Solvent and Extraction Methods.

The lentil seed coat is a waste by-product still rich in phenolic compounds, specifically condensed tannins. The effect of different solvents, as well as different processes, namely conventional solid-liquid extraction (CSLE) and ultrasound-assisted extraction (UAE), on the extraction yield of specific phenolic compound classes was studied. Four empirical two-parameter models were examined to select the one that better fit the experimental data obtained under different operating conditions. Additionally, ultra-high-pressure liquid chromatography coupled to quadrupole-time-of-flight mass spectrometry (UHPLC-ESI/QTOF-MS) was employed to profile the phenolic compounds obtained under distinct extraction conditions. In the operative conditions adopted here, the bioactive compounds yield achieved using UAE was lower than that obtained with CSLE. The kinetics of polyphenols, flavonoids, and condensed tannins extraction from the lentil seed coat were successfully fitted to the power-law models, yielding mean values of the root mean square < 5.4%, standard error of estimation < 0.53, and coefficient of determination > 0.8. In addition, the UHPLC-ESI/QTOF-MS of the lentil seed coat extracts allowed the putative recognition of nearly 500 compounds, mainly flavonoids and phenolic acids.

Optimization Model of Phenolics Encapsulation Conditions for Biofortification in Fatty Acids of Animal Food Products.

The nutritional quality of animal products is strongly related to their fatty acid content and composition. Nowadays, attention is paid to the possibility of producing healthier foods of animal origin by intervening in animal feed. In this field, the use of condensed tannins as dietary supplements in animal nutrition is becoming popular due to their wide range of biological effects related, among others, to their ability to modulate the rumen biohydrogenation and biofortify, through the improvement of the fatty acids profile, the derivate food products. Unfortunately, tannins are characterized by strong astringency and low bioavailability. These disadvantages could be overcome through the microencapsulation in protective matrices. With this in mind, the optimal conditions for microencapsulation of a polyphenolic extract rich in condensed tannins by spray drying using a blend of maltodextrin (MD) and gum Arabic (GA) as shell material were investigated. For this purpose, after the extract characterization, through spectrophotometer assays and ultra-high-performance liquid chromatography-quadrupole time-of-flight (UHPLC-QTOF) mass spectrometry, a central composite design (CCD) was employed to investigate the combined effects of core:shell and MD:GA ratio on the microencapsulation process. The results obtained were used to develop second-order polynomial regression models on different responses, namely encapsulation yield, encapsulation efficiency, loading capacity, and tannin content. The formulation characterized by a core:shell ratio of 1.5:5 and MD:GA ratio of 4:6 was selected as the optimized one with a loading capacity of 17.67%, encapsulation efficiency of 76.58%, encapsulation yield of 35.69%, and tannin concentration of 14.46 g/100 g. Moreover, in vitro release under varying pH of the optimized formulation was carried out with results that could improve the use of microencapsulated condensed tannins in animal nutrition for the biofortification of derivates.

Microencapsulation as a Tool for the Formulation of Functional Foods: The Phytosterols' Case Study.

Hypercholesterolemia, which is an increase in total and low-density lipoprotein (LDL) serum cholesterol, is an important risk factor for the development of cardiovascular diseases. Lifestyle modifications underpin any action plan for reducing serum cholesterol. Phytosterols are natural compounds belonging to the triterpenes family. Thanks to their structural analogy with cholesterol, phytosterols have the ability to reduce serum LDL-cholesterol levels. Phytosterols are used to enrich or fortify a broad spectrum of food products. Like unsaturated fatty acids and cholesterol, phytosterols are easily oxidized. Microencapsulation could be a useful tool to overcome this and other drawbacks linked to the use of phytosterols in food fortification. In this review, in addition to explaining the phytosterols' mechanisms of action, a focus on the use of free and encapsulated phytosterols for the formulation of functional foods, taking also into account both technological and legislative issues, is given.

Preparation and characterization of microencapsulated phytosterols for the formulation of functional foods: Scale up from laboratory to semi-technical production.

Phytosterols were microencapsulated by spray drying in a shell represented by WPI, inulin and chitosan at four different combinations through the formulation of aqueous suspensions. Moreover, two concentrations of Tween 80 (1.25% and 2.50% w/w) and two inlet temperatures (125 °C and 155 °C) were tested. The effect of the different experimental conditions on the process yield and on the microcapsules properties was evaluated. A significant effect of all variables on the microcapsule properties was found. Accordingly, the best performance, with the maximum loading capacity of 25%, was obtained by using only WPI as shell material, Tween 80 at 1.25% and inlet temperature of 155 °C. The process was successfully scaled-up from laboratory equipment to a semi-technical scale keeping the optimal shell formulation and process conditions.

Novel genomic findings in multiple myeloma identified through routine diagnostic sequencing.

AIMS: Multiple myeloma is a genomically complex haematological malignancy with many genomic alterations recognised as important in diagnosis, prognosis and therapeutic decision making. Here, we provide a summary of genomic findings identified through routine diagnostic next-generation sequencing at our centre. METHODS: A cohort of 86 patients with multiple myeloma underwent diagnostic sequencing using a custom hybridisation-based panel targeting 104 genes. Sequence variants, genome-wide copy number changes and structural rearrangements were detected using an inhouse-developed bioinformatics pipeline. RESULTS: At least one mutation was found in 69 (80%) patients. Frequently mutated genes included TP53 (36%), KRAS (22.1%), NRAS (15.1%), FAM46C/DIS3 (8.1%) and TET2/FGFR3 (5.8%), including multiple mutations not previously described in myeloma. Importantly we observed TP53 mutations in the absence of a 17 p deletion in 8% of the cohort, highlighting the need for sequencing-based assessment in addition to cytogenetics to identify these high-risk patients. Multiple novel copy number changes and immunoglobulin heavy chain translocations are also discussed. CONCLUSIONS: Our results demonstrate that many clinically relevant genomic findings remain in multiple myeloma which have not yet been identified through large-scale sequencing efforts, and provide important mechanistic insights into plasma cell pathobiology.

Fortification of dark chocolate with microencapsulated phytosterols: chemical and sensory evaluation.

Chocolate is one of the most consumed delicacies in the world. Nowadays high-cocoa polyphenol-rich chocolates, probiotic chocolates, and prebiotic chocolates are getting more attention. In light of this, dark chocolate containing microencapsulated phytosterols (MPs) has been developed to reduce cholesterol in individuals. In particular, different dark chocolates containing 64, 72 and 85% of cocoa, fortified with 0, 5, 10 and 15% MP have been produced. The obtained chocolates were characterized by a particle size distribution lower than 30 µm and were stable from a chemical point of view. Specifically, peroxide values were always lower than 2 meq O2 per kg of fat, also after three months of storage. The bioaccessibility of phytosterols was comparable with literature values and the antioxidant activity reached a value of 92 µg trolox per g chocolate for samples obtained from 85% of cocoa. Moreover, sensory evaluation demonstrated a positive effect on the acceptability of the functional chocolate produced and a significant effect of the information on the final sample acceptability.

Leaf biochemical responses and fruit oil quality parameters in olive plants subjected to airborne metal pollution.

This study was carried out in two olive orchards (Olea europaea L., cv. Chemlali) located in a polluted area near a fertilizers factory and in a control unpolluted site, managed with similar cultivation techniques. The aim was to investigate the physiological and biochemical responses of polluted plants (PP), exposed to atmospheric metal contamination (Cd, Cu, Fe, Mn, Ni and Pb) as compared to control plants (CP). Leaves, roots and fruits of PP showed a depression of their non-enzymatic and enzymatic antioxidant defences and a disruption of their hormonal homeostasis. The anomalous physiological status of PP was also demonstrated by the lower values of pigments in leaves and fruits, as compared to CP. Atmospheric metals negatively affected olive oil chemical and sensory quality. However, despite metal deposition on fruit surfaces, the accumulation of potentially toxic metals in olive oil was negligible. Considering that olive oil is an important food product worldwide and that many productive olive orchards are exposed to several sources of pollution, this work could contribute to clarify the effects of atmospheric metal pollution on olive oil quality and its potential toxicity for humans.

Encapsulation of health-promoting ingredients: applications in foodstuffs.

Many nutritional experts and food scientists are interested in developing functional foods containing bioactive agents and many of these health-promoting ingredients may benefit from nano/micro-encapsulation technology. Encapsulation has been proven useful to improve the physical and the chemical stability of bioactive agents, as well as their bioavailability and efficacy, enabling their incorporation into a wide range of formulations aimed to functional food production. There are several reviews concerning nano/micro-encapsulation techniques, but none are focused on the incorporation of the bioactive agents into food matrices. The aim of this paper was to investigate the development of microencapsulated food, taking into account the different bioactive ingredients, the variety of processes, techniques and coating materials that can be used for this purpose.

Prediction of the antioxidant activity of extra virgin olive oils produced in the Mediterranean area.

A chemical characterisation was conducted on 75 commercial extra virgin olive oils (EVOO) produced in the years 2011-2012 in Southern Italy from five different olive monovarieties (Coratina, Leccino, Maiatica, Ogliarola del Vulture and Ogliarola del Bradano). The possibility of estimating the antioxidant activity of EVOO by using a chemical index as predictor of this property was considered. In order to build up and validate an antioxidant activity predictive model, the relationship between the antioxidant activity and the chosen chemical parameters was systematically investigated. The results indicated that oil antioxidant activity, measured as IC50, could be satisfactorily predicted, for olive oils from the considered region, by using a simple index, such as the K225 value of oil samples, which represents a spectrophotometric index of the compounds responsible for oil bitterness measured at 225 nm.

Extra virgin olive oil bitterness evaluation by sensory and chemical analyses.

An experimental investigation was performed on blend extra virgin olive oils (EVOOs) from different cultivars and EVOO from different olive monovarieties (Coratina, Leccino, Maiatica, Ogliarola) with the aim to evaluate the possibility of estimating the perceived bitterness intensity by using chemical indices, such as the total phenol content and the compounds responsible for oil bitterness measured spectrophotometrically at 225 nm (K225 value), as bitterness predictors in different EVOO. Therefore, a bitterness predictive model, based on the relationship between the perceived bitterness intensity of the selected stimuli and the chosen chemicals parameters has been built and validated. The results indicated that the oil bitterness intensity could be satisfactorily predicted by using the K225 values of oil samples.

Focused review: agmatine in fermented foods.

Polyamines (PAs) are ubiquitous substances considered to be bioregulators of numerous cell functions; they take part in cell growth, division, and differentiation. These biogenic amines are also involved in tissue repair and in intracellular signaling; in fact, because of their polycationic character, they interact to a large extent with membrane phospholipids and may play an important role in the regulation of membrane-linked enzymes. The intracellular polyamine content derives from the simultaneous regulation of the synthesis, catabolism, uptake, and elimination of the polyamines; furthermore, PAs are present in all cell types at different concentrations, but the highest levels are found in rapid-turnover tissues. In addition to spermidine, spermine, and putrescine, also agmatine (AGM), deriving from arginine and identified in mammals in the 1990s, is a polyamine and several studies have reported its potentially positive role in the production of secretagogues, and in neuronal, vascular, metabolic, and therapeutic functions. Because of the low arginine decarboxylase (ADC) activity in mammalians, the amounts of AGM found in their tissues can be only minimally ascribed to an endogenous de novo synthesis by ADC, while a substantial quantity of AGM may be of dietary origin. Several food products contain only small amounts of polyamines, while higher concentrations can be found in fermented foods. PAs could also be considered as indicators of freshness in fish and meat products; as these moieties are produced during food storage, it would seem to confirm the main role of microorganisms in their synthesis. In particular, high levels of AGM are present in alcoholic beverages, such as wine, beer, sake, which would seem to confirm the role of yeasts in AGM production. Although many biological functions have been attributed to polyamines, high levels of these compounds in foodstuffs can have toxicological effects; however, no safe level for the intake of polyamines in a diet has yet been established. In this paper the presence of AGM in different foodstuffs is discussed, also taking into account the various factors affecting its presence and concentration.

Chemical profile of white wines produced from 'Greco bianco' grape variety in different Italian areas by nuclear magnetic resonance (NMR) and conventional physicochemical analyses.

In this study the characterization of white wines produced from the monovarietal 'Greco bianco' grape variety is presented for the first time. A total of 40 commercial wines, from two different southern Italian regions, Calabria and Campania, from the same grape variety and two different vintages, were investigated. The analyses were performed by means of chromatographic methods, conventional analyses, and nuclear magnetic resonance (NMR) spectroscopy. No differentiation was observed according to the year of production but a significant discrimination was achieved using principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA). In particular, PLS-DA allowed the selection of compounds (total acidity; citric, malic, succinic, and lactic acids; total polyphenol index; glucose and proline/arginine ratio) useful for differentiating the studied wines on the basis of geographical origin.

Role of the cultivar in choosing Clementine fruits with a high level of health-promoting compounds.

Thirteen cultivars and two hybrids of Clementine fruits (Citrus clementina Hort. Ex. Tan) cultivated in Italy were characterized according to pH, titratable acidity, total soluble solids, total polyphenols, carotenoids, vitamin C, hesperidin, rutin, narirutin and naringin and radical scavenging activity. The presence of rutin in Clementine fruit juice is reported for the first time here. The results indicated that all chemical parameters statistically differentiated each cultivar (P < 0.001). In particular, principal component analysis showed a clear discrimination of five cultivars from all the other varieties based on vitamin C and total polyphenols for the Caffin cultivar, which showed also the highest antioxidant activity; narirutin for the Etna hybrid cultivar; hesperidin, rutin and total soluble solids for the SRA 89 cultivar; and naringin, hesperidin and rutin for the Esbal cultivar. Moreover, the Mandalate hybrid cultivar showed the lowest antioxidant activity as well as vitamin C and total polyphenols content, while titratable acidity and naringin level were the highest. The antioxidant activity assessed in all the fruits was closely correlated with vitamin C and total polyphenols content, rather than with the flavonoid compounds.

The species-specific ratios of 2,3-butanediol and acetoin isomers as a tool to evaluate wine yeast performance.

The isomers of 2,3-butanediol [R,R; S,S; R,S (meso-form)] and of acetoin (R,S) were determined in laboratory wine fermentations carried out by 50 yeast strains, 10 for each of the following species, Saccharomyces cerevisiae, Kloeckera apiculata, Candida stellata, Metschnikowia pulcherrima and Brettanomyces bruxellensis, in order to evaluate if such parameters might be used to differentiate wines obtained with different yeast species. According to analysis of variance (ANOVA), the strains of the same species behaved similarly, whereas the five yeast species behaved differently so that species-specific profiles were recognized. Moreover, the discriminant analysis grouped the wines into five groups, each including the 10 wines obtained by the 10 yeast strains of the same species. Trials were also included where musts partially fermented by non-Saccharomyces species were inoculated with a selected strain of S. cerevisiae to complete fermentation, and the content in 2,3-butanediol and acetoin isomers was again determined and statistical analysis was performed. Although the final values of these parameters resembled those obtained in pure fermentation with S. cerevisiae, statistical analysis discriminated wines according to the yeast species performing the first fermentation phase.