Romiplostim for the management of pediatric immune thrombocytopenia: drug development and current practice.

Since successful cloning of thrombopoietin (TPO) in 1994, significant advances have been made in the development of recombinant TPO receptor agonists. The US Food and Drug Administration (FDA) has approved 2 agents for use in patients with immune thrombocytopenia (ITP): eltrombopag and romiplostim. Romiplostim is a once-weekly subcutaneous injection that has been shown to increase the platelet count, lessen bleeding, and reduce concurrent medication use in adults with ITP. In December 2018, the US FDA approved romiplostim for use in pediatric patients ≥1 year of age with ITP of >6 months' duration and insufficient response to corticosteroids, immunoglobulins, or splenectomy, based on similarly favorable clinical trial data. In addition, romiplostim is well tolerated, making it an attractive option for the treatment of children. Expansion of off-label romiplostim use is being reported in children for ITP <6 months, neonatal thrombocytopenia, hereditary thrombocytopenias, and chemotherapy- and bone marrow transplant-associated thrombocytopenia. We review here the development of romiplostim with a focus on pediatric use.

Descrubrimientos sobre reprogramación nuclear merecen el premio Nobel en 2012 / Discoveries on nuclear reprogramming deserves the Nobel prize in 2012

Este artículo fue escrito para honrar a J.B Gurdon y S. Yamanaka, laureados con el Premio Nobel en Fisiología p Medicina 2012 "por el descubrimiento de que las células maduras pueden ser reprogramadas para volverse pluripotentes". Se presentan en forma concisa sus aportes científicos y reseñas biográficas. J.B. Gardon, en Inglaterra, demostró hace 50 años en anfibios que al trasplantar el núcleo de una célula intestinal a un huevo u ovocito enuncleado se obtiene una célula totipotente que se convierte en un embrión y se desarrolla hasta convertirse en una rana adulta, lo cual implica la conservación de genoma en el proceso de diferenciación y la resersibilidad de dicho proceso. Estos descubrimientos llevaron a que otros autores realizaran la clonación de mamiferos utilizando el núcleo de células somáticas y la obtención de células madre pluripotentes a partir de los embrines que se producen in vitro por el desarrollo de las células totipotentes. Se mencionan varias aplicaciones y las contribuciones de Gurdon para comprender el proceso de reprogramación. S. Yamanaka, en Japón, hace seis años, reprogramó al estado embrionario fibroblastos cutáneos de ratones y humanos adultos insertando mediante vectores retrovirales una combinación de los genes de cuatro factores de transcripción: Oct3/4, Sox2, Klf4 y c-Myc. Las células reprogramadas fueron denominadas células madre pluripotentes inducidas. Utilizando la técnica desarrollada por Yamanaka y otras surgidas a raiz de sus descrubrimientos, miles de personas obtienen ahora células madre pluripotentes inducidas a partir de muchas especies y tejidos, incluyendo seres humanos sanos y enfermos. Las células madre pluripotentes o sus derivadas tienen un amplio potencial de aplicación, entre ellas, estudios de embriología y fisiopatología, modelos de enfermedades, descubrimiento de drogas y terapias celulares

This paper was written to honor J.B Gurdon y S. Yamanaka, 2012 Nobel Prize laureates in Physiology or Medicine for "the discovery that mature cells can be reprogrammed to become pluripotent". Their main scientific contributions and biography are presented in a concise manner. JB Gurdon, in England, showed fifty years ago in amphibians that the transplantation of the nucleus of an intestinal cell to an enucleated egg or oocyte produces a totipotent cell that develops into an embryo and adult frog. This implies that cellular differentiation is reversible and the genome is conserved in that process. The discoveries led to the cloning of mammals by other authors using the nucleus of somatic cells and to obtain pluripotent stem cells in vitro from the embryos produced by development of the totipotent cells. Some applications are considered. Gurdon's contribution to the understanding of the reprogramming process is mentioned. S. Yamanaka six years ago in Japan reprogrammed skin fibroblastis from adult mice and humans to the embryonic state by introducing via retroviral vectors a combination of the genes of 4 transcription factors, Oct3/4. Sox2, Klf4 and c-Myc. The reprogammed cells were named induced pluripontent stem cells. Throusands of people are now producing induced pluripotent stem cells from many tissues and species, including healthy and ill humans, using Yamanaka's methods and other techniques stimulated by his work. Pluripotent stem cells or their derivatives have great potential for a wide range of applications including research in embryology and pathophysiology, disease modeling, drug discovery and cell transplantation therapies

Induction of pluripotency.

The molecular and phenotypic irreversibility of mammalian cell differentiation was a fundamental principle of developmental biology at least until the 1980s, despite numerous reports dating back to the 1950s of the induction of pluripotency in amphibian cells by nuclear transfer (NT). Landmark reports in the 1980s and 1990s in sheep progressively challenged this dogmatic assumption; firstly, embryonic development of reconstructed embryos comprising whole (donor) blastomeres fused to enucleated oocytes, and famously, the cloning of Dolly from a terminally differentiated cell. Thus, the intrinsic ability of oocyte-derived factors to reverse the differentiated phenotype was confirmed. The concomitant elucidation of methods for human embryonic stem cell isolation and cultivation presented opportunities for therapeutic cell replacement strategies, particularly through NT of patient nuclei to enucleated oocytes for subsequent isolation of patient-specific (autologous), pluripotent cells from the resulting blastocysts. Associated logistical limitations of working with human oocytes, in addition to ethical and moral objections prompted exploration of alternative approaches to generate autologous stem cells for therapy, utilizing the full repertoire of factors characteristic of pluripotency, primarily through cell fusion and use of pluripotent cell extracts. Stunningly, in 2006, Japanese scientists described somatic cell reprogramming through delivery of four key factors (identified through a deductive approach from 24 candidate genes). Although less efficient than previous approaches, much of current stem cell research adopts this focused approach to cell reprogramming and (autologous) cell therapy. This chapter is a quasi-historical commentary of the various aforementioned approaches for the induction of pluripotency in lineage-committed cells, and introduces transcriptional and epigenetic changes occurring during reprogramming.

Regenerative medicine's historical roots in regeneration, transplantation, and translation.

Regenerative medicine is not new; it has not sprung anew out of stem cell science as has often been suggested. There is a rich history of study of regeneration, of development, and of the ways in which understanding regeneration advances study of development and also has practical and medical applications. This paper explores the history of regenerative medicine, starting especially with T.H. Morgan in 1901 and carrying through the history of transplantation research in the 20th century, to an emphasis on translational medicine in the late 20th century.

Cloning: pathways to a pluripotent future.

In this month's essay, Anne McLaren traces the winding and pitted pathways that connect the early days of the cell theory of biology in the 1830s to the new and unfolding era of cloning science and technology that came to worldwide attention in 1997 with the announcement of the birth of Dolly, the Scottish cloned sheep. The possibilities, including the potential for new medical treatments and perhaps even human cloning, are fantastic ... and ethically charged.

La clonación humana / The human clonation

El evidente desarrollo de los procesos de clonación de mamíferos, que se ha caracterizado con la oveja Dolly, ha puesto de manifiesto el que las posibilidades que se le abren a la ciencia genética son infinitas; la producción de un mamífero de laboratorio partogénico, la posibilidad de concebir un hijo sin el concurso del varón, la fusión de embriones humanos y tantas otras posibilidades de producción de vida. Ante este panorama a la vez alentador y preocupante, queda la esperanza en que la senatez triunfe y nunca se apliquen las mismas técnicas experimentales para obtener seres humanos clónicos