ABSTRACT
Ethical review systems need to build on their experiences of COVID-19 research to enhance their preparedness for future pandemics. Recommendations from representatives from over twenty countries include: improving relationships across the research ecosystem; demonstrating willingness to reform and adapt systems and processes; and making the case robustly for better resourcing.
Subject(s)
COVID-19 , Emergencies , Humans , Ecosystem , Ethical ReviewABSTRACT
Advice from multiple stakeholders is required to design the optimal pediatric clinical trial. We present recommendations for acquiring advice from trial experts and patients/caregivers, derived from advice meetings that were performed through a collaboration of the Collaborative Network for European Clinical Trials for Children (c4c) and the European Patient-CEntric ClinicAl TRial PLatforms (EU-PEARL). Three advice meetings were performed: (1) an advice meeting for clinical and methodology experts, (2) an advice meeting for patients/caregivers, and (3) a combined meeting with both experts and patients/caregivers. Trial experts were recruited from c4c database. Patients/caregivers were recruited through a patient organization. Participants were asked to provide input on a trial protocol, including endpoints, outcomes, and the assessment schedule. Ten experts, 10 patients, and 13 caregivers participated. The advice meetings resulted in modification of eligibility criteria and outcome measures. We have provided recommendations for the most effective meeting type per protocol topic. Topics with limited options for patient input were most efficiently discussed in expert advice meetings. Other topics benefit from patient/caregiver input, either through a combined meeting with experts or a patients/caregivers-only advice meeting. Some topics, such as endpoints and outcome measures, are suitable for all meeting types. Combined sessions profit from synergy between experts and patients/caregivers, balancing input on protocol scientific feasibility and acceptability. Both experts and patients/caregivers provided critical input on the presented protocol. The combined meeting was the most effective methodology for most protocol topics. The presented methodology can be used effectively to acquire expert and patient feedback.
Subject(s)
Caregivers , Outcome Assessment, Health Care , Humans , Child , Patient-Centered CareABSTRACT
Objetivo: identificar os principais aspetos inovadores do Regulamento relativo aos ensaios clínicos de medicamentos para uso humano, em termos de oportunidades para a investigação e desenvolvimento e refletir sobre os desafios éticos deste novo quadro legal. Metodologia: estudo documental, descritivo, comparativo, do Regulamento face à Diretiva 2001/20/CE, e leitura de bibliografia publicada no PubMed, usando termos de pesquisa combinados ou simples como clinical, trials, European, Regulation, Directive, opportunities, challenges e innovation. Resultados: os principais aspetos inovadores identificados foram o Portal da União Europeia para submissão do dossiê do ensaio clínico e avaliação conjunta entre os Estados-Membros envolvidos num ensaio clínico; disponibilização pública de informação, resultados dos ensaios e um sumário de resultados para leigos; foram criadas a figura do copromotor, categorias de ensaios em função do risco; estabelecidos novos procedimentos para obtenção de consentimento informado e requisitos para uma maior proteção para os indivíduos mais vulneráveis; e definido o quadro normativo para a realização de ensaios clínicos em situação de emergência. Discussão: estão previstos procedimentos que visam contrariar a perda de competitividade da Europa, promovendo a inovação, alguns dos quais não estão isentos de questionamento ético. Conclusão: a simplificação, harmonização e maior transparência em todo o processo de submissão e condução dos ensaios clínicos tem o potencial de promover a investigação, mas traz alguns aspetos inquietantes em matéria de proteção dos participantes nos ensaios clínicos.
Objective: to identify the main innovative aspects of the Regulation on clinical trials of medicines for human use, in terms of opportunities for research and development and to reflect on the ethical challenges of this new legal framework. Methods: documentary, descriptive, comparative study of the Regulation in regard with the Directive 2001/20/EC, reading bibliography published in PubMed, using combined or simple research terms such as clinical, trials, European, Regulation, Directive, opportunities, challengesand innovation. Results: the main innovative aspects identified were the Portal for submission of the clinical trial dossier and joint evaluation between the Member States involved in a clinical trial; public dissemination of clinical trial Ìs information, results and lay summary. The idea of co-sponsor and new categories of trials depending on to the risks were created; new procedures for obtaining informed consent and requirements for the protection of the most vulnerable individuals, and the regulatory framework for conducting clinical trials in an emergency were established. Discussion:in order to counteract the loss of competitiveness in Europe, some procedures were implemented in order to promote innovation, some of which are not exempt from ethical questioning. Conclusion: simplification, harmonization and transparency for the submission and conduction of clinical trials have the potential to boost research, but brings some concerns regarding the protection of participants in clinical trials.
Objetivo: identificar los principales aspectos innovadores del Reglamento sobre ensayos clínicos de medicamentos de uso humano, en términos de oportunidades de investigación y desarrollo y reflexionar sobre los desafíos éticos de este nuevo marco legal. Metodología: estudio documental, descriptivo, comparativo del Reglamento en relación con la Directiva 2001/20/CE, y lectura de bibliografía publicada en PubMed, utilizando términos de investigación combinados o simples como clinical, trials, European, Regulation, Directive, opportunities, challengesy innovation. Resultados: los principales aspectos innovadores identificados fueron el Portal de presentación del expediente de ensayo clínico y evaluación conjunta entre los Estados miembros implicados en un ensayo clínico; disponibilidad pública de información, resultados de pruebas y un resumen de resultados para laicos; se creó la figura del co-promotor, categorías de pruebas según el riesgo; se han establecido nuevos procedimientos para obtener el consentimiento informado y requisitos para una mayor protección de las personas más vulnerables; y definió el marco regulatorio para la realización de ensayos clínicos en una situación de emergencia. Discusión:se prevén procedimientos para contrarrestar la pérdida de competitividad en Europa, promoviendo la innovación, algunas de las cuales no están exentas de cuestionamientos éticos. Conclusión: la simplificación, armonización y mayor transparencia en todo el proceso de envío y realización de ensayos clínicos tiene el potencial de promover la investigación, pero trae algunos aspectos inquietantes en términos de protección de los participantes en los ensayos clínicos.
ABSTRACT
Nitric oxide (NO) participates in the regulation of many cell functions in the CNS, including modulation of ion channel function by direct changes in the channel protein structure, modulating permeability or gating kinetics. The mechanisms by which NO donors modulate sodium currents are protein and tissue specific. The present paper concerns sodium currents in the neuroblastoma N1E-115 cell line, applying whole-cell voltage clamp methods. Sodium currents were characterized in terms of the sensitivity to NO donors and the hydrophilic thiol oxidizer thimerosal. Parameters defining steady-state inactivation and activation, removal of inactivation and the voltage dependence of inactivation, were determined before and after thimerosal application. The results concerning the application of thimerosal showed blockade of the resting state, hyperpolarizing shifts of m(infinity) and h(infinity) curves, change in the voltage sensitivity and slower inactivating kinetics, tau(hf) and tau(hs) being affected in the same manner. The present results provide clear evidence for redox modulation of the sodium channel population in N1E-115 cells. Our results showed that the membrane-permeable alkylating agent (NEM) does not inhibit current reduction determined by thimerosal. We have reasons to suspect that the sodium channel population in N1E-115 cells differs in the proposed consensus sequence for nitrosylation or thimerosal cysteine oxidation.
Subject(s)
Membrane Potentials/physiology , Nitric Oxide/metabolism , Sodium Channels/physiology , Animals , Cell Line, Tumor , Dose-Response Relationship, Drug , Dose-Response Relationship, Radiation , Drug Interactions , Electric Stimulation , Membrane Potentials/drug effects , Mice , Neuroblastoma/pathology , Nitric Oxide Donors/pharmacology , Patch-Clamp Techniques/methods , Preservatives, Pharmaceutical/pharmacology , Sodium Channels/drug effects , Statistics, Nonparametric , Thimerosal/pharmacologyABSTRACT
Sodium currents were recorded in CA1 hippocampal cells from new-born (P(4-10)) and older (P(>22)) rats, using whole-cell voltage clamp techniques. The effects of local anaesthetics (procaine and lidocaine) were studied in both cell populations. Parameters defining steady-state inactivation, removal of inactivation and the affinity of the anaesthetic molecules to the inactivated state were determined at both stages of maturation. Procaine and lidocaine induced a hyperpolarizing shift in steady-state inactivation curves, and slowed the rate of recovery from the inactivated state. Procaine disclosed differences between immature and older cells in what concerns block of the closed (resting) channels, drug affinity and binding to the inactivated state, i.e. the binding rate of procaine was found higher and the affinity lower in younger cells. The characteristics of procaine and lidocaine block on CA1 sodium currents differed in some particular aspects: magnitude of block on resting channels, shift in the voltage dependence and voltage sensitivity of steady-state inactivation, slow recovery from inactivation and use-dependent block.