Increasing access to LARC removal in pediatrics to support adolescent reproductive justice in the United States.

BACKGROUND: In the United States (U.S.), adolescents and young adults are increasingly using contraception, including long-acting reversible contraception (LARC) [e.g., subdermal implants (e.g., Nexplanon®) and intrauterine devices (IUDs)]; however, access to LARC device removal may be difficult for adolescents and young adults. Reproductive justice is the right to bodily autonomy, have children, not have children, and safely parent the children we have. METHODS: In this commentary, we discuss that while the specialties of family medicine and obstetrics and gynecology have incorporated the principles of reproductive justice into their contraceptive care, further work is needed to ingrain this philosophy into pediatrics training. Since LARC devices are historically only removable by health care providers, pediatricians may act as gatekeepers to removing LARC, obstructing the reproductive justice of adolescents and young adults. RESULTS: We describe that adolescents and young adults in the U.S. face unique barriers to LARC removal including limited access to the health care system, potential breaches in confidentiality, and provider bias. These barriers may lead adolescents and young adults to remove their own LARC device when experiencing unwanted side effects or desiring pregnancy. While IUD self-removal is a safe and accessible option, safety and efficacy data on subdermal implant self-removal is currently limited. CONCLUSION: In order to promote reproductive justice in adolescents and young adults, we recommend that (1) pediatricians should address potential barriers to LARC removal prior to insertion, (2) pediatricians must offer unbiased LARC removal, (3) pediatricians who place LARC must be knowledgeable about complicated LARC removal, and (4) pediatricians should discuss LARC self-removal options with adolescents and young adults.

Targeting Hyaluronan Interactions for Glioblastoma Stem Cell Therapy.

Even with rigorous treatments, glioblastoma multiforme (GBM) has an abysmal median survival rate, greatly due to the drug-resistant glioblastoma stem cell (GSC) population. GSCs are known to remodel their microenvironment, but the precise role of extracellular matrix components hyaluronic acid (HA) and hyaluronidases (HAases) on the GSC population is still largely unknown. Our objective was to determine how HAase can sensitize GSCs to chemotherapy drugs by disrupting the HA-CD44 signaling. GBM cell line U87-MG and patient-derived D456 cells were grown in GSC-enriching media and treated with HA or HAase. Expressions of GSC markers, HA-related genes, and drug resistance genes were measured via flow cytometry, confocal microscopy, and qRT-PCR. Proliferation after combined HAase and temozolomide (TMZ) treatment was measured via WST-8. HA supplementation promoted the expression of GSC markers and CD44 in GBM cells cultured in serum-free media. Conversely, HAase addition inhibited GSC gene expression while promoting CD44 expression. Finally, HAase sensitized GBM cells to TMZ. We propose a combined treatment of HAase and chemotherapy drugs by disrupting the stemness-promoting HA to target GSCs. This combination therapy shows promise even when temozolomide treatment alone causes resistance.