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  1. Article: Can the Dynamic External Pelvimetry Test in Late Pregnancy Reveal Obstructed and Prolonged Labor? Results From a Pilot Study.

    Siccardi, Marco / Valle, Cristina

    Cureus

    2021  Volume 13, Issue 12, Page(s) e20566

    Abstract: Background The size and mobility of the maternal pelvic space are fundamental factors in successful childbirth and can allow operators to screen for dystocia. This pilot study including a group of 70 pregnant women aimed to test whether the external ... ...

    Abstract Background The size and mobility of the maternal pelvic space are fundamental factors in successful childbirth and can allow operators to screen for dystocia. This pilot study including a group of 70 pregnant women aimed to test whether the external dynamic pelvimetry test can be used to predict the likelihood of obstructed labor. Methodology The study cohort consisted of 70 pregnant women in their third trimester. The cohort was divided retrospectively into an obstructed labor group and a control group. Obstructed labor was defined using the following obstetric outcomes: augmentation with oxytocin from the first phase of the dilating period, Kristeller's maneuvers, vacuum extractor (kiwi), forceps, and the cesarean section following the onset of labor. Results The measurements obtained for the longitudinal hemi-diameter of Michaelis, the inter-tuberous diameter, and the base of the Trillat's triangle were statistically significant in every position. The difference in the measurements of the transverse diameter of Michaelis between standing and hands-and-knees position and the difference in the sizes of the bi-cristal diameter between hands-and-knees and squatting position were statistically significant. Conclusions Dimension and biomechanical properties of the pelvic tissue and spaces influence the evolutionary childbirth process. After clinical confirmation on a large population, hypomobility of specified external pelvic diameters measured in shifting positions can become a screening tool to detect the contracted pelvis and prevent damage caused by dystocia and prolonged labor in women and newborns.
    Language English
    Publishing date 2021-12-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.20566
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: General Framework to Quantitatively Predict Pharmacokinetic Induction Drug-Drug Interactions Using In Vitro Data.

    Grañana-Castillo, Sandra / Williams, Angharad / Pham, Thao / Khoo, Saye / Hodge, Daryl / Akpan, Asangaedem / Bearon, Rachel / Siccardi, Marco

    Clinical pharmacokinetics

    2023  Volume 62, Issue 5, Page(s) 737–748

    Abstract: Introduction: Metabolic inducers can expose people with polypharmacy to adverse health outcomes. A limited fraction of potential drug-drug interactions (DDIs) have been or can ethically be studied in clinical trials, leaving the vast majority unexplored. ...

    Abstract Introduction: Metabolic inducers can expose people with polypharmacy to adverse health outcomes. A limited fraction of potential drug-drug interactions (DDIs) have been or can ethically be studied in clinical trials, leaving the vast majority unexplored. In the present study, an algorithm has been developed to predict the induction DDI magnitude, integrating data related to drug-metabolising enzymes.
    Methods: The area under the curve ratio (AUC
    Results: Two independent variables were deemed significant and included in the algorithm: IVMM and fraction unbound in plasma. The observed and predicted magnitudes of the DDIs were categorised accordingly: no induction, mild, moderate, and strong induction. DDIs were assumed to be well classified if the predictions were in the same category as the observations, or if the ratio between these two was < 1.5-fold. This algorithm correctly classified 70.5% of the DDIs.
    Conclusion: This research presents a rapid screening tool to identify the magnitude of potential DDIs utilising in vitro data which can be highly advantageous in early drug development.
    MeSH term(s) Humans ; Cytochrome P-450 CYP3A/metabolism ; Cytochrome P-450 Enzyme System/metabolism ; Drug Interactions ; Rifampin ; Carbamazepine/pharmacology ; Models, Biological
    Chemical Substances Cytochrome P-450 CYP3A (EC 1.14.14.1) ; Cytochrome P-450 Enzyme System (9035-51-2) ; Rifampin (VJT6J7R4TR) ; Carbamazepine (33CM23913M)
    Language English
    Publishing date 2023-03-29
    Publishing country Switzerland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 197627-8
    ISSN 1179-1926 ; 0312-5963
    ISSN (online) 1179-1926
    ISSN 0312-5963
    DOI 10.1007/s40262-023-01229-3
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  3. Article ; Online: The LEAP Process: Streamlining the Development of Long-Acting Products and Formulations for Infectious Diseases.

    Flexner, Charles / Siccardi, Marco / Bunglawala, Fazila / Owen, Andrew

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2022  Volume 75, Issue Suppl 4, Page(s) S502–S509

    Abstract: ... of such products. Assessment methodology for any new proposal brought to this group is part of a framework-the LEAP ...

    Abstract Developing long-acting products and formulations for infectious diseases is a nontrivial undertaking that is frequently classified as high risk and low reward by the pharmaceutical industry. The Long-Acting/Extended Release Antiretroviral Research Resource Program (LEAP) was founded in 2015 with the support of the National Institutes of Health to encourage, promote, and accelerate the development of such products. Assessment methodology for any new proposal brought to this group is part of a framework-the LEAP Process-that includes a landscape analysis of what is currently available in the public domain. This is followed by in silico modeling and simulation offered as a service to the relevant scientific community. A variety of preclinical and clinical outcome metrics are applied to each new agent as part of a continuous feedback loop to improve product characteristics. This allows us to catalog knowledge gaps and barriers that can be addressed by engaged stakeholders. Results are communicated in scientific articles, reviews, and position papers. This undertaking serves to de-risk discovery, development, and implementation by bridging the gaps between academic, regulatory, and industrial investigators, and by engaging those in the community who will be the eventual users of these medicines. The LEAP Process has supported formulations now approved for human immunodeficiency virus, as well as products in clinical and preclinical development for tuberculosis and hepatitis viruses B and C.
    MeSH term(s) United States ; Humans ; Anti-Retroviral Agents/therapeutic use ; Tuberculosis ; Drug Industry ; HIV Infections/drug therapy ; HIV Infections/prevention & control ; National Institutes of Health (U.S.)
    Chemical Substances Anti-Retroviral Agents
    Language English
    Publishing date 2022-11-21
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciac750
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  4. Article ; Online: Physiologically-based pharmacokinetic modelling of long-acting injectable cabotegravir and rilpivirine in pregnancy.

    Atoyebi, Shakir / Bunglawala, Fazila / Cottura, Nicolas / Grañana-Castillo, Sandra / Montanha, Maiara Camotti / Olagunju, Adeniyi / Siccardi, Marco / Waitt, Catriona

    British journal of clinical pharmacology

    2024  

    Abstract: Aims: Long-acting cabotegravir and rilpivirine have been approved to manage HIV in adults, but data regarding safe use in pregnancy are limited. Physiologically-based pharmacokinetic (PBPK) modelling was used to simulate the approved dosing regimens in ... ...

    Abstract Aims: Long-acting cabotegravir and rilpivirine have been approved to manage HIV in adults, but data regarding safe use in pregnancy are limited. Physiologically-based pharmacokinetic (PBPK) modelling was used to simulate the approved dosing regimens in pregnancy and explore if C
    Methods: An adult PBPK model was validated using clinical data of cabotegravir and rilpivirine in nonpregnant adults. This was modified by incorporating pregnancy-induced metabolic and physiological changes. The pregnancy PBPK model was validated with data on oral rilpivirine and raltegravir (UGT1A1 probe substrate) in pregnancy. Twelve weeks' disposition of monthly and bimonthly dosing of long-acting cabotegravir and rilpivirine was simulated at different trimesters and foetal exposure was also estimated.
    Results: Predicted C
    Conclusions: Model predictions suggest that monthly long-acting cabotegravir could maintain antiviral efficacy throughout pregnancy, but that bimonthly administration may require careful clinical evaluation. Both monthly and bimonthly long-acting rilpivirine may not adequately maintain antiviral efficacy in pregnancy.
    Language English
    Publishing date 2024-02-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 188974-6
    ISSN 1365-2125 ; 0306-5251 ; 0264-3774
    ISSN (online) 1365-2125
    ISSN 0306-5251 ; 0264-3774
    DOI 10.1111/bcp.16006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: A Comprehensive Framework for Physiologically-Based Pharmacokinetic Modeling in Matlab.

    Stader, Felix / Penny, Melissa A / Siccardi, Marco / Marzolini, Catia

    CPT: pharmacometrics & systems pharmacology

    2019  Volume 8, Issue 7, Page(s) 444–459

    Abstract: Physiologically-based pharmacokinetic (PBPK) models are useful tools to predict clinical scenarios for special populations for whom there are high hurdles to conduct clinical trials such as children or the elderly. However, the coding of a PBPK model in ... ...

    Abstract Physiologically-based pharmacokinetic (PBPK) models are useful tools to predict clinical scenarios for special populations for whom there are high hurdles to conduct clinical trials such as children or the elderly. However, the coding of a PBPK model in a mathematical programming language can be challenging. This tutorial illustrates how to build a whole-body PBPK model in Matlab to answer specific pharmacological questions involving drug disposition and magnitudes of drug-drug interactions in different patient populations.
    Language English
    Publishing date 2019-04-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2697010-7
    ISSN 2163-8306 ; 2163-8306
    ISSN (online) 2163-8306
    ISSN 2163-8306
    DOI 10.1002/psp4.12399
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  6. Article: Dynamic External Pelvimetry Test in Third Trimester Pregnant Women: Shifting Positions Affect Pelvic Biomechanics and Create More Room in Obstetric Diameters.

    Siccardi, Marco / Valle, Cristina / Di Matteo, Fiorenza

    Cureus

    2021  Volume 13, Issue 3, Page(s) e13631

    Abstract: Dystocia in labor is still a clinical challenge. The "contracted pelvis" is the absence of pelvic mobility, which leads to fetal-pelvic disproportion, obstructed labor, and operative delivery. Maternal pelvis biomechanics studies by high technological ... ...

    Abstract Dystocia in labor is still a clinical challenge. The "contracted pelvis" is the absence of pelvic mobility, which leads to fetal-pelvic disproportion, obstructed labor, and operative delivery. Maternal pelvis biomechanics studies by high technological techniques have shown that maternal shifting positions during pregnancy and labor can create more room in the pelvis for safe delivery. The external and internal pelvic diameters are related. The present study aims to evaluate the external obstetric pelvic diameters in shifting positions using a clinical technique suitable for daily practice in every clinical setting: the dynamic external pelvimetry test (DEP test). Seventy pregnant women were recruited, and the obstetric external pelvic diameters were measured, moving the position from kneeling standing to "hands-and-knees" to kneeling squat position. Results showed modification of the pelvic diameters in shifting position: the transverse and longitudinal diameters of Michaelis sacral area, the inter-tuberosities diameter, the bi-trochanters diameter, and the external conjugate widened; the bi-crestal iliac diameter, the bi-spinous iliac diameter, and the base of the Trillat's triangle decreased. The test showed good reproducibility and reliability. Linear correlations were found between diameters and between the range of motion of the diameters. The maternal pelvis is confirmed to modify the diameters changing its tridimensional shape. The pelvic inlet edge's inclination is inferred to be modified, facilitating the fetal descend. The pelvic outlet enlarged the transverse diameter, facilitating birth. The DEP test estimates the pelvic diameters' modification with postural changes, as magnetic resonance (MR) and computational biomechanics studies have demonstrated.
    Language English
    Publishing date 2021-03-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.13631
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  7. Article ; Online: Toward a General Framework for Multimodal Big Data Analysis.

    Bellandi, Valerio / Ceravolo, Paolo / Maghool, Samira / Siccardi, Stefano

    Big data

    2022  Volume 10, Issue 5, Page(s) 408–424

    Abstract: Multimodal Analytics in Big Data architectures implies compounded configurations of the data processing tasks. Each modality in data requires specific analytics that triggers specific data processing tasks. Scalability can be reached at the cost of an ... ...

    Abstract Multimodal Analytics in Big Data architectures implies compounded configurations of the data processing tasks. Each modality in data requires specific analytics that triggers specific data processing tasks. Scalability can be reached at the cost of an attentive calibration of the resources shared by the different tasks searching for a trade-off with the multiple requirements they impose. We propose a methodology to address multimodal analytics within the same data processing approach to get a simplified architecture that can fully exploit the potential of the parallel processing of Big Data infrastructures. Multiple data sources are first integrated into a unified knowledge graph (KG). Different modalities of data are addressed by specifying ad hoc views on the KG and producing a rewriting of the graph containing merely the data to be processed. Graph traversal and rule extraction are this way boosted. Using graph embeddings methods, the different ad hoc views can be transformed into low-dimensional representation following the same data format. This way a single machine learning procedure can address the different modalities, simplifying the architecture of our system. The experiments we executed demonstrate that our approach reduces the cost of execution and improves the accuracy of analytics.
    MeSH term(s) Big Data ; Data Analysis ; Electronic Data Processing ; Machine Learning ; Information Storage and Retrieval
    Language English
    Publishing date 2022-06-06
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2167-647X
    ISSN (online) 2167-647X
    DOI 10.1089/big.2021.0326
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  8. Article ; Online: Long-acting drugs and formulations for the treatment and prevention of HIV infection.

    Flexner, Charles / Owen, Andrew / Siccardi, Marco / Swindells, Susan

    International journal of antimicrobial agents

    2020  Volume 57, Issue 1, Page(s) 106220

    Abstract: Long-acting and extended-release formulations represent one of the most important approaches to improving the treatment and prevention of chronic HIV infection. Long-acting small molecules and monoclonal antibodies have demonstrated potent anti-HIV ... ...

    Abstract Long-acting and extended-release formulations represent one of the most important approaches to improving the treatment and prevention of chronic HIV infection. Long-acting small molecules and monoclonal antibodies have demonstrated potent anti-HIV activity in early- and late-stage clinical trials. Strategies to manage toxicity and falling drug concentrations after missed doses, as well as primary and secondary resistance to current drugs and monoclonal antibodies are important considerations. Long-acting injectable nanoformulations of the integrase inhibitor cabotegravir and the non-nucleoside reverse transcriptase inhibitor rilpivirine were safe, well tolerated and efficacious in large randomised phase 3 studies. Regulatory approval for this two-drug combination for HIV maintenance therapy was granted in Canada in 2020 and is expected in the USA during 2021. 4'-Ethynyl-2-fluoro-2'-deoxyadenosine (islatravir) is a novel nucleoside reverse transcriptase inhibitor in clinical development as a long-acting oral drug and as a long-acting subcutaneous polymer implant. GS-6207 is a novel HIV capsid inhibitor that is injected subcutaneously every 3 months. Broadly-neutralising monoclonal antibodies have potent antiviral activity in early human trials, however there is substantial baseline resistance and rapid development of resistance to these antibodies if used as monotherapy. Limitations of these antiretroviral approaches include management of toxicities and prevention of drug resistance when these drugs are discontinued and drug concentrations are slowly reduced over time. These approaches appear to be especially attractive for patients complaining of pill fatigue and for those experiencing HIV-associated stigma. As these formulations are shown to be safe, well tolerated and economical, they are likely to gain broader appeal.
    MeSH term(s) Anti-HIV Agents/therapeutic use ; Canada ; Delayed-Action Preparations ; Deoxyadenosines/therapeutic use ; Drug Combinations ; Drug Delivery Systems ; HIV Antibodies/therapeutic use ; HIV Infections/drug therapy ; HIV Infections/prevention & control ; HIV-1/drug effects ; Humans ; Pyridones/therapeutic use ; Rilpivirine/therapeutic use
    Chemical Substances Anti-HIV Agents ; Delayed-Action Preparations ; Deoxyadenosines ; Drug Combinations ; HIV Antibodies ; Pyridones ; Rilpivirine (FI96A8X663) ; cabotegravir (HMH0132Z1Q) ; islatravir (QPQ082R25D)
    Language English
    Publishing date 2020-11-06
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 1093977-5
    ISSN 1872-7913 ; 0924-8579
    ISSN (online) 1872-7913
    ISSN 0924-8579
    DOI 10.1016/j.ijantimicag.2020.106220
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  9. Article ; Online: Drug-Drug Interactions in People Living With HIV at Risk of Hepatic and Renal Impairment: Current Status and Future Perspectives.

    Cottura, Nicolas / Kinvig, Hannah / Grañana-Castillo, Sandra / Wood, Adam / Siccardi, Marco

    Journal of clinical pharmacology

    2022  Volume 62, Issue 7, Page(s) 835–846

    Abstract: Despite the advancement of antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV), drug-drug interactions (DDIs) remain a relevant clinical issue for people living with HIV receiving ART. Antiretroviral (ARV) drugs can be ... ...

    Abstract Despite the advancement of antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV), drug-drug interactions (DDIs) remain a relevant clinical issue for people living with HIV receiving ART. Antiretroviral (ARV) drugs can be victims and perpetrators of DDIs, and a detailed investigation during drug discovery and development is required to determine whether dose adjustments are necessary or coadministrations are contraindicated. Maintaining therapeutic ARV plasma concentrations is essential for successful ART, and changes resulting from potential DDIs could lead to toxicity, treatment failure, or the emergence of ARV-resistant HIV. The challenges surrounding DDI management are complex in special populations of people living with HIV, and often lack evidence-based guidance as a result of their underrepresentation in clinical investigations. Specifically, the prevalence of hepatic and renal impairment in people living with HIV are between five and 10 times greater than in people who are HIV-negative, with each condition constituting approximately 15% of non-AIDS-related mortality. Therapeutic strategies tend to revolve around the treatment of risk factors that lead to hepatic and renal impairment, such as hepatitis C, hepatitis B, hypertension, hyperlipidemia, and diabetes. These strategies result in a diverse range of potential DDIs with ART. The purpose of this review was 2-fold. First, to summarize current pharmacokinetic DDIs and their mechanisms between ARVs and co-medications used for the prevention and treatment of hepatic and renal impairment in people living with HIV. Second, to identify existing knowledge gaps surrounding DDIs related to these special populations and suggest areas and techniques to focus upon in future research efforts.
    MeSH term(s) Anti-Retroviral Agents/adverse effects ; Drug Interactions ; HIV Infections/complications ; HIV Infections/drug therapy ; Humans ; Prevalence ; Renal Insufficiency/drug therapy ; Risk Factors
    Chemical Substances Anti-Retroviral Agents
    Language English
    Publishing date 2022-02-08
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 188980-1
    ISSN 1552-4604 ; 0091-2700 ; 0021-9754
    ISSN (online) 1552-4604
    ISSN 0091-2700 ; 0021-9754
    DOI 10.1002/jcph.2025
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  10. Article ; Online: Evaluating Islatravir Administered Via Microneedle Array Patch for Long-Acting HIV Pre-exposure Prophylaxis Using Physiologically Based Pharmacokinetic Modelling.

    Kinvig, Hannah / Cottura, Nicolas / Lloyd, Andrew / Frivold, Collrane / Mistilis, Jessica / Jarrahian, Courtney / Siccardi, Marco

    European journal of drug metabolism and pharmacokinetics

    2022  Volume 47, Issue 6, Page(s) 855–868

    Abstract: Background and objectives: Technologies for long-acting administration of antiretrovirals (ARVs) for the prevention and treatment of HIV are at the forefront of research initiatives aiming to tackle issues surrounding drug adherence with the current ... ...

    Abstract Background and objectives: Technologies for long-acting administration of antiretrovirals (ARVs) for the prevention and treatment of HIV are at the forefront of research initiatives aiming to tackle issues surrounding drug adherence with the current standard of once-daily oral administration. Islatravir (ISL) is an emerging ARV that shows promising characteristics for long-acting prevention and treatment both orally as well as through alternative routes of administration. Microneedle array patches (MAPs) are a pain-free and discreet transdermal delivery technology that offer extended-release administration of nanoparticulate drugs. This study aimed to utilise physiologically based pharmacokinetic (PBPK) modelling to predict the pharmacokinetics resulting from ISL administered via MAP and to identify key MAP characteristics required to sustain effective concentrations over extended dosing intervals.
    Methods: A PBPK model describing the conversion of ISL to ISL-triphosphate (ISL-TP) and its whole-body disposition was developed and verified against observed clinical data for orally administered ISL in healthy adults. An intradermal PBPK model was integrated with the ISL PBPK model to predict the dose and nanoparticle release rate required for MAP administration strategies capable of achieving a minimum ISL-TP target concentration of 0.05 pmol/10
    Results: The ISL PBPK model was successfully verified, with predicted vs observed ratios falling within 0.5-2-fold. ISL MAP doses ranging from 15 to 80 mg were predicted to sustain ISL-TP concentrations above the minimum target concentration at 3, 6 and 12 months after administration. Nanoparticle release rate and MAP bioavailability were found to have a major impact on whether dosing strategies achieved the criteria. Minimum doses of 15 mg and 60 mg with a nanoparticle release rate of 0.0005 h
    Conclusions: The ISL PBPK model successfully predicted ISL and ISL-TP pharmacokinetics across a range of orally administered regimens. The integrated intradermal PBPK model outlined optimal MAP dose and nanoparticle release rates for effective ISL-TP concentrations up to 12 months, providing justification for further investigation of ISL as a candidate for MAP administration.
    MeSH term(s) Adult ; Humans ; Pre-Exposure Prophylaxis ; Models, Biological ; Anti-Retroviral Agents/pharmacokinetics ; HIV Infections/drug therapy ; HIV Infections/prevention & control
    Chemical Substances islatravir (QPQ082R25D) ; Anti-Retroviral Agents
    Language English
    Publishing date 2022-09-30
    Publishing country France
    Document type Journal Article
    ZDB-ID 196729-0
    ISSN 2107-0180 ; 0398-7639 ; 0378-7966
    ISSN (online) 2107-0180
    ISSN 0398-7639 ; 0378-7966
    DOI 10.1007/s13318-022-00793-6
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