搜索结果：International journal for parasitology. Drugs and drug resistance

In 2005 there was an outbreak of XDR (extensively drug resistant) TB in Tugela Ferry, which is served by the Church of Scotland Hospital (COSH), in the uMzinyathi District, KwaZulu-Natal, South Africa. An investigation was carried out to determine if XDR TB was occurring elsewhere in the province, and to develop hypotheses for the rise in drug resistance with a view to developing a strategy for the control of MDR (multi-drug resistant) and XDR TB in the province and elsewhere. TB incidence and treatment success rates, for each of the 11 districts in the province, were obtained from the provincial electronic TB register for the years 2002-2007. The results of culture and drug sensitivity tests for the years 2002 to 2007 in each of the districts were compiled and culture taking practices were compared to the number of MDR TB cases. Interviews were conducted with key personnel in affected sites. In 2007, 2799, or 2.3% of 119,218 notified TB cases in the province were multi-drug resistant (MDR), and of these 270 (9.6%) were XDR. The two worst affected districts were uMzinyathi where 226 (4.1%) of 5522 notified TB cases were MDR, and of these 120 (53%) were extensively drug resistant (X

Drug resistance remains a major problem for the treatment of HIV. Resistance can occur due to mutations that were present before treatment starts or due to mutations that occur during treatment. The relative importance of these two sources is unknown. We study three different situations in which HIV drug resistance may evolve: starting triple-drug therapy, treatment with a single dose of nevirapine and interruption of treatment. For each of these three cases good data are available from literature, which allows us to estimate the probability that resistance evolves from standing genetic variation. Depending on the treatment we find probabilities of the evolution of drug resistance due to standing genetic variation between 0 and 39%. For patients who start triple-drug combination therapy, we find that drug resistance evolves from standing genetic variation in approximately 6% of the patients. We use a population-dynamic and population-genetic model to understand the observations and to estimate important evolutionary parameters. We find that both, the effective population size of the virus before treatment, and the fitness of the resistant mutant during treatment, are key-parameters

Access to combination antiretroviral treatment (ART) has improved greatly over recent years. At the end of 2011, more than eight million HIV infected people were receiving antiretroviral therapy in low-income and middle-income countries. ART generally works well in keeping the virus suppressed and the patient healthy. However, treatment only works as long as the virus is not resistant against the drugs used. In the last decades, HIV treatments have become better and better at slowing down the evolution of drug resistance, so that some patients are treated for many years without having any resistance problems. However, for some patients, especially in low-income countries, drug resistance is still a serious threat to their health. This essay will review what is known about transmitted and acquired drug resistance, multi-class drug resistance, resistance to newer drugs, resistance due to treatment for the prevention of mother-to-child transmission, the role of minority variants (low-frequency drug-resistance mutations), and resistance due to pre-exposure prophylaxis.

Drug repurposing has attracted increasing attention from both the pharmaceutical industry and the research community. Many existing computational drug repurposing methods rely on preclinical data (e.g., chemical structures, drug targets), resulting in translational problems for clinical trials. In this study, we propose a clinical connectivity map framework for drug repurposing by leveraging laboratory tests to analyze complementarity between drugs and diseases. We establish clinical drug effect vectors (i.e., drug-laboratory test associations) by applying a continuous self-controlled case series model on a longitudinal electronic health record data. We establish clinical disease sign vectors (i.e., disease-laboratory test associations) by applying a Wilcoxon rank sum test on a large-scale national survey data. Finally, we compute a repurposing possibility score for each drug-disease pair by applying a dot product-based scoring function on clinical disease sign vectors and clinical drug effect vectors. We comprehensively evaluate 392 drugs for 6 important chronic diseases (e.g., asthma, coronary heart disease, type 2 diabetes, etc.). We discover not only known associations between

The role of Artificial Intelligence (AI) is growing in every stage of drug development. Nevertheless, a major challenge in drug discovery AI remains: Drug pharmacokinetic (PK) and Drug-Target Interaction (DTI) datasets collected in different studies often exhibit limited overlap, creating data overlap sparsity. Thus, data curation becomes difficult, negatively impacting downstream research investigations in high-throughput screening, polypharmacy, and drug combination. We propose xImagand-DKI, a novel SMILES/Protein-to-Pharmacokinetic/DTI (SP2PKDTI) diffusion model capable of generating an array of PK and DTI target properties conditioned on SMILES and protein inputs that exhibit data overlap sparsity. We infuse additional molecular and genomic domain knowledge from the Gene Ontology (GO) and molecular fingerprints to further improve our model performance. We show that xImagand-DKI-generated synthetic PK data closely resemble real data univariate and bivariate distributions, and can adequately fill in gaps among PK and DTI datasets. As such, xImagand-DKI is a promising solution for data overlap sparsity and may improve performance for downstream drug discovery research tasks. Code

Learning accurate drug representations is essential for task such as computational drug repositioning. A drug hierarchy is a valuable source that encodes knowledge of relations among drugs in a tree-like structure where drugs that act on the same organs, treat the same disease, or bind to the same biological target are grouped together. However, its utility in learning drug representations has not yet been explored, and currently described drug representations cannot place novel molecules in a drug hierarchy. Here, we develop a semi-supervised drug embedding that incorporates two sources of information: (1) underlying chemical grammar that is inferred from chemical structures of drugs and drug-like molecules (unsupervised), and (2) hierarchical relations that are encoded in an expert-crafted hierarchy of approved drugs (supervised). We use the Variational Auto-Encoder (VAE) framework to encode the chemical structures of molecules and use the drug-drug similarity information obtained from the hierarchy to induce the clustering of drugs in hyperbolic space. The hyperbolic space is amenable for encoding hierarchical relations. Our qualitative results support that the learned drug embe

Longer timelines and lower success rates of drug candidates limit the productivity of clinical trials in the pharmaceutical industry. Promising de novo drug design techniques help solve this by exploring a broader chemical space, efficiently generating new molecules, and providing improved therapies. However, optimizing for molecular characteristics found in approved oral drugs remains a challenge, limiting de novo usage. In this work, we propose NovoMol, a novel de novo method using recurrent neural networks to mass-generate drug molecules with high oral bioavailability, increasing clinical trial time efficiency. Molecules were optimized for desirable traits and ranked using the quantitative estimate of drug-likeness (QED). Generated molecules meeting QED's oral bioavailability threshold were used to retrain the neural network, and, after five training cycles, 76% of generated molecules passed this strict threshold and 96% passed the traditionally used Lipinski's Rule of Five. The trained model was then used to generate specific drug candidates for the cancer-related PDGFRα receptor and 44% of generated candidates had better binding affinity than the current state-of-the-art drug,

Drug repositioning (DR) refers to identification of novel indications for the approved drugs. The requirement of huge investment of time as well as money and risk of failure in clinical trials have led to surge in interest in drug repositioning. DR exploits two major aspects associated with drugs and diseases: existence of similarity among drugs and among diseases due to their shared involved genes or pathways or common biological effects. Existing methods of identifying drug-disease association majorly rely on the information available in the structured databases only. On the other hand, abundant information available in form of free texts in biomedical research articles are not being fully exploited. Word-embedding or obtaining vector representation of words from a large corpora of free texts using neural network methods have been shown to give significant performance for several natural language processing tasks. In this work we propose a novel way of representation learning to obtain features of drugs and diseases by combining complementary information available in unstructured texts and structured datasets. Next we use matrix completion approach on these feature vectors to lea

The continuous evolution of the SARS-CoV-2 virus poses a significant challenge to global public health. Of particular concern is the potential resistance to the widely prescribed drug PAXLOVID, of which the main ingredient nirmatrelvir inhibits the viral main protease (Mpro). Here, we developed CAPTURE (direCted flAg laPlacian Transformer for drUg Resistance prEdictions) to analyze the effects of Mpro mutations on nirmatrelvir-Mpro binding affinities and identify potential drug-resistant mutations. CAPTURE combines a comprehensive mutation analysis with a resistance prediction module based on DFFormer-seq, which is a novel ensemble model that leverages a new Directed Flag Transformer and sequence embeddings from the protein and small-molecule-large-language models. Our analysis of the evolution of Mpro mutations revealed a progressive increase in mutation frequencies for residues near the binding site between May and December 2022, suggesting that the widespread use of PAXLOVID created a selective pressure that accelerated the evolution of drug-resistant variants. Applied to mutations at the nirmatrelvir-Mpro binding site, CAPTURE identified several potential resistance mutations,

Drug-drug interaction (DDI) prediction provides a drug combination strategy for systemically effective treatment. Previous studies usually model drug information constrained on a single view such as the drug itself, leading to incomplete and noisy information, which limits the accuracy of DDI prediction. In this work, we propose a novel multi- view drug substructure network for DDI prediction (MSN-DDI), which learns chemical substructures from both the representations of the single drug (intra-view) and the drug pair (inter-view) simultaneously and utilizes the substructures to update the drug representation iteratively. Comprehensive evaluations demonstrate that MSN-DDI has almost solved DDI prediction for existing drugs by achieving a relatively improved accuracy of 19.32% and an over 99% accuracy under the transductive setting. More importantly, MSN-DDI exhibits better generalization ability to unseen drugs with a relatively improved accuracy of 7.07% under more challenging inductive scenarios. Finally, MSN-DDI improves prediction performance for real-world DDI applications to new drugs.

Antimicrobial resistance is an emerging global health crisis that is undermining advances in modern medicine and, if unmitigated, threatens to kill 10 million people per year worldwide by 2050. Research over the last decade has demonstrated that the differences between genetically identical cells in the same environment can lead to drug resistance. Fluctuations in gene expression, modulated by gene regulatory networks, can lead to non-genetic heterogeneity that results in the fractional killing of microbial populations causing drug therapies to fail; this non-genetic drug resistance can enhance the probability of acquiring genetic drug resistance mutations. Mathematical models of gene networks can elucidate general principles underlying drug resistance, predict the evolution of resistance, and guide drug resistance experiments in the laboratory. Cells genetically engineered to carry synthetic gene networks regulating drug resistance genes allow for controlled, quantitative experiments on the role of non-genetic heterogeneity in the development of drug resistance. In this perspective article, we emphasize the contributions that mathematical, computational, and synthetic gene network

Cell competition is recognized to be instrumental to the dynamics and structure of the tumor-host interface in invasive cancers. In mild competition scenarios, the healthy tissue and cancer cells can coexist. When the competition is aggressive, competitive cells, the so called super-competitors, expand by killing other cells. Novel cytotoxic drugs and molecularly targeted drugs are commonly administered as part of cancer therapy. Both types of drugs are susceptible to various mechanisms of drug resistance, obstructing or preventing a successful outcome. In this paper, we develop a cancer growth model that accounts for the competition between cancer cells and healthy cells. The model incorporates resistance to both cytotoxic and targeted drugs. In both cases, the level of drug resistance is assumed to be a continuous variable ranging from fully-sensitive to fully-resistant. Using our model we demonstrate that when the competition is moderate, therapies using both drugs are more effective compared with single drug therapies. However, when cancer cells are highly competitive, targeted drugs become more effective. In this case, therapies that are initiated with a targeted drug and are

In the absence of sufficient medication for COVID patients due to the increased demand, disused drugs have been employed or the doses of those available were modified by hospital pharmacists. Some evidences for the use of alternative drugs can be found in the existing scientific literature that could assist in such decisions. However, exploiting large corpus of documents in an efficient manner is not easy, since drugs may not appear explicitly related in the texts and could be mentioned under different brand names. Drugs4Covid combines word embedding techniques and semantic web technologies to enable a drug-oriented exploration of large medical literature. Drugs and diseases are identified according to the ATC classification and MeSH categories respectively. More than 60K articles and 2M paragraphs have been processed from the CORD-19 corpus with information of COVID-19, SARS, and other related coronaviruses. An open catalogue of drugs has been created and results are publicly available through a drug browser, a keyword-guided text explorer, and a knowledge graph.

Drug resistance is a serious public health problem that threatens to thwart our ability to treat many infectious diseases. Repeatedly, the introduction of new drugs has been followed by the evolution of resistance. In principle there are two ways to address this problem: (i) enhancing drug development, and (ii) slowing drug resistance. We present data and a modeling approach based on queueing theory that explores how interventions aimed at these two facets affect the ability of the entire drug supply system to provide service. Analytical and simulation-based results show that, all else equal, slowing the evolution of drug resistance is more effective at ensuring an adequate supply of effective drugs than is enhancing the rate at which new drugs are developed. This lends support to the idea that evolution management is not only a significant component of the solution to the problem of drug resistance, but may in fact be the most important component.

Clinicians prescribe antibiotics by looking at the patient's health record with an experienced eye. However, the therapy might be rendered futile if the patient has drug resistance. Determining drug resistance requires time-consuming laboratory-level testing while applying clinicians' heuristics in an automated way is difficult due to the categorical or binary medical events that constitute health records. In this paper, we propose a novel framework for rapid clinical intervention by viewing health records as graphs whose nodes are mapped from medical events and edges as correspondence between events in given a time window. A novel graph-based model is then proposed to extract informative features and yield automated drug resistance analysis from those high-dimensional and scarce graphs. The proposed method integrates multi-task learning into a common feature extracting graph encoder for simultaneous analyses of multiple drugs as well as stabilizing learning. On a massive dataset comprising over 110,000 patients with urinary tract infections, we verify the proposed method is capable of attaining superior performance on the drug resistance prediction problem. Furthermore, automated

Many drugs have been withdrawn from the market worldwide, at a cost of billions of dollars, because of patient fatalities due to them unexpectedly disturbing heart rhythm. Even drugs for ailments as mild as hay fever have been withdrawn due to an unacceptable increase in risk of these heart rhythm disturbances. Consequently, the whole pharmaceutical industry expends a huge effort in checking all new drugs for any unwanted side effects on the heart. The predominant root cause has been identified as drug molecules blocking ionic current flows in the heart. Block of individual types of ionic currents can now be measured experimentally at an early stage of drug development, and this is the standard screening approach for a number of ion currents in many large pharmaceutical companies. However, clinical risk is a complex function of the degree of block of many different types of cardiac ion currents, and this is difficult to understand by looking at results of these screens independently. By using ordinary differential equation models for the electrical activity of heart cells (electrophysiology models) we can integrate information from different types of currents, to predict the effect

Resistance to therapy remains a significant challenge in cancer treatment, often due to the presence of a stem-like cell population that drives tumor recurrence post-treatment. Moreover, many anticancer therapies induce plasticity, converting initially drug-sensitive cells to a more resistant state, e.g. through epigenetic processes and de-differentiation programs. Understanding the balance between therapeutic anti-tumor effects and induced resistance is critical for identifying treatment strategies. In this study, we introduce a robust statistical framework, based on multi-type branching process models of the evolutionary dynamics of tumor cell populations, to detect and quantify therapy-induced resistance phenomena from high throughput drug screening data. Through comprehensive in silico experiments, we show the efficacy of our framework in estimating parameters governing population dynamics and drug responses in a heterogeneous tumor population where cell state transitions are influenced by the drug. Finally, using recent in vitro data from multiple sources, we demonstrate that our framework is effective for analyzing real-world data and generating meaningful predictions.

Histopathological evidence supports the idea that the emergence of phenotypic heterogeneity and resistance to cytotoxic drugs can be considered as a process of adaptation, or evolution, in tumor cell populations. In this framework, can we explain intra-tumor heterogeneity in terms of cell adaptation to local conditions? How do anti-cancer therapies affect the outcome of cell competition for nutrients within solid tumors? Can we overcome the emergence of resistance and favor the eradication of cancer cells by using combination therapies? Bearing these questions in mind, we develop a model describing cell dynamics inside a tumor spheroid under the effects of cytotoxic and cytostatic drugs. Cancer cells are assumed to be structured as a population by two real variables standing for space position and the expression level of a cytotoxic resistant phenotype. The model takes explicitly into account the dynamics of resources and anti-cancer drugs as well as their interactions with the cell population under treatment. We analyze the effects of space structure and combination therapies on phenotypic heterogeneity and chemotherapeutic resistance. Furthermore, we study the efficacy of combine

Repurposing existing drugs to treat new diseases is a cost-effective alternative to de novo drug development, but there are millions of potential drug-disease combinations to be considered with only a small fraction being viable. In silico predictions of drug-disease associations can be invaluable for reducing the size of the search space. In this work we present a novel network of drugs and the diseases they treat, compiled using a combination of existing textual and machine-readable databases, natural-language processing tools, and hand curation, and analyze it using network-based link prediction methods to identify potential drug-disease combinations. We measure the efficacy of these methods using cross-validation tests and find that several methods, particularly those based on graph embedding and network model fitting, achieve impressive prediction performance, significantly better than previous approaches, with area under the ROC curve above 0.95 and average precision almost a thousand times better than chance.