Une décennie d'avancées thérapeutiques
2020 - volume 75 (5-6)
|Editorial. Therapeutic advances during the decade 2010-2020|
|Deceased organ donation in 2020|
Detry O, Massion P, Ledoux D
Rev Med Liege 2020, 75(5-6),276-279
Summary : The success of solid organ transplantation induced an increased need for grafts and the necessary registration of transplant candidates on long waiting lists. Many patients die while waiting for transplantation, even in Belgium where the donation rates have been high these last years. In order to fight this lack of donor organs, the transplant centers widened donation criteria for brain dead donors, including older age and potential transmissible diseases. In addition, programs of donation after circulation death have been developed, first for kidneys, then for livers and recently for the hearts. Organ donation after euthanasia is also regularly performed in Belgium. All these policies lead to the fact that organ donation rates stay high in Belgium, and particularly in the Liege region, but efforts are still ahead if we aim to reduce waiting list mortalities.
|Update in abdominal surgery|
Kohnen L, Meurisse N, Decker E, Haumann A, Remacle G, Honore P, Hamoir E, Coimbra C, Detry O, De Roover A
Rev Med Liege 2020, 75(5-6),280-285
Summary : During the last decade minimal invasive approach progressed in all sectors of abdominal surgery. Technological improvements allowed to perform more complex procedures laparoscopically with increased safety. The implementation of pre-, per- and postoperative protocols with an adaptation of surgical, anesthetic and analgesia methods and the patient’s involvement in the healing process led to enhanced recovery after surgery. The centralization of complex esophageal and pancreatic surgery established the CHU of Liège as a tertiary referral institution for complex oncological surgery thanks to a large cooperation with regional hospitals.
|Enhanced recovery after surgery in colorectal surgery|
Hardy PY, Meunier A, Coimbra C, Decker E, Joris J
Rev Med Liege 2020, 75(5-6),286-291
Summary : Enhanced recovery after surgery (ERAS) in colorectal surgery consists of multidisciplinary, multimodal, and patient-centred care. The implementation of pre-, intra-, and post-operative measures mitigates the surgical stress, the inflammatory reaction, and their consequences. The elements of this protocol are evidence-based medicine. This allows improved and accelerated recovery. Consequently, ERAS reduces the incidence of medical complications by 50 %, including fewer infectious complications, and a possible positive impact on survival after oncologic surgery. Hospital length of stay is shortened. There is no contraindication to ERAS, which must be used for all patients undergoing colorectal surgery. Adaptation of the protocol will nevertheless be necessary in the event of urgent surgery.
|The opportunities of the minimally invasive approach for the cardiovascular and thoracic surgery|
Bru?ls S, Kerzmann A, Durieux R, Quaniers J, Tchana-Sato V, Lavigne JP, Sakalihasan N, Radermecker MA, Desiron Q, Szecel D, Holemans C, Boesmans E, Defraigne JO
Rev Med Liege 2020, 75(5-6),292-299
Summary : There is a continuous growth in the incidence of cardiovascular and thoracic diseases, especially related to the increased life expectancy. Moreover, the quality and efficacy of care for these pathologies are progressing constantly. The evolution of surgery prompts us to develop less aggressive (minimally invasive), although technically more complex, treatment or diagnostic techniques. Pathologies, which until now required heavy surgeries, are managed today in a less invasive way and become therefore accessible to patients even if they are older or in a poor general condition. In this article, we present our experience in the development of the minimal invasive procedures in cardiovascular and thoracic surgery.
|Therapeutic revolution in the treatment of aortic stenosis : transcatheter aortic valve implantation (TAVI )|
Lancellotti P, Nguyen Trung ML, Sprynger M, Lempereur M, Martinez C
Rev Med Liege 2020, 75(5-6),300-303
Summary : Eighteen years after the birth of the concept, TAVI (Transcatheter Aortic Valve Implantation) has established itself as the treatment of choice for symptomatic patients with severe aortic valve stenosis at high surgical risk. Unlike surgical prosthesis, the benefit of which has been validated in observational studies, indications for TAVI are now based on the results of large randomized trials. The TAVI revolution continues today with the miniaturization of the equipment, the development of new closure systems, the availability of a wider range of prosthesis sizes and the growing experience of operators, all contributing to the widening of indications to lower risk patients.
|Therapeutic revolution in heart failure|
Ancion A, Nguyen Trung ML, Tridetti J, Lancellotti P
Rev Med Liege 2020, 75(5-6),304-309
Summary : The introduction of basic treatment for heart failure dates to the late 1990s. Since that time, apart from a few new developments reserved for selected patients, there has been little progress. During these years, the epidemiology of the disease has evolved. The number of patients is constantly increasing and the prognosis is often darker than most oncological pathologies. With the arrival of the sacubitril/valsartan combination, Entresto®, a new therapeutic class has emerged. It has shown a significant reduction in mortality and hospitalizations for heart failure. The additional benefits to be expected from this molecule are still being evaluated. Significant positive remodeling seems to be a reality for many patients. This spectacular advance, however, is not the final solution. In addition, patients with preserved heart failure do not seem to benefit the same from this molecule. Other advances are being assessed. Sacubitril/valsartan is the first revolution, perhaps, in a long series.
|Direct oral anticoagulants : therapeutic breakthroughs over the past decade|
Sprynger M, Lancellotti P
Rev Med Liege 2020, 75(5-6),310-315
Summary : In the past decade atrial fibrillation (AF) and venous thromboembolic disease (VTE) treatment have been revolutionized by direct oral anticoagulants (DOACs). Compared to vitamin K antagonists, DOACs have interesting advantages : standardized dosages (no need for monitoring), fast action, short half-life, (no food interaction and lower risk of intracranial bleeding). In addition to VTE and AF, DOACs have specific indications : prevention of postorthopedic surgery VTE and more recently, prevention of cardiovascular events in patients with stable coronaropathy and/or peripheral artery disease. Nevertheless, DOACs must be handled with care according to dosage regimens, contra-indications, drug-drug interactions. Other anticoagulants are in the pipeline. What will their indications be ? Future will tell us.
|Paradigm shifts in the treatment of venous thrombosis of the lower limbs : are we moving forward or backward?|
|Hemophilia : a disease on the move|
Péters P, Gothot A
Rev Med Liege 2020, 75(5-6),322-328
Summary : Over the last hundred years, the treatment of hemophilia has evolved considerably. To date, its principle is still to prevent the occurrence of hemorrhages by regular intravenous injections of factor VIII or IX concentrate. It allows to reach a life expectancy similar to the general population. The quality of life is constantly improving despite the constraint imposed by the modality and frequency of injections. The main complication remains the development of antibodies that inhibit the administered factors. Concentrates of long-acting factors are now available allowing to limit for example the frequency of injections. A bispecific monoclonal antibody reproducing the action of factor VIII and injectable subcutaneously has recently become available to hemophilia A patients, with the advantage of being effective even in the presence of inhibitors. Other non-substitute products are being studied offering interesting leads. Finally, gene therapy shows promising results, giving hope for access to this therapeutic option in a relatively near future. These advances are, however, a challenge for clinical laboratories, which must adapt their measurement techniques to ensure optimal monitoring. The future is on its way for hemophilia. Treatment remains expensive but it is worth the price.
|Novelties in arterial hypertension management in the last decade|
Krzesinski JM, Saint-Remy A
Rev Med Liege 2020, 75(5-6),329-335
Summary : Hypertension remains one of the most important cardiovascular risk factors. In spite of many efforts for its management, the control of high blood pressure remains insufficient. In the last decade, no new antihypertensive drug was released. The main effort to improve blood pressure control was put on the validation of the hypertensive status, the stimulation of home blood pressure measurement and the therapeutic education of the patients. The releasing in 2018 of new guidelines, which are clear and more simple, would help more efficiently fight against hypertension, the still present silent killer. In Europe, the usual blood pressure target has been kept, i.e.a lowering of blood pressure below 140/90 mmHg in all fit patients whatever their age. Lower target could be proposed according to the patient tolerance. Treatment is decided according to cardiovascular risk evaluation. Quickly a combination of two antihypertensive agents in a single pill is proposed to improve efficacy of the treatment. We also need the help of the family, nurses and pharmacists to increase the chance of a better blood pressure control, which is necessary to get an optimal cardiovascular protection.
|Therapeutic innovation in nephrology : 10 years of progress|
Bovy C, Delanaye P, Jouret F, Krzesinski JM
Rev Med Liege 2020, 75(5-6),336-343
Summary : Chronic kidney disease (CKD) impairs the quality of life and increases the risk for cardiovascular morbimortality. Intensive research is conducted in order to slow down CKD development and progression. During the past decade, a better understanding of the pathophysiological mechanisms of glomerular diseases has highlighted the benefits of rituximab. Progresses have also been made in the understanding of the mechanisms of autosomal polycystic kidney disease, the most frequent inherited kidney disease. These observations led to the discovery and validation of tolvaptan, a blocker of the V2 receptor of the antidiuretic hormone as an innovative treatment. Type 2 diabetic disease is the leading cause worldwide of endstage kidney disease and dialysis. The development of new drugs, such as the gliflozins (inhibiting the sodium glucose reabsorption in the proximal tubule), has contributed to an improvement in the management of the cardiovascular and renal risks especially reducing congestive heart failure rate. Another important progress in nephrology since the beginning of the new century concerns a more precise estimation of the kidney function, which allows to better evaluate the slope of CKD progression and test the influence of different therapeutic approaches aiming at correcting anemia, hyperkalemia, metabolic acidosis and disturbances of calcium and phosphate. The present review summarizes all of these major advances in the field of CKD diagnosis and treatment, and envisions the future of nephrology for the next decade.
|Pulmonary arterial hypertension (PAH ) : a new era of pulmonary arterial vasodilatators|
Guiot J, Cornia O, Louis R
Rev Med Liege 2020, 75(5-6),344-349
Summary : Pulmonary arterial hypertension (PAH) is a rare disease, characterized by a progressive increase in pulmonary arterial pressure. The therapeutic management of PAH patients has evolved significantly over the past decades following the appearance of new specific therapies, but also the performance of multiple clinical studies in an otherwise rare pathology. As a result, the care is very well codified and makes it possible to treat all patients at best. To date, we can cite four therapeutic families: endothelin receptor antagonists (ERA), drugs that interfere with the cyclic guanosine monophosphate (cGMP) pathway such as phosphodiesterase type 5 inhibitors (PDE5i) or the stimulator of soluble guanylate cyclase, prostacyclin analogues, and, finally, calcium antagonists. The therapeutic approach, formerly sequential, has proven to be insufficient in favor of an aggressive and rapidly progressive upfront therapeutic approach, making it possible to greatly improve the morbidity and mortality of patients. In this context, early management remains the most appropriate attitude and justifies recourse, from the first symptoms, to a competence center.
|Asthma : the contribution of biotherapies|
Schleich F , Frix AN , Paulus V , Guissard F , Sanchez CE , Henket ME , Louis R
Rev Med Liege 2020, 75(5-6),350-355
Summary : Asthma is a chronic heterogeneous airway disease. There are different asthma inflammatory phenotypes with various responses to treatment and different disease severities. When asthma requires chronic systemic corticosteroids or hospitalizations despite maximal inhaled therapies in asthmatic patients in whom comorbidities have been managed and who are considered as compliant, the pulmonologist may propose biological treatment to reduce exacerbations and the dose of systemic corticosteroids. During the last ten years, the number of biologics for the management of type-2 severe asthma has increased. Anti-IgE monoclonal antibodies (omalizumab) are available for more than ten years and recommended in severe allergic asthma. New biologics are now available to block IL-5 (mepolizumab, reslizumab) or its receptor (benralizumab). These treatments allow a reduction of exacerbations and of the dose of systemic corticosteroids, an improvement in asthma control, in asthma quality of life and for some of them, an increase in lung function. New biologics will soon be available in Belgium for the management of severe asthma. In addition to the improvement of asthma control in severe asthma, biological treatments have improved the understanding of the mechanisms leading to severe asthma.
|Ten years ahead in infectious diseases : AIDS/ HIV towards stopping transmission|
Struvay S, Plum PE, Pirard C, Meuris C, Sauvage AS
Rev Med Liege 2020, 75(5-6),356-361
Summary : In order to end the AIDS pandemic, new infections must be avoided. This prevention can be divided into four axes depending on the risk of exposure to the HIV virus. Over the past decade, new prevention strategies supported by various studies have emerged. These are effective when they are used in combination. Some are not without risk or even controversial according to some authors
|Therapeutic progress in the control of uncomplicated Plasmodium falciparum malaria|
Pirard C, Léonard P, Plum PE, Struvay S, Moutschen M
Rev Med Liege 2020, 75(5-6),362-365
Summary : Malaria is a worldwide public health problem. In Europe, data show an increasing trend of imported cases in the last ten years. Following an alarming observation reporting resistance to anti-malarial drugs, new effective treatments have been developed in early 21st century. These are artemisinin and its derivatives. Artemisinin-based combination therapies (ACT) are now recommended by the World Health Organisation (WHO) since 2006 as the first-line treatment for uncomplicated Plasmodium falciparum malaria. However, resistance phenomena to these new drugs have been described in South-East Asia since 2009. It is thus necessary to use them properly and to monitor their use to preserve their effectiveness in the future.
|Hepatitis C in 2020: from the therapeutic victory over the virus C to the effort on screening|
Warling O, Delwaide J
Rev Med Liege 2020, 75(5-6),366-368
Summary : New antiviral therapies, available in Belgium since 2015, have revolutionized the treatment of hepatitis C. A definitive eradication of the virus can now be obtained in nearly all treated patients whatever the viral genotype or the fibrosis stage. Moreover, due to the excellent security profile of these therapies, all the patients can have access to a therapy whatever their concomitant pathologies. The therapeutic victory against the virus being acquired, efforts are turning towards the screening of the patients unaware of their infection, in order to obtain a near eradication of the virus in 2030.
|Remarkable medical advances in rheumatology : may be…|
Malaise MG, Chapelier N, Dewael T, Leonori L, Leroy M, Mailleux E, André B, Halleux S, Kaiser MJ, Malaise O, Ribbens C, Rinkin C, von Frenckell C, Volders A
Rev Med Liege 2020, 75(5-6),369-375
Summary : The development of new drugs is a significant activity in a university hospital that favors access to therapeutic novelties to patients. Rheumatology, whose drug armamentarium was poor in the 1980s, has benefited from the huge progresses of immunology in the 1980-1990s, allowing a therapeutic revolution in whom the academic hospital of Liège (CHU Liège) has been strongly implicated. First protocols with anti-TNF-? monoclonal antibodies have been applied in 1997. Sixty-one protocols have been initiated in rheumatoid arthritis, 12 in ankylosing spondylitis, 10 in psoriatic arthritis, 9 in systemic erythematosus lupus, 3 in giant cell arteritis, 1 in polymyalgia rheumatica, 5 in osteoarthritis and 4 in osteoporosis. Potential and pitfalls will be discussed disease by disease and also by drug categories. The balance remains globally positive, but remission is far from be reached.
|Actual treatments of psoriasis : from etanercept to anti-IL17 and anti-IL23 antagonists|
Libon F, Lebas E, El Hayderi L, De Schaetzen V, Dezfoulian B, Nikkels AF
Rev Med Liege 2020, 75(5-6),376-381
Summary : Psoriasis is a chronic inflammatory skin disease affecting around 2-3 % of the population. The disease spectrum evolves from to the knees and elbows limited disease to erythrodermic psoriasis. The impact on the quality of life, the pruritus, the pain from palmo-plantar disease, arthropathic psoriasis and the comorbidities are the major complaints of the patients. The treatment relies on topical treatments with dermocorticosteroids with or without vitamin D derivatives, UVA or UVB phototherapy, conventional treatments including methotrexate, ciclosporin and acitretin, and, since around 15 years, biological treatments. The biological treatments for moderate to severe psoriasis progressed in a spectacular way with an improvement of clinical results and an amelioration of the safety profile at every step. This article discusses these developments from the TNF? antagonists, including etanercept, adalimumab and infliximab to the newly arrivals, the anti-IL17 and anti-IL23 antagonists, the anti-PDE-4 antagonists and the JAK inhibitors.
|Multiple sclerosis : therapy update|
Dive D, Dauby S, Lommers E, Hansen I, Maquet P
Rev Med Liege 2020, 75(5-6),382-385
Summary : Multiple sclerosis is still a severe disease potentially associated with a short- or long-term disability in young adults. Since a few years therapeutic progresses are considerable. New drugs and new therapy rationale considerably improved our knowledge and patient’s care. Early treatment is a key within dedicated specialized and multidisciplinary units. Clinical and neuroradiological no evidence of disease activity (NEDA) is a goal, which is more often reached. Patient’s evolution and follow-up is completely changed in recent years with more efficacy.
|A decade of progress in the management of dyslipidemia|
Wallemacq C, Paquot N
Rev Med Liege 2020, 75(5-6),386-391
Summary : Over the past 10 years, meta-analyzes of statins, randomized clinical trials using ezetimibe and anti-PCSK9 antibodies, and Mendelian randomization studies have strengthened the central and causal role of LDL-c in the development of cardiovascular disease. The LDL-c target has been gradually lowered and to date there is no LDL-c threshold below which the benefit of the reduction disappears. The decrease in cardiovascular risk is proportional to the absolute reduction in the concentration of LDL-c regardless of the means by which this reduction is obtained. These data led to the formulation of new guidelines for the management of dyslipidemias relating in particular to a lowering of the LDL-c target and to the complementary use of ezetimibe and anti-PCSK9 antibodies after statins.
|A revolution in the management of type 2 diabetes : antidiabetic agents providing a cardiovascular and renal protection independently of glucose control !|
Scheen AJ, Paquot N
Rev Med Liege 2020, 75(5-6),392-398
Summary : Type 2 diabetes is a complex disease with an increasing prevalence and a huge morbidity and premature mortality, essentially due to cardiovascular and renal complications. Classical glucose-lowering agents (metformin, sulphonylureas) exert little protective effects on these complications so that emphasis has been put on a multifactorial management targeting all risk factors. Gliptins offer the advantage of an excellent tolerance profile, with no hypoglycaemia or weight gain, but have not shown any specific cardiovascular or renal protection. Over the last decade, new antidiabetic medications (glucagon-like peptide-1 receptor agonists and gliflozins) have demonstrated a cardiovascular and renal protection, independently of glucose control. These data of evidence-based medicine have revolutionized the therapeutic approach of patients with type 2 diabetes who are at high risk of atherosclerotic cardiovascular disease, heart failure and progressive renal disease. Unexpectedly, the protective effect of gliflozins is currently investigated in patients with heart failure or renal disease, in the absence of diabetes.
|Therapeutic and technological advances in the management of adult patients with type 1 diabetes|
Radermecker RP, Philips JC
Rev Med Liege 2020, 75(5-6),399-405
Summary : Management of type 1 diabetes remains a challenge. Indeed, many parameters can influence glycemia. Faced with this challenge, recent years have seen the emergence of various advances. These ones relate not only to new therapeutics but also to techniques dedicated to the management of type 1 diabetes. Among the therapeutic advances, the main ones concern improvement of pharmacokinetic and pharmacodynamic properties of insulins. Some other drugs might be worth considering, such as gliflozins in particular. In addition to these advances, the technological aspect of care continues to improve. There are many new possibilities with continuous insulin infusion pumps. The (semi-) continuous glucose monitoring clearly revolutionized the approach. Coupling this continuous measurement with some insulin pumps allows some patients to benefit from hybrid artificial pancreas. This article briefly discusses advances of the past decade in the management of adults with type 1 diabetes.
|Technological progress and novelty in insulin therapy during those last ten years for diabetes children and adolescents|
|News drugs and evolution towards personalized treatment for cystic fibrosis|
Boboli H , Pirson J , Kempenners C , Seghaye MC
Rev Med Liege 2020, 75(5-6),410-414
Summary : Cystic fibrosis is a genetic disorder responsible for the production of a defective transmembrane protein. In recent years, new protein modulators have been developed. They aim to treat the underlying cause of the disease. The results on the biomarkers of the function of the CFTR protein and on the clinical outcomes are very encouraging. However, there is an individual heterogeneity in the response to modulators within a same genotype. Furthermore, clinical trials focus on the most common mutations in the CFTR gene, in particular DF508. Intestinal organoids, a new model of ex vivo study, could offer a quick approach to increase access to effective treatment for all patients with cystic fibrosis regardless of their CFTR genotype. Organoids could enable personalized treatment of cystic fibrosis.
|Therapeutic advances in neonatology|
Hennuy N, Lefebvre C, de Halleux V, Snyers D, Tribolet S, Viellevoye R, Rigo V
Rev Med Liege 2020, 75(5-6),415-419
Summary : In this article, we will review major therapeutic advances in neonatology over the past ten years. We will discuss the antenatal administration of magnesium sulfate, the interest of hypothermia in the context of hypoxic ischaemic encephalopathy, the benefits and modalities of placental transfusion, less invasive techniques for ventilation and administration of the surfactant, possibilities to fortify breast milk and the concept of developmental care. These therapeutic advances are sometimes based on new therapeutics, sometimes on new concepts and, sometimes, on new less invasive techniques. They have made it possible to optimize the care of premature babies but also of term newborns.
|Current and new therapeutic options in inborn errors of metabolism|
Debray FG, Weekers L, Dadoumont C, Grandjean C, Deberg M, Boemer F, Bours V
Rev Med Liege 2020, 75(5-6),420-425
Summary : Inborn errors of metabolism (IEM) represent a vast group of orphan genetic disorders associated with enzyme deficiencies, substrates accumulation and products depletion. For several decades, the cornerstone of life-saving therapies in IEM was based on extreme manipulations of the nutritional intakes. Such outstanding dietary engineering is still relevant today, but new therapeutic avenues have emerged last years, based on better pathophysiological understanding and technological advances. In this paper, we summarize current and new therapeutic options in the field of IEM.
|Innovative therapeutic approaches in psychiatry : neuromodulation. For whom, why and how ?|
Scantamburlo G, Salado AL
Rev Med Liege 2020, 75(5-6),426-431
Summary : Recent technological advances have seen the resumption or the advent of new approaches in the field of psychiatry such as electroconvulsive therapy, repeated transcranial magnetic stimulation, transcranial direct current electrical stimulation or even deep brain stimulation. These new approaches offer a window into the understanding of the neurobiological mechanisms linked to mental illnesses. This review summarizes current knowledges in the field and the future directions for the treatment of depression or obsessive-compulsive disorder.
|What’s new in diabetic retinopathy ?|
Rigo S, Duchâteau E, Rakic JM
Rev Med Liege 2020, 75(5-6),432-439
Summary : Diabetic retinopathy is a public health issue and the leading cause of blindness in adults in industrialized countries. Many advances have been made during the last few years in the diagnosis, the understanding of the pathophysiology and the treatment of diabetic retinopathy, especially with the rise of anti-angiogenic treatments. We bring here an overview of the last advances, the current therapeutic algorithms and future perspectives.
|What the last 10 years have brought in the treatment of benign prostatic hyperplasia|
Triffaux F, Waltregny D, Nechifor V
Rev Med Liege 2020, 75(5-6),440-444
Summary : Benign prostatic hyperplasia (BPH) is a very frequent condition, most of the times related to age, and with initial manifestations and long term development that may vary widely. Treatment is necessary only if the patient is symptomatic or if he has complications related to the BPH. During the last 10 years, the various BPH treatment means have evolved significantly. Regarding medical treatment, new drugs have been introduced and new combinations of drugs have shown their efficacy in BPH treatment. The surgical treatment of BPH has seen the development of minimally invasive surgical techniques, with broader indications and better results compared to classical surgical techniques. Among these techniques, the better studied and developed is the endoscopic Holmium Laser Enucleation of the Prostate (HoLEP). The continuous development of medical lasers and minimally invasive surgical techniques for the treatment of BPH will, in our opinion, lead the way towards a rich and innovative future decade with regard to the surgical treatment of BPH.
|Innovations in physical and rehabilitation medicine|
Bethlen S, Bornheim S, Delvaux F, Marquet L, Pelzer D, Neuprez A, Lecart MP, Maertens B, Wang FC, Tomasella M, Croisier JL, Servais D, Gobels C, Kaux JF
Rev Med Liege 2020, 75(5-6),445-451
Summary : Over the last decade, Physical and Rehabilitation Medicine (PRM) is a medical specialty that has evolved considerably in the various fields that concern it : from the management of low back pain and lumbosciatalgia or osteoporosis in a multidisciplinary manner, through the use of new technologies in neuro-locomotor rehabilitation and robotisation in amputee patients for example, the development of regenerative medicine and prevention in sports traumatology and, finally, the progress of electrophysiology techniques for the diagnosis of small-fibre neuropathies. These various advances will be discussed in this article.
|A multidisciplinary approach for accelerated orthodontics|
Charavet C, Lambert F
Rev Med Liege 2020, 75(5-6),452-456
Summary : An increasing number of adult patients are seeking orthodontic treatment and several surgical and non-surgical methods have been developed to reduce the overall treatment time. Two randomized controlled clinical trials, performed in our University Hospital, demonstrated that the piezocision surgery - minimally invasive corticotomies - decreased the overall orthodontic treatment time by 43 % - effect during 4 to 6 months after the surgery - without any further clinical and radiological adverse effects. In addition, the use of a custom-made orthodontic system - brackets and arches - optimized the acceleration in the fine-tuning phase of orthodontic treatment. Finally, the combination of the two techniques is therefore relevant to maximize the reduction of the orthodontic treatment time. Fundamentally, our preclinical studies in rats have highlighted the biological phenomena underlying piezocision with an important bone demineralization and osteoclast recruitment associated with a predominant expression of the RANKL-OPG duo.
|Tandem-mess spectrometry coupled with liquid chromatography (LCMS/MS) : a revolution in the clinical chemistry laboratory|
Cavalier E, Le Goff C
Rev Med Liege 2020, 75(5-6),457-459
Summary : Manual or automated immunoassays are largely used in clinical chemistry laboratories for measuring various compounds like steroid or peptide hormones. However, these methods can lack sensibility and specificity. Hence, during this last decade, tandem-mess spectrometry coupled with liquid chromatography (LC-MS/MS) have emerged as a technique of choice to precisely quantify those molecules. However, these instruments remain quite expensive and need highly trained people.
|Novel drug targets and therapeutic perspectives. Towards a precision medicine|
Rev Med Liege 2020, 75(5-6),460-465
Summary : A therapeutic target can be defined as the biochemical entity by which a drug exerts its beneficial effects. Historically, most drugs have been used without a precise knowledge of their mechanism of action. The rational drug design for a predefined target has been progressively implemented during the second half of the 20th century. Recent advances in genomics have accelerated the discovery of several targets involved in many pathologies. During the recent period, there has also been a diversification of the types of targets used in therapy. Generally, the proteins modulated by drugs belonged mainly to the families of membrane receptors (receptors coupled to G proteins, ion channels, etc.), nuclear receptors or enzymes. Technological advances in the field of therapeutic antibodies and biotechnologies enabled curative agents to reach previously undruggable targets. In this article, we review these trends and illustrate them by various examples, notably in the field of anticancer drugs, lipid-lowering drugs, gene therapy or antisense therapy.
|Evolution of systemic anti-cancer therapies|
Poncin A, Jerusalem G
Rev Med Liege 2020, 75(5-6),466-472
Summary : Before the advent of chemotherapy in the 1940s, cancer treatment was dominated by surgery and radiation therapy. The developments of targeted anti-cancer therapies in the 2000s followed by immunotherapy have largely changed the treatment landscape in particular in the metastatic setting. Here we provide a history of these advances.