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Background and ObjectivesTo determine the prevalence and relative importance of symptoms experienced by children and adults with Friedreich ataxia (FA) and to identify factors associated with a higher burden of disease.MethodsWe conducted qualitative interviews with individuals with FA and caregivers of pediatric individuals with FA to identify potential symptoms of importance to those living with FA. We subsequently performed a cross-sectional study to assess which symptoms have the highest prevalence and importance in FA and to determine which factors are associated with a higher burden of disease.ResultsThirty-nine participants provided 2,527 quotes regarding the symptomatic burden of FA. Two hundred two individuals (153 individuals with FA and 49 caregivers) participated in a subsequent cross-sectional study. Individuals with FA and caregivers identified impaired coordination, limitations with mobility and walking, inability to do activities, fatigue, and lower extremity weakness as the most prevalent and life-altering symptomatic themes in FA. Muscle stiffness and functional staging for ataxia were associated with the prevalence of symptomatic themes in FA. In addition, the length of smaller GAA expansion and the mean length of both GAA expansions were strongly associated with the onset of symptoms in FA.DiscussionThere are a wide variety of symptoms that affect the lives of individuals with FA. These symptoms, many underrecognized, have different levels of importance and occur at different rates in the FA population. The most common and life altering of these symptoms represent potential targets for future therapeutic interventions.

Background Adrenoleukodystrophy (ALD) is a multifaceted, x-linked, neurodegenerative disorder that affect patients through a variety of physical, emotional, social, and other disease-specific factors that collectively contribute to disease burden. Adrenomyeloneuropathy (AMN) is one of the most frequent clinical manifestations and a subset of ALD. To facilitate clinical care and research, it is important to identify which symptoms are most common and relevant to individuals with ALD and AMN. Methods We conducted semi-structured qualitative interviews and an international cross-sectional study to determine the most prevalent and important symptoms of ALD and AMN. Our studies included adult participants with a diagnosis of ALD and AMN who were recruited from national and international patient registries. Responses were categorized by age, sex, functional status, and other demographic and clinical features. Results Seventeen individuals with ALD and AMN participated in qualitative interviews, providing 1,709 direct quotes regarding their symptomatic burden. One hundred and nine individuals participated in the cross sectional survey study, which inquired about 182 unique symptoms representing 24 distinct symptomatic themes. The symptomatic themes with the highest prevalence in the ALD and AMN sample cohort were problems with balance (90.9%), limitations with mobility or walking (87.3%), fatigue (86.4%), and leg weakness (86.4%). The symptomatic themes with the highest impact scores (on a 0–4 scale with 4 being the most severe) were trouble getting around (2.35), leg weakness (2.25), and problems with balance (2.21). A higher prevalence of symptomatic themes was associated with functional ability, employment disruption, and speech status. Conclusions There are many patient-relevant symptoms and themes that contribute to disease burden in individuals with ALD and AMN. These symptoms, identified by those diagnosed with ALD and AMN, present key targets for further research and therapeutic development.

Background:To facilitate advances in spinal muscular atrophy therapeutic research, it is important to determine the impact and prevalence of symptoms experienced by children with spinal muscular atrophy. Methods: We conducted qualitative interviews with caregivers of children with spinal muscular atrophy. From these interviews, we generated a survey inquiring about 260 symptoms of importance grouped into 17 symptomatic themes. Results: Sixteen caregivers of children with spinal muscular atrophy aged from 4 months to 12 years participated in initial interviews, and 77 caregivers completed the survey. Higher symptom prevalence was associated with spinal muscular atrophy type, SMN2 copy number, and functional status. Hip, thigh, or knee weakness had the greatest reported impact on the lives of children with spinal muscular atrophy. Conclusions: This research provides one of the largest data sets regarding disease burden in children with spinal muscular atrophy. The most prevalent symptoms are not identical to those with the greatest impact. This unique insight into the most impactful symptoms will help focus therapeutic development in spinal muscular atrophy.

STUDY AIM To bolster Crohn’s disease (CD) clinical trial and research infrastructure through the development and validation of a sensitive, multifactorial, disease-specific, patient-reported outcome measure (PRO) for patient monitoring in therapeutic trials of CD. BACKGROUND As therapeutic advancements are made in the field of CD, it is vital to have a fully validated, sensitive, and reliable, disease-specific PRO to accurately measure changes in disease burden. Importantly, the U.S. Food and Drug Administration has encouraged the use of PROs to measure therapeutic benefit of new treatments on patient populations. This research describes the creation, testing, and validation of a new, multifactorial PRO: The Crohn’s Disease-Health Index (CD-HI). METHODS Questions were selected for the CD-HI based on their importance to patients, potential to respond to therapeutic benefit, reliability, internal consistency, and generalizability (Figure 1). We beta tested the CD-HI to evaluate its clarity, ease of use, and applicability to the CD patient population. We performed test-retest reliability, known groups validity, internal consistency, and area under the curve (AUC) analyses. RESULTS The final version of the CD-HI contains 12 subscales that measure disease burden in the following areas: 1) fatigue, 2) dietary restrictions, 3) gastrointestinal health, 4) sleep and daytime sleepiness, 5) bowel and bladder function, 6) emotional wellbeing, 7) joint health, 8) pain, 9) neck and back health, 10) activity participation, 11) social wellbeing, and 12) skin health. The CD-HI also provides a composite measure of total disease burden. Fifteen participants participated in beta testing and identified the CD-HI as easy to use, clear, relevant, and comprehensive. Twenty-three individuals with CD participated in test-retest reliability testing of the CD-HI, which indicated a high reliability of the individual questions, subscales, and full instrument (intraclass correlation coefficient = 0.84 for the full instrument). The CD-HI and its subscales demonstrated a high internal consistency (Cronbach’s α = 0.98 for the full instrument). The CD-HI total and subscale scores successfully distinguished between patient cohorts with differing disease severity. AUC analysis demonstrated a high sensitivity and specificity of the CD-HI in distinguishing between those with CD on disability vs. not on disability, with an AUC value of 0.9087 (Figure 2). CONCLUSIONS The CD-HI is a fully validated, sensitive, and accurate marker of disease burden in CD. This disease-specific PRO is available for use by researchers, clinicians, patient organizations, and companies to monitor patients and measure disease burden during therapeutic trials

As novel therapeutic interventions are being developed and tested in the amyotrophic lateral sclerosis (ALS) population, there is a need to better understand the symptoms and issues that have the greatest impact on the lives of individuals with ALS. We aimed to determine the frequency and relative importance of symptoms experienced by adults in a national ALS sample and to identify factors that are associated with the greatest disease burden in this population.We conducted 15 qualitative interviews of individuals with varied ALS phenotypes and analyzed 732 quotes regarding the symptomatic disease burden of ALS between August 2018 and March 2019. We subsequently conducted a national, cross-sectional study of 497 participants with ALS and ALS variants through the Centers for Disease Control and Prevention's (CDC) National ALS Registry between July 2019 and December 2019. Participants reported on the prevalence and relative importance of 189 symptomatic questions representing 17 symptomatic themes that were previously identified through qualitative interviews. Analysis was performed to determine how age, sex, education, employment, time since onset of symptoms, location of symptom onset, feeding tube status, breathing status and speech status relate to symptom and symptomatic theme prevalence.Symptomatic themes with the highest prevalence in our sample were an inability to do activities (93.8%), fatigue (92.6%), problems with hands or fingers (87.7%), limitations with mobility or walking (86.7%), and a decreased performance in social situations (85.7%). Participants identified inability to do activities and limitations with mobility or walking as having the greatest overall effect on their lives.Individuals with ALS experience a variety of symptoms that affect their lives. The prevalence and importance of these symptoms differ among the ALS population. The most prevalent and important symptoms offer potential targets for improvements in future therapeutic interventions.Research funding was provided by ALS Association.

Study Aim: The goal of this research is to develop and validate a novel, disease-specific patient-reported outcome measure (PRO) for use in clinical monitoring and therapeutic trials in Lung Cancer (LC). Methods: LC currently accounts for the greatest number of cancer deaths worldwide, driving an increased need for novel therapeutic development in LC. To bolster clinical trial infrastructure, it is critical to have a comprehensive, sensitive and reliable PRO that accurately tracks LC multifactorial disease burden. This research describes the development and validation of the Lung Cancer-Health Index (LC-HI) as an efficient mechanism for assessing how patients with LC feel and function in response to therapeutic treatment. We conducted semi-structured, qualitative interviews with 15 individuals diagnosed with LC and collected 653 direct participant quotes to determine the most frequent and important symptoms in LC. Based upon participant responses, we designed a survey that inquired about 162 symptoms from 14 symptomatic themes. This survey was implemented in a cross-sectional study with 139 participants with LC. The collected data was used to generate the first version of the LC-HI, which contained symptom questions showing the highest impact to the population and the potential to respond to therapeutic intervention. Symptom questions were grouped into distinct subscales using factor analysis. We beta-tested the LC-HI with 15 patients with LC to evaluate its usability, clarity, and applicability. Based on patient feedback, we modified the instrument and evaluated its test-retest reliability with 22 individuals with LC. Known groups testing was performed with the final instrument. Results: The final version of the LC-HI contains 45 symptom questions grouped into 10 subscales that measure the following areas of LC health: 1) fatigue, 2) physical function, 3) emotional health, 4) sleep and daytime sleepiness, 5) activity participation, 6) breathing function, 7) gastrointestinal function, 8) cognitive function, 9) social performance, and 10) pain. Total LC disease burden is measured using a weighted composite of these subscale scores. During beta interviews, individuals with LC deemed the instrument to be easy to use, clear, relevant, and comprehensive. Statistical and psychometric analyses confirmed that the LC-HI is reliable, valid, sensitive, specific, of high internal consistency, and able to differentiate between groups with known varying levels of disease burden (based on disability status and smoking history). Conclusions: Our research demonstrates the validity of the LC-HI as a marker of the multifaceted disease burden in LC. This disease-specific PRO provides researchers and clinicians with a reliable tool to use in patient monitoring, clinical trials, and to support FDA drug labeling claims. Citation Format: Anika Varma, Spencer Rosero, Jamison Seabury, Jennifer Weinstein, Charlotte Engebrecht, Christine Zizzi, Nuran Dilek, John Heatwole, Megan Baumgart, Deborah Mulford, Ronald Maggiore, Lainie Conrow, Jennifer King, Jacinta Wiens, Chad Heatwole. Development and validation of the Lung Cancer-Health Index (LC-HI), a clinically-relevant, disease-specific patient-reported outcome measure. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4383.

Patients with Crohn's disease (CD) experience a variety of symptoms that significantly affect their lives. In this study, we (i) ascertain the most prevalent and impactful symptoms in CD and (ii) identify modifying factors that are associated with a higher disease burden in CD.We conducted semistructured interviews with adult participants with CD to determine what issues have the greatest impact on their lives. Next, we conducted a large cross-sectional study of individuals with CD to determine the prevalence and relative importance of those symptoms and themes and to identify the demographic features that are associated with a higher disease burden.Sixteen individuals with CD provided 792 direct quotes regarding their symptomatic burden. Four hundred three people with CD participated in our cross-sectional study. The symptomatic themes with the highest prevalence in CD were gastrointestinal issues (93.0%), fatigue (86.4%), dietary restrictions (77.9%), and impaired sleep or daytime sleepiness (75.6%). The symptomatic themes that had the greatest impact on patients' lives (0-4 scale) related to fatigue (1.82), impaired sleep or daytime sleepiness (1.71), gastrointestinal issues (1.66), and dietary restrictions (1.61). Symptomatic theme prevalence was strongly associated with a higher number of soft stools per day, greater number of bowel movements per day, missed work, employment and disability status, and having perianal disease.Patients with CD experience numerous symptoms that affect their daily life. These symptoms, some underrecognized, vary based on disease and demographic characteristics and represent potential targets for future therapeutic interventions.

STUDY AIM The goal of this research is to develop and validate a novel, disease-specific patient-reported outcome measure (PROM) for use in clinical monitoring and therapeutic trials of Crohn’s Disease (CD). BACKGROUND With approximately 780,000 cases of CD in the U.S., it is important to have a comprehensive, sensitive, and reliable disease-specific PROM that accurately indicates patient function, perceived health, and quality of life. Moreover, as clinical trials are planned for individuals with CD, a valid PROM is vital to determine the overall effect of potential treatments on patient disease burden. This research describes the construction and testing of the Crohn’s Disease-Health Index (CD-HI) as an efficient mechanism to quantify how patients with CD feel and function, and to measure key changes in a patient’s multifactorial health. METHODS We conducted semi-structured, qualitative interviews with 16 CD patients to determine the most frequent and important symptoms in CD. Based on patient responses, we designed a survey which inquired about 148 symptoms from 17 symptomatic themes. This survey was used in a cross-sectional study with 403 patients with CD recruited through the Crohn’s and Colitis Foundation and IBD Partners. The collected data was used to generate the first version of the CD-HI, which contained symptom questions that had the highest impact to the population and the potential to respond to therapeutic intervention. Symptom questions were grouped into distinct symptomatic themes using factor analysis. We beta-tested the CD-HI with 15 patients with CD to evaluate its usability, clarity, and applicability. Based on patient feedback, we modified the instrument and evaluated its longitudinal reliability with 23 patients with CD. Known groups testing was performed with the final instrument. The final version of the health index is now available for use in clinical trials. RESULTS The final version of the CD-HI contains subscales that measure the following areas of CD health: 1) fatigue, 2) dietary restrictions, 3) gastrointestinal health, 4) sleep and daytime sleepiness, 5) bowel and bladder function, 6) emotional wellbeing, 7) joint health, 8) pain, 9) neck and back health, 10) activity participation, 11) social wellbeing, and 12) skin health. Total CD disease burden is measured using a weighted composite of these subscale scores. During beta interviews, patients with CD deemed the instrument to be easy to use, clear, relevant, and comprehensive. Statistical analyses confirmed the reliability, validity, sensitivity, specificity, and internal consistency of the instrument. CONCLUSIONS Our research demonstrates the validity of the CD-HI as a marker of disease burden in CD. This disease-specific PROM provides researchers and clinicians with a reliable tool to use in patient monitoring and clinical trials.

Transgenic rice cells (Oryza sativa) producing recombinant butyrylcholinesterase (BChE) as a prophylactic/therapeutic against organophosphate nerve agent poisoning, cocaine toxicity, and neurodegenerative diseases like Alzheimer's were immobilized in a polyethylene glycol-based hydrogel. The cells were sustained for 14 days in the semi-solid matrix, undergoing a growth phase from days 0-6, a BChE production phase in sugar-free medium from days 6-12, and a growth/recovery phase from days 12-14. Throughout this period, the cells maintained similar viability to those in suspension cultures and displayed analogous sugar consumption trends. The rice cells in the hydrogel also produced a significant amount of active BChE, comparable to the levels produced in liquid cultures. A considerable fraction of this BChE was secreted into the media, allowing for easier product separation. To the best of our knowledge, this proof-of-concept is the first report of immobilization of recombinant plant cells for continuous production of high-value heterologous proteins. This work serves as a foundation for further investigation towards plant cell bioprinting and the development of a simple, efficient, robust, modular, and potentially field-deployable bioreactor system for the manufacture of biologics. This article is protected by copyright. All rights reserved.