Research Spotlight

Posted April 20th 2021

Interleukin-17 and Interleukin-23: A Narrative Review of Mechanisms of Action in Psoriasis and Associated Comorbidities.

Martin Alan Menter, M.D.

Martin Alan Menter, M.D.

Menter, A., Krueger, G.G., Paek, S.Y., Kivelevitch, D., Adamopoulos, I.E. and Langley, R.G. (2021). “Interleukin-17 and Interleukin-23: A Narrative Review of Mechanisms of Action in Psoriasis and Associated Comorbidities.” Dermatol Ther (Heidelb) 11(2): 385-400.

Full text of this article.

Psoriasis is an immune-mediated inflammatory skin disease associated with numerous inflammatory comorbidities, including increased cardiovascular risk. The interleukin (IL)-23/IL-17 axis plays a central role in the immunopathogenesis of psoriasis and related comorbidities by acting to stimulate keratinocyte hyperproliferation and feed-forwarding circuits of perpetual T cell-mediated inflammation. IL-17 plays an important role in the downstream portion of the psoriatic inflammatory cascade. This review discusses the distinct mechanisms of action of IL-17 and IL-23 in the immunopathogenesis of psoriasis and related comorbidities plus the significant therapeutic benefits of selectively inhibiting these cytokines in patients with moderate to severe plaque psoriasis.


Posted April 20th 2021

Expanded Radiosurgery Capabilities Utilizing Gamma Knife Icon™.

Ankur Patel M.D.

Ankur Patel M.D.

Mendel, J.T., Schroeder, S., Plitt, A., Patel, A., Joo, M., Stojadinovic, S., Dan, T., Timmerman, R., Patel, T.R. and Wardak, Z. (2021). “Expanded Radiosurgery Capabilities Utilizing Gamma Knife Icon™.” Cureus 13(3): e13998.

Full text of this article.

The indications and techniques for the treatment of intracranial lesions continue to evolve with the advent of novel technologies. The Gamma Knife Icon™ (GK Icon™) is the most recent model available from Elekta, providing a frameless solution for stereotactic radiosurgery. At our institution, 382 patients with 3,213 separate intracranial lesions have been treated with frameless stereotactic radiotherapy using the GK Icon. The wide range of diagnoses include brain metastases, meningiomas, arteriovenous malformations, acoustic neuromas, pituitary adenomas, and several other histologies. The ability to perform both frame and frameless treatments on the GK Icon has significantly increased our daily volume by almost 50% on a single machine. Although the frameless approach allows one to take advantage of the precision in radiosurgery, the intricacies regarding treatment with this frameless system are not well established. Our initial experience will help to serve as a guide to those wishing to implement this novel technology in their practice.


Posted April 20th 2021

SARS-CoV-2 infection and the COVID-19 pandemic: a call to action for therapy and interventions to resolve the crisis of hospitalization, death, and handle the aftermath.

Peter McCullough, M.D.

Peter McCullough, M.D.

McCullough, P.A. and Vijay, K. (2021). “SARS-CoV-2 infection and the COVID-19 pandemic: a call to action for therapy and interventions to resolve the crisis of hospitalization, death, and handle the aftermath.” Rev Cardiovasc Med 22(1): 9-10.

Full text of this article.

In this bold issue of Reviews in Cardiovascular Medicine, we present the most comprehensive and scalable early ambulatory treatment program for high-risk patients who have contracted SARS-CoV-2. No such published regimen has received so much acclaim and the concepts embodied in this paper have been responsible for saving hundreds of thousands of lives and sparing millions of hospitalization. Since it took months for the large body of information to congeal on the pathophysiology and rationale for treatment, we cannot go back in time and estimate avoidable losses [6]. Going forward, available sources of data from Zelenko and Procter, suggest available drugs used in combination can reduce hospitalizations and death by 85% and that no high-risk patient with COVID-19 should go untreated at home. Lack of home treatment can only lead to long durations of illness, more intense symptoms, and increases the risk of hospitalization, death, and potentially post-COVID-19 syndromes. At this point in time, there is no justification in any part of the world for denial of available, appropriately prescribed off label intracellular anti-infectives, corticosteroids/colchicine, and antithrombotics. [No abstract; excerpt from article].


Posted April 20th 2021

Ambulatory Worsening of Renal Function in Heart Failure With Preserved Ejection Fraction.

Peter McCullough, M.D.

Peter McCullough, M.D.

McCullough, P.A., Rahimi, G. and Tecson, K.M. (2021). “Ambulatory Worsening of Renal Function in Heart Failure With Preserved Ejection Fraction.” J Am Coll Cardiol 77(9): 1222-1224.

Full text of this article.

The emergence of new pharmacological therapies for heart failure (HF) patients, including angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), mineralocorticoid receptor antagonists (MRAs), and angiotensin receptor–neprilysin inhibitors, has improved the life expectancy of those living with this disease markedly. [No abstract; excerpt from article].


Posted April 20th 2021

Anemia of cardiorenal syndrome.

Peter McCullough, M.D.

Peter McCullough, M.D.

McCullough, P.A. (2021). “Anemia of cardiorenal syndrome.” Kidney Int Suppl (2011) 11(1): 35-45.

Full text of this article.

Cardiorenal syndrome includes a spectrum of disorders of the kidneys and heart in which loss of function in one organ contributes to reduced function in the other organ. Cardiorenal syndrome is frequently complicated by comorbid anemia, which leads to reciprocal and progressive cardiac and renal deterioration. The triad of heart failure, chronic kidney disease (CKD), and anemia is termed cardiorenal anemia syndrome (CRAS). There are currently no evidence-based recommendations for managing patients with CRAS; however, the treatment of these patients is multifactorial. Not only must the anemia be controlled, but heart failure and kidney injury must be addressed, in addition to other comorbidities. Intravenous iron and erythropoiesis-stimulating agents are the mainstays of treatment for anemia of CKD, addressing both iron and erythropoiesis deficiencies. Since erythropoiesis-stimulating agent therapy can be associated with adverse outcomes at higher doses in patients with CKD and is not used in routine practice in patients with heart failure, treatment options for managing anemia in patients with CRAS are limited. Several new therapies, particularly the hypoxia-inducible factor-prolyl hydroxylase inhibitors, are currently under clinical development. The hypoxia-inducible factor-prolyl hydroxylase inhibitors have shown promising results for treating anemia of CKD in clinical trials and may confer benefits in patients with CRAS, potentially addressing some of the limitations of erythropoiesis-stimulating agents. Updated clinical practice guidelines for the screening and management of anemia in cardiorenal syndrome, in light of potential new therapies and clinical evidence, would improve the clinical outcomes of patients with this complex syndrome.