Avoiding insufficient therapies and overdosing with co-reporting eGFRs (estimated glomerular filtration rate) for personalized drug therapy and improved outcomes - a simulation of the financial benefits.

Patients with impaired renal function are at high risk for morbidity and mortality. Chronic kidney disease (CKD) even in the early stages can be associated with significant side effects of drug therapy, longer length of stay, and high costs. Correct assessment of renal function in the hospital is important to detect CKD, to avoid further damage to the kidneys, and to optimize pharmacological therapy. Current protocols for renal function testing in drug dosing are only creatinine based, are not robust enough, and can wrongly classify certain patients. Goal of our simulation study is to optimize noninvasive renal function estimates and to allow for optimal dosing of pharmacological treatment without further renal damage. Co-reporting of creatinine- and of cystatin C-derived estimated glomerular filtration rates (eGFR) allows a personalized approach for patients with large discrepancies in eGFR and it enabled us in detecting patients at high risk for side effects due to incorrect drug dosing. This approach might be highly effective for patients as well as for clinicians. In addition, we simulated the efficiency by estimating savings for the hospital administration and the payor with a benefit cost ratio of 58 to 1.

PRDM9 forms a trimer by interactions within the zinc finger array.

PRDM9 is a trans-acting factor directing meiotic recombination to specific DNA-binding sites by its zinc finger (ZnF) array. It was suggested that PRDM9 is a multimer; however, we do not know the stoichiometry or the components inducing PRDM9 multimerization. In this work, we used in vitro binding studies and characterized with electrophoretic mobility shift assays, mass spectrometry, and fluorescence correlation spectroscopy the stoichiometry of the PRDM9 multimer of two different murine PRDM9 alleles carrying different tags and domains produced with different expression systems. Based on the migration distance of the PRDM9-DNA complex, we show that PRDM9 forms a trimer. Moreover, this stoichiometry is adapted already by the free, soluble protein with little exchange between protein monomers. The variable ZnF array of PRDM9 is sufficient for multimerization, and at least five ZnFs form already a functional trimer. Finally, we also show that only one ZnF array within the PRDM9 oligomer binds to the DNA, whereas the remaining two ZnF arrays likely maintain the trimer by ZnF-ZnF interactions.