Sjögren's syndrome towards precision medicine: the challenge of harmonisation and integration of cohorts.

Primary Sjögren's syndrome (pSS) is a chronic, systemic autoimmune disease with diverse clinical picture and outcome. The disease affects primarily middle-aged females and involves the exocrine glands leading to dry mouth and eyes. When the disease extends beyond the exocrine glands (systemic form), certain extraglandular manifestations involving liver, kidney, lungs, peripheral nervous system and the skin may occur. Primary SS is considered the crossroad between autoimmunity and lymphoproliferation, since approximately 5% of patients develop NHL associated lymphomas. As with every chronic disease with complex aetiopathogenesis and clinical heterogeneity, pSS has certain unmet needs that have to be addressed: a) classification and stratification of patients; b) understanding the distinct pathogenetic mechanisms and clinical phenotypes; c) defining and interpreting the real needs of patients regarding the contemporary diagnostic and therapeutic approaches; d) physician and patients' training regarding the wide spectrum of the disease; e) creating common policies across European countries to evaluate and manage SS patients. To achieve these goals, an intense effort is being currently undertaken by the HarmonicSS consortium in order to harmonise and integrate the largest European cohorts of pSS patients. In this review, we present an overview of our perception and vision, as well as new issues arising from this project such as harmonisation protocols and procedures, data sharing principles and various ethical and legal issues originating from these approaches.

Cohort Harmonization and Integrative Analysis From a Biomedical Engineering Perspective.

In this review, the critical parts and milestones for data harmonization, from the biomedical engineering perspective, are outlined. The need for data sharing between heterogeneous sources paves the way for cohort harmonization; thus, fostering data integration and interdisciplinary research. Unmet needs in chronic diseases, as well as in other diseases, can be addressed based on the integration of patient health records and the sharing of information of the clinical picture and outcome. The stratification of patients, the determination of various clinical and outcome features, and the identification of novel biomarkers for the different phenotypes of the disease characterize the impact of cohort harmonization in patient-centered clinical research and in precision medicine. Subsequently, the establishment of matching techniques and ontologies for the creation of data schemas are also presented. The exploitation of web technologies and data-collection tools supports the opportunities to achieve new levels of integration and interoperability. Ethical and legal issues that arise when sharing and harmonizing individual-level data are discussed in order to evaluate the harmonization potential. Use cases that shape and test the harmonization approach are explicitly analyzed along with their significant results on their research objectives. Finally, future trends and directions are discussed and critically reviewed toward a roadmap in cohort harmonization for clinical medicine.

Assessing The Predictive Value Of Regulatory Molecules For Patient Outcome In Pancreatic Cancer: A Computational Approach.

Pancreatic Cancer (PC) can be characterized as one of the most lethal cancers considering its poor diagnosis and symptoms in early stages. To assess the predictive value of regulatory molecules in terms of differentially expressed genes, we first performed a thorough search of gene expression profiling studies in pancreatic cohorts. We obtained the genes that have been identified and validated experimentally to be associated with patient outcome and also differentially expressed in tumors compared with adjacent non-tumor tissues. A two-step upstream analysis on the derived set of the genes under study was performed. The subsequent promoter and pathway analysis unveiled candidate transcription factors and regulatory molecules that potentially have regulated the detected differentially expressed genes. Predictive analysis was applied in the identified regulators and classification algorithms were implemented to model accurately patient outcome. In view of our findings, Gaussian Naïve Bayes model exhibited the highest classification accuracy and f-score concerning the predictive value of regulatory molecules in PC (accuracy =0.85, f-score =0.84).

The Leishmania donovani histidine acid ecto-phosphatase LdMAcP: insight into its structure and function.

Acid ecto-phosphatase activity has been implicated in Leishmania donovani promastigote virulence. In the present study, we report data contributing to the molecular/structural and functional characterization of the L. donovani LdMAcP (L. donovani membrane acid phosphatase), member of the histidine acid phosphatase (HAcP) family. LdMAcP is membrane-anchored and shares high sequence identity with the major secreted L. donovani acid phosphatases (LdSAcPs). Sequence comparison of the LdMAcP orthologues in Leishmania sp. revealed strain polymorphism and species specificity for the L. donovani complex, responsible for visceral leishmaniasis (Khala azar), proposing thus a potential value of LdMAcP as an epidemiological or diagnostic tool. The extracellular orientation of the LdMAcP catalytic domain was confirmed in L. donovani promastigotes, wild-type (wt) and transgenic overexpressing a recombinant LdMAcP-mRFP1 (monomeric RFP1) chimera, as well as in transiently transfected mammalian cells expressing rLdMAcP-His. For the first time it is demonstrated in the present study that LdMAcP confers tartrate resistant acid ecto-phosphatase activity in live L. donovani promastigotes. The latter confirmed the long sought molecular identity of at least one enzyme contributing to this activity. Interestingly, the L. donovani rLdMAcP-mRFP1 promastigotes generated in this study, showed significantly higher infectivity and virulence indexes than control parasites in the infection of J774 mouse macrophages highlighting thereby a role for LdMAcP in the parasite's virulence.