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CB2 Insights to Host Q1 2020 Earnings Call on July 15, 2020 – Stockhouse

July 10th, 2020 4:46 pm

TORONTO, July 08, 2020 (GLOBE NEWSWIRE) -- CB2 Insights Inc. (CB2” or the Company”) (CSE: CBII; OTCQB: CBIIF), will be hosting its Q1 2020 earnings call on Wednesday, July 15, 2020 at 9:00 a.m. Eastern Daylight Time (EDT).

CB2 will issue a press release and file its interim financial statements and interim Quarterly Management Discussion and Analysis (MD&A”) for the quarter ended March 31, 2020 (the Q1 2020 Filings”) after the close of markets on July 14, 2020.

Conference call details:

A replay of the earnings call will be available on the company’s website 24 hours after the call takes place.

Submitting Questions:

Those interested in submitting questions for the earnings call can do so by emailing investors@cb2inisghts.com prior to the start of the call. CB2 Insights will attempt to answer all questions submitted, however some questions may not be answered during the call due to time constraints.

The Company looks forward to providing additional discussion on its Q1 2020 Filings, as well as providing an update on the business and preliminary expectations for Q2 2020. Further, the Company will update shareholders on its future outlook and plans for growth in the coming quarters.

About CB2 Insights

CB2 Insights (CSE:CBII OCT:CBIIF) CB2 Insights is a healthcare services and technology company, working to positively impact patient health outcomes. Our mission to mainstream alternative health treatments into traditional healthcare by recognizing the need for patient treatment diversity, and the impacts of integrating alternative and conventional medicine. The Company works primarily to roster and treat patients who are seeking alternative treatments due to the ineffectiveness of conventional medicine, and the inability to find support through their existing care network, or in some cases, inability to access a primary care network. Medical services offered by the Company are defined as Integrative medicine, where we work to understand the real world evidence for the safety, impact and effectiveness of medical treatments including plant based medicines that often lack sufficient research and therefore adoption by conventional healthcare providers.

To support patient care and positive health outcomes, the Company is also focused on advancing safety and efficacy research surrounding alternative health treatments by monitoring and assessing Real-World Data (RWD) and providing Real-World Evidence (RWE) through our proprietary technology, data analytics, and a full service contract research organization.

The Company’s primary operations are in the United States, with application to its insights, technology and research services deployed in other International markets including Canada, United Kingdom and Colombia.

The Company’s disciplined operating model, allows patients to receive access to care in a time efficient and cost-effective manner. Utilizing virtual telehealth and over 30 physical brick and mortar clinics, the Company currently treats over 100,000 patients across 12 States. Utilizing proprietary technology and data analytic platforms, the Company is able to monitor, study and assess a variety of healthcare treatments and products for the safety, efficacy and effectiveness. The Company believes it is well positioned to be the research and technology partner of choice for multiple stakeholders including Big Pharma, Life Sciences, Regulatory Bodies and Payors within the traditional and integrative medical industry.

Forward Looking Statements

Statements in this news release that are forward-looking statements are subject to various risks and uncertainties concerning the specific factors disclosed here and elsewhere in CB2’s filings with Canadian securities regulators. When used in this news release, words such as "will, could, plan, estimate, expect, intend, may, potential, believe, should," and similar expressions, are forward-looking statements.

Forward-looking statements may include, without limitation, statements regarding the Company’s unaudited financial results and projected growth.

Although CB2 has attempted to identify important factors that could cause actual results, performance or achievements to differ materially from those contained in the forward-looking statements, there can be other factors that cause results, performance or achievements not to be as anticipated, estimated or intended, including, but not limited to: dependence on obtaining regulatory approvals; investing in target companies or projects which have limited or no operating history and are subject to inconsistent legislation and regulation; change in laws; reliance on management; requirements for additional financing; competition; hindering market growth and state adoption due to inconsistent public opinion and perception of the medical-use and recreational-use marijuana industry and; regulatory or political change.

There can be no assurance that such information will prove to be accurate or that management's expectations or estimates of future developments, circumstances or results will materialize. As a result of these risks and uncertainties, the results or events predicted in these forward-looking statements may differ materially from actual results or events.

Accordingly, readers should not place undue reliance on forward-looking statements. The forward-looking statements in this news release are made as of the date of this release. CB2 disclaims any intention or obligation to update or revise such information, except as required by applicable law, and CB2 does not assume any liability for disclosure relating to any other company mentioned herein.

No securities regulator or exchange has reviewed, approved, disapproved, or accepts responsibility for the content of this news release.

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Nanomedicine Market with Emerging Trends, Global Scope and Demand 2020 to 2026 – The Canton Independent Sentinel

July 10th, 2020 4:45 pm

The Global Nanomedicine Market Report contains essential details of the industry, intended to help the customers identify the optimum approaches to get ahead in the market and make well-informed decisions. An extensive overview of the global sector included in the report examines vital market information to forecast the growth of the market in the forecast duration. The CAGR of the market for the coming years to 2026 has been estimated based on a detailed assessment of the market with authentic and relevant information pertaining to the different segments of the sector. The driving and restraining factors prevailing in the industry have been studied to predict their impact on the growth of the Nanomedicine market in the coming years.

This is the only report that is inclusive of the current effect of the coronavirus on the market and its future trends. The coronavirus has widely impacted the world economy, and its aftereffects are elucidated in detail in the report for the Nanomedicine market.

The sample of the report can be availed by [emailprotected] https://www.reportsanddata.com/sample-enquiry-form/1048

It provides an elaborate breakdown of critical market statistics, market estimation, and profiles of leading players operating in the global Nanomedicine industry.

In market segmentation by manufacturers, the report covers the following companies-

Arrowhead Pharmaceuticals, Inc., Nanospectra Biosciences, Inc., AMAG Pharmaceuticals, Bio-Gate AG, Celgene and Johnson & Johnson

Nanomedicine product types, applications, geographies, and end-user industries are the key market segments that are comprised in this study. The report speculates the prospective growth of the different market segments by studying the current market standing, performance, demand, production, sales, and growth prospects existing in the market.

Get a discount on your copy of the [emailprotected] https://www.reportsanddata.com/discount-enquiry-form/1048

Major highlights of the global Nanomedicine market report:

The report depicts all the analytical details in a well-structured manner, for example, in the statistics, graphs, tables, through which users can more easily grasp detailing. Moreover, it discusses accurate forecasts and gives a detailed research methodology.

The global Nanomedicine market report answers some important questions for you:

Read the full Research Report along with a table of contents, facts and figures, charts, graphs, [emailprotected] https://www.reportsanddata.com/report-detail/nanomedicine-market

To summarize, the global Nanomedicine market report studies the contemporary market to forecast the growth prospects, challenges, opportunities, risks, threats, and the trends observed in the market that can either propel or curtail the growth rate of the industry. The market factors impacting the global sector also include provincial trade policies, international trade disputes, entry barriers, and other regulatory restrictions.

David is an Experience Business writer who regularly contribute to the blog, He specializes in manufacturing news

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Nanomedicine Market with Emerging Trends, Global Scope and Demand 2020 to 2026 - The Canton Independent Sentinel

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Rheumatoid Arthritis Diagnostic Device Market Expected to Witness an Imperishable Growth over 2025 – Jewish Life News

July 10th, 2020 4:44 pm

Rheumatoid Arthritis Diagnostic Device Market (2018) Report Provides an in-depth summary of Rheumatoid Arthritis Diagnostic Device Market Status as well as Product Specification, Technology Development, and Key Manufacturers. The Report Gives Detail Analysis on Market concern Like Rheumatoid Arthritis Diagnostic Device Market share, CAGR Status, Market demand and up to date Market Trends with key Market segments.

The latest report about the Rheumatoid Arthritis Diagnostic Device market provides a detailed evaluation of the business vertical in question, alongside a brief overview of the industry segments. An exceptionally workable estimation of the present industry scenario has been delivered in the study, and the Rheumatoid Arthritis Diagnostic Device market size with regards to the revenue and volume have also been mentioned. In general, the research report is a compilation of key data with regards to the competitive landscape of this vertical and the multiple regions where the business has successfully established its position.

Get PDF Sample Copy of this Report to understand the structure of the complete report: (Including Full TOC, List of Tables & Figures, Chart) @ https://www.marketresearchhub.com/enquiry.php?type=S&repid=2609409&source=atm

Scope of The Rheumatoid Arthritis Diagnostic Device Market Report:

This research report for Rheumatoid Arthritis Diagnostic Device Market explores different topics such as product scope, product market by end users or application, product market by region, the market size for the specific product Type, sales and revenue by region forecast the Market size for various segments. The Report provides detailed information regarding the Major factors (drivers, restraints, opportunities, and challenges) influencing the growth of the Rheumatoid Arthritis Diagnostic Device market. The Rheumatoid Arthritis Diagnostic Device Market Report analyzes opportunities in the overall Rheumatoid Arthritis Diagnostic Device market for stakeholders by identifying the high-growth segments.

The report firstly introduced the Rheumatoid Arthritis Diagnostic Device basics: definitions, classifications, applications and market overview; product specifications; manufacturing processes; cost structures, raw materials and so on. Then it analyzed the worlds main region market conditions, including the product price, profit, capacity, production, supply, demand and market growth rate and forecast etc. In the end, the report introduced new project SWOT analysis, investment feasibility analysis, and investment return analysis.

The major players profiled in this report include:Abbott LaboratoriesDanaher Corp.F. Hoffmann-La Roche Ltd.Siemens Healthineers AGThermo Fisher Scientific Inc.

The end users/applications and product categories analysis:On the basis of product, this report displays the sales volume, revenue (Million USD), product price, market share and growth rate of each type, primarily split into-AnalyzersConsumables

On the basis on the end users/applications, this report focuses on the status and outlook for major applications/end users, sales volume, market share and growth rate of Rheumatoid Arthritis Diagnostic Device for each application, including-HospitalResearch instituteClinic

Do You Have Any Query Or Specific Requirement? Ask to Our Industry [emailprotected] https://www.marketresearchhub.com/enquiry.php?type=E&repid=2609409&source=atm

A detailed overview of the geographical and competitive sphere of the Rheumatoid Arthritis Diagnostic Device market:

You can Buy This Report from Here @ https://www.marketresearchhub.com/checkout?rep_id=2609409&licType=S&source=atm

Table of Content of The Report

Chapter 1- Rheumatoid Arthritis Diagnostic Device Industry Overview:

1.1 Definition of Rheumatoid Arthritis Diagnostic Device

1.2 Brief Introduction of Major Classifications

1.3 Brief Introduction of Major Applications

1.4 Brief Introduction of Major Regions

Chapter 2- Production Market Analysis:

2.1 Global Production Market Analysis

2.1.1 Global Capacity, Production, Capacity Utilization Rate, Ex-Factory Price, Revenue, Cost, Gross and Gross Margin Analysis

2.1.2 Major Manufacturers Performance and Market Share

2.2 Regional Production Market Analysis

Chapter 3- Sales Market Analysis:

3.1 Global Sales Market Analysis

3.2 Regional Sales Market Analysis

Chapter 4- Consumption Market Analysis:

4.1 Global Consumption Market Analysis

4.2 Regional Consumption Market Analysis

Chapter 5- Production, Sales and Consumption Market Comparison Analysis

Chapter 6- Major Manufacturers Production and Sales Market Comparison Analysis

Chapter 7- Major Classification Analysis

Chapter 8- Major Application Analysis

Chapter 9- Industry Chain Analysis:

9.1 Up Stream Industries Analysis

9.2 Manufacturing Analysis

Chapter 10- Global and Regional Market Forecast:

10.1 Production Market Forecast

10.2 Sales Market Forecast

10.3 Consumption Market Forecast

Chapter 11- Major Manufacturers Analysis:

11.1.1 Company Introduction

11.1.2 Product Specification and Major Types Analysis

11.1.3 Production Market Performance

11.1.4 Sales Market Performance

11.1.5 Contact Information

11.2.1 Company Introduction

11.2.2 Product Specification and Major Types Analysis

11.2.3 Production Market Performance

11.2.4 Sales Market Performance

11.2.5 Contact Information

Chapter 12- New Project Investment Feasibility Analysis:

12.1 New Project SWOT Analysis

12.2 New Project Investment Feasibility Analysis

Continued

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Drugs for Rheumatoid Arthritis Market Evolution of Key Players That Will Change Industry AbbVie Inc., Boehringer Ingelheim GmbH, Novartis AG – Daily…

July 10th, 2020 4:44 pm

Drugs for Rheumatoid Arthritis Market has witnessed continuous growth within the past few years and is projected to grow even more throughout the forecast period (2020 2027). The analysis presents a whole assessment of the market and contains Future trends, Current Growth Factors, attentive opinions, facts, historical information, and statistically supported and trade valid market information.

The report, titled Global Drugs for Rheumatoid Arthritis Market defines and briefs readers about its products, applications, and specifications. The research lists key companies operating in the global market and also highlights the key changing trends adopted by the companies to maintain their dominance. By using SWOT analysis and Porters five force analysis tools, the strengths, weaknesses, opportunities, and threats of key companies are all mentioned in the report. All leading players in this global market are profiled with details such as product types, business overview, sales, manufacturing base, competitors, applications, and specifications.

You Can Request A Demo Version of Report Before Buying (Higher Preference For Corporate Email ID User): https://www.worldwidemarketreports.com/sample/201374

AbbVie Inc., Boehringer Ingelheim GmbH, Novartis AG, Regeneron Pharmaceuticals Inc., Pfizer Inc., Johnson & Johnsons Services Inc, Bristol-Myers Squibb Company, F. Hoffmann-La Roche Ltd., Amgen Inc. of the major organizations dominating the global market.(*Note: Other Players Can be Added per Request)

1. Industry outlookThis is where youll find the current state of the Drugs for Rheumatoid Arthritis industry overall and where its headed. Relevant industry metrics like size, trends, life cycle, and projected growth included here. This report comes prepared with the data to back up your business idea. On a regional basis, the Global Drugs for Rheumatoid Arthritis market has been segmented into Asia-Pacific, North America, Europe, Latin America, and the Middle East and Africa.

2. Target marketThis target market section of study includes the following:

User persona and characteristics: It includes demographics such as age, income, and location. It lets you know what their interests and buying habits are, as well as explain the best position to meet their needs.

Market size: How big is the potential Drugs for Rheumatoid Arthritis market for your business? It brings to light the consumption in the Drugs for Rheumatoid Arthritis industry by the type and application.

3. Competitive analysisDiscover your competitors. The report lets you know what youre up against, but it also lets you spot the competitions weaknesses. Are there customers that are underserved? What can you offer that similar businesses arent offering? The competitive analysis contains the following components:

Direct competitors: What other companies are offering similar products and services? Which companies are your true competitors?

Competitor strengths and weaknesses: What is your competition good at? Where do they fall behind? Get insights to spot opportunities to excel where others are falling short.

Barriers to entry: What are the potential pitfalls of entering the Drugs for Rheumatoid Arthritis market? Whats the cost of entry? Is it prohibitively high, or easy to enter?

The window of opportunity:Does your entry into the Drugs for Rheumatoid Arthritis industry rely on time-sensitive technology? Do you need to enter early to take advantage of an emerging market?

4. ProjectionsLikewise, We offered thoughtful, not hockey-stick forecasting.

Market share:We have given the consumption behavior of users. When you know how much can your future customers spend, then only youll understand how much of the Drugs for Rheumatoid Arthritis industry you have a chance to grab, and here we came up with real stats and numbers.

Impact Analysis of COVID-19:The complete version of the Report will include the impact of the COVID-19, and anticipated change on the future outlook of the industry, by taking into account the political, economic, social, and technological parameters.

Finally, It is one report that hasnt shied away from taking a critical look at the current status and future outlook for the consumption/sales of these products, by the end users and applications. Not forgetting the market share control and growth rate of the Drugs for Rheumatoid Arthritis Industry, per application. Most noteworthy, this market analysis will help you find market blind spots.

About WMR

Worldwide Market Reports is your one-stop repository of detailed and in-depth market research reports compiled by an extensive list of publishers from across the globe. We offer reports across virtually all domains and an exhaustive list of sub-domains under the sun. The in-depth market analysis by some of the most vastly experienced analysts provide our diverse range of clients from across all industries with vital decision making insights to plan and align their market strategies in line with current market trends.

Contact Us:

Mr. ShahWorldwide Market ReportsSeattle, WA 98154,U.S.Email: [emailprotected]

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Rheumatoid Factor Isotypes, ACPAs Show Strong Associations With Future Cardiovascular Events in RA – Rheumatology Advisor

July 10th, 2020 4:44 pm

Rheumatoid factor (RF) isotypes and anticitrullinated protein antibodies (ACPA) are strongly associated with future cardiovascular (CV) events, including acute coronary syndrome (ACS) and stroke, in patients with rheumatoid arthritis (RA), according to study results published in Arthritis and Rheumatology.

The study cohort included patients from the Swedish Epidemiological Investigation of RA who received a diagnosis of RA between 1996 and 2009 (N=2814). Using these cases, researchers centrally typed baseline serologic data based on the anticyclic citrullinated peptide test (anti-CCP2), 20 ACPA subspecificities, and RF isotypes. Patients were followed over a median 13-year follow-up period through the Swedish national patient register and cause of death register until the first event of ACS, stroke, CV-related mortality, or major adverse CV event (MACE). The association between each serologic marker and CV outcome was examined and adjustments were made for baseline Disease Activity Score in 28 joints (DAS28), smoking, and income level.

During the follow-up period, a total of 375 first ACS, stroke, and CV death events occurred. There was an association between anti-CCP2 positivity and risk for incident ACS (hazard ratio [HR], 1.46; 95% CI, 1.03-2.06; P =.035), stroke (HR, 1.47; 95% CI, 1.03-2.10; P =.034), and MACE (HR, 1.34; 95% CI, 1.06-1.70; P =.014). A similar nonsignificant association was found between anti-CCP2 positivity and CV death (HR, 1.48; 95% CI, 0.94-2.31; P =.087).

Immunoglobulin M (IgM) RF was associated with stroke (HR, 1.42; 95% CI, 1.01-2.01; P =.045) and MACE (HR, 1.40; 95% CI, 1.11-1.76; P =.0045). The researchers also observed a significant association between IgA RF and an increased risk for CV mortality (HR, 1.88; 95% CI, 1.22-2.88; P =.0038). After adjustment for smoking, income, and DAS28, IgA RF remained associated with CV mortality (HR, 1.61; 95% CI, 1.05-2.48). In analyses stratified by smoking status, IgA and IgG RF were associated with CV mortality and IgG and IgM RF were associated with MACE in patients who had never smoked.

Strong associations were found between all-cause mortality and anti-CCP2 positivity, anti-CCP2 level, autoantibody load, the majority of the ACPA subspecificities, and each RF isotype.

A limitation of this study was the lack of adjustment for lipid profile, family history of cardiovascular disease, physical activity, and comorbid conditions.

The researchers suggested that with regard to the risk for CV events, patients with high anti-CPP2 levels or presence of IgA or IgG RF at diagnosis are at higher risk and might benefit from closer monitoring from a cardio preventative perspective.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors disclosures.

Reference

Westerlind H, Rnnelid J, Hansson M, et al. Anti-citrullinated protein antibody specificities, rheumatoid factor isotypes and incident cardiovascular events in patients with rheumatoid arthritis [published online May 31, 2020]. Arthritis Rheumatol. doi:10.1002/art.41381

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Pain and Fatigue in PsA Linked to Reduced Quality of Life, Physical Function, and Work Productivity – Rheumatology Advisor

July 10th, 2020 4:44 pm

Pain and fatigue in patients with psoriatic arthritis (PsA) receiving tumor necrosis factor inhibitors (TNFis) significantly reduce health-related quality of life (HRQoL), physical function, and work productivity, according to study results published in Rheumatic and Musculoskeletal Diseases.

In this retrospective analysis of global data, researchers evaluated the incidence and severity of pain and fatigue in patients with PsA receiving TNFis, and assessed the association between pain and fatigue severity and HRQoL and work productivity.

A total of 3782 patients with PsA undergoing TNFi treatment participated in the study. Characteristics including patient demographics and comorbidities were collected by questionnaires completed by both patients and their physicians; patient-reported forms included the 3-level 5-dimension EuroQoL, the Medical Outcomes Study 36-Item Short-Form version 2 (SF-36v2), and the Work Productivity and Activity Impairment (WPAI) questionnaires.

Among the total cohort, 640 patients (43.4%) were included in the analysis who were receiving TNFis for 3 months and had completed the SF-36v2 bodily pain and vitality domains of the questionnaire. Overall, 37.7% and 45.6% of patients reported severe pain and fatigue, respectively. A greater percentage of patients who reported severe vs low or no pain and fatigue were considered to have severe and unstable/deteriorating disease by their physicians, respectively. In addition, a higher percentage of patients who reported severe vs low or no pain and fatigue had current flares. A total of 83.3% and 88.0% of patients who reported severe pain and fatigue, respectively, were considered to have stable/improving disease by their physicians; however, physicians reported that 39.8% and 45.5% of patients with severe pain and fatigue were considered to be in remission, which indicated a discordance between patient and physician assessment of pain and fatigue.

Scores across HRQoL and WPAI were significantly different across the pain and fatigue severity cohorts (P <.0001). Both HRQoL and WPAI measures were worse in patients with moderate to severe vs low pain and/or fatigue, indicating an association with greater work impairment.

Based on these findings, the investigators indicated that despite treatment with TNFis, patients with PsA experienced substantial pain and/or fatigue, which was associated with decreased HRQoL, physical function, and work productivity.

Study limitations included the potential subjectivity of physicians ratings, the variability of reporting across regions, and the inclusion of pain and fatigue data only from patients receiving TNFis.

Researchers concluded, The high burden that severe pain and/or fatigue, in spite of TNFi treatment, place on patients in terms of limited function, diminished HRQoL and reduced ability to contribute to society as part of the workforce indicate that these are areas of significant unmet need in the treatment and management of PsA.

Conaghan PG, Alten R, Deodhar A, et al. Relationship of pain and fatigue with health-related quality of life and work in patients with psoriatic arthritis on TNFi: results of a multi-national real-world study [published online July 1, 2020]. RMD Open. doi:10.1136/rmdopen-2020-001240

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Side effects of a stem cell transplant – Canadian Cancer …

July 10th, 2020 3:48 pm

Side effects can happen with any type of treatment, but everyones experience is different. Some people may have many side effects. Others have fewer.

Side effects can happen any time during, immediately after or days to months after a stem cell transplant. Short-term (acute) side effects generally develop during the first 100 days after a stem cell transplant. Long-term (chronic) side effects generally develop 100 or more days after the transplant. Most side effects go away on their own or can be treated, but some side effects can last a long time or become permanent.

Side effects of a stem cell transplant will depend mainly on:

A stem cell transplant is very complex. It can take 6 to 12 months or longer for your blood counts to be back to normal and your immune system to work well. Side effects of a stem cell transplant can be very serious or even life-threatening. The healthcare team will watch you closely during this time. They will take measures to prevent side effects and will quickly deal with any side effects that develop.

Children usually have less severe side effects than adults and will often recover from them faster. But its hard to say exactly which side effects a child will have, how long they will last and when the child will recover.

Many common side effects, such as nausea, vomiting, fatigue and temporary hair loss, are from the chemotherapy or radiation therapy given before the transplant. Other side effects are related to the stem cell transplant.

You will have low blood cells counts after a stem cell transplant. It takes time for stem cells to make their way to the bone marrow and start making new blood cells (called engraftment).

You will have daily blood tests to check the number of different types of blood cells until doctors see a steady increase in blood cell counts.

Infection is one of the most common early side effects of a stem cell transplant. It happens because the white blood cell count is very low and the immune system is weak. Bacterial infections are most common. Viral or fungal infections can also happen.

The risk of infection for all types of transplant is high until the bone marrow starts to make white blood cells. The risk is highest after an allogeneic transplant because you may be taking medicines to suppress the immune system to prevent graft-versus-host disease (GVHD).

Infection can also happen a long time after a stem cell transplant. The risk of late infection depends on how quickly your immune system recovers, whether you have GVHD and if you are taking medicines to suppress your immune system.

Fever is often the first sign of infection. Even if there is no sign of infection, most people are given medicines to prevent infection until their white blood cell counts start to rise. Doctors may also prescribe a colony-stimulating factor (CSF) such as filgrastim (Neupogen) following a stem cell transplant to help lower the risk of infection and speed up the process of making new blood cells.

Bleeding can happen after a stem cell transplant because the platelet count is very low and it reduces the bloods ability to clot. Some people get serious bleeding problems (hemorrhage). If the red blood cell count is too low, it can lead to anemia. You may need platelet transfusions until the transplanted stem cells start to work, especially during the first month after the transplant.

Anemia is a low red blood cell count and a lower concentration of hemoglobin in blood cells. Hemoglobin is the part of the red blood cell that carries oxygen. When hemoglobin levels are low, body tissues dont get enough oxygen and cant work properly. Colony-stimulating factors, such as epoetin alfa (Eprex, erythropoietin) or darbepoetin (Aranesp), may be given to help increase red blood cell counts. If the red blood cell count is too low, blood transfusions may be needed.

Graft-versus-host disease (GVHD) might happen after an allogeneic stem cell transplant. Healthy stem cells from the donor (person who gives the stem cells) attack the cells of the recipient (person receiving the stem cells). The cells from the donor see the recipients cells as foreign and start to destroy them. GVHD can permanently damage an organ.

You may have to take immune-suppressing drugs for months or years after an allogeneic transplant to prevent or treat GVHD.

Veno-occlusive disease (VOD) happens when small blood vessels that lead to the liver become blocked. VOD is more common after an allogeneic transplant. It can develop in the first few weeks after a stem cell transplant and can lead to liver damage.

Symptoms include jaundice, tenderness of the liver and fluid buildup in the abdomen. Medicine may be used to prevent or treat VOD.

Digestive problems happen because tissues in the mouth, stomach and intestines are sensitive to the chemotherapy drugs given before the transplant. Digestive problems can also be caused by infection, GVHD or side effects of medicines.

Digestive system problems include:

Your healthcare team may give you special mouthwashes or lozenges and pain medicines for a sore mouth. They will also talk to you about good mouth care during and after treatment. You may have medicines to control diarrhea, nausea and vomiting.

If you have trouble eating, the healthcare team may suggest that you eat small meals and snacks instead of big meals or take food supplements.

For severe eating problems, you may be given nutrition through the central venous catheter (tube). This is called parenteral nutrition or total parenteral nutrition (TPN).

The therapy given before the transplant and GVHD can cause skin problems. This side effect is common when certain chemotherapy drugs and total body irradiation (TBI) are used. Skin problems include rashes, itching, blisters and peeling skin. The healthcare team will tell you how to care for your skin. Medicated creams or ointments and other medicines may be given to help manage skin problems.

Temporary hair loss can also happen after therapies given before the transplant. Hair loss is rarely permanent. It usually grows back within 3 to 6 months after the transplant.

Pain occurs when tissues or nerves are inflamed. Pain can be caused by the chemotherapy and radiation therapy given before the transplant and by infection, medicine, mouth sores and skin problems.

Pain medicines and other therapies, such as relaxation or visualization, are used to help relieve pain. The healthcare team will help prevent and manage your pain.

Kidney problems can happen when the kidneys are damaged by chemotherapy drugs given before the transplant, by antibiotic therapy or by medicine used to suppress the immune system. Sometimes kidney problems become so serious that they can lead to kidney failure, which is a long-term problem.

To prevent kidney problems after a transplant or to treat kidney problems that happen, your healthcare team may limit the amount of fluids you drink and change some of your medicines. The healthcare team will closely check the amount of fluids you take in and put out as urine. They will take measures to prevent and reduce damage to the kidneys as much as possible during treatment.

Lung problems can happen when the lungs are damaged by the chemotherapy and radiation treatments given before the transplant, by infection or by drinking too much fluid after the transplant. Lung problems are common in people with GVHD and include the following:

The healthcare team will check you with chest x-rays and lung function tests. You may be given medicines to prevent infection after the transplant or to treat lung problems if they develop.

Heart problems are not common after a stem cell transplant but they can happen. Certain chemotherapy drugs given before the transplant can cause the heart not to work as well. They can also cause the tissue around the heart to become inflamed (called pericarditis).

A multigated acquisition (MUGA) scan to check how well your heart is working and assess any damage to the heart muscle is often done before chemotherapy is given. Chemotherapy drugs that are less damaging to the heart may be used before a stem cell transplant. Medicines can be used to treat heart problems that develop after a transplant.

The central nervous system (CNS) is made up of the brain and spinal cord. Brain tissue can be damaged by radiation treatments given before a stem cell transplant, by chronic GVHD, by infection or by a return of the cancer.

CNS problems can develop months or years after a stem cell transplant. CNS problems can include damage to the brain that results in problems with mental (cognitive) function. Other CNS problems include:

Report changes in your mental function to the healthcare team. You may see a neurologist and have therapy to help with these changes.

Eye problems usually develop a year after a stem cell transplant, but they can also happen several years later. Eye problems can happen if total body irradiation is given before a stem cell transplant. Chemotherapy and steroids may also increase the chance of developing eye problems.

The most common eye problem is cataracts. A cataract clouds the lens of the eye and can cause vision loss. You will be encouraged to have regular eye exams and report any vision changes. Cataracts are removed with surgery.

Another eye problem is ocular GVHD. It causes eye dryness with a gritty or sandy feeling. Ocular GVHD is treated with eye drops for comfort and to help the eyes produce tears. You may also be given medicine to prevent infection.

Bladder problems can happen when chemotherapy and radiation treatments given before the transplant scar the bladder wall. This can lead to frequent urination, blood in the urine and bladder spasms. Drugs that suppress the immune system can cause recurring bladder infections. You may be given medicines to decrease bladder spasms and treat infections. You will be encouraged to drink extra fluids.

The risk of developing thyroid problems is quite high when total body irradiation is used before a stem cell transplant. Hypothyroidism is the most common thyroid problem. This is where the thyroid does not make enough thyroid hormone. Symptoms of hypothyroidism include fatigue, weight gain, hair loss, brittle nails, dry skin and feeling cold.

For adults, thyroid function may be checked each year after a stem cell transplant. Some people may need thyroid hormone replacement therapy if the thyroid doesnt make enough thyroid hormone.

If children do not have enough thyroid hormone, it slows their physical and mental development. It usually develops a few years after treatment and can become a long-term problem. The thyroid function will be checked often. Some children may need thyroid hormone replacement every day to regulate the thyroid gland.

In children, total body irradiation can cause long-term developmental and growth delays. This can happen because radiation to the head affects the hypothalamus in the brain. The hypothalamus controls the release of growth hormones. Low levels of growth hormones will result in shorter height, shortened limbs and less overall physical development. Steroid medicines and GVHD can also affect growth. Treatment with growth hormones may be needed.

Fertility problems can happen because of chemotherapy or radiation therapy given before a stem cell transplant. When the reproductive organs (gonads) stop working, it is called gonadal dysfunction.

Children receiving treatment, especially those close to or during puberty, have the greatest chance of having long-term or permanent gonadal dysfunction, called gonadal failure. Children treated before puberty have fewer problems with reproductive organ function and fertility.

Most women who have a stem cell transplant will experience treatment-induced menopause. Men and women may regain gonadal functioning and fertility, but gonadal dysfunction may become permanent and cause infertility.

Hormone replacement therapy may be given for gonadal dysfunction.

Talk to your healthcare team about fertility problems. They can suggest ways to help women cope with symptoms of menopause. They can also provide information about ways you can preserve your fertility. Women may choose to freeze and store fertilized eggs (embryos) to be implanted after the transplant and recovery. Men may choose to freeze and store their sperm for future use.

Liver problems that can develop include veno-occlusive disease (VOD), graft-versus-host disease, infection or damage due to the medicines given before the transplant. Treatment is supportive and includes medicines for VOD, infection and pain. If kidney function is also affected, treatment includes limiting the amount of fluids you drink and changing some medicines.

Graft-versus-host disease is the most common cause of late oral and dental problems. Symptoms range from mild tenderness of the mouth, throat, esophagus and stomach to severe pain. Decreased saliva production results in tooth decay (cavities). Infections can also contribute to oral problems.

Mouth rinses, steroid dental pastes and medicines are used to treat oral and dental problems. You will be taught about careful and thorough care of your teeth and mouth. You will be encouraged to have regular visits to your dentist. You may be given fluoride treatments to help prevent cavities.

Primary graft failure means that transplanted stem cells have not started making new blood cells in the first 3 to 4 weeks after the transplant. Treatment for primary graft failure is a second stem cell transplant.

Secondary graft failure happens after new blood cells start appearing. Treatment includes a combination of growth factors such as erythropoietin and G-CSF. If an allogeneic transplant has been done, medicines to suppress the immune system are stopped. Lymphocytes from the donor or a second transplant may be needed.

Graft rejection (stem cell rejection) happens if the body rejects the transplanted stem cells. This is more common in allogeneic transplants, especially when the donor is unrelated or less well matched. Graft rejection may be treated with growth factors. Sometimes a second transplant can be done.

Osteoporosis is a loss of bone density. It makes the bones weak. It can develop late after a stem cell transplant because of medicines, gonadal dysfunction or lack of physical activity. Treatment includes taking extra vitamin D and calcium. Medicines called bisphosphonates may be given for severe osteoporosis. Women who have treatment-induced menopause may consider hormone replacement therapy to keep bones from becoming weaker.

Quality of life can be greatly affected by the problems caused by the transplant, the long-term side effects and the medicines needed to treat some of the long-term effects.

Some factors that can affect quality of life include depression, anxiety and changes in body image. Relationships with your family and friends can be affected by the stress of having cancer and getting a stem cell transplant for cancer. Also, the duration of the transplant and the long time it takes to recover may make you feel socially isolated.

Transplant centres and hospitals often have plans of care that will improve quality of life, including education for you and your family. Counselling about your work, rehabilitation programs, support groups and psychological counselling may help decrease the negative effects on quality of life.

Other cancers can develop because of the amount of chemotherapy and radiation therapy given before the transplant.

The chance of getting a second cancer increases over time. Doctors will check for a second cancer at all follow-up appointments.

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Triple-negative Breast Cancer | Details, Diagnosis, and Signs

July 10th, 2020 3:48 pm

Triple-negative breast cancer (TNBC) accounts for about 10-15% of all breast cancers. The term triple-negative breast cancer refers to the fact that the cancer cells dont have estrogen or progesterone receptors and also dont make too much of the protein called HER2. (The cells test "negative" on all 3 tests.) These cancers tend to be more common in women younger than age 40, who are African-American, or who have a BRCA1 mutation.

Triple-negative breast cancer differs from other types of invasive breast cancer in that they grow and spread faster, have limited treatment options, and a worse prognosis (outcome).

Triple-negative breast cancer can have the same signs and symptomsas other common types of breast cancer.

Once a breast cancer diagnosis has been made using imaging tests and a biopsy, the cancer cells will be checked for certain features. If the cells do not have estrogen or progesterone receptors, and also do not make too much of the HER2 protein, the cancer is considered to be triple-negative breast cancer.

Triple-negative breast cancer (TNBC) is considered an aggressive cancer because it grows quickly, is more likely to have spread at the time its found and is more likely to come back after treatment than other types of breast cancer. The outlook is generally not as good as it is for other types of breast cancer.

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.

Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.

A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population. For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who dont have that cancer to live for at least 5 years after being diagnosed.

The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.

The SEER database tracks 5-year relative survival rates for breast cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages (stage 1, stage 2, stage 3, etc.). Instead, it groups cancers into localized, regional, and distant stages:

(Based on women diagnosed with triple-negative breast cancer between 2010 and 2015.)

SEER Stage

5-year Relative Survival Rate

Localized

91%

Regional

65%

Distant

11%

Triple-negative breast cancer has fewer treatment options than other types of invasive breast cancer. This is because the cancer cells do not have the estrogen or progesterone receptors or enough of the HER2 protein to make hormone therapy or targeted drugs work.

If the cancer has not spread to distant sites, surgery is an option. Chemotherapy might be given first to shrink a large tumor followed by surgery. It might also be given after surgery to reduce the chances of the cancer coming back. Radiation might also be an option depending on certain features of the tumor.

Because hormone therapy and HER2 drugs are not choices for women with triple negative breast cancer, chemotherapy is often used.In cases where the cancer has spread to other parts of the body (stage IV) chemotherapy and other treatments that can be considered include PARP inhibitors, platinum chemotherapy, or immunotherapy.

For details, see Treatment of Triple-negative Breast Cancer.

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Triple-negative Breast Cancer | Details, Diagnosis, and Signs

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Does Ligand Pharmaceuticals Inc. (LGND) Stock Beat its Rivals in Biotechnology? – InvestorsObserver

July 10th, 2020 3:46 pm

Ligand Pharmaceuticals Inc. (LGND) is near the top in its industry group according to InvestorsObserver. LGND gets an overall rating of 74. That means it scores higher than 74 percent of stocks. Ligand Pharmaceuticals Inc. gets a 85 rank in the Biotechnology industry. Biotechnology is number 13 out of 148 industries.

Trying to find the best stocks can be a daunting task. There are a wide variety of ways to analyze stocks in order to determine which ones are performing the strongest. Investors Observer makes the entire process easier by using percentile rankings that allows you to easily find the stocks who have the strongest evaluations by analysts.

Our proprietary scoring system captures technical factors, fundamental analysis and the opinions of analysts on Wall Street. This makes InvestorsObservers overall rating a great way to get started, regardless of your investing style. Percentile-ranked scores are also easy to understand. A score of 100 is the top and a 0 is the bottom. Theres no need to try to remember what is good for a bunch of complicated ratios, just pay attention to which numbers are the highest.

Ligand Pharmaceuticals Inc. (LGND) stock has risen 3.84% while the S&P 500 is unmoved 0% as of 10:51 AM on Friday, Jul 10. LGND has risen $4.31 from the previous closing price of $112.21 on volume of 83,931 shares. Over the past year the S&P 500 is up 5.07% while LGND has risen 1.69%. LGND lost -$3.44 per share the over the last 12 months.

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Is Chromadex Corp (CDXC) Stock Near the Top of the Biotechnology Industry? – InvestorsObserver

July 10th, 2020 3:46 pm

The 69 rating InvestorsObserver gives to Chromadex Corp (CDXC) stock puts it near the top of the Biotechnology industry. In addition to scoring higher than 79 percent of stocks in the Biotechnology industry, CDXCs 69 overall rating means the stock scores better than 69 percent of all stocks.

Analyzing stocks can be hard. There are tons of numbers and ratios, and it can be hard to remember what they all mean and what counts as good for a given value. InvestorsObserver ranks stocks on eight different metrics. We percentile rank most of our scores to make it easy for investors to understand. A score of 69 means the stock is more attractive than 69 percent of stocks.

This ranking system incorporates numerous factors used by analysts to compare stocks in greater detail. This allows you to find the best stocks available in any industry with relative ease. These percentile-ranked scores using both fundamental and technical analysis give investors an easy way to view the attractiveness of specific stocks. Stocks with the highest scores have the best evaluations by analysts working on Wall Street.

Chromadex Corp (CDXC) stock is higher by 5.28% while the S&P 500 is unchanged 0% as of 10:52 AM on Friday, Jul 10. CDXC is higher by $0.26 from the previous closing price of $5.00 on volume of 393,551 shares. Over the past year the S&P 500 is higher by 5.07% while CDXC is higher by 18.74%. CDXC lost -$0.51 per share the over the last 12 months.

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Is Chromadex Corp (CDXC) Stock Near the Top of the Biotechnology Industry? - InvestorsObserver

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Eucommia Extract Market to Witness Robust Expansion by 2026 with Top Key Players like Novoherb, Naturalin, Nanjing Zelang, EK HERB, Nutragreen…

July 10th, 2020 3:46 pm

Eucommia Extract Market research is an intelligence report with meticulous efforts undertaken to study the right and valuable information. The data which has been looked upon is done considering both, the existing top players and the upcoming competitors. Business strategies of the key players and the new entering market industries are studied in detail. Well explained SWOT analysis, revenue share and contact information are shared in this report analysis.

Eucommia Extract Market is growing at a High CAGR during the forecast period 2020-2026. The increasing interest of the individuals in this industry is that the major reason for the expansion of this market.

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Top Key Players Profiled in This Report:

Novoherb, Naturalin, Nanjing Zelang, E.K HERB, Nutragreen Biotechnology, Changsha Nulant Chem, Changsha Staherb Natural Ingredients, Xian Hao-xuan Bio-tech

The key questions answered in this report:

Various factors are responsible for the markets growth trajectory, which are studied at length in the report. In addition, the report lists down the restraints that are posing threat to the global Eucommia Extract market. It also gauges the bargaining power of suppliers and buyers, threat from new entrants and product substitute, and the degree of competition prevailing in the market. The influence of the latest government guidelines is also analyzed in detail in the report. It studies the Eucommia Extract markets trajectory between forecast periods.

Segmentation analyzation- To experience profitability and make critical decisions for business growth, it is very essential to understand this complex Eucommia Extract market. So to reduce this complexity, the Eucommia Extract market is divided into various segments.

Segmentation by Type:

PowderLiquid

Segmentation by Application:

MedicineDietary Supplement

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Table of Contents

Global Eucommia Extract Market Research Report 2020 2026

Chapter 1 Eucommia Extract Market Overview

Chapter 2 Global Economic Impact on Industry

Chapter 3 Global Market Competition by Manufacturers

Chapter 4 Global Production, Revenue (Value) by Region

Chapter 5 Global Supply (Production), Consumption, Export, Import by Regions

Chapter 6 Global Production, Revenue (Value), Price Trend by Type

Chapter 7 Global Market Analysis by Application

Chapter 8 Manufacturing Cost Analysis

Chapter 9 Industrial Chain, Sourcing Strategy and Downstream Buyers

Chapter 10 Marketing Strategy Analysis, Distributors/Traders

Chapter 11 Market Effect Factors Analysis

Chapter 12 Global Eucommia Extract Market Forecast

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Eucommia Extract Market to Witness Robust Expansion by 2026 with Top Key Players like Novoherb, Naturalin, Nanjing Zelang, EK HERB, Nutragreen...

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Cell Culture Media Market Size Worth USD 2070 Million at a 6.9% CAGR By 2023 | COVID-19 Impact, Growth Estimation and Trends Analysis – Cole of Duty

July 10th, 2020 3:46 pm

Globalcell culture media marketsize is expected to reach a valuation ofUSD 2,070.71million at a6.9% CAGRduring the assessment period (2017 -2023). Cell culture media, also known as media sera, is a key product used in the cell culture environment. Over the last few years, the media sera market size is increasing rapidly, mainly due to the extensive usages of these products in the rising numbers of pharmaceutical & biotechnology companies. The demand for these products from the pharmaceutical labs is continually rising due to the increasing R&D activities for the development of breakthrough drugs and therapeutics.

Furthermore, extensive usages of cell culture media in stem cell research, genetic & tissue engineering, toxicity testing, biochemistry, and cancer research, escalates the market on the global platform. Increasing prevalence of chronic diseases is dictating the dire need for effective medicines and treatment methods. Discoveries of new medicines and other pharmaceutical products demand extensive R&D activities as well as substantial investments & efforts. Hence, private and public entities make significant investments in research & development required in the field of biotechnology and pharma.

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These enormous investments, in turn, act as a substantial growth propeller for the market. Innovative medicines & treatments are mandatory in responding the prevailing chronic diseases and transplants procedures. The rapidly improving global economy, undoubtedly plays a vital role in the development of the cell culture media market, widening the access to quality and improved health care.

Conversely, the prohibitive costs of cell culture media and the lack of funding programs are the major factors acting as growth impeders for the market, especially in the developing regions. However, rising funding support from developed regions and well-established market players would aid in the growth of the market, filling up the demand-supply gap.

Cell Culture Media Market Segmentation

By Product Type, thecell culture media marketis segmented into Reagents, Sera, Media [Stem Cell Media (Neural Stem Cells (NSCs), Bone Marrow, Classical Media, Mesenchymal Stem Cells (MSCs), Embryonic Stem Cells (ESCs), Serum-Free Media, others], and others.

By Application, the cell culture media market is segmented into Biopharmaceutical, Tissue-Culture & Manufacturing, Gene Therapy, Cytogenetic, and others.

By End User, the cell culture media market is segmented into Biopharmaceutical Companies, Academic & Research Laboratories, Hospitals & Diagnostic Centers, and others.

Cell Culture Media Market Regional Analysis

North America leads the global cell culture media market, heading with the substantial R&D investments made in the pharmaceutical and biotech industries. Well-developed economy is a major driving force behind the growth of the cell culture media market in North America, allowing adequate funding required for R&D. Moreover, the presence of many prominent players and increasing biotechnology companies impacts the regional market growth positively.

Europe stands second in the global cell culture media market in terms of size and revenues. Growing emphasis on R&D, especially in the biotechnology sector, is a significant growth driver. Resurging economy in Europe is playing a major role in the growth of the market, driving the pharma sector excellently. Also, factors such as the increased funding and rising numbers of specialty services offered by various health care providers substantiate the growth of the market.

The Asia Pacific market for cell culture media is growing briskly. Increasing numbers of research labs alongside the economic growth act as major tailwinds for the regional market growth. Moreover, the proliferating pharmaceutical industries and healthcare technologies drive the APAC cell culture media market, excellently.

Cell Culture Media Market Competitive Analysis

Highly competitive, the global cell culture media market appears to be well-established, with several players forming a competitive landscape. To gain a larger competitive advantage in this market, players adopt strategic initiatives such as mergers & acquisitions, collaboration, expansion, and product & technology launch try. Given the high growth potential and demand in the cell culture environment, players try to increase their production capabilities.

Key players try to provide flexible packaging systems in multiple formats, including custom configurations to meet customized requirements. They offer efficient containment & delivery systems that can preserve the physical, chemical, and functional characteristics of sterile fluids. They provide a range of cell culture products such as sera, media, reagents, and others combined with liquid-handling products, disposable vessels, and advanced surfaces that can provide life science researchers with a comprehensive portfolio of products.

Cell Culture Media Market Major Players:

Players leading the cell culture media market include Bio-Rad Laboratories, Inc. (US), Merck KGaA (Germany), Thermo Fisher Scientific Inc. (US), GE Healthcare (US), Lonza (Switzerland), Becton, Dickinson, and Company (US), Corning Incorporated (US), HiMedia Laboratories (India), PromoCell (Germany), The Sartorius Group (Germany), Sera Scandia A/S (Denmark), and Fujifilm Holdings Corporation (Japan), among others.

Cell Culture Media Industry/Innovations/Related News:

Crossmark Global Holdings Inc. (the US), a leading global provider of investment management solutions, announced purchasing an additional 433 shares in Bio-Techne Corporation (the US), a holding company for biotechnology & clinical diagnostic brands. After buying these additional shares, the total worth of the companys holdings in BIO-TECHNE reached USD 837,000.

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Sartorius AG (Germany), announced the acquisition of a majority stake in Biological Industries (Israel).

Sartorius is a leading global supplier of pharmaceutical & laboratory equipment, and Biological Industries is a leading cell culture media developer and manufacturer. The acquisition expands Sartorius cell culture media offering and complementing our product portfolio, significantly. The deal was closed at approximately 45 MN (approx. USD 4,86,22,050) to expand its cell culture media capabilities.

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Contract Research Organization Market Contract Research Organization (CRO) Market size is expected to grow at a 11.48% CAGR across the review period.

Medical Billing Market Medical Billing Market size is projected to increase further at 6.5% CAGR during the assessment period (2017-2023).

NOTE: Our team of researchers are studying Covid19 and its impact on various industry verticals and wherever required we will be considering covid19 footprints for a better analysis of markets and industries. Cordially get in touch for more details.

About Market Research Future:

At Market Research Future (MRFR), we enable our customers to unravel the complexity of various industries through our Cooked Research Report (CRR), Half-Cooked Research Reports (HCRR), & Consulting Services. MRFR team have supreme objective to provide the optimum quality market research and intelligence services to our clients.

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Gene therapy or immunotherapy: which approach is more likely to deliver a cure for HIV? – aidsmap

July 10th, 2020 3:44 pm

Amidst speculation that a five-drug antiretroviral regimen and nicotinamide might have cured HIV in one man, researchers debated whether gene therapy or immunotherapy is more likely to lead to an HIV cure that can be delivered to millions during the AIDS 2020 Cure pre-conference last week.

A cure for HIV could take two forms, either a treatment or procedure that can eradicate the virus from the body or one which can keep the virus under control without the need for antiretroviral drugs remission, in the parlance of the field.

Eradication of HIV is challenging because the virus inserts its DNA into long-lived cells in the body where it may lie dormant for decades - the so-called HIV reservoir. All this virus needs to be found, activated and purged, but presentations at AIDS 2020 show that the reservoir is more complex than previously assumed.

A unit of heredity, that determines a specific feature of the shape of a living organism. This genetic element is a sequence of DNA (or RNA, for viruses), located in a very specific place (locus) of a chromosome.

A type of experimental treatment in which foreign genetic material (DNA or RNA) is inserted into a person's cells to prevent or fight disease.

Use of immunologic agents such as antibodies, growth factors, and vaccines to modify (activate, enhance, or suppress) the immune system in order to treat disease. It is applied in the cancer field and in HIV research (attempts to eliminate the virus). Immunotherapy is also used to diminish adverse effects caused by some cancer treatments or to prevent rejection of a transplanted organ or tissue.

To eliminate a disease or a condition in an individual, or to fully restore health. A cure for HIV infection is one of the ultimate long-term goals of research today. It refers to a strategy or strategies that would eliminate HIV from a persons body, or permanently control the virus and render it unable to cause disease. A sterilising cure would completely eliminate the virus. A functional cure would suppress HIV viral load, keeping it below the level of detection without the use of ART. The virus would not be eliminated from the body but would be effectively controlled and prevented from causing any illness.

The HIV reservoir is a group of cells that are infected with HIV but have not produced new HIV (latent stage of infection) for many months or years. Latent HIV reservoirs are established during the earliest stage of HIV infection. Although antiretroviral therapycan reduce the level of HIV in the blood to an undetectable level, latent reservoirs of HIV continue to survive (a phenomenon called residual inflammation). Latently infected cells may be reawakened to begin actively reproducing HIV virions if antiretroviral therapy is stopped.

HIV is distributed across numerous tissues in the body, not just cells in the blood or lymph nodes, an autopsy study by the US National Institutes for Allergy and Infectious Disease shows. Predicting which tissues are the most important reservoirs is difficult, as the small study showed big variation between individuals.

Furthermore, the normal work of CD4 memory cells activation and proliferation in response to pathogens inevitably leads to cloning of cells containing HIV DNA and an increase in intact HIV DNA capable of producing new virus over time, Bethany Horsburgh of Australias Centre for Virus Research at Westmead Institute for Medical Research reported.

Even very early antiretroviral treatment appears unable to halt the development of a reservoir that can sustain SIV infection in the body, Dr Henintsoa Rabazantahary of Canadas Universit Laval told the conference. Her macaque study began treating some animals four days after infection, underscoring how quickly an intractable reservoir is established.

These findings emphasise the importance of approaches to curing HIV that go beyond the `shock and kill` regimens designed to activate HIV-infected cells, which have shown disappointing results in clearing the reservoir.

Gene therapy to eradicate HIV or immunotherapy to contain HIV are being explored as potential approaches but which is more likely to be successful? Two leading cure researchers debated the merits of the approaches at a pre-conference HIV cure workshop last week.

Professor Sharon Lewin, Director of the Doherty Institute of Infection and Immunity at the University of Melbourne argues that gene therapy is more likely to deliver an HIV cure than immunotherapeutic approaches aimed at long-term remission of HIV. Proof of concept for a gene therapy approach already exists, she said, in the form of the Berlin and London patients, Timothy Brown and Adam Castellijo, who were cured of HIV after stem cell transplants from donors with the CCR5 delta 32 mutation that confers resistance to HIV infection of cells.

Gene therapy can be used against multiple targets to engineer protection against HIV infection of cells, to purge the virus from infected cells and enhance immune defences that attack HIV.

But the big challenge for gene therapy is to develop an approach that doesnt require cells to be taken out of the body for gene editing in the laboratory. Almost all gene therapy studies underway are using this 'ex vivo' approach, which harvests cells, edits them in the laboratory and then returns them to the patients body. Although the ex vivo approach has already been proved to work, both for HIV and cancer immunotherapy using CAR T-cells, its expensive and requires state of the art laboratory equipment.

The alternative, in vivo gene therapy, would require nanoparticles or a vector such as adenovirus to deliver the edited gene to cells. One study has already shown that its possible to achieve sustained production of a broadly neutralising antibody against HIV, VRC07, using an adenovirus vector to deliver an antibody gene.

Elimination of host stem cells, achieved in the cases of the Berlin and London patients through gruelling chemotherapy prior to bone marrow transplants, might soon be achievable through antibodies-drug conjugates that would target stem cells, Lewin suggested.

Professor John Frater of the University of Oxford sees immunotherapy as more likely to deliver long-term remission. He argued that gene therapy is still largely unproven in any field and the long-term safety of gene therapy is still unclear. In contrast, immunotherapies are already being used to treat cancers such as melanoma and lymphoma, as well as rheumatoid arthritis. Elite controllers of HIV, or long-term non-progressors, also offer evidence that the immune system can control HIV in some circumstances.

Immunity is the best machine you could imagine its had millions of years of R & D so we should use it and make the most of it, he said. Do not confuse the failure of vaccines so far as a red flag for immunotherapy. A vaccine needs to target a rapidly mutating, fast-replicating virus, whereas an immunotherapy targets a stable antigen that is less prone to mutate the cells in the HIV reservoir. We need to think of it more like a strategy for cancer than infection, he said.

Broadly neutralising antibodies represent one promising avenue of immunological research, along with therapeutic vaccination or anti-PD1 to activate exhausted host defences, Professor Miles Davenport of the Kirby Institute of Immunity & Infection, Australia, told a symposium on emerging cure strategies.

But he warned that we still dont understand how immune control relates to viral rebound and how much the HIV reservoir might need to be reduced to make immunological control of HIV viable. What might overcome this challenge, he suggested, would be gene therapy approaches that could render 90% of cells resistant to infection. Modelling by his research group suggest that this level of transduction of cells would dramatically limit viral rebound, permitting immunological control of HIV.

In summary, it may not be a question of choosing between gene therapy or immunotherapy, but using both approaches to achieve HIV remission.

References

Rabezanahary H et al. Contribution of monocytes and CD4 T cell subsets in maintaining viral reservoirs in SIV-infected macaques treated early after infection with antiretroviral drugs. 23rd International AIDS Conference, abstract OA004, 2020.

Horsburgh H et al. Cell proliferation contributes to the increase of genetically intact HIV over time. 23rd International AIDS Conference, abstract OA005, 2020.

Imamichi H et al. Multiple sanctuary sites for intact and defective HIV-1 in post-mortem tissues in individuals with suppressed HIV-1 replication: Implications for HIV-1 cure strategies. 23rd International AIDS Conference, abstract 0A006, 2020.

S Lewin & J Frater. Gene therapy vs. immunotherapy: which is more likely to work? Debate. AIDS 2020: Virtual, HIV Cure pre-conference.

Davenport M. The promise of immunotherapy in HIV infection. AIDS 2020: Virtual symposium presentation, 'Pushing the boundaries: new approaches to a cure'.

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Gene Therapy Market : Facts, Figures and Analytical Insights 2020 2029 – 3rd Watch News

July 10th, 2020 3:44 pm

The research study on Global Gene Therapy market 2019 presents an extensive analysis of current Gene Therapy market size, drivers, trends, opportunities, challenges, as well as key Gene Therapy market segments. Further, it explains various definitions and classification of the Gene Therapy industry, applications, and chain structure.In continuation of this data, the Gene Therapy report covers various marketing strategies followed by key players and distributors. Also explains Gene Therapy marketing channels, potential buyers and development history. The intent of global Gene Therapy research report is to depict the information to the user regarding Gene Therapy market forecast and dynamics for the upcoming years. The Gene Therapy study lists the essential elements which influence the growth of Gene Therapy industry. Long-term evaluation of the worldwide Gene Therapy market share from diverse countries and regions is roofed within the Gene Therapy report. Additionally, includes Gene Therapy type wise and application wise consumption figures.

The Final Report will cover the impact analysis of COVID-19 on this industry.

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After the basic information, the global Gene Therapy Market study sheds light on the Gene Therapy technological evolution, tie-ups, acquisition, innovative Gene Therapy business approach, new launches and Gene Therapy revenue. In addition, the Gene Therapy industry growth in distinct regions and Gene Therapy R;D status are enclosed within the report.The Gene Therapy study also incorporates new investment feasibility analysis of Gene Therapy. Together with strategically analyzing the key micro markets, the report also focuses on industry-specific drivers, restraints, opportunities, and challenges in the Gene Therapy market.

Global Gene Therapy Market Segmentation 2019: Gene TherapyThe study also classifies the entire Gene Therapy market on basis of leading manufacturers, different types, various applications and diverse geographical regions. Overall Gene Therapy market is characterized by the existence of well-known global and regional Gene Therapy vendors. These established Gene Therapy players have huge essential resources and funds for Gene Therapy research as well as developmental activities. Also, the Gene Therapy manufacturers focusing on the development of new Gene Therapy technologies and feedstock. In fact, this will enhance the competitive scenario of the Gene Therapy industry.

The Leading Players involved in global Gene Therapy market are:

By Gene Therapy Type (Germline Gene Therapy and Somatic Gene Therapy)

By Type of Vector (Viral Vector and Non-viral Vector)

By Disease Indication (Cardio Vascular Diseases, Cancer, Genetic Disorders, Neuro Disorders, Infectious Diseases, and Others)

By Region (North America, Europe, Asia Pacific, Latin America, Middle East, and Africa)

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Worldwide Gene Therapy Market Different Analysis:Competitors Review of Gene Therapy Market: Report presents the competitive landscape scenario seen among top Gene Therapy players, their company profile, revenue, sales, business tactics and forecast Gene Therapy industry situations. Production Review of Gene Therapy Market: It illustrates the production volume, capacity with respect to major Gene Therapy regions, application, type, and the price. Sales Margin and Revenue Accumulation Review of Gene Therapy Market: Eventually explains sales margin and revenue accumulation based on key regions, price, revenue, and Gene Therapy target consumer. Supply and Demand Review of Gene Therapy Market: Coupled with sales margin, the report depicts the supply and demand seen in major regions, among key players and for every Gene Therapy product type. Also interprets the Gene Therapy import/export scenario. Other key reviews of Gene Therapy Market: Apart from the above information, correspondingly covers the company website, number of employees, contact details of major Gene Therapy players, potential consumers and suppliers. Also, the strengths, opportunities, Gene Therapy market driving forces and market restraints are studied in this report.

Highlights of Global Gene Therapy Market Report:* This report provides in detail analysis of the Gene Therapy and provides market size (US$ Million) and Cumulative Annual Growth Rate (CAGR (%)) for the forecast period: 2019 ; 2029. * It also elucidates potential revenue opportunity across different segments and explains attractive investment proposition matrix for world Gene Therapy market. * This study also provides key insights about Gene Therapy market drivers, restraints, opportunities, new product launches, approvals, regional outlook, and competitive strategies adopted by the leading Gene Therapy players. * It profiles leading players in the worldwide Gene Therapy market based on the following parameters ; company overview, financial performance, product portfolio, geographical presence, distribution strategies, key developments and strategies and future plans. * Insights from Gene Therapy report would allow marketers and management authorities of companies to make an informed decision with respect to their future product launches, market expansion, and Gene Therapy marketing tactics. * The world Gene Therapy industry report caters to various stakeholders in Gene Therapy market. That includes investors, device manufacturers, distributors and suppliers for Gene Therapy equipment. Especially incorporates government organizations, Gene Therapy research and consulting firms, new entrants, and financial analysts. *Various strategy matrices used in analyzing the Gene Therapy market would provide stakeholders vital inputs to make strategic decisions accordingly.

Global Gene Therapy Market Report Provides Comprehensive Analysis of Following: ; Gene Therapy Market segments and sub-segments ; Industry size ; Gene Therapy shares ; Gene Therapy Market trends and dynamics ; Market Drivers and Gene Therapy Opportunities ; Supply and demand of world Gene Therapy industry ; Technological inventions in Gene Therapy trade ; Gene Therapy Marketing Channel Development Trend ; Global Gene Therapy Industry Positioning ; Pricing and Brand Strategy ; Distributors/Traders List enclosed in Positioning Gene Therapy Market.

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Moreover, the report organizes to provide essential information on current and future Gene Therapy market movements, organizational needs and Gene Therapy industrial innovations. Additionally, the complete Gene Therapy report helps the new aspirants to inspect the forthcoming opportunities in the Gene Therapy industry. Investors will get a clear idea of the dominant Gene Therapy players and their future forecasts.

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Gene Therapy Market : Facts, Figures and Analytical Insights 2020 2029 - 3rd Watch News

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Cancer Gene Therapy Market Outlook for Major Applications/end Users, Consumption, Share and Growth Rate 2025 – Cole of Duty

July 10th, 2020 3:44 pm

Global Cancer Gene Therapy Market: Overview

Cancer could be defined as uncontrolled cell growth in the body leading to organ malfunction. If untreated, it can lead to death. Uncontrolled growth of cell is managed by the body in several ways, one of them is by deploying white blood cells to detect and eradicate these cancerous cells. It has been discovered that the immune system could be manipulated to influence cancerous cells to destroy itself.

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Radiation and chemotherapy therapy have consistent and reliable effects to decrease cancerous cells in the body. Recently, immunotherapy for hematological cancers has experienced a recognition and is of interest for many researchers Scientists have developed methods to isolate, replicate, and develop cancer-destroying cells from the patients blood cancer and injecting those cells back for the destruction of their cancers, with durable remissions.

New options for the treatment is needed to be developed if order to achieve elimination of cancer suffering and death by 2020. According to NCI, 5-year survival rate for cancers such as lung (15%), glioblastoma (5%), pancreatic (4%), and liver (7%) remains very low. Current available treatments have several side effects, the systemic toxicity due to chemotherapy results in nausea, mild cognitive impairments, and mouth ulcerations, in addition to long-term side effects such as increasing risk of developing other types of cancers. Therefore, new and innovative treatment methods are required to reduce the suffering of cancer patients.

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GlobalCancer Gene Therapy Market: Drivers and Restraints

The emerging field of cancer Gene Therapy offers varied potential treatments. Gene therapy involves a range of treatment types, which use genetic material to alter cells (either in vivo or in vitro) to help cure the disease. Cancer Gene Therapy shown efficacy in various in vitro and preclinical testing. Preclinical testing for cancer gene therapy has been performed on glioma, pancreatic cancer, liver cancer, and many other cancers.

Increase in prevalence of cancer, rise in government funding and initiatives, growth in pipeline of cancer gene therapy products, and collaborations to develop and launch gene-therapy products are some factors driving the market. According to NCBI researchers, development of genetically-modified T-cell therapies for treatment of cancer has had maximum clinical impact among other gene therapies. However, high treatment cost is a major limitation in the cancer gene therapy market. The reason behind the huge cost for cancer gene therapy is the necessity of rigorous, exhaustive clinical trials; also treatment by cancer gene therapy differs from person to person depending upon the genetic acceptance of every patient, unlike other drugs thereby limiting the market growth.

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GlobalCancer Gene Therapy Market: Key Segments

Based on type, the cancer gene therapy market is segmented into gene transfer immunotherapy and oncolytic virotherapy. Immunotherapy uses genetically modified cells and viral particles to stimulate the immune system to destroy cancer cells. Immunotherapy include treatment with either cytokine gene delivery or tumor antigen gene delivery. Oncolytic virotherapy uses viral particles, which replicate within the cancer cell causing the death of the cell. It is an emerging treatment modality that is expected to shows great promise, particularly in metastatic cancer treatment.

It includes treatment with adenovirus, retrovirus, lentivirus, herpes simplex virus, adeno-associated virus, simian virus, alphavirus, and vaccinia virus. Gene transfer is the newest treatment modality that is expected to introduce new modified genes into cancerous cell or associated tissue for destruction of cell or to slow down cancer growth. This technique is flexible as a wide variety of vectors and genes are used for clinical trials with positive outcomes. As gene therapy advance, they could be used alone or in combination with other treatments to control the disease. Gene transfer or gene replacement is performed using naked/plasmid vectors, electroporation, sonoporation, magnetofection, and gene gun.

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Based on region, the global cancer gene therapy market is segmented into North America, Europe, Asia Pacific, Latin America and Middle East & Africa. North America is anticipated to hold the largest market share. The U.S. dominates the cancer gene therapy market owing to its increase in funding for research & development and other government initiatives. Key players in the biotech industry are engaging in research & development of gene therapy products. Moreover, rising demand for DNA vaccines and growing interest of venture capitalists to investment in commercialization of gene-based cancer therapies are likely to propel the market. The cancer gene therapy market in Asia Pacific is anticipated to expand at a rapid pace as in China cancer gene therapy is anticipated to attribute for largest revenue, due to the recent launch of Gendicine and rising healthcare expenditure with strong R&D facilities.

GlobalCancer Gene Therapy Market: Key Players

Key players operating in the global cancer gene therapy market are Adaptimmune, ZioPharm Oncology Altor Bioscience, MolMed, bluebird bio, Shanghai Sunway Biotech company limited , MultiVir, Shenzhen SiBiono GeneTech, Corporation.

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Cancer Gene Therapy Market Outlook for Major Applications/end Users, Consumption, Share and Growth Rate 2025 - Cole of Duty

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Stakeholder urge CMS to finalize new CAR-T therapy payment rule – Healthcare Finance News

July 10th, 2020 3:44 pm

A group of patient advocacy groups has sent a letter to the Centers for Medicare and Medicaid Services urging the agency to establish the new Medicare Severity-Diagnosis Related Group for Chimeric Antigen Receptor T-cell Immunotherapy.

In the letter, the stakeholders argued that CAR-T therapies offer improved outcomes for patients with relapsed/refractory diffuse large B-cell lymphoma and B-cell acute lymphoblastic leukemia and provides hope for many more with other hard-to-treat cancers

The new MS-DRG would also give hospitals and providers a new course of treatment for those cancers.

The letter backed up its praise with a study in which lymphoma patients had significant improvements in their physical, social and emotional wellbeing following CAR-T therapy.

The organizations signing the letter include the American Cancer Society Cancer Action Network, BMT Infonet, Cancer Support Community, CLL Society, CrowdCare Foundation/Myeloma Crowd, International Myeloma Foundation, Leukemia & Lymphoma Society, Lymphoma Research Foundation, Society for Immunotherapy of Cancer and The Pink Fund.

WHY THIS MATTERS

This letter is a comment to CMS' proposed inpatient prospective payment system rule issued in May.

Under the current rule, CAR-T hospital cases are paid at the same rate as bone marrow transplants and qualify for additional payments through the temporary new technology add-on payment for high-cost cases that are set to expire this year.

The rule would create a separate hospital payment category for CAR-T therapy.

The new MS-DRG for CAR-T would provide predictable payment rates for hospitals administering the therapy.

CAR-T is a gene therapy that uses a patient's own genetically modified immune cells as a treatment for certain types of cancer. This is instead of additional chemotherapy or other types of treatment paid for under the inpatient prospective payment system.

The open comment period for the proposed rule ends today, Friday, July 10.

THE LARGER TREND

For years, organizations such as the American Society for Blood and Marrow Transplantation have been asking for an MS-DRG to be created for CAR-T therapies.

ON THE RECORD

"Our organizations commend CMS for its action and appreciate its forward-leaning policy proposal that will optimize patient access for CAR-T therapy," the stakeholders wrote. "We support finalization of the proposed rule and look forward to working with CMS to further support novel treatments for unmet medical needs among immunotherapy patients."

Twitter:@HackettMalloryEmail the writer:mhackett@himss.org

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Engineering a far-red lightactivated split-Cas9 system for remote-controlled genome editing of internal organs and tumors – Science Advances

July 10th, 2020 2:46 pm

INTRODUCTION

Many studies have shown that the CRISPR-Cas9 system is a revolutionary technology (1, 2). This relatively easy-to-use technology has provided unprecedented opportunities for scientific research and disease treatments, including applications in high-throughput screening and functional genomics research and treatment of virus infections (3), genetic diseases (4), and cancer (5). Nevertheless, there are now several well-known disadvantages with the CRISPR-Cas9 system, including the fact that single guide RNAs (sgRNAs) can sometimes lead to off-target effects such as double-strand breaks in untargeted genome regions, which can cause unintended adverse consequences such as gene mutations, insertions, deletions, and even tumorigenic events (6). Seeking to overcome these challenges, several strategies have been developed to improve the precision of CRISPR-Cas9 gene editing, including Cas9 modifications (e.g., Cas9 nickase and high-fidelity variants), prime editors, base editors, and selecting sgRNAs with minimal off-target capacity (7, 8). Recently, some inducible Cas9 expression systems have been developed to limit the activity or lifetime of Cas9, thereby lowering the probability of off-target effects by reducing the exposure time of a cells genome to the Cas9 nuclease (9).

There are a variety of chemically induced CRISPR-Cas9 systems, including doxycycline-regulated Cas9 (10), trimethoprim (TMP) (11) and 4-hydroxytamoxifen (4-OHT)controlled Cas9 (12), rapamycin-inducible split-Cas9 (13), 4-OHTresponsive inteindependent Cas9 (14), and 4-OHTresponsive nuclear receptors split-Cas9 (15), among others. However, a notable adverse effect of these systems is the potential for cytotoxicity from the chemical inducers: Doxycycline can negatively affect cell numbers and colony formation (16), TMP can inhibit uptake of folic acid by the cells (17), 4-OHT can increase cytosolic levels of autophagosomes and cause irregularly clumped chromatin in the nuclei (18), and rapamycin can perturb the endogenous mammalian target of rapamycin pathway (19). Moreover, once these agents are inside the cells or present in an in vivo context, these inducer chemicals can diffuse freely, limiting the spatial resolution of editing induction. In addition, it is difficult to rapidly remove the inducer compounds, so they can persist for a long time, making it difficult to turn Cas9 activity on and off quickly and precisely.

These limitations have helped motivate the development of multiple systems based on the optical control of Cas9 activity because light is a reversible and noninvasive inducer modality that potentially offers fine precise spatiotemporal resolution. The first reported example of a photoactivatable Cas9 system was paCas9 system based on blue light (20). In the paCas9 system, Cas9 nucleases are fragmented into two nonfunctional fragments that can be reconstituted as an active nuclease under blue light illumination based on dimerization of their respective fusion domains, the positive Magnet (pMag) or negative Magnet (nMag) proteins from the filamentous fungus Neurospora crassa (21). Later studies reported the ultraviolet (UV) lightmediated cleavage of a synthesized complementary oligonucleotide element that normally inactivates the editing-guiding function of sgRNAs (22).

There is also a recently reported blue lightbased anti-CRISPR system comprising AcrIIA4 (23) (a potent Cas9 inhibitor) and the LOV2 blue-light photosensor (24). Without illumination, the AcrIIA4-LOV2 complex remains bound to Cas9, inhibiting its nuclease activity. Under blue light illumination, the AcrIIA4-LOV2 complex is separated from Cas9 and its editing activity can be restored (25). However, neither UV nor blue light is able to penetrate deeply into the body, owing to the strong absorption and scattering of these light energies by biological tissues (26). UV light hardly penetrates the skin and blue light does merely by 1 mm (27, 28). This substantial limitation, viewed alongside the fact that UV and prolonged blue light exposure can cause cytotoxicity (29, 30), highlights the difficulty of applying these light-induced Cas9 systems for in vivo research applications and clinical translation.

We have, for some time, been investigating far-red light (FRL)inducible genetic systems due to the deep tissue penetration of FRL with above 5 mm beneath the surface of skin (27, 28). We here report our development of an FRL-activated split-Cas9 (FAST) system that can be used to noninvasively induce gene editing activity in cells located deep inside animal tissues. The FAST system relies on two split-Cas9 fusion proteins with high-affinity binding domains: One half of Cas9 is constitutively expressed, while the other is under the FRL-inducible control of the bacterial phytochrome BphS optical controllable system previously established by our group (31). We initially assembled the FAST system components in human embryonic kidney (HEK)293 cells and used light-emitting diode (LED)based FRL illumination to demonstrate successful activation of targeted genome editing. Next, after achieving FRL-inducible editing in diverse human cell lines, experiments with implants confirmed that FAST was able to robustly activate editing in cells positioned in subdermal animal tissues. Experiments with the transgenic tdTomato reporter mouse line established FRL-induced FASTmediated editing of mouse somatic cells (hepatocytes in the liver), and work with cell cycleinactivating gene edits of cancer cells in xenograft tumor mice demonstrate how FAST can be deployed against disease. Thus, beyond extending the optogenetic toolbox for gene editing of mammalian cells to include induction by the highly in vivocompatible and deep tissuepenetrating energies of FRL, our study extends this initial technology to demonstrate applications relevant for basic biological and biomedical research.

To develop an optogenetically controlled device for genome editing with deep tissuepenetrative capacity and with negligible phototoxicity in vivo, first, we constructed an FRL-controlled full-length Cas9 system based on our previously reported orthogonal FRL-triggered optogenetic system (FRL-v2) (31). However, there was serious background leakage in dark state with low-induction performance under illumination. Therefore, we focused on building a FAST system based on split-Cas9 (13) and FRL-v2, which comprises the bacterial FRL-activated cyclic diguanylate monophosphate (c-di-GMP) synthase (BphS) and a c-di-GMPresponsive hybrid transactivator, p65-VP64-BldD. For the FAST system, we then fused the N-terminal Cas9 fragment [Cas9(N)] to the Coh2 domain from Clostridium thermocellum (32) and fused the C-terminal Cas9 fragment [Cas9(C)] to the DocS domain from the same bacterium. Expression of the NLS-Cas9(N)-Coh2 fusion protein is driven by the FRL-v2specific chimeric promoter (PFRL), while expression of the DocS-Cas9(C)-NES fusion protein is driven by a constitutive promoter (PhCMV). A complete Cas9 protein can be reconstituted upon FRL illumination because of the high-affinity interaction of the Coh2 and DocS domains (Fig. 1). Confirming the editing activity of the reconstituted Cas9, we found that HEK-293 cells cotransfected with pXY137 (PhCMV-p65-VP64-BldD-pA::PhCMV-BphS-P2A-YhjH-pA, 100 ng), pYH20 [PFRL-NLS-Cas9(N)-Linker-Coh2-pA, 50 ng], pYH102 [PhCMV-DocS-Linker-Cas9(C)-NES-pA, 100 ng], and pYW57 [PU6-sgRNA (CCR5)-pA, 50 ng] successfully edited the targeted human CCR5 locus (11.9% indel frequency) upon FRL illumination (1 mW/cm2; from an LED source, 730 nm); no editing was detected for dark control cells (Fig. 2, A and B). These detected edits were analyzed by the mismatch-sensitive T7 endonuclease I (T7E1) assay. We further used Sanger sequencing to confirm that the FRL-induced, FAST-mediated edits (indel mutations) occurred in the targeted region of the human CCR5 locus at a frequency of ~20% using the tracking of indels by decomposition (TIDE) analysis (fig. S1).

(A) Schematic of the split-Cas9 fusion protein components of the FAST system. Coh2 and DocS are two C. thermocellum proteins that interact with high affinity. Cas9 is formed from two separate (N- and C-terminal) Cas9 fragments that individually lack nuclease activity. When Cas9s two fragments Cas9(N) and Cas9(C) are respectively fused with Coh2 and DocS, they readily combine to reconstitute a nuclease-active form of Cas9. (B) Schematic of the FAST system, as deployed in mammalian cells, based on the fragments detailed in (A). FRL (~730 nm) activates the engineered bacterial photoreceptor BphS, which converts guanosine triposphate (GTP) into c-di-GMP. c-di-GMP can bind to BldD (derived from sporulating actinomycete bacteria) and be translocated into the nucleus. This induces dimerization of the synthetic transcriptional activators p65-VP64-BldD [BldD fused with p65 (the nuclear factor Btransactivating domain) and VP64 (a tetramer of the herpes simplex virusderived VP16 activation domain)], after which they bind to PFRL to activate expression of the N-terminal fusion fragment of split-Cas9. The other (C-terminal) fusion fragment is constitutively expressed, as driven by the human cytomegalovirus promoter (PhCMV). DNA double-strand breaks are formed by Cas9 after the Coh2-DocS heterodimerizationmediated reconstitution of the two fusion fragments.

(A) Time schedule of FRL-controlled gene editing in HEK-293 cells. Cells were illuminated (1 mW/cm2; 730 nm) for 4 hours once a day for 2 days and were collected at 48 hours after the first illumination for further analysis. (B) A mismatch-sensitive T7 endonuclease I (T7E1) assay to test HEK-293 cells (6 104) transfected with full-length Cas9 (pHP1) or the FAST system (pXY137, pYH20, and pYH102), together with the sgRNA targeting to CCR5 locus (pYW57). FRL-mediated editing (indel deletions) of the human EMX1, CXCR4, and VEGFA loci by FAST was performed using the same experimental procedure as that used when targeting the CCR5 gene. (C) FRL-mediated multiplex editing of the human CCR5 and CXCR4 loci. (D) FAST-mediated DNA insertion via homology-directed repair (HDR), achieved by adding a single-stranded oligodeoxynucleotide (ssODN) template (10 M), bearing a HindIII restriction endonuclease site. Homologous arms are indicated in red. The target sites of sgRNA (EMX1) are marked in blue. HEK-293 cells (6 104) were cotransfected with full-length Cas9 (pHP1) or the FAST system (pXY137, pYH20, and pYH102) and the sgRNA targeting to EMX1 locus (pYH227) via a nucleofection method. In (B) to (D), n = 2 from two independent experiments. Red arrows indicate the expected cleavage bands. Detailed description of genetic components and transfection mixtures are provided in tables S1 and S5. N.D., not detectable.

We next confirmed that the FAST system can cleave different targeted endogenous genomic loci and induce indel mutations via nonhomologous end joining (NHEJ) in an FRL-dependent manner by designing sgRNAs targeting three additional human genes (EMX1, CXCR4, and VEGFA), and these induced indel mutations were detected by T7E1 assay. With each of these sgRNAs, FRL-induced but not dark-induced indel mutations were observed (Fig. 2B). We also confirmed that the FAST system can cleave targeted exogenous d2EYFP reporter efficiently (fig. S2). In addition to single gene targeting, we also tested whether our FAST system can simultaneously edit multiple target sites. Using one sgRNA targeting CCR5 and another sgRNA targeting CXCR4, the FAST system was capable of inducing the desired indel mutations at the two target sites upon FRL illumination (Fig. 2C), demonstrating optogenetic multiplexed control of NHEJ-mediated indel mutations in mammalian cells.

We further investigated whether FAST can be used for homology-directed repair (HDR)mediated genome editing. The FAST system components and a donor template (single-stranded oligodeoxynucleotide containing a HindIII site) were electroporated into HEK-293 cells. Assessment of HDR events at the EMX1 locus using restriction endonuclease assays showed that the FAST system induced HindIII site integration at the EMX1 locus at a frequency of 5.7% under FRL illumination; no HDR events were detected in dark controls (Fig. 2D). Together, these results establish that the FAST system can be deployed for optogenetic control of NHEJ-/HDR-mediated indel mutations.

To demonstrate photoactivatable regulation of gene editing in diverse mammalian cell lines, we introduced the FAST system into four different human cell lines, and it achieved successful FRL-induced gene editing (CCR5 locus) in each of them (Fig. 3A). Next, experiments testing the FRL illumination intensity and duration-dependent activity of the FAST system showed that the frequency of edits (indel mutations at CCR5) increased along with illumination intensity and with illumination time (Fig. 3, B and C), indicating the tunability of the FAST system. We also used a photomask to establish proof of principle for spatially controlled gene editing with the FAST system (Fig. 3, D and E). We also conducted an experiment with two rounds of FRL illumination to verify repeated induction cycles of the FAST system wherein the first round of illumination achieved indel mutations guided by an sgRNA targeting CXCR4 locus, followed by transfection of a second sgRNA targeting the CCR5 locus, which guided successful indel mutations after the second FRL illumination. However, engineered cells shifted to the dark did not have indel mutations in CCR5 locus (fig. S3, A and B). This result indicates that the FAST system is reusable and reversible.

(A) FAST-mediated gene editing in four human cell lines. (B) Illumination intensitydependent FAST gene editing. In (A) and (B), cells were collected for mismatch-sensitive T7E1 assays, as indicated in the time schedule of Fig. 2A. (C) Evaluation of exposure timedependent FAST system gene editing performance. Cells were collected for T7E1 assays at 24 hours after the start of the second illumination. (D) Schematic of the photomask device used to demonstrate the spatial regulation of FAST-mediated gene editing. Cells were illuminated through a photomask containing a 7-mm line pattern. (E) Spatial control of FRL-dependent gene editing mediated by the FAST system. HEK-293 cells (3 106) were cotransfected with the FAST system, sgRNA (pYW57), and a frameshift enhanced green fluorescent protein (EGFP) reporter containing a CCR5 locus (pYH244) and were illuminated with FRL (0.5 mW/cm2; 730 nm; 2-min on, 2-min off) for 48 hours. EGFP is not expressed without Cas9 activity because the EGFP sequence is out of frame. Upon double-strand cleavage by Cas9, the frameshifts caused via DNA repair by NHEJ enable EGFP expression. The fluorescence of EGFP was assessed via fluorescence meter ChemiScope 4300 Pro imaging equipment (Clinx) at 48 hours. In (A) to (C), n = 2 from two independent experiments. Red arrows indicate the expected cleavage bands. Detailed description of genetic components and transfection mixtures are provided in tables S1 and S5. SEAP, human placental secreted alkaline phosphatase.

We then evaluated the photocytotoxicity of FRL (730 nm) or blue light (470 nm) illumination on mammalian cells. When HEK-293cells were transfected with human placental secreted alkaline phosphatase (pSEAP2)-control-and then exposed to FRL or blue light for different intensity, the SEAP expression demonstrated that the FRL exposure resulted in negligible cytotoxicity. However, a marked difference was observed from the blue light illumination, which substantially reduced cell viability (fig. S4, A and B). Moreover, we did not observe substantially increased cytotoxicity with FRL illumination of cells engineered with the FAST system (fig. S4, C and D), indicating the inertness and noncytotoxicity of the system constituents. In short, neither FRL illumination nor the ectopic presence of FAST system constituents was verified to influence the gene expression capacity of the engineered cells. In addition, we also compared the controllable gene editing performance of our FAST system with the rapamycin-responsive split-Cas9 system (13) and the blue lightcontrolled paCas9 system (20) that have been reported. The results showed that the genome editing efficiency of rapamycin-responsive split-Cas9 system was lower than the FAST system (fig. S5, A and B), and the paCas9 system had relative higher background leakage in the dark. Our FAST system showed notable induction of indel mutations under FRL illumination but with negligible background in the dark (fig. S5, C and D). Off-target activity of the FAST system was also assessed simply. We checked a potential off-target site of human BMP1 locus, as reported previously (33). The indel frequencies were determined through T7E1 assay at the on-target and potential off-target sites of BMP1. As a result, no mutations were detected at the potential off-target site after editing by our FAST system (fig. S6, A and B). This is probably due to the FAST-mediated transient expression of split-Cas9 that lowered the probability of off-target effects by reducing the exposure time of a cells genome to the Cas9 nuclease (79). However, there might be off-target effects that can still occur in illuminated cells.

Having established the basic performance characteristics of the FAST system in human cells, we next conducted experiments with mice to verify the systems capacity to induce gene editing based on the tissue-penetrating capacity of FRL. Specifically, we conducted an experiment using hollow fiber implantation of HEK-293 cells equipped with the FAST system into the dorsum of mice and exposed to FRL illumination (10 mW/cm2; alternating 2-min on/off for 4 hours) (Fig. 4A). Notably, the FRL illumination of the FAST cell-bearing mice induced notable activation of gene editing (~11.4% of the cells retrieved from the implant fibers was edited at the CCR5 locus versus not detectable for dark control cells) (Fig. 4B). These results demonstrate that the FAST system can be used to activate gene editing inside animal tissues, exploiting the physical properties of FRL as an inducer modality.

(A) Schematic for the time schedule and experimental procedure for FRL-controlled gene editing in mice harboring hollow fiber implants with HEK-293 cells. Pairs of 2.5-cm hollow fibers containing a total of 5 106 transgenic HEK-293 cells (engineered with FAST system) were subcutaneously implanted on the dorsum of wild-type mice and illuminated with FRL (10 mW/cm2; 730 nm; 2-min on, 2-min off) for 4 hours each day for 2 days. Cells were collected from the hollow fiber implants at 48 hours after the first illumination and assessed with mismatch-sensitive T7E1 assay to assess targeted gene editing efficiency (CCR5 locus). (B) Representative T7E1 assay for FAST-mediated indel mutations. n = 3 mice. The red arrow indicates the expected cleavage bands. Detailed description of genetic components and transfection mixtures are provided in table S1 and S5.

We obtained transgenic mice harboring a homozygous Rosa26 CAG [cytomegalovirus (CMV) enhancer fused to the chicken beta-actin] promoter loxP-STOP-loxP-tdTomato cassette present in all cells. In this model, tdTomato is silent because of the stop signal [three repeats of the simian virus 40 (SV40) polyadenylate (polyA) sequence], but the deletion of the stop cassette allows transcription of the tdTomato gene, resulting in fluorescence expression. The Cas9-mediated DNA cleavage of the stop sequence guided by sgRNAs can initiate CAG promoter to drive tdTomato expression (34). Therefore, we used this mouse model to examine the in vivo genome editing performance of the FAST system in mice somatic cells (Fig. 5A). We used hydrodynamic injection to introduce the FAST system components, along with an sgRNA designed to target the deletion of the SV40 polyA stop cassette, which should activate tdTomato reporter protein expression upon successful editing. Note that it is difficult to activate tdTomato expression by Cas9 system as the desired edit requires two cuts on the same allele; we eventually achieved the desired edit, but it required optimization of the delivery mode for the FAST components. Briefly, we chose hydrodynamic injection because it is known to result in enrichment of plasmids (and thus, transgene expression) in liver cells (35). We reduced the overall number of plasmids by combining some constructs (fig. S7, A and B) and explored a number of different injection time and illumination schedules (Fig. 5A), but we only detected weak tdTomato signals in the FRL-illuminated FAST mice (fig. S8).

(A) Schematic showing the time schedule and experimental procedure for assessing in vivo gene editing. The minicircle iteration of the FAST system pYH412, pYH413, and pYH414 at a 7:15:4 (w/w/w) ratio were injected hydrodynamically via tail vein. Twenty-four hours after injection, mice were illuminated with FRL (10 mW/cm2; 730 nm; 2-min on, 2-min off) for 4 hours per day for 3 days. A second injection of the minicircle-based FAST system components was performed on the fifth day, followed by 4 hours daily illumination for three additional days. In our design, the tdTomato reporter protein was expressed after a stop cassette was destroyed by Cas9 editing. (B) Fluorescence IVIS image of mouse livers. (C) The frequency of edits (targeting the aforementioned stop cassette) by monitoring fluorescence intensity of the tdTomato reporter in Gt(ROSA)26Sortm14(CAG-tdTomato)Hze mice. (D) Representative fluorescence microscopy images of tdTomato and tdTomato+ hepatocytes present in frozen liver sections from FRL-illuminated mice. Blue indicates 4,6-diamidino-2-phenylindole (DAPI) staining nuclei; red indicates endogenous tdTomato expression. The images represent typical results from three independent measurements. Scale bar, 100 m. Data in (C) are means SEM; n = 3 mice. P values were calculated by Students t test. ****P < 0.0001 versus control.

We speculated that this apparently weak induction of editing activity may result from rapid degradation of the plasmids, so we constructed minicircle (36) iterations of our FAST system. Minicircle DNA vectors without the bacterial backbone of the plasmid, markedly reducing the possibility of random integration of bacterial DNA sequences into the genome, have been shown to maintain gene expression in cells for long durations because these molecules are resistant to degradation (37). We delivered the minicircle iterations of the FAST via hydrodynamic injection and used FRL illumination schedules as follows: alternating 2-min on/off for 4 hours, once each day for 3 days; we then monitored the fluorescence signal intensity in livers. FRL illumination of the mice bearing the FAST system resulted in strong editing and thus, tdTomato reporter expression (Fig. 5, B and C). We also detected strong tdTomato expression in liver sections prepared from the FRL-illuminated FAST mice (Fig. 5D), and Sanger sequencing of genomic DNA extracted from the livers verified the success of the targeted excision of the SV40 polyA stop cassette in the FRL-induced FAST mice (fig. S9). Collectively, these results demonstrate that the FAST system can be used for in vivo editing of the genomes of somatic cells located in the internal organs of mice.

We further investigated the optogenetic activation of the FAST system in tumor models as proof-of-concept examples for therapeutic genome editing. The polo-like kinase (PLK1) protein is a highly conserved serine-threonine kinase that promotes cell division, and strong PLK1 expression is a marker in various types of tumor (38). Extensive work has established that inhibition or depletion of PLK1 leads to cell-cycle arrest, apoptosis, and a so-called mitotic catastrophe in cancer cells, which provides a promising modality for anticancer therapy (39, 40). After initially confirming that the FAST system can edit the PLK1 locus (indel mutations and extensive apoptosis) in the FRL-illuminated human lung cancer A549 cells in vitro (fig. S10, A to D), we then evaluated the tumor therapy application of our FAST system by testing the in-tumor editing performance of the FAST system for the disruption of the PLK1 locus in mice bearing A549 xenograft tumors.

We first delivered the minicircle iterations of the FAST system alongside a PLK1-targeting sgRNA minicircle vector when the tumors had reached 80 to 100 mm3; note that we also injected transfection reagent, a cationic polymer-coated nanoparticle (APC), (41) to facilitate the transfection of tumor cells in situ. Subsequently, FRL illumination was delivered to the xenograft-bearing mice via LED for 4 hours each day for 7 days (Fig. 6A), and tumor development was monitored by measuring the sizes of the tumors every 2 days. Notable inhibition of tumor growth was observed for the FAST mice that received FRL illumination; no such inhibition was observed for the dark control FAST or FRL-illuminated vehicle control mice (Fig. 6, B to D). Mismatch-sensitive T7E1 assays confirmed that the FRL-induced FAST system achieved the desired genome disruption of PLK1 gene in the tumor tissue (Fig. 6E) at a frequency of ~21.5% detected by TIDE analysis (Fig. 6F). Moreover, quantitative real-time polymerase chain reaction (qRT-PCR) verified the expected reductions in tumor PLK1 mRNA expression upon FRL illumination (Fig. 6G). Consistent with the observed antitumor efficacy, subsequent histologic analysis of tumor sections revealed extensive cancer cell necrosis (Fig. 6H) and very extensive cell apoptosis [via both terminal deoxynucleotidyl transferasemediated deoxyuridine triphosphate nick end labeling (TUNEL) and caspase-3labeling assays; Fig. 6, I and J]. Thus, FRL-triggered FAST-mediated gene editing can inhibit cancer cell growth in xenograft tumors in mice. These results further indicate that our FAST system could be deployed for deep tissue gene editing.

(A) Schematic showing the time schedule and experimental procedure for the in-tumor FAST-mediated gene editing. The minicircle iteration of the FAST system targeting to PLK1 locus pYH412, pYH420, and pYH414 at a 7:15:4 (w/w/w) ratio were injected intratumorally. Twenty-four hours after per injection, mice were illuminated with FRL (10 mW/cm2; 730 nm; 2-min on, 2-min off) for 4 hours per day totally for 7 days. (B) Images of tumor tissues from the different treatments. (C) Tumor growth curves for the different treatments. (D) The weight of tumor tissues after the different treatments. (E) Indel mutations in the tumor tissues detected via mismatch-sensitive T7E1 assays. Red arrows indicate the expected cleavage bands. (F) The gene editing efficacy quantified by the TIDE analysis. (G) Relative mRNA expression levels of the PLK1 gene quantified by quantitative real-time polymerase chain reaction (qRT-PCR). The data are means SEM; n = 5 mice. P values were calculated by Students t test. ****P < 0.0001 versus control. (H) Representative fluorescence microscopy images of hematoxylin and eosin (H&E) staining of tumor tissues. The images represent typical results from three independent measurements. Scale bar, 100 m. Representative fluorescence microscopy images of TUNEL staining (I) and caspase-3 (J) staining of tumor tissues. The images represent typical results from three independent measurements. Scale bars, 100 m. Photo credit: Yuanhuan Yu, East China Normal University.

CRISPR-Cas9 is an undeniably revolutionary technology that is changing biological and medical research (4, 5, 42), and several innovative extensions of the basic CRISPR-Cas9 concept have enabled a new era of conditional genome editing activation iterations with chemical (1015) and UV/blue light inducers (20, 22, 25). Nevertheless, limitations with these systems warrant the development of alternatives that exploit different induction sources. The FAST system we developed in the present study opens the door for spatiotemporally selective induction of Cas9 genome editing deep inside animal tissues. It bears emphasis that our induction uses LED lights rather than lasers or optical fibers, highlighting that FAST should be very easy to deploy in a wide range of experimental contexts. Although we did face initial hurdles with induction efficiency for in vivo applications, our development of a minicircle-based iteration of the FAST system easily overcame this and permitted robust editing in mouse livers. The deep tissuepenetrating utility of the FAST system was applied to achieve anticancer therapy by disrupting PLK1 gene in mice bearing A549 xenograft tumors. In this way, we could greatly reduce side effects of the anticancer drugs and promote the precision treatment of cancers. We also envision that the FAST system can be used to study the function of cancer-associated genes during tumor development process by controlling gene knockout or interference in specific tissues at different time nodes.

While we do demonstrate FAST system applications for biological research and the treatment of disease, the present paper merely reports the initial proof-of-principle study. Given that FAST is a fully genetically encoded system, a variety of vectors, alternative plasmids, and tissue-specific promoters could be used to selectively deliver FAST system components to diverse tissues, and we fully anticipate that adeno-associated virus vectors will become a popular modality for this task. Moreover, there is no obvious factor to prevent the deployment of FAST as a genome-integrated stable system, which should enable researchers to selectively activate targeted editing anywhere that they are able to supply sgRNAs and FRL illumination from an LED.

We anticipate that the combination of precise temporal control and deep tissue penetration will enable rapid-uptake FAST in a variety of research communities. Chemical inducers can cause adverse effects in cells and can diffuse freely, and the complexity of cellular and organismal metabolism makes it exceedingly difficult to precisely control the spatiotemporal dynamics of inducible gene editing systems (1619). In this light, perhaps researchers can deploy FAST and FRL induction strategies to explore the development, basic biology, or etiopathological basis of diverse processes that occur in animal internal organs such as the heart, lungs, liver, kidneys, etc., and in tissues, including muscles and bone marrow. In theory, the FAST system should give researchers previously unattainable precise control of conditional genetic knockout and knock-in experiments. A huge variety of temporal illumination schemes should be feasible with FAST because FRL has low phototoxicity, representing a clear advantage over UV- and blue lightbased Cas9 induction systems. Moreover, FAST may offer neuroscientists an alternative to the presently popular optical fiber implantationbased approaches for optogenetic-based gene editing research.

In summary, we have developed a FAST system that is apparently safe (negligible phototoxicity to mammalian cells, high tissue permeability, and noninvasiveness). With FRL as its fundamental basis, the FAST system offers excellent tunability (robust induction of gene editing and almost negligible background activity) and precise controllability (illumination intensity dependent, exposure time dependent, and strong spatiotemporal specificity), making it suitable and practical for the many biological and biomedical applications that require gene editing in vivo, especially for processes that occur within animal tissues.

The FAST system consists of the following main components: the FRL sensors (BphS and p65-VP64-BldD) (31), interacting proteins (cohesion Coh2 and dockerin DocS from C. thermocellum) (32), and the N- and C-terminal fragments of Streptococcus pyogenes Cas9 [Cas9(N) (residues 2 to 713) and Cas9(C) (residues 714 to 1368)] (13). Complementary DNAs (cDNAs) encoding BphS and p65-VP64-BldD were prepared, as previously described (31). cDNAs encoding Coh2 and DocS were chemically synthesized by the company Genewiz Inc. cDNAs encoding the N- and C-terminal fragments of Cas9 fused with a nuclear localization signal from SV40 T antigen were amplified from the Addgene plasmid 42230. The inducible Cas9 was constructed on the basis of the Cas9(N) and Cas9(C) fragments fused with Coh2 and DocS, respectively, which were cloned through Gibson assembly according to the manufacturers instructions [Seamless Assembly Cloning Kit; catalog no. BACR(C) 20144001; OBiO Technology Inc.]. All genetic components have been validated by sequencing (Genewiz Inc.). Plasmids constructed and used in this study are provided in table S1.

The sgRNAs targeting CCR5, EMX1, CXCR4, VEGFA, BMP1, tdTomato stop cassette, and PLK1 were generated by annealed oligos and cloned into the BbsI site of a constitutive mammalian PU6-driven sgRNA expression vector (pYH49). The PU6-sgRNA fragment was PCR amplified from the Addgene plasmid 58767 and then cloned into the corresponding sites (MluI/XbaI) of pcDNA3.1(+) to obtain the pYH49 expression vector. The target sequences and oligonucleotides used for sgRNA construction are listed in table S2.

All cell types {HEK-293 [CRL-1573; American Type Culture Collection (ATCC)], HeLa (CCL-2; ATCC), telomerase-immortalized human mesenchymal stem cells (43), and HEK-293derived Hana3A cells engineered for constitutive expression of RTP1, RTP2, REEP1, and Go} were cultured at 37C in a humidified atmosphere, containing 5% CO2 in Dulbeccos modified Eagles medium (DMEM; catalog no. C11995500BT; Gibco) supplemented with 10% fetal bovine serum (FBS; catalog no. 16000-044; Gibco) and 1% (v/v) penicillin/streptomycin solution (catalog no. ST488-1/ST488-2; Beyotime Inc.). All cell lines were regularly tested for the absence of mycoplasma and bacterial contamination. Cells were transfected with an optimized polyethyleneimine (PEI)based protocol (44). Briefly, cells were seeded in a 24-well cell culture plate (6 104 cells per well) 18 hours before transfection and were subsequently cotransfected with corresponding plasmid mixtures for 6 hours with 50 l of PEI and DNA mixture [PEI and DNA at a ratio of 3:1 or 5:1 (w/w)] (PEI molecular weight, 40,000; stock solution of 1 mg/ml in ddH2O; catalog no. 24765; Polysciences Inc.). At 12 hours after transfection, the culture plate was placed below a custom-designed 4 6 LED array (1 mW/cm2; 730 nm) for illumination.

For HDR-mediated genome editing experiments, 6 105 HEK-293 cells were nucleofected with the FAST system plasmids (pXY137, 200 ng; pYH20, 100 ng; and pYH102, 200 ng), sgRNA expression vector (pYH227, 100 ng; targeting EMX1), and 10 M single-stranded oligonucleotide donor using the SF Cell Line 4D-Nucleofector X Kit L (catalog no. V4XC-2024; Lonza) and the CM-130 program (4D-Nucleofector System; Lonza). At 24 hours after nucleofection, cells were illuminated by FRL (1 mW/cm2; 730 nm) for 4 hours once a day for 2 days, and then cells were collected at 48 hours after the first illumination for analysis. Genomic DNA was isolated using a TIANamp Genomic DNA Extraction Kit (catalog no. DP304; TIANGEN Biotech Inc.) according to the manufacturers instructions.

Genomic DNA was extracted from cells or tissues using the TIANamp Genomic DNA Extraction Kit (catalog no. DP304; TIANGEN Biotech Inc.) according to the manufacturers instructions. The genomic region containing the target sites was PCR amplified using the 2 Taq Plus Master Mix II (Dye Plus) DNA polymerase (catalog no. P213; Vazyme Inc.). The primers used for PCR amplification are listed in table S3. The PCR amplicons were purified using HiPure Gel Pure Micro Kits (catalog no. D2111-03; Magen Inc.) according to the manufacturers protocol. Purified PCR products (300 ng) were mixed with 1.5 l of 10 M buffer for restriction enzyme (catalog no.1093A; Takara Bio) and ultrapure water to a final volume of 15 l and reannealed (95C, 5 min; 94C, 2 s, 0.1C per cycle, 200 times; 75C, 1 s, 0.1C per cycle, 600 times; and 16C, 5 min) to form heteroduplex DNA. After reannealing, the heteroduplexed DNA was treated with 5 U of T7E1 (catalog no. M0302; New England BioLabs) for 1 hour at 37C and then analyzed by 1.5% agarose gel electrophoresis. Gels were stained with GelRed (catalog no. 41003; Biotium) and imaged with Tanon 3500 gel imaging system (Tanon Science & Technology Inc.). Relative band intensities were calculated by ImageJ software. Indel percentage was determined by the formula 100% [1 (1 (b + c)/(a + b + c))1/2], in which a is the integrated intensity of the undigested PCR product, and b and c are the integrated intensities of each cleavage product.

Sequence of the gene region containing the target sequence was amplified by PCR. Purified PCR amplicons from the nuclease target site were cloned into the T-vector pMD19 (catalog no. 3271; Takara Bio). Thirty clones were randomly selected and sequenced using each genes PCR forward primers by the Sanger method (45). Primers used for PCR amplification are listed in table S3.

Target regions were amplified by PCR. Purified PCR samples were analyzed by Sanger sequencing. The sequencing data files (.ab1 format) were imported into the TIDE Web tool (https://tide.nki.nl/) (46) to quantify nature and frequency of generated indels.

The genomic PCR and purification were performed, as described above. Purified PCR products were mixed with 15 U of HindIII (catalog no. 1060B; Takara Bio), 2 l of 10 M buffer for restriction enzyme, and ultrapure water to a final volume of 20 l and then incubated at 37C for 3 hours. The digested products were analyzed by agarose gel electrophoresis. Gel staining and imaging were performed, as described above. Quantification was calculated on the basis of relative band intensities. The HDR percentage was determined by the formula 100% (b + c)/(a + b + c), in which a is the intensity of the undigested PCR product, and b and c are the intensities of each HindIII-digested product.

HEK-293 cells (6 104) were cotransfected with the FAST system (pXY137, 100 ng; pYH20, 50 ng; and pYH102, 100 ng), the sgRNA targeting d2EYFP (pYH410, 50 ng), and the d2EYFP reporter plasmid (pYW110, 200 ng). At 12 hours after transfection, cells were illuminated (1 mW/cm2; 730 nm) for 4 hours once a day for 2 days and were harvested after trypsinization and washed in phosphate-buffered saline (PBS) for three times. About 10,000 events were collected per sample and analyzed with a BD LSRFortessa cell analyzer (BD Biosciences) equipped for d2EYFP [488-nm laser, 513-nm longpass filter, and 520/30 nm emission filter (passband centered on 530 nm; passband width of 30 nm)] detection. Data were analyzed using the FlowJo V10 software.

The production of human placental SEAP in cell culture medium was quantified using a p-nitrophenylphosphatebased light absorbance time course assay, as previously reported (31). Briefly, 120 l of substrate solution [100 l of 2 SEAP buffer containing 20 mM homoarginine, 1 mM MgCl2, and 21% (v/v) diethanolamine (pH 9.8) and 20 l of substrate solution containing 120 mM p-nitrophenylphosphate] were added to 80 l of heat-inactivated (65C, 30 min) cell culture supernatant. The time course of absorbance at 405 nm was measured by using a Synergy H1 hybrid multimode microplate reader (BioTek Instruments Inc.) installed with the Gen5 software (version 2.04).

Cell viability was assayed using an MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] cytotoxicity assay kit (catalog no. E606334-0250; Sangon Biotech Inc.) according to the manufacturers instructions. Briefly, 10 l of MTT reagent (5 mg/ml) was added to each well of 96-well plates. The samples were mixed gently and incubated for 4 hours in a CO2 incubator. Formazan solubilization solution (100 l) was added into each well. The plate was put on a shaker to mix gently for 10 min to dissolve the formazan crystals, and then the plate was read with a Synergy H1 microplate reader (BioTek Instruments Inc.) at 570 nm.

The off-target sites of the BMP1 gene were examined according to the previously reported procedure (33). Genomic DNA was extracted, as described above, and the region of genome containing the possible nuclease off-target sites was PCR amplified using appropriate primers (table S3). The following procedures were similar to those of on-target examination by T7E1 assay, as described above.

Minicircles are episomal DNA vectors that allow sustained transgene expression in quiescent cells and tissues. Minicircle DNA vectors were prepared, as previously described (36). Minicircle-producing system contains the Escherichia coli strain ZYCY10P3S2T (a genetically modified minicircle-producing bacterial strain) and the empty minicircle-producing plasmid pMC.BESPX (gene of interest would be cloned into this plasmid). Briefly, ZYCY10P3S2T competent cells prepared with standard protocol, as previously described (36), were transformed with the minicircle-producing plasmid pMC.BESPX carrying the gene of interest. The transformed cells were cultured and induced by 0.01% l-arabinose to produce minicircle DNA vectors that were devoid of the bacterial plasmid DNA backbone and contain only genes of interest.

The in vivo DNA delivery reagent APC is a cationic polymer-coated nanoparticle composed of biocompatible polystyrene sulfonate and -cyclodextrinPEI (Mw, 25 kDa) and prepared, as previously reported (41). First, the seed solution was prepared by adding freshly prepared 600 l of NaBH4 (10 mM) into 5-ml mixture of HAuCl43H2O (0.5 mM) and cetyltrimethylammonium bromide (CTAB; 0.1 M) and incubated at 30C for 30 min. Ten milliliters of HAuCl43H2O (1 mM), 10 ml of CTAB (0.2 M), 120 l of AgNO3 (0.1 M), and 600 l of hydroquinone (0.1 M) were mixed together as growth solution. When the color of the growth solution turned from yellow to colorless, 320 l of seed solution was added. The desired longitudinal surface plasmon resonance peak was obtained after keeping the reaction mixture undisturbed in dark at 30C for 12 hours. The products were then gathered by centrifugation at 7000 RCF (relative centrifugal force) for 10 min at 30C. The supernatant was removed, and the precipitate was resuspended in 2 ml of 30C ultrapure water. Furthermore, 1 ml of the products from last step [Au (0.2 mg/ml)] was added to 10 ml of polysodium 4-styrenesulfonate (2 mg/ml) dissolved in NaCl (1 mM) solution and stirred for 1 hour at 30C. The solution was centrifuged at 7000 RCF for 10 min, and the residue was resuspended to obtain 2 ml of biocompatible polystyrene sulfonatecoated nanoparticle solution. Last, 1 ml of biocompatible polystyrene sulfonatecoated nanoparticles was added to 10 ml of -cyclodextrinPEI (2 mg/ml) dispersed in NaCl (1 mM) solution and stirred for 1 hour at 30C to obtain APC.

Apoptosis analysis at the cellular level was assessed using the Annexin Vfluorescein isothiocyanate (FITC)/propidium iodide (PI) Apoptosis Detection Kit (catalog no. E606336; Sangon Biotech Inc.). Briefly, A549 cells (3 104) cotransfected with the minicircle iterations of the FAST system and the sgRNA targeting PLK1 {pYH412 (PhCMV-p65-VP64-BldD-pA::PhCMV-BphS-P2A-YhjH-pA, 135 ng), pYH414 [PFRL-NLS-Cas9(N)-Linker-Coh2-pA, 77 ng], and pYH420 [PU6-sgRNA (PLK1)::PhCMV-DocS-Linker-Cas9(C)-NES-pA, 288 ng]} were illuminated by FRL (1 mW/cm2; 730 nm) for 4 hours once a day for 2 days and were then collected at 48 hours after the first illumination for analysis. The subsequent procedures were performed according to the manufacturers instructions and analyzed by flow cytometry (BD LSRFortessa cell analyzer; BD Biosciences). The LSRFortessa was equipped with green fluorescence channel (488-nm laser, 530/30 nm emission filter, 505 nm longpass dichroic mirror) and red fluorescence channel (561-nm laser, 610/20 nm emission filter, 595 nm longpass dichroic mirror). A gate was applied on forward scatter and side scatter to remove debris from cell populations. Data were analyzed using the FlowJo V10 software.

Total RNA of cells or tissues was extracted using the RNAiso Plus kit (catalog no. 9109; Takara Bio). A total of 500 ng of RNA was reverse transcribed into cDNA using a PrimeScript RT Reagent Kit with the genomic DNA Eraser (catalog no. RR047; Takara Bio). Quantitative PCR (qPCR) reactions were performed on the LightCycler 96 real-time PCR instrument (Roche Life Science) using the SYBR Premix Ex Taq (catalog no. RR420; Takara Bio). Program for qPCR amplifications were as follows: 95C for 10 min, followed by 40 cycles at 95C for 10 s, 60C for 15 s, and 72C for 10 s, and then 95C for 10 s, 60C for 60 s, 97C for 1 s, and last, 37C for 30 s. The qPCR primers used in this study are listed in table S4. Samples were normalized to the housekeeping gene glyceraldehyde 3-phosphate dehydrogenase (GAPDH) as the endogenous control. Standard Ct method was used to obtain relative mRNA expression level.

Wild-type mice [8 week old, male, C57BL/6J, East China Normal University (ECNU) Laboratory Animal Center] were randomly divided into two groups. The semipermeable KrosFlo polyvinylidene fluoride hollow fiber membrane (Spectrum Laboratories Inc.; notably, the light-absorption properties of this material to lights of 300 to 1000 nm are almost the same) implants containing optogenetically engineered HEK-293 cells (pairs of 2.5-cm hollow fibers containing a total of 5 106 engineered cells) were subcutaneously implanted beneath the dorsal skin of the mice under anesthesia (two 2.5-cm hollow fibers in each mouse). At 1 hour after implantation, the mice were illuminated by FRL (10 mW/cm2; 730 nm; 2-min on, 2-min off, alternating, to avoid the thermal discomfort in mice caused by continuous illumination) for 4 hours once a day for 2 days. The control mice were kept in dark. Cells were then collected from the implanted hollow fibers at 48 hours after the first illumination, and the genomic DNA was extracted for mismatch-sensitive T7E1 assay to quantify the indel mutations of the endogenous gene CCR5.

The transgenetic Ai14 tdTomato reporter mice [6 week old, female, Gt(ROSA)26Sortm14(CAG-tdTomato)Hze, from the Jackson laboratory; Ai14 is a Cre reporter allele designed to have a loxP-flanked stop cassette, preventing the transcription of a CAG promoterdriven red fluorescent tdTomato, all inserted into the Gt(ROSA)26Sor locus] were randomly divided into three groups (vehicle, FAST without illumination, and FAST with FRL). The minicircle DNA vectors encoding the FAST system {pYH412 (PhCMV-p65-VP64-BldD-pA::PhCMV-BphS-P2A-YhjH-pA, 81 g), pYH413 [PU6-sgRNA (tdtomato stop cassette)::PhCMV-DocS-Linker-Cas9(C)-NES-pA, 173 g], and pYH414 [PFRL-NLS-Cas9(N)-Linker-Coh2-pA, 46 g]} were dissolved in Ringers solution [NaCl (8.6 g/liter), KCl (0.3 g/liter), and CaCl2 (0.28 g/liter)] and injected into mices tail vein by hydrodynamic injection. The injection volume of the DNA mixture solution was 100 l per mouse weight (gram). Twenty-four hours after injection, mice were illuminated with FRL (10 mW/cm2; 730 nm; 2-min on, 2-min off, alternating, to avoid the thermal discomfort in mice caused by continuous illumination) for 4 hours per day for 3 days (according to the time schedule in Fig. 5A). A second-round injection of the minicircle-based FAST system was performed on the fifth day, followed by 4 hours of daily illumination for three additional days. On the 15th day after the first hydrodynamic injection, mice were euthanized, and the livers were isolated for fluorescence imaging or histological analysis. The tdTomato signal from isolated liver was detected using IVIS Lumina II in vivo imaging system (PerkinElmer, USA) and frozen tissue section histological analysis.

First, dissected liver tissue blocks were soaked in 4% paraformaldehyde for 2 hours. Subsequently, the tissue blocks were stepwise dehydrated with 15% sucrose solution overnight and then soaked in 30% sucrose solution for another 3 hours. After being washed three times with PBS, freshly dissected tissue blocks (<5 mm thick) were placed on to a prelabeled tissue base mold and embedded in Tissue-Tek optimal cutting temperature (O.C.T.) compound (catalog no. 4583; Sakura). These tissue blocks were stored at 80C for freezing until ready for sectioning. The tissues were sliced into frozen sections with 5-m thickness using Cryostat Microtome (Clinical Cryostat; CM1950; Leica) for further processing or stored at 80C ultralow-temperature freezer.

A total of 5 106 of A549 cells were suspended in 0.2 ml of sterile PBS and subcutaneously injected onto the back of the 6-week-old female BALB/c nude mice (ECNU Laboratory Animal Center). When the tumor size reached about 80 to 100 mm3, APC/FAST complex containing 20 l of APC and the minicircle iteration of the FAST system {pYH412 (PhCMV-p65-VP64-BldD-pA::PhCMV-BphS-P2A-YhjH-pA, 2.7 g), pYH414 [PFRL-NLS-Cas9(N)-Linker-Coh2-pA, 1.5 g], and pYH420 [PU6-sgRNA (PLK1)::PhCMV-DocS-Linker-Cas9(C)-NES-pA, 5.8 g]} were injected intratumorally. These injected mice were randomly divided into two groups (dark and illumination). Injections were conducted under anesthesia once every 2 days for five times. Twenty-four hours after every injection, mice were illuminated with FRL (10 mW/cm2; 730 nm; 2-min on, 2-min off, alternating, to avoid the thermal discomfort in mice caused by continuous illumination) according to the time schedule in Fig. 6A or kept in dark. Mice of the vehicle control group were intratumorally injected with 20 l of APC and 50 l of PBS and were then illuminated with FRL (10 mW/cm2; 730 nm; 2-min on, 2-min off), as indicated in Fig. 6A. The tumor sizes and the body weights of mice were measured every 2 days. On the 15th day after the first intratumor injection, all mice were sacrificed and tumor weights were recorded. The tumor volumes were measured using a digital caliper and calculated by the following formula: tumor volume = [length of tumor (width of tumor)2]/2. Then, tumors were isolated for indel mutation analysis and tumor apoptosis detection by hematoxylin and eosin (H&E) staining, TUNEL, and caspase-3labeling assays.

Glass slides that hold the frozen tissue sections were washed with PBS three times for 5 min each time, transferred to 0.5% Triton X-100 (dissolved in PBS; Sigma-Aldrich) for 10 min, and washed with PBS twice for 5 min each time. The slides were rinsed in running tap water at room temperature for 1 min. The samples were then stained in hematoxylin staining solution (catalog no. E607317; Sangon Biotech Inc.) for 8 min and washed in running tap water for 10 min. Next, the samples were differentiated in 1% acid alcohol for 10 s, washed in running tap water for 30 min, and were then counterstained in eosin staining solution (catalog no. E607321; Sangon Biotech Inc.) for 30 s to 1 min and washed in running tap water for 10 min. Last, the tissue sections were sealed by a drop of mounting medium over the tissue and then covered by a coverslip. The prepared slides were then observed by a microscope (DMI8; Leica) equipped with an Olympus digital camera (Olympus DP71; Olympus).

A TUNEL Apoptosis Assay Kit (catalog no. 30063; Beyotime Biotechnology Inc.) was used to evaluate tumor tissue apoptosis according to the manufacturers instructions. After washing three times with PBS, the slides were incubated with 4,6-diamidino-2-phenylindole (DAPI) solutions (5 g/ml; catalog no. C1002; Beyotime Inc.) for 2 to 5 min at room temperature. The slides were further washed three times with PBS and mounted with the antifade mounting media. Last, the slides were sealed and observed by a fluorescence microscope (DMI8; Leica) equipped with an Olympus digital camera (Olympus DP71; Olympus). TUNEL-positive nuclei were stained green, and all other nuclei were stained blue.

Isolated tumor frozen tissue sections were thawed at room temperature for 15 min and rehydrated in PBS for 10 min. The tissue samples were surrounded with a hydrophobic barrier using a barrier pen after draining the excess PBS. Then, the slides were soaked in 0.5% Triton X-100 (dissolved in PBS; catalog no. 9002-93-1; Sigma-Aldrich) for 20 min. Nonspecific staining between the primary antibodies and the tissue samples was blocked by incubating sections in the block buffer (1% FBS in PBS) for 1 hour at room temperature. After incubating with the anticaspase-3 antibody (1:100; catalog no. ab32351; Abcam) overnight at 4C, the slides were washed three times for 15 min each time in PBS and then incubated with the Alexa Fluor 555 goat anti-rabbit immunoglobulin G antibody (1:500; catalog no. ab150078; Abcam) for 1 hour at room temperature. After washing three times with PBS, the slides were incubated with DAPI solutions (5 g/ml; catalog no. C1002; Beyotime Inc.) for 2 to 5 min at room temperature. The slides were further washed three times with PBS and mounted with the antifade mounting media. Last, the slides were sealed and observed by a fluorescence microscope (DMI8; Leica) equipped with an Olympus digital camera (Olympus DP71; Olympus). Caspase-3positive cytoplasm was stained red, and all nuclei were stained blue.

All experiments involving animals were conducted in strict adherence to the guidelines of the ECNU Animal Care and Use Committee and in direct accordance with the Ministry of Science and Technology of the Peoples Republic of China on Animal Care. The protocols were approved by the ECNU Animal Care and Use Committee (protocol IDs, m20180105 and m20190607). All mice were euthanized after the termination of the experiments.

All in vitro data represent means SD and are described separately in the figure legends. For the animal experiments, each treatment group consisted of randomly selected mice (n = 3 to 5). Comparisons between groups were performed using Students t test, and the results are expressed as means SEM. GraphPad Prism software (version 6) was used for statistical analysis.

Acknowledgments: We are grateful to all the laboratory members for cooperation in this study, especially J. Jiang, S. Zhu, and X. Yang. Funding: This work was financially supported by the grants from the National Key R&D Program of China, Synthetic Biology Research (no. 2019YFA0904500), the National Natural Science Foundation of China (NSFC; no. 31971346 and no. 31861143016), the Science and Technology Commission of Shanghai Municipality (no. 18JC1411000), the Thousand Youth Talents Plan of China, and the Fundamental Research Funds for the Central Universities to H.Y. This work was also partially supported by NSFC no. 31901023 to N.G. We also thank the ECNU Multifunctional Platform for Innovation (011) for supporting the mouse experiments and the Instruments Sharing Platform of School of Life Sciences, ECNU. Author contributions: H.Y. conceived the project. H.Y. and Y.Y. designed the experiment, analyzed the results, and wrote the manuscript. Y.Y., X.W., J.S., H.L., and Y.C. performed the experimental work. Y.P., D.L., and N.G. analyzed the results and revised the manuscript. All authors edited and approved the manuscript. Competing interests: The authors declare that they have no competing interests. Data and materials availability: All data needed to evaluate the conclusions in the paper are present in the paper and/or the Supplementary Materials. Additional data related to this paper may be requested from the authors. All genetic components related to this paper are available with a material transfer agreement and can be requested from H.Y. (hfye{at}bio.ecnu.edu.cn).

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Molecular Probes Market 2020 Global Industry Analysis, Opportunities, Major Applications and Forecast to 2027 – Cole of Duty

July 10th, 2020 2:46 pm

Molecular probes are the part of small RNA or DNA which recognizes the complementary sequences in DNA and RNA molecules. Molecular probes are used in identification and isolation of specific RNA or DNA sequences from organism. Molecular probes offers as the resources for various applications such as chromosomal mapping, molecular cytogenetics, and DNA fingerprinting. Also, molecular probes are used in various fields such as physiology, embryology, scientific classification, and hereditary building.

Increase in development of map-based cloning of agronomical important genes, marker based gene tags, phylogenetic analysis is expected to boost the global molecular probes market growth. Furthermore, continuous development in genetic engineering technology will have the positive impact on global molecular probes market growth. Molecular probes are developed and designed for genetic engineering research and widely used for diagnosis of infectious diseases. Moreover, increase in government initiatives for clinical investigations in molecular probes, it is expected to propel the growth of molecular probes market during this forecast period.

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However, lack of robust reimbursement framework for customized and genomic medicine is the major restraining factor which is expected to hinder the growth of global molecular probes market.

Market Key Players

Various key players are discussed in this report such as BioRad Laboratories, Hologic, Sysmex Corporation,Dako, Danaher, Thermo Fisher Scientific, and bioMerieux SA.

Market Taxonomy

By Product

By Application

By End User

By Region

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Israel Innovation Authority to invest almost $4 million in bio-convergence R&D programs – CTech

July 10th, 2020 2:46 pm

The Israel Innovation Authority (IIA) will invest nearly $4 million in a new call for proposals in the field of bio-convergence. The IIA announced on Thursday that it is inviting researchers in academia, hospitals and commercial companies to submit requests for R&D funding to develop programs commercializing academic knowhow for medical innovation in bio-convergence, an approach that integrates biology with additional disciplines from engineering such as electronics, AI, physics, computer science, nanotechnology, material science, and advanced genetic engineering. The total budget for the project will be NIS 13.5 million (approximately $3.92 million)

"Given that bio-convergence is still a burgeoning technological field, most relevant expertise in the area remains concentrated in academic institutions," said Aharon Aharon, CEO of the Israel Innovation Authority. "The Israel Innovation Authoritys call for proposals will help in developing R&D programs with the potential to contribute to the commercial application of this technology. This synthesis of academia and industry is part of an overall attempt to develop an innovative ecosystem that will be an engine of growth for Israeli industry."

This is the IIAs first call for proposals from academia and industry in the field of bio-convergence in 2020, with the Israeli government's tech investment arm hoping this will pave the way for commercial deployment through two separate tracks.

In the first track, the proposal must relate to applied multidisciplinary research in medicine, joining a top researcher in the life sciences with at least one leading researcher in the field of engineering, computer sciences, math, or physics. In the second track, the proposal will be for commercialization of medical expertise, developed through multidisciplinary life sciences research integrating engineering, computer science, mathematics or physics.

The proposals must be submitted by September 21, with the results to be finalized in December 2020.

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Israel Innovation Authority to invest almost $4 million in bio-convergence R&D programs - CTech

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Brazilian man in long-term HIV remission without a stem cell transplant – aidsmap

July 10th, 2020 2:45 pm

A man in So Paulo who has no evidence of remaining HIV after more than 15 months off antiretrovirals at least according to tests done so far may represent the first case of a functional cure without the risks of a stem cell transplant, according to a report presented today at the23rd International AIDS Conference (AIDS 2020: Virtual).

As part of a clinical trial, the 35-year-old man had two additional antiretrovirals, the integrase inhibitor dolutegravir (Tivicay) and the entry inhibitor maraviroc (Celsentri), added to his standard three-drug regimen. In addition, he received nicotinamide, a water-soluble form of niacin, or vitamin B3.

He underwent a closely monitored treatment interruption in March 2019. More than 15 months later, he continues to have undetectable HIV RNA (the form of viral genetic material measured in a typical viral load test) as well as undetectable HIV DNA (the form that largely makes up the viral reservoir).

But experts caution against reading too much into this case, as it involved only a single individual and extensive testing for traces of HIV at various sites in the man's body have not yet been carried out.

"The fact that it's a single case suggests that this may not be real," Dr Steven Deeks of the University of California in San Francisco told aidsmap. "We know that some people can achieve what appears to be remission with antiretroviral drugs alone. This may simply be a person who got lucky with antiretrovirals."

So far, two people appear to have been cured of HIV. Timothy Ray Brown, formerly known as the Berlin Patient, has had no evidence of replication-competent HIV anywhere in his body for more than 13 years. The second man, dubbed the London Patient, still has no detectable virus as he approaches three years off antiretroviral therapy (ART).

Both men received bone marrow transplants to treat leukaemia or lymphoma using stem cells from a donor with a rare genetic mutation known as CCR5-delta-32, which results in missing CCR5 co-receptors on T cells, the gateway most types of HIV use to infect cells. Before the transplants, they received chemotherapy to kill off their cancerous immune cells, essentially allowing the donor stem cells to rebuild a new HIV-resistant immune system.

But this procedure is far too dangerous for people whose lives are not already threatened by advanced cancer. What's more, it requires intensive medical intervention, is extremely expensive and could probably not be scaled up enough to make it feasible for the millions of people living with HIV worldwide.

This has led researchers to ask whether the right combination of medications could offer a safer and less expensive path to long-term remission or ultimately a cure.

Dr Ricardo Diaz of the University of So Paulo in Brazil, Dr Andrea Savarino of the Italian Institute of Health in Rome and their team conducted a clinical trial known as SPARC-7 to evaluate multiple interventions aimed at reducing the size of the HIV reservoir.

This reservoir is comprised of latent HIV integrated into inactive host cells, primarily T cells. Antiretrovirals cannot reach this hidden virus, but if treatment stops and the cells become reactivated, they can once again begin churning out new copies of the virus.

The study enrolled HIV-positive adults who were on their first antiretroviral regimen, had viral suppression for more than two years and had never had a CD4 count below 350 cells/mm3.

Five of the participants added dolutegravir, maraviroc and 500mg twice daily of nicotinamide to their original three-drug antiretroviral regimen for 48 weeks. They then reverted back to standard ART and finally underwent an analytical treatment interruption, in which viral load and other parameters are closely monitored.

As Savarino explained in an interview with aidsmap prior to the conference (watch above), nicotinamide was chosen because it appears to fight HIV by multiple mechanisms. Available as an inexpensive oral supplement, nicotinamide is being studied as a cancer treatment because of its immune-boosting properties. It helps prevent exhausted T cells from committing suicide (apoptosis) by inhibiting the activity of enzymes called PARPs that repair broken DNA. It may also act as a histone deacetylase (HDAC) inhibitor that keeps T cells out of a latent state. Maraviroc, too, may act as a latency-reversing agent in addition to its better-known effect of blocking HIV entry into cells.

The Brazilian who remains in remission was diagnosed with HIV in October 2012, at which time he had a lowest-ever CD4 cell count (372 cells/mm3) and viral load (over 20,000 copies/ml) characteristic of chronic infection. Two months later, he started treatment with efavirenz (Sustiva), zidovudine (AZT) and lamivudine (3TC), substituting tenofovir disoproxil fumarate (TDF) for zidovudine in 2014.

The man enrolled in the clinical trial in September 2015 and started on the intensified ART regimen plus nicotinamide. Among the 30 participants receiving various investigational regimens in the study, he was the only one who experienced low-level viral blips during his experimental treatment (at weeks 16 and 24), but his viral load thereafter remained undetectable.

Halting of the function or replication of a virus. In HIV, optimal viral suppression is measured as the reduction of viral load (HIV RNA) to undetectable levels and is the goal of antiretroviral therapy.

Taking a planned break from HIV treatment, sometimes known as a drugs holiday. As this has been shown to lead to worse outcomes, treatment interruptions are not recommended.

The disappearance of signs and symptoms of a disease, usually in response to treatment. The term is often used in relation to cancer, indicating that there is no evidence of disease, although the possibility of cancer remaining in the body cannot be ruled out. In HIV, remission is an alternative term for functional cure. A sustained ART-free remission would boost the immune system to induce long-term control of HIV, allowing a person living with HIV to maintain an undetectable viral load without daily medication.

The HIV reservoir is a group of cells that are infected with HIV but have not produced new HIV (latent stage of infection) for many months or years. Latent HIV reservoirs are established during the earliest stage of HIV infection. Although antiretroviral therapycan reduce the level of HIV in the blood to an undetectable level, latent reservoirs of HIV continue to survive (a phenomenon called residual inflammation). Latently infected cells may be reawakened to begin actively reproducing HIV virions if antiretroviral therapy is stopped.

After completing 48 weeks on this combination, he returned to his prior three-drug regimen, later swapping out efavirenz for nevirapine (Viramune) and ultimately dolutegravir. Throughout, he maintained viral suppression.

In March 2019, he started an analytical treatment interruption, stopping his antiretroviral therapy under medical supervision. Today, his viral load remains undetectable according to HIV RNA blood tests done every three weeks. His last test was on 22 June 2020, meaning he has maintained viral suppression for more than 65 weeks off antiretrovirals.

The man's CD4 cells were generally stable while on the experimental intensified regimen, rose after returning to standard three-drug therapy and then dropped after starting the treatment interruption.

Various markers of CD8 cell activation the type of T cells that fight HIV declined after starting the intensified regimen and remained below the baseline level.

Looking at other parameters can give clues about whether HIV remains present but under control or has truly been eliminated.

The man's HIV DNA level in peripheral blood immune cells rose after starting the experimental regimen suggesting the treatment may have reactivated latent reservoir cells but then fell to an undetectable level after he resumed standard ART. It has remained undetectable during the treatment interruption.

HIV DNA in the man's gut biopsy samples declined while he was on the intensified regimen. Further analysis of HIV in gut tissue, lymph nodes and other sites as Timothy Brown has undergone will be needed to show whether the man is in fact functionally cured. However, Savarino told aidsmap that these more invasive tests have been put on hold due to COVID-19 restrictions on health services in Brazil.

"Four other individuals treated with the same intensified regimen did not maintain viral suppression."

The presence of HIV antibodies indicates that, even while on treatment, enough of the virus remains to stimulate ongoing antibody production. In this case, the man's antibody level declined steadily while he was on the experimental regimen and continued to fall after he resumed three-drug therapy. During the treatment interruption, he maintained a very low antibody level low enough that a rapid antibody test became negative.

Importantly, Savarino told aidsmap, four other individuals treated with the same intensified regimen did not maintain viral suppression.

Speaking at a media briefing, conference co-chair Dr Anton Pozniak of Chelsea and Westminster Hospital recalled that we have heard of many other potential HIV cures before including the famed Mississippi baby, who maintained viral suppression off antiretrovirals for more than two years before her virus rebounded but so far these have mostly ended in disappointment.

Deeks urged caution about "overinterpreting" the findings from this case, which does not suggest any interventions that people living with HIV should undertake on their own at this time. In particular, people should not start taking nicotinamide or niacin, which can cause an uncomfortable flushing side effect at high doses.

"I would certainly encourage people to not jump on this. This may not be real and it could actually cause harm," he said. "I would not encourage anyone to run out to the local health food store and get this drug, and dont stop taking antiretrovirals."

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Brazilian man in long-term HIV remission without a stem cell transplant - aidsmap

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