Background: Neurorehabilitation plays a key role in improving motor recovery for people with neurological conditions. Although 3D printing has emerged as a promising rehabilitation tool, little is known on how it is used for the rehabilitation of adults living with neurological conditions worldwide. Objective: We aimed to provide a comprehensive overview of 3D printing in neurorehabilitation and precisely explore how it is used to improve motor recovery for adults with neurological conditions living in higher- and lower-middle–income countries. Methods: We conducted a scoping review following the Joanna Briggs Institute guidelines. After searching 3 databases (MEDLINE, Web of Science, and Nursing and Allied Health Premium), 2 independent reviewers screened and selected English-language studies involving adults (≥18 years) published between 2019 and 2024 to capture the most recent advancements in this field. We extracted relevant information on neurological conditions, motor recovery outcomes, and types of 3D printing and offered a comparative analysis of 3D printing in physical neurorehabilitation from the perspective of national income levels using a modified Joanna Briggs Institute extraction form. We synthesized the findings narratively with tabular support. Results: After screening 2752 titles and abstracts and 103 (3.7%) full texts, we included 13 (0.5%) studies based on our inclusion criteria. All included studies were conducted in upper-middle–income or high-income countries, and most studies (9/13, 69.2%) focused on stroke, followed by spinal cord injury (2/13, 15.4%), Parkinson disease (1/13, 7.7%), and central nerve disease (1/13, 7.7%). The 3D-printed rehabilitation tools included orthotics (7/13, 53.8% for the upper extremities [UEs]; 3/13, 23.1% for the lower extremities [LEs]), an exoskeleton (1/13, 7.7%; UEs), a modular assistive hand device (1/13, 7.7%; UEs), and an insole (1/13, 7.7%; LEs). In total, 69.2% (9/13) of the studies targeted UE rehabilitation, measured using the Action Research Arm Test, active range of motion, the box and block test, the Fugl-Meyer Assessment, the Modified Ashworth Scale, the manual function test, range of motion, and the Toronto Rehabilitation Institute Hand Function Test, and 30.8% (4/13) targeted LE rehabilitation, measured using the 10-m walk test, anteroposterior ground reaction force analysis, the Barthel index, the Tinetti scale, the RehaWatch system, and the GaitWatch system. Conclusions: Used as a rehabilitation tool, 3D printing technology has demonstrated significant potential in improving upper and lower motor recovery for people with certain neurological conditions in high-middle–income countries. Future research should explore the implementation feasibility and effectiveness of these technologies across different neurological conditions and income settings, particularly in low- and lower-middle–income countries.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/11352972abf74214e055b465780e25ce" />
Comparing Usual Care With Coordinated Clinician and Patient Use of Mobile Technology in Primary Care for Patients With Major Depressive Disorder: Practice-Based Pilot Study
Background: Major depressive disorder (MDD) affects millions of Americans each year and is often diagnosed and treated in primary care. Evidence shows that self-management techniques, shared decision-making (SDM), and goal setting are effective strategies for managing MDD, but the required collaboration between patients and primary care clinicians can be difficult. Primary Care Path is a program for supporting depression management in primary care that includes a patient-facing mobile app and an accompanying care team–facing web interface. Leveraging programs that provide clinician-facing software with companion patient-facing mobile technology may help patients and physicians align depression treatment and management goals, support effective SDM, alleviate barriers, and improve both clinical care and patient outcomes. Objective: To pilot-test the use of Primary Care Path for MDD management in primary care and evaluate the impact of its use on depression treatment, symptoms, goal setting and attainment, and SDM. Methods: Four primary care clinical practices in the United States were assigned to program use (2 practices; intervention) versus usual care (2 practices; control). Intervention practices used the Primary Care Path program in their clinics and engaged patient participants in app use for 18 weeks. Clinical care teams engaged with the patient-informed program portal primarily during patient encounters (in-person, virtual or calls). Patient participants were smartphone users aged 18 years and older who were being treated for MDD. Patient participants received online surveys (medication changes, Patient Health Questionnaire-9 [PHQ-9], goal setting and attainment questions, and Shared Decision-Making Questionnaire-9 [SDM-Q-9]) at baseline, 6, 12, and 18 weeks. Results: A total of 76 patient participants (34 intervention; 42 control) were enrolled; the majority were female (27/34, 79%; 32/42, 76%), White (31/34, 91%; 40/42, 95%), non-Hispanic/Latino/a (29/34, 85%; 40/40, 100%), and employed (26/34, 77%; 34/42, 81%). Control patient participants’ conversations with their medical providers increased over the study period, while intervention patient conversations with their medical providers decreased over time. At week 18, intervention participants felt more successful than control in achieving their personalized treatment goals. More intervention patient participants initiated antidepressant medication by weeks 12 (=.03) and 18 (=.04) and switched medications by weeks 6 (=.009) and 12 (=.04) versus control. All patient participants demonstrated significant improvement in PHQ-9 scores throughout the study period (<.001), with no difference in change by group. Clinicians and patients indicated using the program to support SDM, but no significant differences were observed in SDM-Q-9 between intervention and control. Conclusions: Preliminarily, the use of this digital health program related to earlier medication optimization, earlier conversations between patients and medical providers, and patient attainment of goals that matter most to them, indicating that coordinated use of the program by both patients and clinical team members may enhance MDD management in primary care clinical settings.
Advanced Cardiovascular-Kidney-Metabolic Syndrome Linked to Increased Cancer Risk
Researchers from Japan are calling for increased cross-disciplinary collaboration after showing that people with advanced cardiovascular-kidney-metabolic (CKM) syndrome are at increased risk for cancer.
They explain in Circulation: Population Health and Outcomes that CKM syndrome is a conceptual framework, proposed by the American Heart Association (AHA) in 2023, that captures the interconnected nature of cardiovascular, kidney, and metabolic diseases and reflects the shared risk factors and pathophysiological mechanisms of these diseases.
The current study findings suggest that this framework could also “serve as a valuable, non-invasive stratification tool in precision oncology and preventive medicine,” said Hidehiro Kaneko, MD, PhD, the study’s lead author and associate professor in the department of cardiovascular medicine at the University of Tokyo in Japan.
He told Inside Precision Medicine: “By identifying individuals with advanced CKM (particularly stages 3 and 4), clinicians could tailor and potentially intensify cancer screening protocols for these high-risk patients. This enables more personalized surveillance and early detection strategies that bridge the gap between cardiometabolic management and cancer prevention.”
According to AHA statistics, nearly nine out of 10 adults in the United States have at least one component of CKM syndrome, which includes high blood pressure, abnormal cholesterol, diabetes, obesity, and reduced kidney function.
Although these components of CKM syndrome have each been associated with an increased risk for certain cancers, the relationship between CKM stage and the risk for incident cancer is unclear, as current knowledge is largely derived from studies of individual components rather than the integrated syndrome.
To address this, Kaneko and team analyzed administrative claims data for more than 1.3 million people living in Japan. Of these, 12.5% had CKM stage 0, 9.8% had stage 1, 31.7% had stage 2, 36.3% had stage 3, and 9.8% had stage 4.
The researchers report that, over a median follow-up of 3.4 years, increasing baseline CKM stages were associated with significantly greater cancer incidence.
Specifically, the incidence of cancer was 81.2 cases per 10,000 person–years in people with CKM stage 0, increasing to 97.2, 105.1, 250.9, and 257.7 cases per 10,000 person–years in those with CKM stages 1, 2, 3, and 4, respectively.
After adjustment for age, sex, alcohol consumption, and physical inactivity, individuals with CKM stage 1 or 2 at baseline did not have a significantly increased risk for cancer relative to those with CKM stage 0. However, people with CKM stages 3 and 4 had significant 25% and 30% higher risks for cancer, respectively, than those with stage 0.
When the team analyzed the data by cancer type, they found that the incidence of colorectal, stomach, lung, renal pelvis and ureter, pancreatic, non-Hodgkin lymphoma, bladder, liver, kidney, thyroid, leukemia, and gallbladder cancers increased progressively with higher baseline CKM stages. There was a similar pattern for prostate cancer in men and for breast, cervical, and uterine cancers in women.
Conversely, there was no clear association between baseline CKM stage and the incidence of esophageal cancer, malignant melanoma, or Hodgkin lymphoma.
The associations between CKM stage 3 or 4 and cancer risk were stronger in men than in women and in people younger than 65 years of age relative to older individuals. However, people aged 65 years and older were also at increased risk for cancer even when they had CKM stage 1 or 2 relative to stage 0, whereas younger individuals were not.
Kaneko said that the study highlights a critical need for increased awareness of the link between CKM syndrome and cancer.
“While physicians and the public generally understand that interconnected metabolic and kidney conditions lead to heart disease and stroke, the integrated CKM syndrome is rarely viewed as a significant driver of cancer,” he remarked. “Our study demonstrates a clear, stage-dependent increase in incident cancer risk as CKM progresses, underscoring the need to recognize cancer as a major potential consequence of this multisystem syndrome.”
Kaneko suggested that “this can be addressed by shifting public health messaging to emphasize that proactive lifestyle modifications—such as weight management, a healthy diet, and regular exercise—provide dual protection against both cardiovascular events and cancer.”
He added: “Within the medical community, we should promote the CKM staging framework as a comprehensive health assessment tool, encouraging cross-disciplinary collaboration among cardiologists, nephrologists, endocrinologists, and oncologists to manage these overlapping risks holistically.”
The post Advanced Cardiovascular-Kidney-Metabolic Syndrome Linked to Increased Cancer Risk appeared first on Inside Precision Medicine.
STAT+: Sanofi asks to pull diabetes drug out of FDA voucher program after political appointee interfered with review
WASHINGTON — Sanofi has asked the Food and Drug Administration to pull its type 1 diabetes drug, teplizumab, out of Commissioner Marty Makary’s new speedy drug review program.
The move comes after acting Center for Drug Evaluation and Research Director Tracy Beth Høeg disagreed with a staff decision to approve the drug, according to sources familiar with the dispute who requested anonymity due to fear of reprisal. The agency has missed its goal date of April 21 to deliver a decision to Sanofi.
Such decisions are typically made by career scientists. It’s rare for a center director to become involved in scientific review of a single drug, and particularly a political appointee like Høeg. Makary recently told CNBC that he stands behind review teams, and that “disaster” occurs whenever political leaders overrule scientific staff.
<![CDATA[Tracy Hicks, DNP, FNP/PMHNP-BC, outlines how personalized, team-based care and shared decision-making can improve schizophrenia outcomes in real-world practice.]]>
Heavy-Chain BsAbs More Manufacturable than Light-Chains
Bispecific antibodies (BsAb) were first approved in 2014. Since then, a total of 19 have been approved globally, and approximately 250 BsAbs are being developed by some 180 companies, according to a report from Research and Markets. As this therapeutic class moves out of the lab and into clinical and commercial sectors, manufacturing may be its biggest challenge.
These dual-targeting compounds are considered difficult to produce, especially at scale. With low yields, potential chain mispairing, stability and aggregation issues, and analytical characterization challenges, biomanufacturers are eager to find expedient solutions. “There is still significant work to be done in bioprocess engineering to substantially improve the efficiency of bispecific antibody design and manufacturing,” Laura A. Palomares, PhD, senior researcher, Universidad Nacional Autónoma de Mexico (UNAM), tells GEN.
To that point, rather than relying upon transient expression systems or evaluating various antibody sequences, Palomares and her team are identifying manufacturable BsAbs by correlating their architectures to growth, productivity, downstream recovery, production of product-related variants, and in vitro binding to Zika virus and transferrin receptor (TfR). They found BsAb architecture is crucial in terms of those manufacturing criteria.
Structure governs performance
Specifically, as much as a 70% difference in productivity was found between symmetric heavy-chain scFv fusion BsAbs—which performed like the parental antibody—and BsAbs that were designed as light-chain scFv fusion, dual-variable domain immunoglobulin (DVD), or asymmetric antibodies. That’s according to a recent study by Palomares, doctoral student Juan Carlos Rivera-Castro, and senior researcher Octavio T. Ramirez, PhD.
Asymmetric BsAbs had the worst culture performance and productivity of the BsAb architectures tested. Asymmetry created imbalanced chain expression and formed homodimeric and half-antibody by-products, they reported, which dropped purity to approximately 68% after protein A purification. They found that binding to the LC-scFV diminished the binding to Zika virus, and that DVD increases it. Also, binding to TfR varied according to BsAb valency and configuration.
In contrast, “Bivalent heavy-chain scFV formats show[ed] stronger apparent binding than monovalent formats,” they report.
For the best manufacturability, the team says, “Avoid the modification of the light chain and preserve symmetric assembly.” This strategy resulted in higher cell viability, productivity, and final purity.
“The construction and head-to-head comparison of various formats, including the effect of the formats on antigen binding, can guide those planning the design and production of BsAbs,” Palomares says, by understanding the relative tradeoffs of various architectures as they design and clone BsAbs for specific functionalities.
“Format selection should prioritize manufacturability, with complex designs reserved for cases with particular functional requirements,” the scientists conclude.
Next steps, Palomares says, are to “determine the in vivo functionality of the constructed formats to neutralize Zika virus after traversing the blood-brain barrier. The results of those experiments will also be useful to scientists interested in BsAb design.”
The post Heavy-Chain BsAbs More Manufacturable than Light-Chains appeared first on GEN – Genetic Engineering and Biotechnology News.
Researchers’ Spinout Focuses on Simplifying Viral Vector Purification
U.S.-based researchers have developed a portfolio of peptide ligands for purifying viral vectors for gene therapies and have launched a company that develops affinity technologies for biopharmaceutical manufacturers.
ChromaGenix, a spinout from North Carolina State University (NC State), commercializes peptide ligands as an alternative to the traditional protein ligands used in affinity chromatography.
According to Stefano Menegatti, PhD, CSO at ChromaGenix and a professor in the Department of Chemical and Biomolecular Engineering at NC State, the ligands are cheaper and less likely to trigger an immune response in patients than the protein ligands traditionally used.
“Protein ligands have been a fantastic enabler of advanced biological therapies over the past two decades, but they do have shortcomings,” he explains. “Proteins can denature or degrade, potentially releasing immunogenic fragments, which poses a certain level of risk.” As such, Menegatti says, protein ligands have a short lifetime and must be replaced frequently, adding further to production costs. They can also bind too strongly to the product, making it harder to recover it from the chromatographic step.
By contrast, peptide ligands, which are very small proteins, overcome these issues, he says. They can be produced synthetically, making them cheaper than proteins. As they don’t have a complex structure, they can be cleaned under harsh conditions without becoming inactive. They have a longer lifespan and a much lower immunogenicity risk, Menegatti says. Also, as they’re small, he explains,they can be cleared during final product filtration.
This “represents a new frontier of gene therapy manufacturing, says Menegatti, “as it boosts the efficiency of the viral vector manufacturing pipeline.”
Having developed peptide ligands for a wide variety of viral vectors, ChromaGenix is already selling to many companies, Menegatti says. The researchers and the company are now hoping to move beyond gene therapies.
“Our next chapter is going to be developing ligands for the purification of therapeutic cells, starting with CAR [chimeric antigen receptor] T cells,” he says.
The post Researchers’ Spinout Focuses on Simplifying Viral Vector Purification appeared first on GEN – Genetic Engineering and Biotechnology News.
Moss Powering the Next Drug Frontier
For decades, Chinese hamster ovary (CHO) cells have been the gold standard for producing biologic drugs, from monoclonal antibodies to enzyme therapies. But for some of the most complex and fragile proteins, even CHO systems can fall short. Now, an unlikely contender—moss—is offering a new path forward.
At Germany-based Eleva, researchers are using Physcomitrium patens, a simple moss species, as a suspension cell culture system for producing recombinant human proteins that are difficult and sometimes impossible to manufacture in conventional platforms. According to Andreas Schaaf, PhD, Eleva’s CSO, these include “glycoproteins with complex or sensitive glycosylation requirements,” as well as cytokines, immune-cytokines, complement regulators, enzymes for rare metabolic disorders, and advanced antibody formats such as antibody-toxin conjugates.
The technology has deep academic roots. Plant biotechnologist Ralf Reski, PhD, at the University of Freiburg, helped develop P. patens into a model species for synthetic and systems biology and co-invented the moss bioreactor. His research led to the founding of Greenovation, now known as Eleva, which has since advanced the platform toward clinical-stage drug development.
The company’s first moss-produced drug candidate to enter clinical studies was a recombinant alpha-galactosidase enzyme replacement therapy (ERT) for Fabry disease, a rare lysosomal storage disorder. Current ERT options for Fabry patients are limited by short circulating half-life, inefficient uptake into key affected cell types, and immunogenicity. Eleva believes the more uniform glycosylation achieved through moss production could help overcome these limitations.
A particularly significant demonstration of the platform is Eleva’s recombinant complement Factor H candidate, currently in Phase Ib. Factor H is a large complement-regulatory glycoprotein used to target complement-related renal diseases such as C3 glomerulopathy (C3G), lupus nephritis (LN), and potentially dry age-related macular degeneration (AMD).
Schaaf notes that Factor H “had long resisted reliable expression in conventional systems such as yeast or CHO cells.” For patients with C3G—many of whom are young and face a 50% rate of kidney failure within ten years—the ability to restore natural Factor H activity could represent a major therapeutic shift. Current treatments often rely on broader complement suppression and carry boxed warnings for serious infections.
So why moss?
Unlike mammalian cells, which often generate heterogeneous glycan mixtures, moss produces more uniform glycosylation profiles due to its simplified glycan-processing pathway. This matters because glycosylation can directly affect a drug’s stability, efficacy, and immunogenicity.
Moss cells are also largely unaffected by toxic cytokine feedback, which in mammalian systems can inhibit growth or trigger apoptosis, limiting secretion efficiency and yields. Plant-specific chaperones and folding assistants, including protein disulfide isomerases, also help prevent protein aggregation and support the correct assembly of complex multimeric proteins.
“Moss offers clear advantages over other expression systems for certain protein classes that are difficult or impossible to manufacture otherwise,” Schaaf says, adding that such therapies might otherwise be “deprioritized or abandoned.”
There are practical manufacturing advantages, too. Moss requires no animal-derived media supplements, eliminating mammalian virus risk and removing the need for costly viral filtration in downstream processing. It is also less sensitive to fluctuations in temperature and pH, giving manufacturers greater process flexibility and potentially lowering production costs.
Still, Eleva is careful not to position moss as a replacement for CHO. Björn Cochlovius, PhD, CEO of Eleva, says standard proteins will continue to be best served by established systems. “The goal is not to replace CHO or other systems with moss when those other systems deliver well,” he explains.
Instead, the aim is to ensure that the range of therapeutic candidates in development is not defined by the limits of existing manufacturing platforms. Yields for large-scale GMP production and improving predictability remain ongoing challenges, but commercially viable titers are already being achieved through continuous optimization.
Cochlovius believes regulatory precedent and growing CDMO partnerships will further strengthen adoption. “A moss-based platform capable of reliably producing this category of proteins at scale would open a pipeline of programs that are currently inaccessible,” he says.
For biotech developers—and for patients with limited treatment options—that could make all the difference. Sometimes, the future of medicine grows in the smallest places.
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Regulators Should Rely on Peers’ GMP Audits to Cut Inspection Burden
Biopharma is a global industry with drug firms routinely supplying medicines to multiple markets from the same manufacturing plant. But while globalization has helped expand revenues, it has also increased the number of GMP inspections developers undergo.
The average biopharmaceutical production facility has 2.68 good manufacturing practices (GMP) inspections a year, with auditors spending up to nine days on site per visit, according to recent analysis.
Preparing for an inspection typically involves GAP analysis to determine how current practices measure up to regulations, followed by corrective actions.
Companies also need to ensure they have the correct documentation for all operations. How long these preparatory steps take varies for each company. However, according to the U.S. Center for Professional Innovation and Education, getting set up for an audit can take anywhere from six months to a year.
Down with duplication
But drug companies should not have to undergo multiple GMP visits, according to the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), which says regulators can cut the number they carry out through collaboration.
Sérgio Cavalheiro Filho, IFPMA’s regulatory affairs manager, tells GEN, “The most pressing compliance challenge relating to good manufacturing practice today is the inefficiency created by duplicative inspections.
“In an increasingly complex and globalized manufacturing landscape, it is critical that we look to reduce unnecessary duplication through greater inspection reliance amongst those national regulatory agencies that belong to the Pharmaceutical Inspection Co-operation Scheme.”
For the uninitiated, the Pharmaceutical Inspection Co-operation Scheme is an informal arrangement between regulators focused on GMP. Its key aims are to harmonize inspections and promote information sharing between regulators.
It also aims to foster trust between regulatory agencies, with the idea being to encourage them to rely on GMP inspections carried out by fellow regulators rather than re-auditing sites themselves each time certification is sought.
“Greater inspection reliance would allow both regulators and companies to focus resources where they matter most: patient safety and product development,” Filho says.
IFPMA made the case for greater inspection reliance in a position paper, arguing that while pilot mutual recognition efforts have shown promise, regulators have yet to fully embrace the approach.
Filho tells GEN, “Regulators have made meaningful progress on GMP harmonization through frameworks such as PIC/S and ICH, but more consistent use of inspection reliance is needed to translate alignment on paper into real efficiency.”
Part of the problem is that advanced modalities, such as mAbs and cell and gene therapies, are often perceived as being higher risk, which means, despite the various mutual recognition agreements, regulators still tend to carry out their own inspections.
However, in such cases, trusting others’ audits is a more efficient option, according to Filho, who says, “Relying on trusted regulatory partners where appropriate is a well‑tested and effective strategy that enables regulators to focus on higher‑risk activities. And, any steps to reduce the incidence of the GMP audits they face would be welcomed by biopharma, Filho adds.
“Industry supports moving from pilots to routine reliance, underpinned by sound legal and data‑sharing frameworks. GMP challenges are also increasingly addressed through collaboration between manufacturers and technology suppliers, and through digitalization, automation, and AI‑enabled tools that strengthen monitoring and quality oversight within robust quality systems,” he says.
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STAT+: Color Health moving deeper into cancer services, complete with virtual ‘tumor boards’
The way Color Health’s CEO Othman Laraki sees it, cancer has a scaling problem. New science regularly sets new standards of care, increasing the intricacy of managing an already complex illness. Cancer patients are multiplying faster than oncologists, Laraki said, and costs, too, are exploding. All this makes it difficult for everyone to receive the best possible therapy. The solution that the Silicon Valley executive sees is inevitable.
“In our mind, the only way this is going to be addressed and solved is in a virtual first, AI-driven manner,” Laraki said. “In the coming years, the biggest cancer centers will be virtual first.”
Virtual care for cancer may sound like an oxymoron. After all, the pillars of cancer treatment are almost all hands-on: surgery, radiation, infusions, and the like. But Color Health has been building out a virtual cancer clinic — including a virtual “tumor board” of multidisciplinary experts — that the company says can deliver and manage care at a high quality. The company just received a certification from the American Society of Clinical Oncology to back it up.