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Fecal transplant policy and legislation

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World Journal of Gastroenterology 2015年第1期21卷 6-11页

作者： dinesh vyas Apoorva Aekka Arpita vyas College of Human Medicine Michigan State UniversityEast LansingMI 48912United States Department of Pediatrics Heart Failure Research LabEast LansingMI 48912United States

Fecal microbiota transplantation(FMT) has garnered significant attention in recent years in the face of a reemerging Clostridium difficile(***) *** results from the first randomized control trial evaluating FMT have encouraged the medical community to explore the process further and expand its application beyond *** infections and even the gastrointestinal *** promising and numerous the prospects of FMT appear,the method remains limited in scope today due to several important barriers,most notably a poorly defined federal regulatory *** Food and Drug Administrationhas found it difficult to standardize and regulate the administration of inherently variable,metabolically active,and ubiquitously available fecal *** current cumbersome policy,which classifies human feces as a drug,has prevented physicians from providing FMT and deserving patients from accessing FMT in a timely fashion,and subsequent modifications seem only to be *** argument for reclassifying fecal material as human tissue is well ***,this would allow for a regulatory framework that is sufficiently flexible to expand access to care and facilitate research,but also appropriately restrictive and centralized to ensure patient *** an approach can facilitate the advancement of FMT to a more refined,controlled,and aesthetic process,perhaps in the form of a customized and wellcharacterized stool substitute therapy.

关键词： Stool therapy Clostridium difficile Fecal microbio

Screening colonoscopy:The present and the future

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World Journal of Gastroenterology 2021年第3期27卷 233-239页

作者： Chelsea V Hayman dinesh vyas College of Medicine California Northstate UniversityElk GroveCA 95757United States Department of Surgery San Joaquin General HospitalFrench CampCA 95231United States

In the United States,colorectal cancer(CRC)is the second leading cause of mortality in men and *** are now seeing an increasing number of patients with advanced-stage diagnosis and mortality from colorectal cancer before 50 years of age,which requires earlier *** the increasing need for CRC screening through colonoscopy,and thus endoscopists,easier and simpler techniques are needed to train proficient *** most widely used approach by endoscopists is air insufflation colonoscopy,where air distends the colon to allow visualization of the colonic *** technique is uncomfortable for patients and requires an anesthetist to administer *** addition,patients commonly complain about discomfort post-op as air escapes into the small bowel and cannot be adequately *** research into the use of water insufflation colonoscopies has proved promising in reducing the need for sedation,decreasing discomfort,and increasing the visibility of the colonic *** direction into water insufflation colonoscopies which have shown to be simpler and easier to teach may increase the number of proficient endoscopists in training to serve our aging population.

关键词： Colorectal cancer Water-insufflation colonoscopy Air-insufflation colonoscopy Adenomatous polyps Adenoma detection rate

Harnessing the potential of gene editing technology using CRISPR in inflammatory bowel disease

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World Journal of Gastroenterology 2019年第18期25卷 2177-2187页

作者： Viktor Limanskiy Arpita vyas Lakshmi Shankar Chaturvedi dinesh vyas Department of Surgery San Joaquin General Hospital College of Medicine CNSU College of Medicine and College of Pharmacy California Northstate University

The molecular scalpel of clustered regularly interspersed short palindromic repeats/CRISPR associated protein 9(CRISPR/Cas9) technology may be sharp enough to begin cutting the genes implicated in inflammatory bowel disease(IBD) and consequently decrease the 6.3 billion dollar annual financial healthcare burden in the treatment of IBD. For the past few years CRISPR technology has drastically revolutionized DNA engineering and biomedical research field. We are beginning to see its application in gene manipulation of sickle cell disease,human immunodeficiency virus resistant embryologic twin gene modification and IBD genes such as Gatm(Glycine amidinotransferase, mitochondrial),nucleotide-binding oligomerization domain-containing protein 2, KRT12 and other genes implicated in adaptive immune convergence pathways have been subjected to gene editing, however there are very few publications. Furthermore,since Crohn's disease and ulcerative colitis have shared disease susceptibility and share genetic gene profile, it is paramount and is more advantageous to use CRISPR technology to maximize impact. Although, currently CRISPR does have its limitations due to limited number of specific Cas enzymes, off-target activity,protospacer adjacent motifs and crossfire between different target sites. However,these limitations have given researchers further insight on how to augment and manipulate enzymes to enable precise gene excision and limit crossfire between target sites.

关键词： Clustered regularly interspersed short palindromic repeats Inflammatory bowel disease Crohn’s disease Ulcerative colitis Gene excision Gene editing Gene therapy Financial impact of inflammatory bowel disease on healthcare Clustered regularly interspersed short palindromic repeats crossfire

Advances in endoscopic balloon therapy for weight loss and its limitations

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World Journal of Gastroenterology 2017年第44期23卷 7813-7817页

作者： dinesh vyas Kaivalya Deshpande Yagnik Pandya Department of Surgery Texas Tech University Department Of Surgery Michigan State University Department of Surgery Metro West Medical Center

The field of medical and surgical weight loss is undergoing an explosion of new techniques and devices. A lot of these are geared towards endoscopic approaches rather than the conventional and more invasive laparoscopic or open approach. One such recent advance is the introduction of intrgastric balloons. In this article, we discuss the recently Food and Drug Administration approved following balloons for weight loss: the Orbera? Intragastric Balloon System(Apollo Endosurgery Inc, Austin, TX, United States), the Re Shape? Integrated Dual Balloon System(Re Shape Medical, Inc., San Clemente, CA, United States), and the Obalon(Obalon? Therapeutics, Inc.). The individual features of each of these balloons, the method of introduction and removal, and the expected weight loss and possible complications are discussed. This review of the various balloons highlights the innovation in the field of weight loss.

关键词： Weight loss Gastric balloons Endoscopic balloons Orbera Obalon Reshape

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World Journal of Clinical Cases 2018年第8期6卷 161-166页

作者： Flyn Kaida-Yip Kaivalya Deshpande Trishla Saran dinesh vyas College of Medicine California Northstate University Kaivalya Deshpande Department Of SurgeryMichigan State University Trishla Saran Department of Medicine the University of Texas of the Permian Basin dinesh vyas Department of SurgeryTexas Tech University

Biosimilars are a growing drug class designed to be used interchangeably with *** are cr-eated in living cells and are typically large,complex pr-oteins that may have a variety of *** the field of gastroenterology alone,biologics are used to treat inflammatory bowel diseases,cancers,and endocrine *** biologics have proven to be effective in treating or managing many diseases,patient acce-ss is often limited by high *** development of biosimilars is an attempt to reduce treatment *** must be nearly identical to their reference biologics in terms of efficacy,side effect risk profile,and *** the manufacturing process still involves production within living cells,biosimilars undergo fewer clinical trials than do their reference *** ultimately reduces the cost of production and the cost of the biosimilar drug compared to its reference ***,seven biosimilars have been approved by the United States Food and Drug Administration(FDA)for use in Crohn’s disease,ulcerative colitis,and colorectal *** are other biologics involved in treating gastroenterologic diseases for which there are no FDA approved *** biosimilars have the po-tential to reduce healthcare costs in chronic disease management,they face challenges in establishing a sig-nificant market *** comfort in prescribing reference biologics instead of biosimilars and patient reluctance to switch from a biologic to a biosimilar are two common contributing factors to biosimilars’slow in-crease in *** time will be needed for biosimilars to establish a larger and more consistent market share compared to their reference *** da-ta confirming the safety and efficacy of biosimilars,increased number of available biosimilars,and further cost reduction of biosimilars will all be necessary to im-prove physician confidence in biosimilars and patient comfort with biosimilars.

关键词： Biosimilars Inflammatory bowel disease Biologics Inflammation Drug class

High throughput RNA sequencing utility for diagnosis and prognosis in colon diseases

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World Journal of Gastroenterology 2017年第16期23卷 2819-2825页

作者： Mamie Gao Allen Zhong Neil Patel Chiraag Alur dinesh vyas Department of Surgery Texas Tech UniversityOdessaTX 79763United States

RNA sequencing is the use of hight hroughput next generation sequencing technology to survey, characterize, and quantify the transcriptome of a genome. RNA sequencing has been used to analyze the pathogenesis of several malignancies such melanoma, lung cancer, and colorectal cancer. RNA sequencing can identify differential expression of genes(DEG's), mutated genes, fusion genes, and gene isoforms in disease states. RNA sequencing has been used in the investigation of several colorectal diseases such as colorectal cancer, inflammatory bowel disease(ulcerative colitis and Crohn's disease), and irritable bowel syndrome.

关键词： Colon RNA sequencing Colon cancer Transcriptome Next generation sequencing high throughput

Stool therapy may become a preferred treatment of recurrent Clostridium difficile?

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World Journal of Gastroenterology 2013年第29期19卷 4635-4637页

作者： dinesh vyas Heidi E L'Esperance Arpita vyas Department of Surgery College of Human Medicine Michigan State University East Lansing MI 48912 United States Department of Pediatrics College of Human Medicine Michigan State University East Lansing MI 48912 United States

Fecal enemas were first reported to successfully treat life threatening enterocolitis in 1958, but fecal therapy to treat Clostridium difficile (C. difficile ) infection has remained esoteric and not well investigated until recently. In the past few years, systematic reviews of case series and case reports of fecal microbiota transplant for recurrent C. difficile infection have become available and validate use of fecal transplant for C. difficile enterocolitis. Methods of fecal transplant reported in the literature include: nasogastric tube, gastroscope, duodenal tube, colonoscopy, rectal tube, and fecal enemas administered at home; no method has been shown to be superior. A recent randomized study published in New England Journal of Medicine found fecal transplant to be superior to oral vancomycin alone in treatment of recurrent C. difficile enterocolitis. The significance of this trial cannot be underestimated as it lends credibility to the idea of intentionally using microbes to combat disease, providing an alternative to the older paradigm of disease eradication through use of antimicrobials.

关键词： Clostridium difficile Enterocolitis Pseudomembranous Fecal transplantation Vancomycin

Pharmacological cyclin dependent kinase inhibitors: Implications for colorectal cancer

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World Journal of Gastroenterology 2016年第7期22卷 2159-2164页

作者： Archana Balakrishnan Arpita vyas Kaivalya Deshpande dinesh vyas College of Human Medicine Michigan State University Texas Tech University at the Permian Basin

Colorectal cancer accounts for a significant proportion of cancer deaths worldwide. The need to develop more chemotherapeutic agents to combat this disease is critical. Cyclin dependent kinases(CDKs), along with its binding partner cyclins, serve to control the growth of cells through the cell cycle. A new class of drugs, termed CDK inhibitors, has been studied in preclinical and now clinical trials. These inhibitors are believed to act as an anti-cancer drug by blocking CDKs to block the uncontrolled cellular proliferation that is hallmark of cancers like colorectal cancer. CDK article provides overview of the emerging drug class of CDK inhibitors and provides a list of ones that are currently in clinical trials.

关键词： Colorectal cancer Cyclin Cyclin dependentkinase inhibitor

Nuclear factor kappa B role in inflammation associated gastrointestinal malignancies

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World Journal of Gastroenterology 2015年第11期21卷 3174-3183页

作者： Sahil Gambhir dinesh vyas Michael Hollis Apporva Aekka Arpita vyas Department of Surgery College of Human MedicineMichigan State University Department of Pediatrics College of Human Medicine - Michigan State University

Nuclear factor kappa B(NF-κB) has an established role in the regulation of innate immunity and ***-κB is also involved in critical mechanisms connecting inflammation and cancer *** investigations suggest that the NF-κB signaling cascade may be the central mediator of gastrointestinal malignancies including esophageal,gastric and colorectal *** review will explore NF-κB's function in inflammation-associated gastrointestinal malignancies,highlighting its oncogenic contribution to each step of ***-κB's role in the inflammation-to-carcinoma sequence in gastrointestinal malignancies warrants stronger emphasis upon targeting this pathway in achieving greater therapeutic efficacy.

关键词： Gastrointestinal cancer Inflammation Nuclear facto