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      Rethinking animal models of sepsis – working towards improved clinical translation whilst integrating the 3Rs

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          Abstract

          Sepsis is a major worldwide healthcare issue with unmet clinical need. Despite extensive animal research in this area, successful clinical translation has been largely unsuccessful.

          We propose one reason for this is that, sometimes, the experimental question is misdirected or unrealistic expectations are being made of the animal model.

          As sepsis models can lead to a rapid and substantial suffering – it is essential that we continually review experimental approaches and undertake a full harm:benefit impact assessment for each study. In some instances, this may require refinement of existing sepsis models. In other cases, it may be replacement to a different experimental system altogether, answering a mechanistic question whilst aligning with the principles of reduction, refinement and replacement (3Rs).

          We discuss making better use of patient data to identify potentially useful therapeutic targets which can subsequently be validated in preclinical systems. This may be achieved through greater use of construct validity models, from which mechanistic conclusions are drawn. We argue that such models could provide equally useful scientific data as face validity models, but with an improved 3Rs impact. Indeed, construct validity models may not require sepsis to be modelled, per se. We propose that approaches that could support and refine clinical translation of research findings, whilst reducing the overall welfare burden on research animals.

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          Most cited references91

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          Galleria mellonella infection models for the study of bacterial diseases and for antimicrobial drug testing

          abstract Galleria mellonella (greater wax moth or honeycomb moth) has been introduced as an alternative model to study microbial infections. G. mellonella larvae can be easily and inexpensively obtained in large numbers and are simple to use as they don't require special lab equipment. There are no ethical constraints and their short life cycle makes them ideal for large-scale studies. Although insects lack an adaptive immune response, their innate immune response shows remarkable similarities with the immune response in vertebrates. This review gives a current update of what is known about the immune system of G. mellonella and provides an extensive overview of how G. mellonella is used to study the virulence of Gram-positive and Gram-negative bacteria. In addition, the use of G. mellonella to evaluate the efficacy of antimicrobial agents and experimental phage therapy are also discussed. The review concludes with a critical assessment of the current limitatons of G. mellonella infection models.
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            A targeted real-time early warning score (TREWScore) for septic shock

            Sepsis is a leading cause of death in the United States, with mortality highest among patients who develop septic shock. Early aggressive treatment decreases morbidity and mortality. Although automated screening tools can detect patients currently experiencing severe sepsis and septic shock, none predict those at greatest risk of developing shock. We analyzed routinely available physiological and laboratory data from intensive care unit patients and developed "TREWScore," a targeted real-time early warning score that predicts which patients will develop septic shock. TREWScore identified patients before the onset of septic shock with an area under the ROC (receiver operating characteristic) curve (AUC) of 0.83 [95% confidence interval (CI), 0.81 to 0.85]. At a specificity of 0.67, TREWScore achieved a sensitivity of 0.85 and identified patients a median of 28.2 [interquartile range (IQR), 10.6 to 94.2] hours before onset. Of those identified, two-thirds were identified before any sepsis-related organ dysfunction. In comparison, the Modified Early Warning Score, which has been used clinically for septic shock prediction, achieved a lower AUC of 0.73 (95% CI, 0.71 to 0.76). A routine screening protocol based on the presence of two of the systemic inflammatory response syndrome criteria, suspicion of infection, and either hypotension or hyperlactatemia achieved a lower sensitivity of 0.74 at a comparable specificity of 0.64. Continuous sampling of data from the electronic health records and calculation of TREWScore may allow clinicians to identify patients at risk for septic shock and provide earlier interventions that would prevent or mitigate the associated morbidity and mortality.
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              Lost in translation: the valley of death across preclinical and clinical divide – identification of problems and overcoming obstacles

              A rift that has opened up between basic research (bench) and clinical research and patients (bed) who need their new treatments, diagnostics and prevention, and this rift is widening and getting deeper. The crisis involving the “translation” of basic scientific findings in a laboratory setting into human applications and potential treatments or biomarkers for a disease is widely recognized both in academia and industry. Despite the attempts that have been made both in academic and industry settings to mitigate this problem, the high attrition rates of drug development and the problem with reproducibility and translatability of preclinical findings to human applications remain a fact and the return on the investment has been limited in terms of clinical impact. Here I provide an overview of the challenges facing the drug development, and translational discordance with specific focus on a number of “culprits” in translational research including poor hypothesis, irreproducible data, ambiguous preclinical models, statistical errors, the influence of organizational structures, lack of incentives in the academic setting, governmental funding mechanisms, the clinical relevance of basic research, insufficient transparency, and lack of data sharing in research. I further provide some suggestions and new strategies that include some new aspects on open innovation models, entrepreneurship, transparency, and decision making to overcome each of the many problems during the drug discovery and development process and to more dynamically adjust for innovation challenges with broader scientific feedback.
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                Author and article information

                Contributors
                Journal
                Clin Sci (Lond)
                Clin. Sci
                cs
                Clinical Science (London, England : 1979)
                Portland Press Ltd.
                0143-5221
                1470-8736
                July 2020
                10 July 2020
                : 134
                : 13
                : 1715-1734
                Affiliations
                [1 ]School of Cancer and Pharmaceutical Science, Faculty of Life Sciences and Medicine, King’s College London, London, U.K.
                [2 ]Faculty of Medicine and Dentistry, Institute of Translational and Stratified Medicine, School of Biomedical Sciences, University of Plymouth, Plymouth, U.K.
                [3 ]National Heart and Lung Institute, Imperial College London and Royal Brompton and Harefield NHS Foundation Trust, London, U.K.
                [4 ]School of Immunology and Microbial Sciences, King's College London and Guy’s and St Thomas’ NHS Foundation Trust, London, U.K.
                [5 ]Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, U.K.
                [6 ]Research Animals Department, RSPCA, Southwater, U.K.
                Author notes
                Correspondence: Manasi Nandi ( manasi.nandi@ 123456kcl.ac.uk )
                Author information
                http://orcid.org/0000-0001-8585-5363
                Article
                CS20200679
                10.1042/CS20200679
                7352061
                32648582
                41382a5c-6bea-4c27-b486-617b44d3ae78
                © 2020 The Author(s).

                This is an open access article published by Portland Press Limited on behalf of the Biochemical Society and distributed under the Creative Commons Attribution License 4.0 (CC BY).

                History
                : 21 May 2020
                : 24 June 2020
                : 25 June 2020
                Page count
                Pages: 20
                Categories
                Cardiovascular System & Vascular Biology
                Diabetes & Metabolic Disorders
                Immunology & Inflammation
                Therapeutics & Molecular Medicine
                Society & Bioethics
                Editorial

                Medicine
                sepsis,research animals,3rs,clinical translation,construct validity,mechanistic
                Medicine
                sepsis, research animals, 3rs, clinical translation, construct validity, mechanistic

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