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Fibrosis: from mechanisms to medicines.

ABSTRACT: Fibrosis can affect any organ and is responsible for up to 45% of all deaths in the industrialized world. It has long been thought to be relentlessly progressive and irreversible, but both preclinical models and clinical trials in various organ systems have shown that fibrosis is a highly dynamic process. This has clear implications for therapeutic interventions that are designed to capitalize on this inherent plasticity. However, despite substantial progress in our understanding of the pathobiology of fibrosis, a translational gap remains between the identification of putative antifibrotic targets and conversion of this knowledge into effective treatments in humans. Here we discuss the transformative experimental strategies that are being leveraged to dissect the key cellular and molecular mechanisms that regulate fibrosis, and the translational approaches that are enabling the emergence of precision medicine-based therapies for patients with fibrosis.

SUBMITTER: Henderson NC

PROVIDER: S-EPMC8034822 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Fibrosis: from mechanisms to medicines.

Henderson Neil C NC Rieder Florian F Wynn Thomas A TA

Nature 20201125 7835

Fibrosis can affect any organ and is responsible for up to 45% of all deaths in the industrialized world. It has long been thought to be relentlessly progressive and irreversible, but both preclinical models and clinical trials in various organ systems have shown that fibrosis is a highly dynamic process. This has clear implications for therapeutic interventions that are designed to capitalize on this inherent plasticity. However, despite substantial progress in our understanding of the pathobio ...[more]

PMID: 33239795

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Project description:BackgroundMedicines are the most common medical intervention and medicines adherence is associated with improved clinical outcomes. Understanding drivers and experiences of medicines adherence is important for optimising medicines use. Māori (Indigenous people of Aotearoa New Zealand) experience inequities in access to medicines yet little evidence exists regarding Māori and medicines adherence, or the role of pharmacists in supporting medicines adherence for Māori.ObjectivesTo explore Māori experiences of medicines adherence and non-adherence, and pharmacists' role in supporting adherence.MethodsThis was a convergent parallel mixed methods study. Facilitated wānanga (collaborative knowledge-sharing group discussions) were undertaken either online or in-person with eligible participants, using convenience and snowball sampling to recruit. Participants were eligible if they were Māori, 18 years or older, and had recently obtained medicine from a pharmacy. Wānanga involved semi-structured interviewing and questionnaire completion. General inductive coding and thematic analysis and descriptive statistical analysis were used respectively, and findings were situated in social, cultural and political Māori contexts.ResultsThirteen wānanga were conducted with 62 participants (71% female, median age range 35-44) from September 2021 to February 2022. Four themes were identified: The aspirations of hauora Māori (Māori wellbeing) - medicines as a component of holistic wellbeing; whanaungatanga (relationships); knowledge; and whānau (family and support network) advocacy and problem solving. Forgetting to take medicines was the most frequently identified reason for non-adherence, followed by not having medicines on hand, adverse effects, and lack of symptoms of health conditions. Participants identified that proactive pharmacist support, including developing caring therapeutic relationships, sharing knowledge, acknowledging medicines as just one component of holistic wellbeing, and giving adherence tips to support routine medicine taking were positive ways that pharmacists could support medicines adherence.ConclusionsFactors contributing to medicines adherence were diverse and participants identified numerous practical solutions that pharmacists, health service providers and policymakers could employ to support Māori medicines adherence.

Dataset Information

Fibrosis: from mechanisms to medicines.

Publications

Fibrosis: from mechanisms to medicines.

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