Skip to main content
Top
Published in: European Journal of Clinical Microbiology & Infectious Diseases 9/2012

01-09-2012 | Article

Viral and bacterial aetiologies of epithelial ovarian cancer

Authors: S. Shanmughapriya, G. SenthilKumar, K. Vinodhini, B. C. Das, N. Vasanthi, K. Natarajaseenivasan

Published in: European Journal of Clinical Microbiology & Infectious Diseases | Issue 9/2012

Login to get access

Abstract

We sought to analyse the presence of human papillomavirus (HPV), Chlamydia trachomatis and cytomegalovirus (CMV) infection in women with epithelial ovarian carcinomas. Polymerase chain reaction (PCR)-based detection of microbial infections was carried out. A total of 39 tissue samples were analysed with consensus and type-specific primers for HPV, primers specific for the cryptic plasmid of Chlamydia and primers for glycoprotein B of CMV. The samples analysed showed 40%, 80% and 50% positivity for HPV, Chlamydia and CMV infection, respectively, in cancerous ovarian tissues. The HPV type detected was HPV 6, with its genome integrated to the host genome in case of both invasive and borderline tumours and existed episomally in healthy controls. The patients with Chlamydia (odds ratio [OR] 32; 95% confidence interval [CI] 3.33, 307.65) and CMV infection (OR 8; 95% CI 0.888, 72.10) are at significantly higher risk of development of ovarian tumours. The present study validates the theory of chronic infections and inflammation in the pathogenesis of epithelial ovarian cancer. Further seroepidemiological studies and large fresh tissue sampling may represent the real prevalence of infections among ovarian carcinoma patients. This study is the first of its kind in detecting the bacterial and viral aetiologies in the development of ovarian carcinoma among Indian women.
Literature
1.
go back to reference Posadas EM, Davidson B, Kohn EC (2004) Proteomics and ovarian cancer: implications for diagnosis and treatment: a critical review of the recent literature. Curr Opin Oncol 16:478–484PubMedCrossRef Posadas EM, Davidson B, Kohn EC (2004) Proteomics and ovarian cancer: implications for diagnosis and treatment: a critical review of the recent literature. Curr Opin Oncol 16:478–484PubMedCrossRef
2.
go back to reference Berchuck A, Heron KA, Carney ME, Lancaster JM, Fraser EG, Vinson VL, Deffenbaugh AM, Miron A, Marks JR, Futreal PA, Frank TS (1998) Frequency of germline and somatic BRCA1 mutations in ovarian cancer. Clin Cancer Res 4:2433–2437PubMed Berchuck A, Heron KA, Carney ME, Lancaster JM, Fraser EG, Vinson VL, Deffenbaugh AM, Miron A, Marks JR, Futreal PA, Frank TS (1998) Frequency of germline and somatic BRCA1 mutations in ovarian cancer. Clin Cancer Res 4:2433–2437PubMed
3.
go back to reference Idahl A, Lundin E, Jurstrand M, Kumlin U, Elgh F, Ohlson N, Ottander U (2011) Chlamydia trachomatis and Mycoplasma genitalium plasma antibodies in relation to epithelial ovarian tumors. Infect Dis Obstet Gynecol 2011:824627. doi:10.1155/2011/824627 Idahl A, Lundin E, Jurstrand M, Kumlin U, Elgh F, Ohlson N, Ottander U (2011) Chlamydia trachomatis and Mycoplasma genitalium plasma antibodies in relation to epithelial ovarian tumors. Infect Dis Obstet Gynecol 2011:824627. doi:10.​1155/​2011/​824627
4.
go back to reference Moss SF, Blaser MJ (2005) Mechanisms of disease: inflammation and the origins of cancer. Nat Clin Pract Oncol 2:90–97PubMedCrossRef Moss SF, Blaser MJ (2005) Mechanisms of disease: inflammation and the origins of cancer. Nat Clin Pract Oncol 2:90–97PubMedCrossRef
5.
go back to reference Koskela P, Anttila T, Bjørge T, Brunsvig A, Dillner J, Hakama M, Hakulinen T, Jellum E, Lehtinen M, Lenner P, Luostarinen T, Pukkala E, Saikku P, Thoresen S, Youngman L, Paavonen J (2000) Chlamydia trachomatis infection as a risk factor for invasive cervical cancer. Int J Cancer 85:35–39PubMedCrossRef Koskela P, Anttila T, Bjørge T, Brunsvig A, Dillner J, Hakama M, Hakulinen T, Jellum E, Lehtinen M, Lenner P, Luostarinen T, Pukkala E, Saikku P, Thoresen S, Youngman L, Paavonen J (2000) Chlamydia trachomatis infection as a risk factor for invasive cervical cancer. Int J Cancer 85:35–39PubMedCrossRef
6.
go back to reference Madeleine MM, Anttila T, Schwartz SM, Saikku P, Leinonen M, Carter JJ, Wurscher M, Johnson LG, Galloway DA, Daling JR (2007) Risk of cervical cancer associated with Chlamydia trachomatis antibodies by histology, HPV type and HPV cofactors. Int J Cancer 120:650–655PubMedCrossRef Madeleine MM, Anttila T, Schwartz SM, Saikku P, Leinonen M, Carter JJ, Wurscher M, Johnson LG, Galloway DA, Daling JR (2007) Risk of cervical cancer associated with Chlamydia trachomatis antibodies by histology, HPV type and HPV cofactors. Int J Cancer 120:650–655PubMedCrossRef
7.
go back to reference Risch HA, Howe GR (1995) Pelvic inflammatory disease and the risk of epithelial ovarian cancer. Cancer Epidemiol Biomarkers Prev 4:447–451PubMed Risch HA, Howe GR (1995) Pelvic inflammatory disease and the risk of epithelial ovarian cancer. Cancer Epidemiol Biomarkers Prev 4:447–451PubMed
8.
go back to reference Boom R, Sol CJA, Salimans MMM, Jansen CL, Wertheim-van Dillen PM, van der Noordaa J (1990) Rapid and simple method for purification of nucleic acids. J Clin Microbiol 28:495–503PubMed Boom R, Sol CJA, Salimans MMM, Jansen CL, Wertheim-van Dillen PM, van der Noordaa J (1990) Rapid and simple method for purification of nucleic acids. J Clin Microbiol 28:495–503PubMed
9.
go back to reference Høgdall EVS, Kjaer SK, Blaakaer J, Christensen L, Glud E, Vuust J, Høgdall CK (2006) P53 mutations in tissue from Danish ovarian cancer patients: from the Danish “MALOVA” ovarian cancer study. Gynecol Oncol 100:76–82PubMedCrossRef Høgdall EVS, Kjaer SK, Blaakaer J, Christensen L, Glud E, Vuust J, Høgdall CK (2006) P53 mutations in tissue from Danish ovarian cancer patients: from the Danish “MALOVA” ovarian cancer study. Gynecol Oncol 100:76–82PubMedCrossRef
10.
go back to reference Bauer HM, Greer CE, Manos MM (1992) Determination of genital HPV infection using consensus PCR. In: Herrington CS, McGee JOD (eds) Diagnostic molecular pathology: a practical approach. Oxford University Press, Oxford, pp 131–152 Bauer HM, Greer CE, Manos MM (1992) Determination of genital HPV infection using consensus PCR. In: Herrington CS, McGee JOD (eds) Diagnostic molecular pathology: a practical approach. Oxford University Press, Oxford, pp 131–152
11.
go back to reference Bauer HM, Hildesheim A, Schiffman MH, Glass AG, Rush BB, Scott DR, Cadell DM, Kurman RJ, Manos MM (1993) Determinants of genital human papillomavirus infection in low-risk women in Portland, Oregon. Sex Trans Dis 20:274–278CrossRef Bauer HM, Hildesheim A, Schiffman MH, Glass AG, Rush BB, Scott DR, Cadell DM, Kurman RJ, Manos MM (1993) Determinants of genital human papillomavirus infection in low-risk women in Portland, Oregon. Sex Trans Dis 20:274–278CrossRef
12.
go back to reference de Roda Husman AM, Walboomers JM, van den Brule AJ, Meijer CJ, Snijders PJ (1995) The use of general primers GP5 and GP6 elongated at their 3’ ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR. J Gen Virol 76:1057–1062PubMedCrossRef de Roda Husman AM, Walboomers JM, van den Brule AJ, Meijer CJ, Snijders PJ (1995) The use of general primers GP5 and GP6 elongated at their 3’ ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR. J Gen Virol 76:1057–1062PubMedCrossRef
13.
go back to reference Mahony JB, Luinstra KE, Jang D, Sellors J, Chernesky MA (1992) Chlamydia trachomatis confirmatory testing of PCR-positive genitourinary specimens using a second set of plasmid primers. Mol Cell Probes 6:381–388PubMedCrossRef Mahony JB, Luinstra KE, Jang D, Sellors J, Chernesky MA (1992) Chlamydia trachomatis confirmatory testing of PCR-positive genitourinary specimens using a second set of plasmid primers. Mol Cell Probes 6:381–388PubMedCrossRef
14.
go back to reference Kuhn DE, Beall CJ, Kolattukudy PE (1995) The cytomegalovirus US28 protein binds multiple CC chemokines with high affinity. Biochem Biophys Res Commun 211:325–330PubMedCrossRef Kuhn DE, Beall CJ, Kolattukudy PE (1995) The cytomegalovirus US28 protein binds multiple CC chemokines with high affinity. Biochem Biophys Res Commun 211:325–330PubMedCrossRef
15.
go back to reference Gupta J, Pilotti S, Rilke F, Shah K (1987) Association of human papillomavirus type 16 with neoplastic lesions of the vulva and other genital sites by in situ hybridization. Am J Pathol 127:206–215PubMed Gupta J, Pilotti S, Rilke F, Shah K (1987) Association of human papillomavirus type 16 with neoplastic lesions of the vulva and other genital sites by in situ hybridization. Am J Pathol 127:206–215PubMed
16.
go back to reference Shah KV, Howley PM (1996) Papillomaviruses. In: Fields BN, Knipe DM, Howley PM (eds) Fields virology, vol 2. Lippincott-Raven, Philadelphia, pp 2077–2109 Shah KV, Howley PM (1996) Papillomaviruses. In: Fields BN, Knipe DM, Howley PM (eds) Fields virology, vol 2. Lippincott-Raven, Philadelphia, pp 2077–2109
17.
go back to reference Dillner J, Lehtinen M, Björge T, Luostarinen T, Youngman L, Jellum E, Koskela P, Gislefoss RE, Hallmans G, Paavonen J, Sapp M, Schiller JT, Hakulinen T, Thoresen S, Hakama M (1997) Prospective seroepidemiologic study of human papillomavirus infection as a risk factor for invasive cervical cancer. J Natl Cancer Inst 89:1293–1299PubMedCrossRef Dillner J, Lehtinen M, Björge T, Luostarinen T, Youngman L, Jellum E, Koskela P, Gislefoss RE, Hallmans G, Paavonen J, Sapp M, Schiller JT, Hakulinen T, Thoresen S, Hakama M (1997) Prospective seroepidemiologic study of human papillomavirus infection as a risk factor for invasive cervical cancer. J Natl Cancer Inst 89:1293–1299PubMedCrossRef
18.
go back to reference Runnebaum IB, Maier S, Tong XW, Rosenthal HE, Möbus VJ, Kieback DG, Kreienberg R (1995) Human papillomavirus integration is not associated with advanced epithelial ovarian cancer in German patients. Cancer Epidemiol Biomarkers Prev 4:573–575PubMed Runnebaum IB, Maier S, Tong XW, Rosenthal HE, Möbus VJ, Kieback DG, Kreienberg R (1995) Human papillomavirus integration is not associated with advanced epithelial ovarian cancer in German patients. Cancer Epidemiol Biomarkers Prev 4:573–575PubMed
19.
go back to reference Trottier AM, Provencher D, Mes-Masson AM, Vauclair R, Coutlée F (1995) Absence of human papillomavirus sequences in ovarian pathologies. J Clin Microbiol 33:1011–1013PubMed Trottier AM, Provencher D, Mes-Masson AM, Vauclair R, Coutlée F (1995) Absence of human papillomavirus sequences in ovarian pathologies. J Clin Microbiol 33:1011–1013PubMed
20.
go back to reference Wu QJ, Guo M, Lu ZM, Li T, Qiao HZ, Ke Y (2003) Detection of human papillomavirus-16 in ovarian malignancy. Br J Cancer 89:672–675PubMedCrossRef Wu QJ, Guo M, Lu ZM, Li T, Qiao HZ, Ke Y (2003) Detection of human papillomavirus-16 in ovarian malignancy. Br J Cancer 89:672–675PubMedCrossRef
21.
go back to reference Idahl A, Lundin E, Elgh F, Jurstrand M, Møller JK, Marklund I, Lindgren P, Ottander U (2010) Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoeae, human papillomavirus, and polyomavirus are not detectable in human tissue with epithelial ovarian cancer, borderline tumor, or benign conditions. Am J Obstet Gynecol 202:71.e1–71.e6CrossRef Idahl A, Lundin E, Elgh F, Jurstrand M, Møller JK, Marklund I, Lindgren P, Ottander U (2010) Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoeae, human papillomavirus, and polyomavirus are not detectable in human tissue with epithelial ovarian cancer, borderline tumor, or benign conditions. Am J Obstet Gynecol 202:71.e1–71.e6CrossRef
22.
go back to reference Dürst M, Kleinheinz A, Hotz M, Gissmann L (1985) The physical state of human papillomavirus type 16 DNA in benign and malignant genital tumours. J Gen Virol 66:1515–1522PubMedCrossRef Dürst M, Kleinheinz A, Hotz M, Gissmann L (1985) The physical state of human papillomavirus type 16 DNA in benign and malignant genital tumours. J Gen Virol 66:1515–1522PubMedCrossRef
23.
go back to reference Galehouse D, Jenison E, DeLucia A (1992) Differences in the integration pattern and episomal forms of human papillomavirus type 16 DNA found within an invasive cervical neoplasm and its metastasis. Virology 186:339–341PubMedCrossRef Galehouse D, Jenison E, DeLucia A (1992) Differences in the integration pattern and episomal forms of human papillomavirus type 16 DNA found within an invasive cervical neoplasm and its metastasis. Virology 186:339–341PubMedCrossRef
24.
go back to reference Gissmann L, Wolnik L, Ikenberg H, Koldovsky U, Schnürch HG, zur Hausen H (1983) Human papillomavirus types 6 and 11 DNA sequences in genital and laryngeal papillomas and in some cervical cancers. Proc Nat Acad Sci USA 80:560–563PubMedCrossRef Gissmann L, Wolnik L, Ikenberg H, Koldovsky U, Schnürch HG, zur Hausen H (1983) Human papillomavirus types 6 and 11 DNA sequences in genital and laryngeal papillomas and in some cervical cancers. Proc Nat Acad Sci USA 80:560–563PubMedCrossRef
25.
go back to reference Boshart M, zur Hausen H (1986) Human papillomaviruses in Buschke–Löwenstein tumors: physical state of the DNA and identification of a tandem duplication in the noncoding region of a human papillomavirus 6 subtype. J Virol 58:963–966PubMed Boshart M, zur Hausen H (1986) Human papillomaviruses in Buschke–Löwenstein tumors: physical state of the DNA and identification of a tandem duplication in the noncoding region of a human papillomavirus 6 subtype. J Virol 58:963–966PubMed
26.
go back to reference Rando RF, Sedlacek TV, Hunt J, Jenson AB, Kurman RJ, Lancaster WD (1986) Verrucous carcinoma of the vulva associated with an unusual type 6 human papillomavirus. Obstet Gynecol 67:70S–75SPubMedCrossRef Rando RF, Sedlacek TV, Hunt J, Jenson AB, Kurman RJ, Lancaster WD (1986) Verrucous carcinoma of the vulva associated with an unusual type 6 human papillomavirus. Obstet Gynecol 67:70S–75SPubMedCrossRef
27.
go back to reference Byrne JC, Tsao MS, Fraser RS, Howley PM (1987) Human papillomavirus-11 DNA in a patient with chronic laryngotracheobronchial papillomatosis and metastatic squamous-cell carcinoma of the lung. N Engl J Med 317:873–878PubMedCrossRef Byrne JC, Tsao MS, Fraser RS, Howley PM (1987) Human papillomavirus-11 DNA in a patient with chronic laryngotracheobronchial papillomatosis and metastatic squamous-cell carcinoma of the lung. N Engl J Med 317:873–878PubMedCrossRef
28.
go back to reference Manias DA, Ostrow RS, Mcglennen RC, Estensen RD, Faras AJ (1989) Characterization of integrated human papillomavirus type 11 DNA in primary and metastatic tumors from a renal transplant recipient. Cancer Res 49:2514–2519PubMed Manias DA, Ostrow RS, Mcglennen RC, Estensen RD, Faras AJ (1989) Characterization of integrated human papillomavirus type 11 DNA in primary and metastatic tumors from a renal transplant recipient. Cancer Res 49:2514–2519PubMed
29.
go back to reference Bercovich JA, Centeno CR, Aguilar OG, Grinstein S, Kahn T (1991) Presence and integration of human papillomavirus type 6 in a tonsillar carcinoma. J Gen Virol 72:2569–2572PubMedCrossRef Bercovich JA, Centeno CR, Aguilar OG, Grinstein S, Kahn T (1991) Presence and integration of human papillomavirus type 6 in a tonsillar carcinoma. J Gen Virol 72:2569–2572PubMedCrossRef
30.
go back to reference Lee JW, Choi CH, Choi JJ, Park YA, Kim SJ, Hwang SY, Kim WY, Kim TJ, Lee JH, Kim BG, Bae DS (2008) Altered microRNA expression in cervical carcinomas. Clin Cancer Res 14:2535–2542PubMedCrossRef Lee JW, Choi CH, Choi JJ, Park YA, Kim SJ, Hwang SY, Kim WY, Kim TJ, Lee JH, Kim BG, Bae DS (2008) Altered microRNA expression in cervical carcinomas. Clin Cancer Res 14:2535–2542PubMedCrossRef
31.
go back to reference Mitao M, Reumann W, Winkler B, Richart RM, Fujiwara A, Crum CP (1984) Chlamydial cervicitis and cervical intraepithelial neoplasia: an immunohistochemical analysis. Gynecol Oncol 19:90–97PubMedCrossRef Mitao M, Reumann W, Winkler B, Richart RM, Fujiwara A, Crum CP (1984) Chlamydial cervicitis and cervical intraepithelial neoplasia: an immunohistochemical analysis. Gynecol Oncol 19:90–97PubMedCrossRef
32.
go back to reference Kiviat NB, Paavonen JA, Brockway J, Critchlow CW, Brunham RC, Stevens CE, Stamm WE, Kuo CC, DeRouen T, Holmes KK (1985) Cytologic manifestations of cervical and vaginal infections. I. Epithelial and inflammatory cellular changes. JAMA 253:989–996PubMedCrossRef Kiviat NB, Paavonen JA, Brockway J, Critchlow CW, Brunham RC, Stevens CE, Stamm WE, Kuo CC, DeRouen T, Holmes KK (1985) Cytologic manifestations of cervical and vaginal infections. I. Epithelial and inflammatory cellular changes. JAMA 253:989–996PubMedCrossRef
33.
go back to reference Fan T, Lu H, Hu H, Shi L, McClarty GA, Nance DM, Greenberg AH, Zhong G (1998) Inhibition of apoptosis in Chlamydia-infected cells: blockade of mitochondrial cytochrome C release and caspase activation. J Exp Med 187:487–496PubMedCrossRef Fan T, Lu H, Hu H, Shi L, McClarty GA, Nance DM, Greenberg AH, Zhong G (1998) Inhibition of apoptosis in Chlamydia-infected cells: blockade of mitochondrial cytochrome C release and caspase activation. J Exp Med 187:487–496PubMedCrossRef
34.
go back to reference Felley-Bosco E (1998) Role of nitric oxide in genotoxicity: implication for carcinogenesis. Cancer Metastasis Rev 17:25–37PubMedCrossRef Felley-Bosco E (1998) Role of nitric oxide in genotoxicity: implication for carcinogenesis. Cancer Metastasis Rev 17:25–37PubMedCrossRef
35.
go back to reference Castle PE, Hillier SL, Rabe LK, Hildesheim A, Herrero R, Bratti MC, Sherman ME, Burk RD, Rodriguez AC, Alfaro M, Hutchinson ML, Morales J, Schiffman M (2001) An association of cervical inflammation with high-grade cervical neoplasia in women infected with oncogenic human papillomavirus (HPV). Cancer Epidemiol Biomarkers Prev 10:1021–1027PubMed Castle PE, Hillier SL, Rabe LK, Hildesheim A, Herrero R, Bratti MC, Sherman ME, Burk RD, Rodriguez AC, Alfaro M, Hutchinson ML, Morales J, Schiffman M (2001) An association of cervical inflammation with high-grade cervical neoplasia in women infected with oncogenic human papillomavirus (HPV). Cancer Epidemiol Biomarkers Prev 10:1021–1027PubMed
36.
go back to reference Prozialeck WC, Fay MJ, Lamar PC, Pearson CA, Sigar I, Ramsey KH (2002) Chlamydia trachomatis disrupts N-cadherin-dependent cell–cell junctions and sequesters beta-catenin in human cervical epithelial cells. Infect Immun 70:2605–2613PubMedCrossRef Prozialeck WC, Fay MJ, Lamar PC, Pearson CA, Sigar I, Ramsey KH (2002) Chlamydia trachomatis disrupts N-cadherin-dependent cell–cell junctions and sequesters beta-catenin in human cervical epithelial cells. Infect Immun 70:2605–2613PubMedCrossRef
37.
go back to reference Sharma TM, Nadasdy T, Leech RW, Kingma DW, Johnson LD, Hanson-Painton O (1994) In situ DNA hybridization study of ‘primary’ cytomegalovirus (CMV) oophoritis. Acta Obstet Gynecol Scand 73:429–431PubMedCrossRef Sharma TM, Nadasdy T, Leech RW, Kingma DW, Johnson LD, Hanson-Painton O (1994) In situ DNA hybridization study of ‘primary’ cytomegalovirus (CMV) oophoritis. Acta Obstet Gynecol Scand 73:429–431PubMedCrossRef
38.
go back to reference Manfredi R, Alampi G, Talò S, Calza L, Tadolini M, Martinelli GN, Chiodo F (2000) Silent oophoritis due to cytomegalovirus in a patient with advanced HIV disease. Int J STD AIDS 11:410–412PubMedCrossRef Manfredi R, Alampi G, Talò S, Calza L, Tadolini M, Martinelli GN, Chiodo F (2000) Silent oophoritis due to cytomegalovirus in a patient with advanced HIV disease. Int J STD AIDS 11:410–412PubMedCrossRef
39.
go back to reference Yu J, Solano FX Jr, Seethala RR (2007) Bilateral cytomegalovirus (CMV) oophoritis mimicking widely metastatic carcinoma: a case report and review of the literature. Diagn Pathol 2:50PubMedCrossRef Yu J, Solano FX Jr, Seethala RR (2007) Bilateral cytomegalovirus (CMV) oophoritis mimicking widely metastatic carcinoma: a case report and review of the literature. Diagn Pathol 2:50PubMedCrossRef
40.
go back to reference Hendrix RM, Wagenaar M, Slobbe RL, Bruggeman CA (1997) Widespread presence of cytomegalovirus DNA in tissues of healthy trauma victims. J Clin Pathol 50:59–63PubMedCrossRef Hendrix RM, Wagenaar M, Slobbe RL, Bruggeman CA (1997) Widespread presence of cytomegalovirus DNA in tissues of healthy trauma victims. J Clin Pathol 50:59–63PubMedCrossRef
Metadata
Title
Viral and bacterial aetiologies of epithelial ovarian cancer
Authors
S. Shanmughapriya
G. SenthilKumar
K. Vinodhini
B. C. Das
N. Vasanthi
K. Natarajaseenivasan
Publication date
01-09-2012
Publisher
Springer-Verlag
Published in
European Journal of Clinical Microbiology & Infectious Diseases / Issue 9/2012
Print ISSN: 0934-9723
Electronic ISSN: 1435-4373
DOI
https://doi.org/10.1007/s10096-012-1570-5

Other articles of this Issue 9/2012

European Journal of Clinical Microbiology & Infectious Diseases 9/2012 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine