After the US Food and Drug Administration (FDA) approved esketamine (Spravato) for treatment-resistant depression and depressive symptoms in adults with 

 with acute suicidal ideation in 2019, discussion shifted from the potential of ketamine-based drugs and anesthetics in psychiatric, to how exactly it needs to be used.

, much of the care precedent is now set for esketamine; what’s needed next is greater monitoring.

American Psychiatric Association (APA) 2022 Annual Meeting

 in New Orleans this week, Roger S. McIntyre, MD, professor of psychiatry and pharmacology at the University of Toronto, discussed the ideal esketamine or ketamine delivery care team. From his experience, a series of care providers across sub-disciplines are qualified: nurse practitioners, nurses, anesthetists, psychiatrists, and even primary care.

“The key thing is, there needs to be multidisciplinary expertise in the administration of what is, in fact, an anesthetic now repurposed as an antidepressant, as well as the competencies around assessing and treating depression,” McIntyre said.

The 2 agents—one regulated by the FDA, the other used in limited investigative capacity—differ in standards of procedure, but include similar needs for careful monitoring.

“I think there has to be, on premise, expertise in mental health,” McIntyre said. S”econdly, the esketamine treatment requires a risk evaluation mitigation strategy (REMS), so the premise and the staff have to adhere to the FDA requirement. With ketamine, we also require an observation period. It doesn’t have a REMS, it’s not FDA approved—but we also recommend a similar observation that requires infrastructure and a staff to do that.”

Going forward, McIntyre sees a variety of psychiatric care opportunities with the drug class: potential use in treating bipolar depression, as well as prominent depressive comorbidities including alcohol or substance use disorders or even post-traumatic stress disorder (PTSD). He’s also interested in research surrounding treating pediatric mood disorders.

But in the current real-world application of ketamine and esketamine, clinicians like McIntyre are lacking much-needed databases and repositories, to refer to acute and long-term patient outcomes, as well as safety considerations including potential risk of drug abuse development in treated patients.

“We clearly need a database, because unlike most treatments, ketamine and esketamine are really being delivered at least so far at specialized clinics,” McIntyre said. “And even though there’s many of these clinics opening up, they’re not really brought together to network.”

“It’s not about being alarmist, it’s about being prepared,” he added.

Lastly, McIntyre highlighted the impact these anesthetics have had during an evolutionary period of psychiatric care, discussing how their adopted use in regulated practice may provide blueprints for psychedelics or psychoactive drugs like MDMA. He stressed similar regulation and careful approach when considering the utility of these investigative drugs, though.

“If these drugs are truly capable of helping people, then they’re capable of hurting people,” McIntyre said. “And I think that we need to make sure these studies are done by people who’ve got core competencies and the experience in doing these, and there needs to be a fidelity to good clinical trial methodology to doing these.”

Nonetheless, the options to treating severe depression are expanding—and few of the newest agents are similar to the old guard.

“There’s a paradigm shift of sorts—maybe a paradigm affirmation—wherein maybe people can take treatments episodically,” McIntyre said. “For example, treatments like zuranalone are under development for the episodic treatment of depression—take it when you need it, not once a day.”

Videos

With administration strategies for the psychiatric anesthetic drug well established, clinicians have interest in accumulating long-term data and other potential indications.

The Ketamine & Esketamine Care Teams, and Necessary Monitoring

 in New Orleans this week, “Social Determinants of Mental Health” provided many APA presenters an opportunity to consider the modern definitions of psychiatric and behavioral disease, and what influences that.

And that discussion around disease definition inherently opened the door to discuss what optimal care looks like for the affected patient.

In the second segment of an interview with 

 during APA 2022, Brent Forester, MD, MSc, chief of the division of geriatric psychiatry at McLean Hospital, discussed the inevitable convergence of blood-based testing innovations for Alzheimer’s disease and the standard for dementia—or neurocognitive disrders—in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

“The challenge over the next 5 years is we know the clinical criteria in the DSM for the major and minor neurocognitive disorders—Alzheimer’s being the most common,” Forester said. “We know these dementias are based in neuropathology in the brain, and we can now visualize these neuropathological hallmarks with amyloid and tau PET imaging with CSF analysis, and increasingly with blood-based biomarkers.”

Forester is interested to see how true serum blood biomarkers that could be predictive to patient response to next-line therapies—in the case of Alzheimer’s disease, monoclonal antibodies.

“The coming together of biomarkers and clinical syndrome—we don’t have an example of that anywhere in psychiatry. But we will in Alzheimer’s disease,” Forester said. “That to me is truly exciting, and if we do it right, it will allow us to recognize people earlier.”

Later, Forester discussed the importance of merging pharmacotherapy strategies with proven patient behavioral changes—including exercise, diet, social engagement and cognitive stimulation—that have been proven to aide patients with dementia or Alzheimer’s disease even years after disease progression.

"If we could somehow incorporate those lifestyle interventions along with this increasingly knowledge of the biological interventions that are coming down the pike, we could see a huge change in the trajectory of Alzheimer’s disease,” he said.

Lastly, Forester—whose research program at McLean is a participant of the Biogen EMBARK trial—discussed the controversy surrounding the US Food and Drug Administration (FDA) approval of aducanumab (Aduhelm) for the treatment of Alzheimer’s disease last June.

“The problem that’s occurred since June 7, 2021 is that there’s been massive media attention on this, and I think it’s made the public but especially the medical community suspicious about these drugs and the intentions of pharmaceutical companies,” Forester said. “Everyone here intends to do the right thing.”

The landmark approval for the amyloid beta-targeting monoclonal antibody was met with great scrutiny from clinicians and investigators who challenged the supporting clinical data’s proof of benefit for patients. As Forester noted, though, it has been a well-received agent by eligible patients and various patient organizations even prior to the FDA decision.

As analysis of aducanumab’s absolute benefit for Alzheimer’s, as well as the FDA’s decision, continues to be reviewed amid consideration of yet another 2 monoclonal antibodies for the same indication, Forester expressed hope the backlash of last year’s decision doesn’t “sour the opportunity that’s still there.”

“We can’t be biologically reductionistic in our approach to Alzheimer’s, nor can we only look at psychosocial interventions,” Forester said. “It has to be both, and this is so obvious to all of us in psychiatry—but I will tell you, to the rest of the Alzheimer’s world, not so much.”

Brent Forester, MD, MSc, discusses the confluence of biomarker and disease-targeting therapy in Alzheimer's, and the need to appropriately introduce these tools.

Blood Biomarkers, Aducanumab and Setting Precedent for Dementia Care Advances

The impact of COVID-19 on addiction medicine has been unprecedented—both in the acute impact of the early pandemic on the population’s mental wellness, and in its ongoing effect on community and health care resources.

Overdose deaths have increased by nearly 50% since 2020, and 2021 was the first year in US history when more than 100,000 people died from overdoses. At the same time, people with substance use disorders are at a greater risk of COVID-19 disease severity and mortality if infected.

In this historic hit to addiction disease management, one national leader sees innovations borne out of necessity that may help the field strengthen for the better.

 in New Orleans this week, National Institute on Drug Abuse (NIDA) director Nora D. Volkow, MD, discussed the “havoc” the pandemic had on substance use disorder and overdose prevention while also putting the same population at greater risk of preventable death from the virus.

“There has been a very negative impact in the bi-directionality of these 2 events, Volkow said. “You have a situation from the perspective of the social consequences that the pandemic had, that led all of us to stress—and another one that it has facilitated the entry of extremely dangerous drugs into our country.”

That said, Volkow believes the resolutions made by care systems during the pandemic—both to innovate against necessity, and to correct faults in the current system—could shape the future of substance use disorder care.

“I think we can absolutely take the knowledge we have—and the knowledge we gained during the COVID-19 pandemic—to come up with solutions to address the challenges we’re going to be facing,” Volkow said. “We will be able to succeed, and I would hope that we can actually learn from COVID and create systems that are more equitable and provide more sustainability.”

Such a system would absolutely require addressing the disparities at social, racial, cultural, and economic levels that permeate in US substance use prevalence and care limitations, she noted.

One positive that Volkow highlighted was the greater adoption of telemedicine during COVID-19. She highlighted the capability to more feasibly care for some of the field’s previously most out-of-reach populations, including patients in more remote rural areas, and the US prison and jail populations. Both diagnosis and prescription for substance use disorder has been simplified by telemedicine, she explained—and supplemental patient issues like comorbid mental illnesses are more easily addressed.

“I think it provides a system of care that’s much more sustainable that can be beneficial for many more conditions,” she said. “The question is, what are the conditions where ti requires a face-to-face intervention, and are there certain patients where this is more important than others?”

The director of NIDA discusses the unprecedented impact of the pandemic on overdose deaths—and how substance use disorder care may still reach greater capability when all is said and done.

Nora D. Volkow, MD: Combating COVID-Era Issues in Substance Use Disorder

The presence of dementia and Alzheimer’s disease is already greater in the US than its rate of diagnosis. But with an aging generation approaching greater risk levels and screening methods remaining imperfect, the pressure to better parse memory-loss presentation is increasing.

 in New Orleans this week, Brent Forester, MD, MSc, chief of the division of geriatric psychiatry at McLean Hospital, discussed the importance of adequate screening in older patients complaining of memory loss. As he noted, the Alzheimer’s disease patient population is anticipated to reach 15 million Americans by 2050. Approximately $340 billion annually is dedicated to care for the current population.

“This one condition alone, which represents the sixth-leading cause of death in the United States, will become an economic catastrophe unless we can find a way to diagnose people early and intervene in a way that stops the disease in it tracks or treats it,” Forester said. “But the most important thing is assessing it.”

Forester explained that memory complaints are often associated with normal signs of aging by loved ones, but it’s important to be addressed in the primary care setting, followed by a thorough evaluation; memory loss can be a symptom of anything from a thyroid issue, to anxiety and depression, or even alcohol and substance abuse.

“The way I think about memory problems is it’s the tip of the iceberg, and there’s a whole world underneath that we’ve got to discover what’s driving it,” Forester said.

The care gets trickier when the diagnosis is dementia or Alzheimer’s disease. Approximately half of all Americans with Alzheimer’s are not diagnosed, and many are diagnosed at point when disease pathology has been present in the brain for 2 decades already.

There is no single blood test nor scan available for the disease, and the last decade has been laden with scrutiny over consideration of population-based testing for dementia with available cognition tools generally used for identifying the first risks of diagnosis. This could lead to many false positives, Forester said.

“So increasingly, people are developing targeted screening approaches using algorithms that involve going into the electronic medical record and pulling out components of medical history that might put people at risk of dementia,” he explained. “The question is, how do you create a simple package—an algorithm, almost—that a primary care physician can follow so they don’t feel lost?”

The idea with these proposed screening tools would be to help process patients and their loved ones to resources and care teams that can help address the cognitive burdens of dementia, while attending to retained quality of life.

From there, services like Alzheimer’s Association Dementia Care Consultation program could provide families with assessments linked back to primary care physicians that serves as a “road map” for all involved parties, Forester said.

Forester also highlighted some currently available collaborative care models that could provide timely, prompt, and financially-sound care for new patients with dementia or Alzheimer’s disease. That said, much more work needs to be done at the systemic level to actually make these pathways to care feasible for the anticipated boom of patients.

“These models we know work—they save money and they improve quality of life,” he said. “The 2 things are, how do you pay for them and how do you implement them into a system of care that already exists and is disincentivized to work in this way? We need a new financial model of care to pay for these types of intervention.”

Dementia and Alzheimer's disease cases are anticipated to boom in coming decades. One expert stressed the need for improved screening and facilitation of care at the earliest stages and signs.

The Challenges to Identifying Dementia, Alzheimer-Risk Patients

New findings from the PRISM-EXT trial found CP101 prevented recurrence of C.difficile infection (CDI) through Week 8 of the study, with no treatment-related serious adverse events.

These data were consistent with previous reported findings from the randomized, placebo-controlled PRISM3 trial, said the investigators.

“The PRISM-EXT results also suggest that a second dose of CP101 successfully rescued a significant proportion of participants who did not respond to an initial dose of CP101,” wrote study author Jessica Allegretti, MD, Brigham and Women's Hospital.

The findings were presented at the 2022 Digestive Disease Week Annual Meeting in San Diego, California.

Allegretti and colleagues noted there is a shortage of safety and efficacy data from rigorous trials on the effect of microbiome therapies for CDI. Particularly, few trials have looked at the effect of second dosing with an orally administered microbiome therapeutic due to recurrence after initial dosing.

As such, the PRISM-EXT trial aimed to evaluate safety and efficacy of the investigational orally administered microbiome CP101 in adults with recurrent CDI and those that experienced recurrence in the PRISM3 trial.

The PRISM-EXT enrolled individuals with ≥1 CDI recurrence at over 50 sites in the United States and Canada, with a qualifying CDI episode noted to be diagnosed prior to trial entry. After standard-of-care antibiotics, participants received a single oral administration of CP101 without bowel preparation.

Participants were made up of those who rolled over from the phase 2 PRISM3 following CDI recurrence on-study or direct entry participants with recurrent CDI who were not previously enrolled in PRISM3.

They identified the primary efficacy endpoint was sustained clinical cure, which was defined as an absence of CDI recurrence, through Week 8 following dosing. Then, secondary endpoints of efficacy and safety were evaluated through Week 24.

The study analyzed a total of 132 participants, split into two cohorts:

They noted the rollover cohort included CP101 rollover participants (n = 20) and placebo rollover participants (n = 30). The mean age reported was 69 years.

Investigators found 52% of participants entered the trial after a first CDI recurrence in the direct entry group. Data show the overall proportion of individuals with sustained clinical cure through Week 8 was 80.3%.

Additionally, they observed efficacy was maintained at a sustained clinical cure rate of 78.8% through Week 24. From the PRISM3 CP101 rollover participants, data show 70% (14 of 20) had a sustained clinical cure through week 8 after a second CP101 dose in PRISM-EXT. Investigators reported no treatment-related serious adverse events.

The study, “CP101, An Investigational Orally Administered Microbiome Therapeutic Was Effective For Prevention of Recurrent C.Difficile Infection: Results From Open-Label Prism-EXT Trial,” was presented at 

Articles

Digestive Disease Week

Data show the proportion of individuals with sustained clinical cure through Week 8 was 80.3% with CP101 treatment. 

CP101 Prevented Recurrence of C Difficile Infection in PRISM-EXT Trial

 last December set expert-informed precedence for the use of ketamine and esketamine in eligible patients with 

The recommendations, organized by 2 dozen psychiatrists and investigators in the field, provided answers to key questions surrounding the much-discussed anesthetic drug group, including its place among viable therapies, its role in treatment paradigms, its sequencing, the suitable treatment candidates, and the ideal treatment setting and care team.

Six month since the publication, the lead author reviewed the still-evolving state of ketamine and esketamine use in psychiatric care.

 in New Orleans this week, Roger S. McIntyre, MD, professor of psychiatry and pharmacology at the University of Toronto, emphasized the importance of introducing—and continually guiding—ketamine and esketamine into the paradigm of major depressive disorder treatment.

“The state of the union is that we’ve had conventional antidepressants since the mid 1950s, many people have done extremely well, but most haven’t,” McIntyre said. “The need for a novel, innovative treatment is significant. And ketamine/esketamine have provided not just an alternative, but a treatment that works rapidly—within a day—and a treatment that’s able to actually help people with treatment-resistant depression.”

While McIntyre emphasized the importance of “safety and professionalism guiding its implementation,” he believes enough evidential data exists to consider their position already in the armamentarium of depression treatment.

“Certainly, there is a case to be made—something that would be based on FDA approval of esketamine—that esketamine would be positioned as a third-line strategy, after a person with properly diagnosed depression has tried at least 2 antidepressants or antidepressant options,” McIntyre said. He added the drug’s indicated use for patients with depression with suicide ideation, and the surrounding data for that use, would support its role as a first-line treatment in those patients as well.

McIntyre expressed interest in learning more about the drugs’ benefit for bipolar depression or post-traumatic stress disorder (PTSD)—2 fields for which they are being investigated. All the same, he emphasized continued deliberation and clear communication for the sake of assured benefit and safety in eligible patients.

“To be perfectly blunt, I was in part motivated to lead the guidelines out of my concern that there was really a lack of cohesive, coherent, evidence-based parameters to guide who’s the appropriate patient for ketamine/esketamine, what’s the appropriate setting, what’s the appropriate personnel overseeing the implementation, and what’s the appropriate surveillance of the person receiving the treatment,” he said.

“It’s important that people have options, and optionality has been created by ketamine and esketamine.”

The lead author of treatment recommendations weighs in on their current use and future research.

Guiding Appropriate Ketamine, Esketamine Use in Psychiatry

 infections (CDI) moves toward live microbiota therapeutics, there might be a new potential use for fecal microbiota transplantation (FMT) in treating patients with Graft versus Host disease (GVHD).

2022 Digestive Disease Week Annual Meeting

 in San Diego, investigators from the Mayo Clinic found FMT has promising efficacy in managing GVHD.

, Raseen Tariq, MBBS, Division of Gastroenterology and Hepatology Mayo Clinic libraries, Mayo Clinic, explained the promising initial results and how FMT needs to studied further in the future.

“GVHD is pretty difficult to treat,” Tariq said. “It has been postulated that it is due to dysposis of the microbiome, especially secondary to antibiotics that these patients get.”

The purpose of the study was to see if it was even possible to use FMT in this select patient population. While prior studies have shown some efficacy, those studies were generally limited by small sample sizes.

In the updated meta-analysis, the investigators found about 56% of a total of 73 patients had a complete response and 14 patients had a partial response, for a total efficacy of 73%. There was also no adverse events found in this patient population.

Initial studies have shown a 73% efficacy for FMT in treating patients with HVGD. 

Raseen Tariq, MBBS: FMT for Refractory Host Versus Graft Disease

New findings suggest a lack of association between body mass index (BMI) and 30 day all-cause mortality or hospital-free days among a cohort of hospitalized patients with Clostridioides difficile infection (CDI).

“It is unlikely that BMI will be a useful factor to further risk-stratify patients with CDI,” wrote study author Daniel E Freedberg, MD, Columbia University Irving Medical Center.

Although the incidence and severity of CDI has been showing to increase over the past decades, there are still unknowns regarding whether obesity in combination with established risk factors can aid in predicting outcomes among those hospitalized with CDI.

The current three-center retrospective study included this patient population at Columbia University Irving Medical Center, Brigham and Women’s Hospital, and NYU Langone from 2010 to 2018 to test these associations between obesity and mortality.

Eligible patients had either community-acquired or healthcare-associated CDI, as long as BMI was measured at the time of hospitalization. Investigators classified obesity as BMI:

Investigators used multivariate logistic regression to investigate the relationship between obesity and all-cause death within 30 days after the index CDI test, while a stratified analysis determined if the obesity-death relationship varied based on age. They noted hospital free-days were compared between each obesity category.

A total of 3,851 patients were analyzed, including 373 (9.7%) who died within 30 days following diagnosis of CDI, according to investigators. Following adjustment for other factors, data show BMI did not have an association with increased risk for death in any BMI category.

Investigators then noted it remained true following compression of BMI into fewer categories (adjusted odds ratio [aOR], 0.96; 95% CI, 0.69 to 1.34 for BMI >30 versus BMI 20 - 30 and aOR, 1.02; 95% CI, 0.53 - 1.87 for BMI >40 vs BMI 20 - 30).

They noted advanced age, low albumin, and elevated total bilirubin were factors most closely associated with death. Both low platelet count and elevated bilirubin were associated with increased risk of 30-day mortality in CDI patients. 

Following stratification into three age groups, investigators observed trends towards increased mortality with obesity in the young (≤55 years old) and middle-aged (56 - 75 years) (

 for trend = 0.33 and 0.14, respectively).

However, they observed decreased mortality with obesity in the old age group (

 for trend = 0.37). They additionally found no significant difference in hospital-free days between BMI groups (Kruskal-Wallis 

“Future studies seeking to risk-stratify hospitalized patients with CDI may wish to test alternate variables to improve prognostication for hospitalized patients with CDI,” Freedberg concluded. 

The study, “Obesity Is Not Associated with Adverse Outcomes Among Hospitalized Patients with Clostridium Difficile Infection," was presented at 

BMI did not have an association with increased risk for death in any BMI category, according to study investigators. 

Lack of Association Observed Between BMI and Mortality Among C Difficile Hospitalizations

The use of ozanimod in both studies focusing on ulcerative colitis (UC) and those focusing on multiple sclerosis did not show a signficant increase in cardiovascular events, bradycardia, or cardiac conduction abnormalities, according to new findings. 

, Miguel Regueiro, MD, discussed these new data and what they might represent for this patient population. 

"I think for the practicing gastroenterologist, this lends comfort in terms of the safety findings in using ozanimod in patients, even who have ve had what we would consider mild cardiac events," Regueiro said. "It does not cause cardiac abnormalities and even in the patients that had cardiac abnormalities, the patients tolerated this quite well."

Regueiro went on to discuss the hierarchy of treatment for UC and Crohn's Disease. He noted that while there are no cross-comparisons of ozanimod and ustekinumab, each showed a statistically signficant higher benefit of remission and all primary outcomes, compared to placebo. 

By looking at patient factors, clinicans can determine the severity of disease, risk factors for surgery, and other comorbidities to position the proper therapy for one of these patients. 

"With all of that information, we are taking that into account and a shared decision way with our patients when we look to start these therapies," he said. 

"Patient Identification and Treatment of Adult Patients with Moderately to Severely Active UC with ZEPOSIA (Ozanimod)," was presented at DDW 2022. 

A look into the efficacy of ozanimod in patients with UC and the potential risk for cardiovascular events. 

Miguel Regueiro, MD: Safety Data on Ozanimod for Ulcerative Colitis 

 in San Diego shows the live microbiota therapeutic results in restoring microbe-associated metabolites known to prevent recurrent 

A team, led by Kevin D. Litcofsky, MD, Seres Therapeutics, investigators changes in short, medium, and branched-chain fatty acids based on emerging studies regarding the potential role of microbe-associated metabolites in inhibiting C difficile growth and restoring gut homeostasis.

Recent studies, including a phase 3 trial, have shown that SER-109, an oral investigational microbiome therapeutic made of purified Firmicutes spores, shown promise compared to placebo in reducing the risk of recurrent CDI at week 8.

In the phase 3 trial, the primary endpoint of reducing the risk was superior for patients treated SER-109 compared to placebo (12.4% vs. 39.8%, respectively; RR, 0.32; 95% CI, 0.18-0.58; 

SER-109 also led to a higher engraftment of dose species and rapid conversion of primary to secondary bile acids, known inhibitors of C difficile spore germination and vegetative growth at weeks 1, 2, and 8.

In the study, the investigators examined patients with a history of at least 3 episodes of rCDI. Each patient was randomly assigned to be treated with either placebo or SER-109 following 10-21 days of standard of care antibiotic treatment.

The investigators also looked at a post-hoc analysis in which concentrations of short (acetate, propionate, butyrate), medium (valerate, hexanoate), and branched-chain (2-methylbutyrate, isobutyrate, isovalerate) fatty acids in subjects’ stool samples were measured from baseline to 1, 2, and 8 weeks post-treatment. The measurements were made by targeted liquid chromatography with tandem mass spectrometry.

The team also used two-sided Mann-Whitney U tests to determine statistical significance for metabolite comparisons between the different arms of the trial.

The baseline concentrations of all measured fatty acids were comparable between participants treated with SER-109 and placebo.

The concentrations of butyrate, a short-chain fatty acid, and valerate and hexanoate, medium-chain fatty acids, rapidly and significantly increased in patients treated with SER-109 compared to placebo.

The concentrations of microbe-produced metabolites also remained significantly higher in patients treated with SER-109 at week 2 and week 8 compared to placebo. The changes correlated with a greater magnitude of engraftment of SER-109 dose species through week 8 compared to placebo. However, other short and branched-chain fatty acids did not show consistent treatment related differences across the different time points.

The results show SER-109 could modulate multiple pathways critical to the rapid interruption of the C difficile life cycle.

“Compared to placebo, SER-109 demonstrated a rapid and sustained increase in the concentrations of butyrate, valerate, and hexanoate in parallel with SER-109 engraftment at weeks 1, 2 and 8 in subjects with a history of rCDI,” the authors wrote. “The increase in these microbe-produced metabolites was associated with a reduction in rCDI events suggesting that increasing fatty acid production may improve clinical outcomes.”

The study, “IMPACT OF SER-109, AN INVESTIGATIONAL MICROBIOME THERAPEUTIC, ON STOOL FATTY ACID METABOLITES IN A PHASE 3 RANDOMIZED TRIAL (ECOSPOR III) FOR TREATMENT OF RECURRENT CLOSTRIDIOIDES DIFFICILE INFECTION (CDI),” was published online by 

The live microbiota therapeutic has shown promise in treating patients with recurrent CDI.

SER-109 Results in Increase in Microbe-Producing Metabolites

 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

Latest Conference Articles