Drug Database
PO

polyvalent mechanical bacterial lysate (Ismigen)

✓ Approved

Merck & Co. · Small Molecule · Small Molecule

What is polyvalent mechanical bacterial lysate?

polyvalent mechanical bacterial lysate is a small molecule developed by Merck & Co.. It is approved for therapeutic indications via oral (po) or sublingual (sl)/oral transmucosal.

Drug Profile

Brand NamesIsmigen
CompanyMerck & Co.
Drug ClassSmall Molecule
RouteOral (PO), Sublingual (SL)/Oral Transmucosal
StatusApproved
Sources: ClinicalTrials.gov, Merck & Co.

Therapeutic Indications

polyvalent mechanical bacterial lysate is developed for 2 unique indications across 1 therapeutic area.

Therapeutic AreaConditionPhase
Infections and infestationsLower respiratory tract infection✓ Approved
Infections and infestationsViral upper respiratory tract infection✓ Approved

Related Research Articles

PubMedCureus2026-09-20

Emerging Resistance and Shifting Bacterial Profiles in Lower Respiratory Tract Infections: A Tertiary Care Perspective.

Shaik Firoz B FB, Shinde Ravindra V RV, Patil Satish R SR

Background and objective Lower respiratory tract infections (LRTIs) continue to pose a significant global public health concern, with bacterial agents responsible for a considerable proportion of cases requiring hospitalization and antibiotic treatment. The increasing emergence of antimicrobial resistance (AMR) among respiratory pathogens further complicates disease management and clinical outcomes. This study aimed to identify the bacterial profile of clinical LRTI cases and to determine the antimicrobial susceptibility of the identified pathogens. Materials and methods The study involved laboratory-based investigation of bacterial isolates from hospitalized patients with clinical suspicion of LRTI at Krishna Hospital and Medical Research Center, Karad, India, over one year from May 2024 to May 2025. Clinical specimens, such as endotracheal aspirates, sputum, and pleural fluid samples, were processed according to standard microbiological protocols. Results The study included 120 cases of confirmed LRTI. The 20-29 years age category exhibited the greatest infection burden, representing 35 (29.17%) cases, while the 30-39 years age group followed with 26 (21.67%) cases. Males were more frequently impacted than females, accounting for 77 (64.17%) cases versus 43 (35.83%). Of the 120 bacterial isolates obtained, Pseudomonas spp. were the predominant organism isolated, representing 49 (40.83%) of the isolates, followed by Acinetobacter spp. (n = 39, 32.50%) and Klebsiella species (n = 16, 13.33%), Escherichia coli (E. coli) (6, 5.00%), Streptococcus spp. (n = 5, 4.17%) and Staphylococcus aureus (S. aureus) ( n = 5, 4.17%). Endotracheal tube (ETT) specimens were the main source of isolates (n = 65, 54.17%), followed by sputum specimens (n = 49, 40.83%) and pleural fluid specimens (n = 6, 5.00%). Antimicrobial susceptibility testing (AST) revealed varied susceptibility patterns, with significant resistance noted among the isolates, especially in Gram-negative isolates. Of the 110 Gram-negative isolates, 96 were recognized as multidrug-resistant (MDR). Conclusions This investigation showed that Gram-negative bacterial pathogens dominate LRTI, with Pseudomonas spp.and Acinetobacter spp. being the most commonly isolated species. Most bacterial isolates were recovered from ETT and sputum specimens, underscoring the significance of appropriate diagnostic specimens in the diagnosis of LRTIs. The widespread occurrence of MDR Gram-negative isolates and the significant resistance to commonly used antimicrobial agents highlight the growing challenge of AMR. These results underscore the significance of prompt microbiological diagnosis, regular culture and AST, susceptibility-guided therapy, effective infection control measures, and antimicrobial stewardship initiatives to improve patient outcomes and reduce the transmission of resistant pathogens.

PMID 42763599
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PubMedIn vitro models2026-09-20

Impact of aging treatment and Zr content on microstructure and mechanical properties of Ti-Nb-Mo-Zr metastable β titanium alloys for biomedical applications.

Nunes Aline Raquel Vieira ARV, Precioso João de Ataíde Garcia JAG, Borborema Sinara S, Araújo Leonardo Sales LS et al.

The β-metastable alloys in the quaternary Ti-Nb-Mo-Zr system represent particularly attractive candidates for the fabrication of femoral prostheses. The present work studies the influence of aging heat treatment and Zr content on the microstructure and mechanical properties of two series of alloys comprising respectively Ti-29Nb-2Mo with 0, 3, and 6% Zr and Ti-24Nb-4Mo with 0, 3, and 6% Zr. Aging heat treatments between 300 °C and 500 °C were performed following annealing at 950 °C for 1 h. Microstructural investigations were conducted by optical microscopy, transmission electron microscopy, and X-ray diffraction, while microhardness and Young's modulus measurements were performed. The results showed that the microstructure is not modified by the Zr content but strongly depends on aging temperature due to the precipitation of ω or α phase into the β matrix. The six Ti-Nb-Mo-Zr alloys achieved HV/E values substantially exceeding that of the commercial Ti-6Al-4 V alloy and can all be considered as promising alloys for orthopedic applications. The highest HV/E ratios were observed after aging at 400 °C, with a maximum obtained for the Ti-29Nb-2Mo-6Zr alloy. With a view to using the (Ti-Nb-Mo-Zr) alloys for the fabrication of prosthetic hip stems with a gradient in mechanical properties, a low Young's modulus is required for the distal part whereas, in the neck region, a local aging treatment increases the hardness. In the annealed state, the Ti-29Nb-2Mo-6Zr alloy exhibits the lowest Young's modulus. For this alloy, a maximum hardness of 418 HV is obtained after aging for 4 h at 400 °C.

PMID 42763472
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PubMedCureus2026-09-20

Beyond the Usual Pathogens: Community-Acquired Meningoencephalitis Caused by Streptococcus equi in an Immunocompetent Adult.

Hammadi Hicham H, Elbouti Anas A, Chikhi Brahim B, Aarjouni Youssef Y et al.

Streptococcus equi is a rare zoonotic pathogen that only occasionally causes invasive central nervous system infections in humans. We report the case of a previously healthy 50-year-old man who presented with fever and altered mental status in the setting of recent animal exposure. Cerebrospinal fluid analysis was consistent with acute bacterial meningitis, while direct microscopy and multiplex polymerase chain reaction identified S. equi. Antimicrobial susceptibility testing confirmed susceptibility to ceftriaxone. Despite early initiation of intravenous ceftriaxone and adjunctive dexamethasone, the patient's course was complicated by generalized status epilepticus requiring intensive care support. He subsequently showed progressive neurological recovery with a favorable outcome. This case underscores the importance of considering S. equi as a potential cause of community-acquired bacterial meningoencephalitis in patients with relevant zoonotic exposure and highlights the value of rapid molecular diagnostics for early pathogen identification and targeted antimicrobial therapy.

PMID 42763617
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PubMedIn vitro models2026-09-20

Decellularized extracellular matrix for gastrointestinal organoid culture: a comprehensive review.

He Yong Y, Wong Cheng-San CS, Chen Jinshi J, Leong Cheng-Nam CN et al.

Gastrointestinal organoids, as advanced three-dimensional (3D) in vitro culture models, have revolutionized our understanding of organ development, disease pathophysiology, and therapeutic responses. However, their clinical translation is largely hampered by a reliance on Matrigel. Derived from mouse sarcoma, Matrigel presents inherent limitations, including an undefined composition, significant batch-to-batch variability, potential biosafety risks, and an inability to faithfully mimic the native tissue microenvironment. These limitations severely restrict the application of organoids in regenerative medicine and precision medicine. To overcome these barriers, tissue-specific decellularized extracellular matrix (dECM) has emerged as a superior alternative. Decellularized ECM is derived from native tissues through physical, chemical, or enzymatic removal of cellular components while preserving the intact 3D architecture, tissue-specific protein composition (matrisome), and bioactive signaling molecules of the native extracellular matrix. By preserving the complex 3D architecture, tissue-specific biochemical composition, and critical biological signals of the native ECM, dECM provides a more biomimetic niche for organoid culture. This review begins by examining the anatomical and functional characteristics of the gastrointestinal tract, establishing the physiological context for organoid modeling. This review first outlines the limitations of traditional matrices and establishes the role of the ECM as an active regulator of the stem cell niche. We then detail the preparation process of gastrointestinal dECM, analyzing the selection and optimization of decellularization methods and their impact on the scaffold's biological and mechanical properties. Critical analysis of dECM's mechanical properties reveals that while decellularization may reduce initial matrix stiffness compared to native tissue, appropriate crosslinking and concentration optimization can restore biomechanical integrity while maintaining biochemical fidelity-addressing a key advantage over Matrigel, which lacks both tunability and tissue specificity. Furthermore, we highlight the superiority of dECM in promoting the formation, maturation, and function of gastrointestinal organoids (e.g., stomach, intestine, colon). The review also summarizes recent advances in the application of dECM-cultured gastrointestinal organoids in disease modeling (e.g., inflammatory bowel disease, gastrointestinal cancers, infectious diseases), high-throughput drug screening, personalized medicine, and regenerative medicine (e.g., tissue repair and transplantation). We compare dECM-based matrices with emerging polymer bioinks, highlighting that while synthetic materials offer greater control over mechanical properties, they cannot replicate the complex biochemical signaling and growth factor reservoirs inherent to native ECM-a limitation that current bioengineering approaches continue to address through hybrid formulations. Finally, we discuss current challenges in dECM technology-such as standardization, scalable production, and complexity reconstruction-and envision future directions involving its integration with emerging technologies like 3D bioprinting, microfluidic chips, and multicellular co-culture systems. Such integrated approaches will catalyze the development of more physiologically relevant and functionally robust in vitro gastrointestinal models, opening new avenues for basic research and clinical translation.

PMID 42763512
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PubMedJACC. Case reports2026-09-20

A Curious Change in QRS Width: Timing Is Everything.

Zepeda David Litonjua DL, Sapru Abharika A, E Zarraga Ignatius Gerardo IG

A 61-year-old man with a mechanical aortic valve developed Staphylococcus aureus bacteremia. His electrocardiogram showed sinus rhythm with atrioventricular Wenckebach and phase 4 left bundle branch block. He was subsequently found to have a peri-aortic root abscess that was likely eroding not only into the atrioventricular node, but into the left bundle fibers as well. Phase 4 block is a pause-dependent conduction block that reflects underlying His-Purkinje system disease. During a critical pause, spontaneous phase 4 depolarization in a diseased His-Purkinje system allows more sodium channels to become inactivated, reducing excitability and resulting in transient conduction block.

PMID 42763808
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PubMedCureus2026-09-20

Toward Evidence-Informed Staging in Septic Revision Total Knee Arthroplasty: One-Stage, 1.5-Stage, or Two-Stage?

Salazar Mathias S MS, Almeida Lisbeth T LT, Moyano Carlos A CA, Cadena Gustavo P GP

Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) remains one of the most consequential complications in adult reconstruction because successful treatment requires simultaneous infection control, restoration of a mechanically durable knee, preservation of function, and minimization of surgical morbidity. Two-stage exchange has traditionally been regarded as the reference strategy for chronic knee PJI, but contemporary comparative evidence increasingly challenges its routine use as the default for all patients. This narrative review synthesizes evidence from systematic reviews, meta-analyses, comparative cohorts, propensity-matched analyses, and decision-analytic studies evaluating one-stage, 1.5-stage, and two-stage septic revision TKA. The available data indicate that infection control after one-stage revision is broadly comparable with, and in some analyses superior to, two-stage revision in carefully selected patients. Conversely, two-stage exchange retains a central role in patients with severe host compromise, complex bone or soft-tissue defects, multidrug-resistant or fungal infection, uncertain microbiology, and reconstructive instability. The 1.5-stage strategy has emerged as a pragmatic function-preserving alternative, with encouraging infection-free survivorship and lower treatment burden; however, its long-term mechanical durability remains incompletely defined, particularly because aseptic loosening is consistently identified as a key risk. Evidence-based staging should therefore move beyond a binary hierarchy and toward an algorithm integrating host status, organism profile, soft-tissue envelope, bone loss, fixation requirements, prior failure, timing, and patient goals. Current evidence supports individualized multidisciplinary decision-making rather than routine use of any single staging strategy, while highlighting the need for prospective knee-specific studies using standardized definitions, patient-reported outcomes, mechanical survivorship, and cost-effectiveness endpoints.

PMID 42763776
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