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Nijen Twilhaar MK, Czentner L, van Nostrum CF, Storm G, den Haan JMM. Mimicking Pathogens to Augment the Potency of Liposomal Cancer Vaccines. Pharmaceutics 2021; 13:954. [PMID: 34202919 PMCID: PMC8308965 DOI: 10.3390/pharmaceutics13070954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/02/2023] Open
Abstract
Liposomes have emerged as interesting vehicles in cancer vaccination strategies as their composition enables the inclusion of both hydrophilic and hydrophobic antigens and adjuvants. In addition, liposomes can be decorated with targeting moieties to further resemble pathogenic particles that allow for better engagement with the immune system. However, so far liposomal cancer vaccines have not yet reached their full potential in the clinic. In this review, we summarize recent preclinical studies on liposomal cancer vaccines. We describe the basic ingredients for liposomal cancer vaccines, tumor antigens, and adjuvants, and how their combined inclusion together with targeting moieties potentially derived from pathogens can enhance vaccine immunogenicity. We discuss newly identified antigen-presenting cells in humans and mice that pose as promising targets for cancer vaccines. The lessons learned from these preclinical studies can be applied to enhance the efficacy of liposomal cancer vaccination in the clinic.
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Affiliation(s)
- Maarten K. Nijen Twilhaar
- Department of Molecular Cell Biology and Immunology, Cancer Center Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands;
| | - Lucas Czentner
- Department of Pharmaceutics, Faculty of Science, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands; (L.C.); (C.F.v.N.); (G.S.)
| | - Cornelus F. van Nostrum
- Department of Pharmaceutics, Faculty of Science, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands; (L.C.); (C.F.v.N.); (G.S.)
| | - Gert Storm
- Department of Pharmaceutics, Faculty of Science, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands; (L.C.); (C.F.v.N.); (G.S.)
- Department of Biomaterials, Science and Technology, Faculty of Science and Technology, University of Twente, 7522 NB Enschede, The Netherlands
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Joke M. M. den Haan
- Department of Molecular Cell Biology and Immunology, Cancer Center Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands;
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Lam KH, van Oirschot P, den Teuling B, Hulst HE, de Jong BA, Uitdehaag BMJ, de Groot V, Killestein J. Reliability, construct and concurrent validity of a smartphone-based cognition test in multiple sclerosis. Mult Scler 2021; 28:300-308. [PMID: 34037472 PMCID: PMC8795217 DOI: 10.1177/13524585211018103] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Early detection and monitoring of cognitive dysfunction in multiple sclerosis (MS) may be enabled with smartphone-adapted tests that allow frequent measurements in the everyday environment. Objectives: The aim of this study was to determine the reliability, construct and concurrent validity of a smartphone-adapted Symbol Digit Modalities Test (sSDMT). Methods: During a 28-day follow-up, 102 patients with MS and 24 healthy controls (HC) used the MS sherpa® app to perform the sSDMT every 3 days on their own smartphone. Patients performed the Brief International Cognitive Assessment for MS at baseline. Test–retest reliability (intraclass correlation coefficients, ICC), construct validity (group analyses between cognitively impaired (CI), cognitively preserved (CP) and HC for differences) and concurrent validity (correlation coefficients) were assessed. Results: Patients with MS and HC completed an average of 23.2 (SD = 10.0) and 18.3 (SD = 10.2) sSDMT, respectively. sSDMT demonstrated high test–retest reliability (ICCs > 0.8) with a smallest detectable change of 7 points. sSDMT scores were different between CI patients, CP patients and HC (all ps < 0.05). sSDMT correlated modestly with the clinical SDMT (highest r = 0.690), verbal (highest r= 0.516) and visuospatial memory (highest r= 0.599). Conclusion: Self-administered smartphone-adapted SDMT scores were reliable and different between patients who were CI, CP and HC and demonstrated concurrent validity in assessing information processing speed.
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Affiliation(s)
- KH Lam
- KH Lam Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, De Boelelaan, 1117 Amsterdam, The Netherlands.
| | - P van Oirschot
- Orikami Digital Health Products, Nijmegen, The Netherlands
| | - B den Teuling
- Orikami Digital Health Products, Nijmegen, The Netherlands
| | - HE Hulst
- Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - BA de Jong
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - BMJ Uitdehaag
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - V de Groot
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - J Killestein
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
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La Zara D, Sun F, Zhang F, Franek F, Balogh Sivars K, Horndahl J, Bates S, Brännström M, Ewing P, Quayle MJ, Petersson G, Folestad S, van Ommen JR. Controlled Pulmonary Delivery of Carrier-Free Budesonide Dry Powder by Atomic Layer Deposition. ACS Nano 2021; 15:6684-6698. [PMID: 33769805 PMCID: PMC8155342 DOI: 10.1021/acsnano.0c10040] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/22/2021] [Indexed: 06/12/2023]
Abstract
Ideal controlled pulmonary drug delivery systems provide sustained release by retarding lung clearance mechanisms and efficient lung deposition to maintain therapeutic concentrations over prolonged time. Here, we use atomic layer deposition (ALD) to simultaneously tailor the release and aerosolization properties of inhaled drug particles without the need for lactose carrier. In particular, we deposit uniform nanoscale oxide ceramic films, such as Al2O3, TiO2, and SiO2, on micronized budesonide particles, a common active pharmaceutical ingredient for the treatment of respiratory diseases. In vitro dissolution and ex vivo isolated perfused rat lung tests demonstrate dramatically slowed release with increasing nanofilm thickness, regardless of the nature of the material. Ex situ transmission electron microscopy at various stages during dissolution unravels mostly intact nanofilms, suggesting that the release mechanism mainly involves the transport of dissolution media through the ALD films. Furthermore, in vitro aerosolization testing by fast screening impactor shows a ∼2-fold increase in fine particle fraction (FPF) for each ALD-coated budesonide formulation after 10 ALD process cycles, also applying very low patient inspiratory pressures. The higher FPFs after the ALD process are attributed to the reduction in the interparticle force arising from the ceramic surfaces, as evidenced by atomic force microscopy measurements. Finally, cell viability, cytokine release, and tissue morphology analyses verify a safe and efficacious use of ALD-coated budesonide particles at the cellular level. Therefore, surface nanoengineering by ALD is highly promising in providing the next generation of inhaled formulations with tailored characteristics of drug release and lung deposition, thereby enhancing controlled pulmonary delivery opportunities.
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Affiliation(s)
- Damiano La Zara
- Department
of Chemical Engineering, Delft University
of Technology, Van der Maasweg 9, Delft, 2629HZ, The Netherlands
| | - Feilong Sun
- Department
of Chemical Engineering, Delft University
of Technology, Van der Maasweg 9, Delft, 2629HZ, The Netherlands
| | - Fuweng Zhang
- Department
of Chemical Engineering, Delft University
of Technology, Van der Maasweg 9, Delft, 2629HZ, The Netherlands
| | - Frans Franek
- Advanced
Drug Delivery, Pharmaceutical Sciences, R&D, AstraZeneca, Gothenburg, Sweden
| | - Kinga Balogh Sivars
- Clinical
Testing and Precision Medicine, Global Procurement, Operations, AstraZeneca, Gothenburg, Sweden
| | - Jenny Horndahl
- Bioscience
COPD/IPF, Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Stephanie Bates
- Functional
and Mechanistic Safety, Clinical Pharmacology
and Safety Sciences, R&D, AstraZeneca, Cambridge U.K.
| | - Marie Brännström
- Drug
Metabolism and Pharmacokinetics, Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D,
AstraZeneca, Gothenburg, Sweden
| | - Pär Ewing
- Drug
Metabolism and Pharmacokinetics, Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D,
AstraZeneca, Gothenburg, Sweden
| | - Michael J. Quayle
- New Modalities
and Parenteral Development, Pharmaceutical Technology & Development, Operations, AstraZeneca, Gothenburg, Sweden
| | - Gunilla Petersson
- Innovation
Strategy and External Liaison, Pharmaceutical Technology & Development, Operations, AstraZeneca, Gothenburg, Sweden
| | - Staffan Folestad
- Innovation
Strategy and External Liaison, Pharmaceutical Technology & Development, Operations, AstraZeneca, Gothenburg, Sweden
| | - J. Ruud van Ommen
- Department
of Chemical Engineering, Delft University
of Technology, Van der Maasweg 9, Delft, 2629HZ, The Netherlands
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Smeets ETHC, Mensink RP, Hoeks J, de Vogel-Van den Bosch J, Hageman RJJ, Joris PJ. Effects of Beetroot Powder with or without L-Arginine on Postprandial Vascular Endothelial Function: Results of a Randomized Controlled Trial with Abdominally Obese Men. Nutrients 2020; 12:E3520. [PMID: 33207606 PMCID: PMC7697292 DOI: 10.3390/nu12113520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Through effects on nitric oxide bioavailability, vascular endothelial function is improved after the intake of a high amount of nitrate or L-arginine, but decreased after the intake of a high-fat meal. Therefore, we compared the effects of beetroot powder with or without L-arginine on postprandial brachial artery flow-mediated vasodilation (FMD) after consumption of a high-fat mixed-meal. METHODS Eighteen abdominally obese men completed this randomized, double-blinded, cross-over trial. The study consisted of five test days, each separated by a wash-out period of at least one week. Participants received in random order, a blended meal with a control or nutritional supplement consisting of beetroot powder providing 200 mg nitrate, beetroot with 0.8 g of L-arginine, beetroot with 1.5 g of L-arginine, or 3.0 g of L-arginine. Participants then fasted and 2 h postprandial FMD measurements were performed. RESULTS No significant differences between meals were observed for postprandial FMD (p = 0.45) levels. However, there was a non-significant trend towards a more beneficial postprandial FMD response with the beetroot-containing meals as compared with meals without beetroot. CONCLUSION This trial could not provide evidence for beneficial additive effects of a single dose of beetroot powder combined with L-arginine on postprandial endothelial function in abdominally obese men.
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Affiliation(s)
- Ellen T. H. C. Smeets
- Department of Nutrition and Movement Sciences, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, P.O. Box 616, 6200 Maastricht, The Netherlands; (E.T.H.C.S.); (R.P.M.); (J.H.)
| | - Ronald P. Mensink
- Department of Nutrition and Movement Sciences, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, P.O. Box 616, 6200 Maastricht, The Netherlands; (E.T.H.C.S.); (R.P.M.); (J.H.)
| | - Joris Hoeks
- Department of Nutrition and Movement Sciences, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, P.O. Box 616, 6200 Maastricht, The Netherlands; (E.T.H.C.S.); (R.P.M.); (J.H.)
| | | | - Robert J. J. Hageman
- Danone Nutricia Research, 3584 Utrecht, The Netherlands; (J.d.V.-V.d.B.); (R.J.J.H.)
| | - Peter J. Joris
- Department of Nutrition and Movement Sciences, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, P.O. Box 616, 6200 Maastricht, The Netherlands; (E.T.H.C.S.); (R.P.M.); (J.H.)
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Kleinrensink NJ, Foppen W, Ten Katen I, van der Veen PH, de Klerk B, Diepstraten SCE, Radstake TRDJ, Lafeber FPJG, de Jong PA, Leijten EFA. Comparison of the Heel Enthesitis MRI Scoring System (HEMRIS) with clinical enthesitis and local metabolic activity on PET-CT. RMD Open 2020; 6:e001424. [PMID: 33277402 PMCID: PMC7856158 DOI: 10.1136/rmdopen-2020-001424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/15/2020] [Accepted: 11/11/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To compare the Heel Enthesitis MRI Scoring model (HEMRIS) with clinical and PET/CT outcomes in patients with cutaneous psoriasis (Pso), psoriatic arthritis (PsA) or ankylosing spondylitis (AS). METHODS This prospective, observational study included 38 patients with Pso, PsA and AS. Patients were included regardless of presence or absence of clinical heel enthesitis. MRI-scans of both ankles and a whole-body 18F-FDG PET/CT were acquired. MRIs were assessed for enthesitis by two independent and blinded observers according to the HEMRIS. A physician, blinded for imaging results, performed clinical evaluations of enthesitis at the Achilles tendon and plantar fascia. RESULTS In total, 146 entheses were scored according to the HEMRIS and clinically assessed for enthesitis (6 entheses were clinically affected). In Achilles tendons with clinical enthesitis, the HEMRIS structural damage score was significantly higher, compared to Achilles tendons without clinical enthesitis (respective median scores 1.0 and 0.5; p=0.04). In clinically unaffected entheses, HEMRIS abnormalities occurred in 44/70 (63%) of Achilles tendons and in 23/70 (33%) of plantar fascia. At the Achilles tendon, local metabolic activity measured on PET/CT was weakly associated with the structural (rs=0.25, p=0.03) and total HEMRIS (rs=0.26, p=0.03). CONCLUSION This study revealed a high prevalence of subclinical HEMRIS abnormalities and discrepancy between HEMRIS and clinical and PET/CT findings. This may suggest that the HEMRIS is a sensitive method for detection of inflammatory and structural disease of enthesitis at the Achilles tendon and plantar fascia, although the clinical significance of these MRI findings remains to be determined in longitudinal studies.
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Affiliation(s)
- Nienke J Kleinrensink
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Wouter Foppen
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Iris Ten Katen
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | | | - Bo de Klerk
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
| | | | - Timothy R D J Radstake
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
- Center for Translational Immunology, UMC Utrecht, Utrecht, Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
| | - Pim A de Jong
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Emmerik F A Leijten
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
- Center for Translational Immunology, UMC Utrecht, Utrecht, Netherlands
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Koning M, van den Berg CW, Rabelink TJ. Stem cell-derived kidney organoids: engineering the vasculature. Cell Mol Life Sci 2019; 77:2257-2273. [PMID: 31807815 PMCID: PMC7275011 DOI: 10.1007/s00018-019-03401-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 10/16/2019] [Accepted: 11/26/2019] [Indexed: 01/12/2023]
Abstract
Kidney organoids can be generated from human pluripotent stem cells (PSCs) using protocols that resemble the embryonic development of the kidney. The renal structures thus generated offer great potential for disease modeling, drug screening, and possibly future therapeutic application. At the same time, use of these PSC-derived organoids is hampered by lack of maturation and off-target differentiation. Here, we review the main protocols for the generation of kidney organoids from human-induced PSCs, discussing their advantages and limitations. In particular, we will focus on the vascularization of the kidney organoids, which appears to be one of the critical factors to achieve maturation and functionality of the organoids.
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Affiliation(s)
- Marije Koning
- Department of Internal Medicine-Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
- Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| | - Cathelijne W van den Berg
- Department of Internal Medicine-Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton J Rabelink
- Department of Internal Medicine-Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands
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van den Berg SA, Dippel DWJ, Hofmeijer J, Fransen PSS, Caminada K, Siegers A, Kruyt ND, Kerkhoff H, de Leeuw FE, Nederkoorn PJ, van der Worp HB. Multicentre Randomised trial of Acute Stroke treatment in the Ambulance with a nitroglycerin Patch (MR ASAP): study protocol for a randomised controlled trial. Trials 2019; 20:383. [PMID: 31242931 PMCID: PMC6595565 DOI: 10.1186/s13063-019-3419-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/09/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Some studies have suggested that transdermal administration of glyceryl trinitrate (GTN; nitroglycerin) in the first few hours after symptom onset increases the chance of a favourable outcome after ischaemic stroke or intracerebral haemorrhage, possibly through an increase in intracranial collateral blood flow and a reduction in blood pressure. The Multicentre Randomised trial of Acute Stroke treatment in the Ambulance with a nitroglycerin Patch (MR ASAP) aims to assess the effect of transdermal GTN, started within 3 h after stroke onset in the prehospital setting, on functional outcome at 90 days in patients with acute ischaemic stroke or intracerebral haemorrhage. METHODS MR ASAP is a phase III, multicentre, randomised, open-label clinical trial with a blinded outcome assessment. A total of 1400 adult patients with suspected stroke and a systolic blood pressure ≥ 140 mmHg will be randomised to transdermal GTN (5 mg/day), administered as a transdermal patch by paramedics in the prehospital setting within 3 h of stroke onset and continued for 24 h or to standard care. The primary outcome is the score on the modified Rankin Scale (mRS) at 90 days, analysed with ordinal logistic regression. Secondary outcomes include blood pressure and collateral circulation at hospital admission, neurological deficit measured with the National Institutes of Health Stroke Scale at 24 h, and mortality and poor outcome (mRS score 3 to 6) at 90 days. This trial will be conducted in the Netherlands and will use a deferred consent procedure. The trial is part of the Collaboration for New Treatments of Acute Stroke (CONTRAST) programme. DISCUSSION MR ASAP will assess whether very early administration of GTN improves outcome after stroke in a setting where rates of intravenous thrombolysis and endovascular treatment for acute ischaemic stroke are high. The deferred consent procedure facilitates prompt GTN treatment and will prevent delay to revascularisation therapies. If early transdermal GTN treatment proves to be effective, this low-cost treatment can be readily implemented into daily clinical practice. TRIAL REGISTRATION ISRCTN Registry, ISRCTN99503308 . Registered on 2 January 2018.
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Affiliation(s)
- Sophie A. van den Berg
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Diederik W. J. Dippel
- Department of Neurology, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Jeannette Hofmeijer
- Department of Neurology, Rijnstate, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands
| | - Puck S. S. Fransen
- Department of Neurology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Klaartje Caminada
- Regional Ambulance Service IJsselland, Voltastraat 3-A, 8013 PM Zwolle, The Netherlands
- Department of Emergency Medicine, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Arjen Siegers
- Ambulance Amsterdam, Karperweg 19-25, 1075 LB Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Nyika D. Kruyt
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Henk Kerkhoff
- Department of Neurology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Paul J. Nederkoorn
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - H. Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - on behalf of the MR ASAP Investigators
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
- Department of Neurology, Rijnstate, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands
- Department of Neurology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
- Regional Ambulance Service IJsselland, Voltastraat 3-A, 8013 PM Zwolle, The Netherlands
- Department of Emergency Medicine, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
- Ambulance Amsterdam, Karperweg 19-25, 1075 LB Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Neurology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
- Department of Neurology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Neurology and Neurosurgery, Brain Center University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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