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Kulkarni S, Ganz J, Bayrer J, Becker L, Bogunovic M, Rao M. Advances in Enteric Neurobiology: The "Brain" in the Gut in Health and Disease. J Neurosci 2018; 38:9346-9354. [PMID: 30381426 PMCID: PMC6209840 DOI: 10.1523/jneurosci.1663-18.2018] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/20/2018] [Accepted: 09/22/2018] [Indexed: 12/14/2022] Open
Abstract
The enteric nervous system (ENS) is a large, complex division of the peripheral nervous system that regulates many digestive, immune, hormonal, and metabolic functions. Recent advances have elucidated the dynamic nature of the mature ENS, as well as the complex, bidirectional interactions among enteric neurons, glia, and the many other cell types that are important for mediating gut behaviors. Here, we provide an overview of ENS development and maintenance, and focus on the latest insights gained from the use of novel model systems and live-imaging techniques. We discuss major advances in the understanding of enteric glia, and the functional interactions among enteric neurons, glia, and enteroendocrine cells, a large class of sensory epithelial cells. We conclude by highlighting recent work on muscularis macrophages, a group of immune cells that closely interact with the ENS in the gut wall, and the importance of neurological-immune system communication in digestive health and disease.
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Sood T, Rauthan A, Patil P, Kulkarni S, Somashekhar S, Zaveri S, Ahuja V, Ashwin K. Survival outcomes of dose dense neoadjuvant and adjuvant chemotherapy in triple-negative breast cancer patients: Indian scenario. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kulkarni S, Kazmi S. P3.CR-17 An Interesting Case of Long-Term Immunotherapy Response in Metastatic NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Shimoji M, Ramaswamy B, Shukoor MI, Benhal P, Broda A, Kulkarni S, Malik P, McCaffrey B, Lafond JF, Nacev A, Weinberg IN, Shapiro B, Depireux DA. Toxicology study for magnetic injection of prednisolone into the rat cochlea. Eur J Pharm Sci 2018; 126:33-48. [PMID: 29933075 DOI: 10.1016/j.ejps.2018.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/31/2018] [Accepted: 06/12/2018] [Indexed: 01/28/2023]
Abstract
This paper investigates the safety of a novel 'magnetic injection' method of delivering therapy to the cochlea, in a rodent model. In this method of administration, a magnetic field is employed to actively transport drug-eluting superparamagnetic iron-oxide core nanoparticles into the cochlea, where they then release their drug payload (we delivered the steroid prednisolone). Our study design and selection of control groups was based on published regulatory guidance for safety studies that involve local drug delivery. We tested for both single and multiple delivery doses to the cochlea, and found that magnetic delivery did not harm hearing. There was no statistical difference in hearing between magnetically treated ears versus ears that received intra-tympanic steroid (a mimic of a standard-of-care for sudden sensorineural hearing loss), both 2 and 30 days after treatment. Since our treatment is local to the ear, the levels of steroid and iron circulating systemically after our treatment were low, below mass-spectrometry detection limits for the steroid and no different from normal for iron. No adverse findings were observed in ear tissue histopathology or in animal gross behavior. At 2 and 30 days after treatment, inflammatory changes examined in the ear were limited to the middle ear, were very mild in severity, and by day 90 there was ongoing and almost complete reversibility of these changes. There were no ear tissue scarring or hemorrhage trends associated with magnetic delivery. In summary, after conducting a pre-clinical safety study, no adverse safety issues were observed.
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Sood T, Rauthan A, Patil P, Kulkarni S. Combined analysis of KRAS, NRAS, BRAF mutations and mismatch repair deficiency testing in Indian patients with metastatic colorectal carcinoma: A single centre experience. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Becker L, Nguyen L, Gill J, Kulkarni S, Pasricha PJ, Habtezion A. Age-dependent shift in macrophage polarisation causes inflammation-mediated degeneration of enteric nervous system. Gut 2018; 67:827-836. [PMID: 28228489 PMCID: PMC5565713 DOI: 10.1136/gutjnl-2016-312940] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/21/2016] [Accepted: 01/27/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The enteric nervous system (ENS) undergoes neuronal loss and degenerative changes with age. The cause of this neurodegeneration is poorly understood. Muscularis macrophages residing in close proximity to enteric ganglia maintain neuromuscular function via direct crosstalk with enteric neurons and have been implicated in the pathogenesis of GI motility disorders like gastroparesis and postoperative ileus. The aim of this study was to assess whether ageing causes alterations in macrophage phenotype that contributes to age-related degeneration of the ENS. DESIGN Longitudinal muscle and myenteric plexus from small intestine of young, mid-aged and old mice were dissected and prepared for whole mount immunostaining, flow cytometry, Luminex immunoassays, western blot analysis, enteric neural stem cell (ENSC) isolation or conditioned media. Bone marrow derived macrophages were prepared and polarised to classic (M1) or alternative (M2) activation states. Markers for macrophage phenotype were measured using quantitative RT-PCR. RESULTS Ageing causes a shift in macrophage polarisation from anti-inflammatory 'M2' to proinflammatory 'M1' that is associated with a rise in cytokines and immune cells in the ENS. This phenotypic shift is associated with a neural response to inflammatory signals, increase in apoptosis and loss of enteric neurons and ENSCs, and delayed intestinal transit. An age-dependent decrease in expression of the transcription factor FoxO3, a known longevity gene, contributes to the loss of anti-inflammatory behaviour in macrophages of old mice, and FoxO3-deficient mice demonstrate signs of premature ageing of the ENS. CONCLUSIONS A shift by macrophages towards a proinflammatory phenotype with ageing causes inflammation-mediated degeneration of the ENS.
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Patel P, Kulkarni S, Shetty N, Polnaya A, Gala K, Chivate R. 3:45 PM Abstract No. 257 Role of radiofrequency ablation as a salvage treatment for recurrent fibromatosis: retrospective analysis. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Kulkarni S, Shetty N, Patil S, Polnaya A, Gandhi R, Gala K, Salroo I, Goel M, Shrikhande S, Ramadwar M, Purandare N. Abstract No. 561 Percutaneous endoluminal brush cytology in patients suspected of malignant biliary obstruction: Experience from a tertiary cancer center in India. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Brumwell A, Noyes E, Kulkarni S, Lin V, Becerra MC, Yuen CM. A rapid review of treatment literacy materials for tuberculosis patients. Int J Tuberc Lung Dis 2018; 22:336-341. [PMID: 29471913 DOI: 10.5588/ijtld.17.0363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess available treatment literacy materials for patients undergoing treatment for tuberculosis (TB). DESIGN We conducted a rapid review by searching the US Centers for Disease Control's Find TB Resources website and the websites of health departments and TB-focused organizations. We included English-language documents intended to educate TB patients about anti-tuberculosis treatment. We evaluated the format, readability, and content of documents, and audience. We defined 12 essential content elements based on those previously identified as facilitating human immunodeficiency virus treatment literacy. RESULTS Of the 205 documents obtained, 45 were included in our review. The median reading grade level was 7 (IQR 5-8). The median number of essential content elements present was 6 (IQR 4-8), with the most comprehensive document containing 11 of the 12 elements. Only two documents were written for children with TB or their care givers, and two for patients with drug-resistant TB. Many documents contained paternalistic and non-patient-centered language. CONCLUSION We found few examples of comprehensive, patient-centered documents. Work is needed to achieve consensus as to the essential elements of TB treatment literacy and to create additional materials for children, patients with drug-resistant TB, and those with lower literacy levels.
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Dent S, Califaretti N, Doyle C, Ferrario C, Chouinard E, Kulkarni S, Roy JA, Perri SR, Chia S. Abstract P3-15-02: Treat ER+ight Canadian prospective observational study in HR+ advanced breast cancer: 2nd interim analysis. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-15-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Treat ER+ight is the 1st prospective observational study in Canadian postmenopausal women with HR+ HER2– advanced breast cancer currently receiving endocrine therapy (ET) alone or in combination with targeted therapy (TT) (NCT02753686).
Methods: This pre-planned interim analysis describes baseline characteristics, treatment sequence, monitoring patterns, patient-reported quality-of-life (QoL) and resource utilization of patients enrolled in ET and ET+TT cohorts within the 1st 3 months of therapy. At data cut-off (13Mar'17), 100 patients were enrolled from 24 sites since Mar'16.
Results:
Baseline Patient and Disease Characteristics ET (n=42)ET + TT (n=58)Median age, years (range)70 (37-88)63 (39-80)ECOG 0-1, (%)6072Median time since primary BC diagnosis, years (range)4.5 (0-37)5 (0-25)Median time with advanced BC diagnosis, years (range)1 (0-16)1 (0-7)Sites of metastases (%) Bone only3829Visceral only3338Bone + visceral2924Last prior line of therapy included but not limited to (%) Letrozole4131Anastrozole1219Tamoxifen1214Exemestane122Palbociclib+Fulvestrant07Line (L) of metastatic therapy (%) 1L19222L38433L4335
Enrollment therapy (%): everolimus+exemestane (35), fulvestrant (15), palbociclib + letrozole (15), tamoxifen (14), exemestane (7), palbociclib+fulvestrant (7), letrozole (4) and palbociclib+exemestane (1). Follow-up visits with physician after therapy initiation ET, ET+TT (%): week 2 (5, 47), month 1 (71, 67), month 3 (43, 31). Numerical differences were observed in EORTC QLQ C30 and BR23 global health status/QoL, functional and symptom scale scores between ET and ET+TT cohorts. Mean changes in transformed scores from baseline to month 3 were generally similar between cohorts however 'therapy side effects' symptom item worsened in ET+TT cohort (P = 0.031, Wilcoxon rank sum). Resource utilization in between scheduled visits during 1st 3 months of therapy was similar between cohorts for physician/radiology, hospitalizations and ER visits however patient calls to supportive care nurse was increased in ET+TT cohort (P = 0.008, Fisher's exact). Treatment discontinuation rate (20%) was similar between cohorts with progression as predominant reason for initiating next therapy. Chemotherapy (CT) was the most frequent subsequent therapy and represented 1st line metastatic CT for majority of patients.
Conclusions:
ET+TT patients were younger, had better ECOG, more visceral disease and 60% received everolimus+exemestane with <10% receiving prior CDK4/6 therapy. Half of patients in ET+TT cohort returned for a follow-up visit with oncologist within 2 weeks of therapy initiation (compared to minority in ET cohort) and called the supportive care nurse in between scheduled visits. Patient-reported QoL within 1st 3 months of therapy was generally similar between cohorts. Therapy-related AEs impacted the patient-reported experience in ET+TT cohort however AEs did not lead to therapy discontinuation in over 85% of cases. These results highlight the importance of: (1) proactive AE patient education/management upon ET+TT initiation and at subsequent follow-up visits, (2) week 2 visit and (3) additional nursing telephone support in between visits.
Citation Format: Dent S, Califaretti N, Doyle C, Ferrario C, Chouinard E, Kulkarni S, Roy J-A, Perri SR, Chia S. Treat ER+ight Canadian prospective observational study in HR+ advanced breast cancer: 2nd interim analysis [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-15-02.
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Ravindran K, Murray M, Datta A, Farkas N, Kulkarni S. Flying After Surgery. When is it Safe? Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Baliga S, Aiyer A, Duddempudi P, Liu L, Alonso V, Kulkarni S, Guha C. Exosomes from Adipose Derived Stromal Cells Mitigate Acute Radiation Injury in Mice. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Juneja P, Kulkarni S. Clinical and radiographic comparison of biodentine, mineral trioxide aggregate and formocresol as pulpotomy agents in primary molars. Eur Arch Paediatr Dent 2017; 18:271-278. [PMID: 28780718 DOI: 10.1007/s40368-017-0299-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/10/2017] [Indexed: 11/26/2022]
Abstract
AIM To compare the clinical and radiographic success rates of three different pulpotomy agents in primary molars after 18 months. METHODS The study was carried out with 51 primary molars of children aged 5-9 years old. The teeth were randomly assigned to the experimental or control groups. After coronal pulp removal and haemostasis, the remaining pulp tissue was covered with Biodentine® or mineral trioxide aggregate in the experimental groups. In the control group, formocresol was placed with a cotton pellet over the pulp tissue for 5 min and after removal the pulp tissue was covered with zinc oxide-eugenol (ZOE) paste. All teeth were immediately restored with reinforced ZOE base and resin modified glass-ionomer cement, and later with pre-formed metal crowns. Follow-up assessments were carried out after 3, 6, 12 and 18 months. RESULTS Forty-five teeth were available for follow up at the end of 18 months. All of the available teeth for mineral trioxide aggregate and Biodentine® were clinically successful, as were 73.3% of the FC group. Radiographic success rate for the formocresol group at 18 months follow up was 73.3, 100% for mineral trioxide aggregate and 86.6% for Biodentine® group. CONCLUSION Mineral Trioxide aggregate and Biodentine® showed more favourable results than formocresol.
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Kulkarni S, Micci MA, Leser J, Shin C, Tang SC, Fu YY, Liu L, Li Q, Saha M, Li C, Enikolopov G, Becker L, Rakhilin N, Anderson M, Shen X, Dong X, Butte MJ, Song H, Southard-Smith EM, Kapur RP, Bogunovic M, Pasricha PJ. Adult enteric nervous system in health is maintained by a dynamic balance between neuronal apoptosis and neurogenesis. Proc Natl Acad Sci U S A 2017; 114:E3709-E3718. [PMID: 28420791 PMCID: PMC5422809 DOI: 10.1073/pnas.1619406114] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
According to current dogma, there is little or no ongoing neurogenesis in the fully developed adult enteric nervous system. This lack of neurogenesis leaves unanswered the question of how enteric neuronal populations are maintained in adult guts, given previous reports of ongoing neuronal death. Here, we confirm that despite ongoing neuronal cell loss because of apoptosis in the myenteric ganglia of the adult small intestine, total myenteric neuronal numbers remain constant. This observed neuronal homeostasis is maintained by new neurons formed in vivo from dividing precursor cells that are located within myenteric ganglia and express both Nestin and p75NTR, but not the pan-glial marker Sox10. Mutation of the phosphatase and tensin homolog gene in this pool of adult precursors leads to an increase in enteric neuronal number, resulting in ganglioneuromatosis, modeling the corresponding disorder in humans. Taken together, our results show significant turnover and neurogenesis of adult enteric neurons and provide a paradigm for understanding the enteric nervous system in health and disease.
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Merola J, Yoo PS, Schaub J, Smith JD, Rodriguez-Davalos MI, Tichy E, Mulligan DC, Asch W, Formica R, Kashgarian M, Kulkarni S. Belatacept and Eculizumab for Treatment of Calcineurin Inhibitor-induced Thrombotic Microangiopathy After Kidney Transplantation: Case Report. Transplant Proc 2017; 48:3106-3108. [PMID: 27932157 DOI: 10.1016/j.transproceed.2016.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/27/2016] [Indexed: 11/25/2022]
Abstract
Thrombotic microangiopathy (TMA) after kidney transplantation is an uncommon and challenging cause of graft dysfunction and is associated with early graft loss. An idiosyncratic endothelial reaction to calcineurin inhibitors (CNIs) has been implicated as a frequent cause of TMA. This reaction is marked by uncontrolled activation of complement and subsequent cellular destruction. Usual therapy consists of withdrawal of the inciting drug and plasmapheresis to minimize levels of circulating complement. Recently, eculizumab, a monoclonal antibody to complement component C5, has been used for the treatment of atypical hemolytic uremic syndrome. Belatacept, an inhibitor of T cell costimulatory protein CTLA-4 has been used in immunosuppression strategies aimed at minimization of CNI. Here we report the first case of treatment of CNI-associated TMA/hemolytic uremic syndrome with withdrawal of tacrolimus and initiation of both belatacept and eculizumab. The case describes a favorable clinical course for both graft and patient, and is accompanied by a review of the literature.
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Kulkarni S, Kirkiles-Smith NC, Deng YH, Formica RN, Moeckel G, Broecker V, Bow L, Tomlin R, Pober JS. Eculizumab Therapy for Chronic Antibody-Mediated Injury in Kidney Transplant Recipients: A Pilot Randomized Controlled Trial. Am J Transplant 2017; 17:682-691. [PMID: 27501352 DOI: 10.1111/ajt.14001] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 07/24/2016] [Accepted: 07/24/2016] [Indexed: 01/25/2023]
Abstract
We hypothesized that de novo donor-specific antibody (DSA) causes complement-dependent endothelial cell injury in kidney transplants, as assessed by expression of endothelial cell-associated transcripts (ENDATs), that may be attenuated through complement inhibition. In total, 15 participants (five control, 10 treatment) with DSA and deteriorating renal function were enrolled. The treatment group received 6 mo of eculizumab followed by 6 mo of observation, whereas controls were observed. The primary end point was percentage change in estimated GFR (eGFR) trajectory over the treatment period. The treatment group had an improved eGFR trajectory versus control, based on our predetermined two-sided 0.10 significance level (p = 0.09). Within-subject analysis of treated participants at 6-mo intervals did not show significant change (p = 0.60). Modeling C1q status showed that C1q-positive patients had significantly higher mean eGFR than patients with negative C1q (p = 0.04). Biopsies revealed elevated renal ENDATs in most participants, but ENDATs were not reduced with complement inhibition. Our data suggest that eculizumab treatment may stabilize kidney function in patients with chronic persistent DSA based on our pilot a priori significance threshold. ENDAT expression predicative of acute humoral injury is not reduced with complement inhibition in this chronic setting. Further studies will be necessary to determine which patients may benefit from eculizumab.
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Promod PJ, Deshpande R, Mohanty NK, Kulkarni S, Shah HA, Ganju A, Kukreja A, Joshi S. Efficacy of C.E.R.A. in Routine Clinical Practice for Correction of Anaemia and Maintenance of the Haemoglobin Levels in CKD Patients not on Dialysis. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2017; 65:52-57. [PMID: 28462544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION C.E.R.A. reported effective correction of anaemia and was well tolerated in International studies on CKD patients not on dialysis. OBJECTIVE The study aimed to describe the management of renal anaemia in CKD patients not on dialysis with C.E.R.A. in routine clinical practice in India. METHODS This was a prospective, single-arm, open-label, multi-centre, non-interventional, Phase IV study which followed 108 CKD Stage III-IV patients, not on dialysis with Hb < 10 g/dL for correction of anaemia with C.E.R.A. RESULTS Of the 108 patients with Hb < 10 g/dL at baseline, 83 (90.2%) patients achieved target Hb of 10-12 g/dL and the time taken to achieve correction of anaemia was 9.6 weeks ± 6.13 weeks in the Intent-to-treat population. Haemoglobin concentration increased from 8.59 ± 0.808 g/dL pre-therapy to 10.91 ± 0.634 g/dL post-therapy. The change in mean ± SD Hb value was 2.32 ± 0.174 g/dL. Maintenance of Hb levels within the target range of Hb 10 - 12 g/dL was observed in 78.2% of ITT and 80.8% of the PP population for mean duration of 16.69 weeks. Four patients (3.7%) experienced 5 AEs and 2 patients (1.9%) experienced 3 SAEs in the safety population. As per the treating physician none of the AEs or SAEs was considered related to study drug. There were no deaths reported. CONCLUSIONS This study demonstrated successful correction of anaemia in Indian patients with C.E.R.A. treatment as well as maintenance of Hb levels within the target range. C.E.R.A. was well tolerated with no new safety concerns specific to the Indian population. The less frequent up to monthly dosing schedule of C.E.R.A. may offer clinicians and patients a simplified regimen of anaemia management as compared to traditional frequently administered (thrice weekly to once weekly) ESAs.
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Venkatesh S, Sanyukta J, Jain S, Prabhu SS, Kulkarni S. Aortic and pulmonary artery calcification: An unusual manifestation of twin-to-twin transfusion syndrome. Ann Pediatr Cardiol 2017; 10:75-77. [PMID: 28163434 PMCID: PMC5241851 DOI: 10.4103/0974-2069.197059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Twin-to-twin transfusion syndrome (TTTS) at times complicates monochorionic twin gestations, resulting in conditions ranging from discordant sizes to fetal demise of one baby. Various types of cardiac defects have been described in the recipient twin of this syndrome. Isolated great artery calcification, i.e. aortic and pulmonary artery calcification is one such uncommon condition associated with TTTS. Calcification of the walls of great vessels may be due to chronic vascular injury sustained as a result of circulatory volume overload in the recipient twin. It may also cause severe systemic hypertension and cardiomyopathy. An accurate diagnosis is important for an optimal follow-up and appropriate genetic counseling. We report a case of aortic and pulmonary artery calcification in association with TTTS.
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Gawandi S, Gangawane S, Chakrabarti A, Kedare S, Bantwal K, Wadhe V, Kulkarni A, Kulkarni S, Rajan MGR. A Study of Microalbuminuria (MAU) and Advanced Glycation End Products (AGEs) Levels in Diabetic and Hypertensive Subjects. Indian J Clin Biochem 2017; 33:81-85. [PMID: 29371774 DOI: 10.1007/s12291-017-0638-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/24/2017] [Indexed: 11/24/2022]
Abstract
The prevalence of non-communicable diseases like diabetes mellitus (DM) and hypertension (HTN) is growing worldwide. Both lead to nephropathy if not controlled effectively. Microalbuminuria (MAU) is recognized as an early predictor for nephropathy. Additionally, the timely detection of advanced glycation end products (AGEs) is also considered to be an important prognostic factor for diabetic nephropathies. Hence, screening for the early detection of MAU and AGEs would be an useful and relatively inexpensive laboratory test for early clinical diagnosis for the incidence of nephropathy in these diseases. This study was conducted in DM, HTN and pregnancy induced hypertensive (PIH) subjects. MAU and Nε-Carboxymethyllysine (CML) levels were estimated by in-house RIA kits in the patient groups and controls, while the total AGEs level in serum was determined by ELISA. The levels of MAU, CML and AGE-BSA were observed to be significantly higher in DM, HTN and PIH subjects compared to controls (p < 0.001). Increased serum CML and AGEs levels in DM, HTN and PIH subjects indicated ongoing glycemic damage and their susceptibility to develop renal complications.
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Selby R, Shah Z, Black L, Ongteco J, Kulkarni S, Piraino D. To measure or not to measure direct oral anticoagulants before surgery or invasive procedures: comment. J Thromb Haemost 2017; 15:200-202. [PMID: 27868333 DOI: 10.1111/jth.13573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
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Kulkarni S, Thiessen C, Formica RN, Schilsky M, Mulligan D, D'Aquila R. The Long-Term Follow-up and Support for Living Organ Donors: A Center-Based Initiative Founded on Developing a Community of Living Donors. Am J Transplant 2016; 16:3385-3391. [PMID: 27500361 DOI: 10.1111/ajt.14005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 07/08/2016] [Accepted: 08/04/2016] [Indexed: 01/25/2023]
Abstract
Transplant professionals recognize that the long-term follow-up of living organ donors is a priority, yet there has been no implemented solution to this problem. This critical gap is essential, because the transplant field is now emphasizing living donation as a means to address the organ shortage. We detail our living donor initiative, which sets several priorities we recognize as fundamental to persons who have donated organs at our transplant center. This intervention attempts to mitigate the donor and center factors that are known to contribute to the lack of long-term follow-up. Beyond that, our goals are aimed at providing ongoing engagement, wellness, clinical data accrual, laboratory follow-up, and social support for our living donors, in continuity. Our ultimate goal is to nurture the development of local living donor community networks by providing social engagement for current and past donors, which also serves as a platform for greater population education on the societal importance of living donation. This initiative is based on joint recognition by our transplant team and our hospital leadership that supporting the long-term welfare of living donors is essential to accomplishing the goal of expanding living donor transplantation. The transplant team and hospital missions are aligned, and both contribute resources to the initiative.
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Sacotte R, Fine N, Kim J, Alghoul M, Bethke K, Hansen N, Khan S, Kulkarni S, Strauss J, Hayes J, Donnelly E. Assessing Long-Term Complication Rates in Patients Undergoing Immediate Postmastectomy Breast Reconstruction and Adjuvant Radiation. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cohen EA, Mulligan D, Kulkarni S, Tichy EM. De Novo Belatacept in a Human Immunodeficiency Virus-Positive Kidney Transplant Recipient. Am J Transplant 2016; 16:2753-7. [PMID: 27137752 DOI: 10.1111/ajt.13852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 04/07/2016] [Accepted: 04/28/2016] [Indexed: 01/25/2023]
Abstract
Benefits of belatacept-based immunosuppressive regimens in human immunodeficiency virus (HIV)-positive renal transplant recipients include avoidance of drug interactions between calcineurin inhibitors and highly active antiretroviral agents and decreased likelihood or severity of nonimmune toxicities such as new-onset diabetes after transplant, hyperlipidemia and hypertension. We report a successful case of de novo belatacept at >18 mo from transplant in an HIV-positive black man aged 50 years who received his first transplant from a living related kidney donor. To our knowledge, this case is the first reported of belatacept use in an HIV-positive renal transplant recipient.
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Marathe D, Rokade D, Busher Azad L, Jadhav K, Mahajan S, Ahmad Z, Gupta S, Kulkarni S, Juvekar V, Lele A. Effect of Plug Temperature on the Strain and Thickness Distribution of Components Made by Plug Assist Thermoforming. INT POLYM PROC 2016. [DOI: 10.3139/217.3060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Plug temperature is a key parameter affecting the thickness distribution of thermoplastic components made by plug assist thermoforming. For a specified pair of plug and plastic sheet, the variation in plug temperature can alter the coefficient of friction (COF) between the pair. We show here how the temperature dependence of COF influences the nature and extent of biaxial stretching of the sheet and consequently the thickness distribution of the thermoformed component. In the present study, high impact polystyrene (HIPS) sheets were thermoformed into axisymmetric cups using a plug-assist process in which the aluminum plug temperature (Tplug) was varied from ambient to above the glass transition temperature of HIPS (∼100 °C). Biaxial strain maps on the surfaces of the formed cups were measured and quantified using Grid Strain Analysis (GSA). Thickness distributions of the cups were also measured. Temperature dependent COF between HIPS and aluminum was determined independently using a rotational rheometer. The measured COF was low for T < 100 °C, whereas it increased appreciably at and above 100 °C. We conclude that when Tplug < 100 °C the HIPS sheet slips on the plug during forming, and this results in biaxial stretching of the base and walls of the formed cup. In contrast for Tplug > 100 °C, a significant reduction in the magnitude of slip is expected. Here the sheet is gripped at the clamp and by the plug during forming which causes reduced biaxial stretching of the base and increased uniaxial stretching of the walls of the cup. Simulations of plug-assist thermoforming using a temperature dependent COF showed qualitative agreement with the GSA data thereby supporting our inferences.
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Kulkarni S, Joshi P, Surana S, Hamouda A. Management of panurethral strictures. AFRICAN JOURNAL OF UROLOGY 2016. [DOI: 10.1016/j.afju.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Valic MS, Leong WL, Done SJ, Wilson BC, Kulkarni S, McCready DR, Niu CJ, Atachia Y, Munro EA, Rempel D. Abstract P4-03-05: Wide-field optical coherence tomography (WF-OCT) for near real-time, point-of-care assessment of margin status in breast-conserving surgery specimens: Results of a feasibility study at a high-volume single-centre. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-03-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Wide-Field Optical Coherence Tomography (WF-OCT) is a non-destructive, non-contact light imaging modality capable of label-free visualization of the internal microscopic architecture of breast tissue specimens. Its unique combination of high-resolution imaging in near real-time with tissue penetration depths approaching 2-mm makes it a promising imaging modality for obtaining detailed surgical margin status in breast-conserving surgery (BCS) specimens. A prototype WF-OCT imaging platform developed by Perimeter Medical Imaging, Inc. (Toronto, Canada) has permitted fully-automated, dynamically-focused visualization of margin widths around the intact surfaces of freshly excised BCS specimens. Herein are reported the results of a feasibility study at a high-volume single-centre evaluating the routine use of WF-OCT for sampling of surgical margin status in BCS specimens at the point-of-care.
Methods: Women with biopsy confirmed breast cancer and scheduled for primary BCS were recruited at Princess Margaret Cancer Centre (Toronto, Canada). Standard medical care was not altered. Freshly excised BCS specimens including all lumpectomy samples were imaged by WF-OCT immediately prior to standard histological processing. The system acquired dynamically-focused, hemispherical coverage over two contra-lateral surfaces of the intact BCS specimen within the time constraints of the cold ischemic time window. High-resolution (10 μm) images of the tissue surface down to a 1 to 2-mm depth were obtained. Blinded assessments were performed on image data sets by two clinical readers (surgeon and radiologist) trained on a validated and unrelated data set correlating OCT images with histology slides. The readers were first asked to independently assess margin status using only blinded pre- and intra-operative knowledge (without OCT). Upon completion, the readers were provided OCT images of all scanned surface and similarly asked to assess the margin status with the additional OCT information. These assessments were subsequently evaluated by a breast pathologist comparing the OCT images and corresponding histopathology sections. The added utility of WF-OCT imaging information for margin prediction was studied.
Results: [Pending study completion in August 2015]. Through accurate correlation with the histopathologic gold standard, OCT demonstrated capability to differentiate tissue microstructures, including: distinctive patterns for adipose tissue, fibrous stroma, breast lobules and ducts, cysts and microcysts, as well as in-situ and invasive carcinomas.
Implications: The fully-automated WF-OCT imaging platform can integrate conveniently into standard pathological processing workflows to provide comprehensive sampling of surgical margin status in BCS specimens at the point-of-care. Clinical readers from surgical and radiological backgrounds can be trained to competently interpret WF-OCT images of BCS specimens for accurate prediction margin status. The implementation of WF-OCT at the point-of-care for routine surgical margin assessments will be further explored in future clinical trials.
Citation Format: Valic MS, Leong WL, Done SJ, Wilson BC, Kulkarni S, McCready DR, Niu CJ, Atachia Y, Munro EA, Rempel D. Wide-field optical coherence tomography (WF-OCT) for near real-time, point-of-care assessment of margin status in breast-conserving surgery specimens: Results of a feasibility study at a high-volume single-centre. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-03-05.
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Chakradhar K, Doshi D, Srikanth Reddy B, Kulkarni S, Padma Reddy M, Sruthi Reddy S. Knowledge, Attitude and Practice Regarding Organ Donation among Indian Dental Students. Int J Organ Transplant Med 2016; 7:28-35. [PMID: 26889371 PMCID: PMC4756262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Of the overall 9.5 million deaths annually in India, nearly 100,000 are due to organ failure. To save and extend lives, organ donation and organ transplantation have become the only hope. Health care professionals (HCPs) are a key element in facilitating cadaveric organ donation process. OBJECTIVE To assess and compare the knowledge, attitude, and practice regarding organ donation among undergraduate dental students. METHODS A cross-sectional study was conducted among 298 undergraduate dental students of the Panineeya Institute of Dental Sciences and Hospital, Hyderabad, India. A 27-item self-administered questionnaire, which assessed the levels of knowledge (Q1-13), positive attitude (Q14-24) and practice habits (Q25-27) regarding organ donation with dichotomous scale (Yes/No). RESULTS As compared to males, females reported better mean±SD scores in knowledge (8.22±1.51) and practice (0.91±0.8); higher mean±SD attitude scores (8.55±1.56) were reported among males (p<0.001). While second year dental students had higher scores for their knowledge (8.55±1.56) and practice (1.02±0.44) compared to other year of training, third year students showed a significant higher mean attitude score (1.73±1.17) (p=0.02). Hindus and Muslims scored significantly lower mean knowledge, attitude and practice habits compared to others (Christians, Jains and Athesists) (p<0.001). There was a positive correlation between mean knowledge, attitude, and practice habits. CONCLUSION There are an average level of knowledge and low levels of positive attitude and practice habits among studied dental students towards organ donation and transplantation.
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Wali RK, Lee AH, Kam JC, Jonsson J, Thatcher A, Poretz D, Ambardar S, Piper J, Lynch C, Kulkarni S, Cochran J, Djurkovic S. Acute Neurological Illness in a Kidney Transplant Recipient Following Infection With Enterovirus-D68: An Emerging Infection? Am J Transplant 2015; 15:3224-8. [PMID: 26228743 DOI: 10.1111/ajt.13398] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/28/2015] [Accepted: 05/13/2015] [Indexed: 01/25/2023]
Abstract
We report the first case of enterovirus-D68 infection in an adult living-donor kidney transplant recipient who developed rapidly progressive bulbar weakness and acute flaccid limb paralysis following an upper respiratory infection. We present a 45-year-old gentleman who underwent pre-emptive living-donor kidney transplantation for IgA nephropathy. Eight weeks following transplantation, he developed an acute respiratory illness from enterovirus/rhinovirus that was detectable in nasopharyngeal (NP) swabs. Within 24 h of onset of respiratory symptoms, the patient developed binocular diplopia which rapidly progressed to multiple cranial nerve dysfunctions (acute bulbar syndrome) over the next 24 h. Within the next 48 h, asymmetric flaccid paralysis of the left arm and urinary retention developed. While his neurological symptoms were evolving, the Centers for Disease Control reported that the enterovirus strain from the NP swabs was, in fact, Enterovirus-D68 (EV-D68). Magnetic resonance imaging of the brain demonstrated unique gray matter and anterior horn cell changes in the midbrain and spinal cord, respectively. Constellation of these neurological symptoms and signs was suggestive for postinfectious encephalomyelitis (acute disseminated encephalomyelitis [ADEM]) from EV-D68. Treatment based on the principles of ADEM included intensive physical therapy and other supportive measures, which resulted in a steady albeit slow improvement in his left arm and bulbar weakness, while maintaining stable allograft function.
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Paul S, Kulkarni S, Rao KJ. Effect of Indian Cottage Cheese (Paneer)-Whey on Rheological and Proofing Characteristics of Multigrain Bread Dough. J Texture Stud 2015. [DOI: 10.1111/jtxs.12168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vaitheesvaran B, Bhanja P, Kulkarni S, Saha S, Kurland I, Guha C. Assessment of Mitigation of Acute Radiation Syndrome by a Comprehensive Plasma Metabolite Panel (RAD-SMA). Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chand BR, Kulkarni S, Mishra P. Inhibition of enamel demineralisation using "Nd-YAG and diode laser assisted fluoride therapy". Eur Arch Paediatr Dent 2015; 17:59-64. [PMID: 26474878 DOI: 10.1007/s40368-015-0206-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/04/2015] [Indexed: 11/28/2022]
Abstract
AIM This in vitro study was to evaluate the irradiation efficacy of the Diode laser and the Nd-YAG laser either un-assisted or assisted by acidulated phosphate fluoride (APF) treatment on enamel's acid resistance. METHODS Seventy-two enamel samples, obtained from 12 extracted human molars, were randomly assigned to 6 groups as follows: (1) Control (C); (2) Exposed to APF gel (F); (3) Diode laser (DL); (4) Irradiated with Diode laser through APF gel (DL/F); (5) Nd-YAG laser (NL) and (6) Irradiated with Nd-YAG laser through APF gel (NL/F). The specimens were individually demineralised in an acidified hydroxyethylcellulose system, and the acid resistance was evaluated by determining the calcium ion dissolution using atomic absorption spectrometry. RESULTS The average concentration of the calcium ion determined in groups 1 to 6 was 901, 757, 736, 592, 497 and 416 parts per million micrograms/gram, respectively. The results showed that demineralisation in the NL/F group was significantly less than the other groups and the control group was significantly greater than the other groups (P < 0.001). CONCLUSION The effect of Nd-YAG laser irradiation, used alone or in combination with APF, in decreasing the enamel demineralisation was greater than all the other groups.
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Thiessen C, Gordon EJ, Reese PP, Kulkarni S. Development of a Donor-Centered Approach to Risk Assessment: Rebalancing Nonmaleficence and Autonomy. Am J Transplant 2015; 15:2314-23. [PMID: 25868787 DOI: 10.1111/ajt.13272] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/11/2015] [Accepted: 02/17/2015] [Indexed: 01/25/2023]
Abstract
Living kidney donors are often excluded from the shared decision making and patient-centered models that are advocated in medical practice. Thresholds for acceptable risk vary between transplant centers, and between clinicians and donors. Although donor selection committees commonly focus on medical risks, potential donors also consider nonmedical risks and burdens, which may alter their assessment of an acceptable level of medical risk. Thus, transplant centers may encounter ethical tensions between nonmaleficence and respect for donor autonomy. A donor-centered model of risk assessment and risk reconciliation would integrate the donor's values and preferences in a shared decision about their eligibility to donate. This paper argues for shifting to a donor-centered model of risk assessment, and presents a research agenda to facilitate the greater participation of donors in their own evaluation and approval processes.
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Sangeeta S, Arangasamy A, Kulkarni S, Selvaraju S. Role of amino acids as additives on sperm motility, plasma membrane integrity and lipid peroxidation levels at pre-freeze and post-thawed ram semen. Anim Reprod Sci 2015; 161:82-8. [PMID: 26362050 DOI: 10.1016/j.anireprosci.2015.08.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/13/2015] [Accepted: 08/23/2015] [Indexed: 11/24/2022]
Abstract
The possibility of including amino acids for cryopreservation of ram semen to improve the quality of frozen semen was explored in this study in sheep model. 24 samples were collected in triplicate from 8 rams of 2-3 year old Bannur cross bred rams maintained at the Institute Experimental Livestock Unit. Semen was diluted in tris-egg yolk glycerol diluent and made into 7 aliquots as follows: aliquot 1 served as control, "l-alanine" was added at 100 and 135mM in the aliquots 2 and 3, "l-glutamine" was added at 20 and 25mM in the aliquots 4 and 5 and "l-proline" was added at 25 and 50mM in the aliquots 6 and 7, respectively. Diluted semen was filled in 0.25ml French straws and frozen in LN2. Inclusion of "l-proline" and "l-glutamine" in the diluent increased the percent live sperm (P<0.001), total motility (P<0.05) and maintained higher functional membrane and acrosomal integrity (P<0.001) by decreasing lipid peroxidation (P<0.001) compared to the control group. In contrast, "l-alanine" decreased the percentage of total motility, fast progressive spermatozoa and increased (P<0.01) the percentage of immotile spermatozoa. It can be concluded that 20mM "l-glutamine" and 25mM "l-proline" can be used as semen additive to freeze ram semen as they prevented cryoinjuries to sperm and improved the pre-freeze and post-thaw semen characteristics.
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Wisnioski E, Förster Schreiber NM, Wuyts S, Wuyts E, Bandara K, Wilman D, Genzel R, Bender R, Davies R, Fossati M, Lang P, Mendel JT, Beifiori A, Brammer G, Chan J, Fabricius M, Fudamoto Y, Kulkarni S, Kurk J, Lutz D, Nelson EJ, Momcheva I, Rosario D, Saglia R, Seitz S, Tacconi LJ, van Dokkum PG. THE KMOS3DSURVEY: DESIGN, FIRST RESULTS, AND THE EVOLUTION OF GALAXY KINEMATICS FROM 0.7 ⩽z⩽ 2.7. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/799/2/209] [Citation(s) in RCA: 338] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wu N, Ming X, Xiao J, Wu Z, Chen X, Shinawi M, Shen Y, Yu G, Liu J, Xie H, Gucev ZS, Liu S, Yang N, Al-Kateb H, Chen J, Zhang J, Hauser N, Zhang T, Tasic V, Liu P, Su X, Pan X, Liu C, Wang L, Shen J, Shen J, Chen Y, Zhang T, Zhang J, Choy KW, Wang J, Wang Q, Li S, Zhou W, Guo J, Wang Y, Zhang C, Zhao H, An Y, Zhao Y, Wang J, Liu Z, Zuo Y, Tian Y, Weng X, Sutton VR, Wang H, Ming Y, Kulkarni S, Zhong TP, Giampietro PF, Dunwoodie SL, Cheung SW, Zhang X, Jin L, Lupski JR, Qiu G, Zhang F. TBX6 null variants and a common hypomorphic allele in congenital scoliosis. N Engl J Med 2015; 372:341-50. [PMID: 25564734 PMCID: PMC4326244 DOI: 10.1056/nejmoa1406829] [Citation(s) in RCA: 203] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Congenital scoliosis is a common type of vertebral malformation. Genetic susceptibility has been implicated in congenital scoliosis. METHODS We evaluated 161 Han Chinese persons with sporadic congenital scoliosis, 166 Han Chinese controls, and 2 pedigrees, family members of which had a 16p11.2 deletion, using comparative genomic hybridization, quantitative polymerase-chain-reaction analysis, and DNA sequencing. We carried out tests of replication using an additional series of 76 Han Chinese persons with congenital scoliosis and a multicenter series of 42 persons with 16p11.2 deletions. RESULTS We identified a total of 17 heterozygous TBX6 null mutations in the 161 persons with sporadic congenital scoliosis (11%); we did not observe any null mutations in TBX6 in 166 controls (P<3.8×10(-6)). These null alleles include copy-number variants (12 instances of a 16p11.2 deletion affecting TBX6) and single-nucleotide variants (1 nonsense and 4 frame-shift mutations). However, the discordant intrafamilial phenotypes of 16p11.2 deletion carriers suggest that heterozygous TBX6 null mutation is insufficient to cause congenital scoliosis. We went on to identify a common TBX6 haplotype as the second risk allele in all 17 carriers of TBX6 null mutations (P<1.1×10(-6)). Replication studies involving additional persons with congenital scoliosis who carried a deletion affecting TBX6 confirmed this compound inheritance model. In vitro functional assays suggested that the risk haplotype is a hypomorphic allele. Hemivertebrae are characteristic of TBX6-associated congenital scoliosis. CONCLUSIONS Compound inheritance of a rare null mutation and a hypomorphic allele of TBX6 accounted for up to 11% of congenital scoliosis cases in the series that we analyzed. (Funded by the National Basic Research Program of China and others.).
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Goel-Bhattacharya S, Kulkarni S, Sengupta S, Khagi S, Cochran B. CS-11 * AN RNAi KINOME SCREEN OF GLIOBLASTOMA STEM CELLS UNDER NORMOXIA AND HYPOXIA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou242.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Genzel R, Förster Schreiber NM, Rosario D, Lang P, Lutz D, Wisnioski E, Wuyts E, Wuyts S, Bandara K, Bender R, Berta S, Kurk J, Mendel JT, Tacconi LJ, Wilman D, Beifiori A, Brammer G, Burkert A, Buschkamp P, Chan J, Carollo CM, Davies R, Eisenhauer F, Fabricius M, Fossati M, Kriek M, Kulkarni S, Lilly SJ, Mancini C, Momcheva I, Naab T, Nelson EJ, Renzini A, Saglia R, Sharples RM, Sternberg A, Tacchella S, van Dokkum P. EVIDENCE FOR WIDE-SPREAD ACTIVE GALACTIC NUCLEUS-DRIVEN OUTFLOWS IN THE MOST MASSIVEz∼ 1-2 STAR-FORMING GALAXIES. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/0004-637x/796/1/7] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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88
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Gupta G, Banavali S, Puri A, Gulia A, Chinnaswamy G, Arora B, Kulkarni S, Shetty N, Laskar S, Khanna N, Merchant N, Juvekar S, Rekhi B. Role of Metronomic Therapy in the Non-Surgical Management of Desmoid Tumors. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu354.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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89
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Shapiro B, Kulkarni S, Nacev A, Sarwar A, Preciado D, Depireux D. Shaping Magnetic Fields to Direct Therapy to Ears and Eyes. Annu Rev Biomed Eng 2014; 16:455-81. [DOI: 10.1146/annurev-bioeng-071813-105206] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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90
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Mahalingaiah L, Venkateshaiah BV, Kulkarni S, Rao KJ. Study on the effect of packaging materials on the physico-chemical, microbiological and sensory quality of kunda. Journal of Food Science and Technology 2014; 51:1000-5. [PMID: 24803711 DOI: 10.1007/s13197-011-0562-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 09/05/2011] [Accepted: 10/10/2011] [Indexed: 11/29/2022]
Abstract
Kunda, an indigenous heat desiccated sweet product prepared from milk and sugar, has a shelf-life of a few days under market conditions. In this study, shelf-life of kunda packed in select packaging materials viz. LDPE, metallised polyester and tin cans and stored at 30° and 5 °C was investigated. During storage, several changes took place in physico-chemical and sensory characteristics, the changes being faster at 30 °C than at 5 °C. The storage study indicated that kunda was acceptable throughout the storage period of 42 days at 30 °C and 90 days at 5 °C, irrespective of packaging material. However, the rate of changes in characteristics of the product packaged in tin cans and metalized polyester was slower. Hence, it was recommended that kunda be packed in tin cans and metallised polyester pouches which possess high barrier properties for achieving long shelf-life.
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Vyas S, Puwar B, Patel V, Bhatt G, Kulkarni S, Fancy M. Study on validity of a rapid diagnostic test kit versus light microscopy for malaria diagnosis in Ahmedabad city, India. EASTERN MEDITERRANEAN HEALTH JOURNAL = LA REVUE DE SANTE DE LA MEDITERRANEE ORIENTALE = AL-MAJALLAH AL-SIHHIYAH LI-SHARQ AL-MUTAWASSIT 2014; 20:236-241. [PMID: 24952120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 06/02/2013] [Indexed: 06/03/2023]
Abstract
Light microscopy of blood smears for diagnosis of malaria in the field has several limitations, notably delays in diagnosis. This study in Ahmedabad in Gujarat State, India, evaluated the diagnostic performance of a rapid diagnostic test for malaria (SD Bioline Malaria Ag P.f/Pan) versus blood smear examination as the gold standard. All fever cases presenting at 13 urban health centres were subjected to rapid diagnostic testing and thick and thin blood smears. A total of 677 cases with fever were examined; 135 (20.0%) tested positive by rapid diagnostic test and 86 (12.7%) by blood smear. The sensitivity of the rapid diagnostic test for malaria was 98.8%, specificity was 91.5%, positive predictive value 63.0% and negative predictive value 99.8%. For detection of Plasmodium falciparum the sensitivity of rapid diagnostic test was 100% and specificity was 97.3%. The results show the acceptability of the rapid test as an alternative to light microscopy in the field setting.
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Vyas S, Puwar B, Patel V, Bhatt G, Kulkarni S, Fancy M. Study on validity of a rapid diagnostic test kit versus light microscopy for malaria diagnosis in Ahmedabad city, India. EASTERN MEDITERRANEAN HEALTH JOURNAL 2014. [DOI: 10.26719/2014.20.4.236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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93
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Chapa J, Kulkarni S, An G. Investigating Differential Mechanisms of Estrogen Receptor (ER) Directed Therapies for ER+ Breast Tumors using an Agent-based Model of the Mammary Epithelium. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kulkarni S, Krishnan G, Clerc C, Merdan K, Tryon R. Using Probabilistic Computational Durability Modeling and Simulation to Create a Virtual Design of Experiments Based on Limited Laboratory Tests. J Med Device 2013. [DOI: 10.1115/1.4025848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Euteneuer J, Carvalho CMB, Kulkarni S, Vineyard M, Grady RM, Lupski JR, Shinawi M. Molecular and phenotypic characterization of atypical Williams-Beuren syndrome. Clin Genet 2013; 86:487-91. [PMID: 24246242 DOI: 10.1111/cge.12305] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 10/08/2013] [Accepted: 10/16/2013] [Indexed: 11/29/2022]
Abstract
Williams-Beuren syndrome (WBS) is a multisystemic genomic disorder typically caused by a recurrent ˜1.5-1.8 Mb deletion on 7q11.23. Atypical deletions can provide important insight into the genotype-phenotype correlations. Here, we report the phenotypic and molecular characterization of a girl with a de novo 81.8 kb deletion in the WBS critical region, which involves the ELN and LIMK1 genes only. The patient presented at 2 months of age with extensive vascular abnormalities, mild facial dysmorphism and delays in her fine motor skills. We discuss potential molecular mechanisms and the role of ELN and LIMK1 in the different phenotypic features. We compare the findings in our patient with previously reported overlapping deletions. The phenotypic variability among these patients suggests that other factors are important in the phenotype and possibly include: position effects related to copy number variation size, variations in the non-deleted alleles, genetic modifiers elsewhere in the genome, or reduced penetrance for specific phenotypes.
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Cheng L, Huang Z, Zhou W, Wu Q, Rich J, Bao S, Baxter P, Mao H, Zhao X, Liu Z, Huang Y, Voicu H, Gurusiddappa S, Su JM, Perlaky L, Dauser R, Leung HCE, Muraszko KM, Heth JA, Fan X, Lau CC, Man TK, Chintagumpala M, Li XN, Clark P, Zorniak M, Cho Y, Zhang X, Walden D, Shusta E, Kuo J, Sengupta S, Goel-Bhattacharya S, Kulkarni S, Cochran B, Cusulin C, Luchman A, Weiss S, Wu M, Fernandez N, Agnihotri S, Diaz R, Rutka J, Bredel M, Karamchandani J, Das S, Day B, Stringer B, Al-Ejeh F, Ting M, Wilson J, Ensbey K, Jamieson P, Bruce Z, Lim YC, Offenhauser C, Charmsaz S, Cooper L, Ellacott J, Harding A, Lickliter J, Inglis P, Reynolds B, Walker D, Lackmann M, Boyd A, Berezovsky A, Poisson L, Hasselbach L, Irtenkauf S, Transou A, Mikkelsen T, deCarvalho AC, Emlet D, Del Vecchio C, Gupta P, Li G, Skirboll S, Wong A, Figueroa J, Shahar T, Hossain A, Lang F, Fouse S, Nakamura J, James CD, Chang S, Costello J, Frerich JM, Rahimpour S, Zhuang Z, Heiss JD, Golebiewska A, Stieber D, Evers L, Lenkiewicz E, Brons NHC, Nicot N, Oudin A, Bougnaud S, Hertel F, Bjerkvig R, Barrett M, Vallar L, Niclou SP, Hao X, Rahn J, Ujack E, Lun X, Cairncross G, Weiss S, Senger D, Robbins S, Harness J, Lerner R, Ihara Y, Santos R, Torre JDL, Lu A, Ozawa T, Nicolaides T, James D, Petritsch C, Higgins D, Schroeder M, Ball B, Milligan B, Meyer F, Sarkaria J, Henley J, Flavahan W, Wu Q, Hitomi M, Rahim N, Kim Y, Sloan A, Weil R, Nakano I, Sarkaria J, Stringer B, Li M, Lathia J, Rich J, Hjelmeland A, Kaluzova M, Platt S, Kent M, Bouras A, Machaidze R, Hadjipanayis C, Kang SG, Kim SH, Huh YM, Kim EH, Park EK, Chang JH, Kim SH, Hong YK, Kim DS, Lee SJ, Kim EH, Kang SG, Hitomi M, Deleyrolle L, Sinyuk M, Li M, Goan W, Otvos B, Rohaus M, Oli M, Vedam-Mai V, Schonberg D, Wu Q, Rich J, Reynolds B, Lathia J, Lee ST, Chu K, Kim SH, Lee SK, Kim M, Roh JK, Lerner R, Griveau A, Ihara Y, Reichholf B, McMahon M, Rowitch D, James D, Petritsch C, Nitta R, Mitra S, Agarwal M, Bui T, Li G, Lin J, Adamson C, Martinez-Quintanilla J, Choi SH, Bhere D, Heidari P, He D, Mahmood U, Shah K, Mitra S, Gholamin S, Feroze A, Achrol A, Kahn S, Weissman I, Cheshier S, Nakano I, Sulman EP, Wang Q, Mostovenko E, Liu H, Lichti CF, Shavkunov A, Kroes RA, Moskal JR, Conrad CA, Lang FF, Emmett MR, Nilsson CL, Osuka S, Sampetrean O, Shimizu T, Saga I, Onishi N, Sugihara E, Okubo J, Fujita S, Takano S, Matsumura A, Saya H, Saito N, Fu J, Wang S, Yung WKA, Koul D, Schmid RS, Irvin DM, Vitucci M, Bash RE, Werneke AM, Miller CR, Shinojima N, Hossain A, Takezaki T, Fueyo J, Gumin J, Gao F, Nwajei F, Marini FC, Andreeff M, Kuratsu JI, Lang FF, Singh S, Burrell K, Koch E, Agnihotri S, Jalali S, Vartanian A, Gumin J, Sulman E, Lang F, Wouters B, Zadeh G, Spelat R, Singer E, Matlaf L, McAllister S, Soroceanu L, Spiegl-Kreinecker S, Loetsch D, Laaber M, Schrangl C, Wohrer A, Hainfellner J, Marosi C, Pichler J, Weis S, Wurm G, Widhalm G, Knosp E, Berger W, Takezaki T, Shinojima N, Kuratsu JI, Lang F, Tam Q, Tanaka S, Nakada M, Yamada D, Nakano I, Todo T, Hayashi Y, Hamada JI, Hirao A, Tilghman J, Ying M, Laterra J, Venere M, Chang C, Wu Q, Summers M, Rosenfeld S, Rich J, Tanaka S, Luk S, Chang C, Iafrate J, Cahill D, Martuza R, Rabkin S, Chi A, Wakimoto H, Wirsching HG, Krishnan S, Frei K, Krayenbuhl N, Reifenberger G, Weller M, Tabatabai G, Man J, Shoemake J, Venere M, Rich J, Yu J. STEM CELLS. Neuro Oncol 2013. [DOI: 10.1093/neuonc/not190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Thiessen C, Kim YA, Formica R, Bia M, Kulkarni S. Written informed consent for living kidney donors: practices and compliance with CMS and OPTN requirements. Am J Transplant 2013; 13:2713-21. [PMID: 24020884 DOI: 10.1111/ajt.12406] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 06/19/2013] [Accepted: 06/25/2013] [Indexed: 01/25/2023]
Abstract
We sought to assess how written informed consent practices for candidate living kidney donors have changed over the last 5 years and to assess compliance with Centers for Medicare and Medicaid (CMS) and Organ Procurement and Transplantation Network (OPTN) regulations that took effect in 2007. We requested evaluation consent forms from US centers that performed >5 living kidney transplants during the prior year (n = 184). We received 148 consent forms; each was reviewed for information provided and inclusion of CMS- and OPTN-required elements. We found that nearly all transplant centers now obtain written consent for living kidney donor evaluation. However, most centers' evaluation consent forms do not include all CMS and OPTN requirements. Multiple items balancing donor and recipient interests and confidentiality were omitted. In addition, information about payment for routine follow-up care, complications related to surgery and other health problems following surgery were highly variable and frequently ambiguous. As centers revise their consent forms to address the 2013 OPTN policies, our findings may help them identify areas of potential deficiency. We propose that UNOS develop a uniform donor evaluation consent form to improve the clarity, consistency and efficiency of living donor consent.
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Manoli NN, Manoli N, Kulkarni S, Chandrashekar AP. P5.018 Improved Diagnosis of Non-Neoplastic Conditions of Cervix by Liquid Based Cytology, Cellbock in Comparison with Conventional Pap Smear Method. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ramos EI, Bien-Willner GA, Li J, Hughes AEO, Giacalone J, Chasnoff S, Kulkarni S, Parmacek M, Cole FS, Druley TE. Genetic variation in MKL2 and decreased downstream PCTAIRE1 expression in extreme, fatal primary human microcephaly. Clin Genet 2013; 85:423-32. [PMID: 23692340 PMCID: PMC3929543 DOI: 10.1111/cge.12197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/16/2013] [Accepted: 05/16/2013] [Indexed: 11/26/2022]
Abstract
The genetic mechanisms driving normal brain development remain largely unknown. We performed genomic and immunohistochemical characterization of a novel, fatal human phenotype including extreme microcephaly with cerebral growth arrest at 14-18 weeks gestation in three full sisters born to healthy, non-consanguineous parents. Analysis of index cases and parents included familial exome sequencing, karyotyping, and genome-wide single nucleotide polymorphism (SNP) array. From proband, control and unrelated microcephalic fetal cortical tissue, we compared gene expression of RNA and targeted immunohistochemistry. Each daughter was homozygous for a rare, non-synonymous, deleterious variant in the MKL2 gene and heterozygous for a private 185 kb deletion on the paternal allele, upstream and in cis with his MKL2 variant allele, eliminating 24 CArG transcription factor binding sites and MIR4718. MKL1 was underexpressed in probands. Dysfunction of MKL2 and its transcriptional coactivation partner, serum response factor (SRF), was supported by a decrease in gene and protein expression of PCTAIRE1, a downstream target of MKL2:SRF heterodimer transcriptional activation, previously shown to result in severe microcephaly in murine models. While disruption of the MKL2:SRF axis has been associated with severe microcephaly and disordered brain development in multiple model systems, the role of this transcription factor complex has not been previously demonstrated in human brain development.
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Becker L, Peterson J, Kulkarni S, Pasricha PJ. Ex vivo neurogenesis within enteric ganglia occurs in a PTEN dependent manner. PLoS One 2013; 8:e59452. [PMID: 23527198 PMCID: PMC3602370 DOI: 10.1371/journal.pone.0059452] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/14/2013] [Indexed: 12/13/2022] Open
Abstract
A population of multipotent stem cells capable of differentiating into neurons and glia has been isolated from adult intestine in humans and rodents. While these cells may provide a pool of stem cells for neurogenesis in the enteric nervous system (ENS), such a function has been difficult to demonstrate in vivo. An extensive study by Joseph et al. involving 108 rats and 51 mice submitted to various insults demonstrated neuronal uptake of thymidine analog BrdU in only 1 rat. Here we introduce a novel approach to study neurogenesis in the ENS using an ex vivo organotypic tissue culturing system. Culturing longitudinal muscle and myenteric plexus tissue, we show that the enteric nervous system has tremendous replicative capacity with the majority of neural crest cells demonstrating EdU uptake by 48 hours. EdU+ cells express both neuronal and glial markers. Proliferation appears dependent on the PTEN/PI3K/Akt pathway with decreased PTEN mRNA expression and increased PTEN phosphorylation (inactivation) corresponding to increased Akt activity and proliferation. Inhibition of PTEN with bpV(phen) augments proliferation while LY294002, a PI3K inhibitor, blocks it. These data suggest that the ENS is capable of neurogenesis in a PTEN dependent manner.
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