51
|
Bell C, Richardson D, Goldmeier D, Crowley T, Kocsis A, Hill S. Persistent sexual arousal in a woman with associated cardiac defects and raised atrial natriuretic peptide. Int J STD AIDS 2016; 18:130-1. [PMID: 17331290 DOI: 10.1258/095646207779949592] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The persistent sexual arousal syndrome (PSAS) is a newly described entity where the woman becomes involuntarily genitally aroused for extended periods of time in the absence of sexual desire and is distressed by this situation. The cause of this sexual problem is not well understood. We describe such a case where the subjective feelings were confirmed by observing genital engorgement. In her case, PSAS came on after initiation of fludrocortisone given for hypotension and bradycardia that was associated with an atrial septal defect (ASD). We argue that the combined effect of the ASD and fludrocortisone may be associated with an increase in her levels of atrial natriuretic peptide (ANP). ANP causes profound vasodilation and vascular leakage. We postulate that the high serum levels of ANP in her case may be contributory to her PSAS.
Collapse
|
52
|
Legg SJ, Gilbey A, Hill S, Raman A, Dubray A, Iremonger G, Mündel T. Effects of mild hypoxia in aviation on mood and complex cognition. APPLIED ERGONOMICS 2016; 53 Pt B:357-363. [PMID: 26482893 DOI: 10.1016/j.apergo.2015.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 09/07/2015] [Accepted: 10/04/2015] [Indexed: 06/05/2023]
Abstract
Thirty six volunteer air force personnel were sequentially exposed in a randomized balanced order in a hypobaric chamber to 30 min of baseline (sea level) and mild hypoxia induced by a specified altitude (sea level, 8000 ft and 12,000 ft), followed immediately by breathing 100% oxygen from an oro-nasal mask. Mood and complex cognition were assessed. Analysis of variance indicated that mood (fatigue and vigour) remained the same at 8000 ft but fatigue was increased (p = 0.001) and vigour reduced (p = 0.035) at 12,000 ft and was restored by supplementary oxygen. Complex cognition was not significantly altered by the test conditions. The results of this study do not support prior evidence that mild hypoxia equivalent to either 8000 or 12,000 ft, impairs complex cognition, but suggests that some aspects of mood may be affected at 12,000 ft and can be restored by breathing 100% oxygen.
Collapse
|
53
|
Pillai S, Center SA, McDonough SP, Demarco J, Pintar J, Henderson AK, Cooper J, Bolton T, Sharpe K, Hill S, Benedict AG, Haviland R. Ductal Plate Malformation in the Liver of Boxer Dogs: Clinical and Histological Features. Vet Pathol 2016; 53:602-13. [PMID: 26797094 DOI: 10.1177/0300985815610567] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Ductal plate malformations (DPMs) represent developmental biliary disorders with a wide phenotypic spectrum. This study characterizes DPM in 30 Boxer dogs. Median age was 1.5 (range, 0.3-10.0) years, with 12 dogs <1 year. Clinical features included increased serum levels of liver enzymes (28), gastrointestinal signs (16), poor body condition (14), abdominal effusion (9), and hepatic encephalopathy (2). Additional malformations included gallbladder atresia (8), atrophied left liver (2), absent quadrate lobe with left-displaced gallbladder (1), portal vasculature atresia (left liver, 1), intrahepatic portosystemic shunt (1), and complex intrahepatic arteriovenous malformation (1). All dogs had portal tracts dimensionally expanded by a moderate-to-severe multiple small bile duct phenotype embedded in abundant extracellular matrix; 80% displayed variable portal-to-portal bridging. Quantitative analysis confirmed significantly increased fibrillar collagen and a 3-fold increased portal tract area relative to 6 Boxer and 10 non-Boxer controls. Biliary phenotype was dominated by tightly formed CK19-positive ductules, typically 10 to 15 μm in diameter, with 3 to >30 profiles per portal tract, reduced luminal apertures, and negative Ki-67 immunoreactivity. CK19-positive biliary epithelium intersected directly with zone 1 hepatocytes as a signature feature when considered with other DPM characteristics. Phenotypic variation included a multiple small bile duct phenotype (all dogs), predominantly thin-walled sacculated ducts (4), well-formed saccular ducts (4), and sacculated segmental, interlobular, and intralobular ducts (Caroli malformation, 2 dogs, one with bridging portal fibrosis). Histologic evidence of portal venous hypoperfusion accompanied increased biliary profiles in every case. We propose that this spectrum of disorders be referred to as DPM with appropriate modifiers to characterize the unique phenotypes.
Collapse
|
54
|
Kofler M, Baumbach H, Reinstadler S, Ahad S, Hill S, Stastny L, Feuchtner G, Müller S, Müller L, Bartel T, Franz W, Grimm M, Bonaros N. Impact of Gradient and Flow on Perioperative Renal Function after Transcatheter Aortic Valve Implantation. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571563] [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]
|
55
|
Blaxter LL, Morris DE, Crowe JA, Henry C, Hill S, Sharkey D, Vyas H, Hayes-Gill BR. An automated quasi-continuous capillary refill timing device. Physiol Meas 2015; 37:83-99. [PMID: 26642080 PMCID: PMC4770525 DOI: 10.1088/0967-3334/37/1/83] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Capillary refill time (CRT) is a simple means of cardiovascular assessment which is widely used in clinical care. Currently, CRT is measured through manual assessment of the time taken for skin tone to return to normal colour following blanching of the skin surface. There is evidence to suggest that manually assessed CRT is subject to bias from ambient light conditions, a lack of standardisation of both blanching time and manually applied pressure, subjectiveness of return to normal colour, and variability in the manual assessment of time. We present a novel automated system for CRT measurement, incorporating three components: a non-invasive adhesive sensor incorporating a pneumatic actuator, a diffuse multi-wavelength reflectance measurement device, and a temperature sensor; a battery operated datalogger unit containing a self contained pneumatic supply; and PC based data analysis software for the extraction of refill time, patient skin surface temperature, and sensor signal quality. Through standardisation of the test, it is hoped that some of the shortcomings of manual CRT can be overcome. In addition, an automated system will facilitate easier integration of CRT into electronic record keeping and clinical monitoring or scoring systems, as well as reducing demands on clinicians. Summary analysis of volunteer (n = 30) automated CRT datasets are presented, from 15 healthy adults and 15 healthy children (aged from 5 to 15 years), as their arms were cooled from ambient temperature to 5°C. A more detailed analysis of two typical datasets is also presented, demonstrating that the response of automated CRT to cooling matches that of previously published studies.
Collapse
|
56
|
Zacuto AC, Pesavento PA, Hill S, McAlister A, Rosenthal K, Cherbinsky O, Marks SL. Intestinal Leiomyositis: A Cause of Chronic Intestinal Pseudo-Obstruction in 6 Dogs. J Vet Intern Med 2015; 30:132-40. [PMID: 26608226 PMCID: PMC4913632 DOI: 10.1111/jvim.13652] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/02/2015] [Accepted: 09/24/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Intestinal leiomyositis is a suspected autoimmune disorder affecting the muscularis propria layer of the gastrointestinal tract and is a cause of chronic intestinal pseudo-obstruction in humans and animals. OBJECTIVE To characterize the clinical presentation, histopathologic features, and outcome of dogs with intestinal leiomyositis in an effort to optimize treatment and prognosis. ANIMALS Six client-owned dogs. METHODS Retrospective case series. Medical records were reviewed to describe signalment, clinicopathologic and imaging findings, histopathologic diagnoses, treatment, and outcome. All biopsy specimens were reviewed by a board-certified pathologist. RESULTS Median age of dogs was 5.4 years (range, 15 months-9 years). Consistent clinical signs included vomiting (6/6), regurgitation (2/6), and small bowel diarrhea (3/6). Median duration of clinical signs before presentation was 13 days (range, 5-150 days). Diagnostic imaging showed marked gastric distension with dilated small intestines in 4/6 dogs. Full-thickness intestinal biopsies were obtained in all dogs by laparotomy. Histopathology of the stomach and intestines disclosed mononuclear inflammation, myofiber degeneration and necrosis, and fibrosis centered within the region of myofiber loss in the intestinal muscularis propria. All dogs received various combinations of immunomodulatory and prokinetic treatment, antimicrobial agents, antiemetics, and IV fluids, but none of the dogs showed a clinically relevant improvement with treatment. Median survival was 19 days after diagnosis (range, 3-270 days). CONCLUSIONS AND CLINICAL IMPORTANCE Intestinal leiomyositis is a cause of intestinal pseudo-obstruction and must be diagnosed by full-thickness intestinal biopsy. This disease should be considered in dogs with acute and chronic vomiting, regurgitation, and small bowel diarrhea.
Collapse
|
57
|
Nargund A, Penketh R, Bruen E, Hill S, Groves L. Microwave Endometrial Ablation: Prospective Case Review and Patient Satisfaction Survey. J Minim Invasive Gynecol 2015; 22:S182-S183. [DOI: 10.1016/j.jmig.2015.08.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
58
|
Nargund A, Penketh R, Thomas C, Groves L, Hill S. The Essure Hysteroscopic Sterilization: Initial Experience in Cardiff, UK – Does Prior Contraception Influence the Ease of Device Placement? J Minim Invasive Gynecol 2015; 22:S190-S191. [DOI: 10.1016/j.jmig.2015.08.695] [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]
|
59
|
Forbes-Penfold D, Pearson A, Hughes A, Koeglmeier J, Hill S, Evans V. Reducing Central Venous Lines [CVL] infections within the Home Parental Nutrition [HPN] patient group by using Parafilm ®. Clin Nutr ESPEN 2015; 10:e209. [DOI: 10.1016/j.clnesp.2015.03.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
60
|
Evans V, Hughes A, Forbes-Penfold D, Koeglmeier J, Hill S. Candida post gram-negative line sepsis in patients on Home Parenteral Nutrition: A study of 32 patients. Clin Nutr ESPEN 2015; 10:e209-e210. [DOI: 10.1016/j.clnesp.2015.03.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
61
|
Kyrana E, Beath S, Small M, Gabe S, Madonald S, Hill S. Please mind the gap, young people with intestinal failure need you! A joint BSPGHAN, BIFA and BAPEN survey of transition experiences between paediatrics and adult services for Home Parenteral Nutrition (HPN). Clin Nutr ESPEN 2015; 10:e191. [DOI: 10.1016/j.clnesp.2015.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
62
|
Malle L, Marrero B, Liu Y, Montealegre G, Chapelle D, Kim H, O'Brien M, Hill S, Fontana JR, Ramsey S, Duckers G, Ozen S, Issekutz A, Wittkowski H, Foell D, Tenbrock K, Jones O, Holland S, Gonzalez B, Brogan P, Omoyinmi E, Gomes SM, Paller A, Deng Z, Goldback-Mansky R, de Jesus AA. Interstitial lung disease in STING-associated vasculopathy with onset in infancy (SAVI): preliminary genotype-phenotype correlation. Pediatr Rheumatol Online J 2015. [PMCID: PMC4596964 DOI: 10.1186/1546-0096-13-s1-o32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
63
|
Carrathers T, Roseberry J, Hill S. A-39Order Reconstruction without Item Specific Retrieval Demands is Deficient in Schizophrenia. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.39] [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
|
64
|
Hill S, Venick R, Carter B, Horslen S, Youssef N, Kocoshis S. SUN-LB012: Teduglutide Increases Plasma Citrulline Levels in Children with Short Bowel Syndrome (SBS). Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30733-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
65
|
Venick R, Horslen S, Carter B, Kocoshis S, Youssef N, Hill S. SUN-LB013: Nutritional Status Maintained with Teduglutide Treatment in Children with Short Bowel Syndrome (SBS). Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30734-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
66
|
Hochberger W, Hill S, Nelson C, Pearlson G, Keshavan M, Tamminga C, Sweeney J, Reilly J. A-38Exploratory and Confirmatory Factor Analysis Converge on a Unitary Construct Underlying BACS Performance Across Psychotic Disorders, Their First-Degree Relatives, and Healthy Volunteers. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.38] [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
|
67
|
Carter B, Hill S, Horslen S, Kocoshis S, Youssef N, Venick R. SUN-LB011: Successful Intestinal Adaptation with Teduglutide in Children with Short Bowel Syndrome (SBS). Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30732-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
68
|
Hughes A, Evans V, Forbes-Penfold D, Koeglmeier J, Hill S. Burden of care at night when living with a child on parenteral nutrition at home. Clin Nutr ESPEN 2015; 10:e180. [PMID: 28531479 DOI: 10.1016/j.clnesp.2015.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
69
|
Hill S, McNamara M, Seals D, Kaplon R. Endothelial Cell Senescence with Age is Associated with Oxidative Stress‐Mediated Suppression of Endothelial Function in Healthy Adults. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.lb572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
70
|
Ahad S, Hill S, Berroth R, Bayer M, Franke U, Baumbach H. Transcatheter Aortic Valve Implantation and Concomitant off Pump Revascularization - Individual Approaches. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
71
|
Baumbach H, Oppermann T, Wachter K, Ahad S, Hill S, Schäufele T, Ursulescu A, Franke U. Anticoagulation In TAVI-Patients - Do We Need Dual Platelet Therapy? Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
72
|
Lane D, Hill S, Huntingford J, Lafuente P, Wall R, Jones K. Effectiveness of slow motion video compared to real time video in improving the accuracy and consistency of subjective gait analysis in dogs. Open Vet J 2015. [DOI: 10.5455/ovj.2015.v5.i2.p158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective measures of canine gait quality via force plates, pressure mats or kinematic analysis are considered superior to subjective gait assessment (SGA). Despite research demonstrating that SGA does not accurately detect subtle lameness, it remains the most commonly performed diagnostic test for detecting lameness in dogs. This is largely because the financial, temporal and spatial requirements for existing objective gait analysis equipment makes this technology impractical for use in general practice. The utility of slow motion video as a potential tool to augment SGA is currently untested. To evaluate a more accessible way to overcome the limitations of SGA, a slow motion video study was undertaken. Three experienced veterinarians reviewed video footage of 30 dogs, 15 with a diagnosis of primary limb lameness based on history and physical examination, and 15 with no indication of limb lameness based on history and physical examination. Four different videos were made for each dog, demonstrating each dog walking and trotting in real time, and then again walking and trotting in 50% slow motion. For each video, the veterinary raters assessed both the degree of lameness, and which limb(s) they felt represented the source of the lameness. Spearmans rho, Cramers V, and t-tests were performed to determine if slow motion video increased either the accuracy or consistency of raters SGA relative to real time video. Raters demonstrated no significant increase in consistency or accuracy in their SGA of slow motion video relative to real time video. Based on these findings, slow motion video does not increase the consistency or accuracy of SGA values. Further research is required to determine if slow motion video will benefit SGA in other ways.
Collapse
|
73
|
Ahad S, Baumbach H, Hill S, Schaeufele T, Beyer M, Berroth R, Franke UF. 227 * CONVENTIONAL VERSUS TRANSAPICAL AORTIC VALVE REPLACEMENT: IS IT TIME FOR INDICATION SHIFT? Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.227] [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
|
74
|
Chen YJ, Hill S, Huang H, Taraboletti A, Cho K, Gallo R, Manchester M, Shriver LP, Patti GJ. Inflammation triggers production of dimethylsphingosine from oligodendrocytes. Neuroscience 2014; 279:113-21. [PMID: 25151189 DOI: 10.1016/j.neuroscience.2014.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/08/2014] [Accepted: 08/14/2014] [Indexed: 02/04/2023]
Abstract
Neuropathic pain is a chronic, refractory condition that arises after damage to the nervous system. We previously showed that an increased level of the endogenous metabolite N,N-dimethylsphingosine (DMS) in the central nervous system (CNS) is sufficient to induce neuropathic pain-like behavior in rats. However, several important questions remain. First, it has not yet been demonstrated that DMS is produced in humans and its value as a therapeutic target is therefore unknown. Second, the cell types within the CNS that produce DMS are currently unidentified. Here we provide evidence that DMS is present in human CNS tissue. We show that DMS levels increase in demyelinating lesions isolated from patients with multiple sclerosis, an autoimmune disease in which the majority of patients experience chronic pain. On the basis of these results, we hypothesized that oligodendrocytes may be a cellular source of DMS. We show that human oligodendrocytes produce DMS in culture and that the levels of DMS increase when oligodendrocytes are challenged with agents that damage white matter. These results suggest that damage to oligodendrocytes leads to increased DMS production which in turn drives inflammatory astrocyte responses involved in sensory neuron sensitization. Interruption of this pathway in patients may provide analgesia without the debilitating side effects that are commonly observed with other chronic pain therapies.
Collapse
|
75
|
Liu Y, Jesus AA, Marrero B, Yang D, Ramsey SE, Sanchez GAM, Tenbrock K, Wittkowski H, Jones OY, Kuehn HS, Lee CCR, DiMattia MA, Cowen EW, Gonzalez B, Palmer I, DiGiovanna JJ, Biancotto A, Kim H, Tsai WL, Trier AM, Huang Y, Stone DL, Hill S, Kim HJ, St Hilaire C, Gurprasad S, Plass N, Chapelle D, Horkayne-Szakaly I, Foell D, Barysenka A, Candotti F, Holland SM, Hughes JD, Mehmet H, Issekutz AC, Raffeld M, McElwee J, Fontana JR, Minniti CP, Moir S, Kastner DL, Gadina M, Steven AC, Wingfield PT, Brooks SR, Rosenzweig SD, Fleisher TA, Deng Z, Boehm M, Paller AS, Goldbach-Mansky R. Activated STING in a vascular and pulmonary syndrome. N Engl J Med 2014; 371:507-518. [PMID: 25029335 PMCID: PMC4174543 DOI: 10.1056/nejmoa1312625] [Citation(s) in RCA: 933] [Impact Index Per Article: 93.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The study of autoinflammatory diseases has uncovered mechanisms underlying cytokine dysregulation and inflammation. METHODS We analyzed the DNA of an index patient with early-onset systemic inflammation, cutaneous vasculopathy, and pulmonary inflammation. We sequenced a candidate gene, TMEM173, encoding the stimulator of interferon genes (STING), in this patient and in five unrelated children with similar clinical phenotypes. Four children were evaluated clinically and immunologically. With the STING ligand cyclic guanosine monophosphate-adenosine monophosphate (cGAMP), we stimulated peripheral-blood mononuclear cells and fibroblasts from patients and controls, as well as commercially obtained endothelial cells, and then assayed transcription of IFNB1, the gene encoding interferon-β, in the stimulated cells. We analyzed IFNB1 reporter levels in HEK293T cells cotransfected with mutant or nonmutant STING constructs. Mutant STING leads to increased phosphorylation of signal transducer and activator of transcription 1 (STAT1), so we tested the effect of Janus kinase (JAK) inhibitors on STAT1 phosphorylation in lymphocytes from the affected children and controls. RESULTS We identified three mutations in exon 5 of TMEM173 in the six patients. Elevated transcription of IFNB1 and other gene targets of STING in peripheral-blood mononuclear cells from the patients indicated constitutive activation of the pathway that cannot be further up-regulated with stimulation. On stimulation with cGAMP, fibroblasts from the patients showed increased transcription of IFNB1 but not of the genes encoding interleukin-1 (IL1), interleukin-6 (IL6), or tumor necrosis factor (TNF). HEK293T cells transfected with mutant constructs show elevated IFNB1 reporter levels. STING is expressed in endothelial cells, and exposure of these cells to cGAMP resulted in endothelial activation and apoptosis. Constitutive up-regulation of phosphorylated STAT1 in patients' lymphocytes was reduced by JAK inhibitors. CONCLUSIONS STING-associated vasculopathy with onset in infancy (SAVI) is an autoinflammatory disease caused by gain-of-function mutations in TMEM173. (Funded by the Intramural Research Program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases; ClinicalTrials.gov number, NCT00059748.).
Collapse
|