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Li P, Brown S, Williams M, White T, Xie W, Cui W, Peker D, Lei L, Kunder CA, Wang HY, Murray SS, Vagher J, Kovacsovics T, Patel JL. The genetic landscape of germline DDX41 variants predisposing to myeloid neoplasms. Blood 2022; 140:716-755. [PMID: 35671390 PMCID: PMC9389629 DOI: 10.1182/blood.2021015135] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/09/2022] [Indexed: 11/20/2022] Open
Abstract
Germline DDX41 variants are the most common mutations predisposing to acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) in adults, but the causal variant (CV) landscape and clinical spectrum of hematologic malignancies (HMs) remain unexplored. Here, we analyzed the genomic profiles of 176 patients with HM carrying 82 distinct presumably germline DDX41 variants among a group of 9821 unrelated patients. Using our proposed DDX41-specific variant classification, we identified features distinguishing 116 patients with HM with CV from 60 patients with HM with variant of uncertain significance (VUS): an older age (median 69 years), male predominance (74% in CV vs 60% in VUS, P = .03), frequent concurrent somatic DDX41 variants (79% in CV vs 5% in VUS, P < .0001), a lower somatic mutation burden (1.4 ± 0.1 in CV vs 2.9 ± 0.04 in VUS, P = .012), near exclusion of canonical recurrent genetic abnormalities including mutations in NPM1, CEBPA, and FLT3 in AML, and favorable overall survival (OS) in patients with AML/MDS. This superior OS was determined independent of blast count, abnormal karyotypes, and concurrent variants, including TP53 in patients with AML/MDS, regardless of patient's sex, age, or specific germline CV, suggesting that germline DDX41 variants define a distinct clinical entity. Furthermore, unrelated patients with myeloproliferative neoplasm and B-cell lymphoma were linked by DDX41 CV, thus expanding the known disease spectrum. This study outlines the CV landscape, expands the phenotypic spectrum in unrelated DDX41-mutated patients, and underscores the urgent need for gene-specific diagnostic and clinical management guidelines.
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Affiliation(s)
- Peng Li
- Division of Hematopathology, Department of Pathology, University of Utah Health, Salt Lake City, UT
- Genomics Laboratory, ARUP Laboratories, Salt Lake City, UT
| | - Sara Brown
- Genomics Laboratory, ARUP Laboratories, Salt Lake City, UT
| | - Margaret Williams
- Division of Hematopathology, Department of Pathology, University of Utah Health, Salt Lake City, UT
- Genomics Laboratory, ARUP Laboratories, Salt Lake City, UT
| | - Thomas White
- Genomics Laboratory, ARUP Laboratories, Salt Lake City, UT
| | - Wei Xie
- Department of Pathology, School of Medicine, Oregon Health and Science University, Portland, OR
| | - Wei Cui
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Deniz Peker
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Li Lei
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA
- Department of Pathology, Stanford University, School of Medicine, Stanford, CA
| | - Christian A Kunder
- Department of Pathology, Stanford University, School of Medicine, Stanford, CA
| | - Huan-You Wang
- Department of Pathology & Immunology, University of California San Diego Health System, La Jolla, CA
| | - Sarah S Murray
- Department of Pathology & Immunology, University of California San Diego Health System, La Jolla, CA
| | - Jennie Vagher
- Department of Internal Medicine, University of Utah Health, Salt Lake City, UT; and
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Tibor Kovacsovics
- Department of Internal Medicine, University of Utah Health, Salt Lake City, UT; and
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Jay L Patel
- Division of Hematopathology, Department of Pathology, University of Utah Health, Salt Lake City, UT
- Genomics Laboratory, ARUP Laboratories, Salt Lake City, UT
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Misra DP, Rathore U, Patro P, Agarwal V, Sharma A. Disease-modifying anti-rheumatic drugs for the management of Takayasu arteritis-a systematic review and meta-analysis. Clin Rheumatol 2021; 40:4391-4416. [PMID: 33932173 PMCID: PMC8087890 DOI: 10.1007/s10067-021-05743-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 01/17/2023]
Abstract
The pharmacotherapy of Takayasu arteritis (TAK) with disease-modifying anti-rheumatic drugs (DMARDs) is an evolving area. A systematic review of Scopus, Web of Science, Pubmed Central, clinical trial databases and recent international rheumatology conferences for interventional and observational studies reporting the effectiveness of DMARDs in TAK identified four randomized controlled trials (RCTs, with another longer-term follow-up of one RCT) and 63 observational studies. The identified trials had some concern or high risk of bias. Most observational studies were downgraded on the Newcastle-Ottawa scale due to lack of appropriate comparator groups. Studies used heterogenous outcomes of clinical responses, angiographic stabilization, normalization of inflammatory markers, reduction in vascular uptake on positron emission tomography, reduction in prednisolone doses and relapses. Tocilizumab showed benefit in a RCT compared to placebo in a secondary per-protocol analysis but not the primary intention-to-treat analysis. Abatacept failed to demonstrate benefit compared to placebo for preventing relapses in another RCT. Pooled data from uncontrolled observational studies demonstrated beneficial clinical responses and angiographic stabilization in nearly 80% patients treated with tumour necrosis factor alpha inhibitors, tocilizumab or leflunomide. Certainty of evidence for outcomes from RCTs ranged from moderate to very low and was low to very low for all observational studies. There is a paucity of high-quality evidence to guide the pharmacotherapy of TAK. Future observational studies should attempt to include appropriate comparator arms. Multicentric, adequately powered RCTs assessing both clinical and angiographic responses are necessary in TAK.
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Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), -226014, Lucknow, India
| | - Upendra Rathore
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), -226014, Lucknow, India
| | - Pallavi Patro
- School of Telemedicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), -226014, Lucknow, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), -226014, Lucknow, India
| | - Aman Sharma
- Clinical Immunology and Rheumatology Services, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), -160012, Chandigarh, India
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Pérez-Neri I, González-Aguilar A, Sandoval H, Pineda C, Ríos C. Therapeutic Potential of Ultrasound Neuromodulation in Decreasing Neuropathic Pain: Clinical and Experimental Evidence. Curr Neuropharmacol 2021; 19:334-348. [PMID: 32691714 PMCID: PMC8033967 DOI: 10.2174/1570159x18666200720175253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/23/2020] [Accepted: 07/07/2020] [Indexed: 01/01/2023] Open
Abstract
Background For more than seven decades, ultrasound has been used as an imaging and diagnostic tool. Today, new technologies, such as focused ultrasound (FUS) neuromodulation, have revealed some innovative, potential applications. However, those applications have been barely studied to deal with neuropathic pain (NP), a cluster of chronic pain syndromes with a restricted response to conventional pharmaceuticals. Objective To analyze the therapeutic potential of low-intensity (LIFUS) and high-intensity (HIFUS) FUS for managing NP. Methods We performed a narrative review, including clinical and experimental ultrasound neuromodulation studies published in three main database repositories. Discussion Evidence shows that FUS may influence several mechanisms relevant for neuropathic pain management such as modulation of ion channels, glutamatergic neurotransmission, cerebral blood flow, inflammation and neurotoxicity, neuronal morphology and survival, nerve regeneration, and remyelination. Some experimental models have shown that LIFUS may reduce allodynia after peripheral nerve damage. At the same time, a few clinical studies support its beneficial effect on reducing pain in nerve compression syndromes. In turn, Thalamic HIFUS ablation can reduce NP from several etiologies with minor side-effects, but some neurological sequelae might be permanent. HIFUS is also useful in lowering non-neuropathic pain in several disorders. Conclusion Although an emerging set of studies brings new evidence on the therapeutic potential of both LIFUS and HIFUS for managing NP with minor side-effects, we need more controlled clinical trials to conclude about its safety and efficacy.
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Affiliation(s)
- Iván Pérez-Neri
- Department of Neurochemistry, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, La Fama, Tlalpan, Mexico City, 14269, Mexico
| | - Alberto González-Aguilar
- Neuro-oncology Unit, Instituto Nacional de Neurología y Neurocirugia Manuel Velasco Suarez, Insurgentes Sur 3877, La Fama, Tlalpan, Mexico City, 14269, Mexico
| | - Hugo Sandoval
- Sociomedical Research Unit, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Calzada México-Xochimilco 289, Col, Arenal de Guadalupe, Alcaldia Tlalpan, C.P. 14389, Mexico City, Mexico
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Calzada Mexico-Xochimilco 289, Col, Arenal de Guadalupe, Alcaldia Tlalpan, C.P.14389, Mexico City, Mexico
| | - Camilo Ríos
- Department of Neurochemistry, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, La Fama, Tlalpan, Mexico City, 14269, Mexico
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Misra DP, Zimba O, Gasparyan AY. Statistical data presentation: a primer for rheumatology researchers. Rheumatol Int 2020; 41:43-55. [PMID: 33201265 DOI: 10.1007/s00296-020-04740-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/24/2020] [Indexed: 12/29/2022]
Abstract
Statistical presentation of data is key to understanding patterns and drawing inferences about biomedical phenomena. In this article, we provide an overview of basic statistical considerations for data analysis. Assessment of whether tested parameters are distributed normally is important to decide whether to employ parametric or non-parametric data analyses. The nature of variables (continuous or discrete) also determines analysis strategies. Normally distributed data can be presented using means with standard deviations (SD), whereas non-parametric measures such as medians (with range or interquartile range) should be used for non-normal distributions. While the SD provides a measure of data dispersion, the standard error provides estimates of the 95% confidence interval i.e. the actual mean in the population. Univariable analyses should be directed to denote effect sizes, as well as test a priori hypothesis (i.e. null hypothesis significance testing). Univariable analyses should be followed up by suitable adjusted multivariable analyses such as linear or logistic regression. Linear correlation statistics can help assess whether two variables change hand in hand. Concordance rather than correlation should be used to compare outcome measures of disease states. Prior sample size calculation to ensure adequate study power is recommended for studies which have analogues in the literature with SDs. Statistical considerations for systematic reviews should include appropriate use of meta-analysis, assessment of heterogeneity, publication bias assessment when there are more than ten studies, and quality assessment of studies. Since statistical errors are responsible for a significant proportion of retractions, appropriate statistical analysis is mandatory during study planning and data analysis.
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Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India.
| | - Olena Zimba
- Department of Internal Medicine No. 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, West Midlands, UK
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