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Yi M, Feng Z, He H, Dinulescu D, Xu B. Evaluating Alkaline Phosphatase-Instructed Self-Assembly of d-Peptides for Selectively Inhibiting Ovarian Cancer Cells. J Med Chem 2023; 66:10027-10035. [PMID: 37459116 PMCID: PMC10614160 DOI: 10.1021/acs.jmedchem.3c00949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Cancer is a major public health concern requiring novel treatment approaches. Enzyme-instructed self-assembly (EISA) provides a unique approach for selectively inhibiting cancer cells. However, the structure and activity correlation of EISA remains to be explored. This study investigates new EISA substrates of alkaline phosphatase (ALP) to hinder ovarian cancer cells. Analogues 2-8 were synthesized by modifying the amino acid residues of a potent EISA substrate 1 that effectively inhibits the growth of OVSAHO, a high-grade serous ovarian cancer (HGSOC) cell line. The efficacy of 2-8 against OVSAHO was assessed, along with the combination of substrate 1 with clinically used drugs. The results reveal that substrate 1 displays the highest cytotoxicity against OVSAHO cells, with an IC50 of around 8 μM. However, there was limited synergism observed between substrate 1 and the tested clinically used drugs. These findings indicate that EISA likely operates through a distinct mechanism that necessitates further elucidation.
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Affiliation(s)
- Meihui Yi
- Department of Chemistry, Brandeis University, 415 South Street, Waltham, MA 02453, USA
| | - Zhaoqianqi Feng
- Department of Chemistry, Brandeis University, 415 South Street, Waltham, MA 02453, USA
| | - Hongjian He
- Department of Chemistry, Brandeis University, 415 South Street, Waltham, MA 02453, USA
| | - Daniela Dinulescu
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Bing Xu
- Department of Chemistry, Brandeis University, 415 South Street, Waltham, MA 02453, USA
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30-Day Postoperative Outcomes in Adults with Obstructive Sleep Apnea Undergoing Upper Airway Surgery. J Clin Med 2022; 11:jcm11247371. [PMID: 36555986 PMCID: PMC9783895 DOI: 10.3390/jcm11247371] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Obstructive sleep apnea (OSA) is a chronic disorder of the upper airway. OSA surgery has oftentimes been researched based on the outcomes of single-institutional facilities. We retrospectively analyzed a multi-institutional national database to investigate the outcomes of OSA surgery and identify risk factors for complications. Methods: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2008−2020) to identify patients who underwent OSA surgery. The postoperative outcomes of interest included 30-day surgical and medical complications, reoperation, readmission, and mortality. Additionally, we assessed risk-associated factors for complications, including comorbidities and preoperative blood values. Results: The study population included 4662 patients. Obesity (n = 2909; 63%) and hypertension (n = 1435; 31%) were the most frequent comorbidities. While two (0.04%) deaths were reported within the 30-day postoperative period, the total complication rate was 6.3% (n = 292). Increased BMI (p = 0.01), male sex (p = 0.03), history of diabetes (p = 0.002), hypertension requiring treatment (p = 0.03), inpatient setting (p < 0.0001), and American Society of Anesthesiology (ASA) physical status classification scores ≥ 4 (p < 0.0001) were identified as risk-associated factors for any postoperative complications. Increased alkaline phosphatase (ALP) was identified as a risk-associated factor for the occurrence of any complications (p = 0.02) and medical complications (p = 0.001). Conclusions: OSA surgery outcomes were analyzed at the national level, with complications shown to depend on AP levels, male gender, extreme BMI, and diabetes mellitus. While OSA surgery has demonstrated an overall positive safety profile, the implementation of these novel risk-associated variables into the perioperative workflow may further enhance patient care.
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Xia W, Zhao D, Li C, Xu L, Yao X, Hu H. Prognostic significance of albumin to alkaline phosphatase ratio in critically ill patients with acute kidney injury. Clin Exp Nephrol 2022; 26:917-924. [PMID: 35579723 DOI: 10.1007/s10157-022-02234-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE No epidemiological evidence has investigated the effect of albumin to alkaline phosphatase ratio (AAPR) on the prognosis among critically ill patients with acute kidney injury (AKI). We aimed to explore the prognostic value of AAPR in these patients. METHODS We extracted all clinical data from MIMIC III. ROC curve analysis was used to evaluate the discrimination of AAPR for predicting in-hospital mortality. A generalized additive model was applied to identify a nonlinear association between AAPR and in-hospital mortality. The Cox proportional hazards models were used to determine the association between AAPR and in-hospital and 30-day mortality. RESULTS A total of 6894 eligible subjects were enrolled in this study. The relationship between AAPR and in-hospital mortality was nonlinear. Multivariate analysis demonstrated that lower AAPR (AAPR < 0.35) was an independent predictor of in-hospital and 30-day mortality after adjusting for potential confounders (HR 1.74, 95% CI 1.72-2.20, P < 0.001; HR 1.89, 95% CI 1.66-2.14, P < 0.001, respectively). CONCLUSIONS AAPR may serve as a potential prognostic biomarker in critically ill patients with AKI and lower AAPR was associated with increased risk of in-hospital and 30-day mortality among these patients.
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Affiliation(s)
- Wenkai Xia
- Department of Nephrology, Jiangyin People's Hospital Affiliated to Nantong University, 3 Yinrui Road, Jiangyin, 214400, Jiangsu, China
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Danyang Zhao
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Chenyu Li
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lingyu Xu
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiajuan Yao
- Department of Nephrology, Jiangyin People's Hospital Affiliated to Nantong University, 3 Yinrui Road, Jiangyin, 214400, Jiangsu, China
| | - Hong Hu
- Department of Nephrology, Jiangyin People's Hospital Affiliated to Nantong University, 3 Yinrui Road, Jiangyin, 214400, Jiangsu, China.
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Thio QCBS, Karhade AV, Notman E, Raskin KA, Lozano-Calderón SA, Ferrone ML, Bramer JAM, Schwab JH. Serum alkaline phosphatase is a prognostic marker in bone metastatic disease of the extremity. J Orthop 2020; 22:346-351. [PMID: 32921951 DOI: 10.1016/j.jor.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/11/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this study was to determine the prognostic value of serum alkaline phosphatase for treatment decision making in metastatic bone disease. Methods 1090 patients who underwent surgery for extremity metastatic disease were retrospectively identified at two tertiary care centers. The association between alkaline phosphatase and mortality was assessed by bivariate and multivariate analyses. Results Three-month and one-year mortality rates were 305 (29%) and 639 (62%), respectively. Alkaline phosphatase was associated with mortality at both three months and one year. Conclusion Serum alkaline phosphatase may be a useful marker in prognostic algorithms for patients with extremity metastatic disease.
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Affiliation(s)
- Quirina C B S Thio
- Department of Orthopedic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Aditya V Karhade
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily Notman
- Department of Orthopedic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Kevin A Raskin
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Santiago A Lozano-Calderón
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco L Ferrone
- Department of Orthopedic Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, MA, USA
| | - Jos A M Bramer
- Department of Orthopedic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Kushioka J, Takenaka S, Makino T, Sakai Y, Kashii M, Iwasaki M, Yoshikawa H, Kaito T. Risk factors for in-hospital mortality after spine surgery: a matched case-control study using a multicenter database. Spine J 2020; 20:321-328. [PMID: 31669616 DOI: 10.1016/j.spinee.2019.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/10/2019] [Accepted: 10/17/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND/CONTEXT It is yet unclear what preoperative and intraoperative factors affect mortality after spine surgery. PURPOSE To identify the preoperative and intraoperative risk factors for in-hospital mortality after spine surgery using a matched case-control study based on a multicenter database. STUDY DESIGN/SETTING A retrospective matched case-control study based on a registry of prospectively collected multicenter data. PATIENT SAMPLE We identified 25 patients who died in the hospital (the mortality group) from the 26,604 patients in the database who underwent spine surgery at our 27 affiliated institutions between 2012 and 2018. An age-, sex-, spinal disease-, and surgical procedure-matched control group of patients (n=100, 4:1 ratio with the mortality group) was selected from the same database. OUTCOME MEASURES Data relating to comorbidities, preoperative blood tests, operative factors, and perioperative complications. METHODS We retrospectively reviewed all the medical records of each patient in the two groups to nullify the effects of overt risk factors such as age, sex, diseases, and surgical procedures. Risk factors for in-hospital mortality were initially evaluated by univariate analysis. Then, multivariate logistic regression models were generated to analyze independent risk factors for in-hospital mortality. RESULTS The overall in-hospital mortality rate was 0.09% (25/26,604). Mortality was lowest in patients with degenerative cervical (0.04%, 2/5,027) or lumbar disease (0.03%, 5/15,630). In contrast, mortality was highest in patients with dialysis-related spondyloarthropathy (3.0%, 3/99), patients with infectious spondylodiscitis (1.5%, 6/401), and patients with metastatic spinal tumors (0.9%, 3/334). Multivariate logistic regression analysis revealed that massive intraoperative hemorrhage (>2 L) (odds ratio [OR], 28.2; 95% confidence interval [CI], 2.27-349), preoperative renal comorbidity (OR, 4.33; 95% CI, 1.38-13.6), and elevated preoperative aspartate aminotransferase levels (OR, 1.51 per 10 units; 95% CI, 1.04-2.20) were risk factors. CONCLUSIONS Spine surgery for patients with dialysis-dependency, infectious diseases or metastatic tumors had much more potential of in-hospital mortality compared with those for patients with degenerative diseases. Massive intraoperative hemorrhage and preoperative renal and liver comorbidities were identified as risk factors for in-hospital mortality in patients who underwent spine surgery.
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Affiliation(s)
- Junichi Kushioka
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Shota Takenaka
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takahiro Makino
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yusuke Sakai
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Masafumi Kashii
- Department of Orthopedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibaharacho, Toyonaka, Osaka 560-8565, Japan
| | - Motoki Iwasaki
- Department of Orthopedic Surgery, Osaka-Rosai Hospital, 1179‑3 Nagasonecho, Sakai, Osaka 591‑8025, Japan
| | - Hideki Yoshikawa
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
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Karhade AV, Thio QCBS, Ogink PT, Bono CM, Ferrone ML, Oh KS, Saylor PJ, Schoenfeld AJ, Shin JH, Harris MB, Schwab JH. Predicting 90-Day and 1-Year Mortality in Spinal Metastatic Disease: Development and Internal Validation. Neurosurgery 2019; 85:E671-E681. [DOI: 10.1093/neuros/nyz070] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/12/2019] [Indexed: 01/15/2023] Open
Abstract
Abstract
BACKGROUND
Increasing prevalence of metastatic disease has been accompanied by increasing rates of surgical intervention. Current tools have poor to fair predictive performance for intermediate (90-d) and long-term (1-yr) mortality.
OBJECTIVE
To develop predictive algorithms for spinal metastatic disease at these time points and to provide patient-specific explanations of the predictions generated by these algorithms.
METHODS
Retrospective review was conducted at 2 large academic medical centers to identify patients undergoing initial operative management for spinal metastatic disease between January 2000 and December 2016. Five models (penalized logistic regression, random forest, stochastic gradient boosting, neural network, and support vector machine) were developed to predict 90-d and 1-yr mortality.
RESULTS
Overall, 732 patients were identified with 90-d and 1-yr mortality rates of 181 (25.1%) and 385 (54.3%), respectively. The stochastic gradient boosting algorithm had the best performance for 90-d mortality and 1-yr mortality. On global variable importance assessment, albumin, primary tumor histology, and performance status were the 3 most important predictors of 90-d mortality. The final models were incorporated into an open access web application able to provide predictions as well as patient-specific explanations of the results generated by the algorithms. The application can be found at https://sorg-apps.shinyapps.io/spinemetssurvival/
CONCLUSION
Preoperative estimation of 90-d and 1-yr mortality was achieved with assessment of more flexible modeling techniques such as machine learning. Integration of these models into applications and patient-centered explanations of predictions represent opportunities for incorporation into healthcare systems as decision tools in the future.
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Affiliation(s)
- Aditya V Karhade
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quirina C B S Thio
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul T Ogink
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher M Bono
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marco L Ferrone
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kevin S Oh
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philip J Saylor
- Department of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Schoenfeld
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mitchel B Harris
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Karhade AV, Thio QCBS, Kuverji M, Ogink PT, Ferrone ML, Schwab JH. Prognostic value of serum alkaline phosphatase in spinal metastatic disease. Br J Cancer 2019; 120:640-646. [PMID: 30792532 PMCID: PMC6461951 DOI: 10.1038/s41416-019-0407-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 11/09/2022] Open
Abstract
Background Determination of the appropriateness of invasive management in patients with spinal metastatic disease requires accurate pre-operative estimation of survival. The purpose of this study was to examine serum alkaline phosphatase as a prognostic marker in spinal metastatic disease. Methods Chart reviews from two tertiary care centres were used to identify spinal metastatic disease patients. Bivariate and multivariate analyses were used to determine if serum alkaline phosphatase was an independent prognostic marker for survival. Results Overall, 732 patients were included with 90-day and 1-year survival of n = 539 (74.9%) and n = 324 (45.7%), respectively. The 1-year survival of patients in the first quartile of alkaline phosphatase (≤73 IU/L) was 78 (57.8%) compared to 31 (24.0%) for patients in the fourth quartile (>140 IU/L). Preoperative serum alkaline phosphatase levels were significantly elevated in patients with multiple spine metastases, non-spine bone metastasis, and visceral metastasis but not in patients with brain metastasis. On multivariate analysis, elevated serum alkaline phosphatase was identified as an independent prognostic factor for survival in spinal metastatic disease. Conclusion Serum alkaline phosphatase is associated with preoperative metastatic tumour burden and is a biomarker for overall survival in spinal metastatic disease.
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Affiliation(s)
- Aditya V Karhade
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Quirina C B S Thio
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Megna Kuverji
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul T Ogink
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco L Ferrone
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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