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Martin-Way D, Puche-Sanz I, Cozar JM, Zafra-Gomez A, Gomez-Regalado MDC, Morales-Alvarez CM, Hernandez AF, Martinez-Gonzalez LJ, Alvarez-Cubero MJ. Genetic variants of antioxidant enzymes and environmental exposures as molecular biomarkers associated with the risk and aggressiveness of bladder cancer. Sci Total Environ 2022; 843:156965. [PMID: 35764155 DOI: 10.1016/j.scitotenv.2022.156965] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
Bladder cancer (BC) is one of the top 10 most common tumours worldwide; however, no molecular markers are currently available for tumour management and follow-up. BC could benefit from molecular biomarkers in environmental disease, which provide mechanistic understanding of individual susceptibility to exposure-related cancers and allow characterizing genetic alterations in the molecular pathway for malignancy. This case-control study performed a molecular analysis in 99 BC and 125 controls. Buccal swabs were collected to assess SNPs in eleven genes coding for xenobiotic detoxification enzymes, cellular antioxidant defences, and hormone synthesis and signalling (NAT2 (rs1801280), GPX1 (rs1050450 and rs17650792), TXNRD1 (rs7310505), PRDX3 (rs3740562), PON1 (rs662), SOD1 (rs10432782), SOD2 (rs4880), CAT (rs1001179), CYP17A1 (rs743572) and ESR1 (rs746432)). A structured questionnaire was administered to study participants to assess environmental and dietary chemical exposures. Several miRNAs associated with BC and detoxification/antioxidant pathways were analysed in a subsample of the study population, including miR-93-5p, miR-221-3p, miR-126, miR-27a-3p, miR-193b, and miR-193a-5p. Levels of selected environmental pollutants (polycyclic aromatic hydrocarbons and endocrine disrupting chemicals) were determined in urine from a subsample of BC cases and controls. We found that CYP17A1, CAT, SOD1, ESR1, PON1, and GPX1 (rs17650792) were associated with BC risk. Furthermore, exposure to smoke and/or dust, and alcohol intake were identified as risk factors for BC. Increased urinary levels of benzo[a]pyrene and bisphenol A were observed in BC patients relative to controls, along with an increased expression of miR-193b, miR-27a and miR-93-5p in BC. Nevertheless, further studies with a larger sample size are warranted to confirm these exploratory results. This study also shows that the combination of genetic markers (PON1 and CYP17A1) and miRNA (miR-221-3p and miR-93-5p) open a new scenario in the use of non-invasive biomarkers in the stratification of BC to guide personalized medicine, which is extremely urged in the current clinical setting.
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Affiliation(s)
- D Martin-Way
- Urology Department, University Hospital Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - I Puche-Sanz
- Urology Department, University Hospital Virgen de las Nieves, Av. de las Fuerzas Armadas 2, 18014 Granada, Spain
| | - J M Cozar
- Urology Department, University Hospital Virgen de las Nieves, Av. de las Fuerzas Armadas 2, 18014 Granada, Spain
| | - A Zafra-Gomez
- University of Granada, Department of Analytical Chemistry, Campus of Fuentenueva, 18071 Granada, Spain
| | - M D C Gomez-Regalado
- University of Granada, Department of Analytical Chemistry, Campus of Fuentenueva, 18071 Granada, Spain
| | - C M Morales-Alvarez
- GENYO, Centre for Genomics and Oncological Research: Pfizer, University of Granada, Andalusian Regional Government, PTS Granada, Granada, Spain; University of Granada, Department of Biochemistry and Molecular Biology III, Faculty of Medicine, PTS, Granada, Spain
| | - A F Hernandez
- University of Granada, Legal Medicine and Toxicology Department, Faculty of Medicine, PTS, Granada, Spain; Instituto de Investigación Biosanitaria ibs. GRANADA, 18014 Granada, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain
| | - L J Martinez-Gonzalez
- GENYO, Centre for Genomics and Oncological Research: Pfizer, University of Granada, Andalusian Regional Government, PTS Granada, Granada, Spain.
| | - M J Alvarez-Cubero
- GENYO, Centre for Genomics and Oncological Research: Pfizer, University of Granada, Andalusian Regional Government, PTS Granada, Granada, Spain; University of Granada, Department of Biochemistry and Molecular Biology III, Faculty of Medicine, PTS, Granada, Spain; Instituto de Investigación Biosanitaria ibs. GRANADA, 18014 Granada, Spain
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Tsutsui H, Lam CSP, Zhang J, Godoy-Palomino A, Tziakas D, Cohen-Solal A, Freitas C, Patel MJ, Ezekowitz JA, Hernandez AF, Pieske B, O'Connor CM, Westerhout CM, Alemayehu W, Armstrong PW. Geographic variation in heart failure with reduced ejection fraction: insights from the VICTORIA trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Geographic differences and background therapy have not been explored in the global VICTORIA trial, which enrolled high-risk patients with recent worsening heart failure with reduced ejection fraction (HFrEF).
Methods and results
Among 5050 patients enrolled in 5 pre-specified geographic regions, 34% were from Eastern Europe, 18% Western Europe, 23% Asia Pacific, 14% Latin and South America, and 11% North America (Table 1). Patients from Western Europe were older, had more atrial fibrillation, and lower glomerular filtration rates. Patients from Eastern Europe had more coronary artery disease and exhibited more advanced symptoms (∼50% New York Heart Association [NYHA] class III), whereas those from Latin and South America were less symptomatic (∼70% NYHA class II). North American patients had the largest body mass index as well as more diabetes and hypertension. Levels of NT-proBNP at randomization and MAGGIC risk scores were highest in Western European patients. Evidence-based triple medication therapy was used most frequently in Latin and South America and less frequently in North America; conversely, cardiac resynchronization therapy and implantable cardioverter defibrillators were most frequently used in North America and least frequently in Latin and South America. The overall primary composite event rate (cardiovascular death or HF hospitalization) in the placebo arm was 36.6/100 person-years over a median of 10.8 months and after adjusting for the MAGGIC score. When examined by region, these event rates were nominally highest in North America and lowest in Western Europe.
Conclusion
Substantial regional differences exist in characteristics and treatments among patients in this global trial of patients with HFrEF and a recent worsening event. These findings demonstrate the continuing unmet needs and opportunities for enhancing care in HFrEF.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): VICTORIA was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA and Bayer AG, Wuppertal, Germany.
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Affiliation(s)
- H Tsutsui
- Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - C S P Lam
- National Heart Centre Singapore, Duke-NUS , Singapore , Singapore
| | - J Zhang
- Fuwai Hospital Chinese Academy of Medical Sciences , Beijing , China
| | | | - D Tziakas
- Democritus University of Thrace , Alexandroupolis , Greece
| | | | | | - M J Patel
- Merck & Co., Inc. , Kenilworth , United States of America
| | - J A Ezekowitz
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - A F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine , Durham , United States of America
| | - B Pieske
- Charité - University Medicine Berlin , Berlin , Germany
| | - C M O'Connor
- Inova Heart and Vascular Institute , Falls Church , United States of America
| | - C M Westerhout
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - W Alemayehu
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - P W Armstrong
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
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Martinez-Gonzalez LJ, Antúnez-Rodríguez A, Vazquez-Alonso F, Hernandez AF, Alvarez-Cubero MJ. Genetic variants in xenobiotic detoxification enzymes, antioxidant defenses and hormonal pathways as biomarkers of susceptibility to prostate cancer. Sci Total Environ 2020; 730:138314. [PMID: 32388358 DOI: 10.1016/j.scitotenv.2020.138314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/19/2020] [Accepted: 03/28/2020] [Indexed: 05/05/2023]
Abstract
Cancer is considered a complex disease that in many cases results from the interaction between chemical exposures, either from environmental or dietary sources, and genetic polymorphisms of xenobiotic-metabolizing enzymes (XME) or antioxidant enzymatic defenses. This study explored associations and interactions between genetic and environmental risk factors on the risk of prostate cancer (PCa) in 323 subjects that underwent prostate biopsy due to prostate specific antigen (PSA) levels above 4 ng/ml (161 PCa and 162 non-PCa). Eleven genes involved directly or indirectly in xenobiotic detoxification, oxidative stress and estrogen signaling were studied (GSTM1, GPX1 (rs1050450 and rs17650792), NAT2 (rs1801280), TXNRD1 (rs7310505), PRDX3 (rs3740562), CYP17A1 (rs743572), PON1 (rs662), SOD1 (rs10432782), SOD2 (rs4880), CAT (rs1001179), and ESR1 (rs746432)). A structured questionnaire was administered to all individuals to assess environmental and dietary chemical exposures. Medical data was collected by urologists. GPX1 rs17650792 polymorphism was the only one showing a significant inverse association with PCa risk. PRDX3 and GPX1 (rs17650792) genetic polymorphisms were significantly associated with Gleason score and PSA levels, respectively. The intake of nuts and soya products was associated with a reduced risk of PCa, as well as the performance of physical activity. Moreover, a number of gene-environmental interactions were found to increase the risk of PCa, particularly exposure to pesticides and rs1801280 (NAT2) and tobacco smoking and rs1050450 (GPX1). These findings suggest that the association of genetic and environmental risk factors with PCa risk should be assessed jointly for a better understanding of this complex disease.
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Affiliation(s)
- L J Martinez-Gonzalez
- GENYO, Centre for Genomics and Oncological Research: Pfizer, University of Granada, Andalusian Regional Government, PTS Granada, Granada, Spain.
| | - A Antúnez-Rodríguez
- GENYO, Centre for Genomics and Oncological Research: Pfizer, University of Granada, Andalusian Regional Government, PTS Granada, Granada, Spain
| | - F Vazquez-Alonso
- Urology Department, University Hospital Virgen de las Nieves, Av. de las Fuerzas Armadas 2, 18014 Granada, Spain
| | - A F Hernandez
- University of Granada, Legal Medicine and Toxicology Department, Faculty of Medicine, PTS, Granada, Spain
| | - M J Alvarez-Cubero
- GENYO, Centre for Genomics and Oncological Research: Pfizer, University of Granada, Andalusian Regional Government, PTS Granada, Granada, Spain; University of Granada, Department of Biochemistry and Molecular Biology III, Faculty of Medicine, PTS, Granada, Spain
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Mentz RJ, Thompson VP, Gustavson SM, Iqbal N, Ohman P, Holman RR, Hernandez AF. 5257Effects of once-weekly exenatide on clinical outcomes in the subgroup of patients with pre-existing cardiovascular disease: insights from EXSCEL. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R J Mentz
- Duke University Medical Center, Durham, United States of America
| | - V P Thompson
- Duke University Medical Center, Durham, United States of America
| | - S M Gustavson
- AstraZeneca Research and Development, Gaithersburg, United States of America
| | - N Iqbal
- AstraZeneca Research and Development, Gaithersburg, United States of America
| | - P Ohman
- AstraZeneca Research and Development, Gaithersburg, United States of America
| | - R R Holman
- Oxford Centre for Diabetes, Oxford, United Kingdom
| | - A F Hernandez
- Duke University Medical Center, Durham, United States of America
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Kalayci A, Gibson CM, Chi G, Yee M, Korjian S, Datta S, Nafee T, Gurin M, Haroian N, Hull RD, Hernandez AF, Cohen AT, Harrington RA, Goldhaber SZ. P251Asymptomatic deep vein thrombosis in acutely ill medical patients: insights from the APEX trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Kalayci
- Harvard Medical School, Cardiology, Boston, United States of America
| | - C M Gibson
- Harvard Medical School, Cardiology, Boston, United States of America
| | - G Chi
- Harvard Medical School, Cardiology, Boston, United States of America
| | - M Yee
- Harvard Medical School, Cardiology, Boston, United States of America
| | - S Korjian
- Harvard Medical School, Cardiology, Boston, United States of America
| | - S Datta
- Harvard Medical School, Cardiology, Boston, United States of America
| | - T Nafee
- Harvard Medical School, Cardiology, Boston, United States of America
| | - M Gurin
- Harvard Medical School, Cardiology, Boston, United States of America
| | - N Haroian
- Harvard Medical School, Cardiology, Boston, United States of America
| | - R D Hull
- University of Calgary, Cardiology, Calgary, Canada
| | - A F Hernandez
- Duke University Medical Center, Cardiology, Durham, United States of America
| | - A T Cohen
- St Thomas' Hospital, Haematology, London, United Kingdom
| | - R A Harrington
- Stanford University Medical Center, Cardiology, Stanford, United States of America
| | - S Z Goldhaber
- Brigham and Women's Hospital, Cardiology, Boston, United States of America
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Fudim M, Kelly JG, Jones A, Coles A, McNulty SJ, Redfield M, Lewis G, Hernandez AF, Felker GM. P884Can biomarkers be used to predict cardiopulmonary exercise test performance in patients with chronic heart failure? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Fudim
- Duke Clinical Research Institute, Cardiology, Durham, United States of America
| | - J G Kelly
- Duke Clinical Research Institute, Cardiology, Durham, United States of America
| | - A Jones
- Duke Clinical Research Institute, Cardiology, Durham, United States of America
| | - A Coles
- Duke Clinical Research Institute, Cardiology, Durham, United States of America
| | - S J McNulty
- Duke Clinical Research Institute, Cardiology, Durham, United States of America
| | - M Redfield
- Mayo Clinic, Rochester, United States of America
| | - G Lewis
- Massachusetts General Hospital, Boston, United States of America
| | - A F Hernandez
- Duke Clinical Research Institute, Cardiology, Durham, United States of America
| | - G M Felker
- Duke Clinical Research Institute, Cardiology, Durham, United States of America
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Nafee T, Gibson CM, Yee MK, Travis R, Kerneis M, Chi G, Alkhalfan F, Daaboul Y, Korjian S, Bandman O, Hernandez AF, Hull RD, Cohen AT, Harrington RA, Goldhaber SZ. P6072Characterization of major and clinically relevant non-major bleeding in the APEX trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Nafee
- Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
| | - C M Gibson
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M K Yee
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - R Travis
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M Kerneis
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - G Chi
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - F Alkhalfan
- Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
| | - Y Daaboul
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - S Korjian
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - O Bandman
- Portola Pharmaceuticals Inc., South San Francisco, United States of America
| | - A F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - R D Hull
- University of Calgary, Calgary, Canada
| | - A T Cohen
- Guy's Hospital, London, United Kingdom
| | - R A Harrington
- Stanford University Medical Center, Department of Medicine, Stanford, United States of America
| | - S Z Goldhaber
- Brigham and Women's Hospital, Boston, United States of America
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8
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Chi G, Gibson CM, Hernandez AF, Hull RD, Kalayci A, Kerneis M, Alkhalfan F, Nafee T, Cohen AT, Harrington RA, Goldhaber SZ. P1623Association of low hemoglobin with venous thromboembolism in acutely ill hospitalized medical patients: findings from the APEX trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- G Chi
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - C M Gibson
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - A F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - R D Hull
- University of Calgary, Calgary, Canada
| | - A Kalayci
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - M Kerneis
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - F Alkhalfan
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - T Nafee
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - A T Cohen
- Guy's Hospital, London, United Kingdom
| | - R A Harrington
- Stanford University Medical Center, Stanford, United States of America
| | - S Z Goldhaber
- Brigham and Women's Hospital, Boston, United States of America
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Yee MK, Gibson CM, Nafee T, Kerneis M, Travis R, Alkhalfan F, Chi G, Datta S, Jafarizade M, Ghaffarpasand E, Hull RD, Hernandez AF, Cohen AT, Harrington RA, Goldhaber SZ. 109Betrixaban compared to enoxaparin among obese acute medically ill subjects: an APEX trial subgroup analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M K Yee
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - C M Gibson
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - T Nafee
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M Kerneis
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - R Travis
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - F Alkhalfan
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - G Chi
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - S Datta
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M Jafarizade
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - E Ghaffarpasand
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - R D Hull
- University of Calgary, Calgary, Canada
| | - A F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - A T Cohen
- Guy's Hospital, London, United Kingdom
| | - R A Harrington
- Stanford University, Department of Medicine, Palo Alto, United States of America
| | - S Z Goldhaber
- Brigham and Women's Hospital, Boston, United States of America
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Nafee T, Gibson CM, Travis R, Kerneis M, Yee MK, Alkhalfan F, Chi G, Kalayci A, Mir M, Alihashemi M, Hull RD, Hernandez AF, Cohen AT, Harrington RA, Goldhaber SZ. 2160Performance of a machine learning model vs. IMPROVE score for VTE prediction in acute medically ill patients: insights from the APEX trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Nafee
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - C M Gibson
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - R Travis
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M Kerneis
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M K Yee
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - F Alkhalfan
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - G Chi
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - A Kalayci
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M Mir
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M Alihashemi
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - R D Hull
- University of Calgary, Calgary, Canada
| | - A F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - A T Cohen
- Guy's Hospital, London, United Kingdom
| | - R A Harrington
- Stanford University, Department of Medicine, Stanford, United States of America
| | - S Z Goldhaber
- Brigham and Women's Hospital, Boston, United States of America
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Chi G, Gibson CM, Hernandez AF, Hull RD, Cohen AT, Harrington RA, Alkhalfan F, Kalayci A, Kerneis M, Nafee T, Goldhaber SZ. 4321Betrixaban versus enoxaparin for venous thromboembolism prophylaxis in critically ill patients: findings from the APEX trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Chi
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - C M Gibson
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - A F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - R D Hull
- University of Calgary, Calgary, Canada
| | - A T Cohen
- Guy's Hospital, London, United Kingdom
| | - R A Harrington
- Stanford University Medical Center, Stanford, United States of America
| | - F Alkhalfan
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - A Kalayci
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - M Kerneis
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - T Nafee
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - S Z Goldhaber
- Brigham and Women's Hospital, Boston, United States of America
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12
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Chi G, Goldhaber SZ, Kittelson JM, Turpie AGG, Hernandez AF, Hull RD, Gold A, Curnutte JT, Cohen AT, Harrington RA, Gibson CM. Effect of extended-duration thromboprophylaxis on venous thromboembolism and major bleeding among acutely ill hospitalized medical patients: a bivariate analysis. J Thromb Haemost 2017; 15:1913-1922. [PMID: 28762617 DOI: 10.1111/jth.13783] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Indexed: 11/30/2022]
Abstract
Essentials Anticoagulants prevent venous thromboembolism but may be associated with greater bleeding risks. Bivariate analysis assumes a non-linear relationship between efficacy and safety outcomes. Extended full-dose betrixaban is favorable over standard enoxaparin in bivariate endpoint. Clinicians must weigh efficacy and safety outcomes in decision-making on thromboprophylaxis. SUMMARY Background Among acutely ill hospitalized medical patients, extended-duration thromboprophylaxis reduces the risk of venous thromboembolism (VTE), but some pharmacologic strategies have been associated with greater risks of major bleeding, thereby offsetting the net clinical benefit (NCB). Methods To assess the risk-benefit profile of anticoagulation regimens, a previously described bivariate method that does not assume a linear risk-benefit tradeoff and can accommodate different margins for efficacy and safety was performed to simultaneously assess efficacy (symptomatic VTE) and safety (major bleeding) on the basis of data from four randomized controlled trials of extended-duration (30-46 days) versus standard-duration (6-14 days) thromboprophylaxis among 28 227 patients (EXCLAIM, ADOPT, MAGELLAN and APEX trials). Results Extended thromboprophylaxis with full-dose betrixaban (80 mg once daily) was superior in efficacy and non-inferior in safety to standard-duration enoxaparin, and showed a significantly favorable NCB, with a risk difference of - 0.51% (- 0.89% to - 0.10%) in the bivariate outcome. Extended enoxaparin was superior in efficacy and inferior in safety (bivariate outcome: 0.03% [- 0.37% to 0.43%]), whereas apixaban and rivaroxaban were non-inferior in efficacy and inferior in safety (- 0.20% [- 0.49% to 0.17%] and 0.23% [- 0.16% to 0.69%], respectively). Reduced-dose betrixaban did not show a significant difference in either efficacy or safety (0.41% [- 0.85% to 1.94%]). Conclusions In a bivariate analysis that assumes non-linear risk-benefit tradeoffs, extended prophylaxis with full-dose betrixaban was superior to standard-duration enoxaparin, whereas other regimens failed to simultaneously achieve both superiority and non-inferiority with respect to symptomatic VTE and major bleeding in the management of acutely ill hospitalized medical patients.
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Affiliation(s)
- G Chi
- Cardiovascular Division, Departments of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S Z Goldhaber
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J M Kittelson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A G G Turpie
- Department of Medicine, Hamilton Health Sciences, General Division, Hamilton, Ontario, Canada
| | - A F Hernandez
- Duke University and Duke Clinical Research Institute, Durham, NC, USA
| | - R D Hull
- Division of Cardiology, R. A. H. Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Gold
- Portola Pharmaceuticals Inc., South San Francisco, CA, USA
| | - J T Curnutte
- Portola Pharmaceuticals Inc., South San Francisco, CA, USA
| | - A T Cohen
- Department of Haematological Medicine, Guy's and St Thomas' Hospitals, King's College, London, UK
| | - R A Harrington
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - C M Gibson
- Cardiovascular Division, Departments of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Tsatsakis AM, Kouretas D, Tzatzarakis MN, Stivaktakis P, Tsarouhas K, Golokhvast KS, Rakitskii VN, Tutelyan VA, Hernandez AF, Rezaee R, Chung G, Fenga C, Engin AB, Neagu M, Arsene AL, Docea AO, Gofita E, Calina D, Taitzoglou I, Liesivuori J, Hayes AW, Gutnikov S, Tsitsimpikou C. Simulating real-life exposures to uncover possible risks to human health: A proposed consensus for a novel methodological approach. Hum Exp Toxicol 2016; 36:554-564. [PMID: 28539089 DOI: 10.1177/0960327116681652] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In real life, consumers are exposed to complex mixtures of chemicals via food, water and commercial products consumption. Since risk assessment usually focuses on individual compounds, the current regulatory approach doesn't assess the overall risk of chemicals present in a mixture. This study will evaluate the cumulative toxicity of mixtures of different classes of pesticides and mixtures of different classes of pesticides together with food additives (FAs) and common consumer product chemicals using realistic doses after long-term exposure. Groups of Sprague Dawley (CD-SD) rats (20 males and 20 females) will be treated with mixtures of pesticides or mixtures of pesticides together with FAs and common consumer product chemicals in 0.0, 0.25 × acceptable daily intake (ADI)/tolerable daily intake (TDI), ADI/TDI and 5 × ADI/TDI doses for 104 weeks. All animals will be examined every day for signs of morbidity and mortality. Clinical chemistry hematological parameters, serum hormone levels, biomarkers of oxidative stress, cardiotoxicity, genotoxicity, urinalysis and echocardiographic tests will be assessed periodically at 6 month intervals. At 3-month intervals, ophthalmological examination, test for sensory reactivity to different types of stimuli, together with assessment of learning abilities and memory performance of the adult and ageing animals will be conducted. After 24 months, animals will be necropsied, and internal organs will be histopathologically examined. If the hypothesis of an increased risk or a new hazard not currently identified from cumulative exposure to multiple chemicals was observed, this will provide further information to public authorities and research communities supporting the need of replacing current single-compound risk assessment by a more robust cumulative risk assessment paradigm.
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Affiliation(s)
- A M Tsatsakis
- 1 Center of Toxicology Science and Research, Medical School, University of Crete, Heraklion, Crete, Greece.,2 Scientific Educational Center of Nanotechnology, Far Eastern Federal University, Vladivostok, Russian Federation.,3 Federal Scientific Center of Hygiene, F.F. Erisman, Moscow, Russian Federation
| | - D Kouretas
- 4 Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
| | - M N Tzatzarakis
- 1 Center of Toxicology Science and Research, Medical School, University of Crete, Heraklion, Crete, Greece
| | - P Stivaktakis
- 1 Center of Toxicology Science and Research, Medical School, University of Crete, Heraklion, Crete, Greece
| | - K Tsarouhas
- 5 Department of Cardiology, University Hospital of Larissa, Thessaly Prefecture, Larissa, Greece
| | - K S Golokhvast
- 2 Scientific Educational Center of Nanotechnology, Far Eastern Federal University, Vladivostok, Russian Federation
| | - V N Rakitskii
- 3 Federal Scientific Center of Hygiene, F.F. Erisman, Moscow, Russian Federation
| | - V A Tutelyan
- 6 Federal Research Center of Nutrition, Biotechnology and Food Safety, Moscow, Russian Federation
| | - A F Hernandez
- 7 Department of Legal Medicine and Toxicology, University of Granada School of Medicine, Granada, Spain
| | - R Rezaee
- 8 Department of Physiology and Pharmacology, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - G Chung
- 9 Department of Biotechnology, Chonnam National University, Yeosu, Chonnam, Korea
| | - C Fenga
- 10 Department of Occupational Medicine, University of Messina, Messina, Italy
| | - A B Engin
- 11 Department of Toxicology, Faculty of Pharmacy, Gazi University, Ankara, Turkey
| | - M Neagu
- 12 Department of Immunology , Victor Babes National Institute of Pathology, Bucharest, Romania
| | - A L Arsene
- 13 Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - A O Docea
- 14 Department of Toxicology, Faculty of Pharmacy, University of Medicine and Pharmacy, Craiova, Romania
| | - E Gofita
- 14 Department of Toxicology, Faculty of Pharmacy, University of Medicine and Pharmacy, Craiova, Romania
| | - D Calina
- 15 Department of Clinical Pharmacology, Faculty of Pharmacy, University of Medicine and Pharmacy, Craiova, Romania
| | - I Taitzoglou
- 16 Department of Physiology, Faculty of Veterinary Medicine, School of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - J Liesivuori
- 17 Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
| | - A W Hayes
- 18 Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, USA.,19 Environmental Health, Harvard University, Cambridge, MA USA
| | - S Gutnikov
- 20 School of Natural Sciences, Far Eastern Federal University, Vladivostok, Russian Federation
| | - C Tsitsimpikou
- 21 Department of Hazardous Substances, Mixtures and Articles, Directorate of Energy, Industrial and Chemical Products, General Chemical State Laboratory of Greece, Athens, Greece
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14
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O'Brien EC, Xian Y, Fonarow GC, Olson DM, Schwamm LH, Hernandez AF. Clinical Commentary on "Certain Uncertainty: Life After Stroke From the Patient's Perspective". Circ Cardiovasc Qual Outcomes 2014; 7:970. [DOI: 10.1161/circoutcomes.114.001484] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lin CB, Peterson ED, Smith EE, Saver JL, Liang L, Xian Y, Olson DM, Shah BR, Hernandez AF, Schwamm LH, Fonarow GC. Patterns, Predictors, Variations, and Temporal Trends in Emergency Medical Service Hospital Prenotification for Acute Ischemic Stroke. J Am Heart Assoc 2012. [DOI: 10.1161/jaha.112.002345x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Patel CB, MacKinnon ML, Smith AD, Felker GM, Vikraman-Sushama D, Sudan DL, Rosenberg PB, Hernandez AF, Milano CA, Rogers JG. Successful organ donation after long-term circulatory support with nonpulsatile mechanical support. Am J Transplant 2012; 12:1962-3. [PMID: 22594645 DOI: 10.1111/j.1600-6143.2012.04105.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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18
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Fonarow GC, Saver JL, Smith EE, Broderick JP, Kleindorfer DO, Sacco RL, Pan W, Olson DM, Hernandez AF, Peterson ED, Schwamm LH. Relationship of National Institutes of Health Stroke Scale to 30-Day Mortality in Medicare Beneficiaries With Acute Ischemic Stroke. J Am Heart Assoc 2012. [DOI: 10.1161/xjaha.111.000034] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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O'Connor CM, Starling RC, Hernandez AF, Armstrong PW, Dickstein K, Hasselblad V, Heizer GM, Komajda M, Massie BM, McMurray JJV, Nieminen MS, Reist CJ, Rouleau JL, Swedberg K, Adams KF, Anker SD, Atar D, Battler A, Botero R, Bohidar NR, Butler J, Clausell N, Corbalán R, Costanzo MR, Dahlstrom U, Deckelbaum LI, Diaz R, Dunlap ME, Ezekowitz JA, Feldman D, Felker GM, Fonarow GC, Gennevois D, Gottlieb SS, Hill JA, Hollander JE, Howlett JG, Hudson MP, Kociol RD, Krum H, Laucevicius A, Levy WC, Méndez GF, Metra M, Mittal S, Oh BH, Pereira NL, Ponikowski P, Tang WHW, Tanomsup S, Teerlink JR, Triposkiadis F, Troughton RW, Voors AA, Whellan DJ, Zannad F, Califf RM. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med 2011; 365:32-43. [PMID: 21732835 DOI: 10.1056/nejmoa1100171] [Citation(s) in RCA: 970] [Impact Index Per Article: 74.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nesiritide is approved in the United States for early relief of dyspnea in patients with acute heart failure. Previous meta-analyses have raised questions regarding renal toxicity and the mortality associated with this agent. METHODS We randomly assigned 7141 patients who were hospitalized with acute heart failure to receive either nesiritide or placebo for 24 to 168 hours in addition to standard care. Coprimary end points were the change in dyspnea at 6 and 24 hours, as measured on a 7-point Likert scale, and the composite end point of rehospitalization for heart failure or death within 30 days. RESULTS Patients randomly assigned to nesiritide, as compared with those assigned to placebo, more frequently reported markedly or moderately improved dyspnea at 6 hours (44.5% vs. 42.1%, P=0.03) and 24 hours (68.2% vs. 66.1%, P=0.007), but the prespecified level for significance (P≤0.005 for both assessments or P≤0.0025 for either) was not met. The rate of rehospitalization for heart failure or death from any cause within 30 days was 9.4% in the nesiritide group versus 10.1% in the placebo group (absolute difference, -0.7 percentage points; 95% confidence interval [CI], -2.1 to 0.7; P=0.31). There were no significant differences in rates of death from any cause at 30 days (3.6% with nesiritide vs. 4.0% with placebo; absolute difference, -0.4 percentage points; 95% CI, -1.3 to 0.5) or rates of worsening renal function, defined by more than a 25% decrease in the estimated glomerular filtration rate (31.4% vs. 29.5%; odds ratio, 1.09; 95% CI, 0.98 to 1.21; P=0.11). CONCLUSIONS Nesiritide was not associated with an increase or a decrease in the rate of death and rehospitalization and had a small, nonsignificant effect on dyspnea when used in combination with other therapies. It was not associated with a worsening of renal function, but it was associated with an increase in rates of hypotension. On the basis of these results, nesiritide cannot be recommended for routine use in the broad population of patients with acute heart failure. (Funded by Scios; ClinicalTrials.gov number, NCT00475852.).
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Affiliation(s)
- C M O'Connor
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27710, USA.
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20
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Abstract
The subcellular localization and different biochemical properties of a human hepatic microsomal enzyme that hydrolyses paraoxon (paraoxonase, PON1) were studied and compared to the paraoxon hydrolase activity found in human plasma as well as in rat liver and plasma. Having evaluated the influence of the postmortem interval by a parallel experiment performed in rats, we conclude that the paraoxonase activity was preferentially localized in the microsomal fraction. The enzyme reaction was optimized according to temperature, pH, buffer, ionic strength, substrate concentration, and enzyme protein concentration. The characterization of human liver paraoxonase included the study of optimum pH, pH stability, heat inactivation assays, and kinetic parameters (K(m) and Vmax). In addition, the enzyme activity showed an absolute requirement for exogenous calcium. The activity was lost after incubation with EDTA and partially restored by the addition of calcium; however, other metals assayed were not able to activate the human liver enzyme as did calcium. Our results support the possible identity between human plasma and liver paraoxonases. In spite of the technical difficulties of this study and the possible interference of the postmortem changes in the results, this article represents the first systematic approach to the characterization of human liver paraoxonase.
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Affiliation(s)
- M C Gonzalvo
- Department of Legal Medicine and Toxicology Service, Faculty of Medicine, University Hospital, University of Granada, Spain
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21
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Hernandez AF, Schiaffino S, Ballesteros JL, Gil F, Pla A, Villanueva E. Lack of clinical symptoms in an acute arsenic poisoning: an unusual case. Vet Hum Toxicol 1998; 40:344-5. [PMID: 9830695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A 32-y-old woman was admitted to Granada University Hospital for attempted suicide by ingestion of an ant-killer containing 10% sodium arsenate and 5% pyrethrins. Neither gastrointestinal distress nor hepatic, renal, or neurologic disturbances were clinically observed. However, the presence of toxic levels of arsenic (14 mg/L) was confirmed by atomic absorption spectrophotometry in a sample of urine taken about 12 h after poisoning. An uneventful clinical course was observed, and the patient was discharged after 6 days upon her request. Long-term follow-up was unavailable. From a Medline search over the years 1985-1998 only one similar report also dealing with sodium arsenate was found. Different pathogenic hypotheses are discussed in the light of the clinical data.
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Affiliation(s)
- A F Hernandez
- Department of Legal Medicine and Toxicology Service, University Hospital, University of Granada School of Medicine, Spain
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22
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Hernandez AF, Pomares J, Schiaffino S, Pla A, Villanueva E. Acute chemical pancreatitis associated with nonfatal strychnine poisoning. J Toxicol Clin Toxicol 1998; 36:67-71. [PMID: 9541047 DOI: 10.3109/15563659809162589] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CASE REPORT An 18-year-old female who accidentally ingested strychnine developed chemical pancreatitis in addition to the classical clinical picture of strychnine poisoning. Many drugs or chemicals have been reported to be associated with pancreatitis; however, this paper provides us with the first evidence that acute pancreatitis may follow strychnine poisoning. The patient survived despite the development of seizures, lactic acidosis, rhabdomyolysis, and pulmonary infiltrates. Toxicology testing confirmed the presence of strychnine in blood (2.17 mg/L), gastric aspirate, and urine. Attention is drawn to the fact that survival can follow the ingestion of large doses of strychnine providing there is no delay in diagnosis and treatment. The pathophysiologic mechanism of chemical pancreatitis is discussed.
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Affiliation(s)
- A F Hernandez
- University Hospital, University of Granada School of Medicine, Spain.
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23
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Abstract
Paraoxonase (paraoxon hydrolase), an enzyme that hydrolyses paraoxon (O,O-diethyl O-p-nitrophenyl phosphate), is located in mammals primarily in the serum and liver. Although considerable information is available regarding serum paraoxonase, little is known about the hepatic form of this enzyme. The present work represents the first study on the purification of rat liver paraoxonase. This enzyme has been purified 415-fold to apparent homogeneity with a final specific activity of 1370 units/mg using a protocol consisting of five steps: solubilization of the microsomal fraction, hydroxyapatite adsorption, chromatography on DEAE-Sepharose CL-6B, non-specific affinity chromatography on Cibacron Blue 3GA and anion exchange on Mono Q HR 5/5. The presence of Ca2+ and Triton X-100 in the buffers throughout the purification procedure was essential for maintaining enzyme activity. SDS/PAGE of the final preparation indicated a single protein-staining band with an apparent Mr of 45 000. N-terminal and internal amino acid sequences were determined and compared with those of paraoxonases from human and rabbit serum and mouse liver, showing a high similarity. The pH profile showed optimum activity at pH 8.5. The pH stability and heat inactivation of the enzyme were also studied. The Km for liver paraoxonase was 1.69 mM.
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Affiliation(s)
- L Rodrigo
- Departamento de Medicina Legal y Toxicología, Facultad de Medicina, Universidad de Granada, Spain
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24
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Hernandez AF, Montero MN, Pla A, Villanueva E. Fatal moclobemide overdose or death caused by serotonin syndrome? J Forensic Sci 1995; 40:128-30. [PMID: 7876795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 41-year-old man was found dead in a hotel room. He was previously diagnosed with depression. Multiple containers of medication and paraphenalia were found at the scene. Autopsy findings included fully developed rigor mortis and pulmonary edema with hemorrhage. Toxicologic analysis of different body fluids was performed and the following drugs were identified in the blood (mg/L): moclobemide (59.76), clomipramine (1.69), tramadol (10.89), diazepam (2.08), nordiazepam (0.82) and caffeine (9.64). A fatal serotonin syndrome was presumably developed as a result of moclobemide-clomipramine interaction as has been recently reported. Tramadol could have a synergistic effect on that syndrome. The forensic pathologists ruled that the cause of death was multiple drug intoxication resulting in serotonin syndrome and that the manner of death was suicide. However, an accidental death from drug abuse could be an alternative diagnosis.
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Affiliation(s)
- A F Hernandez
- Department of Legal Medicine and Toxicology Service, University of Granada, Spain
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25
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Gil F, Gonzalvo MC, Hernandez AF, Villanueva E, Pla A. Differences in the kinetic properties, effect of calcium and sensitivity to inhibitors of paraoxon hydrolase activity in rat plasma and microsomal fraction from rat liver. Biochem Pharmacol 1994; 48:1559-68. [PMID: 7980621 DOI: 10.1016/0006-2952(94)90200-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The properties of a rat hepatic microsomal enzyme that hydrolyses O,O-diethyl-p-nitrophenylphosphate (paraoxon) were studied and compared to the paraoxon hydrolase activity found in rat plasma. The pH stability for both enzyme activities was optimum between pH 6.0 and 9.0. An overall analysis of the data showed that the microsomal fraction was less resistant to the effect of the pH than plasma. The kinetic constants for heat inactivation evaluated for paraoxonase in rat plasma and liver microsomal fraction indicate that paraoxonase tends to inactivate faster in rat liver microsomes than in rat plasma. The apparent activation energies of the heat inactivation process were 77.7 and 61.1 kcal/mol for rat plasma and microsomal fraction, respectively. Enzyme activity was lost after both dialysis and incubation with EDTA and partially restored by the addition of calcium. In rat plasma samples the requirement for calcium was absolute (essential activator) while in the microsomal fraction the reaction may occur, to a minimum extent, in the absence of the activator (non-essential activator). Calcium restored 85% activity when added immediately after EDTA; restored activity decreased when the time interval between addition of EDTA and calcium was increased. Other metals were not able to restore activity previously inhibited by EDTA or dialysis. The response to several inhibitors (EDTA, Mn, Co, Zn, Ba, Mg, Cu, La, Hg and p-hydroxy-mercuribenzoate) of rat plasma and microsomal fraction was studied, determining the type of inhibition and the inhibition constants. Plasma enzyme was always more resistant than liver sample to the effect of the inhibitors and showed different types of inhibition than the liver microsomal fraction. In general we found more differences than analogies between the rat plasma and liver enzyme which suggests the presence of two enzymes or two different forms of the same enzyme. Furthermore the existence of an EDTA-resistant fraction in rat liver microsomes suggests that more than one enzyme capable of hydrolysing paraoxon is present in the microsomal fraction of rat liver.
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Affiliation(s)
- F Gil
- Department of Legal Medicine, Faculty of Medicine, University Hospital, University of Granada, Spain
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26
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Hernandez AF, Martin-Rubi JC, Ballesteros JL, Oliver M, Pla A, Villanueva E. Clinical and pathological findings in fatal 1,3-dichloropropene intoxication. Hum Exp Toxicol 1994; 13:303-6. [PMID: 8043309 DOI: 10.1177/096032719401300502] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
1. A 27-year-old, previously healthy, worker accidentally drank a solution containing 1,3-dichloropropene. 2. He developed gastrointestinal distress, adult respiratory distress syndrome, haematological and hepatorenal functional impairment and died after 40 h. 3. Damage to the pancreas was also thought to have been caused by the chemical as part of a multiorgan disorder.
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Affiliation(s)
- A F Hernandez
- Department of Legal Medicine, University Hospital, University of Granada, Spain
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27
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Hernandez AF, Pla A, Valenzuela A, Gil F, Hougen HP, Villanueva E. Paraoxonase activity in human pericardial fluid: its relationship to coronary artery disease. Int J Legal Med 1993; 105:321-4. [PMID: 8390852 DOI: 10.1007/bf01222115] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Pericardial fluid paraoxonase activity was compared with 3 biochemical markers of atherosclerosis (HDL, LDL/HDL ratio and Apolipoprotein A-I) and a significant association was found. When the paraoxonase activity in pericardial fluid samples was separated into 2 groups according to the degree of coronary atherosclerosis (slight and severe), most of the cases showing low levels of paraoxonase activity also showed severe coronary atherosclerosis. In addition, paraoxonase activity in pericardial fluid was found to be statistically correlated with HDL levels, which agrees with the results reported in serum.
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Affiliation(s)
- A F Hernandez
- Department of Legal Medicine, University Hospital, University of Granada, Spain
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28
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Pla A, Hernandez AF, Gil F, Garcia-Alonso M, Villanueva E. A fatal case of oral ingestion of methanol. Distribution in postmortem tissues and fluids including pericardial fluid and vitreous humor. Forensic Sci Int 1991; 49:193-6. [PMID: 1855718 DOI: 10.1016/0379-0738(91)90079-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 41-year-old man ingested orally a large quantity of methanol and was found dead at home. The presence of methanol in body fluids and tissues was determined by head-space gas chromatography. The blood ethanol and acetone were negative. Tissue distribution of methanol showed that the kidney presented the highest content of methanol (5.13 g/kg) followed by liver (4.18 g/kg), vitreous humor (3.96 g/l), heart (3.45 g/kg), urine (3.43 g/l), pericardial fluid (3.29 g/l), blood (2.84 g/l) and finally stomach content (2.21 g/l).
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Affiliation(s)
- A Pla
- Department of Legal Medicine, University of Granada, Spain
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29
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Hernandez AF, Pla A, Villanueva E. Decreased phosphofructokinase activity during the development of triorthocresyl-phosphate-induced delayed neuropathy. Toxicol Lett 1989; 49:35-40. [PMID: 2554537 DOI: 10.1016/0378-4274(89)90098-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The effect of triorthocresyl phosphate on selected glycolytic enzymes (hexokinase, phosphofructokinase, glyceraldehyde 3-phosphate dehydrogenase, lactate dehydrogenase) was investigated during the development of organophosphate-induced delayed neuropathy. Only phosphofructokinase activity was decreased 15 days after treatment. The effect was dose-dependent and was observed in sciatic nerve while the brain enzyme activity was not affected.
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Affiliation(s)
- A F Hernandez
- Department of Legal Medicine and Toxicology Service, Faculty of Medicine, University Hospital, University of Granada, Spain
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