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Grimes H, Ansari M, Ashraf T, Cueto-González AM, Calder A, Day M, Fernandez Alvarez P, Foster A, Lahiri N, Repetto GM, Scurr I, Varghese V, Low KJ. PUF60-related developmental disorder: A case series and phenotypic analysis of 10 additional patients with monoallelic PUF60 variants. Am J Med Genet A 2023; 191:2610-2622. [PMID: 37303278 DOI: 10.1002/ajmg.a.63313] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 01/07/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 06/13/2023]
Abstract
PUF60-related developmental disorder (also referred to as Verheij syndrome), resulting from haploinsufficiency of PUF60, is associated with multiple congenital anomalies affecting a wide range of body systems. These anomalies include ophthalmic coloboma, and congenital anomalies of the heart, kidney, and musculoskeletal system. Behavioral and intellectual difficulties are also observed. While less common than other features associated with PUF60-related developmental disorder, for instance hearing impairment and short stature, identification of specific anomalies such as ophthalmic coloboma can aid with diagnostic identification given the limited spectrum of genes linked with this feature. We describe 10 patients with PUF60 gene variants, bringing the total number reported in the literature, to varying levels of details, to 56 patients. Patients were recruited both via locally based exome sequencing from international sites and from the DDD study in the United Kingdom. Eight of the variants reported were novel PUF60 variants. The addition of a further patient with a reported c449-457del variant to the existing literature highlights this as a recurrent variant. One variant was inherited from an affected parent. This is the first example in the literature of an inherited variant resulting in PUF60-related developmental disorder. Two patients (20%) were reported to have a renal anomaly consistent with 22% of cases in previously reported literature. Two patients received specialist endocrine treatment. More commonly observed were clinical features such as: cardiac anomalies (40%), ocular abnormalities (70%), intellectual disability (60%), and skeletal abnormalities (80%). Facial features did not demonstrate a recognizable gestalt. Of note, but remaining of unclear causality, we describe a single pediatric patient with pineoblastoma. We recommend that stature and pubertal progress should be monitored in PUF60-related developmental disorder with a low threshold for endocrine investigations as hormone therapy may be indicated. Our study reports an inherited case with PUF60-related developmental disorder which has important genetic counseling implications for families.
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Affiliation(s)
- H Grimes
- Department of Clinical Genetics, University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - M Ansari
- South East Scotland Genetics Service, Western General Hospital, Edinburgh, UK
| | - T Ashraf
- Department of Clinical Genetics, Great Ormond Street Hospital, London, UK
| | - Anna Mª Cueto-González
- Department of Clinical and Molecular Genetics, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Medicine Genetics Group, Vall Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Autonomous University of Barcelona, Barcelona, Spain
| | - A Calder
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - M Day
- Exeter Genetics Laboratory, Royal Devon and Exeter NHS Trust, Exeter, UK
| | - P Fernandez Alvarez
- Department of Clinical and Molecular Genetics, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - A Foster
- Department of Clinical Genetics, West Midlands Regional Genetics Centre, Birmingham, UK
| | - N Lahiri
- Department of Clinical Genetics, St Georges University Hospital NHS Foundation Trust, London, UK
- Department of Clinical and Molecular Science, St Georges University of London, London, UK
| | - G M Repetto
- Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - I Scurr
- Department of Clinical Genetics, University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - V Varghese
- All Wales Medical Genomics Services, University Hospital of Wales, Cardiff, UK
| | - Karen J Low
- Department of Clinical Genetics, University Hospitals Bristol and Weston NHS Trust, Bristol, UK
- Centre for Academic Child Health, University of Bristol, Bristol, UK
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Hu X, Beauchesne P, Manner K, Gattis C, Ngo P, De Jesus R, Ankala R, Young C, Wells F, Weng L, White K, Dowdle WE, Foster A, Fry TJ, Schrepfer S. Abstract 4091: Engineered hypoimmune CAR T cells provide lasting tumor control in immunocompetent allogeneic humanized mice even with re-challenge. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-4091] [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] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Off-the-shelf CAR T cells potentially offer advantages over autologous strategies such as ease of manufacturing, quality control, off-the-shelf availability, and lack of T cell dysfunction, as well as the ability to generate a more consistent CAR T product from healthy T cells. However, the vigorous host-versus-graft immune response against histoincompatible T cells prevents expansion and persistence of allogeneic CAR T cells and mitigates the efficacy of this approach. A major challenge is that, while HLA deletion can result in adaptive immune evasion, innate reactivity is enhanced with this approach. CD47 overexpression can block both NK cell and macrophage killing (J Exp Med 2021;218(3):e20200839), and we hypothesized that T cells would lose their immunogenicity when human leukocyte antigen (HLA) class I and II genes are disrupted and CD47 is over-expressed. We describe here the engineering of human immune evasive CAR T cells building on our previously described hypoimmune technology (Nat Biotechnol 2019;37(3):252-258 and Proc Natl Acad Sci U S A 2021;118(28):e2022091118).Human T cells from healthy donors were obtained by leukapheresis. CRISPR/Cas12b technology was used to disrupt the B2M, CIITA, and TCR genes, and lentiviral transduction was used to overexpress CD47 and to express a CD19 CAR to generate hypoimmune (HIP) CD19 CAR T cells. Control T cells were unmanipulated except for overexpression of the CD19 CAR (unmodified).For 3 months persistence studies, allogeneic SGM3 humanized mice were injected with 1 × 106 Luc+ Nalm6 cells and received 7 × 106 control CD19 CAR T cells or HIP CD19 CAR T cells.In the mice treated with either unmodified CD19 CAR T cells and HIP CD19 CAR T cells, tumor control was initially rapidly achieved. However, unmodified CD19 CAR T cells were eventually rejected by the host and the loss of these cells resulted in re-growth of tumor. By contrast, in HIP CD19 CAR T injected mice, tumor control was maintained throughout the study, including following a rechallenge at day 83 with NALM6 cells without further administration of HIP CD19 CAR T cell. Flow cytometry at endpoint from bone marrow and spleen confirmed persistence of HIP CD19 CAR T cells.These findings show that HIP CD19 CAR T cells are immune evasive in allogeneic recipients and data suggest that HIP CD19 CAR T cells are able to persist and maintain efficacy without immunosuppression.
Citation Format: Xiaomeng Hu, Pascal Beauchesne, Karl Manner, Corie Gattis, Priscilla Ngo, Rowena De Jesus, Ramya Ankala, Chi Young, Frank Wells, Lindong Weng, Kathy White, William E. Dowdle, Aaron Foster, Terry J. Fry, Sonja Schrepfer. Engineered hypoimmune CAR T cells provide lasting tumor control in immunocompetent allogeneic humanized mice even with re-challenge. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4091.
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Affiliation(s)
- Xiaomeng Hu
- 1Sana Biotechnology, South San Francisco, CA
| | | | - Karl Manner
- 1Sana Biotechnology, South San Francisco, CA
| | | | | | | | | | - Chi Young
- 1Sana Biotechnology, South San Francisco, CA
| | - Frank Wells
- 1Sana Biotechnology, South San Francisco, CA
| | | | - Kathy White
- 1Sana Biotechnology, South San Francisco, CA
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Foster A, Holding E, Lumley E, Roxby S, Portman D, Holliday J, Peace A, Del Rosario I, Khan W, Brenman A, Gillett M, Goyder E. Learning from the challenges of undertaking an evaluation of a multi-partner housing support initiative delivered within a hospital setting. Public Health in Practice 2022; 4:100333. [PMID: 36345288 PMCID: PMC9636567 DOI: 10.1016/j.puhip.2022.100333] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/05/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives We present learning from a mixed-methods evaluation of a housing support initiative for hospital inpatients. Study design A mixed-methods process evaluation. Methods A social housing provider delivered a housing support service in two hospitals (mental health unit and general hospital). Healthcare providers, the social housing provider and academic researchers designed and undertook a co-produced, mixed-methods process evaluation of the intervention. The evaluation included questionnaires, semi-structured interviews, analysis of routinely collected data and economic analysis. Despite commitment from the partners, the evaluation faced challenges. We reflect on the lessons learnt within our discussion paper. Results Despite the commitment of the partners, we faced several challenges. We took an iterative approach to the design and processes of the evaluation to respond to arising challenges. Recruitment of service-users was more difficult than anticipated, requiring additional staff resources. Given the small-scale nature of the intervention, and the quality of data recorded in hospital records, the planned economic analysis was not feasible. Positive factors facilitating evaluation included involvement of staff delivering the intervention, as well as managers. Being able to offer payment to partner organisations for staff time also facilitated ongoing engagement. Conclusions Multi-partner evaluations are useful, however, researchers and partners need to be prepared to take an iterative, resource intensive approach. Both availability and quality of routine data, and the resources required to support data collection, may limit feasibility of specific methods when evaluating small-scale cross-sector initiatives. Thus, this necessitates a flexible approach to design and analysis.
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Affiliation(s)
- A. Foster
- School of Health and Related Research, University of Sheffield, Sheffield, UK,Corresponding author. University of Sheffield, Regents Court, Regent Street, Sheffield, S1 4DA, UK.
| | - E. Holding
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E. Lumley
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S. Roxby
- Wakefield District Housing, Wakefield, UK
| | - D. Portman
- Wakefield District Housing, Wakefield, UK
| | | | - A. Peace
- School of Health and Related Research, University of Sheffield (Formerly at South West Yorkshire Partnership NHS Foundation Trust), Yorkshire, UK
| | | | - W. Khan
- South West Yorkshire Partnership NHS Foundation Trust, Yorkshire, UK
| | - A. Brenman
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - M. Gillett
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E. Goyder
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Hu X, White K, Gattis C, Clarke R, Landry S, Basco R, Tham E, Luo E, Tucker A, Bandoro C, Chu E, Young C, Manner K, Nho P, Lam B, Beauchesne P, Foster A, Dowdle WE, Rebar EJ, Fry TJ, Schrepfer S. Abstract 5598: Engineered hypoimmune allogeneic CAR T cells as potential off-the-shelf CAR T cell immunotherapies. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5598] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Off-the-shelf CAR T cells may offer advantages over autologous strategies, including ease of manufacturing, improved quality control with avoidance of malignant contamination and T cell dysfunction, and the ability to generate a final product from healthy T cells. However, host-versus-graft immune response against histoincompatible T cells prevents the expansion and persistence of allogeneic CAR T cells and mitigates the efficacy of this approach. A major challenge is that, while HLA deletion can result in adaptive immune evasion, innate reactivity is enhanced. While T cells express CD47, we demonstrate here that CD47 expression above endogenous levels is important for immune evasion. We describe here the engineering of human immune evasive CAR T cells building on our previously described hypoimmune technology (Nat Biotechnol 2019;37(3):252-258 and Proc Natl Acad Sci U S A 2021;118(28):e2022091118). The goal is to achieve improved rates of durable complete remissions by improving allogeneic CD19CAR persistence, since it has been shown that autologous CAR T cells have greater durability over years than allogeneic CAR T cells. Human T cells from healthy donors were obtained by leukapheresis. To generate hypoimmune CD19CAR T cells, gene editing was used to eliminate HLA-I/II and TCR expression and lentiviral transduction was used to express CD47 and CD19CAR containing a 4-1BB costimulatory domain to generate hypoimmune CD19CAR T cells. Control CD19CAR T cells were unmanipulated, i.e., unedited, except for lentiviral transduction used to express CD19CAR. Hypoimmune CD19CAR T cells persist in allogeneic humanized mice and lack T cell activation measured using bioluminescence imaging and ELISPOT analysis, respectively. In contrast, transplantation of control CD19CAR T cells generated from the same human donor resulted in rejection (ELISPOT mean 59 and 558 spot frequencies for hypoimmune CD19CAR T cells and control CD19CAR T cells, respectively; p<0.0001 unpaired t-test). Innate immune cell assays show that CD47 overexpression protects hypoimmune CD19CAR T cells from NK cell and macrophage killing. A blocking antibody against CD47 made the hypoimmune CD19CAR T cells susceptible to macrophage and NK cell killing, confirming the importance of CD47 overexpression to evade innate immune clearance. Importantly, CD47 seemed to provide protection from all NK cell populations while other tested NK cell inhibitory molecules (such as HLA-E/G, PD-L1) seemed to prevent NK cell killing of only certain subpopulations rather than primary NK cells in total. Hypoimmune CD19CAR T cells retain their antitumor activity in the Nalm-6 B cell leukemia model in vitro and in vivo comparable to control CD19CAR T cells derived from various donors. Thus, hypoimmune edits seem to not impact CD19CAR T cell activity and have the potential to provide universal CAR T cells that are able to persist without immunosuppression.
Citation Format: Xiaomeng Hu, Kathy White, Corie Gattis, Ryan Clarke, Sam Landry, Ron Basco, Eleonore Tham, Emily Luo, Andrew Tucker, Christopher Bandoro, Elaine Chu, Chi Young, Karl Manner, Priscilla Nho, Ben Lam, Pascal Beauchesne, Aaron Foster, William E. Dowdle, Edward J. Rebar, Terry J. Fry, Sonja Schrepfer. Engineered hypoimmune allogeneic CAR T cells as potential off-the-shelf CAR T cell immunotherapies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5598.
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Affiliation(s)
| | | | | | | | - Sam Landry
- 1Sana Biotechnology Inc, San Francisco, CA
| | - Ron Basco
- 1Sana Biotechnology Inc, San Francisco, CA
| | | | - Emily Luo
- 1Sana Biotechnology Inc, San Francisco, CA
| | | | | | - Elaine Chu
- 1Sana Biotechnology Inc, San Francisco, CA
| | - Chi Young
- 1Sana Biotechnology Inc, San Francisco, CA
| | | | | | - Ben Lam
- 1Sana Biotechnology Inc, San Francisco, CA
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Fisher T, Evans E, Mallow C, Foster A, Boise M, Smith E, Leonard J, Chaney M, Beck J, Hager S, Saba N, Steuer C, Adkins D, Burtness B, Zauderer M. Phase 1/2 Study of Pepinemab in Combination with Pembrolizumab as First-Line Treatment of Advanced, Recurrent or Metastatic Head and Neck Cancer (KEYNOTE B84). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hamann M, Shimada T, Duce S, Foster A, To ATY, Limpus C. Patterns of nesting behaviour and nesting success for green turtles at Raine Island, Australia. ENDANGER SPECIES RES 2022. [DOI: 10.3354/esr01175] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To understand how turtles use the nesting habitat at Raine Island across a nesting season, and how the turtles respond to the restoration of the island’s dune systems, we identified 534 nesting events for 39 green turtles Chelonia mydas across 2 breeding seasons using data derived from satellite tags. Tracked turtles laid between 4 and 10 clutches of eggs. Patterns of nesting success varied between individuals, within and between seasons. Nesting success was higher in 2018-19 (57%) than 2017-18 (45%), and in both years, nesting success was lowest between October and early January (<50%). In 2017-18, increased rainfall in January corresponded with increased nesting success (>50%). The density of female turtles ashore was lower in 2018-19, and likely explains higher nesting success in 2018-19 because competition for nest space was lower. In 2017-18, females had more attempts per clutch, and the attempts were around 90 min longer. Consequently, energy required to lay a clutch of eggs in 2017-18 was significantly higher than in 2018-19, highlighting potential costs of lower nesting success rates on reproductive output. The area of beach re-profiled as an intervention in 2014 and 2017 was a nesting hotspot in 2017-18. However, in 2018-19, the area was not used to the same extent, and the nesting hotspot occurred on the north-eastern unaltered beach. Collectively, the tracking of turtles across the whole nesting season enabled us to assess overall beach use and nesting site fidelity of green turtles at Raine Island. Results will aid future planning and management of beach restoration activities at turtle nesting sites.
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Affiliation(s)
- M Hamann
- College of Science and Engineering, James Cook University, Townsville, Qld 4811, Australia
| | - T Shimada
- College of Science and Engineering, James Cook University, Townsville, Qld 4811, Australia
- Queensland Department of Environment and Science, Brisbane, Qld 4102, Australia
| | - S Duce
- College of Science and Engineering, James Cook University, Townsville, Qld 4811, Australia
| | - A Foster
- College of Science and Engineering, James Cook University, Townsville, Qld 4811, Australia
| | - ATY To
- College of Science and Engineering, James Cook University, Townsville, Qld 4811, Australia
| | - C Limpus
- Queensland Department of Environment and Science, Brisbane, Qld 4102, Australia
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Foster A, Kinzel M. SARS-CoV-2 transmission in classroom settings: Effects of mitigation, age, and Delta variant. Phys Fluids (1994) 2021; 33:113311. [PMID: 34803364 PMCID: PMC8597576 DOI: 10.1063/5.0067798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/22/2021] [Indexed: 06/13/2023]
Abstract
Traditional, in-person classroom settings have been limited during the COVID-19 pandemic due to their potential to transmit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among students, teachers, and other educational workers. Using computational fluid dynamics simulations, mitigation strategies that span approaches using face coverings, various ventilation schemes, air purifiers/cleaners, and desk shields are systematically evaluated in thermally controlled classrooms. Individually, face coverings and source control were the most effective, which was followed by well-designed ventilation systems. The use of desk shields was also studied and appeared to be ineffective. The best mitigation approach is shown to be through multiple measures-using face coverings and ventilation systems combined with air purifiers. The studies were extended to elementary schools and consider Delta variants of SARS-CoV-2. In elementary settings, the reduced pulmonary and viral emission rates of small children are observed to drive reduced transmission rates, to values even lower than those observed with several mitigation methods for classrooms with adults. The Delta variant, with adults, was evaluated by considering an increase in quanta and indicated higher transmission probabilities. These increases are levels that are controllable by increasing the mitigation methods. Results indicate several plans of action for schools to return to in-person schooling in the context of age and new variants.
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Affiliation(s)
- Aaron Foster
- University of Central Florida, Mechanical and Aerospace Engineering, Orlando, Florida 32766, USA
| | - Michael Kinzel
- University of Central Florida, Mechanical and Aerospace Engineering, Orlando, Florida 32766, USA
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Essa H, Oguguo E, Douglas H, Foster A, Walker L, Hadcroft J, Bellieu J, Kahn M, Rao A, Cuthbertson D, Akpan A, Wong C, Sankaranarayanan R. One year outcomes of heart failure multispecialty multidisciplinary team virtual meetings. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/13/2022] Open
Abstract
Abstract
Heart Failure is frequently associated with several comorbidities such as ischaemic heard disease, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease and frailty. This level of complexity is best dealt with by a multispecialty multidisciplinary team (MDT) model.
This was a single centre observational study (January 2020-December 2020) that was undertaken in a British university hospital looking at effect of HF multispecialty virtual MDT meetings on HF outcomes. Patients acted as their own controls outcomes compared for equal period pre versus post MDT meeting. The multi-specialty meeting was conducted once monthly via video-conferencing. It consisted of heart failure cardiologists (from primary secondary and tertiary care), heart failure specialist nurses (hospital and community), nephrologist, endocrinologist, palliative care specialists, chest physician, pharmacist, pharmacologist and geriatrician. Recommendations were made as consensus from the multispecialty meeting. The main outcome measures were 1) number of hospitalisations and 2) outpatient clinic attendances 3) cost savings.
A total of 189 patients were discussed from January-December 2020. This was uninterrupted during the COVID-19 pandemic. The mean age was 70.3±18.1 years and median follow-up 6 months (range 1–13 months). The mean Charlson Co-morbidity score was 5.3±1.2 and Rockwood Frailty Score was 4.9±1. The mean number of outpatient clinic attendances avoided was 1.7±0.4. This reduced inconvenience to patients, saved patients money (transport and parking costs) and led to carbon footprint reduction. The MDT meeting total costs were £15,400 and the 31 clinic appointments they generated cost an estimated £3720. However, the MDT meetings prevented 277 clinic appointments (cost saving £33,352). Finally, the mean number of hospitalisations pre-MDT was 0.7 Vs 0.2 post MDT (p<0.01) with a saving of around 730 bed days (estimated cost-saving £260,000).
The HF multispecialty virtual MDT approach provides seamless integration of primary care community services with secondary and tertiary care. Consensus decision from MDT meetings provides holistic approach for HF patients with comorbidities and frailty, and reduces inconvenience to patients by preventing the need to attend multiple specialty clinics. This approach can also lead to significant cost-savings to the healthcare system.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Essa
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - E Oguguo
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - H Douglas
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - A Foster
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - L Walker
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - J Hadcroft
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - J Bellieu
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - M Kahn
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - A Rao
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - D Cuthbertson
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - A Akpan
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - C Wong
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
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Hartig M, Stephens C, Foster A, Fontes D, Kinzel M, García-Godoy F. Stopping the COVID-19 pandemic in dental offices: A review of SARS-CoV-2 transmission and cross-infection prevention. Exp Biol Med (Maywood) 2021; 246:2381-2390. [PMID: 34342550 DOI: 10.1177/15353702211034164] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Due to the essential role of dentists in stopping the COVID-19 pandemic, the purpose of this review is to help dentists to detect any weaknesses in their disinfection and cross-contamination prevention protocols, and to triage dental treatments to meet the needs of patients during the pandemic. We used PRISMA to identify peer-reviewed publications which supplemented guidance from the center for disease control about infection control and guidelines for dentists. Dentists must triage dental treatments to meet the needs of patients during the pandemic. The ongoing pandemic has changed the practice of dentistry forever, the changes make it more cumbersome, time-consuming, and costly due to the possible pathways of transmission and mitigation steps needed to prevent the spread of COVID-19. Dental chairside rapid tests for SARS-CoV-2 are urgently needed. Until then, dentists need to screen patients for COVID-19 even though 75% of people with COVID-19 have no symptoms. Despite the widespread anxiety and fear of the devastating health effects of COVID-19, only 61% of dentists have implemented a change to their treatment protocols. As an urgent matter of public health, all dentists must identify the additional steps they can take to prevent the spread of COVID-19. The most effective steps to stop the pandemic in dental offices are to; vaccinate all dentists, staff, and patients; triage dental treatments for patients, separate vulnerable patients, separate COVID-19 patients, prevent cross-contamination, disinfect areas touched by patients, maintain social distancing, and change personal protective equipment between patients.
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Affiliation(s)
- Maya Hartig
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL 32766, USA
| | - Carley Stephens
- University of Central Florida, Mechanical and Aerospace Engineering, 6243Orlando, FL 32766, USA
| | - Aaron Foster
- University of Central Florida, Mechanical and Aerospace Engineering, 6243Orlando, FL 32766, USA
| | - Douglas Fontes
- Florida Space Institute, University of Central Florida, Orlando, FL 32766, USA
| | - Michael Kinzel
- University of Central Florida, Mechanical and Aerospace Engineering, 6243Orlando, FL 32766, USA
| | - Franklin García-Godoy
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis TN 38163, USA.,The Forsyth Institute, Cambridge, MA 02142, USA
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Broderick L, Chen WH, Levy R, Foster A, Umanzor C, Chauhan D. POS0739 DEVELOPMENT OF A CONCEPTUAL MODEL TO UNDERSTAND DISEASE BURDEN IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND LONG-TERM ORGAN DAMAGE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease resulting in increased morbidity and mortality and reduced health-related quality of life (HRQoL). Patients with SLE are at risk of developing irreversible long-term organ damage (LTOD) caused by both disease activity and cumulative medication toxicities. Data regarding the overall disease burden and impact of LTOD in patients with SLE are limited.Objectives:The primary objective of this qualitative study was to develop a conceptual model to describe the burden experienced by patients with SLE and LTOD.Methods:This study (GSK Study 209754) was conducted in three phases. First, a targeted literature review was performed to aid the development of an initial draft conceptual model. Key opinion leaders (KOLs) with experience in SLE and LTOD were then interviewed to assess the clarity, language, comprehensibility, and potential use of the conceptual model, and to help shape the patient interview materials. Finally, one-on-one interviews were performed with patients with SLE and LTOD in any of the 12 organ areas (defined by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), to gather patient perspectives on the common symptoms, functional impacts, treatment experiences, and HRQoL factors associated with LTOD. Data from the interviews were coded and analysed using NVivo software to identify patterns in responses concerning the key concepts of the overall patient burden of LTOD, and used to identify concepts to include in the model.Results:The literature review produced the preliminary conceptual model of LTOD. Results of the KOL interviews (n=5 clinicians and n=1 patient advocate) indicated that the preliminary conceptual model broadly captured the patient experience of LTOD. KOLs emphasised the difference between SLE activity (flares) and LTOD; the conceptual model was subsequently updated in accordance with these recommendations. Interviews conducted with patients with confirmed single (n=9) and multiple LTOD (n=31) indicated that the burden of LTOD associated with SLE was more severe, debilitating, and life threatening than that caused by SLE flares. Almost all patients (39/40) reported aspects of their lives that were more severely affected since their LTOD diagnosis. All 40 patients reported LTOD-related physical impacts, which often affected patients’ ability to perform everyday tasks. The most frequent physical impacts reported were a loss of vitality (39/40), long-term complications (e.g. unstable blood pressure, extreme pain, poor mobility, inflammation, dialysis, infection; 36/40), and severe fatigue (29/40). Cognitive impairments that became more pronounced after their LTOD diagnosis were reported by 27/40 of patients. Typically characterised as “brain fog”, these impairments were described as slower cognitive processing, forgetfulness, confusion, and aphasia. Economic impacts associated with LTOD included patients’ inability to work (31/40), costs of care (33/40), and non-medical-related costs (17/30). Psychosocial impacts reported by patients with LTOD affected their emotional state (39/40), ability to socialise (40/40) and relationships (30/40). Additionally, 30/40 patients reported symptoms as more severe since their LTOD diagnosis, including pain (14/40), fatigue (9/40), and oedema (8/40). Patients’ treatment goals were largely aligned with their experienced impacts of LTOD, including managing the disease and symptoms (25/40), limiting further organ damage (15/40), and improving HRQoL (11/40).Conclusion:The findings from this research clearly indicate that the patient burden of LTOD far surpasses that of SLE without LTOD. These data were incorporated and refined into a conceptual model that fully represents the patient experience of LTOD. The model will help researchers, clinicians, and patients to better understand the impact of SLE-related LTOD progression.Funding:GSKAcknowledgements:Medical writing assistance was provided by Casmira Brazaitis, PhD, Fishawack Indicia Ltd., UK, part of Fishawack Health, and was funded by GSK.Disclosure of Interests:Lynne Broderick Consultant of: GSK, Wen-Hung Chen Shareholder of: GSK, Employee of: GSK, Roger Levy Shareholder of: GSK, Employee of: GSK, April Foster Consultant of: GSK, Cindy Umanzor Consultant of: GSK, Deven Chauhan Shareholder of: GSK, Employee of: GSK
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Shepherd T, Foster A. 244 Does Direct Admission to ICU In Emergency Laparotomy Patients with A NELA Score ≥ 10% Affect Outcome at Fiona Stanley Hospital? Br J Surg 2021. [DOI: 10.1093/bjs/znab134.390] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
The Australian and New Zealand Emergency Laparotomy Audit (ANZELA) is a quality improvement project based on UK NELA. Direct admission to ICU post-operatively for patients with a NELA ≥ 10% is recommended. In the current pandemic, the use of critical care beds must be rationalised. We investigated if patients with NELA ≥ 10% experienced worse outcomes if admitted to the ward post-operatively (instead of ICU).
Method
We performed a retrospective audit of emergency laparotomies at Fiona Stanley Hospital over 6 months December 2019 – May 2020. NELA scores were obtained from the ANZELA database and patient notes reviewed to identify post-operative unplanned ICU admissions and mortalities.
Results
Twenty-four (30%) emergency laparotomy patients had a NELA ≥ 10%. Ten (42%) patients were admitted to the ward post-operatively. There were no unplanned ICU admissions in this group. Two (20%) patients had a documented ‘code blue’ but were managed conservatively on the ward. No patients in this group died within 30 days.
Conclusions
Post-operative ward admission in selected patients with NELA ≥ 10% does not result in unplanned ICU admissions or increased mortality at a tertiary Acute Surgical Unit. This data is reassuring as we expect future ICU bed shortages for non-COVID surgical patients during the pandemic.
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Affiliation(s)
- T Shepherd
- Fiona Stanley Hospital, Perth, Australia
| | - A Foster
- Fiona Stanley Hospital, Perth, Australia
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Foster A, Kinzel M. Estimating COVID-19 exposure in a classroom setting: A comparison between mathematical and numerical models. Phys Fluids (1994) 2021; 33:021904. [PMID: 33746487 PMCID: PMC7975712 DOI: 10.1063/5.0040755] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/11/2021] [Indexed: 05/18/2023]
Abstract
The COVID-19 pandemic has driven numerous studies of airborne-driven transmission risk primarily through two methods: Wells-Riley and computational fluid dynamics (CFD) models. This effort provides a detailed comparison of the two methods for a classroom scenario with masked habitants and various ventilation conditions. The results of the studies concluded that (1) the Wells-Riley model agrees with CFD results without forced ventilation (6% error); (2) for the forced ventilation cases, there was a significantly higher error (29% error); (3) ventilation with moderate filtration is shown to significantly reduce infection transmission probability in the context of a classroom scenario; (4) for both cases, there was a significant amount of variation in individual transmission route infection probabilities (up to 220%), local air patterns were the main contributor driving the variation, and the separation distance from infected to susceptible was the secondary contributor; (5) masks are shown to have benefits from interacting with the thermal plume created from natural convection induced from body heat, which pushes aerosols vertically away from adjacent students.
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Affiliation(s)
- Aaron Foster
- University of Central Florida, Mechanical and Aerospace Engineering, Orlando, Florida 32766, USA
| | - Michael Kinzel
- University of Central Florida, Mechanical and Aerospace Engineering, Orlando, Florida 32766, USA
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Mulder PA, van Balkom IDC, Landlust AM, Priolo M, Menke LA, Acero IH, Alkuraya FS, Arias P, Bernardini L, Bijlsma EK, Cole T, Coubes C, Dapia I, Davies S, Di Donato N, Elcioglu NH, Fahrner JA, Foster A, González NG, Huber I, Iascone M, Kaiser AS, Kamath A, Kooblall K, Lapunzina P, Liebelt J, Lynch SA, Maas SM, Mammì C, Mathijssen IB, McKee S, Mirzaa GM, Montgomery T, Neubauer D, Neumann TE, Pintomalli L, Pisanti MA, Plomp AS, Price S, Salter C, Santos-Simarro F, Sarda P, Schanze D, Segovia M, Shaw-Smith C, Smithson S, Suri M, Tatton-Brown K, Tenorio J, Thakker RV, Valdez RM, Van Haeringen A, Van Hagen JM, Zenker M, Zollino M, Dunn WW, Piening S, Hennekam RC. Development, behaviour and sensory processing in Marshall-Smith syndrome and Malan syndrome: phenotype comparison in two related syndromes. J Intellect Disabil Res 2020; 64:956-969. [PMID: 33034087 PMCID: PMC8957705 DOI: 10.1111/jir.12787] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 08/19/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ultrarare Marshall-Smith and Malan syndromes, caused by changes of the gene nuclear factor I X (NFIX), are characterised by intellectual disability (ID) and behavioural problems, although questions remain. Here, development and behaviour are studied and compared in a cross-sectional study, and results are presented with genetic findings. METHODS Behavioural phenotypes are compared of eight individuals with Marshall-Smith syndrome (three male individuals) and seven with Malan syndrome (four male individuals). Long-term follow-up assessment of cognition and adaptive behaviour was possible in three individuals with Marshall-Smith syndrome. RESULTS Marshall-Smith syndrome individuals have more severe ID, less adaptive behaviour, more impaired speech and less reciprocal interaction compared with individuals with Malan syndrome. Sensory processing difficulties occur in both syndromes. Follow-up measurement of cognition and adaptive behaviour in Marshall-Smith syndrome shows different individual learning curves over time. CONCLUSIONS Results show significant between and within syndrome variability. Different NFIX variants underlie distinct clinical phenotypes leading to separate entities. Cognitive, adaptive and sensory impairments are common in both syndromes and increase the risk of challenging behaviour. This study highlights the value of considering behaviour within developmental and environmental context. To improve quality of life, adaptations to environment and treatment are suggested to create a better person-environment fit.
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Affiliation(s)
- P A Mulder
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
| | - I D C van Balkom
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - A M Landlust
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
| | - M Priolo
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - L A Menke
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - I H Acero
- Genetics Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - F S Alkuraya
- Saudi Human Genome Project, King Abdulaziz City for Science and Technology, and Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - P Arias
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - L Bernardini
- Cytogenetics Unit, Casa Sollievo della Sofferenza Foundation, San Giovanni Rotondo, Italy
| | - E K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - T Cole
- Department of Clinical Genetics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - C Coubes
- Département de Génétique Médicale, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - I Dapia
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - S Davies
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - N Di Donato
- Institute for Clinical Genetics, TU Dresden, Dresden, Germany
| | - N H Elcioglu
- Department of Pediatric Genetics, Marmara University Medical School, Istanbul and Eastern Mediterranean University, Mersin, Turkey
| | - J A Fahrner
- McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Foster
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - N G González
- Unit Hospital Universitario Central de Asturias, Oviedo, Spain
| | - I Huber
- Sørland Hospital, Kristiansand, Norway
| | - M Iascone
- Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A-S Kaiser
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - A Kamath
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - K Kooblall
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - P Lapunzina
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - J Liebelt
- South Australian Clinical Genetics Services, Women's and Children's Hospital, North Adelaide, Australia
| | - S A Lynch
- UCD Academic Centre on Rare Diseases, School of Medicine and Medical Sciences, University College Dublin, and Clinical Genetics, Temple Street Children's University Hospital, Dublin, Ireland
| | - S M Maas
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - C Mammì
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - I B Mathijssen
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - S McKee
- Northern Ireland Regional Genetics Service, Belfast Health and Social Care Trust, Belfast, UK
| | - G M Mirzaa
- Center for Integrative Brain Research, Seattle Children's Research Institute, and Division of Genetic Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - T Montgomery
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - D Neubauer
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - T E Neumann
- Mitteldeutscher Praxisverbund Humangenetik, Halle, Germany
| | - L Pintomalli
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - M A Pisanti
- Medical Genetic and Laboratory Unit, "Antonio Cardarelli" Hospital, Naples, Italy
| | - A S Plomp
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - S Price
- Department of Clinical Genetics, Northampton General Hospital NHS Trust, Northampton, UK
| | - C Salter
- Wessex Clinical Genetics Service, Princess Ann Hospital, Southampton, UK
| | - F Santos-Simarro
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - P Sarda
- Département de Génétique Médicale, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - D Schanze
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - M Segovia
- CENAGEM, Centro Nacional de Genética, Buenos Aires, Argentina
| | - C Shaw-Smith
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - S Smithson
- University Hospitals Bristol NHS Trust, Bristol, UK
| | - M Suri
- Nottingham Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Tatton-Brown
- Division of Genetics and Epidemiology, Institute of Cancer Research, London and South West Thames Regional Genetics Service, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - J Tenorio
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - R V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - R M Valdez
- Genetics Unit, Hospital Militar Central "Cirujano Mayor Dr. Cosme Argerich", Buenos Aires, Argentina
| | - A Van Haeringen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - J M Van Hagen
- Department of Clinical Genetics, VU University Medical Centre, Amsterdam, Netherlands
| | - M Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - M Zollino
- Department of Laboratory Medicine, Institute of Medical Genetics, Catholic University, Rome, Italy
| | - W W Dunn
- Department of Occupational Therapy Education, School of Health Professions, University of Missouri, Columbia, MO, USA
| | - S Piening
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - R C Hennekam
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Fortier E, Foster A, Ali A. P66 Exploring the experiences and health needs of young womxn living in Ontario, Canada: An action-oriented study dedicated to interpersonal reproductive coercion. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Foster A, Shaw J, Collinson-Pautz M, Mahendravada A, Gagliardi C, Khalil M, Paczkowski P, Mackay S, Zhou J. Abstract 898: Single-cell multiplex proteomics reveals synergistic activity of antigen and MyD88/CD40 stimulatory signals on promoting polyfunctional chimeric antigen receptor T cells. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-898] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: GoCAR is a chimeric antigen receptor (CAR) platform that utilizes a rimiducid-dependent activation switch (inducible MyD88/CD40; iMC) to enhance CAR-T cell proliferation and to stimulate the host immune system. To understand how these unique CAR signaling molecules compare to conventional costimulatory domains (e.g., CD28 and 4-1BB), we employed a detection and bioinformatics platform to assess the functional attributes of CD19-specific CAR-T cells by simultaneous detection of 32 proteins secreted from single CAR-T cells upon various stimulation conditions.
Methods: T cells were transduced with retrovirus encoding CD19-specific CARs with conventional costimulatory molecules (CD19.ζ, CD19.28.ζ or CD19.BB.ζ) or with GoCAR, a vector encoding iMC and a CD19-specific CAR (iMC-CD19.ζ). Control or modified T cells were enriched by anti-CD4 or anti-CD8 microbeads and stimulated with CD19 or ΔNGFR-expressing K562 cells with or without 10 nM rimiducid. After 24-hour, CD4 and CD8 T cells were collected and loaded into an IsoCode chip containing ~12,000 microchambers. Each chamber (~1.2 nL) was pre-patterned with a complete copy of a 32-plex antibody array. Cells on-chip were imaged, and single-cell cytokine signals were captured with a microarray scanner. The T cell polyfunctional profile (2+ cytokines per cell) of single T cells was evaluated across 5 functional groups: Effector: Granzyme B, TNFα, IFNγ, MIP1α, Perforin, TNFβ; Stimulatory: GM-CSF, IL-2, IL-5, IL-7, IL-8, IL-9, IL-12, IL-15, IL-21; Chemoattractive: CCL11, IP-10, MIP-1β, RANTES; Regulatory: IL-4, IL-10, IL-13, IL-22, sCD137, sCD40L, TGFβ1; Inflammatory: IL-6, IL-17A, IL-17F, MCP-1, MCP-4, IL-1β.
Results: Single-cell multiplex proteomic analysis demonstrated the synergistic effects of CD19-specific and rimiducid-induced stimulation on polyfunctional upregulation in both CD4 and CD8 GoCAR-T cells across donors. In the “off” state (i.e., no rimiducid), CD19-specific GoCAR-T showed a reduced polyfunctional strength index (PSI) compared to CD28 and 4-1BB CAR-T cells, which was predominated by antitumor-associated proteins. In contrast, activation of iMC dramatically increased GoCAR-T PSI, which was characterized by elevated “stimulatory” (GM-CSF, IL-2, IL-5, IL-8, IL-9), “chemotactic” (MIP-1b) and “regulatory” (IL-4, sCD137) molecules compared to conventional CAR constructs. Polyfunctional heatmaps revealed that GoCAR-T cells co-secreted combinatorial proteins in response to CD19-expressing target cells in combination with iMC-based costimulation. Further, both CD4+ and CD8+ GoCAR-T cells acquired the ability to produce IL-2 as part of their polyfunctional profile, which was only observed with iMC costimulation.
Conclusions: Single-cell multiplexed proteomic profiling reveals that polyfunctionality can be regulated by small molecule activation of an inducible costimulatory switch, producing distinct “on/off” states. iMC signaling also enhances production of important stimulatory and chemoattractive molecules which may improve CAR-T cell activity and provoke a host anti-tumor immune response. Thus, the GoCAR-T platform may potentially be used to optimize CAR-T activity through rimiducid administration to maximize efficacy while mitigating CAR-T-related toxicities.
Citation Format: Aaron Foster, Joanne Shaw, Matthew Collinson-Pautz, Aruna Mahendravada, Christine Gagliardi, Mariam Khalil, Patrick Paczkowski, Sean Mackay, Jing Zhou. Single-cell multiplex proteomics reveals synergistic activity of antigen and MyD88/CD40 stimulatory signals on promoting polyfunctional chimeric antigen receptor T cells [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 898.
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Affiliation(s)
| | - Joanne Shaw
- 1Bellicum Pharmaceuticals, Inc., Houston, TX
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Fleischl W, Barrett K, Meredith I, Foster A. P11 Metastatic breast cancer in Wellington, New Zealand. How do we do? Breast 2020. [DOI: 10.1016/j.breast.2020.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Nadolski A, Vieira JD, Sobrin JA, Kofman AM, Ade PAR, Ahmed Z, Anderson AJ, Avva JS, Basu Thakur R, Bender AN, Benson BA, Bryant L, Carlstrom JE, Carter FW, Cecil TW, Chang CL, Cheshire JR, Chesmore GE, Cliche JF, Cukierman A, de Haan T, Dierickx M, Ding J, Dutcher D, Everett W, Farwick J, Ferguson KR, Florez L, Foster A, Fu J, Gallicchio J, Gambrel AE, Gardner RW, Groh JC, Guns S, Guyser R, Halverson NW, Harke-Hosemann AH, Harrington NL, Harris RJ, Henning JW, Holzapfel WL, Howe D, Huang N, Irwin KD, Jeong O, Jonas M, Jones A, Korman M, Kovac J, Kubik DL, Kuhlmann S, Kuo CL, Lee AT, Lowitz AE, McMahon J, Meier J, Meyer SS, Michalik D, Montgomery J, Natoli T, Nguyen H, Noble GI, Novosad V, Padin S, Pan Z, Paschos P, Pearson J, Posada CM, Quan W, Rahlin A, Riebel D, Ruhl JE, Sayre JT, Shirokoff E, Smecher G, Stark AA, Stephen J, Story KT, Suzuki A, Tandoi C, Thompson KL, Tucker C, Vanderlinde K, Wang G, Whitehorn N, Yefremenko V, Yoon KW, Young MR. Broadband, millimeter-wave antireflection coatings for large-format, cryogenic aluminum oxide optics. Appl Opt 2020; 59:3285-3295. [PMID: 32400613 DOI: 10.1364/ao.383921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/25/2020] [Indexed: 06/11/2023]
Abstract
We present two prescriptions for broadband ($ {\sim} 77 - 252\;{\rm GHz} $), millimeter-wave antireflection coatings for cryogenic, sintered polycrystalline aluminum oxide optics: one for large-format (700 mm diameter) planar and plano-convex elements, the other for densely packed arrays of quasi-optical elements-in our case, 5 mm diameter half-spheres (called "lenslets"). The coatings comprise three layers of commercially available, polytetrafluoroethylene-based, dielectric sheet material. The lenslet coating is molded to fit the 150 mm diameter arrays directly, while the large-diameter lenses are coated using a tiled approach. We review the fabrication processes for both prescriptions, then discuss laboratory measurements of their transmittance and reflectance. In addition, we present the inferred refractive indices and loss tangents for the coating materials and the aluminum oxide substrate. We find that at 150 GHz and 300 K the large-format coating sample achieves $ (97 \pm 2)\% $ transmittance, and the lenslet coating sample achieves $ (94 \pm 3)\% $ transmittance.
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Al Yaarubi Z, Foster A, Avinashi V, Lam G, Soller L, Chan E. A198 EOSINOPHILIC ESOPHAGITIS WITH STRICTURE PRESENTING SHORTING AFTER INITIATION OF ORAL PEANUT IMMUNOTHERAPY. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.197] [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: 11/15/2022] Open
Abstract
Abstract
Background
Oral immunotherapy (OIT) is increasingly practiced outside of research settings with reasonable success (Soller 2019).
With OIT, a patient eats their food allergen daily, gradually increasing the dose, with the goal to prevent or reduce the severity of an anaphylactic reaction.
One of the described adverse events of OIT is a risk of developing Eosinophilic Esophagitis (EoE), with cited frequency of 2.7% (Lucendo 2014). In addition, OIT is typically contraindicated in patients with known EoE but patients are not routinely screened for EoE prior to initiation of OIT.
Aims
To present a case of a 12 year old boy with peanut anaphylaxis who developed eosinophilic esophagitis and an esophageal stricture shortly after starting peanut immunotherapy
Methods
Patient chart review was conducted. A literature review was done using the words “eosinophilic esophagitis” and “immunotherapy”.
Results
A12 year old boy with asthma, allergic rhinitis and multiple anaphylactic food allergies, started peanut OIT with an allergist. Prior to OIT, the patient had no symptoms suggestive of EoE such as dysphagia, heartburn, chest pain or washing of food. Approximately 3.5 weeks into treatment, the patient developed daily vomiting. The patient was advised to stop the peanut OIT three days after symptom onset, but the vomiting continued for another 8 days. By the time of endoscopy (16 days after onset of vomiting), the vomiting had completely subsided for the previous five days.
The upper GI endoscopy demonstrated signs of EoE throughout the length of the esophagus. In the mid esophagus there was resistance where the 9.8 mm gastroscope was unable to pass. A smaller gastroscope with a 5.9 mm width was easily able to pass through the stricture. Histology showed marked eosinophilia throughout the esophagus with basal cell hyperplasia, spongiosis, superficial microabscesses and stromal fibrosis consistent with EoE. The patient continued to be ‘asymptomatic’ at the time of endoscopy and after despite the presence of a stricture. After discussion, the patient was started on oral viscous budesonide (OVB) 1mg PO BID.
The patient was re-scoped 4 weeks into OVB therapy with complete resolution of the stricture with neither macroscopic nor histologic findings of EoE. Patient is now off OVB for over a month, remains asymptomatic, and will undergo repeat endoscopy in the upcoming month to ensure normal histology
Conclusions
This is the first case describing EoE with an esophageal stricture shortly after initiation of OIT. Pediatric Gastroenterologists need to be increasingly aware that patients undergoing OIT are at an increasing risk of ‘developing’ or at least ‘unmasking’ EoE. More research is required to evaluate whether EoE screening, by symptom questionnaire or endoscopy is warranted prior to beginning OIT, and whether OIT is truly needed.
Upper GI endoscopy showing signs of EoE and an esophageal stricture
Funding Agencies
CAG
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Affiliation(s)
- Z Al Yaarubi
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - A Foster
- BC Children’s Hospital, Vancouver, BC, Canada
| | - V Avinashi
- BC Children’s Hospital, Vancouver, BC, Canada
| | - G Lam
- Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - L Soller
- BC Children’s Hospital, Vancouver, BC, Canada
| | - E Chan
- BC Children’s Hospital, Vancouver, BC, Canada
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Tadesse BT, Foster A, Aklillu E. Rebuttal: Response to the comments by Buck
et al
. on our published article: Hepatic and renal toxicity and associated factors among
HIV
‐infected children on antiretroviral therapy: a prospective cohort study;
HIV
Medicine
(2019), 20, 147–156. HIV Med 2019; 20:e13-e14. [DOI: 10.1111/hiv.12742] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- BT Tadesse
- Hawassa University College of Medicine and Health Sciences Hawassa Ethiopia
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Stockholm Sweden
| | - A Foster
- Departments of Dermatology and Pediatrics, Oregon Health Sciences University Portland, OR USA
| | - E Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Stockholm Sweden
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Foster A, Scott D, Layfield R, Rea S. An FTLD-associated SQSTM1 variant impacts Nrf2 and NF-κB signalling and is associated with reduced phosphorylation of p62. Mol Cell Neurosci 2019; 98:32-45. [DOI: 10.1016/j.mcn.2019.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 12/12/2022] Open
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21
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Briglia F, Lawrence S, Foster A, Briglia E, Jacobson K. A69 INFLIXIMAB DOSE OPTIMIZATION DURING MAINTENANCE THERAPY IN CHILDREN WITH IBD. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.068] [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)
- F Briglia
- BC Children’s Hospital, Vancouver, BC, Canada
| | - S Lawrence
- BC Children’s Hospital, Vancouver, BC, Canada
| | - A Foster
- BC Children’s Hospital, Vancouver, BC, Canada
| | - E Briglia
- BC Children’s Hospital, Vancouver, BC, Canada
| | - K Jacobson
- BC Children’s Hospital, Vancouver, BC, Canada
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Becerra C, Hoof P, Paulson S, Manji G, Gardner O, Malankar A, Shaw J, Blass D, Ballard B, Yi X, Anumula M, Foster A, Senesac J, Woodard P. Ligand-inducible, prostate stem cell antigen (PSCA)-directed GoCAR-T™ cells in advanced solid tumors: Preliminary results from a dose escalation study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Rajakumar PD, Gowers GOF, Suckling L, Foster A, Ellis T, Kitney RI, McClymont DW, Freemont PS. Rapid Prototyping Platform for Saccharomyces cerevisiae Using Computer-Aided Genetic Design Enabled by Parallel Software and Workcell Platform Development. SLAS Technol 2018; 24:291-297. [DOI: 10.1177/2472630318798304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Biofoundries have enabled the ability to automate the construction of genetic constructs using computer-aided design. In this study, we have developed the methodology required to abstract and automate the construction of yeast-compatible designs. We demonstrate the use of our in-house software tool, AMOS, to coordinate with design software, JMP, and robotic liquid handling platforms to successfully manage the construction of a library of 88 yeast expression plasmids. In this proof-of-principle study, we used three fluorescent genes as proxy for three enzyme coding sequences. Our platform has been designed to quickly iterate around a design cycle of four protein coding sequences per plasmid, with larger numbers possible with multiplexed genome integrations in Saccharomyces cerevisiae. This work highlights how developing scalable new biotechnology applications requires a close integration between software development, liquid handling robotics, and protocol development.
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Affiliation(s)
| | - G-O. F. Gowers
- Imperial College Centre for Synthetic Biology, Imperial College London, London, UK
- Department of Bioengineering, Imperial College London, London, UK
| | - L. Suckling
- The London DNA Foundry, Imperial College London, London, UK
| | - A. Foster
- The London DNA Foundry, Imperial College London, London, UK
| | - T. Ellis
- Imperial College Centre for Synthetic Biology, Imperial College London, London, UK
- Department of Bioengineering, Imperial College London, London, UK
| | - R. I. Kitney
- The London DNA Foundry, Imperial College London, London, UK
- Department of Bioengineering, Imperial College London, London, UK
| | | | - P. S. Freemont
- The London DNA Foundry, Imperial College London, London, UK
- Section of Structural Biology, Department of Medicine, Imperial College London, London, UK
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Duong M, Morschl E, Mahendravada A, Collinson-Pautz M, Brandt M, Zhang M, Foster A, Bayle JH, Spencer D. Abstract LB-141: A unified dual-switch CAR vector to target solid cancer with controllable "on" and "off" states. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-lb-141] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Despite impressive efficacy in liquid tumors, improved CAR-T efficacy and persistence appear necessary to control solid tumors, but this increased potency will likely increase the risk of toxicity. Here, we present two independently regulated molecular switches that can elicit specific and rapid induction of cellular responses upon exposure to cognate ligands. Cell activation is controlled by rimiducid (Rim), which triggers signaling cascades downstream of MyD88 and CD40 via an engineered chimeric protein termed iMC. A rapamycin (Rap)-controlled apoptotic switch, iRC9, is co-expressed, which induces dimerization of caspase-9 active domains to mitigate possible toxicity from excessive CAR-T function. When combined with a first generation CAR in a single vector, these molecular switches allow for specific and efficient regulation of engineered T cells to eliminate HER2+ and PSCA+ cancer cells.
Results Transduction of activated T cells using γ-retroviruses encoding the unified dual-switch (DS) HER2- or PSCA-CAR components (SFG-iRC9.2A-CAR.ζ.2A-iMC) yielded efficient transgene expression despite the large insert size (60.5±8.7% CAR+). Greater transduction efficiency was achieved with single-cell producer clones encoding the PSCA DS CAR vector (79.3±2.9% CAR+). When exposed to target antigen in a coculture assay with tumor cells, robust IL-2 and IFN- γ production by DS CAR-T cells was Rim-dependent. Tumor cell killing and T cell expansion were also enhanced by Rim stimulation. In an OE19 tumor-bearing mouse model, Rim stimulation of HER2 DS CAR-T cells significantly enhanced tumor killing (205.8±58.3 mm2 vehicle (veh)-treated vs 55.9±10.9 mm2 Rim-treated, p<0.05) and T cell expansion (4.6E5 average radiance veh-treated vs 1.9E6 Rim-treated). When targeting PSCA+ HPAC cancer cells, PSCA DS CAR-T cells proliferated in a Rim dose-dependent manner and tumor control was maintained even after cessation of Rim treatment. In a second pancreatic tumor model, SU8686, Rim treatment induced long-term tumor control (>80 days). When necessary, deployment of the off-switch (iRC9) rapidly (½ Vmax ~ 8 hours) and efficiently eliminated DS CAR-T cells in a caspase-3 activation assay with real-time (IncuCyte) monitoring, as well as AnnV/PI detection by flow cytometry (3.2±1.0% AnnV+/PI+ veh-treated vs 80.0±5.2% 10nM Rap-treated, p<0.005). In vivo assessment of the iRC9 switch was performed via eGFPluciferase (eGFPfluc)-labeled PSCA dual-switch CAR-T cells in NSG mice. Temsirolimus (Tem; a Rap prodrug) treatment efficiently eliminated PSCA DS CAR-T cells within 6 hours (6.1E4 average radiance veh-treated vs 2.1E4 0.4mg/kg Tem-treated, p<0.0001).
Summary Dual-switch CAR-T, a novel platform comprising a CAR combined with regulated costimulation and apoptotic signaling elements, effectively control solid tumor growth and T cell expansion and elimination. This technology provides a user-controlled system for managing persistence and safety of tumor antigen-specific CAR-T cells.
Citation Format: MyLinh Duong, Eva Morschl, Aruna Mahendravada, Matthew Collinson-Pautz, Mary Brandt, Ming Zhang, Aaron Foster, J. Henri Bayle, David Spencer. A unified dual-switch CAR vector to target solid cancer with controllable "on" and "off" states [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr LB-141.
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Davey V, Raturaga T, Shirley R, Barrett K, Harvey V, Campbell I, Foster A, Harris G. PO6 Consolidation of the four New Zealand breast cancer registers. Breast 2018. [DOI: 10.1016/j.breast.2018.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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26
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Carney D, Mongelluzzo J, Foster A, Fee C, Ekman E. 379TF Understanding Emotions: Combating Burnout With Empathy During Emergency Medicine Residency. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Foster A, Boyes L, Burgess L, Carless S, Bowyer V, Jenkinson H, Parulekar M, Ainsworth J, Hungerford J, Onadim Z, Sagoo M, Rosser E, Reddy MA, Cole T. Patient understanding of genetic information influences reproductive decision making in retinoblastoma. Clin Genet 2017; 92:587-593. [PMID: 28397259 DOI: 10.1111/cge.13035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/04/2017] [Accepted: 04/06/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Retinoblastoma is the most common malignant tumour of the eye in childhood, with nearly all bilateral tumours and around 17% to 18% of unilateral tumours due to an oncogenic mutation in the RB1 gene in the germline. Genetic testing enables accurate risk assessment and optimal clinical management for the affected individual, siblings, and future offspring. MATERIAL AND METHODS We carried out the first UK-wide audit of understanding of genetic testing in individuals with retinoblastoma. A total of 292 individuals aged 16 to 45 years were included. RESULTS Patients with bilateral disease were significantly more likely to understand the implications of retinoblastoma for siblings and children. There was a significant association between not knowing the results of genetic testing or not understanding the implications and not having children, particularly in women. Surprisingly, this was also true for individuals treated for unilateral disease with a low risk of retinoblastoma for their offspring. CONCLUSION We are concerned that individuals may be making life choices based on insufficient information regarding risks of retinoblastoma and reproductive options. We suggest that improvement in transition care is needed to enable individuals to make informed reproductive decisions and to ensure optimal care for children born at risk of retinoblastoma.
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Affiliation(s)
- A Foster
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - L Boyes
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - L Burgess
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - S Carless
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - V Bowyer
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - H Jenkinson
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - M Parulekar
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - J Ainsworth
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - J Hungerford
- Retinoblastoma Service, Royal London Hospital, Barts Health NHS Trust, London, UK.,Moorfields Eye Hospital NHS Trust, London, UK
| | - Z Onadim
- Retinoblastoma Genetic Screening Unit, Barts Health NHS Trust, London, UK
| | - M Sagoo
- Retinoblastoma Service, Royal London Hospital, Barts Health NHS Trust, London, UK.,Moorfields Eye Hospital NHS Trust, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - E Rosser
- Retinoblastoma Service, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M A Reddy
- Retinoblastoma Service, Royal London Hospital, Barts Health NHS Trust, London, UK.,Moorfields Eye Hospital NHS Trust, London, UK
| | - T Cole
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
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Fain W, Farmer S, Owens S, Fausset C, Foster A. MEDICATION ADHERENCE FACILITATORS AND BARRIERS FOR OLDER ADULTS WITH DISABILITIES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.051] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- W.B. Fain
- Georgia Tech Research Institute, Georgia Institute of Technology, Waco, Georgia
| | - S. Farmer
- Georgia Tech Research Institute, Georgia Institute of Technology, Waco, Georgia
| | - S. Owens
- Georgia Tech Research Institute, Georgia Institute of Technology, Waco, Georgia
| | - C. Fausset
- Georgia Tech Research Institute, Georgia Institute of Technology, Waco, Georgia
| | - A. Foster
- Georgia Tech Research Institute, Georgia Institute of Technology, Waco, Georgia
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Abstract
PURPOSE The quality of cataract surgery delivered in sub-Saharan Africa (SSA) is a significant constraint to achieving the elimination of avoidable blindness. No published reports from routine SSA cataract services attain the WHO benchmarks for visual outcomes; poor outcomes (<6/60) often comprise 20% in published case series. This Delphi exercise aimed to identify and prioritise potential interventions for improving the quality of cataract surgery in SSA to guide research and eye health programme development. METHODS An initial email open-question survey created a ranked list of priorities for improving quality of surgical services. A second-round face-to-face discussion facilitated at a Vision 2020 Research Mentorship Workshop in Tanzania created a refined list for repeated ranking. RESULTS Seventeen factors were agreed that might form target interventions to promote quality of cataract services. Improved training of surgeons was the top-ranked item, followed by utilisation of biometry, surgical equipment availability, effective monitoring of outcomes of cataract surgery by the surgeon, and well-trained support staff for the cataract pathway (including nurses seeing post-operative cases). CONCLUSION Improving the quality of cataract surgery in SSA is a clinical, programmatic and public health priority. In the absence of other evidence, the collective expert opinion of those involved in ophthalmic services regarding the ranking of factors to promote quality improvement, refined through this Delphi exercise, provides us with candidate intervention areas to be evaluated.
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Affiliation(s)
- J C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - W H Dean
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - A Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - M J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Schwartz EC, Renk J, Hopkins AD, Huss R, Foster A. A method to determine the coverage of ivermectin distribution in onchocerciasis-control programmes. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.1998.11813341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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31
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Pentcheva-Hoang T, Torres D, Rodriguez T, Korngold A, Lu A, Crisostomo J, Moseley A, Jahn L, Heemskerk MH, Slawin K, Spencer D, Foster A. Abstract B078: GoTCR: Inducible MyD88/CD40 (iMC) enhances proliferation and survival of tumor-specific TCR-modified T cells and improves antitumor efficacy in myeloma. Cancer Immunol Res 2016. [DOI: 10.1158/2326-6066.imm2016-b078] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Use of T cells engineered to express antigen-specific T cell receptors (TCRs) has shown promise as a cancer immunotherapy treatment; however, durable responses have been limited by poor T cell persistence and expansion in vivo. Additionally, MHC class I downregulation on tumor cells further reduces therapeutic efficacy. Therefore, we co-expressed in human T cells a novel, small molecule dimerizer (rimiducid)-dependent T cell “activation switch”, called inducible MyD88/CD40 (iMC), along with tumor antigen-specific TCRs to regulate T cell activation and expansion, while upregulating MHC class I expression on tumor cells.
Methods: Human T cells were activated with anti-CD3/CD28 and transduced with γ-retroviruses encoding TCR α and β chains recognizing either the cancer-testes antigen PRAME (HLA-A*201-restricted SLLQHLIGL) or the B cell-specific transcriptional co-activator, Bob1/OBF-1 (HLA-B*702-restricted APAPTAVVL). Parallel “GoTCR” vectors co-expressed the αβ TCR and iMC, comprising signaling domains from MyD88 and CD40 fused in frame with tandem rimiducid-binding FKBP12v36 domains. Proliferation, cytokine production and cytotoxicity of modified T cells was assessed using peptide-pulsed EGFPluc-expressing T2 cells (PRAME only) or PRAME+/Bob1+, HLA-A2+ HLA-B7+ EGFPluc-expressing U266 myeloma cells ± rimiducid (10 nM). MHC class I upregulation on tumor cells was measured using transwell assays and flow cytometry. In vitro tumor killing and T cell proliferation were analyzed using T cell and tumor coculture assays by either measuring loss of luciferase activity overnight or by flow cytometry over a period of 4-7 days. Finally, in vivo efficacy was determined using immune-deficient NSG mice engrafted i.v. with U266 cells and treated i.v. with 5×106-1×107 transduced T cells. iMC was activated in vivo by weekly or biweekly i.p. rimiducid injections (1-5 mg/kg). Tumor size and T cell expansion was measured using in vivo bioluminescence imaging and flow cytometry, respectively.
Results: All vectors efficiently (∼85%) transduced activated T cells and showed antigen-specific IFN-γ production and cytolytic function against peptide-pulsed T2 cells and/or PRAME+Bob1+ U266 myeloma cells. However, both TCR ligation and rimiducid-dependent iMC costimulation were required for IL-2 production against PRAME peptide-pulsed T2 cells. Coculture assays against U266 cells showed that tumor elimination was optimized with concurrent rimiducid-driven iMC activation in both “GoPRAME” and “GoBob1” constructs, and this was accompanied by greatly increased IL-2 secretion and robust T cell proliferation (∼ 50-fold vs PRAME or Bob1-specific TCRs alone). Further, iMC activation produced IFN-γ independently of TCR ligation, which significantly increased MHC class I expression on tumor cells (∼ 7-fold) relative to PRAME TCR-transduced T cells. In NSG mice engrafted with PRAME+ U266 myeloma tumors, GoPRAME TCR-modified T cells persisted for 81 days post-injection and prevented tumor growth, unlike any of the other T cell groups. Importantly, weekly rimiducid injection dramatically expanded iMC-PRAME TCR-expressing T cell numbers by ∼1000-fold on day 81 post-injection compared to T cells expressing only the PRAME TCR (p < 0.001).
Summary: iMC is a novel “Go” switch that utilizes rimiducid, a small molecule dimerizer, to provide costimulation to PRAME and Bob1-specific TCR-engineered T cells while sensitizing tumors to TCR-mediated recognition via cytokine-induced MHC I upregulation. These iMC-enhanced TCRs are prototypes of novel “GoTCR” engineered T cell therapies that may increase efficacy, safety and durability of adoptive T cell therapies.
Citation Format: Tsvetelina Pentcheva-Hoang, David Torres, Tania Rodriguez, Ana Korngold, An Lu, Jeannette Crisostomo, Annemarie Moseley, Lorenz Jahn, Mirjam H.M. Heemskerk, Kevin Slawin, David Spencer, Aaron Foster. GoTCR: Inducible MyD88/CD40 (iMC) enhances proliferation and survival of tumor-specific TCR-modified T cells and improves antitumor efficacy in myeloma [abstract]. In: Proceedings of the Second CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; 2016 Sept 25-28; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(11 Suppl):Abstract nr B078.
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Affiliation(s)
| | | | | | | | - An Lu
- 1Bellicum Pharmaceuticals, Houston, TX
| | | | | | - Lorenz Jahn
- 2Leiden University Medical Center, Leiden, Netherlands
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Foster A. Location, location, location: documenting women's abortion experiences in Canada. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Williams D, Foster A, Sefton C, Regan S, Woods A, Morgan P, Haddrick M. Development of an automated, high-throughput hepatocyte spheroid screen for use within the pharmaceutical industry. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.06.1553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Spencer DM, Hoang TP, Foster A, Rodriguez T, Torres D, Lu A, Crisostomo J, Jahn L, Heemskerk MH. Abstract LB-084: Go-TCR™: Inducible MyD88/CD40 (iMC) enhances proliferation and survival of tumor-specific TCR-modified T cells, increasing anti-tumor efficacy. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-lb-084] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Use of tumor antigen-specific T cell receptors (TCRs) to refocus T cell killing has shown tantalizing clinical efficacy; however, durable responses have been limited by poor T cell persistence and expansion in vivo. Also, MHC class I downregulation in tumors further reduces therapeutic efficacy. Therefore, we co-expressed in human T cells a small molecule dimerizer (rimiducid)-dependent “activation switch”, called inducible MyD88/CD40 (iMC), along with tumor-targeted TCRs to regulate T cell expansion and activation, while affecting upregulation of MHC class I on tumors.
Methods: Human T cells were CD3/CD28-activated and transduced with αβTCR-encoding γ-retroviruses recognizing either the CT antigen, PRAME (HLA-A*02:01/SLLQHLIGL), or the B-cell-specific transcriptional co-activator, Bob1/OBF-1 (HLA-B*07:02/APAPTAVVL). Parallel “Go-TCR” vectors co-expressed iMC, comprising MyD88 and CD40 signaling domains along with rimiducid-binding FKBP12-V36. Proliferation, cytokine production and cytotoxicity of modified T cells was assessed using peptide-pulsed T2 cells (PRAME only) or against PRAME+/Bob1+, HLA-A2+ -B7+ U266 myeloma cells +/- 10 nM rimiducid. MHC class I induction was measured using transwell assays and flow cytometry. In vitro tumor killing was analyzed by T cell and tumor coculture assays at various effector to target ratios over a 7-day period. Finally, in vivo efficacy was determined using immune-deficient NSG mice engrafted i.v. with U266 cells and treated i.v. with 1×107 transduced T cells. iMC was activated in vivo by weekly i.p. rimiducid injections (1-5 mg/kg). Tumor size and T cell expansion was measured using in vivo BLI imaging and flow cytometry.
Results: All vectors efficiently (∼85%) transduced activated T cells and showed antigen-specific IFN-γ production and cytotoxicity against peptide-pulsed T2 cells and/or PRAME+Bob1+ U266 cells. However, both iMC signaling and TCR ligation of PRAME peptide-pulsed T2 Cells were required for IL-2 production. Coculture assays with U266 cells showed that tumor elimination, IL-2 secretion and robust (∼ 50-fold) T cell proliferation (vs TCR signaling alone) was optimized with concurrent rimiducid-driven iMC activation in both “Go-PRAME” and “Go-Bob1” constructs. Further, iMC activation produced TCR-independent IFN-γ that increased (∼100-fold) MHC class I expression on tumor cells. In NSG mice engrafted with U266 tumors, iMC-PRAME TCR-modified T cells persisted for at least 81 days post-injection and prevented tumor growth, unlike other T cell groups. Importantly, weekly rimiducid injection dramatically expanded iMC-PRAME TCR-expressing T cell numbers by ∼1000-fold on day 81 post-injection vs T cells expressing only the PRAME TCR (p < 0.001).
Summary: The novel rimiducid-regulated “Go” switch, iMC, greatly augments activation and expansion of TCR-engineered T cells while sensitizing tumors to T cells via cytokine-induced MHC class I upregulation. iMC-enhanced TCRs are prototypes of novel “Go-TCR” engineered T cell therapies that increase efficacy, safety and durability of adoptive T cell therapies.
Citation Format: David M. Spencer, Tsvetelina P. Hoang, Aaron Foster, Tania Rodriguez, David Torres, An Lu, Jeannette Crisostomo, Lorenz Jahn, Mirjam H.M. Heemskerk. Go-TCR™: Inducible MyD88/CD40 (iMC) enhances proliferation and survival of tumor-specific TCR-modified T cells, increasing anti-tumor efficacy. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-084.
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Affiliation(s)
| | | | | | | | | | - An Lu
- 1Bellicum Pharmaceuticals, Houston, TX
| | | | - Lorenz Jahn
- 2Leiden Univ Medical Center, Leiden, Netherlands
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Redmond CE, Healy GM, Murphy CF, O'Doherty A, Foster A. The use of ultrasonography and digital mammography in women under 40 years with symptomatic breast cancer: a 7-year Irish experience. Ir J Med Sci 2016; 186:63-67. [PMID: 27271165 DOI: 10.1007/s11845-016-1472-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 03/23/2016] [Accepted: 05/27/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast cancer in women under 40 years of age is rare and typically presents symptomatically. The optimal imaging modality for this patient group is controversial. Most women undergo ultrasonography with/without mammography. Young women typically have dense breasts, which can obscure the features of malignancy on film mammography, however, initial studies have suggested that digital mammography may have a more accurate diagnostic performance in younger women. Ultrasound generally performs well in this age group, although it is poor at detecting carcinoma in situ (DCIS). AIMS To evaluate the comparative diagnostic performance of ultrasonography and digital mammography in the initial diagnostic evaluation of women under 40 years of age with symptomatic breast cancer. METHODS Retrospective review of all women under the age of 40 years managed at our symptomatic breast cancer unit from January 2009 to December 2015. RESULTS There were 120 patients that met the inclusion criteria for this study. The sensitivity of ultrasonography and digital mammography for breast cancer in this patient group was 95.8 and 87.5 %, respectively. The patients with a false negative mammographic examination were more likely to have dense breasts (p < 0.01). Five patients had a false negative ultrasonographic examination, withal of whom were diagnosed with DCIS detected by mammography. CONCLUSION This study demonstrates the superior sensitivity of ultrasound for breast cancer in women under the age of 40 years, however, the results show that digital mammography has an important complimentary role in the comprehensive assessment of these patients, particularly in the diagnosis of DCIS.
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Affiliation(s)
- C E Redmond
- Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - G M Healy
- Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - C F Murphy
- Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A O'Doherty
- Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A Foster
- Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Hoang TP, Foster A, Rodriguez T, Torres D, Lu A, Crisostomo J, Jahn L, Heemskerk MH, Spencer DM. 746. Go-TCR: Inducible MyD88/CD40 (iMC) Enhances Proliferation and Survival of Tumor-Specific TCR-Modified T Cells, Increasing Anti-Tumor Efficacy. Mol Ther 2016. [DOI: 10.1016/s1525-0016(16)33554-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Titloye NA, Foster A, Omoniyi-Esan GO, Komolafe AO, Daramola AO, Adeoye OA, Adisa AO, Manoharan A, Pathak D, D'Cruz MN, Alizadeh Y, Lewis PD, Shaaban AM. Histological Features and Tissue Microarray Taxonomy of Nigerian Breast Cancer Reveal Predominance of the High-Grade Triple-Negative Phenotype. Pathobiology 2016; 83:24-32. [PMID: 26730581 DOI: 10.1159/000441949] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/26/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Little is known about the biology, molecular profile and hence optimal treatment of African Nigerian breast cancer. The aim of this work, therefore, was to characterize the histology and molecular profile of Nigerian breast cancer. METHODS Breast carcinomas from women at 6 centres of similar tribal origin in Nigeria were reviewed and assembled into tissue microarrays (TMAs), and sections were stained for hormone receptors, i.e. estrogen receptor (ER)α, ERβ1, ERβ progesterone receptor (PR) and androgen receptor, cyclin D, HER2, Ki67 and cytokeratins (CKs), i.e. CK5/6 and CK14 (basal) and CK18 and 19 (luminal). RESULTS A total of 835 tumours were analysed. The mean age at diagnosis was 48.62 ± 12.41 years. The most common histological subtype was ductal NST (no-special-type) carcinoma (87.3%). Over 90% of the tumours were grade 2 or 3. The predominant molecular phenotype was the non-basal, triple-negative type (47.65%) followed by the HER2-positive group (19.6%). The percentage of ER-, PR- and HER2-positive tumours was 22.4, 18.9 and 18.8%, respectively. CONCLUSION Nigerian breast cancer predominantly has a high-grade, triple-negative profile. It occurs at a younger age and bears similarities at the molecular level to pre-menopausal breast cancer in white women, with remarkably lower levels of ERβ expression. The early presentation and histological and molecular phenotype may explain the poor prognosis, and tailoring treatment strategies to target this unique profile are required.
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Affiliation(s)
- N A Titloye
- School of Medical Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Foster A, Jones DL, Cooper EJ, Roberts P. Freeze-thaw cycles have minimal effect on the mineralisation of low molecular weight, dissolved organic carbon in Arctic soils. Polar Biol 2016; 39:2387-2401. [PMID: 32669755 PMCID: PMC7346978 DOI: 10.1007/s00300-016-1914-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 01/23/2016] [Accepted: 02/26/2016] [Indexed: 12/04/2022]
Abstract
Warmer winters in Arctic regions may melt insulating snow cover and subject soils to more freeze–thaw cycles. The effect of freeze–thaw cycles on the microbial use of low molecular weight, dissolved organic carbon (LMW-DOC) is poorly understood. In this study, soils from the Arctic heath tundra, Arctic meadow tundra and a temperate grassland were frozen to −7.5 °C and thawed once and three times. Subsequently, the mineralisation of 3 LMW-DOC substrates types (sugars, amino acids and peptides) was measured over an 8-day period and compared to controls which had not been frozen. This allowed the comparison of freeze–thaw effects between Arctic and temperate soil and between different substrates. The results showed that freeze–thaw cycles had no significant effect on C mineralisation in the Arctic tundra soils. In contrast, for the same intensity freeze–thaw cycles, a significant effect on C mineralisation was observed for all substrate types in the temperate soil although the response was substrate specific. Peptide and amino acid mineralisation were similarly affected by FT, whilst glucose had a different response. Further work is required to fully understand microbial use of LMW-DOC after freeze–thaw, yet these results suggest that relatively short freeze–thaw cycles have little effect on microbial use of LMW-DOC in Arctic tundra soils after thaw.
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Affiliation(s)
- A Foster
- School of the Environment, Natural Resources and Geography, Bangor University, Bangor, UK
| | - D L Jones
- School of the Environment, Natural Resources and Geography, Bangor University, Bangor, UK
| | - E J Cooper
- Department of Arctic and Marine Biology, Faculty of Biosciences, Fisheries and Economics, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - P Roberts
- School of the Environment, Natural Resources and Geography, Bangor University, Bangor, UK
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Lok B, Pietanza M, Foster A, Rudin C, Perez C, Ong L, Krug L, Rimner A, Wu A. The Factors Influencing the Utilization of Prophylactic Cranial Irradiation in Patients With Limited-Stage Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Foster A, Gaisa M, Turner S, Morey T, Jacobson K, Fierer D. P11.23 Evaluation of hepatitis c virus in the rectum of hiv-infected men who have sex with men. Sex Transm Infect 2015. [DOI: 10.1136/sextrans-2015-052270.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Turner S, Yip M, Smith D, Weibel S, van Seggelen W, Foster A, Morey T, Barbati Z, Branch A, Fierer D. O22.2 Detection of hepatitis c virus (hcv) in semen from hiv-infected men who have sex with men (msm) during acute hcv infection. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Turner S, Yip M, Smith D, Weibel S, van Seggelen W, Foster A, Morey T, Barbati Z, Branch A, Fierer D. 007.3 Detection of hepatitis c virus (hcv) in semen from hiv-infected men who have sex with men (msm) during acute hcv infection. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Heyes GJ, Tucker A, Marley D, Foster A. Predictors for 1-year mortality following hip fracture: a retrospective review of 465 consecutive patients. Eur J Trauma Emerg Surg 2015; 43:113-119. [PMID: 26260068 DOI: 10.1007/s00068-015-0556-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 02/22/2015] [Accepted: 07/31/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In Europe, trauma admissions and in particular hip fractures are on the rise. In recent years, health care systems have placed particular emphasis, including financial incentives, on delivering patients quickly and safely to surgery. At our unit, we have observed that hip fracture patients appear to be at significant risk of mortality even up to a year following injury. This study reviews a consecutive population of hip fracture patients to identify predictors of excess risk. MATERIALS AND METHODS Four hundred and sixty-five consecutive patients were treated over a 2-year period at our district general hospital with no ward-based orthogeriatricians. Follow-up was for 1 year following hip fracture admission. Statistical analysis of variables and their influence on 1-year mortality were performed by calculating odd's ratio (OR) using a logistic regression model and a p value <0.05 was considered statistically significant. RESULTS Four patients were lost to follow-up, 18 patients (4.1 %) were managed conservatively, 16 were too unwell for surgery and their mortality rate at 1 year was 50 %. Following hip fracture, we found an overall 1-year mortality rate of 15.1 %. Patients with a time to surgery ≥36 h were at significantly increased risk of mortality even up to 1 year. We did not identify a further reduction in mortality in those operated on within 24 h. Raised ORs (p > 0.05) were found with increasing comorbidity, surgery type, independence on discharge, alcohol ingestion, history of smoking, readmission and several biochemical markers. CONCLUSION Minimising mortality risk, even over the longer term, should begin on admission with prompt optimisation of any acute medical or biochemical abnormalities, followed by early surgery and intensive rehabilitation to maintain patients' functional independence.
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Affiliation(s)
- G J Heyes
- , Apartment 1001, 70 Chichester Street, Belfast, BT1 4JQ, UK.
| | - A Tucker
- Department of Trauma and Orthopaedics, Altnagelvin Hospital, Glenshane Road, County Londonderry, BT47 6SB, Northern Ireland
| | - D Marley
- Department of Trauma and Orthopaedics, Altnagelvin Hospital, Glenshane Road, County Londonderry, BT47 6SB, Northern Ireland
| | - A Foster
- Department of Trauma and Orthopaedics, Altnagelvin Hospital, Glenshane Road, County Londonderry, BT47 6SB, Northern Ireland
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Leidhin CN, Heeney A, Connolly C, Swan N, Foster A, Geraghty J. A Rare Case of BRCA2-Associated Breast Cancer in Pregnancy. Ir Med J 2015; 108:217-218. [PMID: 26349355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 30-year old woman was referred to our department with symptomatic breast cancer at 35 weeks gestation. Genetic testing revealed a pathogenic BRCA2 mutation. Labour was induced at 38 weeks. Mastectomy and axillary clearance were performed with a view to adjuvant chemotherapy, radiation and hormonal therapy. Multidisciplinary involvement is crucial for management of BRCA-associated breast cancer, especially in the context of pregnancy. Bilateral mastectomy may be indicated given the increased risk of ipsilateral and contralateral breast cancers. Tamoxifen may lower contralateral breast cancer risk in those in whom risk-reducing surgery is not performed.
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Ibrahim O, Foster A, Oluleye T. BARRIERS TO AN EFFECTIVE DIABETIC RETINOPATHY SERVICE IN IBADAN, NIGERIA (SUB -SAHARAN AFRICA) - A PILOT QUALITATIVE STUDY. Ann Ib Postgrad Med 2015; 13:36-43. [PMID: 26807085 PMCID: PMC4715371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Diabetic retinopathy is an increasing cause of blindness. The prevalence of retinopathy in hospital attending diabetics in Ibadan is reported to be 42 %. This study assessed the barriers identified by patients and service providers to delivering good services for diabetic retinopathy in Ibadan, Nigeria, Sub-Saharan Africa. METHODS A qualitative survey using non-participatory observation, in-depth interviews (patients and healthcare providers), and focus group discussion for diabetic patients in the eye clinic in University College Hospital, Ibadan was done. Semistructured interview and topic guides were used to evaluate the barriers to effective service. The participants were selected using a non-probability, purposive sampling strategy. Twenty participants were involved in the pilot study. There were ten in-depth interviews of patients and two focus group discussions of patients (3 in each group). Four healthcare providers were interviewed (a retinal surgeon, a senior registrar, an endocrinologist and a public health nurse). RESULTS Lack of awareness that diabetes causes irreversible blindness was identified as a major barrier by both patients and providers. Cost of treatment of diabetes and treatment of retinopathy was also an important barrier. The long waiting time before consultation, staff attitudes to patients and appointment scheduling problems deterred patients from using the service. CONCLUSIONS More diabetic patients can be encouraged to use eye service by providing more detailed information/counselling and making clinic attendance less costly and more convenient.
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Affiliation(s)
- O.A. Ibrahim
- Ancilla Catholic Hospital, Eye Centre, Lagos State, Nigeria, Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
| | - A. Foster
- International Centre for Eye Health (ICEH), London School of Hygiene and Tropical Medicine, UK
| | - T.S. Oluleye
- Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
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Rimner A, Din S, Shaikh F, Foster A, Tyagi N, Abi Aad S, Paik P, Yorke E, Chaft J, Gelblum D, Rosenzweig K, Wu A. Stage III Non-Small Cell Lung Cancer Treated Without Concurrent Chemotherapy: What Is the Optimal Radiation Dose? Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.08.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Patel S, Rimner A, Foster A, Zhang Z, Woo K, Yu H, Riely G, Wu A. Pattern of Failure in Metastatic EGFR-Mutant NSCLC Treated With Erlotinib: A Role for Upfront Radiation Therapy? Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.08.233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rimner A, Din S, Shaikh F, Foster A, Tyagi N, Abi Aad S, Paik P, Yorke E, Chaft J, Gelblum D, Rosenzweig K, Wu A. Stage III Non-Small Cell Lung Cancer Treated Without Concurrent Chemotherapy: What Is the Optimal Radiation Dose? Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Patel S, Rimner A, Foster A, Zhang Z, Woo K, Yu H, Riely G, Wu A. Risk of Brain Metastasis in EGFR-Mutant NSCLC Treated With Erlotinib: A Role for Prophylactic Cranial Irradiation? Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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