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Cummings A, Kelly T, Champaloux EP, Zhang Y, Adami AJ. To the Editor: Resident Perspectives Optimize and Legitimize Redeployment. J Grad Med Educ 2021; 13:593-594. [PMID: 34434527 PMCID: PMC8370371 DOI: 10.4300/jgme-d-20-01529.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Allison Cummings
- Board Member, Resident and Fellow Physician Union-Northwest, and PGY-3 Family Medicine Resident, University of Washington
| | - Tim Kelly
- Secretary, Resident and Fellow Physician Union-Northwest, and PGY-2 Psychiatry Resident, University of Washington
| | - Eve P Champaloux
- Treasurer, Resident and Fellow Physician Union-Northwest, and PGY-3 Otolaryngology Resident, University of Washington
| | - Yuemei Zhang
- Board Member, Resident and Fellow Physician Union-Northwest, and PGY-3 Anesthesiology and Pain Medicine Resident, University of Washington
| | - Alexander J Adami
- Lead Negotiator, Resident and Fellow Physician Union-Northwest, and PGY-3 Internal Medicine Resident, University of Washington
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Siebert AL, Chou S, Toubat O, Adami AJ, Kim H, Daye D, Kwan JM. Factors associated with underrepresented minority physician scientist trainee career choices. BMC Med Educ 2020; 20:422. [PMID: 33176758 PMCID: PMC7656762 DOI: 10.1186/s12909-020-02328-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/21/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Recently, there have been concerted efforts to improve racial and ethnic diversity in the physician-scientist workforce. Identifying factors associated with career choices among those underrepresented in medicine and science is a necessary first step to advance this objective. The aim of the present study was to assess the attitudes and factors associated with academic and research career interests among underrepresented predoctoral physician-scientists. METHODS A cross-sectional 70-question survey was distributed to all predoctoral single degree (MD or DO) and dual degree (MD/PhD or DO/PhD) trainees at 32 medical schools in the United States from 2012 to 2014. Main outcomes included factors important to advancement in academic medicine, intended medical specialty, and future career plans. To test the post-hoc hypothesis of whether trainees from underrepresented groups have differing perceptions of career trajectories and obstacles than their counterparts, we evaluated responses according to self-identified race/ethnic status using Chi-square and Fisher's exact tests. All tests were two-sided and significance level of < 0.05 was used. RESULTS There were a total of 4433 responses representing all predoctoral training stages. The response rate was 27%. Most respondents were single degree trainees (MD/DO 79% vs MD/DO-PhD 21%). Most respondents self-identified as White (67%), followed by Multi-racial or Other (14.3%), Asian or Pacific Islander (10.4%), Hispanic (6%), and Black or African American (4.1%). Desired career sector, career intention, and clinical specialty interest differed across race/ethnic groups. With respect to career selection factors, anticipated non-work related responsibilities during residency were also significantly different between these groups. By multivariable regression analysis, Black or African American trainees were significantly less likely than White trainees to indicate a career in academia (OR 0.496, 95% CI 0.322-0.764) and basic research (OR 0.314, 95% CI 0.115-0.857), while Multi-racial or Other trainees were also less likely than White trainees to indicate a career in academia (OR 0.763, 95% CI 0.594-0.980). CONCLUSIONS These data represent the first in-depth survey of career aspirations, perceptions, and interests between demographically underrepresented and non-underrepresented predoctoral physician-scientist trainees. Our results identify key differences between these cohorts, which may guide efforts to improve diversity within the physician-scientist workforce.
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Affiliation(s)
| | | | - Omar Toubat
- Keck School of Medicine of USC, University of Southern California, Los Angeles, USA
| | - Alexander J Adami
- Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | - Hajwa Kim
- University of Illinois, Chicago, IL, USA
| | - Dania Daye
- Massachusetts General Hospital, Boston, USA.
| | - Jennifer M Kwan
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, 06511, USA.
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Williams CS, Iness AN, Baron RM, Ajijola OA, Hu PJ, Vyas JM, Baiocchi R, Adami AJ, Lever JM, Klein PS, Demer L, Madaio M, Geraci M, Brass LF, Blanchard M, Salata R, Zaidi M. Training the physician-scientist: views from program directors and aspiring young investigators. JCI Insight 2018; 3:125651. [PMID: 30518696 DOI: 10.1172/jci.insight.125651] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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] Open
Abstract
There is growing concern that the physician-scientist is endangered due to a leaky training pipeline and prolonged time to scientific independence (1). The NIH Physician-Scientist Workforce Working Group has concluded that as many as 1,000 individuals will need to enter the pipeline each year to sustain the workforce (2). Moreover, surveys of postgraduate training programs document considerable variability in disposition and infrastructure (3). Programs can be broadly grouped into two classes: physician-scientist training programs (PSTPs) that span residency and fellowship training, and research-in-residency programs (RiRs), which are limited to residency but trainees are able to match into PSTPs upon transitioning to fellowship (Figure 1). Funding sources for RiRs and PSTPs are varied and include NIH KL2 and T32 awards, charitable foundations, philanthropy, and institutional support. Furthermore, standards for research training and tools for evaluating programmatic success are lacking. Here, we share consensus generated from iterative workshops hosted by the Alliance of Academic Internal Medicine (AAIM) and the student-led American Physician Scientists Association (APSA).
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Affiliation(s)
- Christopher S Williams
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Audra N Iness
- MD/PhD Program, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rebecca M Baron
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Olujimi A Ajijola
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Patrick J Hu
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jatin M Vyas
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Baiocchi
- Department of Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Alexander J Adami
- MD/PhD Program, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Jeremie M Lever
- MD/PhD Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter S Klein
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Linda Demer
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Michael Madaio
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Mark Geraci
- Department of Medicine, University of Indiana School of Medicine, Indianapolis, Indiana, USA
| | - Lawrence F Brass
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melvin Blanchard
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert Salata
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mone Zaidi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Zelin NS, Hastings C, Beaulieu-Jones BR, Scott C, Rodriguez-Villa A, Duarte C, Calahan C, Adami AJ. Sexual and gender minority health in medical curricula in new England: a pilot study of medical student comfort, competence and perception of curricula. Med Educ Online 2018; 23:1461513. [PMID: 29717635 PMCID: PMC5933287 DOI: 10.1080/10872981.2018.1461513] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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] [Indexed: 05/04/2023]
Abstract
BACKGROUND Sexual and gender minority (SGM) individuals experience high rates of harassment and discrimination when seeking healthcare, which contributes to substantial healthcare disparities. Improving physician training about gender identity, sexual orientation, and the healthcare needs of SGM patients has been identified as a critical strategy for mitigating these disparities. In 2014, the Association of American Medical Colleges (AAMC) published medical education competencies to guide undergraduate medical education on SGM topics. OBJECTIVE Conduct pilot study to investigate medical student comfort and competence about SGM health competencies outlined by the AAMC and evaluate curricular coverage of SGM topics. DESIGN Six-hundred and fifty-eight students at New England allopathic medical schools (response rate 21.2%) completed an anonymous, online survey evaluating self-reported comfort and competence regarding SGM health competencies, and coverage of SGM health in the medical curriculum. RESULTS 92.7% of students felt somewhat or very comfortable treating sexual minorities; 68.4% felt comfortable treating gender minorities. Most respondents felt not competent or somewhat not competent with medical treatment of gender minority patients (76.7%) and patients with a difference of sex development (81%). At seven schools, more than 50% of students indicated that the curriculum neither adequately covers SGM-specific topics nor adequately prepares students to serve SGM patients. CONCLUSIONS The prevalence of self-reported comfort is greater than that of self-reported competence serving SGM patients in a convenience sample of New England allopathic medical students. The majority of participants reported insufficient curricular preparation to achieve the competencies necessary to care for SGM patients. This multi-institution pilot study provides preliminary evidence that further curriculum development may be needed to enable medical students to achieve core competencies in SGM health, as defined by AAMC. Further mixed methods research is necessary to substantiate and expand upon the findings of this pilot study. This pilot study also demonstrates the importance of creating specific evaluation tools to assess medical student achievement of competencies established by the AAMC.
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Affiliation(s)
- Nicole Sitkin Zelin
- Yale University School of Medicine, New Haven, CT, USA
- CONTACT Nicole Sitkin Zelin Yale University School of Medicine, New Haven, CT, USA
| | - Charlotte Hastings
- The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, VT, USA
| | | | - Caroline Scott
- School of Public Health and Tropical Medicine of Tulane University, New Orleans, LA, USA
| | | | - Cassandra Duarte
- The Warren Alpert School of Medicine at Brown University, Providence, RI, USA
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Adami AJ, Bracken SJ, Guernsey LA, Rafti E, Maas KR, Graf J, Matson AP, Thrall RS, Schramm CM. Early-life antibiotics attenuate regulatory T cell generation and increase the severity of murine house dust mite-induced asthma. Pediatr Res 2018; 84:426-434. [PMID: 29967529 PMCID: PMC6258300 DOI: 10.1038/s41390-018-0031-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/29/2018] [Accepted: 04/10/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Early-life exposure to antibiotics (ABX) has been linked to increases in asthma severity and prevalence in both children and laboratory animals. We explored the immunologic mechanisms behind this association using a mouse model of house dust mite (HDM)-induced asthma and early-life ABX exposure. METHODS Mice were exposed to three short courses of ABX following weaning and experimental asthma was thereafter induced. Airway cell counts and differentials; serum immunoglobulin E (IgE); pulmonary function; lung histopathology; pulmonary regulatory T cells (Tregs); and the fecal microbiome were characterized following ABX exposure and induction of experimental asthma. RESULTS Asthma severity was increased in mice exposed to ABX, including: airway eosinophilia, airway hyper-reactivity, serum HDM-specific IgE, and lung histopathology. ABX treatment led to sharp reduction in fecal microbiome diversity, including the loss of pro-regulatory organisms such as Lachnospira. Pulmonary Tregs were reduced with ABX treatment, and this reduction was directly proportional to diminished microbiome diversity. CONCLUSION Intermittent exposure to ABX early in life worsened the severity of experimental asthma and reduced pulmonary Tregs; the latter change correlated with decreased microbiome diversity. These data may suggest targets for immunologic or probiotic therapy to counteract the harmful effects of childhood ABX.
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Affiliation(s)
- Alexander J. Adami
- Department of Immunology, University of Connecticut Health, Farmington, CT
| | - Sonali J. Bracken
- Department of Immunology, University of Connecticut Health, Farmington, CT
| | - Linda A. Guernsey
- Department of Immunology, University of Connecticut Health, Farmington, CT,Department of Pediatrics, University of Connecticut Health, Farmington, CT
| | - Ektor Rafti
- Department of Pediatrics, University of Connecticut Health, Farmington, CT
| | - Kendra R. Maas
- Microbial Analysis, Resources, and Services Facility, University of Connecticut, Storrs, CT
| | - Joerg Graf
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT
| | - Adam P. Matson
- Department of Immunology, University of Connecticut Health, Farmington, CT,Department of Pediatrics, University of Connecticut Health, Farmington, CT,Division of Neonatology, Connecticut Children’s Medical Center, Hartford, CT
| | - Roger S. Thrall
- Department of Immunology, University of Connecticut Health, Farmington, CT
| | - Craig M. Schramm
- Department of Pediatrics, University of Connecticut Health, Farmington, CT,Division of Pulmonary Medicine, Connecticut Children’s Medical Center, Hartford, CT,Corresponding Author: Craig M. Schramm, Connecticut Children’s Medical Center, 282 Washington
Street, Hartford, CT 06106; ; Telephone: 860-545- 9440; Fax: 860-545-9445
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Fox BM, Adami AJ, Hull TD. Reinforcing our pipeline: trainee-driven approaches to improving physician-scientist training. J Clin Invest 2018; 128:3206-3208. [PMID: 30010622 DOI: 10.1172/jci122100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Brandon M Fox
- Medical Scientist Training Program, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Alexander J Adami
- MD-PhD Program, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Travis D Hull
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Bracken SJ, Adami AJ, Rafti E, Schramm CM, Matson AP. Regulation of IgE activity in inhalational tolerance via formation of IgG anti-IgE/IgE immune complexes. Clin Mol Allergy 2018; 16:13. [PMID: 29796009 PMCID: PMC5960149 DOI: 10.1186/s12948-018-0091-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background Allergic asthma is an inflammatory disorder of the airways that results from inappropriate production of IgE against harmless, environmental antigens. Sequestration of free IgE using humanized IgG anti-IgE is an effective therapy for asthma and other atopic disorders. However, the status of free IgE in subjects who have naturally developed immune tolerance to inhaled antigens has not been well studied. Methods C57BL/6 mice were sensitized and challenged with ovalbumin (OVA) for 7 days to induce allergic airway disease (AAD) or 6 weeks to induce a state of local inhalational tolerance (LIT). Serum from AAD or LIT mice, diluted to achieve equivalent levels of total OVA-specific IgE, was used to sensitize rat basophil leukemia cells for allergen-mediated degranulation. Levels of degranulation were measured in relation to serum concentrations of free IgE and IgG anti-IgE/IgE immune complexes. Results Serum from AAD animals induced a greater degree of basophil degranulation than serum from LIT animals. These results correlated with higher levels of free IgE in AAD animals, whereas LIT mice demonstrated a significant increase in IgG anti-IgE/IgE immune complexes relative to their diseased counterparts. Conclusions Sequestration of free IgE by naturally occurring IgG anti-IgE may aid in the development of immune tolerance against inhaled allergens. The decrease in bioavailability of free IgE may, in turn, contribute to the overall reduction of asthma symptoms via a mechanism that mimics the therapeutic effects of humanized IgG anti-IgE.
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Affiliation(s)
- Sonali J Bracken
- 1Department of Immunology, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT 06030 USA
| | - Alexander J Adami
- 1Department of Immunology, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT 06030 USA
| | - Ektor Rafti
- 2Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT USA
| | - Craig M Schramm
- 2Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT USA
| | - Adam P Matson
- 1Department of Immunology, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT 06030 USA.,2Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT USA
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9
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Kwan JM, Daye D, Schmidt ML, Conlon CM, Kim H, Gaonkar B, Payne AS, Riddle M, Madera S, Adami AJ, Winter KQ. Exploring intentions of physician-scientist trainees: factors influencing MD and MD/PhD interest in research careers. BMC Med Educ 2017; 17:115. [PMID: 28697782 PMCID: PMC5505137 DOI: 10.1186/s12909-017-0954-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/27/2017] [Indexed: 05/03/2023]
Abstract
BACKGROUND Prior studies have described the career paths of physician-scientist candidates after graduation, but the factors that influence career choices at the candidate stage remain unclear. Additionally, previous work has focused on MD/PhDs, despite many physician-scientists being MDs. This study sought to identify career sector intentions, important factors in career selection, and experienced and predicted obstacles to career success that influence the career choices of MD candidates, MD candidates with research-intense career intentions (MD-RI), and MD/PhD candidates. METHODS A 70-question survey was administered to students at 5 academic medical centers with Medical Scientist Training Programs (MSTPs) and Clinical and Translational Science Awards (CTSA) from the NIH. Data were analyzed using bivariate or multivariate analyses. RESULTS More MD/PhD and MD-RI candidates anticipated or had experienced obstacles related to balancing academic and family responsibilities and to balancing clinical, research, and education responsibilities, whereas more MD candidates indicated experienced and predicted obstacles related to loan repayment. MD/PhD candidates expressed higher interest in basic and translational research compared to MD-RI candidates, who indicated more interest in clinical research. Overall, MD-RI candidates displayed a profile distinct from both MD/PhD and MD candidates. CONCLUSIONS MD/PhD and MD-RI candidates experience obstacles that influence their intentions to pursue academic medical careers from the earliest training stage, obstacles which differ from those of their MD peers. The differences between the aspirations of and challenges facing MD, MD-RI and MD/PhD candidates present opportunities for training programs to target curricula and support services to ensure the career development of successful physician-scientists.
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Affiliation(s)
- Jennifer M Kwan
- American Physician Scientists Association, Westford, MA, USA.
- Internal Medicine Physician Scientist Training Program, University of Illinois Chicago, College of Medicine, Chicago, USA.
| | - Dania Daye
- American Physician Scientists Association, Westford, MA, USA.
- Brigham and Women's Hospital, Boston, USA.
- Harvard Medical School, Boston, USA.
| | - Mary Lou Schmidt
- Pediatrics, University of Illinois Chicago, College of Medicine, Chicago, USA
| | - Claudia Morrissey Conlon
- United States Agency for International Development, Washington, USA
- Saving Mothers, Giving Life, Washington, USA
| | - Hajwa Kim
- Center for Clinical Translational Sciences, University of Illinois Chicago, College of Medicine, Chicago, USA
| | | | - Aimee S Payne
- Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | | | - Sharline Madera
- Medical Scientist Training Program, Weill Cornell Medical College, New York, USA
| | - Alexander J Adami
- American Physician Scientists Association, Westford, MA, USA
- MD/PhD Program, University of Connecticut Health, Farmington, CT, USA
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Adami AJ, Bracken SJ. Breathing Better Through Bugs: Asthma and the Microbiome. Yale J Biol Med 2016; 89:309-324. [PMID: 27698615 PMCID: PMC5045140] [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] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Asthma is a highly heterogeneous disease characterized by inflammation of the airways, which invokes symptoms such as wheeze, dyspnea, and chest tightness. Asthma is the product of multiple interconnected immunological processes and represents a constellation of related, but distinct, disease phenotypes. The prevalence of asthma has more than doubled since the 1980s, and efforts to understand this increase have inspired consideration of the microbiome as a key player in the pathophysiology and regulation of this disease. While recent years have seen an explosion of new research in this area, researchers are only beginning to untangle to mechanisms by which the microbiome may influence asthma. This review will focus on the relationship between the microbiome and the immune system and how this influences development of asthma. This review will also highlight evidence that may point the way toward new therapies and potential cures for this ancient respiratory foe.
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Affiliation(s)
- Alexander J. Adami
- To whom all correspondence should be addressed: Alexander J. Adami, MD/PhD Student, University of Connecticut Health Center, Department of Immunology, 263 Farmington Avenue, MC 1319, Farmington, CT 06030, , Phone: 1-860-679-1995, Fax: 1-860-679-1047
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Vang AG, Basole C, Dong H, Nguyen RK, Housley W, Guernsey L, Adami AJ, Thrall RS, Clark RB, Epstein PM, Brocke S. Differential Expression and Function of PDE8 and PDE4 in Effector T cells: Implications for PDE8 as a Drug Target in Inflammation. Front Pharmacol 2016; 7:259. [PMID: 27601994 PMCID: PMC4993990 DOI: 10.3389/fphar.2016.00259] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 02/03/2016] [Accepted: 08/02/2016] [Indexed: 11/22/2022] Open
Abstract
Abolishing the inhibitory signal of intracellular cAMP is a prerequisite for effector T (Teff) cell function. The regulation of cAMP within leukocytes critically depends on its degradation by cyclic nucleotide phosphodiesterases (PDEs). We have previously shown that PDE8A, a PDE isoform with 40–100-fold greater affinity for cAMP than PDE4, is selectively expressed in Teff vs. regulatory T (Treg) cells and controls CD4+ Teff cell adhesion and chemotaxis. Here, we determined PDE8A expression and function in CD4+ Teff cell populations in vivo. Using magnetic bead separation to purify leukocyte populations from the lung draining hilar lymph node (HLN) in a mouse model of ovalbumin-induced allergic airway disease (AAD), we found by Western immunoblot and quantitative (q)RT-PCR that PDE8A protein and gene expression are enhanced in the CD4+ T cell fraction over the course of the acute inflammatory disease and recede at the late tolerant non-inflammatory stage. To evaluate PDE8A as a potential drug target, we compared the selective and combined effects of the recently characterized highly potent PDE8-selective inhibitor PF-04957325 with the PDE4-selective inhibitor piclamilast (PICL). As previously shown, PF-04957325 suppresses T cell adhesion to endothelial cells. In contrast, we found that PICL alone increased firm T cell adhesion to endothelial cells by ~20% and significantly abrogated the inhibitory effect of PF-04957325 on T cell adhesion by over 50% when cells were co-exposed to PICL and PF-04957325. Despite its robust effect on T cell adhesion, PF-04957325 was over two orders of magnitude less efficient than PICL in suppressing polyclonal Teff cell proliferation, and showed no effect on cytokine gene expression in these cells. More importantly, PDE8 inhibition did not suppress proliferation and cytokine production of myelin-antigen reactive proinflammatory Teff cells in vivo and in vitro. Thus, targeting PDE8 through PF-04957325 selectively regulates Teff cell interactions with endothelial cells without marked immunosuppression of proliferation, while PDE4 inhibition has partially opposing effects. Collectively, our data identify PF-04957325 as a novel function-specific tool for the suppression of Teff cell adhesion and indicate that PDE4 and PDE8 play unique and non-redundant roles in the control of Teff cell functions.
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Affiliation(s)
- Amanda G Vang
- Department of Immunology, University of Connecticut Health CenterFarmington, CT, USA; Department of Diagnostic Medicine, National Hospital of the Faroe IslandsTórshavn, Faroe Islands
| | - Chaitali Basole
- Department of Immunology, University of Connecticut Health Center Farmington, CT, USA
| | - Hongli Dong
- Department of Cell Biology, University of Connecticut Health Center Farmington, CT, USA
| | - Rebecca K Nguyen
- Department of Immunology, University of Connecticut Health Center Farmington, CT, USA
| | - William Housley
- Department of Immunology, University of Connecticut Health Center Farmington, CT, USA
| | - Linda Guernsey
- Department of Immunology, University of Connecticut Health Center Farmington, CT, USA
| | - Alexander J Adami
- Department of Immunology, University of Connecticut Health Center Farmington, CT, USA
| | - Roger S Thrall
- Department of Immunology, University of Connecticut Health Center Farmington, CT, USA
| | - Robert B Clark
- Department of Immunology, University of Connecticut Health Center Farmington, CT, USA
| | - Paul M Epstein
- Department of Cell Biology, University of Connecticut Health Center Farmington, CT, USA
| | - Stefan Brocke
- Department of Immunology, University of Connecticut Health Center Farmington, CT, USA
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Szczepanek SM, Roberts S, Rogers K, Cotte C, Adami AJ, Bracken SJ, Salmon S, Secor ER, Thrall RS, Andemariam B, Metzger DW. Poor Long-Term Efficacy of Prevnar-13 in Sickle Cell Disease Mice Is Associated with an Inability to Sustain Pneumococcal-Specific Antibody Titers. PLoS One 2016; 11:e0149261. [PMID: 26910228 PMCID: PMC4766082 DOI: 10.1371/journal.pone.0149261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 01/30/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND One of the most common causes of morbidity and mortality in children with sickle cell disease (SCD) is infection with the pneumococcal bacterium (Streptococcus pneumoniae). Unfortunately, the polysaccharide-conjugate vaccine appears to be less effective in individuals with SCD when compared to the general population. We sought to better understand the relative efficacy of pneumococcal vaccination in a SCD mouse challenge model. METHODS Transgenic control and SCD mice were monitored for mortality after intranasal pneumococcal infection or pneumococcal vaccination with Prevnar-13 and type-matched challenge. Anti-pneumococcal antibody titers were measured by ELISA and opsonophagocytosis was measured in vitro. RESULTS Mortality after pneumococcal infection was similar between control and SCD mice. However, after three intramuscular polysaccharide-conjugate vaccinations, all control mice were protected following high-dose intranasal infection, whereas 60% of SCD mice died. Anti-pneumococcal antibody titers showed initial IgG and IgM responses in both groups, but waning titers were observed in the SCD group, even after boosting. When functionally assayed in vitro, serum from SCD mice 13 weeks after a second booster shot maintained little to no ability to opsonize pneumococci, while serum from control mice sustained a significantly higher capacity opsonization. Thus, it appears that SCD mice do not maintain antibody responses to pneumococcal polysaccharides after Prevnar-13 vaccination, thereby leaving them susceptible to mortality after type-matched infection. CONCLUSION Our results emphasize the need to better understand the correlates of immune protection in SCD so that pneumococcal vaccines can be improved and mortality reduced in this susceptible population.
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Affiliation(s)
- Steven M. Szczepanek
- Center of Excellence for Vaccine Research, Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT, United States of America, 06269
- * E-mail:
| | - Sean Roberts
- Center for Immunology and Microbial Disease, Albany Medical College, Albany, NY, United States of America, 12208
| | - Kara Rogers
- Center of Excellence for Vaccine Research, Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT, United States of America, 06269
| | - Christina Cotte
- Center of Excellence for Vaccine Research, Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT, United States of America, 06269
| | - Alexander J. Adami
- Department of Immunology, University of Connecticut Health Center, Farmington, CT, United States of America, 06030
| | - Sonali J. Bracken
- Department of Immunology, University of Connecticut Health Center, Farmington, CT, United States of America, 06030
| | - Sharon Salmon
- Center for Immunology and Microbial Disease, Albany Medical College, Albany, NY, United States of America, 12208
| | - Eric R. Secor
- Helen and Harry Gray Cancer Center and Department of Medicine, Division of Integrative Medicine, Hartford Hospital, Hartford, CT, United States of America, 06106
| | - Roger S. Thrall
- Department of Immunology, University of Connecticut Health Center, Farmington, CT, United States of America, 06030
| | - Biree Andemariam
- The Lea’s Foundation Center for Hematological Disorders, Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington, CT, United States of America, 06030
| | - Dennis W. Metzger
- Center for Immunology and Microbial Disease, Albany Medical College, Albany, NY, United States of America, 12208
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Andemariam B, Adami AJ, Singh A, McNamara JT, Secor ER, Guernsey LA, Thrall RS. The sickle cell mouse lung: proinflammatory and primed for allergic inflammation. Transl Res 2015; 166:254-68. [PMID: 25843670 PMCID: PMC4537824 DOI: 10.1016/j.trsl.2015.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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] [Received: 12/02/2014] [Revised: 02/09/2015] [Accepted: 03/10/2015] [Indexed: 01/22/2023]
Abstract
Comorbid asthma in sickle cell disease (SCD) confers higher rates of vaso-occlusive pain and mortality, yet the physiological link between these two distinct diseases remains puzzling. We used a mouse model of SCD to study pulmonary immunology and physiology before and after the induction of allergic airway disease (AAD). SCD mice were sensitized with ovalbumin (OVA) and aluminum hydroxide by the intraperitoneal route followed by daily, nose-only OVA-aerosol challenge to induce AAD. The lungs of naive SCD mice showed signs of inflammatory and immune processes: (1) histologic and cytochemical evidence of airway inflammation compared with naive wild-type mice; (2) bronchoalveolar lavage (BAL) fluid contained increased total lymphocytes, %CD8+ T cells, granulocyte-colony stimulating factor, interleukin 5 (IL-5), IL-7, and chemokine (C-X-C motif) ligand (CXCL)1; and (3) lung tissue and hilar lymph node (HLN) had increased CD4+, CD8+, and regulatory T (Treg) cells. Furthermore, SCD mice at AAD demonstrated significant changes compared with the naive state: (1) BAL fluid with increased %CD4+ T cells and Treg cells, lower %CD8+ T cells, and decreased interferon gamma, CXCL10, chemokine (C-C motif) ligand 2, and IL-17; (2) serum with increased OVA-specific immunoglobulin E, IL-6, and IL-13, and decreased IL-1α and CXCL10; (3) no increase in Treg cells in the lung tissue or HLN; and (4) hyporesponsiveness to methacholine challenge. In conclusion, SCD mice have an altered immunologic pulmonary milieu and physiological responsiveness. These findings suggest that the clinical phenotype of AAD in SCD mice differs from that of wild-type mice and that individuals with SCD may also have a unique, divergent phenotype perhaps amenable to a different therapeutic approach.
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Affiliation(s)
- Biree Andemariam
- Division of Hematology-Oncology, Lea Center for Hematologic Disorders, Adult Sickle Cell Center, University of Connecticut Health Center, Farmington, Conn.
| | - Alexander J Adami
- Department of Immunology, University of Connecticut Health Center, Farmington, Conn
| | - Anurag Singh
- Department of Immunology, University of Connecticut Health Center, Farmington, Conn
| | - Jeffrey T McNamara
- Department of Immunology, University of Connecticut Health Center, Farmington, Conn
| | - Eric R Secor
- Department of Immunology, University of Connecticut Health Center, Farmington, Conn
| | - Linda A Guernsey
- Department of Immunology, University of Connecticut Health Center, Farmington, Conn
| | - Roger S Thrall
- Department of Immunology, University of Connecticut Health Center, Farmington, Conn
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14
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Vigil GD, Adami AJ, Ahmed T, Khan A, Chapman S, Andemariam B, Thrall RS, Howard SS. Label-free and depth resolved optical sectioning of iron-complex deposits in sickle cell disease splenic tissue by multiphoton microscopy. J Biomed Opt 2015; 20:066001. [PMID: 26042382 DOI: 10.1117/1.jbo.20.6.066001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 04/21/2015] [Indexed: 06/04/2023]
Abstract
Multiphoton microscopy (MPM) imaging of intrinsic two-photon excited fluorescence (TPEF) is performed on humanized sickle cell disease (SCD) mouse model splenic tissue. Distinct morphological and spectral features associated with SCD are identified and discussed in terms of diagnostic relevance. Specifically, spectrally unique splenic iron-complex deposits are identified by MPM; this finding is supported by TPEF spectroscopy and object size to standard histopathological methods. Further, iron deposits are found at higher concentrations in diseased tissue than in healthy tissue by all imaging methods employed here including MPM, and therefore, may provide a useful biomarker related to the disease state. These newly characterized biomarkers allow for further investigations of SCD in live animals as a means to gain insight into the mechanisms impacting immune dysregulation and organ malfunction, which are currently not well understood.
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Affiliation(s)
- Genevieve D Vigil
- University of Notre Dame, Department of Electrical Engineering, 275 Fitzpatrick Hall, Notre Dame, Indiana 46556, United States
| | - Alexander J Adami
- University of Connecticut Health Center, Department of Immunology, 263 Farmington Avenue, Farmington, Connecticut 06030-3710, United States
| | - Tahsin Ahmed
- University of Notre Dame, Department of Electrical Engineering, 275 Fitzpatrick Hall, Notre Dame, Indiana 46556, United States
| | - Aamir Khan
- University of Notre Dame, Department of Electrical Engineering, 275 Fitzpatrick Hall, Notre Dame, Indiana 46556, United States
| | - Sarah Chapman
- University of Notre Dame, Notre Dame Integrated Imaging Facility Histology Core, 400 D Friemann Life Science Center, Notre Dame, Indiana 46556, United States
| | - Biree Andemariam
- University of Connecticut Health Center, Department of Medicine, 263 Farmington Avenue, Farmington, Connecticut 06030-3710, United States
| | - Roger S Thrall
- University of Connecticut Health Center, Department of Immunology, 263 Farmington Avenue, Farmington, Connecticut 06030-3710, United States
| | - Scott S Howard
- University of Notre Dame, Department of Electrical Engineering, 275 Fitzpatrick Hall, Notre Dame, Indiana 46556, United States
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15
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Bracken SJ, Adami AJ, Szczepanek SM, Ehsan M, Natarajan P, Guernsey LA, Shahriari N, Rafti E, Matson AP, Schramm CM, Thrall RS. Long-Term Exposure to House Dust Mite Leads to the Suppression of Allergic Airway Disease Despite Persistent Lung Inflammation. Int Arch Allergy Immunol 2015; 166:243-58. [PMID: 25924733 DOI: 10.1159/000381058] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 02/18/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Allergic asthma is a major cause of worldwide morbidity and results from inadequate immune regulation in response to innocuous, environmental antigens. The need exists to understand the mechanisms that promote nonreactivity to human-relevant allergens such as house dust mite (HDM) in order to develop curative therapies for asthma. The aim of our study was to compare the effects of short-, intermediate- and long-term HDM administration in a murine asthma model and determine the ability of long-term HDM exposure to suppress allergic inflammation. METHODS C57BL/6 mice were intranasally instilled with HDM for short-term (2 weeks), intermediate-term (5 weeks) and long-term (11 weeks) periods to induce allergic airway disease (AAD). The severity of AAD was compared across all stages of the model via both immunological and pulmonary parameters. RESULTS Short- and intermediate-term HDM exposure stimulated the development of AAD that included eosinophilia in the bronchoalveolar lavage fluid (BALF), pronounced airway hyperreactivity (AHR) and evidence of lung inflammation. Long-term HDM exposure promoted the suppression of AAD, with a loss of BALF eosinophilia and AHR despite persistent mononuclear inflammation in the lungs. Suppression of AAD with long-term HDM exposure was associated with an increase in both Foxp3+ regulatory T cells and IL-10-positive alveolar macrophages at the site of inflammation. CONCLUSIONS This model recapitulates the key features of human asthma and may facilitate investigation into the mechanisms that promote immunological tolerance against clinically relevant aeroallergens.
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Affiliation(s)
- Sonali J Bracken
- Department of Immunology, University of Connecticut Health Center, Farmington, Conn., USA
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16
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Adami GR, Adami AJ. Looking in the mouth for noninvasive gene expression-based methods to detect oral, oropharyngeal, and systemic cancer. ISRN Oncol 2012; 2012:931301. [PMID: 23050165 PMCID: PMC3462394 DOI: 10.5402/2012/931301] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/12/2012] [Indexed: 01/15/2023]
Abstract
Noninvasive diagnosis, whether by sampling body fluids, body scans, or other technique, has the potential to simplify early cancer detection. A classic example is Pap smear screening, which has helped to reduce cervical cancer 75% over the last 50 years. No test is error-free; the real concern is sufficient accuracy combined with ease of use. This paper will discuss methods that measure gene expression or epigenetic markers in oral cells or saliva to diagnose oral and pharyngeal cancers, without requiring surgical biopsy. Evidence for lung and other distal cancer detection is also reviewed.
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Affiliation(s)
- Guy R Adami
- Department of Oral Medicine and Diagnostic Sciences, Center for Molecular Biology of Oral Diseases, University of Illinois at Chicago, Chicago, IL 60612, USA
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Adami AJ, O'Keefe L, Venna VR, Li J, Siegel CS, Benashski SE, McCullough LD. Abstract 3432: Sex-dependent Differences in Autophagy After Experimentally-induced Stroke. Stroke 2012. [DOI: 10.1161/str.43.suppl_1.a3432] [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
Background and Purpose:
Autophagy is a catabolic process where the cell consumes pieces of itself as a part of normal cellular growth, development, and homeostasis. In response to nutrient challenge or other stressors, including ischemia, autophagy levels may rise, enabling the cell to survive. Autophagy has been shown to play a role in the cellular response to neonatal cerebral ischemia, and sex differences have been found in cell culture models of neuronal nutrient starvation. However, the role of sex in the autophagic response to stroke has not been investigated
in vivo
. The objective of this study was to examine the impact of sex on autophagy following experimental stroke.
Methods:
Stroke was induced by reversible right middle cerebral artery occlusion (MCAO - 90 minutes) in male, gonadally-intact female, and ovariectomized (OVX) WT C57BL/6 mice (20-25 gm). Autophagy activity was assessed at 6 and 24 hours following MCAO with LC3-I/II and Atg7 protein levels by western blot (n=3 MCAO; n=3 sham/group). Beta-actin was utilized as a loading control.
Results:
Atg7 levels were higher in sham males at both the 6h and 24h timepoint compared to intact females and OVX females. After MCAO, males and OXV females showed increased levels of Atg7 relative to sham at 6h, while intact female levels were unchanged. By 24h, Atg7 levels in MCAO males and OVX females remained higher than sham, while intact females showed no difference. LC3-II levels were higher in MCAO for OVX females at 6h and 24h, while intact females saw transiently-elevated LC3-II levels at 6h and no elevation by 24h. Males had higher levels of LC3-II in both MCAO and sham relative to intact females at both 6h and 24h and higher levels than OVX females at 6h.
Conclusions:
This study demonstrates that autophagy activation in response to stroke differs between the sexes. We found that males had overall higher levels of autophagy than both OVX females and intact females at both 6h and 24h. Both males and OVX females showed higher levels of autophagy at 24h and 6h after MCAO relative to sham, while females showed no change. Our study suggests that changes in autophagy may contribute to the differential outcome after stroke between the sexes. Studies examining sex differences in infarct size after MCAO after inhibition of autophagy with 3-methyladenine (3-MA, Sigma-Aldrich, St. Louis, MO) are ongoing in our laboratory.
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Affiliation(s)
| | | | | | - Jun Li
- Univ of Connecticut, Farmington, CT
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Schwartz JL, Brunnemann KD, Adami AJ, Panda S, Gordon SC, Hoffmann D, Adami GR. Brand specific responses to smokeless tobacco in a rat lip canal model. J Oral Pathol Med 2010; 39:453-9. [DOI: 10.1111/j.1600-0714.2010.00892.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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