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McMurray JC, Pacheco CS, Schornack BJ, Sun X, Brunader JA, Scott AE, Ariza JS, Kou CTJ, Costantino RC, Pittman LM, Adams KE, Waters AM, Pryor EM, Lyons JJ, Metcalfe D, Maric I, Boggs NA. Standardized indolent systemic mastocytosis evaluations across a healthcare system: implications for screening accuracy. Blood 2024:blood.2023023347. [PMID: 38635793 DOI: 10.1182/blood.2023023347] [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] [Received: 12/06/2023] [Revised: 03/11/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024] Open
Abstract
Timely diagnosis of systemic mastocytosis (SM) remains challenging due to care heterogeneity. We implemented a standardized approach for SM screening and diagnosis utilizing a novel healthcare system-wide international screening registry. A retrospective analysis assessed rates of SM, cutaneous mastocytosis (CM), and molecular diagnoses before and two years after care standardization. Accuracy of individual and combined SM screening tests - basal serum tryptase (BST) ≥11.5 and ≥20.0 ng/mL, REMA ≥2, monomorphic maculopapular CM, and elevated BST based upon tryptase genotype - was analyzed. Tryptase genotyping and high-sensitivity KIT p.D816V testing increased substantially two years following care standardization. SM diagnoses doubled from 47 to 94 and KIT p.D816V molecular diagnoses increased from 24 to 79. Mean BST and KIT p.D816V variant allele frequency (VAF) values were significantly lower in patients diagnosed after standardization. Hereditary-alpha tryptasemia prevalence was increased in SM prior to care standardization at 4/30 (13.3%) but reflected the general population prevalence two years later at 5/76 (6.6%). Elevated BST based upon genotype and BST ≥11.5 ng/mL had the highest sensitivities at 84.2% and 88.3%, respectively. Presence of monomorphic MPCM, elevated BST based upon tryptase genotype, and the combination of REMA ≥2 with elevated BST based upon tryptase genotype had specificities >90%. BST >20.0 ng/mL had low sensitivity and specificity and was not required to establish any indolent SM diagnosis. Care standardization increased SM diagnosis rates, particularly in patients with low BSTs. Stratifying BST based upon genotype had the best overall sensitivity and specificity of any indolent SM screening test and improved the REMA score specificity.
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Affiliation(s)
- Jeremy C McMurray
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States
| | - Curtis S Pacheco
- Brooke Army Medical Center, Fort Sam Houston, Texas, United States
| | - Brandon J Schornack
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States
| | - Xiaoping Sun
- Clinical center, national institute of health, Bethesda, Maryland, United States
| | - Janet A Brunader
- Defense Health Agency Immunization Healthcare Division, United States
| | | | - Juan S Ariza
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States
| | - Chung-Ting J Kou
- Brooke Army Medical Center, Fort Sam Houston, Texas, United States
| | - Ryan C Costantino
- Defense Healthcare Management Systems, San Antonio, Texas, United States
| | - Luke M Pittman
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States
| | - Karla E Adams
- Wilford Hall Ambulatory Surgical Center, JBSA-Lackland, Texas, United States
| | | | - Eric M Pryor
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States
| | - Jonathan J Lyons
- University of California San Diego, La Jolla, California, United States
| | | | | | - Nathan A Boggs
- Walter Reed National Military Medical Center, United States
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Kovacs-Simon A, Hemsley CM, Scott AE, Prior JL, Titball RW. Burkholderia thailandensis strain E555 is a surrogate for the investigation of Burkholderia pseudomallei replication and survival in macrophages. BMC Microbiol 2019; 19:97. [PMID: 31092204 PMCID: PMC6521459 DOI: 10.1186/s12866-019-1469-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 12/06/2018] [Accepted: 04/30/2019] [Indexed: 02/02/2023] Open
Abstract
Background Burkholderia pseudomallei is a human pathogen causing severe infections in tropical and subtropical regions and is classified as a bio-threat agent. B. thailandensis strain E264 has been proposed as less pathogenic surrogate for understanding the interactions of B. pseudomallei with host cells. Results We show that, unlike B. thailandensis strain E264, the pattern of growth of B. thailandensis strain E555 in macrophages is similar to that of B. pseudomallei. We have genome sequenced B. thailandensis strain E555 and using the annotated sequence identified genes and proteins up-regulated during infection. Changes in gene expression identified more of the known B. pseudomallei virulence factors than changes in protein levels and used together we identified 16% of the currently known B. pseudomallei virulence factors. These findings demonstrate the utility of B. thailandensis strain E555 to study virulence of B. pseudomallei. Conclusions A weakness of studies using B. thailandensis as a surrogate for B. pseudomallei is that the strains used replicate at a slower rate in infected cells. We show that the pattern of growth of B. thailandensis strain E555 in macrophages closely mirrors that of B. pseudomallei. Using this infection model we have shown that virulence factors of B. pseudomallei can be identified as genes or proteins whose expression is elevated on the infection of macrophages. This finding confirms the utility of B. thailandensis strain E555 as a surrogate for B. pseudomallei and this strain should be used for future studies on virulence mechanisms. Electronic supplementary material The online version of this article (10.1186/s12866-019-1469-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Kovacs-Simon
- College of Life and Environmental Sciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter, EX4 4QD, UK.
| | - C M Hemsley
- College of Life and Environmental Sciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter, EX4 4QD, UK
| | - A E Scott
- CBR Division, Defence Science and Technology Laboratory, Porton Down, Salisbury, SP4 0JQ, UK
| | - J L Prior
- College of Life and Environmental Sciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter, EX4 4QD, UK.,CBR Division, Defence Science and Technology Laboratory, Porton Down, Salisbury, SP4 0JQ, UK
| | - R W Titball
- College of Life and Environmental Sciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter, EX4 4QD, UK
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Williams MC, Weir NW, Mirsadraee S, Scott AE, Uren NG, McKillop G, Bull RK, van Beek EJR, Reid JH, Newby DE. 116 IMAGE QUALITY AND RADIATION DOSE WITH SINGLE HEART BEAT 320 MULTIDETECTOR CT CORONARY ANGIOGRAPHY. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Harding CR, Moore AE, Rogers JS, Meldrum H, Scott AE, McGlone FP. Dandruff: a condition characterized by decreased levels of intercellular lipids in scalp stratum corneum and impaired barrier function. Arch Dermatol Res 2002; 294:221-30. [PMID: 12115025 DOI: 10.1007/s00403-002-0323-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2001] [Revised: 01/15/2002] [Accepted: 04/24/2002] [Indexed: 11/28/2022]
Abstract
Dandruff is a major problem, yet little is known about the underlying mechanism and subsequent biochemical changes occurring in the scalp skin that lead to its manifestation. The characteristic flaking and scaling of the scalp experienced by dandruff sufferers suggests, similar to the changes classically seen in xerosis, that the desquamation process is impaired. We initiated studies to quantify the biochemical nature of the stratum corneum in the scalp of healthy individuals and dandruff sufferers. Total amounts and relative ratios of stratum corneum lipids species were analysed in scalp stratum corneum samples collected during studies conducted in the UK and Thailand in order to examine ethnic differences. In both populations, dandruff was associated with a dramatic decrease in free lipid levels, with significant decreases in ceramides, fatty acids, and cholesterol. Detailed sub-analysis of the major ceramide species within the total ceramide fraction revealed a decrease in ceramide 1 and increased proportions of ceramide 6i and 6ii. In a separate study, we demonstrated that dandruff sufferers show both an elevated blood flow and an increased reported incidence of itch in response to histamine topically applied to the scalp compared with no-dandruff controls. Taken together these two studies indicate that the quality and resilience of the epidermal water barrier is impaired in the scalp of dandruff sufferers. We propose that the perturbed barrier leaves dandruff sufferers more prone to the adverse effects of microbial and fungal toxins, and environmental pollutants, thus perpetuating their impaired barrier.
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Affiliation(s)
- C R Harding
- Unilever Research, Colworth House Laboratory, Sharnbrook, Bedfordshire MK44 1LQ, UK.
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Abstract
Clinical and laboratory studies have provided evidence of oncostatic activity by the pineal neurohormone melatonin. However, these studies have not elucidated its mechanism of action. The following series of MCF-7 breast tumor cell studies conducted in the absence of exogenous steroid hormones provide evidence for a novel mechanism of oncostatic activity by this endogenous hormone. We observed a 40--60% loss of MCF-7 cells after 20-h treatment with 100 nM melatonin, which confirmed and extended previous reports of its oncostatic potency. Interestingly, there were no observed changes in tritiated thymidine uptake, suggesting a lack of effect on cell cycle/nascent DNA synthesis. Further evidence of a cytocidal effect came from morphologic observations of acute cell death and autophagocytosis accompanied by degenerative changes in mitochondria. Studies of mitochondrial function via standard polarography revealed a significant increase in oxygen consumption in melatonin-treated MCF-7 cells. Enzyme-substrate studies of electron transport chain (complex IV) activity in detergent permeabilized cells demonstrated a concomitant 53% increase (p < 0.01) in cytochrome c oxidase activity. Additional studies of succinate dehydrogenase activity (complex II) as determined by reduction of (3-4,5-dimethylthiazol-2-yl)2,5-diphenyltetrazolium bromide demonstrated a significant increase (p < 0.05) in melatonin-treated cells and further confirmed the accelerated ET activity. Finally, there was a 64% decrease (p < 0.05) in cellular ATP levels in melatonin-treated cells. The G-protein-coupled melatonin receptor antagonist luzindole abrogated the cytotoxic and mitochondrial effects. These studies suggest a receptor-modulated pathway of cytotoxicity in melatonin-treated MCF-7 tumor cells with apparent uncoupling of oxidative phosphorylation.
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Affiliation(s)
- A E Scott
- Department of Environmental Health, Colorado State University, Fort Collins, Colorado, USA.
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Scott AE. Medical management of taste and smell disorders. Ear Nose Throat J 1989; 68:386, 388-90, 392. [PMID: 2663435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Chemosensory dysfunction is most often secondary to one of only a few causes: nasal/sinus disease, viral infection, toxic chemical exposure, head trauma, as well as medication-related and idiopathic conditions. Medication-related disorders are corrected by discontinuance of the causative medicine. Our experiences have also shown that only dysfunctions of smell caused by disorders of the nose and/or sinuses are amendable to therapy.
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Scott AE. Clinical characteristics of taste and smell disorders. Ear Nose Throat J 1989; 68:297-8, 301, 304-10 passim. [PMID: 2661201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Chemosensory problems can have major consequences for those patients who develop them. Although more than 200 conditions and 40 medications have been linked to taste and smell disorders, for most patients the cause will fall into one of the following categories: nasal/sinus disease, idiopathic, postviral URI, and head trauma. Careful attention to clinical characteristics will aid immensely in the diagnosis. Parosmias, dysgeusias and the burning mouth syndrome are symptoms that deserve special consideration.
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Lowry RB, Miller JR, Scott AE, Renwick DH. The British Columbia Registry for Handicapped Children and Adults: evolutionary changes over twenty years. Can J Public Health 1975; 66:322-6. [PMID: 125623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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