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Asadollahi S, Hamilton TW, Sabah SA, Scarborough M, Price AJ, Gibbons CLMH, Murray DW, Alvand A. The outcomes of acute periprosthetic joint infection following unicompartmental knee replacement managed with early debridement, Antibiotics, and implant retention. Knee 2024; 47:13-20. [PMID: 38171207 DOI: 10.1016/j.knee.2023.12.001] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Periprosthetic joint infection (PJI) following unicompartmental knee replacement (UKR) is an uncommon, yet serious, complication. There is a paucity of evidence regarding the effectiveness of Debridement-Antibiotics-and-Implant-Retention (DAIR) in this setting. The aim of this study is to investigate the effectiveness of DAIR for acute UKR PJI. METHOD Between 2006 and 2019, 5195 UKR were performed at our institution. Over this period, sixteen patients underwent DAIR for early, acute PJI. All patients met MSIS PJI diagnostic criteria. The median age at DAIR was 67 years (range 40-73) and 12 patients were male (75.0%). The median time to DAIR was 24 days (range 6-60). Patients were followed up for a median of 6.5 years (range1.4-10.5) following DAIR. RESULTS 0.3% (16/5195) of UKR in our institution had a DAIR within 3 months. 15 of 16 patients (93.8%) were culture positive, with the most common organism MSSA (n = 8, 50.0%). Patients were treated with an organism-specific intravenous antibiotic regime for a median of 6 weeks, followed by oral antibiotics for a median duration of 6 months. The Kaplan-Meier survivor estimate for revision for PJI was 57% (95%CI: 28-78%) at five years, and survivor estimate for all cause revision 52% (95%CI: 25-74%).The median Oxford Knee Score for patients with a viable implant at final follow-up was 45 points (range 39-46). CONCLUSION Early, acute PJI after UKR is rare. DAIR had a moderate success rate, with infection-free survivorship of 57% at 5 years. Those successfully treated with DAIR had excellent functional outcome and implant survival.
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Affiliation(s)
- S Asadollahi
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - T W Hamilton
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - S A Sabah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - M Scarborough
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - A J Price
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - C L M H Gibbons
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - D W Murray
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - A Alvand
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK.
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Sabah SA, Alvand A, Beard DJ, Price AJ. Minimal important changes and differences were estimated for Oxford hip and knee scores following primary and revision arthroplasty. J Clin Epidemiol 2021; 143:159-168. [PMID: 34920113 DOI: 10.1016/j.jclinepi.2021.12.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To create estimates for clinically meaningful changes and differences in pain and joint function for the Oxford Hip and Knee Scores (OHS/OKS) in primary and revision joint replacement. STUDY DESIGN AND SETTING 694,487 primary and revision joint replacement procedures were analysed from the NHS PROMs dataset between 2012-2020. Minimal important changes (MIC) and differences (MID) were calculated using distribution and anchor-based methods (including receiver-operating characteristic (ROC) curve and predictive-modelling techniques). RESULTS For comparison of two or more groups (such as in a clinic trial), MID estimates were ∼5 points. For cohort studies investigating changes over time in a single group of patients, MICgroup estimates were 12.4 points (primary hip replacement), 8.6 points (revision hip replacement), 10.5 points (primary knee replacement) and 9.4 points (revision knee replacement). For studies investigating changes over time at the individual patient level, MICadjusted estimates were ∼8 points, ∼6 points, ∼7 points and ∼6 points respectively. CONCLUSION This study has calculated contemporary estimates of clinically important changes and differences for the OHS/OKS for primary and revision hip and knee replacement. These estimates can be used to inform sample size calculations and to interpret changes in joint function over time and differences between groups.
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Affiliation(s)
- S A Sabah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford.
| | - A Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; Nuffield Orthopaedic Centre, Oxford.
| | - D J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford.
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; Nuffield Orthopaedic Centre, Oxford.
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Kalson NS, Mathews JA, Phillips JRA, Baker PN, Price AJ, Toms AD. Revision knee replacement surgery in the NHS: A BASK surgical practice guideline. Knee 2021; 29:353-364. [PMID: 33690016 DOI: 10.1016/j.knee.2021.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 01/20/2021] [Accepted: 01/30/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Revision knee replacement (KR) is both challenging for the surgical team and expensive for the healthcare provider. Limited high quality evidence is available to guide decision-making. AIM To provide guidelines for surgeons and units delivering revision KR services. METHODS A formal consensus process was followed by BASK's Revision Knee Working Group, which included surgeons from England, Wales, Scotland and Northern Ireland. This was supported by analysis of National Joint Registry data. RESULTS There are a large number of surgeons operating at NHS sites who undertake a small number of revision KR procedures. To optimise patient outcomes and deliver cost-effective care high-volume revision knee surgeons working at high volume centres should undertake revision KR. This document outlines practice guidelines for units providing a revision KR service and sets out: The current landscape of revision KR in England, Wales and Northern Ireland. Service organisation within a network model. The necessary infrastructure required to provide a sustainable revision service. Outcome metrics and auditable standards. Financial mechanisms to support this service model. CONCLUSIONS Revision KR patients being treated in the NHS should be provided with the best care available. This report sets out a framework to both guide and support revision KR surgeons and centres to achieve this aim.
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Affiliation(s)
- N S Kalson
- British Association for Surgery of the Knee Revision Knee Working Group, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom
| | - J A Mathews
- British Association for Surgery of the Knee Revision Knee Working Group, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom
| | - J R A Phillips
- British Association for Surgery of the Knee Revision Knee Working Group, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom
| | - P N Baker
- British Association for Surgery of the Knee Revision Knee Working Group, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom
| | - A J Price
- British Association for Surgery of the Knee Revision Knee Working Group, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom
| | - A D Toms
- British Association for Surgery of the Knee Revision Knee Working Group, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom.
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- British Association for Surgery of the Knee Revision Knee Working Group, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom
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Campi S, Kendrick BJL, Kaptein BL, Valstar ER, Jackson WFM, Dodd CAF, Price AJ, Murray DW. Five-year results of a randomised controlled trial comparing cemented and cementless Oxford unicompartmental knee replacement using radiostereometric analysis. Knee 2021; 28:383-390. [PMID: 33408039 DOI: 10.1016/j.knee.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/18/2020] [Accepted: 09/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cementless fixation is an alternative to cemented unicompartmental knee replacement (UKR). The aim of this study was to determine if cementless UKR fixation is as good as cemented by comparing the five-year migration measured radiostereometric analysis (RSA) in a randomised controlled trial. METHODS Thirty-nine patients were randomised to receive either a cemented or a cementless Oxford UKR and were studied at intervals up to five years to assess migration with RSA and radiolucencies with radiographs. RESULTS During the first year there was a small and significant amount of migration, predominantly in an anterior direction, of both the cemented (0.24 mm, SD 0.32, p = 0.01) and cementless (0.26 mm, SD 0.31, p = 0.00) femoral components. Thereafter there was no significant migration in any direction. At no stage was there any significant difference between the migrations of the cemented or cementless femoral components. During the first year, particularly the first three months, the cementless tibial components subsided 0.28 mm (SD 0.19, p = 0.00). This was significantly (p = 0.00) greater than the subsidence of the cemented tibial component (0.09, SD 0.19, p = 0.28). Between the second and fifth years there was no significant migration of either cemented or cementless tibial components. At five years radiolucent lines occurred significantly less with cementless (one partial) compared to cemented (six partial and one complete) tibial components. CONCLUSIONS As, between two and five years, there was no significant migration of cemented or cementless components, and no significant difference between them, we conclude that cementless fixation is as reliable as cemented. It may be better as there are fewer radiolucent lines.
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Affiliation(s)
- S Campi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - B J L Kendrick
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - B L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - E R Valstar
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - W F M Jackson
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - C A F Dodd
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK.
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Abstract
While a definitive understanding of schizophrenia etiology is far from current reality, an increasing body of evidence implicates perturbations in early development that alter the trajectory of brain maturation in this disorder, leading to abnormal function in early childhood and adulthood. This atypical development likely arises from an interaction of many brain cell types that follow distinct developmental paths. Because both cellular identity and development are governed by the transcriptome and epigenome, two levels of gene regulation that have the potential to reflect both genetic and environmental influences, mapping "omic" changes over development in diverse cells is a fruitful avenue for schizophrenia research. In this review, we provide a survey of human brain cellular composition and development, levels of genomic regulation that determine cellular identity and developmental trajectories, and what is known about how genomic regulation is dysregulated in specific cell types in schizophrenia. We also outline technical challenges and solutions to conducting cell type-specific functional genomic studies in human postmortem brain.
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Affiliation(s)
- Amanda J. Price
- Lieber Institute for Brain Development, Baltimore, MD,McKusick Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Andrew E. Jaffe
- Lieber Institute for Brain Development, Baltimore, MD,McKusick Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Daniel R. Weinberger
- Lieber Institute for Brain Development, Baltimore, MD,McKusick Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
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6
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Perzel Mandell KA, Price AJ, Wilton R, Collado-Torres L, Tao R, Eagles NJ, Szalay AS, Hyde TM, Weinberger DR, Kleinman JE, Jaffe AE. Characterizing the dynamic and functional DNA methylation landscape in the developing human cortex. Epigenetics 2020; 16:1-13. [PMID: 32602773 DOI: 10.1080/15592294.2020.1786304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
DNA methylation (DNAm) is a key epigenetic regulator of gene expression across development. The developing prenatal brain is a highly dynamic tissue, but our understanding of key drivers of epigenetic variability across development is limited. We, therefore, assessed genomic methylation at over 39 million sites in the prenatal cortex using whole-genome bisulfite sequencing and found loci and regions in which methylation levels are dynamic across development. We saw that DNAm at these loci was associated with nearby gene expression and enriched for enhancer chromatin states in prenatal brain tissue. Additionally, these loci were enriched for genes associated with neuropsychiatric disorders and genes involved with neurogenesis. We also found autosomal differences in DNAm between the sexes during prenatal development, though these have less clear functional consequences. We lastly confirmed that the dynamic methylation at this critical period is specifically CpG methylation, with generally low levels of CpH methylation. Our findings provide detailed insight into prenatal brain development as well as clues to the pathogenesis of psychiatric traits seen later in life.
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Affiliation(s)
- Kira A Perzel Mandell
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus , Baltimore, MD, USA.,Department of Genetic Medicine, Johns Hopkins University School of Medicine (JHSOM) , Baltimore, MD, USA
| | - Amanda J Price
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus , Baltimore, MD, USA.,Department of Genetic Medicine, Johns Hopkins University School of Medicine (JHSOM) , Baltimore, MD, USA
| | - Richard Wilton
- Department of Physics and Astronomy, Krieger School of Arts and Sciences, Johns Hopkins University , Baltimore, MD, USA
| | - Leonardo Collado-Torres
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus , Baltimore, MD, USA.,Center for Computational Biology, Johns Hopkins University , Baltimore, MD, USA
| | - Ran Tao
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus , Baltimore, MD, USA
| | - Nicholas J Eagles
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus , Baltimore, MD, USA
| | - Alexander S Szalay
- Department of Physics and Astronomy, Krieger School of Arts and Sciences, Johns Hopkins University , Baltimore, MD, USA.,Department of Computer Science, Whiting School of Engineering, Johns Hopkins University , Baltimore, MD, USA
| | - Thomas M Hyde
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus , Baltimore, MD, USA.,Department of Neurology, JHSOM , Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, JHSOM , Baltimore, MD, USA
| | - Daniel R Weinberger
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus , Baltimore, MD, USA.,Department of Genetic Medicine, Johns Hopkins University School of Medicine (JHSOM) , Baltimore, MD, USA.,Department of Neurology, JHSOM , Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, JHSOM , Baltimore, MD, USA.,Department of Neuroscience, JHSOM , Baltimore, MD, USA
| | - Joel E Kleinman
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus , Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, JHSOM , Baltimore, MD, USA
| | - Andrew E Jaffe
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus , Baltimore, MD, USA.,Department of Genetic Medicine, Johns Hopkins University School of Medicine (JHSOM) , Baltimore, MD, USA.,Center for Computational Biology, Johns Hopkins University , Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, JHSOM , Baltimore, MD, USA.,Department of Neuroscience, JHSOM , Baltimore, MD, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health (JHBSPH) , Baltimore, MD, USA.,Department of Biostatistics, JHBSPH , Baltimore, MD, USA
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7
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Fuggle NR, Cooper C, Oreffo ROC, Price AJ, Kaux JF, Maheu E, Cutolo M, Honvo G, Conaghan PG, Berenbaum F, Branco J, Brandi ML, Cortet B, Veronese N, Kurth AA, Matijevic R, Roth R, Pelletier JP, Martel-Pelletier J, Vlaskovska M, Thomas T, Lems WF, Al-Daghri N, Bruyère O, Rizzoli R, Kanis JA, Reginster JY. Alternative and complementary therapies in osteoarthritis and cartilage repair. Aging Clin Exp Res 2020; 32:547-560. [PMID: 32170710 PMCID: PMC7170824 DOI: 10.1007/s40520-020-01515-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/14/2020] [Indexed: 12/28/2022]
Abstract
Osteoarthritis (OA) is the most common joint condition and, with a burgeoning ageing population, is due to increase in prevalence. Beyond conventional medical and surgical interventions, there are an increasing number of ‘alternative’ therapies. These alternative therapies may have a limited evidence base and, for this reason, are often only afforded brief reference (or completely excluded) from current OA guidelines. Thus, the aim of this review was to synthesize the current evidence regarding autologous chondrocyte implantation (ACI), mesenchymal stem cell (MSC) therapy, platelet-rich plasma (PRP), vitamin D and other alternative therapies. The majority of studies were in knee OA or chondral defects. Matrix-assisted ACI has demonstrated exceedingly limited, symptomatic improvements in the treatment of cartilage defects of the knee and is not supported for the treatment of knee OA. There is some evidence to suggest symptomatic improvement with MSC injection in knee OA, with the suggestion of minimal structural improvement demonstrated on MRI and there are positive signals that PRP may also lead to symptomatic improvement, though variation in preparation makes inter-study comparison difficult. There is variability in findings with vitamin D supplementation in OA, and the only recommendation which can be made, at this time, is for replacement when vitamin D is deplete. Other alternative therapies reviewed have some evidence (though from small, poor-quality studies) to support improvement in symptoms and again there is often a wide variation in dosage and regimens. For all these therapeutic modalities, although controlled studies have been undertaken to evaluate effectiveness in OA, these have often been of small size, limited statistical power, uncertain blindness and using various methodologies. These deficiencies must leave the question as to whether they have been validated as effective therapies in OA (or chondral defects). The conclusions of this review are that all alternative interventions definitely require clinical trials with robust methodology, to assess their efficacy and safety in the treatment of OA beyond contextual and placebo effects.
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Affiliation(s)
- N R Fuggle
- MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
| | - R O C Oreffo
- Bone and Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, Institute of Developmental Sciences, University of Southampton, Southampton, UK
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J F Kaux
- Department of Physical and Rehabilitation Medicine & Sports Traumatology, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University Hospital and University of Liège, Liege, Belgium
| | - E Maheu
- Rheumatology Department, AP-HP, Saint-Antoine Hospital, 4 Blvd. Beaumarchais, Paris, France
| | - M Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - G Honvo
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - F Berenbaum
- Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Saint-Antoine Hospital, Paris, France
| | - J Branco
- Centro Hospitalar de Lisboa Ocidental- Hospital Egas Moniz, Lisbon, Portugal
- CEDOC / NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - M L Brandi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - B Cortet
- Department of Rheumatology and EA 4490, Lille University Hospital, Lille, France
| | - N Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - A A Kurth
- Department of Orthopaedic Surgery, Themistocles Gluck Hospital, Ratingen, Germany
| | - R Matijevic
- Faculty of Medicine, Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - R Roth
- Institute of Outdoor Sports and Environmental Science, German Sport University, Cologne, Germany
| | - J P Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - J Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - M Vlaskovska
- Medical Faculty, Department of Pharmacology, Medical University Sofia, 2, Zdrave Str, 1431, Sofia, Bulgaria
| | - T Thomas
- Department of Rheumatology, Hôpital Nord, CHU de Saint-Etienne, Saint-Étienne, France
- INSERM U1059, Université de Lyon, Saint-Étienne, France
| | - W F Lems
- Location VU Medical Center, Department of Rheumatology and Immunology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - N Al-Daghri
- Chair for Biomarkers Research, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - O Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - J A Kanis
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - J Y Reginster
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
- Chair for Biomarkers Research, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liege, Belgium
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8
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Ma L, Semick SA, Chen Q, Li C, Tao R, Price AJ, Shin JH, Jia Y, Brandon NJ, Cross AJ, Hyde TM, Kleinman JE, Jaffe AE, Weinberger DR, Straub RE. Schizophrenia risk variants influence multiple classes of transcripts of sorting nexin 19 (SNX19). Mol Psychiatry 2020; 25:831-843. [PMID: 30635639 DOI: 10.1038/s41380-018-0293-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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] [Received: 05/25/2018] [Revised: 09/16/2018] [Accepted: 10/03/2018] [Indexed: 01/15/2023]
Abstract
Genome-wide association studies (GWAS) have identified many genomic loci associated with risk for schizophrenia, but unambiguous identification of the relationship between disease-associated variants and specific genes, and in particular their effect on risk conferring transcripts, has proven difficult. To better understand the specific molecular mechanism(s) at the schizophrenia locus in 11q25, we undertook cis expression quantitative trait loci (cis-eQTL) mapping for this 2 megabase genomic region using postmortem human brain samples. To comprehensively assess the effects of genetic risk upon local expression, we evaluated multiple transcript features: genes, exons, and exon-exon junctions in multiple brain regions-dorsolateral prefrontal cortex (DLPFC), hippocampus, and caudate. Genetic risk variants strongly associated with expression of SNX19 transcript features that tag multiple rare classes of SNX19 transcripts, whereas they only weakly affected expression of an exon-exon junction that tags the majority of abundant transcripts. The most prominent class of SNX19 risk-associated transcripts is predicted to be overexpressed, defined by an exon-exon splice junction between exons 8 and 10 (junc8.10) and that is predicted to encode proteins that lack the characteristic nexin C terminal domain. Risk alleles were also associated with either increased or decreased expression of multiple additional classes of transcripts. With RACE, molecular cloning, and long read sequencing, we found a number of novel SNX19 transcripts that further define the set of potential etiological transcripts. We explored epigenetic regulation of SNX19 expression and found that DNA methylation at CpG sites near the primary transcription start site and within exon 2 partially mediate the effects of risk variants on risk-associated expression. ATAC sequencing revealed that some of the most strongly risk-associated SNPs are located within a region of open chromatin, suggesting a nearby regulatory element is involved. These findings indicate a potentially complex molecular etiology, in which risk alleles for schizophrenia generate epigenetic alterations and dysregulation of multiple classes of SNX19 transcripts.
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Affiliation(s)
- Liang Ma
- Lieber Institute for Brain Development, Baltimore, MD, 21205, USA
| | - Stephen A Semick
- Lieber Institute for Brain Development, Baltimore, MD, 21205, USA
| | - Qiang Chen
- Lieber Institute for Brain Development, Baltimore, MD, 21205, USA
| | - Chao Li
- Lieber Institute for Brain Development, Baltimore, MD, 21205, USA
| | - Ran Tao
- Lieber Institute for Brain Development, Baltimore, MD, 21205, USA
| | - Amanda J Price
- Lieber Institute for Brain Development, Baltimore, MD, 21205, USA.,McKusick-Nathans Institute of Genetic Medicine, Baltimore, MD, 21205, USA
| | - Joo Heon Shin
- Lieber Institute for Brain Development, Baltimore, MD, 21205, USA
| | - Yankai Jia
- Lieber Institute for Brain Development, Baltimore, MD, 21205, USA
| | | | - Nicholas J Brandon
- AstraZeneca Neuroscience, IMED Biotech Unit, AstraZeneca R&D, Boston, MA, 02451, USA
| | - Alan J Cross
- AstraZeneca Neuroscience, IMED Biotech Unit, AstraZeneca R&D, Boston, MA, 02451, USA
| | - Thomas M Hyde
- Lieber Institute for Brain Development, Baltimore, MD, 21205, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Joel E Kleinman
- Lieber Institute for Brain Development, Baltimore, MD, 21205, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Andrew E Jaffe
- Lieber Institute for Brain Development, Baltimore, MD, 21205, USA.,Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, 21205, USA.,Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, 21205, USA
| | - Daniel R Weinberger
- Lieber Institute for Brain Development, Baltimore, MD, 21205, USA.,McKusick-Nathans Institute of Genetic Medicine, Baltimore, MD, 21205, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Richard E Straub
- Lieber Institute for Brain Development, Baltimore, MD, 21205, USA.
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9
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Burke EE, Chenoweth JG, Shin JH, Collado-Torres L, Kim SK, Micali N, Wang Y, Colantuoni C, Straub RE, Hoeppner DJ, Chen HY, Sellers A, Shibbani K, Hamersky GR, Diaz Bustamante M, Phan BN, Ulrich WS, Valencia C, Jaishankar A, Price AJ, Rajpurohit A, Semick SA, Bürli RW, Barrow JC, Hiler DJ, Page SC, Martinowich K, Hyde TM, Kleinman JE, Berman KF, Apud JA, Cross AJ, Brandon NJ, Weinberger DR, Maher BJ, McKay RDG, Jaffe AE. Dissecting transcriptomic signatures of neuronal differentiation and maturation using iPSCs. Nat Commun 2020; 11:462. [PMID: 31974374 PMCID: PMC6978526 DOI: 10.1038/s41467-019-14266-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 12/23/2019] [Indexed: 01/02/2023] Open
Abstract
Human induced pluripotent stem cells (hiPSCs) are a powerful model of neural differentiation and maturation. We present a hiPSC transcriptomics resource on corticogenesis from 5 iPSC donor and 13 subclonal lines across 9 time points over 5 broad conditions: self-renewal, early neuronal differentiation, neural precursor cells (NPCs), assembled rosettes, and differentiated neuronal cells. We identify widespread changes in the expression of both individual features and global patterns of transcription. We next demonstrate that co-culturing human NPCs with rodent astrocytes results in mutually synergistic maturation, and that cell type-specific expression data can be extracted using only sequencing read alignments without cell sorting. We lastly adapt a previously generated RNA deconvolution approach to single-cell expression data to estimate the relative neuronal maturity of iPSC-derived neuronal cultures and human brain tissue. Using many public datasets, we demonstrate neuronal cultures are maturationally heterogeneous but contain subsets of neurons more mature than previously observed.
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Affiliation(s)
- Emily E Burke
- Lieber Institute for Brain Development, Baltimore, MD, USA
| | | | - Joo Heon Shin
- Lieber Institute for Brain Development, Baltimore, MD, USA
| | | | - Suel-Kee Kim
- Lieber Institute for Brain Development, Baltimore, MD, USA
| | - Nicola Micali
- Lieber Institute for Brain Development, Baltimore, MD, USA
| | - Yanhong Wang
- Lieber Institute for Brain Development, Baltimore, MD, USA
| | | | | | | | - Huei-Ying Chen
- Lieber Institute for Brain Development, Baltimore, MD, USA
| | - Alana Sellers
- Lieber Institute for Brain Development, Baltimore, MD, USA
| | - Kamel Shibbani
- Lieber Institute for Brain Development, Baltimore, MD, USA
| | | | | | - BaDoi N Phan
- Lieber Institute for Brain Development, Baltimore, MD, USA
| | | | | | | | - Amanda J Price
- Lieber Institute for Brain Development, Baltimore, MD, USA.,McKusick Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | | | - Roland W Bürli
- Neuroscience, IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | - James C Barrow
- Lieber Institute for Brain Development, Baltimore, MD, USA
| | - Daniel J Hiler
- Lieber Institute for Brain Development, Baltimore, MD, USA
| | | | - Keri Martinowich
- Lieber Institute for Brain Development, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Thomas M Hyde
- Lieber Institute for Brain Development, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Joel E Kleinman
- Lieber Institute for Brain Development, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Karen F Berman
- Clinical and Translational Neuroscience Branch, NIMH Intramural Research Program, Bethesda, MD, USA
| | - Jose A Apud
- Clinical and Translational Neuroscience Branch, NIMH Intramural Research Program, Bethesda, MD, USA
| | - Alan J Cross
- Neuroscience, IMED Biotech Unit, AstraZeneca, Boston, MA, USA
| | | | - Daniel R Weinberger
- Lieber Institute for Brain Development, Baltimore, MD, USA.,McKusick Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Brady J Maher
- Lieber Institute for Brain Development, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Andrew E Jaffe
- Lieber Institute for Brain Development, Baltimore, MD, USA. .,McKusick Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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10
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Price AJ, Hwang T, Tao R, Burke EE, Rajpurohit A, Shin JH, Hyde TM, Kleinman JE, Jaffe AE, Weinberger DR. Characterizing the nuclear and cytoplasmic transcriptomes in developing and mature human cortex uncovers new insight into psychiatric disease gene regulation. Genome Res 2019; 30:1-11. [PMID: 31852722 PMCID: PMC6961577 DOI: 10.1101/gr.250217.119] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 12/16/2019] [Indexed: 12/24/2022]
Abstract
Transcriptome compartmentalization by the nuclear membrane provides both stochastic and functional buffering of transcript activity in the cytoplasm, and has recently been implicated in neurodegenerative disease processes. Although many mechanisms regulating transcript compartmentalization are also prevalent in brain development, the extent to which subcellular localization differs as the brain matures has yet to be addressed. To characterize the nuclear and cytoplasmic transcriptomes during brain development, we sequenced both RNA fractions from homogenate prenatal and adult human postmortem cortex using poly(A)+ and Ribo-Zero library preparation methods. We find that while many genes are differentially expressed by fraction and developmental expression changes are similarly detectable in nuclear and cytoplasmic RNA, the compartmented transcriptomes become more distinct as the brain matures, perhaps reflecting increased utilization of nuclear retention as a regulatory strategy in adult brain. We examined potential mechanisms of this developmental divergence including alternative splicing, RNA editing, nuclear pore composition, RNA-binding protein motif enrichment, and RNA secondary structure. Intron retention is associated with greater nuclear abundance in a subset of transcripts, as is enrichment for several splicing factor binding motifs. Finally, we examined disease association with fraction-regulated gene sets and found nuclear-enriched genes were also preferentially enriched in gene sets associated with neurodevelopmental psychiatric disorders. These results suggest that although gene-level expression is globally comparable between fractions, nuclear retention of transcripts may play an underappreciated role in developmental regulation of gene expression in brain, particularly in genes whose dysregulation is related to neuropsychiatric disorders.
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Affiliation(s)
- Amanda J Price
- Lieber Institute for Brain Development, Baltimore, Maryland 21205, USA.,McKusick Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA
| | - Taeyoung Hwang
- Lieber Institute for Brain Development, Baltimore, Maryland 21205, USA
| | - Ran Tao
- Lieber Institute for Brain Development, Baltimore, Maryland 21205, USA
| | - Emily E Burke
- Lieber Institute for Brain Development, Baltimore, Maryland 21205, USA
| | | | - Joo Heon Shin
- Lieber Institute for Brain Development, Baltimore, Maryland 21205, USA
| | - Thomas M Hyde
- Lieber Institute for Brain Development, Baltimore, Maryland 21205, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA.,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA
| | - Joel E Kleinman
- Lieber Institute for Brain Development, Baltimore, Maryland 21205, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA
| | - Andrew E Jaffe
- Lieber Institute for Brain Development, Baltimore, Maryland 21205, USA.,McKusick Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA
| | - Daniel R Weinberger
- Lieber Institute for Brain Development, Baltimore, Maryland 21205, USA.,McKusick Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA.,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA.,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA
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11
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Abram SGF, Judge A, Beard DJ, Price AJ. Rates of knee arthroplasty within one-year of undergoing arthroscopic partial meniscectomy in England: temporal trends, regional and age-group variation in conversion rates. Osteoarthritis Cartilage 2019; 27:1420-1429. [PMID: 31034923 DOI: 10.1016/j.joca.2019.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/07/2019] [Accepted: 03/28/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to determine the proportion of patients undergoing arthroscopic partial meniscectomy (APM) then subsequently receiving a knee arthroplasty within one or two years, with focus on patients over the age of 60 years and regional variation. METHODS Patients undergoing APM in England over 20-years (01-April-1997 to 31-March 2017) were identified in the national Hospital Episode Statistics (HES). The proportion of patients undergoing arthroplasty in the same knee within one or two years of APM was determined and trends were analysed over time nationally and by NHS Clinical Commissioning Group (CCG) region. RESULTS 806,195 APM patients were eligible for analysis with at least one-year of follow up and 746,630 with two-years. The odds of arthroplasty conversion within one year increased over the study period (odds ratio [OR] 3.10 within 1-year in 2014 vs 2000; 95% confidence interval [CI] 2.75-3.50). For patients undergoing APM aged 60 years or older in 2015-16, 9.9% (1689/17,043; 95% CI 9.5-10.4) underwent arthroplasty within 1-year and, in 2014-15, 16.6% (3100/18,734; 95% CI 16.0-17.1) underwent arthroplasty within 2-years. There was greater than 10-fold variation by CCG. CONCLUSIONS Over the study period, the proportion of patients undergoing arthroplasty within one-year of APM increased. In 2015-16, of patients aged 60 years or older who underwent APM, 10% subsequently underwent knee arthroplasty within one year (17% within two years in 2014-15) and there was a high level of regional variation in this outcome. The development and adoption of national treatment guidance is recommended to improve and standardise treatment selection.
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Affiliation(s)
- S G F Abram
- NIHR Biomedical Research Centre, Oxford & Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
| | - A Judge
- NIHR Biomedical Research Centre, Oxford & Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; NIHR Biomedical Research Centre, Bristol & Musculoskeletal Research Unit, University of Bristol, UK
| | - D J Beard
- NIHR Biomedical Research Centre, Oxford & Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - A J Price
- NIHR Biomedical Research Centre, Oxford & Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
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12
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Price AJ, Collado-Torres L, Ivanov NA, Xia W, Burke EE, Shin JH, Tao R, Ma L, Jia Y, Hyde TM, Kleinman JE, Weinberger DR, Jaffe AE. Divergent neuronal DNA methylation patterns across human cortical development reveal critical periods and a unique role of CpH methylation. Genome Biol 2019; 20:196. [PMID: 31554518 PMCID: PMC6761727 DOI: 10.1186/s13059-019-1805-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [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: 06/17/2019] [Accepted: 08/28/2019] [Indexed: 01/03/2023] Open
Abstract
Background DNA methylation (DNAm) is a critical regulator of both development and cellular identity and shows unique patterns in neurons. To better characterize maturational changes in DNAm patterns in these cells, we profile the DNAm landscape at single-base resolution across the first two decades of human neocortical development in NeuN+ neurons using whole-genome bisulfite sequencing and compare them to non-neurons (primarily glia) and prenatal homogenate cortex. Results We show that DNAm changes more dramatically during the first 5 years of postnatal life than during the entire remaining period. We further refine global patterns of increasingly divergent neuronal CpG and CpH methylation (mCpG and mCpH) into six developmental trajectories and find that in contrast to genome-wide patterns, neighboring mCpG and mCpH levels within these regions are highly correlated. We integrate paired RNA-seq data and identify putative regulation of hundreds of transcripts and their splicing events exclusively by mCpH levels, independently from mCpG levels, across this period. We finally explore the relationship between DNAm patterns and development of brain-related phenotypes and find enriched heritability for many phenotypes within identified DNAm features. Conclusions By profiling DNAm changes in NeuN-sorted neurons over the span of human cortical development, we identify novel, dynamic regions of DNAm that would be masked in homogenate DNAm data; expand on the relationship between CpG methylation, CpH methylation, and gene expression; and find enrichment particularly for neuropsychiatric diseases in genomic regions with cell type-specific, developmentally dynamic DNAm patterns. Electronic supplementary material The online version of this article (10.1186/s13059-019-1805-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amanda J Price
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 N Wolfe St, Ste 300, Baltimore, MD, 21205, USA.,McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine (JHSOM), Baltimore, MD, 21205, USA
| | - Leonardo Collado-Torres
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 N Wolfe St, Ste 300, Baltimore, MD, 21205, USA.,Center for Computational Biology, Johns Hopkins University, Baltimore, MD, USA
| | - Nikolay A Ivanov
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 N Wolfe St, Ste 300, Baltimore, MD, 21205, USA
| | - Wei Xia
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 N Wolfe St, Ste 300, Baltimore, MD, 21205, USA
| | - Emily E Burke
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 N Wolfe St, Ste 300, Baltimore, MD, 21205, USA
| | - Joo Heon Shin
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 N Wolfe St, Ste 300, Baltimore, MD, 21205, USA
| | - Ran Tao
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 N Wolfe St, Ste 300, Baltimore, MD, 21205, USA
| | - Liang Ma
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 N Wolfe St, Ste 300, Baltimore, MD, 21205, USA
| | - Yankai Jia
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 N Wolfe St, Ste 300, Baltimore, MD, 21205, USA
| | - Thomas M Hyde
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 N Wolfe St, Ste 300, Baltimore, MD, 21205, USA.,Department of Neurology, JHSOM, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, JHSOM, Baltimore, MD, USA
| | - Joel E Kleinman
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 N Wolfe St, Ste 300, Baltimore, MD, 21205, USA.,Department of Psychiatry and Behavioral Sciences, JHSOM, Baltimore, MD, USA
| | - Daniel R Weinberger
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 N Wolfe St, Ste 300, Baltimore, MD, 21205, USA.,McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine (JHSOM), Baltimore, MD, 21205, USA.,Department of Neurology, JHSOM, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, JHSOM, Baltimore, MD, USA.,Department of Neuroscience, JHSOM, Baltimore, MD, USA
| | - Andrew E Jaffe
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, 855 N Wolfe St, Ste 300, Baltimore, MD, 21205, USA. .,McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine (JHSOM), Baltimore, MD, 21205, USA. .,Center for Computational Biology, Johns Hopkins University, Baltimore, MD, USA. .,Department of Psychiatry and Behavioral Sciences, JHSOM, Baltimore, MD, USA. .,Department of Neuroscience, JHSOM, Baltimore, MD, USA. .,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health (JHBSPH), 615 N Wolfe St, Baltimore, MD, 21205, USA. .,Department of Biostatistics, JHBSPH, 615 N Wolfe St, Baltimore, MD, 21205, USA.
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14
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Abstract
AIMS The aim of the British Association for Surgery of the Knee (BASK) Meniscal Consensus Project was to develop an evidence-based treatment guideline for patients with meniscal lesions of the knee. MATERIALS AND METHODS A formal consensus process was undertaken applying nominal group, Delphi, and appropriateness methods. Consensus was first reached on the terminology relating to the definition, investigation, and classification of meniscal lesions. A series of simulated clinical scenarios was then created and the appropriateness of arthroscopic meniscal surgery or nonoperative treatment in each scenario was rated by the group. The process was informed throughout by the latest published, and previously unpublished, clinical and epidemiological evidence. Scenarios were then grouped together based upon the similarity of clinical features and ratings to form the guideline for treatment. Feedback on the draft guideline was sought from the entire membership of BASK before final revisions and approval by the consensus group. RESULTS A total of 45 simulated clinical scenarios were refined to five common clinical presentations and six corresponding treatment recommendations. The final guideline stratifies patients based upon a new, standardized classification of symptoms, signs, radiological findings, duration of symptoms, and previous treatment. CONCLUSION The 2018 BASK Arthroscopic Meniscal Surgery Treatment Guidance will facilitate the consistent identification and treatment of patients with meniscal lesions. It is hoped that this guidance will be adopted nationally by surgeons and help inform healthcare commissioning guidance. Validation in clinical practice is now required and several areas of uncertainty in relation to treatment should be a priority for future high-quality prospective studies. Cite this article: Bone Joint J 2019;101-B:652-659.
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Affiliation(s)
- S G F Abram
- Botnar Research Centre, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - D J Beard
- Botnar Research Centre, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - A J Price
- Botnar Research Centre, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
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15
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Collado-Torres L, Burke EE, Peterson A, Shin J, Straub RE, Rajpurohit A, Semick SA, Ulrich WS, Price AJ, Valencia C, Tao R, Deep-Soboslay A, Hyde TM, Kleinman JE, Weinberger DR, Jaffe AE. Regional Heterogeneity in Gene Expression, Regulation, and Coherence in the Frontal Cortex and Hippocampus across Development and Schizophrenia. Neuron 2019; 103:203-216.e8. [PMID: 31174959 DOI: 10.1016/j.neuron.2019.05.013] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [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: 09/27/2018] [Revised: 04/08/2019] [Accepted: 05/06/2019] [Indexed: 02/06/2023]
Abstract
The hippocampus formation, although prominently implicated in schizophrenia pathogenesis, has been overlooked in large-scale genomics efforts in the schizophrenic brain. We performed RNA-seq in hippocampi and dorsolateral prefrontal cortices (DLPFCs) from 551 individuals (286 with schizophrenia). We identified substantial regional differences in gene expression and found widespread developmental differences that were independent of cellular composition. We identified 48 and 245 differentially expressed genes (DEGs) associated with schizophrenia within the hippocampus and DLPFC, with little overlap between the brain regions. 124 of 163 (76.6%) of schizophrenia GWAS risk loci contained eQTLs in any region. Transcriptome-wide association studies in each region identified many novel schizophrenia risk features that were brain region-specific. Last, we identified potential molecular correlates of in vivo evidence of altered prefrontal-hippocampal functional coherence in schizophrenia. These results underscore the complexity and regional heterogeneity of the transcriptional correlates of schizophrenia and offer new insights into potentially causative biology.
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Affiliation(s)
- Leonardo Collado-Torres
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA; Center for Computational Biology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Emily E Burke
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA
| | - Amy Peterson
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - JooHeon Shin
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA
| | - Richard E Straub
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA
| | - Anandita Rajpurohit
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA
| | - Stephen A Semick
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA
| | - William S Ulrich
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA
| | | | - Amanda J Price
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA; McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Cristian Valencia
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Ran Tao
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA
| | - Amy Deep-Soboslay
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA
| | - Thomas M Hyde
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Joel E Kleinman
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Daniel R Weinberger
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA; McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
| | - Andrew E Jaffe
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD 21205, USA; Center for Computational Biology, Johns Hopkins University, Baltimore, MD 21205, USA; McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Abram SGF, Beard DJ, Price AJ. National consensus on the definition, investigation, and classification of meniscal lesions of the knee. Knee 2018; 25:834-840. [PMID: 29983330 DOI: 10.1016/j.knee.2018.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/15/2018] [Accepted: 06/04/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to deliver standardised terminology for the identification and stratification of patients with meniscal lesions of the knee. METHODS A national group of expert surgeons was convened by the British Association for Surgery of the Knee (BASK) and a formal consensus process was undertaken following a validated methodology. A combination of nominal group techniques and an iterative Delphi process was used to develop and refine relevant definitions. Where appropriate, definitions were placed into categories to facilitate use in clinical practice and guideline development. RESULTS A degenerative meniscus develops progressively with degradation of meniscal tissue and this may be revealed by intra-meniscal high signal on magnetic resonance imaging (MRI). A meniscal tear was defined as a defect or split in the meniscocapsular complex, which can occur in a degenerative or non-degenerative meniscus. Degenerative meniscal lesions (high signal or tear) are frequent in the general population and are often incidental findings on knee MRI. Symptoms were defined and classified into three groups: (1) strongly suggestive of a treatable meniscal lesion, (2) potentially suggestive of a treatable meniscal lesion, (3) osteoarthritic. A strategy for radiological imaging (radiograph ± MRI) was agreed for the investigation of the patients with a possible meniscal tear. Meniscal lesions and tear patterns on MRI imaging were defined and classified with reference to potential treatability: (1) target, (2) possible target, (3) no target. CONCLUSIONS The agreed terminology will enable patients with meniscal lesions to be identified and stratified consistently in clinical practice, research and guideline development.
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Affiliation(s)
- S G F Abram
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom.
| | - D J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
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- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
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Sanchez-Santos MT, Garriga C, Judge A, Batra RN, Price AJ, Liddle AD, Javaid MK, Cooper C, Murray DW, Arden NK. Development and validation of a clinical prediction model for patient-reported pain and function after primary total knee replacement surgery. Sci Rep 2018; 8:3381. [PMID: 29467465 PMCID: PMC5821875 DOI: 10.1038/s41598-018-21714-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 01/22/2018] [Indexed: 12/23/2022] Open
Abstract
To develop and validate a clinical prediction model of patient-reported pain and function after undergoing total knee replacement (TKR). We used data of 1,649 patients from the Knee Arthroplasty Trial who received primary TKR across 34 centres in the UK. The external validation included 595 patients from Southampton University Hospital, and Nuffield Orthopaedic Centre (Oxford). The outcome was the Oxford Knee Score (OKS) 12-month after TKR. Pre-operative predictors including patient characteristics and clinical factors were considered. Bootstrap backward linear regression analysis was used. Low pre-operative OKS, living in poor areas, high body mass index, and patient-reported anxiety or depression were associated with worse outcome. The clinical factors associated with worse outcome were worse pre-operative physical status, presence of other conditions affecting mobility and previous knee arthroscopy. Presence of fixed flexion deformity and an absent or damaged pre-operative anterior cruciate ligament (compared with intact) were associated with better outcome. Discrimination and calibration statistics were satisfactory. External validation predicted 21.1% of the variance of outcome. This is the first clinical prediction model for predicting self-reported pain and function 12 months after TKR to be externally validated. It will help to inform to patients regarding expectations of the outcome after knee replacement surgery.
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Affiliation(s)
- M T Sanchez-Santos
- Musculoskeletal Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Arthritis research UK Centre for Sport, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - C Garriga
- Musculoskeletal Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - A Judge
- Musculoskeletal Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - R N Batra
- Musculoskeletal Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A J Price
- Musculoskeletal Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A D Liddle
- Musculoskeletal Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - M K Javaid
- Musculoskeletal Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - C Cooper
- Musculoskeletal Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - D W Murray
- Musculoskeletal Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - N K Arden
- Musculoskeletal Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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18
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Jones LD, Brown CP, Jackson W, Monk AP, Price AJ. Assessing accuracy requirements in high tibial osteotomy: a theoretical, computer-based model using AP radiographs. Knee Surg Sports Traumatol Arthrosc 2017; 25:2952-2956. [PMID: 27056695 DOI: 10.1007/s00167-016-4092-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE High tibial osteotomy (HTO) is a recognised treatment for medial compartment knee arthritis and in recent years has regained popularity. Preoperative planning of wedge opening is based on standing AP radiographs, aiming to deliver the WBL to a desired point. Clinical results can be unpredictable, and this may be due to an inability to deliver the preoperative plan. This study explores the theoretical wedge opening accuracy required to deliver preoperative plans, based on clinical AP radiographs. METHODS A theoretical 2-D model of osteotomy was developed to determine the degree of radiological wedge opening accuracy required to deliver the weight-bearing line to a preoperative target of 62-66 % of the width of the tibial plateau. RESULTS This model suggests that, to deliver the weight-bearing line to the preoperative target on plane radiographs, the theoretical medial wedge must be opened to an accuracy of ±0.9 mm. CONCLUSION Although this study only explores a model of wedge opening based on AP radiographs, with current surgical systems, it is unlikely that the surgeon can achieve this level of accuracy within a real-life surgical setting. Surgical accuracy in HTO is known to be important for both short- and long-term clinical outcomes. This study highlights the need for improved surgical accuracy aids and/or patient stratification to mitigate the effects of surgical errors. LEVEL OF EVIDENCE II.
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Affiliation(s)
- L D Jones
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK.
| | - C P Brown
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK
| | - W Jackson
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK
| | - A P Monk
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK
| | - A J Price
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK
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19
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Pandit H, Mancuso F, Jenkins C, Jackson WFM, Price AJ, Dodd CAF, Murray DW. Lateral unicompartmental knee replacement for the treatment of arthritis progression after medial unicompartmental replacement. Knee Surg Sports Traumatol Arthrosc 2017; 25:669-674. [PMID: 27017212 DOI: 10.1007/s00167-016-4075-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/01/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE Lateral progression of arthritis following medial unicompartmental knee arthroplasty (UKA), although infrequent, is still the most common reason for revision surgery. Treatment options normally include conversion to total knee arthroplasty. An alternative strategy for some patients may be addition of a lateral UKA. We report the first results of staged bi-compartmental UKA (Bi-UKA) strategy. METHODS We retrospectively selected from our UKA database patients who underwent a lateral UKA to treat a symptomatic lateral osteoarthritis progression after a medial UKA. The analysis included a clinical and radiological assessment of each patient. RESULTS Twenty-five patients for a total of 27 knees of staged Bi-UKA were carried out in a single centre. The mean time interval between primary medial UKA and the subsequent lateral UKA was 8.1 years (SD ± 4.6 years). The mean age at the time of the Bi-UKA was 77.1 years (SD ± 6.5 years). The median hospital stay was 3 (range 2-9 days) days, and the mean follow-up after Bi-UKA was 4 years (SD ± 1.9 years). The functional scores showed a significant improvement as compared to the pre-operative status (paired t test, p = 0.003). There were no radiological evidences of failure. None of the patients needed blood transfusion, and there was no significant complications related to the surgical procedure without further surgeries or revisions at final follow-up. CONCLUSIONS These results suggest that addition of a lateral UKA for arthritis progression following medial UKA is a good option in appropriately selected patients. LEVEL OF EVIDENCE Observational study without controls, Level IV.
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Affiliation(s)
- H Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
| | - F Mancuso
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Orthopaedics and Traumatology Unit, "Santa Maria della Misericordia" University Hospital, Udine, UD, Italy
| | - C Jenkins
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - W F M Jackson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - C A F Dodd
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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20
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Bottomley N, Jones LD, Rout R, Alvand A, Rombach I, Evans T, Jackson WFM, Beard DJ, Price AJ. A survival analysis of 1084 knees of the Oxford unicompartmental knee arthroplasty: a comparison between consultant and trainee surgeons. Bone Joint J 2017; 98-B:22-27. [PMID: 27694512 PMCID: PMC5047132 DOI: 10.1302/0301-620x.98b10.bjj-2016-0483.r1] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/02/2016] [Indexed: 01/30/2023]
Abstract
Aims The aim of this to study was to compare the previously unreported
long-term survival outcome of the Oxford medial unicompartmental
knee arthroplasty (UKA) performed by trainee surgeons and consultants. Patients and Methods We therefore identified a previously unreported cohort of 1084
knees in 947 patients who had a UKA inserted for anteromedial knee
arthritis by consultants and surgeons in training, at a tertiary
arthroplasty centre and performed survival analysis on the group
with revision as the endpoint. Results The ten-year cumulative survival rate for revision or exchange
of any part of the prosthetic components was 93.2% (95% confidence
interval (CI) 86.1 to 100, number at risk 45). Consultant surgeons
had a nine-year cumulative survival rate of 93.9% (95% CI 90.2 to
97.6, number at risk 16). Trainee surgeons had a cumulative nine-year
survival rate of 93.0% (95% CI 90.3 to 95.7, number at risk 35).
Although there was no differences in implant survival between consultants
and trainees (p = 0.30), there was a difference in failure pattern
whereby all re-operations performed for bearing dislocation (n =
7), occurred in the trainee group. This accounted for 0.6% of the
entire cohort and 15% of the re-operations. Conclusion This is the largest single series of the Oxford UKA ever reported
and demonstrates that good results can be achieved by a heterogeneous
group of surgeons, including trainees, if performed within a high-volume
centre with considerable experience with the procedure. Cite this article: Bone Joint J 2016;(10 Suppl
B):22–7.
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Affiliation(s)
- N Bottomley
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - L D Jones
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - R Rout
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - A Alvand
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - I Rombach
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - T Evans
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - W F M Jackson
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - D J Beard
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
| | - A J Price
- NDORMs, University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, UK
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21
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Akbarian S, Liu C, Knowles JA, Vaccarino FM, Farnham PJ, Crawford GE, Jaffe AE, Pinto D, Dracheva S, Geschwind DH, Mill J, Nairn AC, Abyzov A, Pochareddy S, Prabhakar S, Weissman S, Sullivan PF, State MW, Weng Z, Peters MA, White KP, Gerstein MB, Amiri A, Armoskus C, Ashley-Koch AE, Bae T, Beckel-Mitchener A, Berman BP, Coetzee GA, Coppola G, Francoeur N, Fromer M, Gao R, Grennan K, Herstein J, Kavanagh DH, Ivanov NA, Jiang Y, Kitchen RR, Kozlenkov A, Kundakovic M, Li M, Li Z, Liu S, Mangravite LM, Mattei E, Markenscoff-Papadimitriou E, Navarro FCP, North N, Omberg L, Panchision D, Parikshak N, Poschmann J, Price AJ, Purcaro M, Reddy TE, Roussos P, Schreiner S, Scuderi S, Sebra R, Shibata M, Shieh AW, Skarica M, Sun W, Swarup V, Thomas A, Tsuji J, van Bakel H, Wang D, Wang Y, Wang K, Werling DM, Willsey AJ, Witt H, Won H, Wong CCY, Wray GA, Wu EY, Xu X, Yao L, Senthil G, Lehner T, Sklar P, Sestan N. The PsychENCODE project. Nat Neurosci 2016; 18:1707-12. [PMID: 26605881 DOI: 10.1038/nn.4156] [Citation(s) in RCA: 272] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Chunyu Liu
- University of Illinois at Chicago, Chicago, Illinois, USA
| | - James A Knowles
- University of Southern California, Los Angeles, California, USA
| | | | - Peggy J Farnham
- University of Southern California, Los Angeles, California, USA
| | | | - Andrew E Jaffe
- Lieber Institute for Brain Development, Baltimore, Maryland, USA
| | - Dalila Pinto
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stella Dracheva
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Jonathan Mill
- King's College London, London, and University of Exeter, Devon, UK
| | | | | | | | | | | | | | | | - Zhiping Weng
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | | | | | | | - Chris Armoskus
- University of Southern California, Los Angeles, California, USA
| | | | | | | | | | | | | | - Nancy Francoeur
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Menachem Fromer
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert Gao
- University of Southern California, Los Angeles, California, USA
| | - Kay Grennan
- University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - David H Kavanagh
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nikolay A Ivanov
- Lieber Institute for Brain Development, Baltimore, Maryland, USA
| | - Yan Jiang
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Alexey Kozlenkov
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Mingfeng Li
- Yale University, New Haven, Connecticut, USA
| | - Zhen Li
- Yale University, New Haven, Connecticut, USA
| | - Shuang Liu
- Yale University, New Haven, Connecticut, USA
| | | | - Eugenio Mattei
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | | | - Nicole North
- National Institute of Mental Health, Bethesda, Maryland, USA
| | | | | | | | | | - Amanda J Price
- Lieber Institute for Brain Development, Baltimore, Maryland, USA
| | - Michael Purcaro
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Panos Roussos
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Robert Sebra
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Annie W Shieh
- University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - Wenjie Sun
- Genome Institute of Singapore, Singapore
| | - Vivek Swarup
- University of California, Los Angeles, California, USA
| | - Amber Thomas
- The University of Chicago, Chicago, Illinois, USA
| | - Junko Tsuji
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Harm van Bakel
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Yongjun Wang
- University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kai Wang
- University of Southern California, Los Angeles, California, USA
| | | | | | - Heather Witt
- University of Southern California, Los Angeles, California, USA
| | - Hyejung Won
- University of California, Los Angeles, California, USA
| | - Chloe C Y Wong
- King's College London, London, and University of Exeter, Devon, UK
| | | | - Emily Y Wu
- University of California, Los Angeles, California, USA
| | - Xuming Xu
- Yale University, New Haven, Connecticut, USA
| | - Lijing Yao
- University of Southern California, Los Angeles, California, USA
| | - Geetha Senthil
- National Institute of Mental Health, Bethesda, Maryland, USA
| | - Thomas Lehner
- National Institute of Mental Health, Bethesda, Maryland, USA
| | - Pamela Sklar
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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22
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Price AJ, Erturan G, Akhtar K, Judge A, Alvand A, Rees JL. Evidence-based surgical training in orthopaedics: how many arthroscopies of the knee are needed to achieve consultant level performance? Bone Joint J 2016; 97-B:1309-15. [PMID: 26430003 DOI: 10.1302/0301-620x.97b10.35973] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite being one of the most common orthopaedic operations, it is still not known how many arthroscopies of the knee must be performed during training in order to develop the skills required to become a Consultant. A total of 54 subjects were divided into five groups according to clinical experience: Novices (n = 10), Junior trainees (n = 10), Registrars (n = 18), Fellows (n = 10) and Consultants (n = 6). After viewing an instructional presentation, each subject performed a simple diagnostic arthroscopy of the knee on a simulator with visualisation and probing of ten anatomical landmarks. Performance was assessed using a validated global rating scale (GRS). Comparisons were made against clinical experience measured by the number of arthroscopies which had been undertaken, and ROC curve analysis was used to determine the number of procedures needed to perform at the level of the Consultants. There were marked differences between the groups. There was significant improvement in performance with increasing experience (p < 0.05). ROC curve analysis identified that approximately 170 procedures were required to achieve the level of skills of a Consultant. We suggest that this approach to identify what represents the level of surgical skills of a Consultant should be used more widely so that standards of training are maintained through the development of an evidenced-based curriculum.
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Affiliation(s)
- A J Price
- University of Oxford, Windmill Road, OX3 7LD, UK
| | - G Erturan
- University of Oxford, Windmill Road, OX3 7LD, UK
| | - K Akhtar
- Royal London Hospital, Barts Health NHS Trust, 4 Newark Street, London, E1 2AT, UK
| | - A Judge
- University of Oxford, Windmill Road, OX3 7LD, UK
| | - A Alvand
- University of Oxford, Windmill Road, OX3 7LD, UK
| | - J L Rees
- University of Oxford, Windmill Road, OX3 7LD, UK
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23
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Jones LD, Bottomley N, Harris K, Jackson W, Price AJ, Beard DJ. The clinical symptom profile of early radiographic knee arthritis: a pain and function comparison with advanced disease. Knee Surg Sports Traumatol Arthrosc 2016; 24:161-8. [PMID: 25274096 DOI: 10.1007/s00167-014-3356-z] [Citation(s) in RCA: 18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 09/23/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Early knee OA is a significant problem that can be disabling. The purpose of this study was to understand the symptomatic profile of patients with early knee OA when compared to those with end-stage knee OA. METHODS A cross-sectional case control study design was used to compare those with early structural change to those with advanced structural change. In total, 100 consecutive patients with early radiographic knee OA presenting to the knee service outpatient clinic from December 2010 to August 2011 were prospectively identified on the basis of their radiographic changes. All met the symptomatic and radiological diagnostic criteria of early knee OA as defined by Luyten et al. They were compared with 200 knees with full thickness anteromedial knee OA and 200 knees with full thickness tricompartmental knee OA for their demographic, pain and functional profile. RESULTS Patients with early knee OA were younger than those with full thickness disease. However, 78% of individual patients with early radiographic OA had pain and function scores equal to individual patients presenting for UKA, whilst 74% of individual patients with early radiographic OA had pain and function scores that are equal to or worse than individual patients presenting for TKA. CONCLUSIONS Patients with early radiographic knee OA demonstrate considerable overlap in the severity of their symptoms with those demonstrating end-stage structural changes within the knee. Patients with early structural changes of arthritis should not be assumed by clinicians to have mild disease. In many cases, their symptoms are as bad as those with end-stage structural changes. This work will help clinicians to identify and categorise those with early arthritis and thereby assist in guiding appropriate treatments.
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Affiliation(s)
- L D Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - N Bottomley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - K Harris
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - W Jackson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - D J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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24
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Pegg EC, Baré J, Gill HS, Pandit HG, O'Connor JJ, Murray DW, Price AJ. Influence of consciousness, muscle action and activity on medial condyle translation after Oxford unicompartmental knee replacement. Knee 2015; 22:646-52. [PMID: 26514940 DOI: 10.1016/j.knee.2015.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/09/2015] [Accepted: 09/30/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Quantification of the in vivo position of the medial condyle throughout flexion is important for knee replacement design, and understanding knee pathology. The influence of consciousness, muscle action, and activity type on condyle translation was examined in patients who had undergone medial unicompartmental knee replacement (UKR) using lateral video fluoroscopy. METHODS The position of the centre of the femoral component relative to the tibial component was measured for nine patients under different conditions. The following activities were assessed; passive flexion and extension when anaesthetised, passive flexion and extension when conscious, and active flexion, extension and step-up. RESULTS The position of the centre of the femoral component relative to the tibial component was highly patient dependent. The greatest average translation range (14.9 mm) was observed in anaesthetised patients, and the condyle was significantly more anterior near to extension. Furthermore, when conscious but being moved passively, the femoral condyle translated a greater range (8.9 mm) than when moving actively (5.2mm). When ascending stairs, the femoral condyle was more posterior at 20-30° of flexion than during flexion/extension. CONCLUSIONS The similarity between these results and published data suggest that knee kinematics following mobile-bearing UKR is relatively normal. The results show that in the normal knee and after UKR, knee kinematics is variable and is influenced by the patient, consciousness, muscle action, and activity type. CLINICAL RELEVANCE It is therefore essential that all these factors are considered during knee replacement design, if the aim is to achieve more normal knee kinematics.
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Affiliation(s)
- E C Pegg
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - J Baré
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia
| | - H S Gill
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - H G Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J J O'Connor
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Abstract
Osteoarthritis is a major source of pain, disability, and socioeconomic cost worldwide. The epidemiology of the disorder is complex and multifactorial, with genetic, biological, and biomechanical components. Aetiological factors are also joint specific. Joint replacement is an effective treatment for symptomatic end-stage disease, although functional outcomes can be poor and the lifespan of prostheses is limited. Consequently, the focus is shifting to disease prevention and the treatment of early osteoarthritis. This task is challenging since conventional imaging techniques can detect only quite advanced disease and the relation between pain and structural degeneration is not close. Nevertheless, advances in both imaging and biochemical markers offer potential for diagnosis and as outcome measures for new treatments. Joint-preserving interventions under development include lifestyle modification and pharmaceutical and surgical modalities. Some show potential, but at present few have proven ability to arrest or delay disease progression.
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Affiliation(s)
- S Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - R Agricola
- Department of Orthopaedics, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - T L Vincent
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - H Weinans
- Department of Orthopaedics, University Medical Centre Utrecht, Netherlands
| | - A J Carr
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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26
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Springer S, Yi KH, Park J, Rajpurohit A, Price AJ, Lauring J. Engineering targeted chromosomal amplifications in human breast epithelial cells. Breast Cancer Res Treat 2015; 152:313-21. [PMID: 26099605 PMCID: PMC4491111 DOI: 10.1007/s10549-015-3468-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 06/09/2015] [Indexed: 01/28/2023]
Abstract
Chromosomal amplifications are among the most common genetic alterations found in human cancers. However, experimental systems to study the processes that lead to specific, recurrent amplification events in human cancers are lacking. Moreover, some common amplifications, such as that at 8p11-12 in breast cancer, harbor multiple driver oncogenes, which are poorly modeled by conventional overexpression approaches. We sought to develop an experimental system to model recurrent chromosomal amplification events in human cell lines. Our strategy is to use homologous-recombination-mediated gene targeting to deliver a dominantly selectable, amplifiable marker to a specified chromosomal location. We used adeno-associated virus vectors to target human MCF-7 breast cancer cells at the ZNF703 locus, in the recurrent 8p11-12 amplicon, using the E. coli inosine monophosphate dehydrogenase (IMPDH) enzyme as a marker. We applied selective pressure using IMPDH inhibitors. Surviving clones were found to have increased copy number of ZNF703 (average 2.5-fold increase) by droplet digital PCR and FISH. Genome-wide array comparative genomic hybridization confirmed that amplifications had occurred on the short arm of chromosome 8, without changes on 8q or other chromosomes. Patterns of amplification were variable and similar to those seen in primary human breast cancers, including “sawtooth” patterns, distal copy number loss, and large continuous regions of copy number gain. This system will allow study of the cis- and trans-acting factors that are permissive for chromosomal amplification and provide a model to analyze oncogene cooperativity in amplifications harboring multiple candidate driver genes.
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Affiliation(s)
- Simeon Springer
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, CRB 1 Room 146, 1650 Orleans Street, Baltimore, MD, 21287, USA
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Rhodes DA, Chen HC, Price AJ, Keeble AH, Davey MS, James LC, Eberl M, Trowsdale J. Activation of human γδ T cells by cytosolic interactions of BTN3A1 with soluble phosphoantigens and the cytoskeletal adaptor periplakin. J Immunol 2015; 194:2390-8. [PMID: 25637025 PMCID: PMC4337483 DOI: 10.4049/jimmunol.1401064] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The three butyrophilin BTN3A molecules, BTN3A1, BTN3A2, and BTN3A3, are members of the B7/butyrophilin-like group of Ig superfamily receptors, which modulate the function of T cells. BTN3A1 controls activation of human Vγ9/Vδ2 T cells by direct or indirect presentation of self and nonself phosphoantigens (pAg). We show that the microbial metabolite (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate binds to the intracellular B30.2 domain of BTN3A1 with an affinity of 1.1 μM, whereas the endogenous pAg isopentenyl pyrophosphate binds with an affinity of 627 μM. Coculture experiments using knockdown cell lines showed that in addition to BTN3A1, BTN3A2 and BTN3A3 transmit activation signals to human γδ T cells in response to (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate and the aminobisphosphonate drug zoledronate that causes intracellular accumulation of isopentenyl pyrophosphate. The plakin family member periplakin, identified in yeast two-hybrid assays, interacted with a membrane-proximal di-leucine motif, located proximal to the B30.2 domain in the BTN3A1 cytoplasmic tail. Periplakin did not interact with BTN3A2 or BTN3A3, which do not contain the di-leucine motif. Re-expression into a BTN3A1 knockdown line of wild-type BTN3A1, but not of a variant lacking the periplakin binding motif, BTN3A1Δexon5, restored γδ T cell responses, demonstrating a functional role for periplakin interaction. These data, together with the widespread expression in epithelial cells, tumor tissues, and macrophages detected using BTN3A antiserum, are consistent with complex functions for BTN3A molecules in tissue immune surveillance and infection, linking the cell cytoskeleton to γδ T cell activation by indirectly presenting pAg to the Vγ9/Vδ2 TCR.
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Affiliation(s)
- David A Rhodes
- Immunology Division, Department of Pathology, University of Cambridge, Cambridge Institute for Medical Research, Cambridge CB2 0XY, United Kingdom;
| | - Hung-Chang Chen
- Cardiff Institute of Infection & Immunity, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, United Kingdom; and
| | - Amanda J Price
- Protein and Nucleic Acid Chemistry Division, Medical Research Council Laboratory of Molecular Biology, Cambridge CB2 0QH, United Kingdom
| | - Anthony H Keeble
- Protein and Nucleic Acid Chemistry Division, Medical Research Council Laboratory of Molecular Biology, Cambridge CB2 0QH, United Kingdom
| | - Martin S Davey
- Cardiff Institute of Infection & Immunity, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, United Kingdom; and
| | - Leo C James
- Protein and Nucleic Acid Chemistry Division, Medical Research Council Laboratory of Molecular Biology, Cambridge CB2 0QH, United Kingdom
| | - Matthias Eberl
- Cardiff Institute of Infection & Immunity, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, United Kingdom; and
| | - John Trowsdale
- Immunology Division, Department of Pathology, University of Cambridge, Cambridge Institute for Medical Research, Cambridge CB2 0XY, United Kingdom
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Harris KK, Price AJ, Beard DJ, Fitzpatrick R, Jenkinson C, Dawson J. Can pain and function be distinguished in the Oxford Hip Score in a meaningful way? : an exploratory and confirmatory factor analysis. Bone Joint Res 2014; 3:305-9. [PMID: 25368370 PMCID: PMC4238024 DOI: 10.1302/2046-3758.311.2000313] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective The objective of this study was to explore dimensionality of
the Oxford Hip Score (OHS) and examine whether self-reported pain
and functioning can be distinguished in the form of subscales. Methods This was a secondary data analysis of the UK NHS hospital episode
statistics/patient-reported outcome measures dataset containing
pre-operative OHS scores on 97 487 patients who were undergoing
hip replacement surgery. Results The proposed number of factors to extract depended on the method
of extraction employed. Velicer’s Minimum Average Partial test and
the Parallel Analysis suggested one factor, the Cattell’s scree
test and Kaiser-over-1 rule suggested two factors. Exploratory factor
analysis demonstrated that the two-factor OHS had most of the items saliently
loading either of the two factors. These factors were named ‘Pain’
and ‘Function’ and their respective subscales were created. There
was some cross-loading of items: 8 (pain on standing up from a chair)
and 11 (pain during work). These items were assigned to the ‘Pain’
subscale. The final ‘Pain’ subscale consisted of items 1, 8, 9, 10,
11 and 12. The ‘Function’ subscale consisted of items 2, 3, 4, 5,
6 and 7, with the recommended scoring of the subscales being from
0 (worst) to 100 (best). Cronbach’s alpha was 0.855 for the ‘Pain’
subscale and 0.861 for the ‘Function’ subscale. A confirmatory factor
analysis demonstrated that the two-factor model of the OHS had a better
fit. However, none of the one-factor or two-factor models was rejected. Conclusion Factor analyses demonstrated that, in addition to current usage
as a single summary scale, separate information on pain and self-reported
function can be extracted from the OHS in a meaningful way in the
form of subscales. Cite this article: Bone Joint Res 2014;3:305–9.
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Affiliation(s)
- K K Harris
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Windmill Road, Oxford OX3 7LD, UK
| | - A J Price
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Windmill Road, Oxford OX3 7LD, UK
| | - D J Beard
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Windmill Road, Oxford OX3 7LD, UK
| | - R Fitzpatrick
- University of Oxford, Nuffield Department of Population Health, Oxford OX3 7LF, UK
| | - C Jenkinson
- University of Oxford, Nuffield Department of Population Health, Oxford OX3 7LF, UK
| | - J Dawson
- University of Oxford, Nuffield Department of Population Health, Oxford OX3 7LF, UK
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Price AJ, Jacques DA, McEwan WA, Fletcher AJ, Essig S, Chin JW, Halambage UD, Aiken C, James LC. Host cofactors and pharmacologic ligands share an essential interface in HIV-1 capsid that is lost upon disassembly. PLoS Pathog 2014; 10:e1004459. [PMID: 25356722 PMCID: PMC4214760 DOI: 10.1371/journal.ppat.1004459] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
The HIV-1 capsid is involved in all infectious steps from reverse transcription to integration site selection, and is the target of multiple host cell and pharmacologic ligands. However, structural studies have been limited to capsid monomers (CA), and the mechanistic basis for how these ligands influence infection is not well understood. Here we show that a multi-subunit interface formed exclusively within CA hexamers mediates binding to linear epitopes within cellular cofactors NUP153 and CPSF6, and is competed for by the antiretroviral compounds PF74 and BI-2. Each ligand is anchored via a shared phenylalanine-glycine (FG) motif to a pocket within the N-terminal domain of one monomer, and all but BI-2 also make essential interactions across the N-terminal domain: C-terminal domain (NTD:CTD) interface to a second monomer. Dissociation of hexamer into CA monomers prevents high affinity interaction with CPSF6 and PF74, and abolishes binding to NUP153. The second interface is conformationally dynamic, but binding of NUP153 or CPSF6 peptides is accommodated by only one conformation. NUP153 and CPSF6 have overlapping binding sites, but each makes unique CA interactions that, when mutated selectively, perturb cofactor dependency. These results reveal that multiple ligands share an overlapping interface in HIV-1 capsid that is lost upon viral disassembly. The early steps of HIV-1 infection are poorly understood, in part because of the difficulty in obtaining high-resolution information on encapsidated virus and its interaction with host cofactors. This, in turn, has made it difficult to design effective anti-capsid (CA) drugs. In our present study, we have used stabilized hexamers of HIV-1 CA to obtain complexed crystal structures with two cellular cofactors that are important for HIV-1 infection. These structures and accompanying virology reveal an essential interface in the capsid of HIV-1 that is lost upon viral uncoating. This interface is used to recruit both the nuclear targeting cofactor CPSF6 and NUP153, a nuclear pore component that facilitates nuclear entry. The high-resolution information provided by these structures reveals that the interface is degenerate and CA mutations can be made that selectively perturb sensitivity to each cofactor. This interface is also competed by two antiviral drugs, PF74 and BI-2, whose different mechanisms of action are not fully understood. We show that PF74, but not BI-2, binds across monomers within multimerized capsid affecting an inter-hexamer interface that is crucial for maintaining intact virions and that the addition of saturating concentrations of PF74 causes an irreversible block to viral reverse transcription.
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Affiliation(s)
- Amanda J. Price
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Cambridge, United Kingdom
| | - David A. Jacques
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Cambridge, United Kingdom
| | - William A. McEwan
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Cambridge, United Kingdom
| | - Adam J. Fletcher
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Cambridge, United Kingdom
| | - Sebastian Essig
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Cambridge, United Kingdom
| | - Jason W. Chin
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Cambridge, United Kingdom
| | - Upul D. Halambage
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Christopher Aiken
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Leo C. James
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Cambridge, United Kingdom
- * E-mail:
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Williams DP, O'Brien S, Doran E, Price AJ, Beard DJ, Murray DW, Beverland DE. Early postoperative predictors of satisfaction following total knee arthroplasty. Knee 2013; 20:442-6. [PMID: 23777807 DOI: 10.1016/j.knee.2013.05.011] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 04/26/2013] [Accepted: 05/22/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite the excellent total knee arthroplasty (TKA) results reported using traditional outcome measures, dissatisfaction rates of up to 30% are reported following surgery. Although several preoperative factors have been identified as possible predictors of satisfaction, there is conflicting evidence. Identification of dissatisfaction in the early postoperative assessment may therefore be an alternative consideration. METHODS We examined the relationship between 12-month satisfaction, and early post-operative outcomes in a cohort of 486 TKA patients. Preoperative, and postoperative outcome measures at 3- and 12-months (Oxford knee score, pain score, SF12, and knee motion), were analysed and compared between patients who were satisfied and dissatisfied at 12-months following TKA. Mean scores, and postoperative change in scores were calculated. Postoperative outcomes were examined for correlation with satisfaction, and multivariate logistic regression models used to identify potential predictors of dissatisfaction. RESULTS Overall satisfaction was 77.0%. No preoperative differences were observed between groups. Dissatisfaction was associated with worse postoperative status across all outcome measures (p<0.001), except the 3-month SF12-physical component (p=0.052). Dissatisfied patients demonstrated minimal further improvement or even worsening of outcome scores between 3- and 12-months postoperatively (p<0.02). Both the 3-month OKS (OR=1.15, p<0.001), and knee flexion (OR=1.03, p=0.009) were significant predictors of subsequent 12-month satisfaction. CONCLUSIONS Dissatisfaction following TKA is associated with worse outcomes as early as 3months following surgery, with minimal further improvement subsequently achieved at 12-months. Early postoperative assessment following TKA should therefore be considered, including clinical assessment, to identify those patients at risk of dissatisfaction.
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Affiliation(s)
- D P Williams
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
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31
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Rasaiyaah J, Tan CP, Fletcher AJ, Price AJ, Blondeau C, Hilditch L, Jacques DA, Selwood DL, James LC, Noursadeghi M, Towers GJ. HIV-1 evades innate immune recognition through specific cofactor recruitment. Nature 2013; 503:402-405. [PMID: 24196705 PMCID: PMC3928559 DOI: 10.1038/nature12769] [Citation(s) in RCA: 339] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 10/08/2013] [Indexed: 01/15/2023]
Abstract
Human immunodeficiency virus (HIV)-1 is able to replicate in primary human macrophages without stimulating innate immunity despite reverse transcription of genomic RNA into double-stranded DNA, an activity that might be expected to trigger innate pattern recognition receptors. We reasoned that if correctly orchestrated HIV-1 uncoating and nuclear entry is important for evasion of innate sensors then manipulation of specific interactions between HIV-1 capsid and host factors that putatively regulate these processes should trigger pattern recognition receptors and stimulate type 1 interferon (IFN) secretion. Here we show that HIV-1 capsid mutants N74D and P90A, which are impaired for interaction with cofactors cleavage and polyadenylation specificity factor subunit 6 (CPSF6) and cyclophilins (Nup358 and CypA), respectively, cannot replicate in primary human monocyte-derived macrophages because they trigger innate sensors leading to nuclear translocation of NF-κB and IRF3, the production of soluble type 1 IFN and induction of an antiviral state. Depletion of CPSF6 with short hairpin RNA expression allows wild-type virus to trigger innate sensors and IFN production. In each case, suppressed replication is rescued by IFN-receptor blockade, demonstrating a role for IFN in restriction. IFN production is dependent on viral reverse transcription but not integration, indicating that a viral reverse transcription product comprises the HIV-1 pathogen-associated molecular pattern. Finally, we show that we can pharmacologically induce wild-type HIV-1 infection to stimulate IFN secretion and an antiviral state using a non-immunosuppressive cyclosporine analogue. We conclude that HIV-1 has evolved to use CPSF6 and cyclophilins to cloak its replication, allowing evasion of innate immune sensors and induction of a cell-autonomous innate immune response in primary human macrophages.
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Affiliation(s)
- Jane Rasaiyaah
- University College London, Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, University College London, 90 Gower St, London WC1E 6BT, United Kingdom
| | - Choon Ping Tan
- University College London, Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, University College London, 90 Gower St, London WC1E 6BT, United Kingdom
| | - Adam J. Fletcher
- University College London, Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, University College London, 90 Gower St, London WC1E 6BT, United Kingdom
| | - Amanda J. Price
- Protein and Nucleic Acid Chemistry Division, Medical Research Council Laboratory of Molecular Biology, Cambridge, UK
| | - Caroline Blondeau
- University College London, Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, University College London, 90 Gower St, London WC1E 6BT, United Kingdom
| | - Laura Hilditch
- University College London, Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, University College London, 90 Gower St, London WC1E 6BT, United Kingdom
| | - David A Jacques
- Protein and Nucleic Acid Chemistry Division, Medical Research Council Laboratory of Molecular Biology, Cambridge, UK
| | - David L Selwood
- Wolfson Institute for Biomedical Research, University College London, Gower Street, London WC1E 6BT, UK
| | - Leo C James
- Protein and Nucleic Acid Chemistry Division, Medical Research Council Laboratory of Molecular Biology, Cambridge, UK
| | - Mahdad Noursadeghi
- University College London, Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, University College London, 90 Gower St, London WC1E 6BT, United Kingdom
| | - Greg J Towers
- University College London, Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, University College London, 90 Gower St, London WC1E 6BT, United Kingdom
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Liddle AD, Pandit H, Jenkins C, Price AJ, Dodd CAF, Gill HS, Murray DW. Preoperative pain location is a poor predictor of outcome after Oxford unicompartmental knee arthroplasty at 1 and 5 years. Knee Surg Sports Traumatol Arthrosc 2013; 21:2421-6. [PMID: 23000922 DOI: 10.1007/s00167-012-2211-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 04/20/2012] [Accepted: 09/10/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE Indications for unicompartmental knee arthroplasty (UKA) vary between units. Some authors have suggested, and many surgeons believe, that medial UKA should only be performed in patients who localise their pain to the medial joint line. This is despite research showing a poor correlation between patient-reported location of pain and radiological or operative findings in osteoarthritis. The aim of this study is to determine the effect of patient-reported preoperative pain location and functional outcome of UKA at 1 and 5 years. METHODS Preoperative pain location data were collected for 406 knees (380 patients) undergoing Oxford medial UKA. Oxford Knee Score, American Knee Society Scores and Tegner activity scale were recorded preoperatively and at follow-up; 272/406 (67 %) had pure medial pain, 25/406 (6 %) had pure anterior knee pain, and 109/406 (27 %) had mixed or generalised pain. None had pure lateral pain. The primary outcome interval is 1 year; 132/406 patients had attained 5 years by the time of analysis, and their 5-year data are presented. RESULTS At 1 and 5 years, each group had improved significantly by each measure [mean ΔOKS 15.6 (SD 8.9) at year 1, 16.3 (9.3) at year 5]. There was no difference between the groups, nor between patients with and without anterior knee pain or isolated medial pain. CONCLUSIONS No correlation is demonstrated between preoperative pain location and outcome. We conclude that localised medial pain should not be a prerequisite to UKA and that it may be performed in patients with generalised or anterior knee pain.
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Affiliation(s)
- A D Liddle
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK,
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Pandit H, Liddle AD, Kendrick BJL, Jenkins C, Price AJ, Gill HS, Dodd CAF, Murray DW. Improved fixation in cementless unicompartmental knee replacement: five-year results of a randomized controlled trial. J Bone Joint Surg Am 2013; 95:1365-72. [PMID: 23925740 DOI: 10.2106/jbjs.l.01005] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [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: 02/01/2023]
Abstract
BACKGROUND When used for appropriate indications, unicompartmental knee replacement is associated with fewer complications, faster recovery, and better function than total knee replacement. However, joint registries demonstrate a higher revision rate for unicompartmental knee replacement. Currently, most unicompartmental knee replacements are cemented; common reasons for revision include aseptic loosening and pain. These problems could potentially be addressed by using cementless implants, with coatings designed to improve fixation. The objectives of this study were to compare the quality of fixation as well as clinical outcomes of cemented and cementless unicompartmental knee replacements at five years of follow-up. METHODS A randomized controlled trial was established with sixty-three knees (sixty-two patients) receiving either cemented (thirty-two patients) or cementless Oxford unicompartmental knee replacements (thirty patients). Fixation was assessed with fluoroscopic radiographs aligned to the bone-implant interface at one and five years. Outcome scores, including the Oxford Knee Score, Knee Society objective and functional scores, and Tegner Activity Score, were collected preoperatively and at six months and one, two, and five years postoperatively. At each postoperative time point, these were recorded as absolute scores and change from the preoperative score. RESULTS Four patients died during the study period. There were no revisions. Mean operative time was nine minutes shorter in the cementless group (p = 0.049). At five years, there was no significant difference in any outcome measure except the Knee Society functional score and the change in the Knee Society functional score, which were significantly better in the cementless group (p = 0.003 for both). There were significantly more tibial radiolucencies in the cemented group (twenty of thirty knees versus two of twenty-seven knees; p < 0.001). There were nine complete radiolucencies in the cemented group and none in the cementless group (p = 0.01). CONCLUSIONS Cementless fixation provides improved fixation at five years compared with cemented fixation in mobile-bearing unicompartmental knee replacements, maintaining equivalent or superior clinical outcomes with a shorter operative time and no increase in complications. LEVEL OF EVIDENCE Therapeutic level I. See Instructions for authors for a complete description of levels of evidence.
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Affiliation(s)
- H Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford OX3 7LD, UK
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Bichel K, Price AJ, Schaller T, Towers GJ, Freund SMV, James LC. HIV-1 capsid undergoes coupled binding and isomerization by the nuclear pore protein NUP358. Retrovirology 2013; 10:81. [PMID: 23902822 PMCID: PMC3750474 DOI: 10.1186/1742-4690-10-81] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 07/12/2013] [Indexed: 11/21/2022] Open
Abstract
Background Lentiviruses such as HIV-1 can be distinguished from other retroviruses by the cyclophilin A-binding loop in their capsid and their ability to infect non-dividing cells. Infection of non-dividing cells requires transport through the nuclear pore but how this is mediated is unknown. Results Here we present the crystal structure of the N-terminal capsid domain of HIV-1 in complex with the cyclophilin domain of nuclear pore protein NUP358. The structure reveals that HIV-1 is positioned to allow single-bond resonance stabilisation of exposed capsid residue P90. NMR exchange experiments demonstrate that NUP358 is an active isomerase, which efficiently catalyzes cis-trans isomerization of the HIV-1 capsid. In contrast, the distantly related feline lentivirus FIV can bind NUP358 but is neither isomerized by it nor requires it for infection. Conclusion Isomerization by NUP358 may be preserved by HIV-1 to target the nuclear pore and synchronize nuclear entry with capsid uncoating.
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Affiliation(s)
- Katsiaryna Bichel
- Protein and Nucleic Acid Chemistry Division, Medical Research Council Laboratory of Molecular Biology, Hills Road, Cambridge CB2 0QH, UK
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Abstract
Treatment for osteoarthritis (OA) has traditionally focused on joint replacement for end-stage disease. An increasing number of surgical and pharmaceutical strategies for disease prevention have now been proposed. However, these require the ability to identify OA at a stage when it is potentially reversible, and detect small changes in cartilage structure and function to enable treatment efficacy to be evaluated within an acceptable timeframe. This has not been possible using conventional imaging techniques but recent advances in musculoskeletal imaging have been significant. In this review we discuss the role of different imaging modalities in the diagnosis of the earliest changes of OA. The increasing number of MRI sequences that are able to non-invasively detect biochemical changes in cartilage that precede structural damage may offer a great advance in the diagnosis and treatment of this debilitating condition.
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Affiliation(s)
- A J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington OX3 7LD, UK
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Williams DP, Price AJ, Beard DJ, Hadfield SG, Arden NK, Murray DW, Field RE. The effects of age on patient-reported outcome measures in total knee replacements. Bone Joint J 2013; 95-B:38-44. [PMID: 23307671 DOI: 10.1302/0301-620x.95b1.28061] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [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: 11/05/2022]
Abstract
We present a comparison of patient-reported outcomes (PROMs) in relation to patient age, in patients who had received a total (TKR) or unicompartmental knee replacement (UKR). The outcome was evaluated using the Oxford knee score (OKS), EuroQol (EQ-5D) and satisfaction scores. Patients aged 65 to 84 years demonstrated better pre-operative function scores than those aged < 65 years (OKS, p = 0.03; EQ-5D, p = 0.048) and those aged ≥ 85 years (OKS, p = 0.03). Post-operative scores were comparable across age groups, but a linear trend for greater post-operative improvement in OKS and EQ-5D was seen with decreasing age (p < 0.033). The overall mean satisfaction score at six months was 84.9, but those aged < 55 years exhibited a lower mean level of satisfaction (78.3) compared with all other age groups (all p < 0.031). The cumulative overall two-year revision rate was 1.3%. This study demonstrates that good early outcomes, as measured by the OKS and EQ-5D, can be anticipated following knee replacement regardless of the patient's age, although younger patients gain greater improvement. However, the lower satisfaction in those aged < 55 years is a concern, and suggests that outcome is not fully encapsulated by the OKS and EQ-5D evaluation, and raises the question whether the OKS alone is an appropriate measure of pain and function in younger, more active individuals.
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Affiliation(s)
- D P Williams
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Windmill Road, Oxford OX3 7LD, UK.
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Abstract
The Oxford knee score (OKS) is a validated and widely accepted disease-specific patient-reported outcome measure, but there is limited evidence regarding any long-term trends in the score. We reviewed 5600 individual OKS questionnaires (1547 patients) from a prospectively-collected knee replacement database, to determine the trends in OKS over a ten-year period following total knee replacement. The mean OKS pre-operatively was 19.5 (95% confidence interval (CI) 18.8 to 20.2). The maximum post-operative OKS was observed at two years (mean score 34.4 (95% CI 33.7 to 35.2)), following which a gradual but significant decline was observed through to the ten-year assessment (mean score 30.1 (95% CI 29.1 to 31.1)) (p < 0.001). A similar trend was observed for most of the individual OKS components (p < 0.001). Kneeling ability initially improved in the first year but was then followed by rapid deterioration (p < 0.001). Pain severity exhibited the greatest improvement, although residual pain was reported in over two-thirds of patients post-operatively, and peak improvement in the night pain component did not occur until year four. Post-operative OKS was lower for women (p < 0.001), those aged < 60 years (p < 0.003) and those with a body mass index > 35 kg/m(2) (p < 0.014), although similar changes in scores were observed. This information may assist surgeons in advising patients of their expected outcomes, as well as providing a comparative benchmark for evaluating longer-term outcomes following knee replacement.
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Affiliation(s)
- D P Williams
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, BOTNAR Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK.
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Kendrick BJL, James AR, Pandit H, Gill HS, Price AJ, Blunn GW, Murray DW. Histology of the bone-cement interface in retrieved Oxford unicompartmental knee replacements. Knee 2012; 19:918-22. [PMID: 22542361 DOI: 10.1016/j.knee.2012.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [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: 11/16/2011] [Revised: 03/15/2012] [Accepted: 03/19/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Radiolucent lines (RLL) are commonly seen at the cement-bone interface of knee replacements, yet are poorly understood. Although thin RLL are not associated with implant loosening or poor patient outcome there is still concern that they indicate sub-optimal fixation. The primary study aim is to characterise the histology at the cement-tibia interface in Oxford unicompartmental knee replacement (UKR). The second aim is to assess whether a correlation exists between the presence of a RLL and the type of tissue that predominates at the interface. METHODS The radiology and histology of retrieved specimens of the interface from around firmly fixed tibial trays in ten patients undergoing revision between 1 and 19 years after Oxford UKR were studied. RESULTS Pre-revision radiographs showed the presence of both full and partial RLL. On contact radiographs of 5mm thick sections of the interface the total percentage of radiolucency ranged from 0 to 90% between patients. There was no consistent pattern for the distribution of radiolucency. Histological assessment demonstrated that under every tibial component there were areas where there was direct contact and interdigitation between bone and cement. The amount of direct bone-cement contact was between 19% and 95% of the tibial tray surface area. The remaining tissue was mainly fibrocartilage but there was also fibrous tissue. The presence of radiolucency was strongly inversely correlated with the percentage of cement-bone contact. CONCLUSION This study demonstrates that even with partial or complete RLL seen on radiographs there is still cement-bone contact, thus indicating that there is stable fixation.
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Affiliation(s)
- B J L Kendrick
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK.
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Beard DJ, Holt MD, Mullins MM, Malek S, Massa E, Price AJ. Decision making for knee replacement: variation in treatment choice for late stage medial compartment osteoarthritis. Knee 2012; 19:886-9. [PMID: 22682210 DOI: 10.1016/j.knee.2012.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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: 09/28/2011] [Revised: 05/15/2012] [Accepted: 05/16/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with medial unicompartmental osteoarthritic disease of the knee requiring arthroplasty can be treated with either Total or Unicompartmental Knee Replacement (TKR or UKR). Currently, the decision to choose one operation over another is not well defined and may depend on the profile of the surgeon consulted. We tested the hypothesis that different surgeons will select different treatment for identical patients requiring knee replacement. METHOD Four different surgeons, representing four different levels of expertise, made a forced choice decision of whether they would perform TKR or UKR based on radiographs alone and subsequent additional clinical information including gender and age, in 140 patients. Individual surgeon repeatability was tested by repeat assessment 3 months later. RESULTS The knee surgeon from the UKR design centre would have performed a UKR in up to 88% of the patients. The remaining surgeons would have performed UKR in 29-48% of patients; a variation in decision making of up to 59%. Additional clinical information had little effect on decision making with surgeons maintaining their radiographic based choice in 80 to 87% of cases. The repeatability study showed high within surgeon consistency for treatment choice. CONCLUSION Surgeons, given identical information, do not concur on treatment for patients with the same pathology. The decision making process appears heavily influenced by radiographic findings but individual surgeons are consistent with their own treatment choice. The study shows that consensus treatment for medial osteoarthritis of the knee remains in question.
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Affiliation(s)
- D J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Oxford, OX3 7LD, UK.
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Abstract
BACKGROUND Previous studies of task-specific skills have suggested that a loss of technical performance occurs if the skill is not practiced for a six-month period. The aims of this study were to objectively demonstrate the learning curve for a complex arthroscopic task (meniscal repair) by means of motion analysis and to determine the impact of task repetition on the retention of this skill. METHODS Nineteen orthopaedic residents with experience in routine knee arthroscopy but not in arthroscopic meniscal repair were recruited into a randomized study. During the initial learning phase, all subjects performed twelve meniscal repairs on a knee simulator over a three-week period. A validated motion analysis tracking system was used to objectively record the performance and learning of each subject; the outcomes were the time taken, distance traveled, and number of hand movements. The subjects were then randomized into three groups. Group A performed one meniscal repair each month, Group B performed one meniscal repair at three months, and Group C performed no repairs during this interim phase. All three groups then returned at the six-month point for the final assessment phase, during which they carried out an additional twelve meniscal repairs over three weeks. RESULTS All subjects demonstrated a clear learning curve during the initial learning phase, with significant objective improvement in all motion analysis parameters over the initial twelve episodes (p < 0.0001). Although some residents had reached a learning plateau by twelve episodes, others continued to make further improvements for up to another nine episodes. Importantly, Group C did not display any loss of skill between the initial learning phase and final evaluation phase despite a six-month break in task repetition (p > 0.05). CONCLUSIONS In contrast to previous studies, residents did not lose any skill over a six-month interruption in task performance, and other residents took longer to produce a more consistent performance.
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Affiliation(s)
- W F M Jackson
- Oxford Orthopaedic Simulation and Education Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, United Kingdom
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Price AJ, Fletcher AJ, Schaller T, Elliott T, Lee K, KewalRamani VN, Chin JW, Towers GJ, James LC. CPSF6 defines a conserved capsid interface that modulates HIV-1 replication. PLoS Pathog 2012; 8:e1002896. [PMID: 22956906 PMCID: PMC3431306 DOI: 10.1371/journal.ppat.1002896] [Citation(s) in RCA: 195] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 07/23/2012] [Indexed: 12/25/2022] Open
Abstract
The HIV-1 genome enters cells inside a shell comprised of capsid (CA) protein. Variation in CA sequence alters HIV-1 infectivity and escape from host restriction factors. However, apart from the Cyclophilin A-binding loop, CA has no known interfaces with which to interact with cellular cofactors. Here we describe a novel protein-protein interface in the N-terminal domain of HIV-1 CA, determined by X-ray crystallography, which mediates both viral restriction and host cofactor dependence. The interface is highly conserved across lentiviruses and is accessible in the context of a hexameric lattice. Mutation of the interface prevents binding to and restriction by CPSF6-358, a truncated cytosolic form of the RNA processing factor, cleavage and polyadenylation specific factor 6 (CPSF6). Furthermore, mutations that prevent CPSF6 binding also relieve dependence on nuclear entry cofactors TNPO3 and RanBP2. These results suggest that the HIV-1 capsid mediates direct host cofactor interactions to facilitate viral infection.
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Affiliation(s)
- Amanda J. Price
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Cambridge, United Kingdom
| | - Adam J. Fletcher
- Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Torsten Schaller
- Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Tom Elliott
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Cambridge, United Kingdom
| | - KyeongEun Lee
- HIV Drug Resistance Program, National Cancer Institute, Frederick, Maryland, United States of America
| | - Vineet N. KewalRamani
- HIV Drug Resistance Program, National Cancer Institute, Frederick, Maryland, United States of America
| | - Jason W. Chin
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Cambridge, United Kingdom
| | - Greg J. Towers
- Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Leo C. James
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Cambridge, United Kingdom
- * E-mail:
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Khan T, Jackson WF, Beard DJ, Marfin A, Ahmad M, Spacie R, Jones R, Howes S, Barker K, Price AJ. The use of standard operating procedures in day case anterior cruciate ligament reconstruction. Knee 2012; 19:464-8. [PMID: 21646025 DOI: 10.1016/j.knee.2011.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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: 03/10/2011] [Revised: 04/19/2011] [Accepted: 04/21/2011] [Indexed: 02/02/2023]
Abstract
The current rate of day-case anterior cruciate ligament reconstruction (ACLR) in the UK remains low. Although specialised care pathways with standard operating procedures (SOPs) have been effective in reducing length of stay following some surgical procedures, this has not been previously reported for ACLR. We evaluate the effectiveness of SOPs for establishing day-case ACLR in a specialist unit. Fifty patients undergoing ACLR between May and September 2010 were studied prospectively ("study group"). SOPs were designed for pre-operative assessment, anaesthesia, surgical procedure, mobilisation and discharge. We evaluated length of stay, readmission rates, patient satisfaction and compliance to SOPs. A retrospective analysis of 50 patients who underwent ACLR prior to implementation of the day-case pathway was performed ("standard practice group"). Eighty percent of patients in the study group were discharged on the day of surgery (mean length of stay=5.3h) compared to 16% in the standard practice group (mean length of stay=21.6h). This difference was statistically significant (p<0.05, Mann-Whitney U test). All patients were satisfied with the day case pathway. Ninety-two percent of the study group were discharged on the day of surgery when all SOPs were followed and 46% where they were not. High rates of day-case ACLR with excellent patient satisfaction can be achieved with the use of a specialised patient pathway with SOPs.
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Affiliation(s)
- T Khan
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Oxford, OX3 7LD, UK
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Abstract
BACKGROUND Restrictions placed on the working hours of doctors over the past decade have resulted in substantial changes to the training and assessment of orthopaedic surgical residents. Many who are responsible for training the surgeons of the future have become concerned that this reduced clinical exposure is having a detrimental impact on technical skill acquisition. Consequently, there is a need for surgical educators to develop more objective methods for assessing surgical skill. The primary aim of this study was to determine whether a novel set of visual parameters assessing visuospatial ability, fine motor dexterity, and gaze control could objectively discriminate among various levels of arthroscopic experience. The secondary aim was to evaluate the correlations between these new parameters and previously established technical skill assessment methods. METHODS Twenty-seven subjects were divided into a novice group (n = 7), a resident group (n = 15), and an expert group (n = 5) on the basis of arthroscopic experience. All subjects performed a diagnostic knee arthroscopy task on a simulator. Their performance was assessed with use of novel simple visual parameters that included the prevalence of instrument loss, triangulation time, and prevalence of lookdowns. Performance was also evaluated with use of previously validated technical skill assessment methods (a global rating scale and motion analysis). RESULTS A significant difference in performance among the groups was demonstrated with use of all three novel visual parameters, the global rating scale, and motion analysis (p < 0.05). There were strong and highly significant correlations (p < 0.0001) between each of the novel parameters and the previously validated skill assessment methods. CONCLUSIONS This study demonstrates the construct validity of three novel visual parameters for objectively assessing arthroscopic performance. These parameters are simple, can be used easily in the operating room, and are strongly correlated with current validated methods of technical skill assessment.
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Affiliation(s)
- A Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, 150 Windmill Road, Oxford OX3 7LD, United Kingdom
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Caines ME, Bichel K, Price AJ, McEwan WA, Towers GJ, Willett BJ, Freund SM, James LC. Diverse HIV viruses are targeted by a conformationally dynamic antiviral. Nat Struct Mol Biol 2012; 19:411-6. [PMID: 22407016 PMCID: PMC3407371 DOI: 10.1038/nsmb.2253] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 01/30/2012] [Indexed: 11/09/2022]
Abstract
Rhesus macaque TRIMCyp (RhTC) is a potent primate antiviral host protein that inhibits the replication of diverse HIV viruses. Here we show that it has acquired the ability to target multiple viruses by evolving an active site that interconverts between multiple conformations. Mutations that have relieved active site constraints allow RhTC to dynamically sample conformational space, including radically different conformers that target both HIV-1 and HIV-2 viruses. Introduction of a reversible constraint into RhTC allows specificity to be switched between a single conformation specific for HIV-1 and a dynamic ensemble that targets multiple viruses. These results show that conformational diversity can be used to expand the target diversity of innate immune receptors by supplementing their limited genetic variability with variability in protein structure.
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Affiliation(s)
- Matthew E.C. Caines
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Hills Road, Cambridge, CB2 0QH, United Kingdom
| | - Katsiaryna Bichel
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Hills Road, Cambridge, CB2 0QH, United Kingdom
| | - Amanda J. Price
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Hills Road, Cambridge, CB2 0QH, United Kingdom
| | - William A. McEwan
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Hills Road, Cambridge, CB2 0QH, United Kingdom
| | - Greg J. Towers
- Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, University College London, 46 Cleveland Street, London, W1T 4JF, United Kingdom
| | - Brian J. Willett
- Retrovirus Research Laboratory, Institute of Comparative Medicine, Faculty of Veterinary Medicine, University of Glasgow, Bearsden Road, Glasgow, G61 1QH, United Kingdom
| | - Stefan M.V. Freund
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Hills Road, Cambridge, CB2 0QH, United Kingdom
| | - Leo C. James
- Medical Research Council Laboratory of Molecular Biology, Division of Protein and Nucleic Acid Chemistry, Hills Road, Cambridge, CB2 0QH, United Kingdom
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Brown CP, Oloyede A, Crawford RW, Thomas GER, Price AJ, Gill HS. Acoustic, mechanical and near-infrared profiling of osteoarthritic progression in bovine joints. Phys Med Biol 2012; 57:547-59. [DOI: 10.1088/0031-9155/57/2/547] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Schaller T, Ocwieja KE, Rasaiyaah J, Price AJ, Brady TL, Roth SL, Hué S, Fletcher AJ, Lee K, KewalRamani VN, Noursadeghi M, Jenner RG, James LC, Bushman FD, Towers GJ. HIV-1 capsid-cyclophilin interactions determine nuclear import pathway, integration targeting and replication efficiency. PLoS Pathog 2011; 7:e1002439. [PMID: 22174692 PMCID: PMC3234246 DOI: 10.1371/journal.ppat.1002439] [Citation(s) in RCA: 350] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 11/01/2011] [Indexed: 01/10/2023] Open
Abstract
Lentiviruses such as HIV-1 traverse nuclear pore complexes (NPC) and infect terminally differentiated non-dividing cells, but how they do this is unclear. The cytoplasmic NPC protein Nup358/RanBP2 was identified as an HIV-1 co-factor in previous studies. Here we report that HIV-1 capsid (CA) binds directly to the cyclophilin domain of Nup358/RanBP2. Fusion of the Nup358/RanBP2 cyclophilin (Cyp) domain to the tripartite motif of TRIM5 created a novel inhibitor of HIV-1 replication, consistent with an interaction in vivo. In contrast to CypA binding to HIV-1 CA, Nup358 binding is insensitive to inhibition with cyclosporine, allowing contributions from CypA and Nup358 to be distinguished. Inhibition of CypA reduced dependence on Nup358 and the nuclear basket protein Nup153, suggesting that CypA regulates the choice of the nuclear import machinery that is engaged by the virus. HIV-1 cyclophilin-binding mutants CA G89V and P90A favored integration in genomic regions with a higher density of transcription units and associated features than wild type virus. Integration preference of wild type virus in the presence of cyclosporine was similarly altered to regions of higher transcription density. In contrast, HIV-1 CA alterations in another patch on the capsid surface that render the virus less sensitive to Nup358 or TRN-SR2 depletion (CA N74D, N57A) resulted in integration in genomic regions sparse in transcription units. Both groups of CA mutants are impaired in replication in HeLa cells and human monocyte derived macrophages. Our findings link HIV-1 engagement of cyclophilins with both integration targeting and replication efficiency and provide insight into the conservation of viral cyclophilin recruitment.
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Affiliation(s)
- Torsten Schaller
- University College London Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, London, United Kingdom
| | - Karen E. Ocwieja
- University of Pennsylvania School of Medicine, Department of Microbiology, Philadelphia, Pennsylvania, United States of America
| | - Jane Rasaiyaah
- University College London Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, London, United Kingdom
| | - Amanda J. Price
- Medical Research Council Laboratory of Molecular Biology, Protein and Nucleic Acid Chemistry Division, Cambridge, United Kingdom
| | - Troy L. Brady
- University of Pennsylvania School of Medicine, Department of Microbiology, Philadelphia, Pennsylvania, United States of America
| | - Shoshannah L. Roth
- University of Pennsylvania School of Medicine, Department of Microbiology, Philadelphia, Pennsylvania, United States of America
| | - Stéphane Hué
- University College London Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, London, United Kingdom
| | - Adam J. Fletcher
- University College London Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, London, United Kingdom
| | - KyeongEun Lee
- HIV Drug Resistance Program, National Cancer Institute, Frederick, Maryland, United States of America
| | - Vineet N. KewalRamani
- HIV Drug Resistance Program, National Cancer Institute, Frederick, Maryland, United States of America
| | - Mahdad Noursadeghi
- University College London Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, London, United Kingdom
| | - Richard G. Jenner
- University College London Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, London, United Kingdom
| | - Leo C. James
- Medical Research Council Laboratory of Molecular Biology, Protein and Nucleic Acid Chemistry Division, Cambridge, United Kingdom
| | - Frederic D. Bushman
- University of Pennsylvania School of Medicine, Department of Microbiology, Philadelphia, Pennsylvania, United States of America
| | - Greg J. Towers
- University College London Medical Research Council Centre for Medical Molecular Virology, Division of Infection and Immunity, London, United Kingdom
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Brown CP, Houle MA, Chen M, Price AJ, Légaré F, Gill HS. Damage initiation and progression in the cartilage surface probed by nonlinear optical microscopy. J Mech Behav Biomed Mater 2011; 5:62-70. [PMID: 22100080 DOI: 10.1016/j.jmbbm.2011.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 08/11/2011] [Accepted: 08/15/2011] [Indexed: 11/24/2022]
Abstract
With increasing interest in treating osteoarthritis at its earliest stages, it has become important to understand the mechanisms by which the disease progresses across a joint. Here, second harmonic generation (SHG) microscopy, coupled with a two-dimensional spring-mass network model, was used to image and investigate the collagen meshwork architecture at the cartilage surface surrounding osteoarthritic lesions. We found that minor weakening of the collagen meshwork leads to the bundling of fibrils at the surface under normal loading. This bundling appears to be an irreversible step in the degradation process, as the stress concentrations drive the progression of damage, forming larger bundles and cracks that eventually form lesions.
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Affiliation(s)
- C P Brown
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom.
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Kendrick BJL, Simpson DJ, Kaptein BL, Valstar ER, Gill HS, Murray DW, Price AJ. Polyethylene wear of mobile-bearing unicompartmental knee replacement at 20 years. ACTA ACUST UNITED AC 2011; 93:470-5. [PMID: 21464484 DOI: 10.1302/0301-620x.93b4.25605] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The Oxford unicompartmental knee replacement (UKR) was designed to minimise wear utilising a fully-congruent, mobile, polyethylene bearing. Wear of polyethylene is a significant cause of revision surgery in UKR in the first decade, and the incidence increases in the second decade. Our study used model-based radiostereometric analysis to measure the combined wear of the upper and lower bearing surfaces in 13 medial-compartment Oxford UKRs at a mean of 20.9 years (17.2 to 25.9) post-operatively. The mean linear penetration of the polyethylene bearing was 1.04 mm (0.307 to 2.15), with a mean annual wear rate of 0.045 mm/year (0.016 to 0.099). The annual wear rate of the phase-2 bearings (mean 0.022 mm/year) was significantly less (p = 0.01) than that of phase-1 bearings (mean 0.07 mm/year). The linear wear rate of the Oxford UKR remains very low into the third decade. We believe that phase-2 bearings had lower wear rates than phase-1 implants because of the improved bearing design and surgical technique which decreased the incidence of impingement. We conclude that the design of the Oxford UKR gives low rates of wear in the long term.
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Affiliation(s)
- B J L Kendrick
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Biomedical Research Unit, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
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Pandit H, Gulati A, Jenkins C, Barker K, Price AJ, Dodd CAF, Murray DW. Unicompartmental knee replacement for patients with partial thickness cartilage loss in the affected compartment. Knee 2011; 18:168-71. [PMID: 20627734 DOI: 10.1016/j.knee.2010.05.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [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: 03/23/2010] [Revised: 05/03/2010] [Accepted: 05/04/2010] [Indexed: 02/02/2023]
Abstract
It is recommended that in medial compartment osteoarthritis (OA) unicompartmental knee replacement (UKR) should not be undertaken unless there is bone on bone. This recommendation is not evidence based and it is important to know if it is correct as there are many patients with pain and partial thickness cartilage loss (PTCL) who could potentially benefit from UKR. The aim of this study was to determine if the recommendation is valid. From our database of over 1000 patients treated with the Oxford UKR, we identified 29 with medial OA that had PTCL, confirmed at operation, but otherwise satisfied the recommended indications. This group was matched with 29 knees that had bone exposed (BE) on both sides of the medial compartment and 29 knees that had bone loss (BL) on both sides of the medial compartment. There was no significant difference in the demographics or preoperative scores between the three groups. At a mean follow up of 2 years (range 1-6) the Oxford Knee Score (OKS) of the PTCL group (mean 36 SD 10) was significantly (p < 0.001) worse than the OKS of either the bone exposed group (mean 43 SD 4) or the bone loss group (mean 43 SD 5). 21% of those with PTCL did not benefit substantially from the operation (increase in OKS ≤ 6), whereas all patients in the other groups did. We conclude that the results of UKR for PTCL are unpredictable and therefore that UKR should only be done for medial compartment OA if there is bone on bone. There is a need to develop a method to identify which patients with PTCL will do well so that this subgroup could be treated with UKR.
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Affiliation(s)
- H Pandit
- Nuffield Department of Orthopaedics, Rheumatology and musculoskeletal Sciences, University of Oxford, UK.
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