1
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Major-Monfried H, Hosszu K, McAvoy DP, Vallone A, Shukla N, Gillio A, Spitzer B, Kung AL, Cancio M, Curran K, Scaradavou A, Oved JH, O'Reilly RJ, Boelens JJ, Harris AC. Two novel assays demonstrate persistent daratumumab exposure in a pediatric patient with delayed engraftment following allogeneic hematopoietic stem cell transplantation. Cytotherapy 2024; 26:466-471. [PMID: 38430078 DOI: 10.1016/j.jcyt.2024.01.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/08/2023] [Accepted: 01/25/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND AIMS Daratumumab, a human IgG monoclonal antibody targeting CD38, is a promising treatment for pediatric patients with relapsed or refractory T-cell acute lymphoblastic leukemia (T-ALL). We describe a case of delayed engraftment following a mismatched, unrelated donor hematopoietic stem cell transplant (HSCT) in a 14-year-old female with relapsed T-ALL, treated with daratumumab and chemotherapy. By Day 28 post-HSCT, the patient had no neutrophil engraftment but full donor myeloid chimerism. METHODS We developed two novel, semi-quantitative, antibody-based assays to measure the patient's bound and plasma daratumumab levels to determine if prolonged drug exposure may have contributed to her slow engraftment. RESULTS Daratumumab levels were significantly elevated more than 30 days after the patient's final infusion, and levels inversely correlated with her white blood cell counts. To clear daratumumab, the patient underwent several rounds of plasmapheresis and subsequently engrafted. CONCLUSIONS This is the first report of both delayed daratumumab clearance and delayed stem cell engraftment following daratumumab treatment in a pediatric patient. Further investigation is needed to elucidate the optimal dosing of daratumumab for treatment of acute leukemias in pediatric populations as well as daratumumab's potential effects on hematopoietic stem cells and stem cell engraftment following allogenic HSCT.
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Affiliation(s)
- Hannah Major-Monfried
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
| | - Kinga Hosszu
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Devin P McAvoy
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexander Vallone
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Neerav Shukla
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alfred Gillio
- Pediatric Blood and Marrow Transplantation, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Barbara Spitzer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Pediatric Blood and Marrow Transplantation, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Andrew L Kung
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria Cancio
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kevin Curran
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andromachi Scaradavou
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joseph H Oved
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard J O'Reilly
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jaap Jan Boelens
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew C Harris
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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2
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Gorfinkel L, Raghunandan S, Watkins B, Hebert K, Neuberg DS, Bratrude B, Betz K, Yu A, Choi SW, Davis J, Duncan C, Giller R, Grimley M, Harris AC, Jacobsohn D, Lalefar N, Farhadfar N, Pulsipher MA, Shenoy S, Petrovic A, Schultz KR, Yanik GA, Blazar BR, Horan JT, Langston A, Kean LS, Qayed M. Overlap chronic GVHD is associated with adverse survival outcomes compared to classic chronic GVHD. Bone Marrow Transplant 2024; 59:680-687. [PMID: 38383714 DOI: 10.1038/s41409-024-02245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/20/2023] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
Chronic graft-versus-host-disease (cGVHD) is divided into two subtypes: classic (absence of acute GVHD features) and overlap cGVHD ('ocGVHD'), in which both chronic and acute GVHD clinical features are present simultaneously. While worse outcomes with ocGVHD have been reported, there are few recent analyses. We performed a secondary analysis of data from the ABA2 trial (N = 185), in which detailed GVHD data were collected prospectively and systematically adjudicated. Analyses included cumulative incidence of classic versus ocGVHD, their specific organ manifestations, global disease severity scores, non-relapse mortality (NRM), disease-free survival (DFS) and overall survival (OS) in these two cGVHD subtypes. Of 92 patients who developed cGVHD, 35 were classified as ocGVHD. The 1-year cumulative incidence, organ involvement, and global severity of classic and ocGVHD were similar between ABA2 patients receiving CNI/MTX+placebo and CNI/MTX+abatacept; thus, cohorts were combined for ocGVHD evaluation. This analysis identified ocGVHD as having significantly higher severity at presentation and at maximum global severity compared to classic cGVHD. OS and DFS were significantly lower for ocGVHD versus classic cGVHD. OcGVHD is associated with increased cGVHD severity scores, and is associated with decreased OS and DFS compared to classic cGVHD, underscoring the high risks with this cGVHD subtype.
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Affiliation(s)
- Lev Gorfinkel
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sharmila Raghunandan
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA, USA
| | - Benjamin Watkins
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA, USA
| | - Kyle Hebert
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Donna S Neuberg
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Brandi Bratrude
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kayla Betz
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alison Yu
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Jeffrey Davis
- BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Christine Duncan
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Roger Giller
- Center for Cancer and Blood Disorders, Children Hospital of Colorado, University of Colorado, Aurora, CO, USA
| | - Michael Grimley
- University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Nahal Lalefar
- University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | | | | | - Shalini Shenoy
- Washington University School of Medicine, St Louis, MO, USA
| | | | - Kirk R Schultz
- BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Bruce R Blazar
- University of Minnesota, Department of Pediatrics, Division of Blood and Marrow Transplantation, Minneapolis, MN, USA
| | - John T Horan
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Amelia Langston
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Leslie S Kean
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA, USA.
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3
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Takahashi T, Watkins B, Bratrude B, Neuberg D, Hebert K, Betz K, Yu A, Choi SW, Davis J, Duncan C, Giller R, Grimley M, Harris AC, Jacobsohn D, Lalefar N, Farhadfar N, Pulsipher MA, Shenoy S, Petrovic A, Schultz KR, Yanik GA, Blazar BR, Horan JT, Langston A, Kean LS, Qayed M. The Adverse Event Landscape of Stem Cell Transplant: Evidence for aGVHD Driving Early Transplant Associated Toxicities. Transplant Cell Ther 2024:S2666-6367(24)00317-8. [PMID: 38583802 DOI: 10.1016/j.jtct.2024.03.030] [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] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/26/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024]
Abstract
Although unrelated-donor (URD) hematopoietic cell transplantation (HCT) is associated with many toxicities, a detailed analysis of adverse events, as defined by the Common Terminology Criteria for Adverse Events (CTCAE), has not previously been curated. This represents a major unmet need, especially as it relates to assessing the safety of novel agents. We analyzed a detailed AE database from the "ABA2" randomized, double-blind, placebo-controlled clinical trial of abatacept for acute graft-versus-host disease (aGVHD) prevention, for which the FDA mandated a detailed AE assessment through Day +180, and weekly neutrophil and platelet counts through Day +100. These were analyzed for their relationship to key transplant outcomes, with a major focus on the impact of aGVHD on the development/severity of AEs. A total of 2102 AEs and 1816 neutrophil/platelet counts were analyzed from 142 8/8-HLA-matched URD HCT recipients on ABA2 (placebo cohort, n = 69, abatacept cohort, n = 73). This analysis resulted in 2 major observations. (1) Among graft source, conditioning intensity, age, and Grade 2 to 4 aGVHD, only aGVHD impacted Grade 3 to 5 AE acquisition after the first month post-transplant. (2) The development of Grade 3 to 4 aGVHD was associated with thrombocytopenia. We have created a detailed resource for the transplant community by which to contextualize clinical toxicities after transplant. It has identified aGVHD as a major driver of post-HCT Grade 3 to 5 AEs, and underscored a link between aGVHD and thrombocytopenia. This establishes a critical safety framework upon which the impact of novel post-transplant aGVHD therapeutics should be evaluated. This trial was registered at www.clinicaltrials.gov (#NCT01743131).
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Affiliation(s)
- Takuto Takahashi
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Benjamin Watkins
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, Georgia
| | - Brandi Bratrude
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donna Neuberg
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kyle Hebert
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kayla Betz
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alison Yu
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Jeffrey Davis
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christine Duncan
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Roger Giller
- Center for Cancer and Blood Disorders, Children Hospital of Colorado, University of Colorado, Aurora, Colorado
| | - Michael Grimley
- University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew C Harris
- Memorial Sloan Kettering Cancer Center, New York City, New York
| | - David Jacobsohn
- Children's National Health System, Washington, District of Columbia
| | - Nahal Lalefar
- University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | | | - Michael A Pulsipher
- Spencer Fox Eccles School of Medicine at the University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, Utah
| | - Shalini Shenoy
- Washington University School of Medicine, St Louis, Missouri
| | - Aleksandra Petrovic
- Seattle Children's Hospital and Fred Hutch Cancer Center, Seattle, Washington
| | - Kirk R Schultz
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Bruce R Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - John T Horan
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amelia Langston
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Leslie S Kean
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, Georgia
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4
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Lakkaraja M, Mauguen A, Boulad F, Cancio MI, Curran KJ, Harris AC, Kernan NA, Klein E, Kung AL, Oved J, Prockop S, Scaradavou A, Spitzer B, O'Reilly RJ, Boelens JJ. Impact of rabbit anti-thymocyte globulin (ATG) exposure on outcomes after ex vivo T-cell-depleted hematopoietic cell transplantation in pediatric and young adult patients. Cytotherapy 2024; 26:351-359. [PMID: 38349310 PMCID: PMC10997457 DOI: 10.1016/j.jcyt.2024.01.004] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 11/03/2023] [Accepted: 01/24/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND AIMS Traditional weight-based dosing of rabbit anti-thymocyte globulin (rATG) used in allogeneic hematopoietic cell transplantation (HCT) to prevent graft-versus-host disease (GVHD) and graft rejection leads to variable exposures. High exposures induce delayed CD4+immune reconstitution (CD4+IR) and greater mortality. We sought to determine the impact of rATG exposure in children and young adults receiving various types of EX-VIVO T-cell-depleted (EX-VIVO-TCD) HCT. METHODS Patients receiving their first EX-VIVO-TCD HCT (CliniMACS CD34+, Isolex or soybean lectin agglutination), with removal of residual T cells by E-rosette depletion (E-) between 2008 and 2018 at Memorial Sloan Kettering Cancer Center were retrospectively analyzed. rATG exposure post-HCT was estimated (AU*d/L) using a validated population pharmacokinetic model. Previously defined rATG-exposures, <30, 30-55, ≥55 AU*d/L, were related with outcomes of interest. Cox proportional hazard and cause-specific models were used for analyses. RESULTS In total, 180 patients (median age 11 years; range 0.1-44 years) were included, malignant 124 (69%) and nonmalignant 56 (31%). Median post-HCT rATG exposure was 32 (0-104) AU*d/L. Exposure <30 AU*d/L was associated with a 3-fold greater probability of CD4+IR (P < 0.001); 2- to 4-fold lower risk of death (P = 0.002); and 3- to 4-fold lower risk of non-relapse mortality (NRM) (P = 0.02). Cumulative incidence of NRM was 8-fold lower in patients who attained CD4+IR compared with those who did not (P < 0.0001). There was no relation between rATG exposure and aGVHD (P = 0.33) or relapse (P = 0.23). Effect of rATG exposure on outcomes was similar in three EX-VIVO-TCD methods. CONCLUSIONS Individualizing rATG dosing to target a low rATG exposure post-HCT while maintaining total cumulative exposure may better predict CD4+IR, reduce NRM and increase overall survival, independent of the EX-VIVO-TCD method.
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Affiliation(s)
- Madhavi Lakkaraja
- Fred Hutchinson Cancer Center, Seattle, Washington, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Audrey Mauguen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Farid Boulad
- Department of Pediatrics, BMT Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria I Cancio
- Department of Pediatrics, BMT Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Kevin J Curran
- Department of Pediatrics, BMT Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Andrew C Harris
- Department of Pediatrics, BMT Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Nancy A Kernan
- Department of Pediatrics, BMT Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth Klein
- Department of Pediatrics, BMT Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew L Kung
- Department of Pediatrics, BMT Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joseph Oved
- Department of Pediatrics, BMT Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Susan Prockop
- Dana Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andromachi Scaradavou
- Department of Pediatrics, BMT Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Barbara Spitzer
- Department of Pediatrics, BMT Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Richard J O'Reilly
- Department of Pediatrics, BMT Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Jaap Jan Boelens
- Department of Pediatrics, BMT Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA.
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5
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Kunvarjee B, Contreras Yametti GP, Blouin AG, Linder GE, Borge PD, Maryamchik E, Budhai A, Gupta GK, Scaradavou A, Spitzer BG, Curran KJ, Oved JH, Harris AC, Sharma A, Boelens JJ, Cancio MI. Donor-specific antibody desensitization with daratumumab prior to haematopoietic cell transplant for sickle cell disease: A case report. Br J Haematol 2024; 204:1540-1544. [PMID: 38212144 DOI: 10.1111/bjh.19289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Binni Kunvarjee
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gloria Paz Contreras Yametti
- Pediatric Bone Marrow Transplant and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Amanda G Blouin
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Grace E Linder
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - P Dayand Borge
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elena Maryamchik
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexandra Budhai
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gaurav K Gupta
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andromachi Scaradavou
- Pediatric Bone Marrow Transplant and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Barbara G Spitzer
- Pediatric Bone Marrow Transplant and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kevin J Curran
- Pediatric Bone Marrow Transplant and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joseph H Oved
- Pediatric Bone Marrow Transplant and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew C Harris
- Pediatric Bone Marrow Transplant and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jaap Jan Boelens
- Pediatric Bone Marrow Transplant and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria I Cancio
- Pediatric Bone Marrow Transplant and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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6
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Meyers G, Hamadani M, Martens M, Ali H, Chevallier P, Choe H, Harris AC, Holler E, van Hooren E, Klaassen W, Leifer E, van Oosterhout Y, Perez L, Pusic I, Stelljes M, van der Velden W, Ammatuna E, Beauvais D, Cornillon J, Maziarz RT, Schetelig J, Romeril J, MacMillan ML, Levine JE, Socié G. Anti-CD3/CD7 immunoconjugate (T-Guard) for severe, steroid-refractory GVHD: final report of BMT CTN 2002. Bone Marrow Transplant 2023; 58:1416-1418. [PMID: 37749187 DOI: 10.1038/s41409-023-02110-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Gabrielle Meyers
- Center for Hematologic Malignancies, Oregon Health and Science University, Knight Cancer Institute, Portland, OR, USA.
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin and Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael Martens
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, and Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Haris Ali
- Division of Leukemia, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical, Duarte, CA, USA
| | | | - Hannah Choe
- Division of Hematology, The Ohio State University Comprehensive Cancer Center - The James, Columbus, OH, USA
| | - Andrew C Harris
- MSK Kids Stem Cell Transplantation and Cellular Therapies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ernst Holler
- Universitätsklinikum Regensburg, Regensburg, Germany
| | | | | | - Eric Leifer
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | | | - Lia Perez
- H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Iskra Pusic
- Division of Oncology, BMT and Leukemia Section, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Walter van der Velden
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Jérôme Cornillon
- Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Richard T Maziarz
- Center for Hematologic Malignancies, Oregon Health and Science University, Knight Cancer Institute, Portland, OR, USA
| | | | | | - Margaret L MacMillan
- Blood and Marrow Transplantation & Cellular Therapy Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - John E Levine
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gérard Socié
- Hematology Transplantation, Hospital St Louis and University Paris Cité, Paris, France
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7
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Kunvarjee B, Bidgoli A, Madan RP, Vidal E, McAvoy D, Hosszu KK, Scaradavou A, Spitzer BG, Curran KJ, Cancio M, Harris AC, O'Reilly RJ, Kung AL, Prockop S, Boelens JJ, Oved JH. Emapalumab as bridge to hematopoietic cell transplant for STAT1 gain-of-function mutations. J Allergy Clin Immunol 2023; 152:815-817. [PMID: 37367708 PMCID: PMC11066755 DOI: 10.1016/j.jaci.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Binni Kunvarjee
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alan Bidgoli
- Pediatric Bone Marrow Transplant and Cellular Therapy Program, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rebecca Pellett Madan
- Department of Pediatrics, NYU Grossman School of Medicine and Hassenfeld Children's Hospital at NYU Langone, New York, NY
| | - Esther Vidal
- Immune Discovery and Modeling Service, Sloan Kettering Institute, New York, NY
| | - Devin McAvoy
- Immune Discovery and Modeling Service, Sloan Kettering Institute, New York, NY
| | - Kinga K Hosszu
- Immune Discovery and Modeling Service, Sloan Kettering Institute, New York, NY
| | - Andromachi Scaradavou
- Pediatric Bone Marrow Transplant and Cellular Therapy Program, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Barbara G Spitzer
- Pediatric Bone Marrow Transplant and Cellular Therapy Program, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kevin J Curran
- Pediatric Bone Marrow Transplant and Cellular Therapy Program, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria Cancio
- Pediatric Bone Marrow Transplant and Cellular Therapy Program, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew C Harris
- Pediatric Bone Marrow Transplant and Cellular Therapy Program, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard J O'Reilly
- Pediatric Bone Marrow Transplant and Cellular Therapy Program, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew L Kung
- Pediatric Bone Marrow Transplant and Cellular Therapy Program, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Susan Prockop
- Hematopoietic Stem Cell Transplant Program, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass
| | - Jaap Jan Boelens
- Pediatric Bone Marrow Transplant and Cellular Therapy Program, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph H Oved
- Pediatric Bone Marrow Transplant and Cellular Therapy Program, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY.
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8
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Takahashi T, Al-Kofahi M, Jaber M, Bratrude B, Betz K, Suessmuth Y, Yu A, Neuberg DS, Choi SW, Davis J, Duncan C, Giller R, Grimley M, Harris AC, Jacobsohn D, Lalefar N, Farhadfar N, Pulsipher MA, Shenoy S, Petrovic A, Schultz KR, Yanik GA, Blazar BR, Horan JT, Watkins B, Langston A, Qayed M, Kean LS. Higher abatacept exposure after transplant decreases acute GVHD risk without increasing adverse events. Blood 2023; 142:700-710. [PMID: 37319437 PMCID: PMC10797507 DOI: 10.1182/blood.2023020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 06/17/2023] Open
Abstract
In the ABA2 study, the T-cell costimulation blockade agent, abatacept, was safe and effective in preventing acute graft-versus-host disease (aGVHD) after unrelated-donor hematopoietic cell transplant (HCT), leading to US Food and Drug Administration approval. Here, we performed a determination of abatacept pharmacokinetics (PK), which enabled an examination of how abatacept exposure-response relationships affected clinical outcomes. We performed a population PK analysis of IV abatacept using nonlinear mixed-effect modeling and assessed the association between abatacept exposure and key transplant outcomes. We tested the association between the trough after dose 1 (Ctrough_1) and grade (GR) 2 or 4 aGVHD (GR2-4 aGVHD) through day +100. An optimal Ctrough_1 threshold was identified via recursive partitioning and classification tree analysis. This demonstrated that abatacept PK was characterized by a 2-compartment model with first-order elimination. The ABA2 dosing regimen was based on previous work targeting a steady-state abatacept trough of 10 μg/mL. However, a higher Ctrough_1 (≥39 μg/mL, attained in ∼60% of patients on ABA2) was associated with a favorable GR2-4 aGVHD risk (hazard ratio, 0.35; 95% confidence interval, 0.19-0.65; P < .001), with a Ctrough_1 <39 μg/mL associated with GR2-4 aGVHD risk indistinguishable from placebo (P = .37). Importantly, no significant association was found between Ctrough_1 and key safety indicators, including relapse, and cytomegalovirus or Epstein-Barr virus viremia. These data demonstrate that a higher abatacept Ctrough_1 (≥39 μg/mL) was associated with a favorable GR2-4 aGVHD risk, without any observed exposure-toxicity relationships. This trial was registered at www.clinicaltrials.gov as #NCT01743131.
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Affiliation(s)
- Takuto Takahashi
- Division Hematology/Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN
| | - Mahmoud Al-Kofahi
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN
| | - Mutaz Jaber
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN
| | - Brandi Bratrude
- Division Hematology/Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kayla Betz
- Division Hematology/Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Yvonne Suessmuth
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University, Atlanta, GA
| | - Alison Yu
- Division Hematology/Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Donna S. Neuberg
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Sung W. Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Jeffrey Davis
- BC Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Christine Duncan
- Division Hematology/Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Roger Giller
- Center for Cancer and Blood Disorders, Children Hospital of Colorado, University of Colorado, Aurora, CO
| | - Michael Grimley
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew C. Harris
- Pediatric Bone Marrow Transplant and Cellular Therapy Program, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Jacobsohn
- Division of Blood and Marrow Transplantation, Center for Cancer and Blood Disorders, Children’s National Health System, Washington, DC
| | - Nahal Lalefar
- Division of Pediatric Hematology/Oncology, UCSF Benioff Children’s Hospital Oakland, University of California San Francisco, Oakland, CA
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL
| | - Michael A. Pulsipher
- Huntsman Cancer Institute, Spencer Fox Eccles School of Medicine, Primary Children’s Hospital, University of Utah, Salt Lake City, UT
| | - Shalini Shenoy
- Division Hematology/Oncology, Washington University School of Medicine, St Louis, MO
| | - Aleksandra Petrovic
- Department of Pediatrics, Seattle Children’s Hospital and Fred Hutch Cancer Center, Seattle, WA
| | - Kirk R. Schultz
- BC Children’s Hospital, University of British Columbia, Vancouver, Canada
| | | | - Bruce R. Blazar
- Division of Blood and Marrow Transplant & Cellular Therapy, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - John T. Horan
- Division Hematology/Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Benjamin Watkins
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University, Atlanta, GA
| | | | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University, Atlanta, GA
| | - Leslie S. Kean
- Division Hematology/Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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9
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Cuvelier GDE, Ng B, Abdossamadi S, Nemecek ER, Melton A, Kitko CL, Lewis VA, Schechter T, Jacobsohn DA, Harris AC, Pulsipher MA, Bittencourt H, Choi SW, Caywood EH, Kasow KA, Bhatia M, Oshrine BR, Chaudhury S, Coulter D, Chewning JH, Joyce M, Savaşan S, Pawlowska AB, Megason GC, Mitchell D, Cheerva AC, Lawitschka A, Ostroumov E, Schultz KR. A diagnostic classifier for pediatric chronic graft-versus-host disease: results of the ABLE/PBMTC 1202 study. Blood Adv 2023; 7:3612-3623. [PMID: 36219586 PMCID: PMC10365946 DOI: 10.1182/bloodadvances.2022007715] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 03/29/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 11/20/2022] Open
Abstract
The National Institutes of Health Consensus criteria for chronic graft-versus-host disease (cGVHD) diagnosis can be challenging to apply in children, making pediatric cGVHD diagnosis difficult. We aimed to identify diagnostic pediatric cGVHD biomarkers that would complement the current clinical criteria and help differentiate cGVHD from non-cGVHD. The Applied Biomarkers of Late Effects of Childhood Cancer (ABLE) study, open at 27 transplant centers, prospectively evaluated 302 pediatric patients after hematopoietic cell transplant (234 evaluable). Forty-four patients developed cGVHD. Mixed and fixed effect regression analyses were performed on diagnostic cGVHD onset blood samples for cellular and plasma biomarkers, with individual markers declared relevant if they met 3 criteria: an effect ratio ≥1.3 or ≤0.75; an area under the curve (AUC) of ≥0.60; and a P value <5.814 × 10-4 (Bonferroni correction) (mixed effect) or <.05 (fixed effect). To address the complexity of cGVHD diagnosis in children, we built a machine learning-based classifier that combined multiple cellular and plasma biomarkers with clinical factors. Decreases in regulatory natural killer cells, naïve CD4 T helper cells, and naïve regulatory T cells, and elevated levels of CXCL9, CXCL10, CXCL11, ST2, ICAM-1, and soluble CD13 (sCD13) characterize the onset of cGVHD. Evaluation of the time dependence revealed that sCD13, ST2, and ICAM-1 levels varied with the timing of cGVHD onset. The cGVHD diagnostic classifier achieved an AUC of 0.89, with a positive predictive value of 82% and a negative predictive value of 80% for diagnosing cGVHD. Our polyomic approach to building a diagnostic classifier could help improve the diagnosis of cGVHD in children but requires validation in future prospective studies. This trial was registered at www.clinicaltrials.gov as #NCT02067832.
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Affiliation(s)
- Geoffrey D. E. Cuvelier
- Pediatric Blood and Marrow Transplantation, Manitoba Blood and Marrow Transplant Program, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Bernard Ng
- Department of Statistics, Centre for Molecular Medicine and Therapeutics, British Columbia Children’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Sayeh Abdossamadi
- Michael Cuccione Childhood Cancer Research Program, British Columbia Children’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Eneida R. Nemecek
- Pediatric Blood and Marrow Transplantation, Doernbechter Children’s Hospital, Oregon Health and Sciences University, Portland, OR
| | - Alexis Melton
- Pediatric Blood and Marrow Transplant Program, Benioff Children’s Hospital, UC San Francisco, San Francisco, CA
| | - Carrie L. Kitko
- Pediatric Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, TN
| | - Victor A. Lewis
- Pediatric Oncology, Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada
| | - Tal Schechter
- Pediatric Hematology-Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - David A. Jacobsohn
- Division of Blood and Marrow Transplantation, Children’s National Hospital, School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | - Andrew C. Harris
- MSK Kids Stem Cell Transplantation and Cellular Therapies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael A. Pulsipher
- Division of Pediatric Hematology and Oncology, Intermountain Primary Children’s Hospital, Huntsman Cancer Institute, Spencer Fox Eccles School of Medicine, The University of Utah, Salt Lake City, UT
| | - Henrique Bittencourt
- Pediatric Hematology-Oncology, Saint-Justine University Hospital Centre, Montreal, QC, Canada
| | - Sung Won Choi
- Blood and Marrow Transplant Program, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Emi H. Caywood
- Nemours Children’s Health, Thomas Jefferson University, Wilmington, DE
| | - Kimberly A. Kasow
- Pediatric Bone Marrow Transplant, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Monica Bhatia
- Pediatric Stem Cell Transplant Program, Morgan Stanley Children’s Hospital, Columbia University, New York, NY
| | - Benjamin R. Oshrine
- Cancer and Blood Disorders Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | - Sonali Chaudhury
- Hematology, Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL
| | - Donald Coulter
- Division of Pediatric Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Joseph H. Chewning
- Division of Pediatric Hematology and Oncology, The University of Alabama at Birmingham, Birmingham, AL
| | - Michael Joyce
- Division of Pediatric Hematology-Oncology, Nemours Children’s Specialty Care, Jacksonville, FL
| | - Süreyya Savaşan
- Pediatric Hematology & Oncology, Children’s Hospital of Michigan, Detroit, MI
| | - Anna B. Pawlowska
- Pediatric Hematology, Oncology and Hematopoietic Stem Cell Transplant, City of Hope, Duarte, CA
| | - Gail C. Megason
- Children’s Hematology-Oncology, University of Mississippi Medical Center, Jackson, MS
| | - David Mitchell
- Division of Pediatric Hematology-Oncology, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
| | - Alexandra C. Cheerva
- Pediatric Hematology, Oncology and Stem Cell Transplantation, Norton Children’s Hospital, University of Louisville, Louisville, KY
| | - Anita Lawitschka
- Stem Cell Transplant Unit, St. Anna Children’s Hospital, Medical University, Vienna, Austria
| | - Elena Ostroumov
- Michael Cuccione Childhood Cancer Research Program, British Columbia Children’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Kirk R. Schultz
- Michael Cuccione Childhood Cancer Research Program, British Columbia Children’s Hospital, The University of British Columbia, Vancouver, BC, Canada
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Bidgoli A, Yametti GC, Shahid S, Harris AC, Cancio MI, Spitzer B, Oved JH, O’Reilly RJ, Mauguen A, Scaradavou A, Kung AL, Boelens JJ, Curran KJ. Clinical Outcomes and Salvage Therapies of Pediatric Patients with Progressive B-ALL Following CD19 Chimeric Antigen Receptor (CAR) T Cell Therapy. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00350-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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11
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Major-Monfried H, Shukla N, Scaradavou A, Cancio MI, Harris AC, Boelens JJ, Curran KJ, Oved JH, Tolar J, Kernan NA, Ebens CL, Spitzer B. Donor Derived Leukemia in a Recipient of Allogeneic Hematopoietic Cell Transplantation for Recessive Dystrophic Epidermolysis Bullosa. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00559-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Harris AC, Muelken P, Alcheva A, Stepanov I, LeSage MG. Cigarette Smoke Extract, but Not Electronic Cigarette Aerosol Extract, Inhibits Monoamine Oxidase in vitro and Produces Greater Acute Aversive/Anhedonic Effects Than Nicotine Alone on Intracranial Self-Stimulation in Rats. Front Neurosci 2022; 16:868088. [PMID: 35712461 PMCID: PMC9196039 DOI: 10.3389/fnins.2022.868088] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/25/2022] [Indexed: 12/14/2022] Open
Abstract
Conventional tobacco cigarettes appear to have greater abuse liability than non-combusted products such as electronic cigarettes (ECs) and nicotine replacement therapy (NRT). This may be due to the higher levels of behaviorally active non-nicotine constituents [e.g., monoamine oxidase (MAO) inhibitors such as β-carbolines] in cigarette smoke (CS) compared to non-combusted products. To evaluate this hypothesis, the current studies compared the relative abuse liability of CS and EC aerosol extracts containing nicotine and a range of non-nicotine constituents to that of nicotine alone (NRT analog) using intracranial self-stimulation (ICSS) in rats. Effects of formulations on brain MAO activity in vitro and ex vivo were also studied to evaluate the potential role of MAO inhibition in the ICSS study. CS extract contained higher levels of several behaviorally active non-nicotine constituents (e.g., the β-carbolines norharmane and harmane) than EC extract. Nicotine alone reduced ICSS thresholds at a moderate nicotine dose, suggesting a reinforcement-enhancing effect that may promote abuse liability, and elevated ICSS thresholds at a high nicotine dose, suggesting an aversive/anhedonic effect that may limit abuse liability. CS extract elevated ICSS thresholds to a greater degree than nicotine alone at high nicotine doses. Effects of EC extract on ICSS did not differ from those of nicotine alone. Finally, CS extract significantly inhibited MAO-A and MAO-B activity in vitro, whereas EC extract and nicotine alone did not. None of the formulations inhibited MAO measured ex vivo. These findings indicate greater acute aversive/anhedonic effects for CS extract compared to nicotine alone, suggesting lower abuse liability. Although confirmation of our findings using other dosing regimens, preclinical addiction models, and tobacco product extracts is needed, these findings suggest that the centrally-mediated effects of MAO inhibitors and other non-nicotine constituents may not account for the greater abuse liability of cigarettes compared to non-combusted products. Nonetheless, identifying the specific constituent(s) mediating the effects of CS extracts in this study could help clarify mechanisms mediating tobacco addiction and inform FDA product standards.
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Affiliation(s)
- Andrew C. Harris
- Hennepin Healthcare Research Institute, Minneapolis, MN, United States,Department of Medicine, University of Minnesota, Minneapolis, MN, United States,Department of Psychology, University of Minnesota, Minneapolis, MN, United States,*Correspondence: Andrew C. Harris,
| | - Peter Muelken
- Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Aleksandra Alcheva
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
| | - Irina Stepanov
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
| | - Mark G. LeSage
- Hennepin Healthcare Research Institute, Minneapolis, MN, United States,Department of Medicine, University of Minnesota, Minneapolis, MN, United States,Department of Psychology, University of Minnesota, Minneapolis, MN, United States
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13
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O'Brien MM, Ji L, Shah NN, Rheingold SR, Bhojwani D, Yuan CM, Xu X, Yi JS, Harris AC, Brown PA, Borowitz MJ, Militano O, Kairalla J, Devidas M, Raetz EA, Gore L, Loh ML. Phase II Trial of Inotuzumab Ozogamicin in Children and Adolescents With Relapsed or Refractory B-Cell Acute Lymphoblastic Leukemia: Children's Oncology Group Protocol AALL1621. J Clin Oncol 2022; 40:956-967. [PMID: 35007127 PMCID: PMC8937013 DOI: 10.1200/jco.21.01693] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [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: 07/09/2021] [Revised: 11/05/2021] [Accepted: 12/08/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Children's Oncology Group trial AALL1621 was conducted to prospectively determine the safety and efficacy of inotuzumab ozogamicin (InO) in pediatric and adolescent patients with relapsed or refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL). PATIENTS AND METHODS This single-arm phase II trial enrolled patients age 1-21 years with R/R CD22-positive B-ALL. In cycle 1, InO dosing was 0.8 mg/m2 intravenously on day 1 and 0.5 mg/m2 on days 8 and 15 of a 28-day cycle with response evaluation at day 28. Using a two-stage design, the trial was continuously monitored for dose-limiting toxicities and sinusoidal obstruction syndrome (SOS). CD22 expression was retrospectively evaluated by central flow cytometry. RESULTS Forty-eight patients were evaluable for response and toxicity; 19 had complete response (CR) and nine CR with incomplete count recovery (CRi) after cycle 1 (CR/CRi rate: 58.3%; two-sided 90% CI, 46.5 to 69.3). Twenty-seven of 28 patients with CR or CRi had minimal residual disease measured by flow cytometry; 18 (66.7%) had minimal residual disease < 0.01%. Seven of 28 patients (25%) with CR or CRi had delayed count recovery past day 42 in cycle 1. Three (6.3%) patients had grade 3 ALT elevation and one patient had grade 3 hyperbilirubinemia in cycle 1. Of 21 patients undergoing hematopoietic stem-cell transplantation after InO, 6 (28.6%) developed grade 3 SOS. Partial CD22 expression and lower CD22 site density were associated with lower likelihood of response to InO. CONCLUSION InO is effective and well tolerated in heavily pretreated children and adolescents with R/R CD22-positive B-ALL. SOS after hematopoietic stem-cell transplantation and prolonged cytopenias were notable. CD22 modulation was identified as a mechanism of resistance. Expanded study of InO combined with chemotherapy is underway.
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Affiliation(s)
- Maureen M. O'Brien
- University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati OH
| | - Lingyun Ji
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Nirali N. Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Susan R. Rheingold
- Perelman School of Medicine, Division of Oncology at the Children's Hospital of Philadelphia, Philadelphia, PA
| | - Deepa Bhojwani
- Division of Pediatric Hematology and Oncology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Constance M. Yuan
- Flow Cytometry Unit, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Xinxin Xu
- Children's Oncology Group, Monrovia, CA
| | - Joanna S. Yi
- Pediatric Hematology/Oncology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Andrew C. Harris
- Pediatric Blood and Marrow Transplantation, University of Utah/Primary Children's Hospital, Salt Lake City, UT
| | - Patrick A. Brown
- Division of Pediatric Oncology, Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - Michael J. Borowitz
- Departments of Pathology and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - John Kairalla
- Department of Biostatistics, Colleges of Medicine, Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | | | - Lia Gore
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Mignon L. Loh
- Department of Pediatrics, Benioff Children's Hospital and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
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14
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Harris AC. Further pharmacological characterization of a preclinical model of the early development of nicotine withdrawal. Drug Alcohol Depend 2021; 226:108870. [PMID: 34216863 DOI: 10.1016/j.drugalcdep.2021.108870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/24/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Establishing preclinical models of the development of nicotine withdrawal following acute nicotine exposure could inform tobacco addiction-related research, treatment, and policy. To this end, this lab has previously reported that rats exhibit withdrawal-like elevations in intracranial self-stimulation (ICSS) thresholds (anhedonia-like behavior) following acute nicotine exposure. The goal of this study was to provide further pharmacological characterization of ICSS as a measure of spontaneous and antagonist-precipitated withdrawal from acute nicotine. METHODS AND RESULTS Rats exhibited a small increase in ICSS thresholds over time following a single nicotine injection (1.0 mg/kg, s.c.), suggesting a modest spontaneous withdrawal effect (Experiment 1). In Experiment 2, the antidepressant bupropion (5.0 mg/kg, i.p.), which is used to treat tobacco addiction and attenuates nicotine withdrawal in both humans and rodents, blocked elevations in ICSS thresholds induced by a single injection of nicotine (0.5 mg/kg, s.c.) followed ≈ 2 h later by the non-selective, non-competitive nicotinic acetylcholine receptor (nAChR) antagonist mecamylamine (3.0 mg/kg, s.c.). In Experiment 3a, s.c. administration of the competitive, relatively selective α4ß2 nAChR antagonist dihydro-beta-erythroidine (DHßE) (5.6 mg/kg, but not 3.0 mg/kg) following each of 5 daily injections of nicotine (0.5 mg/kg, s.c.) elevated ICSS thresholds. Mecamylamine (3.0 mg/kg, s.c.) also elevated ICSS thresholds when administered following all 5 daily nicotine injections (0.5 mg/kg, s.c., Experiment 3b). CONCLUSIONS These findings provide further characterization of elevations in ICSS thresholds as a measure of withdrawal from acute nicotine exposure. Further use of these models may be useful for understanding the early development of nicotine withdrawal.
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Affiliation(s)
- Andrew C Harris
- Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN 55415, United States; Departments of Medicine and Psychology, University of Minnesota Minneapolis, MN, United States.
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15
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Harris AC. Magnitude of open-field thigmotaxis during mecamylamine-precipitated nicotine withdrawal in rats is influenced by mecamylamine dose, duration of nicotine infusion, number of withdrawal episodes, and age. Pharmacol Biochem Behav 2021; 205:173185. [DOI: 10.1016/j.pbb.2021.173185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 12/17/2022]
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Swain Y, Gewirtz JC, Harris AC. Behavioral predictors of individual differences in opioid addiction vulnerability as measured using i.v. self-administration in rats. Drug Alcohol Depend 2021; 221:108561. [PMID: 33588371 PMCID: PMC8048102 DOI: 10.1016/j.drugalcdep.2021.108561] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Like other forms of psychopathology, vulnerability to opioid addiction is subject to wide individual differences. Animal behavioral models are valuable in advancing our understanding of mechanisms underlying vulnerability to the disorder's development and amenability to treatment. METHODS This review provides an overview of preclinical work on behavioral predictors of opioid addiction vulnerability as measured using the intravenous (i.v.) self-administration (SA) model in rats. We also highlight several new approaches to studying individual differences in opioid addiction vulnerability in preclinical models that could have greater sensitivity and lead to more clinically relevant findings. RESULTS AND CONCLUSIONS Evidence for the relationship between various behavioral traits and opioid SA in the preclinical literature is limited. With the possible exceptions of sensitivity to opioid agonist/withdrawal effects and stress reactivity, predictors of individual differences in SA of other drugs of abuse (e.g. sensation-seeking, impulsivity) do not predict vulnerability to opioid SA in rats. Refinement of SA measures and the use of multivariate designs and statistics could help identify predictors of opioid SA and lead to more clinically relevant studies on opioid addiction vulnerability.
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Affiliation(s)
- Yayi Swain
- Departments of Psychology, University of Minnesota, United States; Hennepin Healthcare Research Institute, United States
| | | | - Andrew C Harris
- Departments of Psychology, University of Minnesota, United States; Hennepin Healthcare Research Institute, United States; Departments of Medicine, University of Minnesota, United States.
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Liu SX, Gades MS, Swain Y, Ramakrishnan A, Harris AC, Tran PV, Gewirtz JC. Repeated morphine exposure activates synaptogenesis and other neuroplasticity-related gene networks in the dorsomedial prefrontal cortex of male and female rats. Drug Alcohol Depend 2021; 221:108598. [PMID: 33626484 PMCID: PMC8026706 DOI: 10.1016/j.drugalcdep.2021.108598] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 03/17/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Opioid abuse is a chronic disorder likely involving stable neuroplastic modifications. While a number of molecules contributing to these changes have been identified, the broader spectrum of genes and gene networks that are affected by repeated opioid administration remain understudied. METHODS We employed Next-Generation RNA-sequencing (RNA-seq) followed by quantitative chromatin immunoprecipitation to investigate changes in gene expression and their regulation in adult male and female rats' dorsomedial prefrontal cortex (dmPFC) after a regimen of daily injection of morphine (5.0 mg/kg; 10 days). Ingenuity Pathway Analysis (IPA) was used to analyze affected molecular pathways, gene networks, and associated regulatory factors. A complementary behavioral study evaluated the effects of the same morphine injection regimen on locomotor activity, pain sensitivity, and somatic withdrawal signs. RESULTS Behaviorally, repeated morphine injection induced locomotor hyperactivity and hyperalgesia in both sexes. 90 % of differentially expressed genes (DEGs) in morphine-treated rats were upregulated in both males and females, with a 35 % overlap between sexes. A substantial number of DEGs play roles in synaptic signaling and neuroplasticity. Chromatin immunoprecipitation revealed enrichment of H3 acetylation, a transcriptionally activating chromatin mark. Although broadly similar, some differences were revealed in the gene ontology networks enriched in females and males. CONCLUSIONS Our results cohere with findings from previous studies based on a priori gene selection. Our results also reveal novel genes and molecular pathways that are upregulated by repeated morphine exposure, with some common to males and females and others that are sex-specific.
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Affiliation(s)
| | - Mari S. Gades
- Department of Psychology, University of Minnesota, MN 55455
| | - Yayi Swain
- Department of Psychology, University of Minnesota, MN 55455,Hennepin Healthcare Research Institute, 914 S 8th St, Minneapolis, MN 55404
| | | | - Andrew C. Harris
- Department of Psychology, University of Minnesota, MN 55455,Department of Medicine, University of Minnesota, MN 55455,Hennepin Healthcare Research Institute, 914 S 8th St, Minneapolis, MN 55404
| | - Phu V. Tran
- Department of Pediatrics, University of Minnesota, MN 55455
| | - Jonathan C. Gewirtz
- Department of Psychology, University of Minnesota, MN 55455,Corresponding author: Jonathan Gewirtz Department of Psychology University of Minnesota Elliott Hall 75 East River Road Minneapolis, MN 55455
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Qayed M, Watkins B, Gillespie S, Bratrude B, Betz K, Suessmuth Y, Yu A, Furlan SN, Zhang C, Mccracken C, Cribbin K, Choi S, Davis JH, Duncan C, Giller RH, Grimley MS, Harris AC, Jacobsohn DA, Yanik GA, Rogatko A, Tighiouart M, Bresee C, Kim S, Lalefar NR, Rhodes J, Norkin M, Farhadfar N, Shenoy S, Petrovic A, Schultz KR, Pulsipher MA, Waller EK, Blazar BR, Langston AA, Kean LS, Horan J. Comparable Outcomes for Matched and Mismatched Unrelated Donor (URD) Transplantation with the Addition of Abatacept to Standard Graft Versus Host Disease Prophylaxis. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Watkins B, Qayed M, McCracken C, Bratrude B, Betz K, Suessmuth Y, Yu A, Sinclair S, Furlan S, Bosinger S, Tkachev V, Rhodes J, Tumlin AG, Narayan A, Cribbin K, Gillespie S, Gooley TA, Pasquini MC, Hebert K, Kapoor U, Rogatko A, Tighiouart M, Kim S, Bresee C, Choi SW, Davis J, Duncan C, Giller R, Grimley M, Harris AC, Jacobsohn D, Lalefar N, Norkin M, Farhadfar N, Pulsipher MA, Shenoy S, Petrovic A, Schultz KR, Yanik GA, Waller EK, Levine JE, Ferrara JL, Blazar BR, Langston A, Horan JT, Kean LS. Phase II Trial of Costimulation Blockade With Abatacept for Prevention of Acute GVHD. J Clin Oncol 2021; 39:1865-1877. [PMID: 33449816 DOI: 10.1200/jco.20.01086] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Severe (grade 3-4) acute graft-versus-host disease (AGVHD) is a major cause of death after unrelated-donor (URD) hematopoietic cell transplant (HCT), resulting in particularly high mortality after HLA-mismatched transplantation. There are no approved agents for AGVHD prevention, underscoring the critical unmet need for novel therapeutics. ABA2 was a phase II trial to rigorously assess safety, efficacy, and immunologic effects of adding T-cell costimulation blockade with abatacept to calcineurin inhibitor (CNI)/methotrexate (MTX)-based GVHD prophylaxis, to test whether abatacept could decrease AGVHD. METHODS ABA2 enrolled adults and children with hematologic malignancies under two strata: a randomized, double-blind, placebo-controlled stratum (8/8-HLA-matched URD), comparing CNI/MTX plus abatacept with CNI/MTX plus placebo, and a single-arm stratum (7/8-HLA-mismatched URD) comparing CNI/MTX plus abatacept versus CNI/MTX CIBMTR controls. The primary end point was day +100 grade 3-4 AGVHD, with day +180 severe-AGVHD-free-survival (SGFS) a key secondary end point. Sample sizes were calculated using a higher type-1 error (0.2) as recommended for phase II trials, and were based on predicting that abatacept would reduce grade 3-4 AGVHD from 20% to 10% (8/8s) and 30% to 10% (7/8s). ABA2 enrolled 142 recipients (8/8s, median follow-up = 716 days) and 43 recipients (7/8s, median follow-up = 708 days). RESULTS In 8/8s, grade 3-4 AGVHD was 6.8% (abatacept) versus 14.8% (placebo) (P = .13, hazard ratio = 0.45). SGFS was 93.2% (CNI/MTX plus abatacept) versus 82% (CNI/MTX plus placebo, P = .05). In the smaller 7/8 cohort, grade 3-4 AGVHD was 2.3% (CNI/MTX plus abatacept, intention-to-treat population), which compared favorably with a nonrandomized matched cohort of CNI/MTX (30.2%, P < .001), and the SGFS was better (97.7% v 58.7%, P < .001). Immunologic analysis revealed control of T-cell activation in abatacept-treated patients. CONCLUSION Adding abatacept to URD HCT was safe, reduced AGVHD, and improved SGFS. These results suggest that abatacept may substantially improve AGVHD-related transplant outcomes, with a particularly beneficial impact on HLA-mismatched HCT.
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Affiliation(s)
- Benjamin Watkins
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA
| | | | - Brandi Bratrude
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Kayla Betz
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Yvonne Suessmuth
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA
| | - Alison Yu
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | | | - Scott Furlan
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Steven Bosinger
- Emory University, Yerkes National Primate Research Center, Atlanta, GA
| | - Victor Tkachev
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - James Rhodes
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Audrey Grizzle Tumlin
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | | | | | | | - Ted A Gooley
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Kyle Hebert
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | | | | | | | - Sungjin Kim
- Cedars Sinai Medical Center, Los Angeles, CA
| | | | | | - Jeffrey Davis
- BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Christine Duncan
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Roger Giller
- Center for Cancer and Blood Disorders, Children Hospital of Colorado, University of Colorado, Aurora, CO
| | - Michael Grimley
- University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew C Harris
- University of Utah, Primary Children's Hospital, Salt Lake City, UT
| | | | - Nahal Lalefar
- University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Maxim Norkin
- Baptist Medical Center Jacksonville, Jacksonville, FL
| | - Nosha Farhadfar
- University of Florida, UF Health Shands Hospital, Gainesville, FL
| | - Michael A Pulsipher
- Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA
| | | | | | - Kirk R Schultz
- BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | | | | | | | | | - Bruce R Blazar
- University of Minnesota, Department of Pediatrics, Division of Blood and Marrow Transplantation, Minneapolis, MN
| | | | - John T Horan
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Leslie S Kean
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
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20
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Swain Y, Waller NG, Gewirtz JC, Harris AC. Individual Differences in Different Measures of Opioid Self-Administration in Rats Are Accounted for by a Single Latent Variable. Front Psychiatry 2021; 12:712163. [PMID: 34557118 PMCID: PMC8453143 DOI: 10.3389/fpsyt.2021.712163] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/10/2021] [Indexed: 12/02/2022] Open
Abstract
Individual differences in vulnerability to addiction have been widely studied through factor analysis (FA) in humans, a statistical method that identifies "latent" variables (variables that are not measured directly) that reflect the common variance among a larger number of observed measures. Despite its widespread application in behavioral genetics, FA has not been used in preclinical opioid addiction research. The current study used FA to examine the latent factor structure of four measures of i.v. morphine self-administration (MSA) in rats (i.e., acquisition, demand elasticity, morphine/cue- and stress/cue-induced reinstatement). All four MSA measures are generally assumed in the preclinical literature to reflect "addiction vulnerability," and individual differences in multiple measures of abuse liability are best accounted for by a single latent factor in some human studies. A one-factor model was therefore fitted to the data. Two different regularized FAs indicated that a one-factor model fit our data well. Acquisition, elasticity of demand and morphine/cue-induced reinstatement loaded significantly onto a single latent factor while stress/cue-induced reinstatement did not. Consistent with findings from some human studies, our results indicated a common drug "addiction" factor underlying several measures of opioid SA. However, stress/cue-induced reinstatement loaded poorly onto this factor, suggesting that unique mechanisms mediate individual differences in this vs. other MSA measures. Further establishing FA approaches in drug SA and in preclinical neuropsychopathology more broadly will provide more reliable, clinically relevant core factors underlying disease vulnerability in animal models for further genetic analyses.
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Affiliation(s)
- Yayi Swain
- Hennepin Healthcare Research Institute, Minneapolis, MN, United States.,Department of Psychology, University of Minnesota, Minneapolis, MN, United States
| | - Niels G Waller
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States
| | - Jonathan C Gewirtz
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States.,Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
| | - Andrew C Harris
- Hennepin Healthcare Research Institute, Minneapolis, MN, United States.,Department of Psychology, University of Minnesota, Minneapolis, MN, United States.,Department of Medicine, University of Minnesota, Minneapolis, MN, United States
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21
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Harris AC, Muelken P, LeSage MG. β-Carbolines found in cigarette smoke elevate intracranial self-stimulation thresholds in rats. Pharmacol Biochem Behav 2020; 198:173041. [PMID: 32926882 PMCID: PMC7554228 DOI: 10.1016/j.pbb.2020.173041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/25/2022]
Abstract
Identifying novel constituents that contribute to tobacco addiction is essential for developing more effective treatments and informing FDA regulation of tobacco products. While preclinical data indicate that monoamine oxidase (MAO) inhibitors can have abuse liability or potentiate the addiction-related effects of nicotine, most of these studies have used clinical MAO inhibitors (e.g., tranylcypromine) that are not present in cigarette smoke. The primary goal of this study was to evaluate the abuse potential of the β-carbolines harmane, norharmane, and harmine - MAO inhibitors that are found in cigarette smoke - in an intracranial self-simulation (ICSS) model in rats. A secondary goal was to evaluate the ability of norharmane to influence nicotine's acute effects on ICSS. None of the β-carbolines lowered ICSS thresholds at any dose studied when administered alone, suggesting a lack of abuse liability. Rather, all three β-carbolines produced dose-dependent elevations in ICSS thresholds, indicating aversive/anhedonic effects. Harmane and harmine also elevated ICSS response latencies, suggesting a disruption of motor function, albeit with reduced potency compared to their ICSS threshold-elevating effects. Norharmane (2.5 mg/kg) modestly attenuated the effects of nicotine on ICSS thresholds. Our findings indicate that these β-carbolines produced only aversive/anhedonic effects in an ICSS model when administered alone, and that norharmane unexpectedly attenuated nicotines acute effects on ICSS. Future work evaluating the addiction-related effects of nicotine combined with these and other MAO inhibitors present in smoke may be useful for understanding the role of MAO inhibition in tobacco addiction and informing FDA tobacco regulation.
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Affiliation(s)
- Andrew C Harris
- Hennepin Healthcare Research Institute, Minneapolis, MN, United States of America; Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, United States of America; Department of Psychology, University of Minnesota, Minneapolis, MN, United States of America.
| | - Peter Muelken
- Hennepin Healthcare Research Institute, Minneapolis, MN, United States of America
| | - Mark G LeSage
- Hennepin Healthcare Research Institute, Minneapolis, MN, United States of America; Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, United States of America; Department of Psychology, University of Minnesota, Minneapolis, MN, United States of America
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22
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Swain Y, Muelken P, Skansberg A, Lanzdorf D, Haave Z, LeSage MG, Gewirtz JC, Harris AC. Higher anhedonia during withdrawal from initial opioid exposure is protective against subsequent opioid self-administration in rats. Psychopharmacology (Berl) 2020; 237:2279-2291. [PMID: 32388620 PMCID: PMC7354901 DOI: 10.1007/s00213-020-05532-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/17/2020] [Indexed: 12/15/2022]
Abstract
RATIONALE Understanding factors contributing to individual differences in vulnerability to opioid addiction is essential for developing more effective preventions and treatments, yet few reliable behavioral predictors of subsequent opioid self-administration have been identified in rodents. Sensitivity to the acute effects of initial drug exposure predicts later addiction vulnerability in both humans and animals, but the relationship between sensitivity to withdrawal from initial drug exposure and later drug use vulnerability is unclear. OBJECTIVE The goal of the current study was to evaluate whether the degree of anhedonia experienced during withdrawal from early opioid exposure predicts subsequent vulnerability to opioid self-administration. METHODS Rats were first tested for withdrawal sensitivity following acute injections of morphine (i.e., "acute dependence"), measured as elevations in intracranial self-stimulation (ICSS) thresholds (anhedonia-like behavior) during naloxone-precipitated and spontaneous withdrawal. Rats were then tested for addiction-like behavior using various measures of i.v. morphine self-administration (MSA) including acquisition, demand, extinction, and reinstatement induced by morphine, stress, and/or drug-associated cues. RESULTS Greater naloxone-precipitated withdrawal across repeated morphine injections and greater peak spontaneous withdrawal severity following a single morphine injection were associated with lower addiction-like behavior on multiple MSA measures. Withdrawal-induced anhedonia predicted a wider range of MSA measures than did any individual measure of MSA itself. CONCLUSIONS Our data establish WIA as one of the first behavioral measures to predict individual differences in opioid SA in rodents. This model promises to be useful for furthering our understanding of behavioral and neurobiological mechanisms underlying vulnerability to opioid addiction.
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Affiliation(s)
- Yayi Swain
- Hennepin Healthcare Research Institute,,University of Minnesota Department of Psychology
| | | | - Annika Skansberg
- Hennepin Healthcare Research Institute,,University of Minnesota Department of Psychology
| | - Danielle Lanzdorf
- Hennepin Healthcare Research Institute,,University of Minnesota Department of Psychology
| | - Zachary Haave
- Hennepin Healthcare Research Institute,,University of Minnesota Department of Neuroscience
| | - Mark G. LeSage
- Hennepin Healthcare Research Institute,,University of Minnesota Department of Psychology,,University of Minnesota Department of Medicine
| | - Jonathan C. Gewirtz
- University of Minnesota Department of Psychology,,University of Minnesota Department of Neuroscience
| | - Andrew C. Harris
- Hennepin Healthcare Research Institute,,University of Minnesota Department of Psychology,,University of Minnesota Department of Medicine
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23
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Wong AL, McElroy SM, Robinson JM, Mulloy SM, El Banna FK, Harris AC, LeSage MG, Lee AM. Flavor-specific enhancement of electronic cigarette liquid consumption and preference in mice. Drug Alcohol Depend 2020; 211:107995. [PMID: 32354580 PMCID: PMC7328293 DOI: 10.1016/j.drugalcdep.2020.107995] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The use of electronic cigarettes has increased over the past decade. To determine how the abuse liability of electronic cigarette liquids (e-liquids) differs from nicotine alone, and to determine the impact of flavor, we compared nicotine-containing fruit- and tobacco-flavored e-liquids, and their nicotine-free versions, to nicotine alone in mouse models of oral consumption, reward and aversion. METHODS Adult male C57BL/6 J mice voluntarily consumed oral nicotine, equivalent nicotine concentrations of fruit- and tobacco-flavored e-liquid, and equivalent dilutions of the nicotine-free versions in 2-bottle choice tests. Conditioned place preference and place aversion were assessed with peripherally administered e-liquids or nicotine. Serum nicotine and cotinine levels were measured after subcutaneous injections of e-liquid or nicotine. RESULTS Mice showed higher consumption and preference for the fruit-flavored e-liquid compared with nicotine alone. This increase was not due to the flavor itself as consumption of the nicotine-free fruit-flavored e-liquid was not elevated until the highest concentration tested. The increased consumption and preference were not observed with the tobacco-flavored e-liquid. The conditioned place preference, place aversion and nicotine pharmacokinetics of the fruit-flavored e-liquid were not significantly different from nicotine alone. CONCLUSIONS Our data suggest that fruit, but not tobacco flavor, increased the oral consumption of e-liquid compared with nicotine alone. Moreover, this enhancement was not due to increased consumption of the flavor itself, altered rewarding or aversive properties after peripheral administration, or altered pharmacokinetics. This flavor-specific enhancement suggests that some flavors may lead to higher nicotine intake and increased use of e-liquids compared with nicotine alone.
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Affiliation(s)
- A L Wong
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - S M McElroy
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - J M Robinson
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - S M Mulloy
- Graduate Program in Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - F K El Banna
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - A C Harris
- Graduate Program in Neuroscience, University of Minnesota, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Department of Medicine, Hennepin Healthcare Research Institute, Minneapolis, MN, USA; Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - M G LeSage
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Department of Medicine, Hennepin Healthcare Research Institute, Minneapolis, MN, USA; Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - A M Lee
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, USA; Graduate Program in Neuroscience, University of Minnesota, Minneapolis, MN, USA.
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Schultz KR, Kariminia A, Ng B, Abdossamadi S, Lauener M, Nemecek ER, Wahlstrom JT, Kitko CL, Lewis VA, Schechter T, Jacobsohn DA, Harris AC, Pulsipher MA, Bittencourt H, Choi SW, Caywood EH, Kasow KA, Bhatia M, Oshrine BR, Flower A, Chaudhury S, Coulter D, Chewning JH, Joyce M, Savasan S, Pawlowska AB, Megason GC, Mitchell D, Cheerva AC, Lawitschka A, Azadpour S, Ostroumov E, Subrt P, Halevy A, Mostafavi S, Cuvelier GDE. Immune profile differences between chronic GVHD and late acute GVHD: results of the ABLE/PBMTC 1202 studies. Blood 2020; 135:1287-1298. [PMID: 32047896 PMCID: PMC7146024 DOI: 10.1182/blood.2019003186] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/20/2020] [Indexed: 12/14/2022] Open
Abstract
Human graft-versus-host disease (GVHD) biology beyond 3 months after hematopoietic stem cell transplantation (HSCT) is complex. The Applied Biomarker in Late Effects of Childhood Cancer study (ABLE/PBMTC1202, NCT02067832) evaluated the immune profiles in chronic GVHD (cGVHD) and late acute GVHD (L-aGVHD). Peripheral blood immune cell and plasma markers were analyzed at day 100 post-HSCT and correlated with GVHD diagnosed according to the National Institutes of Health consensus criteria (NIH-CC) for cGVHD. Of 302 children enrolled, 241 were evaluable as L-aGVHD, cGVHD, active L-aGVHD or cGVHD, and no cGVHD/L-aGVHD. Significant marker differences, adjusted for major clinical factors, were defined as meeting all 3 criteria: receiver-operating characteristic area under the curve ≥0.60, P ≤ .05, and effect ratio ≥1.3 or ≤0.75. Patients with only distinctive features but determined as cGVHD by the adjudication committee (non-NIH-CC) had immune profiles similar to NIH-CC. Both cGVHD and L-aGVHD had decreased transitional B cells and increased cytolytic natural killer (NK) cells. cGVHD had additional abnormalities, with increased activated T cells, naive helper T (Th) and cytotoxic T cells, loss of CD56bright regulatory NK cells, and increased ST2 and soluble CD13. Active L-aGVHD before day 114 had additional abnormalities in naive Th, naive regulatory T (Treg) cell populations, and cytokines, and active cGVHD had an increase in PD-1- and a decrease in PD-1+ memory Treg cells. Unsupervised analysis appeared to show a progression of immune abnormalities from no cGVHD/L-aGVHD to L-aGVHD, with the most complex pattern in cGVHD. Comprehensive immune profiling will allow us to better understand how to minimize L-aGVHD and cGVHD. Further confirmation in adult and pediatric cohorts is needed.
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Affiliation(s)
- Kirk R Schultz
- Michael Cuccione Childhood Cancer research program, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Amina Kariminia
- Michael Cuccione Childhood Cancer research program, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Bernard Ng
- Department of Statistics, Centre for Molecular Medicine and Therapeutics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Sayeh Abdossamadi
- Michael Cuccione Childhood Cancer research program, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Madeline Lauener
- Michael Cuccione Childhood Cancer research program, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Eneida R Nemecek
- Pediatric Blood and Marrow Transplantation, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR
| | - Justin T Wahlstrom
- Blood and Marrow Transplantation Program, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA
| | - Carrie L Kitko
- Pediatric Stem Cell Transplantation Program, Vanderbilt University Medical Center, Nashville, TN
| | - Victor A Lewis
- Pediatric Oncology, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Tal Schechter
- Hematology-Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - David A Jacobsohn
- Blood and Marrow Transplantation, Children's National Health System, Washington, DC
| | - Andrew C Harris
- Pediatric Hematology Oncology, Primary Children's Hospital, University of Utah, Salt Lake City, UT
| | - Michael A Pulsipher
- Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA
| | - Henrique Bittencourt
- Hematology Oncology, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Sung Won Choi
- Michigan Medicine Pediatric Bone Marrow Transplant, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI
| | - Emi H Caywood
- Pediatric Hematology Oncology, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Kimberly A Kasow
- Pediatric Bone Marrow Transplant, University of North Carolina, Chapel Hill, NC
| | - Monica Bhatia
- Pediatric Stem Cell Transplant Program, Morgan Stanley Children's Hospital, Columbia University, New York, NY
| | - Benjamin R Oshrine
- Oncology and Hematology, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Allyson Flower
- Division of Pediatric Hematology, Oncology, Stem Cell Transplant, New York Medical College, Valhalla, NY
| | - Sonali Chaudhury
- Hematology, Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL
| | - Donald Coulter
- Division of Pediatric Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Joseph H Chewning
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Michael Joyce
- Division of Pediatric Hematology/Oncology Clinic, Nemours Children's Specialty Care, Jacksonville, FL
| | - Sureyya Savasan
- Pediatric Hematology & Oncology, Children's Hospital of Michigan, Detroit, MI
| | | | - Gail C Megason
- Children's Hematology/Oncology, University of Mississippi Medical Center, Jackson, MS
| | - David Mitchell
- Division of Pediatric Hematology/Oncology, Montreal Children's Hospital, Montreal, QC
| | - Alexandra C Cheerva
- Pediatric Hematology, Oncology and Stem Cell Transplantation, Norton Children's Hospital, University of Louisville, Louisville, KY
| | - Anita Lawitschka
- Stem Cell Transplant Outpatient & Aftercare Clinic, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | | | - Elena Ostroumov
- Michael Cuccione Childhood Cancer research program, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Peter Subrt
- Michael Cuccione Childhood Cancer research program, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Anat Halevy
- Michael Cuccione Childhood Cancer research program, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Sara Mostafavi
- Department of Statistics, Centre for Molecular Medicine and Therapeutics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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Shyr DC, Homsombath AA, Chan PP, Boyer MW, Harris AC. Using CD19 chimeric antigen receptor-T cell therapy in a 4-month-old patient with infantile acute lymphoblastic leukemia. Pediatr Blood Cancer 2020; 67:e28155. [PMID: 31925900 DOI: 10.1002/pbc.28155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 01/18/2023]
Affiliation(s)
- David C Shyr
- Division of Pediatric Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Amy A Homsombath
- Cell Therapy & Regenerative Medicine Program, University of Utah School of Medicine, Salt Lake City, Utah
| | - Priya P Chan
- Division of Pediatric Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Michael W Boyer
- Division of Pediatric Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Andrew C Harris
- Division of Pediatric Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, Utah
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Laetsch TW, Myers GD, Baruchel A, Dietz AC, Pulsipher MA, Bittencourt H, Buechner J, De Moerloose B, Davis KL, Nemecek E, Driscoll T, Mechinaud F, Boissel N, Rives S, Bader P, Peters C, Sabnis HS, Grupp SA, Yanik GA, Hiramatsu H, Stefanski HE, Rasouliyan L, Yi L, Shah S, Zhang J, Harris AC. Patient-reported quality of life after tisagenlecleucel infusion in children and young adults with relapsed or refractory B-cell acute lymphoblastic leukaemia: a global, single-arm, phase 2 trial. Lancet Oncol 2019; 20:1710-1718. [PMID: 31606419 DOI: 10.1016/s1470-2045(19)30493-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/09/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The ELIANA trial showed that 61 (81%) of 75 paediatric and young adult patients with relapsed or refractory B-cell acute lymphoblastic leukaemia achieved overall remission after treatment with tisagenlecleucel, a chimeric antigen receptor targeted against the CD19 antigen. We aimed to evaluate patient-reported quality of life in these patients before and after tisagenlecleucel infusion. METHODS ELIANA, a global, single-arm, open-label, phase 2 trial, was done in 25 hospitals across Australia, Austria, Belgium, Canada, France, Germany, Italy, Japan, Norway, Spain, and the USA. Patients with B-cell acute lymphoblastic leukaemia aged at least 3 years at the time of screening and 21 years or younger at the time of initial diagnosis who were in second or greater bone marrow relapse, chemorefractory, relapsed after allogeneic stem-cell transplantation, or were otherwise ineligible for allogeneic stem-cell transplantation were enrolled. Patients received a single intravenous administration of a target dose of 0·2-5 × 106 transduced viable T cells per kg for patients weighing 50 kg or less or 0·1-2·5 × 108 transduced viable T cells for patients weighing more than 50 kg. The primary outcome, reported previously, was the proportion of patients who achieved remission. A prespecified secondary endpoint, reported here, was patient-reported quality of life measured with the Pediatric Quality of Life Inventory (PedsQL) and European Quality of Life-5 Dimensions questionnaire (EQ-5D). Patients completed the questionnaires at baseline, day 28, and months 3, 6, 9, and 12 after treatment. The data collected were summarised using descriptive statistics and post-hoc mixed models for repeated measures. Change from baseline response profiles were illustrated with cumulative distribution function plots. The proportion of patients achieving the minimal clinically important difference and normative mean value were reported. Analysis was per protocol. This study is registered with ClinicalTrials.gov, NCT02435849. FINDINGS Between April 8, 2015, and April 25, 2017, 107 patients were screened, 92 were enrolled, and 75 received tisagenlecleucel. 58 patients aged 8-23 years were included in the analysis of quality of life. At baseline, 50 (86%) patients had completed the PedsQL questionnaire and 48 (83%) had completed the EQ-5D VAS. Improvements in patient-reported quality-of-life scores were observed for all measures at month 3 after tisagenlecleucel infusion (mean change from baseline to month 3 was 13·3 [95% CI 8·9-17·6] for the PedsQL total score and 16·8 [9·4-24·3] for the EQ-5D visual analogue scale). 30 (81%) of 37 patients achieved the minimal clinically important difference at month 3 for the PedsQL total score and 24 (67%) of 36 patients achieved this for the EQ-5D visual analogue scale. INTERPRETATION These findings, along with the activity and safety results of ELIANA, suggest a favourable benefit-risk profile of tisagenlecleucel in the treatment of paediatric and young adult patients with relapsed or refractory B-cell acute lymphoblastic leukaemia. FUNDING Novartis.
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Affiliation(s)
- Theodore W Laetsch
- Department of Pediatrics and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, TX, USA; Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health, Dallas, TX, USA.
| | - Gary Douglas Myers
- Division of BMT/Hematology/Oncology, Children's Mercy Hospital Kansas City, Kansas City, MO, USA
| | - André Baruchel
- Pediatric Hemato-Immunology Department, Robert Debré University Hospital (APHP) and University Paris Diderot, Paris, France
| | - Andrew C Dietz
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael A Pulsipher
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Henrique Bittencourt
- Hematology-Oncology Division, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Kara L Davis
- Bass Center for Childhood Cancer and Blood Disorders, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Eneida Nemecek
- Bone Marrow Transplantation Program, Oregon Health & Science University, Portland, OR, USA
| | - Timothy Driscoll
- Division of Pediatric Blood and Marrow Transplant, Children's Health Center, Duke University Medical Center, Durham, NC, USA
| | - Francoise Mechinaud
- Children's Cancer Centre, The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Nicolas Boissel
- Hematology Adolescent and Young Adult Unit, Saint-Louis Hospital, Paris, France
| | - Susana Rives
- Department of Pediatric Hematology and Oncology Hospital Sant Joan de Déu de Barcelona, Institut de Recerca Sant Joan de Déu, Barcelona Spain
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Goethe University, Hospital for Children and Adolescents, Frankfurt, Germany
| | - Christina Peters
- Stem Cell Transplant Unit, St. Anna Children's Hospital, Medical University, Vienna, Austria
| | - Himalee S Sabnis
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Stephan A Grupp
- Division of Oncology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory A Yanik
- Department of Pediatrics, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Hidefumi Hiramatsu
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Heather E Stefanski
- Department of Pediatric Blood and Marrow Transplant, University of Minnesota, Minneapolis, MN, USA
| | | | - Lan Yi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Sweta Shah
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Jie Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Andrew C Harris
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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Harris AC, Muelken P, Swain Y, Palumbo M, Jain V, Goniewicz ML, Stepanov I, LeSage MG. Non-nicotine constituents in e-cigarette aerosol extract attenuate nicotine's aversive effects in adolescent rats. Drug Alcohol Depend 2019; 203:51-60. [PMID: 31404849 PMCID: PMC6941564 DOI: 10.1016/j.drugalcdep.2019.05.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 10/30/2018] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Development of preclinical methodology for evaluating the abuse liability of electronic cigarettes (ECs) in adolescents is urgently needed to inform FDA regulation of these products. We previously reported reduced aversive effects of EC liquids containing nicotine and a range of non-nicotine constituents (e.g., propylene glycol, minor tobacco alkaloids) compared to nicotine alone in adult rats as measured using intracranial self-stimulation. The goal of this study was to compare the aversive effects of nicotine alone and EC aerosol extracts in adolescent rats as measured using conditioned taste aversion (CTA), which can be conducted during the brief adolescent period. METHODS AND RESULTS In Experiment 1, nicotine alone (1.0 or 1.5 mg/kg, s.c.) produced significant CTA in adolescent rats in a two-bottle procedure, thereby establishing a model to study the effects of EC extracts. At a nicotine dose of 1.0 mg/kg, CTA to Vuse Menthol EC extract, but not Aroma E-Juice EC extract, was attenuated compared to nicotine alone during repeated two-bottle CTA tests (Experiment 2a). At a nicotine dose of 0.5 mg/kg, CTA to Vuse Menthol EC extract did not differ from nicotine alone during the first two-bottle CTA test but extinguished more rapidly across repeated two-bottle tests (Experiment 2b). CONCLUSIONS Non-nicotine constituents in Vuse Menthol EC extracts attenuated CTA in a two-bottle procedure in adolescents. This model may be useful for anticipating the abuse liability of ECs in adolescents and for modeling FDA-mandated changes in product standards for nicotine or other constituents in ECs.
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Affiliation(s)
- Andrew C. Harris
- Department of Medicine, Hennepin Healthcare Research Institute, Minneapolis, MN, USA,Department of Medicine, University of Minnesota, Minneapolis, MN, USA,Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Peter Muelken
- Department of Medicine, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Yayi Swain
- Department of Medicine, Hennepin Healthcare Research Institute, Minneapolis, MN, USA,Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Mary Palumbo
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Vipin Jain
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Irina Stepanov
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Mark G. LeSage
- Department of Medicine, Hennepin Healthcare Research Institute, Minneapolis, MN, USA,Department of Medicine, University of Minnesota, Minneapolis, MN, USA,Department of Psychology, University of Minnesota, Minneapolis, MN, USA
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Berman ML, Bickel WK, Harris AC, LeSage MG, O'Connor RJ, Stepanov I, Shields PG, Hatsukami DK. Consortium on Methods Evaluating Tobacco: Research Tools to Inform US Food and Drug Administration Regulation of Snus. Nicotine Tob Res 2019; 20:1292-1300. [PMID: 29059363 DOI: 10.1093/ntr/ntx228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/28/2017] [Indexed: 11/13/2022]
Abstract
Introduction The US Food and Drug Administration (FDA) has purview over tobacco products. To set policy, the FDA must rely on sound science, yet most existing tobacco research methods have not been designed to specifically inform regulation. The NCI and FDA-funded Consortium on Methods Evaluating Tobacco (COMET) was established to develop and assess valid and reliable methods for tobacco product evaluation. The goal of this article is to describe these assessment methods using a US manufactured "snus" as the test product. Methods In designing studies that could inform FDA regulation, COMET has taken a multidisciplinary approach that includes experimental animal models and a range of human studies that examine tobacco product appeal, addictiveness, and toxicity. This article integrates COMET's findings over the last 4 years. Results Consistency in results was observed across the various studies, lending validity to our methods. Studies showed low abuse liability for snus and low levels of consumer demand. Toxicity was less than cigarettes on some biomarkers but higher than medicinal nicotine. Conclusions Using our study methods and the convergence of results, the snus that we tested as a potential modified risk tobacco product is likely to neither result in substantial public health harm nor benefit. Implications This review describes methods that were used to assess the appeal, abuse liability, and toxicity of snus. These methods included animal, behavioral economics, consumer perception studies, and clinical trials. Across these varied methods, study results showed low abuse-liability and appeal of the snus product we tested. In several studies, demand for snus was lower than for less toxic nicotine gum. The consistency and convergence of results across a range of multi-disciplinary studies lends validity to our methods and suggests that promotion of snus as a modified risk tobacco products is unlikely to produce substantial public health benefit or harm.
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Affiliation(s)
- Micah L Berman
- College of Public Health, Ohio State University, Columbus, OH.,Moritz College of Law, Ohio State University, Columbus, OH
| | | | - Andrew C Harris
- Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Medicine, University of Minnesota, Minneapolis, MN.,Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Mark G LeSage
- Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Medicine, University of Minnesota, Minneapolis, MN.,Department of Psychology, University of Minnesota, Minneapolis, MN
| | | | - Irina Stepanov
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Peter G Shields
- Comprehensive Cancer Center, Ohio State University, Columbus, OH
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Cuvelier GDE, Nemecek ER, Wahlstrom JT, Kitko CL, Lewis VA, Schechter T, Jacobsohn DA, Harris AC, Pulsipher MA, Bittencourt H, Choi SW, Caywood EH, Kasow KA, Bhatia M, Oshrine BR, Flower A, Chaudhury S, Coulter D, Chewning JH, Joyce M, Savaşan S, Pawlowska AB, Megason GC, Mitchell D, Cheerva AC, Lawitschka A, West LJ, Pan B, Al Hamarneh YN, Halevy A, Schultz KR. Benefits and challenges with diagnosing chronic and late acute GVHD in children using the NIH consensus criteria. Blood 2019; 134:304-316. [PMID: 31043425 PMCID: PMC6911839 DOI: 10.1182/blood.2019000216] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [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: 02/18/2019] [Accepted: 04/25/2019] [Indexed: 12/16/2022] Open
Abstract
Chronic graft-versus-host disease (cGVHD) and late acute graft-versus-host disease (L-aGVHD) are understudied complications of allogeneic hematopoietic stem cell transplantation in children. The National Institutes of Health Consensus Criteria (NIH-CC) were designed to improve the diagnostic accuracy of cGVHD and to better classify graft-versus-host disease (GVHD) syndromes but have not been validated in patients <18 years of age. The objectives of this prospective multi-institution study were to determine: (1) whether the NIH-CC could be used to diagnose pediatric cGVHD and whether the criteria operationalize well in a multi-institution study; (2) the frequency of cGVHD and L-aGVHD in children using the NIH-CC; and (3) the clinical features and risk factors for cGVHD and L-aGVHD using the NIH-CC. Twenty-seven transplant centers enrolled 302 patients <18 years of age before conditioning and prospectively followed them for 1 year posttransplant for development of cGVHD. Centers justified their cGVHD diagnosis according to the NIH-CC using central review and a study adjudication committee. A total of 28.2% of reported cGVHD cases was reclassified, usually as L-aGVHD, following study committee review. Similar incidence of cGVHD and L-aGVHD was found (21% and 24.7%, respectively). The most common organs involved with diagnostic or distinctive manifestations of cGVHD in children include the mouth, skin, eyes, and lungs. Importantly, the 2014 NIH-CC for bronchiolitis obliterans syndrome perform poorly in children. Past acute GVHD and peripheral blood grafts are major risk factors for cGVHD and L-aGVHD, with recipients ≥12 years of age being at risk for cGVHD. Applying the NIH-CC in pediatrics is feasible and reliable; however, further refinement of the criteria specifically for children is needed.
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Affiliation(s)
| | - Eneida R Nemecek
- Pediatric Blood and Marrow Transplant, Doernbechter Children's Hospital, Oregon Health and Science University, Portland, OR
| | - Justin T Wahlstrom
- Benioff Children's Hospital, University of California San Francisco, San Francisco, CA
| | | | - Victor A Lewis
- Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Tal Schechter
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Andrew C Harris
- Primary Children's Hospital, University of Utah, Salt Lake City, UT
| | | | | | - Sung Won Choi
- C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI
| | - Emi H Caywood
- Nemours Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Kimberly A Kasow
- Division of Pediatric Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Monica Bhatia
- Morgan Stanley Children's Hospital, Columbia University, New York, NY
| | | | | | - Sonali Chaudhury
- Ann & Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL
| | | | - Joseph H Chewning
- Division of Pediatric Hematology-Oncology, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | | | | | - Anita Lawitschka
- St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Lori J West
- Alberta Transplant Institute, University of Alberta, Edmonton, AB, Canada
| | - Bo Pan
- EPICORE Centre, University of Alberta, Edmonton, AB, Canada; and
| | | | - Anat Halevy
- British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Kirk R Schultz
- British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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Watkins BK, Qayed M, Bratrude B, Betz K, Sinclair S, Suessmuth Y, Rhodes J, Yu A, Cribbin K, Dean C, Narayan A, Hunt D, Schwartz N, Hebert K, Pasquini MC, Rogatko A, Tighiouart M, Kim S, Bresee C, Banks A, Gillespie S, Choi S, Davis JH, Duncan C, Giller R, Grimley MS, Harris AC, Jacobsohn DA, Lalefar NR, Norkin M, Pulsipher MA, Shenoy S, Petrovic A, Schultz KR, Blazar BR, Langston AA, Horan J, Kean LS. T Cell Costimulation Blockade with CTLA4-Ig (Abatacept) for Acute Gvhd Prevention in HLA Matched and Mismatched Unrelated Donor Transplantation: Results of the First Phase 2 Trial. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Harris AC, Muelken P, Haave Z, Swain Y, Smethells JR, LeSage MG. Propylene glycol, a major electronic cigarette constituent, attenuates the adverse effects of high-dose nicotine as measured by intracranial self-stimulation in rats. Drug Alcohol Depend 2018; 193:162-168. [PMID: 30384324 PMCID: PMC6278948 DOI: 10.1016/j.drugalcdep.2018.08.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/25/2018] [Accepted: 08/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Non-nicotine tobacco constituents may contribute to the abuse liability of tobacco products. We previously reported that electronic cigarette (EC) refill liquids containing nicotine and a range of non-nicotine constituents attenuated the anhedonic/aversive effects of nicotine in an intracranial self-stimulation (ICSS) model. The alcohol propylene glycol (PG) is a primary ingredient in these and other EC liquids, yet its abuse potential has not been established. The goal of this study was to evaluate the effects of parenteral administration of PG alone and PG combined with nicotine on ICSS in rats. METHODS AND RESULTS PG alone did not affect ICSS at concentrations up to 100%. PG (25% or 60%) did not affect nicotine's reinforcement-enhancing (ICSS threshold-decreasing) effects at low to moderate nicotine doses, but attenuated nicotine's reinforcement-attenuating/aversive (ICSS threshold-increasing) effects at a high nicotine dose. PG concentrations similar to those in EC liquid doses used in our previous studies (1% or 3%) modestly attenuated the ICSS threshold-elevating effects of a high nicotine dose. CONCLUSIONS PG attenuated elevations in ICSS thresholds induced by high-dose nicotine, which may reflect an attenuation of nicotine's acute aversive/anhedonic and/or toxic effects. PG may have contributed to the attenuated ICSS threshold-elevating effects of EC liquids reported previously. Further examination of PG in models of addiction and toxicity is needed to understand the consequences of EC use and to inform the development of EC product standards by the FDA.
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Affiliation(s)
- Andrew C Harris
- Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN USA; Departments of Medicine, University of Minnesota Medical School, Variety Club Research Center (VCRC), 401 East River Parkway, 1(st) Floor - Suite 131, Minneapolis, MN 55455, USA; Departments of Psychology, University of Minnesota Medical School, N218 Elliott Hall, 75 E River Rd, Minneapolis, MN 55455, USA.
| | - Peter Muelken
- Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN USA
| | - Zach Haave
- Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN USA; Departments of Neuroscience, University of Minnesota Medical School, 6-145 Jackson Hall, 321 Church Street SE, Minneapolis, MN 55455, USA
| | - Yayi Swain
- Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN USA; Departments of Psychology, University of Minnesota Medical School, N218 Elliott Hall, 75 E River Rd, Minneapolis, MN 55455, USA
| | - John R Smethells
- Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN USA; Departments of Psychiatry, University of Minnesota Medical School, Fairview Riverside West Building, 2312 S. 6th St., Floor 2, Suite F-275, Minneapolis, MN 55454, USA
| | - Mark G LeSage
- Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN USA; Departments of Medicine, University of Minnesota Medical School, Variety Club Research Center (VCRC), 401 East River Parkway, 1(st) Floor - Suite 131, Minneapolis, MN 55455, USA; Departments of Psychology, University of Minnesota Medical School, N218 Elliott Hall, 75 E River Rd, Minneapolis, MN 55455, USA
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Zhao D, Kim YH, Jeong S, Greenson JK, Chaudhry MS, Hoepting M, Anderson ER, van den Brink MR, Peled JU, Gomes AL, Slingerland AE, Donovan MJ, Harris AC, Levine JE, Ozbek U, Hooper LV, Stappenbeck TS, Ver Heul A, Liu TC, Reddy P, Ferrara JL. Survival signal REG3α prevents crypt apoptosis to control acute gastrointestinal graft-versus-host disease. J Clin Invest 2018; 128:4970-4979. [PMID: 30106382 DOI: 10.1172/jci99261] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [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: 12/14/2017] [Accepted: 08/07/2018] [Indexed: 12/30/2022] Open
Abstract
Graft-versus-host disease (GVHD) in the gastrointestinal (GI) tract remains the major cause of morbidity and nonrelapse mortality after BM transplantation (BMT). The Paneth cell protein regenerating islet-derived 3α (REG3α) is a biomarker specific for GI GVHD. REG3α serum levels rose in the systematic circulation as GVHD progressively destroyed Paneth cells and reduced GI epithelial barrier function. Paradoxically, GVHD suppressed intestinal REG3γ (the mouse homolog of human REG3α), and the absence of REG3γ in BMT recipients intensified GVHD but did not change the composition of the microbiome. IL-22 administration restored REG3γ production and prevented apoptosis of both intestinal stem cells (ISCs) and Paneth cells, but this protection was completely abrogated in Reg3g-/- mice. In vitro, addition of REG3α reduced the apoptosis of colonic cell lines. Strategies that increase intestinal REG3α/γ to promote crypt regeneration may offer a novel, nonimmunosuppressive approach for GVHD and perhaps for other diseases involving the ISC niche, such as inflammatory bowel disease.
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Affiliation(s)
- Dongchang Zhao
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | | | - Seihwan Jeong
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Joel K Greenson
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mohammed S Chaudhry
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Matthias Hoepting
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Erik R Anderson
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Marcel Rm van den Brink
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA
| | - Jonathan U Peled
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA
| | - Antonio Lc Gomes
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA
| | - Ann E Slingerland
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA
| | - Michael J Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Andrew C Harris
- Blood and Marrow Transplantation Program, University of Utah, Salt Lake City, Utah, USA
| | - John E Levine
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Umut Ozbek
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Lora V Hooper
- Howard Hughes Medical Institute, Department of Immunology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Thaddeus S Stappenbeck
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Aaron Ver Heul
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ta-Chiang Liu
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Pavan Reddy
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - James Lm Ferrara
- The Tisch Cancer Institute and Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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Hartwell MJ, Özbek U, Holler E, Renteria AS, Major-Monfried H, Reddy P, Aziz M, Hogan WJ, Ayuk F, Efebera YA, Hexner EO, Bunworasate U, Qayed M, Ordemann R, Wölfl M, Mielke S, Pawarode A, Chen YB, Devine S, Harris AC, Jagasia M, Kitko CL, Litzow MR, Kröger N, Locatelli F, Morales G, Nakamura R, Reshef R, Rösler W, Weber D, Wudhikarn K, Yanik GA, Levine JE, Ferrara JL. An early-biomarker algorithm predicts lethal graft-versus-host disease and survival. JCI Insight 2018; 3:124015. [PMID: 30135313 DOI: 10.1172/jci.insight.124015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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LeSage MG, Smethells JR, Harris AC. Status and Future Directions of Preclinical Behavioral Pharmacology in Tobacco Regulatory Science. ACTA ACUST UNITED AC 2018; 18:252-274. [PMID: 30214916 DOI: 10.1037/bar0000113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Behavioral pharmacology is a branch of the experimental analysis of behavior that has had great influence in drug addiction research and policy. This paper provides an overview of recent behavioral pharmacology research in the field of tobacco regulatory science, which provides the scientific foundation for the Food and Drug Administration Center for Tobacco Products (FDA CTP) to set tobacco control policies. The rationale and aims of tobacco regulatory science are provided, including the types of preclinical operant behavioral models it deems important for assessing the abuse liability of tobacco products and their constituents. We then review literature relevant to key regulatory actions being considered by the FDA CTP, including regulations over nicotine and menthol content of cigarettes, and conclude with suggesting some directions for future research. The current era of tobacco regulatory science provides great opportunities for behavioral pharmacologists to address the leading cause of preventable death and disease worldwide.
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Affiliation(s)
- Mark G LeSage
- Department of Medicine, Minneapolis Medical Research Foundation
- Departments of Medicine, University of Minnesota
- Department of Psychology, University of Minnesota
| | - John R Smethells
- Department of Medicine, Minneapolis Medical Research Foundation
- Departments of Medicine, University of Minnesota
| | - Andrew C Harris
- Department of Medicine, Minneapolis Medical Research Foundation
- Departments of Medicine, University of Minnesota
- Department of Psychology, University of Minnesota
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Smethells JR, Harris AC, Burroughs D, Hursh SR, LeSage MG. Substitutability of nicotine alone and an electronic cigarette liquid using a concurrent choice assay in rats: A behavioral economic analysis. Drug Alcohol Depend 2018; 185:58-66. [PMID: 29427916 PMCID: PMC5889753 DOI: 10.1016/j.drugalcdep.2017.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND For the Food and Drug Administration to effectively regulate tobacco products, the contribution of non-nicotine tobacco constituents to the abuse liability of tobacco must be well understood. Our previous work compared the abuse liability of electronic cigarette refill liquids (EC liquids) and nicotine (Nic) alone when each was available in isolation and found no difference in abuse liability (i.e., demand elasticity). Another, and potentially more sensitive measure, would be to examine abuse liability in a choice context, which also provides a better model of the tobacco marketplace. METHODS Demand elasticity for Nic alone and an EC liquid were measured when only one formulation was available (alone-price demand) and when both formulations were concurrently available (own-price demand), allowing an assessment of the degree to which each formulation served as a substitute (cross-price demand) when available at a low fixed-price. RESULTS Own-price demand for both formulations were more elastic compared to alone-price demand, indicating that availability of a substitute increased demand elasticity. During concurrent access, consumption of the fixed-price formulation increased as the unit-price of the other formulation increased. The rate of increase was similar between formulations, indicating that they served as symmetrical substitutes. CONCLUSION The cross-price model reliably quantified the substitutability of both nicotine formulations and indicated that the direct CNS effects of non-nicotine constituents in EC liquid did not alter its abuse liability compared to Nic. These data highlight the sensitivity of this model and its potential utility for examining the relative abuse liability and substitutability of tobacco products.
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Affiliation(s)
- John R Smethells
- Minneapolis Medical Research Foundation, 914 S. 8th Street, Minneapolis, MN, United States.
| | - Andrew C Harris
- Minneapolis Medical Research Foundation, 914 S. 8th Street, Minneapolis, MN, United States; Department of Medicine, University of Minnesota Medical School, 420 Delaware Street, SE, Minneapolis, MN, United States; Department of Psychology, University of Minnesota, 75 E. River Road, Minneapolis, MN, United States
| | - Danielle Burroughs
- Minneapolis Medical Research Foundation, 914 S. 8th Street, Minneapolis, MN, United States
| | - Steven R Hursh
- Institutes for Behavior Resources, Inc., 2104 Maryland Avenue, Baltimore, MD, United States; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, United States
| | - Mark G LeSage
- Minneapolis Medical Research Foundation, 914 S. 8th Street, Minneapolis, MN, United States; Department of Medicine, University of Minnesota Medical School, 420 Delaware Street, SE, Minneapolis, MN, United States; Department of Psychology, University of Minnesota, 75 E. River Road, Minneapolis, MN, United States
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Harris AC, Muelken P, Smethells JR, Yershova K, Stepanov I, Olson TT, Kellar KJ, LeSage MG. Effects of nicotine-containing and "nicotine-free" e-cigarette refill liquids on intracranial self-stimulation in rats. Drug Alcohol Depend 2018; 185:1-9. [PMID: 29413432 PMCID: PMC5889751 DOI: 10.1016/j.drugalcdep.2017.11.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 07/13/2017] [Revised: 11/10/2017] [Accepted: 11/30/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Animal models are needed to inform FDA regulation of electronic cigarettes (ECs) because they avoid limitations associated with human studies. We previously reported that an EC refill liquid produced less aversive/anhedonic effects at a high nicotine dose than nicotine alone as measured by elevations in intracranial self-stimulation (ICSS) thresholds, which may reflect the presence of behaviorally active non-nicotine constituents (e.g., propylene glycol) in the EC liquids. The primary objective of this study was to assess the generality of our prior ICSS findings to two additional EC liquids. We also compared effects of "nicotine-free" varieties of these EC liquids on ICSS, as well as binding affinity and/or functional activity of nicotine alone, nicotine-containing EC liquids, and "nicotine-free" EC liquids at nicotinic acetylcholine receptors (nAChRs). METHODS AND RESULTS Nicotine alone and nicotine dose-equivalent concentrations of both nicotine-containing EC liquids produced similar lowering of ICSS thresholds at low to moderate nicotine doses, indicating similar reinforcement-enhancing effects. At high nicotine doses, nicotine alone elevated ICSS thresholds (a measure of anhedonia-like behavior) while the EC liquids did not. Nicotine-containing EC liquids did not differ from nicotine alone in terms of binding affinity or functional activity at nAChRs. "Nicotine-free" EC liquids did not affect ICSS, but bound with low affinity at some (e.g., α4ß2) nAChRs. CONCLUSIONS These findings suggest that non-nicotine constituents in these EC liquids do not contribute to their reinforcement-enhancing effects. However, they may attenuate nicotine's acute aversive/anhedonic and/or toxic effects, which may moderate the abuse liability and/or toxicity of ECs.
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Affiliation(s)
- Andrew C. Harris
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN, USA,Department of Medicine, University of Minnesota, Minneapolis, MN, USA,Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Peter Muelken
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - John R. Smethells
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN, USA,Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Katrina Yershova
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Irina Stepanov
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Thao Tran Olson
- Department of Pharmacology and Physiology, Georgetown University School of Medicine, Washington, DC, USA
| | - Kenneth J. Kellar
- Department of Pharmacology and Physiology, Georgetown University School of Medicine, Washington, DC, USA
| | - Mark G. LeSage
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN, USA,Department of Medicine, University of Minnesota, Minneapolis, MN, USA,Department of Psychology, University of Minnesota, Minneapolis, MN, USA
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Zhao D, Kim YH, Greenson JK, Chaudhry MS, Hoepting M, Jeong S, Anderson ER, Harris AC, Levine JE, Ozbek U, Hooper LV, Stappenbeck TS, Heul AV, Liu TC, Reddy P, Ferrara J. Regenerating Islet-Derived 3-Alpha (REG3A) Protects the Intestinal Stem Cell Niche to Control Acute Gastrointestinal Graft-Versus-Host Disease. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cuvelier GD, Nemecek ER, Wahlstrom JT, Harris AC, Pulsipher MA, Lewis V, Bittencourt H, Choi SW, Kitko CL, Caywood E, Bhatia M, Kasow K, Jacobsohn DA, Oshrine BR, Kheradpour A, Chaudhury S, Chewning JH, Schechter T, Flower A, Coulter DW, Joyce M, Savasan S, Pawlowska A, Megason G, Mitchell D, Cheerva A, Kariminia A, Halevy A, Schultz KR. Recent Thymic Emigrants and Tregs Expressing CD31 and CD45RA Are Decreased at Day 100 and Prognostic for Chronic GvHD in Children: Results From the Applied Biomarkers of Late Effects (ABLE)/Pediatric Blood and Marrow Transplant Consortium 1202 Study. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Swain Y, Muelken P, LeSage MG, Gewirtz JC, Harris AC. Locomotor activity does not predict individual differences in morphine self-administration in rats. Pharmacol Biochem Behav 2018; 166:48-56. [PMID: 29409807 DOI: 10.1016/j.pbb.2018.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 12/19/2022]
Abstract
Understanding factors contributing to individual differences in opioid addiction vulnerability is essential for developing more effective preventions and treatments. Sensation seeking has been implicated in addiction to several drugs of abuse, yet its relationship with individual differences in opioid addiction vulnerability has not been well established. The primary goal of this study was to evaluate the relationship between locomotor activity in a novel environment, a preclinical model of sensation-seeking, and individual differences in acquisition of i.v. morphine self-administration (SA) in rats. A secondary goal was to evaluate the relationship between activity and elasticity of demand (reinforcing efficacy) for morphine measured using a behavioral economic approach. Following an initial locomotor activity screen, animals were allowed to acquire morphine SA at a unit dose of 0.5 mg/kg/infusion in 4 hour/day sessions (Experiment 1) or 0.2 mg/kg/infusion in 2 hour/day sessions (Experiment 2) until infusion rates were stable. Unit price was subsequently manipulated via progressive reductions in unit dose (Experiment 1) or increases in response requirement per infusion (Experiment 2). Activity levels were not correlated with acquisition of morphine SA in either experiment. Morphine consumption was generally well described by an exponential demand function in both experiments (R2 values > 0.95 for rats as a group), but activity did not correlate with behavioral economic measures. Locomotor activity in a novel environment did not predict individual differences in acquisition of morphine SA. These data complement findings from some human studies and suggest that the role of sensation seeking in individual differences in opioid addiction vulnerability may be limited.
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Affiliation(s)
- Yayi Swain
- Minneapolis Medical Research Foundation, Minneapolis, MN, United States; Department of Psychology, University of Minnesota, Minneapolis, MN, United States
| | - Peter Muelken
- Minneapolis Medical Research Foundation, Minneapolis, MN, United States
| | - Mark G LeSage
- Minneapolis Medical Research Foundation, Minneapolis, MN, United States; Department of Psychology, University of Minnesota, Minneapolis, MN, United States; Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Jonathan C Gewirtz
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States; Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
| | - Andrew C Harris
- Minneapolis Medical Research Foundation, Minneapolis, MN, United States; Department of Psychology, University of Minnesota, Minneapolis, MN, United States; Department of Medicine, University of Minnesota, Minneapolis, MN, United States.
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Harris AC, Muelken P, Smethells JR, Krueger M, LeSage MG. Similar precipitated withdrawal effects on intracranial self-stimulation during chronic infusion of an e-cigarette liquid or nicotine alone. Pharmacol Biochem Behav 2017; 161:1-5. [PMID: 28867606 DOI: 10.1016/j.pbb.2017.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 11/19/2022]
Abstract
The FDA recently extended their regulatory authority to electronic cigarettes (ECs). Because the abuse liability of ECs is a leading concern of the FDA, animal models are urgently needed to identify factors that influence the relative abuse liability of these products. The ability of tobacco products to induce nicotine dependence, defined by the emergence of anhedonia and other symptoms of nicotine withdrawal following cessation of their use, contributes to tobacco abuse liability. The present study compared the severity of precipitated withdrawal during chronic infusion of nicotine alone or nicotine-dose equivalent concentrations of three different EC refill liquids in rats, as indicated by elevations in intracranial self-stimulation (ICSS) thresholds (anhedonia-like behavior). Because these EC liquids contain constituents that may enhance their abuse liability (e.g., minor alkaloids), we hypothesized that they would be associated with greater withdrawal effects than nicotine alone. Results indicated that the nicotinic acetylcholine receptor antagonist mecamylamine precipitated elevations in ICSS thresholds in rats receiving a chronic infusion of nicotine alone or EC liquids (3.2mg/kg/day, via osmotic pump). Magnitude of this effect did not differ between formulations. Our findings indicate that nicotine alone is the primary CNS determinant of the ability of ECs to engender dependence. Combined with our previous findings that nicotine alone and these EC liquids do not differ in other preclinical addiction models, these data suggest that product standards set by the FDA to reduce EC abuse liability should primarily target nicotine, other constituents with peripheral sensory effects (e.g. flavorants), and factors that influence product appeal (e.g., marketing).
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Affiliation(s)
- A C Harris
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Department of Psychology, University of Minnesota, Minneapolis, MN, USA.
| | - P Muelken
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - J R Smethells
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN, USA; Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - M Krueger
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN, USA; Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - M G LeSage
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Department of Psychology, University of Minnesota, Minneapolis, MN, USA
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Major-Monfried H, Ozbek U, Renteria AS, Hartwell MJ, Pawarode A, Yanik GA, Ayuk F, Holler E, Efebera YA, Hogan WJ, Qayed M, Hexner EO, Wudhikarn K, Wolfl M, Ordemann R, Mielke S, Bunworasate U, Devine SM, Kroeger N, Al-Malki M, Chen YB, Harris AC, Jagasia M, Kitko CL, Litzow MR, Locatelli F, Nakamura R, Reddy P, Reshef R, Roesler W, Weber D, Ferrara J, Levine JE. Biomarkers Predict Graft-Vs-Host Disease Outcomes Better Than Clinical Response after One Week of Treatment. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cuvelier GD, Nemecek ER, Wahlstrom JT, Harris AC, Pulsipher MA, Lewis V, Bittencourt H, Choi SW, Kitko CL, Caywood E, Bhatia M, Kasow KA, Jacobsohn DA, Petrovic A, Kerhadpour A, Chaudhury S, Chewning JH, Schechter T, Abikoff C, Coulter DW, Joyce M, Savasan S, Pawlowska A, Megason G, Mitchell D, Cheerva A, Halevy A, Schultz KR. Challenges with Diagnosing Pulmonary Chronic GVHD in Children as Per the 2014 National Institutes of Health Consensus Criteria: Applied Biomarkers of Late Effects (ABLE)/Pediatric Blood and Marrow Transplant Consortium (PBMTC) 1202 Study. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hartwell MJ, Ozbek U, Holler E, Renteria AS, Reddy P, Aziz M, Hogan WJ, Ayuk F, Efebera YA, Hexner EO, Bunworasate U, Qayed M, Ordemann R, Wolfl M, Mielke S, Pawarode A, Chen YB, Devine SM, Harris AC, Jagasia M, Kitko CL, Litzow MR, Kroeger N, Locatelli F, Nakamura R, Reshef R, Roesler W, Weber D, Wudhikarn K, Yanik GA, Levine JE, Ferrara J. An Early Biomarker Algorithm Predicts Lethal Graft-Vs-Host Disease and Survival after Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hartwell MJ, Özbek U, Holler E, Renteria AS, Major-Monfried H, Reddy P, Aziz M, Hogan WJ, Ayuk F, Efebera YA, Hexner EO, Bunworasate U, Qayed M, Ordemann R, Wölfl M, Mielke S, Pawarode A, Chen YB, Devine S, Harris AC, Jagasia M, Kitko CL, Litzow MR, Kröger N, Locatelli F, Morales G, Nakamura R, Reshef R, Rösler W, Weber D, Wudhikarn K, Yanik GA, Levine JE, Ferrara JL. An early-biomarker algorithm predicts lethal graft-versus-host disease and survival. JCI Insight 2017; 2:e89798. [PMID: 28194439 DOI: 10.1172/jci.insight.89798] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND. No laboratory test can predict the risk of nonrelapse mortality (NRM) or severe graft-versus-host disease (GVHD) after hematopoietic cellular transplantation (HCT) prior to the onset of GVHD symptoms. METHODS. Patient blood samples on day 7 after HCT were obtained from a multicenter set of 1,287 patients, and 620 samples were assigned to a training set. We measured the concentrations of 4 GVHD biomarkers (ST2, REG3α, TNFR1, and IL-2Rα) and used them to model 6-month NRM using rigorous cross-validation strategies to identify the best algorithm that defined 2 distinct risk groups. We then applied the final algorithm in an independent test set (n = 309) and validation set (n = 358). RESULTS. A 2-biomarker model using ST2 and REG3α concentrations identified patients with a cumulative incidence of 6-month NRM of 28% in the high-risk group and 7% in the low-risk group (P < 0.001). The algorithm performed equally well in the test set (33% vs. 7%, P < 0.001) and the multicenter validation set (26% vs. 10%, P < 0.001). Sixteen percent, 17%, and 20% of patients were at high risk in the training, test, and validation sets, respectively. GVHD-related mortality was greater in high-risk patients (18% vs. 4%, P < 0.001), as was severe gastrointestinal GVHD (17% vs. 8%, P < 0.001). The same algorithm can be successfully adapted to define 3 distinct risk groups at GVHD onset. CONCLUSION. A biomarker algorithm based on a blood sample taken 7 days after HCT can consistently identify a group of patients at high risk for lethal GVHD and NRM. FUNDING. The National Cancer Institute, American Cancer Society, and the Doris Duke Charitable Foundation.
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Affiliation(s)
| | - Umut Özbek
- Biostatistics Shared Resource Facility, TischCancer Institute, the Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ernst Holler
- Blood and Marrow Transplantation Program, University of Regensburg, Regensburg, Germany
| | - Anne S Renteria
- Tisch Cancer Institute, the Icahn School of Medicine at Mount Sinai
| | | | - Pavan Reddy
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Mina Aziz
- Tisch Cancer Institute, the Icahn School of Medicine at Mount Sinai
| | - William J Hogan
- Blood and Marrow Transplantation Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center, Hamburg-Eppendorf, Germany
| | - Yvonne A Efebera
- Blood and Marrow Transplantation Program, Ohio State University, Columbus, Ohio, USA
| | - Elizabeth O Hexner
- Blood and Marrow Transplantation Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Udomsak Bunworasate
- Blood and Marrow Transplantation Program, Chulalongkorn University, Bangkok, Thailand
| | - Muna Qayed
- Pediatric Blood and Marrow Transplantation Program, Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Rainer Ordemann
- Blood and Marrow Transplantation Program, University Hospital TU Dresden, Dresden, Germany
| | - Matthias Wölfl
- Pediatric Blood and Marrow Transplantation Program, Children's Hospital
| | - Stephan Mielke
- Blood and Marrow Transplantation Program, University of Würzburg, Würzburg, Germany
| | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Yi-Bin Chen
- Bone Marrow Transplantation Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Steven Devine
- Blood and Marrow Transplantation Program, Ohio State University, Columbus, Ohio, USA
| | - Andrew C Harris
- Blood and Marrow Transplantation Program, University of Utah, Salt Lake City, Utah, USA
| | | | - Carrie L Kitko
- Pediatric Blood and Marrow Transplantation Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark R Litzow
- Blood and Marrow Transplantation Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center, Hamburg-Eppendorf, Germany
| | - Franco Locatelli
- Pediatric Blood and Marrow Transplantation Program, Ospedale Pediatrico Bambino Gesu, Rome, Italy
| | - George Morales
- Tisch Cancer Institute, the Icahn School of Medicine at Mount Sinai
| | - Ryotaro Nakamura
- Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California, USA
| | - Ran Reshef
- Blood and Marrow Transplantation Program, Columbia University Medical Center, New York, New York, USA
| | - Wolf Rösler
- Department of Internal Medicine 5, Hematology/Oncology, University Hospital Erlangen-Nuremburg, Erlangen, Germany
| | - Daniela Weber
- Blood and Marrow Transplantation Program, University of Regensburg, Regensburg, Germany
| | - Kitsada Wudhikarn
- Blood and Marrow Transplantation Program, Chulalongkorn University, Bangkok, Thailand
| | - Gregory A Yanik
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan, USA
| | - John E Levine
- Tisch Cancer Institute, the Icahn School of Medicine at Mount Sinai
| | - James Lm Ferrara
- Tisch Cancer Institute, the Icahn School of Medicine at Mount Sinai
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LeSage MG, Staley M, Muelken P, Smethells JR, Stepanov I, Vogel RI, Pentel PR, Harris AC. Abuse liability assessment of an e-cigarette refill liquid using intracranial self-stimulation and self-administration models in rats. Drug Alcohol Depend 2016; 168:76-88. [PMID: 27627814 PMCID: PMC5257285 DOI: 10.1016/j.drugalcdep.2016.08.628] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 03/21/2016] [Revised: 07/14/2016] [Accepted: 08/22/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND The popularity of electronic cigarettes (ECs) has increased dramatically despite their unknown health consequences. Because the abuse liability of ECs is one of the leading concerns of the Food and Drug Administration (FDA), models to assess it are urgently needed to inform FDA regulatory decisions regarding these products. The purpose of this study was to assess the relative abuse liability of an EC liquid compared to nicotine alone in rats. Because this EC liquid contains non-nicotine constituents that may enhance its abuse liability, we hypothesized that it would have greater abuse liability than nicotine alone. METHODS Nicotine alone and nicotine dose-equivalent concentrations of EC liquid were compared in terms of their acute effects on intracranial self-stimulation (ICSS) thresholds, acquisition of self-administration, reinforcing efficacy (i.e., elasticity of demand), blockade of these behavioral effects by mecamylamine, nicotine pharmacokinetics and nicotinic acetylcholine receptor binding and activation. RESULTS There were no significant differences between formulations on any measure, except that EC liquid produced less of an elevation in ICSS thresholds at high nicotine doses. CONCLUSIONS Collectively, these findings suggest that the relative abuse liability of this EC liquid is similar to that of nicotine alone in terms of its reinforcing and reinforcement-enhancing effects, but that it may have less aversive/anhedonic effects at high doses. The present methods may be useful for assessing the abuse liability of other ECs to inform potential FDA regulation of those products.
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Affiliation(s)
- MG LeSage
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Medicine, University of Minnesota, Minneapolis, MN,Department of Psychology, University of Minnesota, Minneapolis, MN, 55455
| | - M Staley
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - P Muelken
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - JR Smethells
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Psychiatry, University of Minnesota, Minneapolis, MN, 55455
| | - I Stepanov
- Masonic Cancer, Center University of Minnesota, Minneapolis, MN
| | - RI Vogel
- Masonic Cancer Center Biostatistics and Bioinformatics Core ,University of Minnesota Minneapolis, MN
| | - PR Pentel
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Medicine, University of Minnesota, Minneapolis, MN
| | - AC Harris
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Medicine, University of Minnesota, Minneapolis, MN,Department of Psychology, University of Minnesota, Minneapolis, MN, 55455
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Schmidt CE, Manbeck KE, Shelley D, Harris AC. Blockade of cholinergic transmission elicits somatic signs in nicotine-naïve adolescent rats. Front Pharmacol 2015; 6:239. [PMID: 26539119 PMCID: PMC4611158 DOI: 10.3389/fphar.2015.00239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/05/2015] [Indexed: 01/24/2023] Open
Abstract
High doses of the nicotinic acetylcholine receptor (nAChR) antagonist mecamylamine can elicit somatic signs resembling those associated with nicotine withdrawal in nicotine-naïve adult rats. Understanding this phenomenon, and its possible modulation by acute nicotine and age, could inform the use of mecamylamine as both an experimental tool and potential pharmacotherapy for tobacco dependence and other disorders. This study evaluated the ability of high-dose mecamylamine to elicit somatic signs in adolescent rats, and the potential for acute nicotine pretreatment to potentiate this effect as previously reported in adults. Single or repeated injections of mecamylamine (1.5 or 3.0 mg/kg, s.c.) elicited somatic signs in nicotine-naïve adolescents, but this effect was not influenced by 2 h pretreatment with acute nicotine (0.5 mg/kg, s.c.). In an initial evaluation of the effects of age in this model, mecamylamine (2.25 mg/kg, s.c.) elicited somatic signs in nicotine-naïve adolescents and adults. This effect was modestly enhanced following acute nicotine injections in adults but not in adolescents, even when a higher nicotine dose (1.0 rather than 0.5 mg/kg, s.c.) was used in adolescents to account for age differences in nicotine pharmacokinetics. These studies are the first to show that mecamylamine elicits somatic signs in nicotine-naïve adolescent rats, an effect that should be considered when designing and interpreting studies examining effects of high doses of mecamylamine in adolescents. Our findings also provide preliminary evidence that these signs may be differentially modulated by acute nicotine pretreatment in adolescents versus adults.
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Affiliation(s)
- Clare E Schmidt
- Minneapolis Medical Research Foundation , Minneapolis, MN, USA ; Department of Neuroscience, University of Minnesota , Minneapolis, MN, USA
| | - Katherine E Manbeck
- Minneapolis Medical Research Foundation , Minneapolis, MN, USA ; Department of Psychology, University of Minnesota , Minneapolis, MN, USA
| | - David Shelley
- Minneapolis Medical Research Foundation , Minneapolis, MN, USA
| | - Andrew C Harris
- Minneapolis Medical Research Foundation , Minneapolis, MN, USA ; Department of Psychology, University of Minnesota , Minneapolis, MN, USA ; Department of Medicine, University of Minnesota , Minneapolis, MN, USA
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47
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Harris AC, Young R, Devine S, Hogan WJ, Ayuk F, Bunworasate U, Chanswangphuwana C, Efebera YA, Holler E, Litzow M, Ordemann R, Qayed M, Renteria AS, Reshef R, Wölfl M, Chen YB, Goldstein S, Jagasia M, Locatelli F, Mielke S, Porter D, Schechter T, Shekhovtsova Z, Ferrara JLM, Levine JE. International, Multicenter Standardization of Acute Graft-versus-Host Disease Clinical Data Collection: A Report from the Mount Sinai Acute GVHD International Consortium. Biol Blood Marrow Transplant 2015; 22:4-10. [PMID: 26386318 DOI: 10.1016/j.bbmt.2015.09.001] [Citation(s) in RCA: 432] [Impact Index Per Article: 48.0] [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: 08/06/2015] [Accepted: 09/01/2015] [Indexed: 10/23/2022]
Abstract
Acute graft-versus-host disease (GVHD) remains a leading cause of morbidity and nonrelapse mortality after allogeneic hematopoietic cell transplantation. The clinical staging of GVHD varies greatly between transplant centers and is frequently not agreed on by independent reviewers. The lack of standardized approaches to handle common sources of discrepancy in GVHD grading likely contributes to why promising GVHD treatments reported from single centers have failed to show benefit in randomized multicenter clinical trials. We developed guidelines through international expert consensus opinion to standardize the diagnosis and clinical staging of GVHD for use in a large international GVHD research consortium. During the first year of use, the guidance followed discussion of complex clinical phenotypes by experienced transplant physicians and data managers. These guidelines increase the uniformity of GVHD symptom capture, which may improve the reproducibility of GVHD clinical trials after further prospective validation.
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Affiliation(s)
- Andrew C Harris
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan; Blood and Marrow Transplantation Program, University of Utah, Salt Lake City, Utah
| | - Rachel Young
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan; Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Steven Devine
- Blood and Marrow Transplantation Program, Ohio State University, Columbus, Ohio
| | - William J Hogan
- Blood and Marrow Transplantation Program, Mayo Clinic, Rochester, Minnesota
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center, Hamburg-Eppendorf, Germany
| | - Udomsak Bunworasate
- Blood and Marrow Transplantation Program, Chulalongkorn University, Bangkok, Thailand
| | | | - Yvonne A Efebera
- Blood and Marrow Transplantation Program, Ohio State University, Columbus, Ohio
| | - Ernst Holler
- Blood and Marrow Transplantation Program, University of Regensburg, Regensburg, Germany
| | - Mark Litzow
- Blood and Marrow Transplantation Program, Mayo Clinic, Rochester, Minnesota
| | - Rainer Ordemann
- Blood and Marrow Transplantation Program, University Hospital TU Dresden, Dresden, Germany
| | - Muna Qayed
- Pediatric Blood and Marrow Transplantation Program, Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Anne S Renteria
- Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Ran Reshef
- Blood and Marrow Transplantation Program, Columbia University Medical Center, New York, New York
| | - Matthias Wölfl
- Pediatric Blood and Marrow Transplantation Program, Children's Hospital, University of Würzburg, Würzburg, Germany
| | - Yi-Bin Chen
- Bone Marrow Transplantation Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven Goldstein
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Madan Jagasia
- Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Franco Locatelli
- Pediatric Blood and Marrow Transplantation Program, Ospedale Pediatrico Bambino Gesu, Rome, Italy
| | - Stephan Mielke
- Blood and Marrow Transplantation Program, University of Würzburg, Würzburg, Germany
| | - David Porter
- Blood and Marrow Transplantation Program, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tal Schechter
- Pediatric Blood and Marrow Transplantation Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zhanna Shekhovtsova
- Federal Clinical Research Center for Children's Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - James L M Ferrara
- Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - John E Levine
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan; Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai Hospital, New York, New York.
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48
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Mody RJ, Wu YM, Lonigro RJ, Cao X, Roychowdhury S, Vats P, Frank KM, Prensner JR, Asangani I, Palanisamy N, Dillman JR, Rabah RM, Kunju LP, Everett J, Raymond VM, Ning Y, Su F, Wang R, Stoffel EM, Innis JW, Roberts JS, Robertson PL, Yanik G, Chamdin A, Connelly JA, Choi S, Harris AC, Kitko C, Rao RJ, Levine JE, Castle VP, Hutchinson RJ, Talpaz M, Robinson DR, Chinnaiyan AM. Integrative Clinical Sequencing in the Management of Refractory or Relapsed Cancer in Youth. JAMA 2015; 314:913-25. [PMID: 26325560 PMCID: PMC4758114 DOI: 10.1001/jama.2015.10080] [Citation(s) in RCA: 295] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Cancer is caused by a diverse array of somatic and germline genomic aberrations. Advances in genomic sequencing technologies have improved the ability to detect these molecular aberrations with greater sensitivity. However, integrating them into clinical management in an individualized manner has proven challenging. OBJECTIVE To evaluate the use of integrative clinical sequencing and genetic counseling in the assessment and treatment of children and young adults with cancer. DESIGN, SETTING, AND PARTICIPANTS Single-site, observational, consecutive case series (May 2012-October 2014) involving 102 children and young adults (mean age, 10.6 years; median age, 11.5 years, range, 0-22 years) with relapsed, refractory, or rare cancer. EXPOSURES Participants underwent integrative clinical exome (tumor and germline DNA) and transcriptome (tumor RNA) sequencing and genetic counseling. Results were discussed by a precision medicine tumor board, which made recommendations to families and their physicians. MAIN OUTCOMES AND MEASURES Proportion of patients with potentially actionable findings, results of clinical actions based on integrative clinical sequencing, and estimated proportion of patients or their families at risk of future cancer. RESULTS Of the 104 screened patients, 102 enrolled with 91 (89%) having adequate tumor tissue to complete sequencing. Only the 91 patients were included in all calculations, including 28 (31%) with hematological malignancies and 63 (69%) with solid tumors. Forty-two patients (46%) had actionable findings that changed their cancer management: 15 of 28 (54%) with hematological malignancies and 27 of 63 (43%) with solid tumors. Individualized actions were taken in 23 of the 91 (25%) based on actionable integrative clinical sequencing findings, including change in treatment for 14 patients (15%) and genetic counseling for future risk for 9 patients (10%). Nine of 91 (10%) of the personalized clinical interventions resulted in ongoing partial clinical remission of 8 to 16 months or helped sustain complete clinical remission of 6 to 21 months. All 9 patients and families with actionable incidental genetic findings agreed to genetic counseling and screening. CONCLUSIONS AND RELEVANCE In this single-center case series involving young patients with relapsed or refractory cancer, incorporation of integrative clinical sequencing data into clinical management was feasible, revealed potentially actionable findings in 46% of patients, and was associated with change in treatment and family genetic counseling for a small proportion of patients. The lack of a control group limited assessing whether better clinical outcomes resulted from this approach than outcomes that would have occurred with standard care.
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Affiliation(s)
- Rajen J. Mody
- Department of Pediatrics, University of Michigan. Ann Arbor, MI
- Michigan Center for Translational Pathology, University of Michigan. Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan. Ann Arbor, MI
| | - Yi-Mi Wu
- Michigan Center for Translational Pathology, University of Michigan. Ann Arbor, MI
- Department of Pathology, University of Michigan. Ann Arbor, MI
| | - Robert J. Lonigro
- Michigan Center for Translational Pathology, University of Michigan. Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan. Ann Arbor, MI
| | - Xuhong Cao
- Michigan Center for Translational Pathology, University of Michigan. Ann Arbor, MI
- Department of Pathology, University of Michigan. Ann Arbor, MI
- Howard Hughes Medical Institute, University of Michigan. Ann Arbor, MI
| | | | - Pankaj Vats
- Michigan Center for Translational Pathology, University of Michigan. Ann Arbor, MI
| | - Kevin M. Frank
- Department of Pediatrics, University of Michigan. Ann Arbor, MI
| | - John R. Prensner
- Michigan Center for Translational Pathology, University of Michigan. Ann Arbor, MI
- Department of Pediatrics, Boston Children’s Hospital. Boston, MA
| | - Irfan Asangani
- Michigan Center for Translational Pathology, University of Michigan. Ann Arbor, MI
| | | | | | - Raja M. Rabah
- Department of Pathology, University of Michigan. Ann Arbor, MI
| | | | - Jessica Everett
- Department of Internal Medicine, University of Michigan. Ann Arbor, MI
| | | | - Yu Ning
- Michigan Center for Translational Pathology, University of Michigan. Ann Arbor, MI
| | - Fengyun Su
- Michigan Center for Translational Pathology, University of Michigan. Ann Arbor, MI
| | - Rui Wang
- Michigan Center for Translational Pathology, University of Michigan. Ann Arbor, MI
| | - Elena M. Stoffel
- Department of Internal Medicine, University of Michigan. Ann Arbor, MI
| | | | - J. Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan. Ann Arbor, MI
| | - Patricia L. Robertson
- Department of Pediatrics, University of Michigan. Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan. Ann Arbor, MI
| | - Gregory Yanik
- Department of Pediatrics, University of Michigan. Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan. Ann Arbor, MI
| | - Aghiad Chamdin
- Department of Pediatrics, Michigan State University, East Lansing, MI
| | - James A. Connelly
- Department of Pediatrics, University of Michigan. Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan. Ann Arbor, MI
| | - Sung Choi
- Department of Pediatrics, University of Michigan. Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan. Ann Arbor, MI
| | - Andrew C. Harris
- Department of Pediatrics, University of Michigan. Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan. Ann Arbor, MI
| | - Carrie Kitko
- Department of Pediatrics, University of Michigan. Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan. Ann Arbor, MI
| | - Rama Jasty Rao
- Department of Pediatrics, University of Michigan. Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan. Ann Arbor, MI
| | - John E. Levine
- Department of Pediatrics, University of Michigan. Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan. Ann Arbor, MI
| | - Valerie P. Castle
- Department of Pediatrics, University of Michigan. Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan. Ann Arbor, MI
| | - Raymond J. Hutchinson
- Department of Pediatrics, University of Michigan. Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan. Ann Arbor, MI
| | - Moshe Talpaz
- Comprehensive Cancer Center, University of Michigan. Ann Arbor, MI
- Department of Internal Medicine, Ohio State University. Columbus, OH
| | - Dan R. Robinson
- Michigan Center for Translational Pathology, University of Michigan. Ann Arbor, MI
- Department of Pathology, University of Michigan. Ann Arbor, MI
| | - Arul M. Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan. Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan. Ann Arbor, MI
- Department of Pathology, University of Michigan. Ann Arbor, MI
- Howard Hughes Medical Institute, University of Michigan. Ann Arbor, MI
- Department of Urology, University of Michigan. Ann Arbor, MI
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49
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Harris AC, Tally L, Muelken P, Banal A, Schmidt CE, Cao Q, LeSage MG. Effects of nicotine and minor tobacco alkaloids on intracranial-self-stimulation in rats. Drug Alcohol Depend 2015; 153:330-4. [PMID: 26094184 PMCID: PMC4509975 DOI: 10.1016/j.drugalcdep.2015.06.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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: 04/30/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND While nicotine is the primary addictive compound in tobacco, other tobacco constituents including minor alkaloids (e.g., nornicotine, anabasine) may also contribute to tobacco addiction by mimicking or enhancing the effects of nicotine. Further evaluating the behavioral effects of minor alkaloids is essential for understanding their impact on tobacco addiction and informing development of tobacco product standards by the FDA. METHODS This study compared the addiction-related effects of nicotine and the minor alkaloids nornicotine, anabasine, myosmine, anatabine, and cotinine on intracranial self-stimulation (ICSS) thresholds in rats. RESULTS Acute injection of nicotine produced reinforcement-enhancing (ICSS threshold-decreasing) effects at low to moderate doses, and reinforcement-attenuating/aversive (ICSS threshold-increasing) effects at high doses. Nornicotine and anabasine produced similar biphasic effects on ICSS thresholds, although with lower potency compared to nicotine. Myosmine only elevated ICSS thresholds at relatively high doses, while anatabine and cotinine did not influence ICSS thresholds at any dose. None of the alkaloids significantly influenced ICSS response latencies, indicating a lack of nonspecific motoric effects. CONCLUSIONS These findings indicate that some minor tobacco alkaloids can either fully (nornicotine, anabasine) or partially (myosmine) mimic nicotine's addiction-related effects on ICSS, albeit at reduced potency. These findings emphasize the need for further study of the abuse potential of minor alkaloids, including evaluation of their effects when combined with nicotine and other tobacco constituents to better simulate tobacco exposure in humans. Such work is essential for informing FDA regulation of tobacco products and could also lead to the development of novel pharmacotherapies for tobacco addiction.
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Affiliation(s)
- Andrew C. Harris
- Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN,Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Laura Tally
- Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Peter Muelken
- Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Ecology, Evolution, and Behavior, University of Minnesota, Minneapolis, MN
| | - Andrew Banal
- Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Clare E. Schmidt
- Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Neuroscience, University of Minnesota, Minneapolis, MN
| | - Qing Cao
- Masonic Cancer Center Biostatistics and Bioinformatics Core, University of Minnesota, Minneapolis, MN
| | - Mark G. LeSage
- Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN,Department of Psychology, University of Minnesota, Minneapolis, MN
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50
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Pawarode A, Mineishi S, Reddy P, Braun TM, Khaled YA, Choi SW, Magenau JM, Harris AC, Connelly JA, Kitko CL, Parkin BL, Goldstein SC, Yanik GA, Levine JE, Ferrara JL, Couriel DR. Reducing Treatment-Related Mortality Did Not Improve Outcomes of Allogeneic Myeloablative Hematopoietic Cell Transplantation for High-Risk Multiple Myeloma: A University of Michigan Prospective Series. Biol Blood Marrow Transplant 2015. [PMID: 26211984 DOI: 10.1016/j.bbmt.2015.07.021] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Despite the ongoing advent of more effective immunomodulators and proteasome inhibitors, multiple myeloma (MM) remains incurable and no effective therapy is available for advanced aggressive disease. Although allogeneic (Allo) hematopoietic cell transplantation (HCT) has a curative potential, the outcomes remain poor because of high treatment-related mortality (TRM), mostly due to regimen-related toxicities and graft-versus-host disease (GVHD) in case of myeloablative conditionings, high relapse rate in case of reduced-intensity or nonmyeloablative regimens, and possibly other unknown MM-specific issues. In an attempt to improve TRM, without compromising conditioning intensity, we prospectively explored the feasibility and efficacy of a myeloablative but reduced-toxicity conditioning regimen, consisting of fludarabine and busulfan (FluBu4; fludarabine 40 mg/m(2)/day and busulfan 3.2 mg/kg/day i.v. × 4 days) in 22 patients with high-risk or advanced refractory MM. The majority (14 of 22, 64%) had prior autologous HCT. The median HCT-specific comorbidity index score was 3 (range, 0 to 6), with 46% having a Karnofsky performance score < 80%. Ten patients had unrelated donors, 3 of whom were 7/8 HLA-loci matched. GVHD prophylaxis was tacrolimus and methotrexate in 20 (91%). Most patients had active MM at transplantation, with a partial response in 12 of 22 (46%) and stable disease in 1 of 22 (4.5%). All 22 patients tolerated the FluBu4 conditioning well, without early toxic deaths or graft failure. Common regimen-related toxicities included mild to moderate mucositis (18 of 22, 82%) and mild transient liver function abnormality (9 of 22, 41%). There were no grade 4 toxicities but grade 3 mucositis occurred in 7 of 22 patients (32%). The cumulative incidence of severe, grades III and IV acute GVHD at day 180 was 23% (95% confidence interval [CI], 10% to 47%) and that of chronic GVHD was 68% (95% CI, 46% to 88%). The cumulative incidences of TRM at 100 days, 1 year, and 3 years were 9% (95% CI, 2% to 33%), 19% (95% CI, 7% to 44%), and 29% (95% CI, 13% to 55%), respectively. Two TRMs were due to idiopathic pneumonia syndrome and 1 was due to cirrhosis. They all had decreased pre-HCT corresponding organ function, with HCT-specific comorbidity index scores of > 3. With a median follow-up of 58.7 (range, 39 to 82) months, the cumulative incidences of relapse at 1 and 3 years were 37% (95% CI, 20% to 61%) and 50% (95% CI, 29% to 75%); those for 1-year and 3-year overall survival (OS) were 58% (95% CI, 40% to 83%) and 29% (95% CI, 15% to 57%), respectively, and those for the 1-year and 3-year progression-free survivals (PFS) were 40% (95% CI, 23% to 67%) and 15% (95% CI, 5% to 42%), respectively. In summary, the use of the myeloablative FluBu4 conditioning Allo-HCT for high-risk MM resulted in decreased TRM, compared with that of Allo-HCT using conventional myeloablative regimens; however, the relapse rate was high, including in those developing moderate-to-severe chronic GVHD. This suggested a less robust graft-versus-myeloma effect against high-risk MM, thus resulting in poor PFS and OS. Nonetheless, the FluBu4 regimen may be used as a lower-TRM platform to combine with other strategies, eg, addition of an MM-targeted agent and/or maintenance therapy with these agents, to decrease relapse or progression in patients with high-risk MM.
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Affiliation(s)
- Attaphol Pawarode
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan.
| | - Shin Mineishi
- Blood and Marrow Transplantation and Cell Therapy Program, University of Alabama at Birmingham, Alabama
| | - Pavan Reddy
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Thomas M Braun
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Yasser A Khaled
- Blood and Marrow Transplantation Program, The University of Tennessee, Memphis, Tennessee
| | - Sung W Choi
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - John M Magenau
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Andrew C Harris
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - James A Connelly
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Carrie L Kitko
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Brian L Parkin
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Steven C Goldstein
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Gregory A Yanik
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - John E Levine
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - James L Ferrara
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel R Couriel
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
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