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Eisen A, Nedergaard M, Gray E, Kiernan MC. The glymphatic system and Amyotrophic lateral sclerosis. Prog Neurobiol 2024; 234:102571. [PMID: 38266701 DOI: 10.1016/j.pneurobio.2024.102571] [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: 08/07/2023] [Revised: 11/18/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
The glymphatic system and the meningeal lymphatic vessels provide a pathway for transport of solutes and clearance of toxic material from the brain. Of specific relevance to ALS, this is applicable for TDP-43 and glutamate, both major elements in disease pathogenesis. Flow is propelled by arterial pulsation, respiration, posture, as well as the positioning and proportion of aquaporin-4 channels (AQP4). Non-REM slow wave sleep is the is key to glymphatic drainage which discontinues during wakefulness. In Parkinson's disease and Alzheimer's disease, sleep impairment is known to predate the development of characteristic clinical features by several years and is associated with progressive accumulation of toxic proteinaceous products. While sleep issues are well described in ALS, consideration of preclinical sleep impairment or the potential of a failing glymphatic system in ALS has rarely been considered. Here we review how the glymphatic system may impact ALS. Preclinical sleep impairment as an unrecognized major risk factor for ALS is considered, while potential therapeutic options to improve glymphatic flow are explored.
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Affiliation(s)
- Andrew Eisen
- Department of Neurology, University of British Columbia, Vancouver, Canada.
| | - Maiken Nedergaard
- Center for Translational Neuromedicine, University of Rochester Medical School and Center for Basic and Translational Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Emma Gray
- Department of Neurology, Royal Prince Alfred Hospital and University of Sydney, NSW 2050, Australia
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Eisen A, Vucic S, Mitsumoto H. History of ALS and the competing theories on pathogenesis: IFCN handbook chapter. Clin Neurophysiol Pract 2023; 9:1-12. [PMID: 38213309 PMCID: PMC10776891 DOI: 10.1016/j.cnp.2023.11.004] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/07/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disorder of the human motor system, first described in the 19th Century. The etiology of ALS appears to be multifactorial, with a complex interaction of genetic, epigenetic, and environmental factors underlying the onset of disease. Importantly, there are no known naturally occurring animal models, and transgenic mouse models fail to faithfully reproduce ALS as it manifests in patients. Debate as to the site of onset of ALS remain, with three competing theories proposed, including (i) the dying-forward hypothesis, whereby motor neuron degeneration is mediated by hyperexcitable corticomotoneurons via an anterograde transsynaptic excitotoxic mechanism, (ii) dying-back hypothesis, proposing the ALS begins in the peripheral nervous system with a toxic factor(s) retrogradely transported into the central nervous system and mediating upper motor neuron dysfunction, and (iii) independent hypothesis, suggesting that upper and lower motor neuron degenerated independently. Transcranial magnetic stimulation studies, along with pathological and genetic findings have supported the dying forward hypothesis theory, although the science is yet to be settled. The review provides a historical overview of ALS, discusses phenotypes and likely pathogenic mechanisms.
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Affiliation(s)
- Andrew Eisen
- Division of Neurology, Department of Medicine, University of British Columbia, Canada
| | - Steve Vucic
- Director Brain and Nerve Research Center, Clinical School, University of Sydney, Australia
| | - Hiroshi Mitsumoto
- Wesley J. Howe Professor of Neurology, Columbia University, The Neurological Institute of New York, and New York-Presbyterian Hospital/Columbia University Medical Center, United States
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Novo G, D'Agostino A, Di Lisi D, Di Palermo A, Evola S, Immordino F, Rossetto L, Spica G, Pavan D, Mattia AD, Belfiore R, Grandis U, Vendrametto F, Spagnolo C, Carniel L, Sonego E, Gaudio C, Barillà F, Biccire FG, Bruno N, Ferrari I, Paravati V, Torromeo C, Galasso G, Peluso A, Prota C, Radano I, Benvenga RM, Ferraioli D, Anselmi M, Frigo GM, Sinagra G, Merlo M, Perkan A, Ramani F, Altinier A, Fabris E, Rinaldi M, Usmiani T, Checco L, Frea S, Mussida M, Matsukawa R, Sugi K, Kitai T, Furukawa Y, Masumoto A, Miyoshi Y, Nishino S, Assembekov B, Amirov B, Chernokurova Y, Ibragimova F, Mirrakhimov E, Ibraimova A, Murataliev T, Radzhapova Z, Uulu ES, Zhanyshbekova N, Zventsova V, Erglis A, Bondare L, Zaliunas R, Gustiene O, Dirsiene R, Marcinkeviciene J, Sakalyte G, Virbickiene A, Baksyte G, Bardauskiene L, Gelmaniene R, Salkauskaite A, Ziubryte G, Kupstyte-Kristapone N, Badariene J, Balciute S, Kapleriene L, Lizaitis M, Marinskiene J, Navickaite A, Pilkiene A, Ramanauskaite D, Serpytis R, 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Al-Mashari S, Al-Riyami H, Laghari AH, Faheem O, Ahmed SW, Qamar N, Furnaz S, Kazmi K, Saghir T, Aneel A, Asim A, Madiha F, Sobkowicz B, Tycinska A, Kazimierczyk E, Szyszkowska A, Mizia-Stec K, Wybraniec M, Bednarek A, Glowacki K, Prokopczuk J, Babinski W, Blachut A, Kosiak M, Kusinska A, Samborski S, Stachura J, Szastok H, Wester A, Bartoszewska D, Sosnowska-Pasiarska B, Krzysiek M, Legutko J, Nawrotek B, Kasprzak JD, Klosinska M, Wiklo K, Kurpesa M, Rechcinski T, Cieslik-Guerra U, Gierlotka M, Bugajski J, Feusette P, Sacha J, Przybylo P, Krzesinski P, Ryczek R, Karasek A, Kazmierczak-Dziuk A, Mielniczuk M, Betkier-Lipinska K, Roik M, Labyk A, Krakowian M, Machowski M, Paczynska M, Potepa M, Pruszczyk P, Budaj A, Ambroziak M, Omelanczuk-Wiech E, Torun A, Opolski G, Glowczynska R, Fojt A, Kowalik R, Huczek Z, Jedrzejczyk S, Roleder T, Brust K, Gasior M, Desperak P, Hawranek M, Farto-Abreu P, Santos M, Baptista S, Brizida L, Faria D, Loureiro J, Magno P, Monteiro C, Nédio M, Tavares J, Sousa C, Almeida I, Almeida S, Miranda H, Santos H, Santos AP, Goncalves L, Monteiro S, Baptista R, Ferreira C, Ferreira J, Goncalves F, Lourenço C, Monteiro P, Picarra B, Santos AR, Guerreiro RA, Carias M, Carrington M, Pais J, de Figueiredo MP, Rocha AR, Mimoso J, De Jesus I, Fernandes R, Guedes J, Mota T, Mendes M, Ferreira J, Tralhão A, Aguiar CT, Strong C, Da Gama FF, Pais G, Timóteo AT, Rosa SAO, Mano T, Reis J, Selas M, Mendes DE, Satendra M, Pinto P, Queirós C, Oliveira I, Reis L, Cruz I, Fernandes R, Torres S, Luz A, Campinas A, Costa R, Frias A, Oliveira M, Martins V, Castilho B, Coelho C, Moura AR, Cotrim N, Dos Santos RC, Custodio P, Duarte R, Gomes R, Matias F, Mendonca C, Neiva J, Rabacal C, Almeida AR, Caeiro D, Queiroz P, Silva G, Pop-Moldovan AL, Darabantiu D, Mercea S, Dan GA, Dan AR, Dobranici M, Popescu RA, Adam C, Sinescu CJ, Andrei CL, Brezeanu R, Samoila N, Baluta MM, Pop D, Tomoaia R, Istratoaie O, Donoiu I, Cojocaru A, Oprita OC, Rocsoreanu A, Grecu M, Ailoaei S, Popescu MI, Cozma A, Babes EE, Rus M, Ardelean A, Larisa R, Moisi M, Ban E, Buzle A, Filimon G, Dobreanu D, Lupu S, Mitre A, Rudzik R, Sus I, Opris D, Somkereki C, Mornos C, Petrescu L, Betiu A, Volcescu A, Ioan O, Luca C, Maximov D, Mosteoru S, Pascalau L, Roman C, Brie D, Crisan S, Erimescu C, Falnita L, Gaita D, Gheorghiu M, Levashov S, Redkina M, Novitskii N, Dementiev E, Baglikov A, Zateyshchikov D, Zubova E, Rogozhina A, Salikov A, Nikitin I, Reznik EV, Komissarova MS, Shebzukhova M, Shitaya K, Stolbova S, Larina V, Akhmatova F, Chuvarayan G, Arefyev MN, Averkov OV, Volkova AL, Sepkhanyan MS, Vecherko VI, Meray I, Babaeva L, Goreva L, Pisaryuk A, Potapov P, Teterina M, Ageev F, Silvestrova G, Fedulaev Y, Pinchuk T, Staroverov I, Kalimullin D, Sukhinina T, Zhukova N, Ryabov V, Kruchinkina E, Vorobeva D, Shevchenko I, Budyak V, Elistratova O, Fetisova E, Islamov R, Ponomareva E, Khalaf H, Shaimaa AA, Kamal W, Alrahimi J, Elshiekh A, Balghith M, Ahmed A, Attia N, Jamiel AA, Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Gurevitz C, Mohsen J, Ovdat T, Zwas DR, Fluk Gmach S, Beigel R, Eisen A. Temporal trends in the management and outcome of obese patients with an acute coronary syndrome – the ACSIS registry 2000–2018. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Obesity has been increasing in epidemic proportions over many decades, and is clearly associated with major cardiovascular (CV) risk factors [1–2]. We aimed to examine temporal trends in the management and clinical outcomes of obese patients with an acute coronary syndrome (ACS).
Methods
Data from the ACSIS registry including all obese patients (calculated BMI of 30 or above) between the years 2000–2018. Patients were stratified by BMI to obesity classes: Class 1 – BMI 30–34; class 2 – BMI 35–39 and class 3 – BMI 40 and above. Clinical endpoints included 30d MACE and 1-year mortality. Temporal trends were examined in the late (2010–2018) vs. the early period (2000–2008).
Results
Among the 13,816 patients from the ACSIS registry with available BMI data, of whom 3567 were defined as obese, 2670 were in obesity class 1, 679 were in class 2, and 218 were defined as class 3. Patients in higher obesity classes had more CV risk-factors including dyslipidemia, hypertension, and diabetes mellitus (p<0.01 for all interactions). Overall, invasive and pharmacological treatment has improved during time in all obesity classes. The rates of 30-day MACE were numerically higher among patients in class 3 (11.6% in class 1, 11.3% in class 2, and 15.6% in class 3, p-trend= 0.3), and so was the rate of 1-year mortality (7.3%, 7.3%, and 10.9%, respectively, p-trend = 0.1) Comparing the 2 time-periods, 30-day MACE was significantly lower in the late period in class 1 and 2, but has remained unchanged in class 3. Similarly, 1-year mortality has not changed during the years among patients in class 3, but has decreased among patients in classes 1 and 2 (8.6% to 5.8%, p=0.007, and 9.3% to 5.5%, p=0.08, respectively) [Figure 1].
Conclusions
In obese patients admitted with an ACS, the rates of 30-day MACE and 1-year mortality are numerically higher among patients who are extremely obese. During 2 decades, 30-day MACE and 1-year mortality have decreased among obesity classes 1 and 2, but remained unchanged among patients in class 3. Extremely obese patients admitted with an ACS are a particularly high-risk group and future efforts should examine treatment modalities in order to curtail this increased risk.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Gurevitz
- Rabin Medical Center , Petah Tikva , Israel
| | - J Mohsen
- Hillel Yaffe Medical Center , Hadera , Israel
| | - T Ovdat
- Sheba Medical Center, Israeli center for cardiovascular research , Ramat Gan , Israel
| | - D R Zwas
- Hadassah University Medical Center , Jerusalem , Israel
| | | | - R Beigel
- Sheba Medical Center , Ramat Gan , Israel
| | - A Eisen
- Rabin Medical Center , Petah Tikva , Israel
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5
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Gurevitz C, Mohsen J, Ovdat T, Zwas DR, Fluk Gmach S, Beigel R, Eisen A. The obesity paradox in patients with acute coronary syndromes – is it still applicable to the current era? The ACSIS registry 2000–2018. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Obesity is a major epidemic which is associated with major cardiovascular (CV) risk factors. Nevertheless, substantial data, mostly published more than a decade ago, have demonstrated an obesity paradox, where obese patients generally have a better short- and long-term prognosis than do their leaner counterparts with the same CV profile. As for the obesity paradox in acute coronary syndrome (ACS), prior studies demonstrated that the body-mass index (BMI)-mortality association followed a “U” shape curve: it is the highest in underweight (BMI<19) or severely obese (BMI >44), and is the lowest in overweight or mildly obese patients (BMI 30–34 and BMI 35–39) [1–2]. It is not fully elucidated whether the obesity paradox is still relevant in the current era in patients with ACS. We aimed to examine temporal trends in the clinical outcomes of ACS patients by their BMI status.
Methods
Data from the ACSIS registry including all patients with calculated BMI data between the years 2000–2018. Patients were stratified by BMI groups to underweight, normal, overweight and obese. Clinical endpoints included 30d MACE, and 1-year mortality. Temporal trends were examined in the late (2010–2018) vs. the early period (2000–2008). Multivariable models examined factors associated with clinical outcomes by BMI status.
Results
Among the 13,816 patients from the ACSIS registry with available BMI data, 104 were underweight, 3921 were normal, 6224 were overweight and 3567 were obese. 1-year mortality was highest among underweight patients (24.8%), as compared to normal weight patients (10.7%) and lowest among overweight and obese patients (7.1% and 7.5% respectively; p for trend <0.001) [Figure 1]. 30-day MACE rates were qualitatively similar (24.3% for underweight, 13.6% for normal weight, 11.6% for overweight, and 11.7% for obese; p for trend<0.001). Comparing the 2 time-periods, 30-day MACE was significantly lower in the late period in all BMI groups, excluding patients who were underweight. Similarly, 1-year mortality has not changed during the years in underweight patients, and has decreased in normal weight and obese patients.
Conclusions
In ACS patients, during 2-decades, 30-day MACE and 1-year mortality were lower among overweight and obese patients compared with underweight and normal weight patients. During time, 30-day MACE and 1-year mortality have decreased among the majority of BMI groups, excluding the underweight patients, in which the rates were consistently high. Our findings suggest that the obesity paradox is still relevant in ACS patients in the current era.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Gurevitz
- Rabin Medical Center , Petah Tikva , Israel
| | - J Mohsen
- Hillel Yaffe Medical Center , Hadera , Israel
| | - T Ovdat
- Sheba Medical Center, Israeli center for cardiovascular research , Ramat Gan , Israel
| | - D R Zwas
- Hadassah University Medical Center , Jerusalem , Israel
| | | | - R Beigel
- Sheba Medical Center , Ramat Gan , Israel
| | - A Eisen
- Rabin Medical Center , Petah Tikva , Israel
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Geyer C, Garber J, Gelber R, Yothers G, Taboada M, Ross L, Rastogi P, Cui K, Arahmani A, Aktan G, Armstrong A, Arnedos M, Balmaña J, Bergh J, Bliss J, Delaloge S, Domchek S, Eisen A, Elsafy F, Fein L, Fielding A, Ford J, Friedman S, Gelmon K, Gianni L, Gnant M, Hollingsworth S, Im SA, Jager A, Jóhannsson Ó, Lakhani S, Janni W, Linderholm B, Liu TW, Loman N, Korde L, Loibl S, Lucas P, Marmé F, Martinez de Dueñas E, McConnell R, Phillips KA, Piccart M, Rossi G, Schmutzler R, Senkus E, Shao Z, Sharma P, Singer C, Španić T, Stickeler E, Toi M, Traina T, Viale G, Zoppoli G, Park Y, Yerushalmi R, Yang H, Pang D, Jung K, Mailliez A, Fan Z, Tennevet I, Zhang J, Nagy T, Sonke G, Sun Q, Parton M, Colleoni M, Schmidt M, Brufsky A, Razaq W, Kaufman B, Cameron D, Campbell C, Tutt A. Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high risk, early breast cancer. Ann Oncol 2022; 33:1250-1268. [PMID: 36228963 DOI: 10.1016/j.annonc.2022.09.159] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The randomized, double-blind OlympiA trial compared 1 year of the oral poly(adenosine diphosphate-ribose) polymerase inhibitor, olaparib, to matching placebo as adjuvant therapy for patients with pathogenic or likely pathogenic variants in germline BRCA1 or BRCA2 (gBRCA1/2pv) and high-risk, human epidermal growth factor receptor 2-negative, early breast cancer (EBC). The first pre-specified interim analysis (IA) previously demonstrated statistically significant improvement in invasive disease-free survival (IDFS) and distant disease-free survival (DDFS). The olaparib group had fewer deaths than the placebo group, but the difference did not reach statistical significance for overall survival (OS). We now report the pre-specified second IA of OS with updates of IDFS, DDFS, and safety. PATIENTS AND METHODS One thousand eight hundred and thirty-six patients were randomly assigned to olaparib or placebo following (neo)adjuvant chemotherapy, surgery, and radiation therapy if indicated. Endocrine therapy was given concurrently with study medication for hormone receptor-positive cancers. Statistical significance for OS at this IA required P < 0.015. RESULTS With a median follow-up of 3.5 years, the second IA of OS demonstrated significant improvement in the olaparib group relative to the placebo group [hazard ratio 0.68; 98.5% confidence interval (CI) 0.47-0.97; P = 0.009]. Four-year OS was 89.8% in the olaparib group and 86.4% in the placebo group (Δ 3.4%, 95% CI -0.1% to 6.8%). Four-year IDFS for the olaparib group versus placebo group was 82.7% versus 75.4% (Δ 7.3%, 95% CI 3.0% to 11.5%) and 4-year DDFS was 86.5% versus 79.1% (Δ 7.4%, 95% CI 3.6% to 11.3%), respectively. Subset analyses for OS, IDFS, and DDFS demonstrated benefit across major subgroups. No new safety signals were identified including no new cases of acute myeloid leukemia or myelodysplastic syndrome. CONCLUSION With 3.5 years of median follow-up, OlympiA demonstrates statistically significant improvement in OS with adjuvant olaparib compared with placebo for gBRCA1/2pv-associated EBC and maintained improvements in the previously reported, statistically significant endpoints of IDFS and DDFS with no new safety signals.
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Abstract
Amyotrophic lateral sclerosis and frontotemporal dementia (ALS/FTD) are neurodegenerations with evolutionary underpinnings, expansive clinical presentations, and multiple genetic risk factors involving a complex network of pathways. This perspective considers the complex cellular pathology of aging motoneuronal and frontal/prefrontal cortical networks in the context of evolutionary, clinical, and biochemical features of the disease. We emphasize the importance of evolution in the development of the higher cortical function, within the influence of increasing lifespan. Particularly, the role of aging on the metabolic competence of delicately optimized neurons, age-related increased proteostatic costs, and specific genetic risk factors that gradually reduce the energy available for neuronal function leading to neuronal failure and disease.
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Affiliation(s)
| | - Kasper Planeta Kepp
- Department of Chemistry, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Andrew Eisen
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Kheifets M, Goshen A, Goldbourt U, Witberg G, Eisen A, Kornowski R, Gerber Y. Association of socioeconomic status measures with physical activity and subsequent frailty in older adults. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Despite increased recognition, frailty remains a significant public health challenge.
Methods
Using a population-based cohort of older adults, this study examined the relationship between socioeconomic status (SES) factors, physical activity and frailty. The study included 1,799 participants (mean [SD], age 75[6]; 53% women) from the "National Health and Nutrition Survey of Older Adults Aged 65 and Over in Israel", conducted in 2005-2006. A follow-up interview was performed 12-14 years later in a subgroup of 601 subjects (mean [SD], age 84[4]; 56% women). Extensive data including self-reported leisure time physical activity (LTPA) and SES measures were assessed at baseline. Frailty was measured at follow-up.
Results
All SES measures were strongly and positively associated with LTPA (all p<0.001). Eighty-two participants (14%) were classified as frail at follow-up. After age and sex adjustment and accounting for attrition bias using inverse probability weighting, baseline LTPA (OR=2.77, 95% CI: 1.57-4.90, for inactivity; OR=1.41, 95% CI: 0.75-2.68, for insufficient activity, compared with sufficient activity, Ptrend<0.001) was inversely associated with incident frailty. The association persisted after further adjustment for SES and comorbidity.
Conclusion
Among older individuals, multiple SES measures were positively associated with LTPA, which was a strong predictor of lower subsequent frailty risk.
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Affiliation(s)
- M Kheifets
- Rabin Medical Center, Petah Tikva, Israel
| | - A Goshen
- Tel Aviv University, Tel Aviv, Israel
| | | | - G Witberg
- Rabin Medical Center, Petah Tikva, Israel
| | - A Eisen
- Rabin Medical Center, Petah Tikva, Israel
| | | | - Y Gerber
- Tel Aviv University, Tel Aviv, Israel
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Balmana J, Fasching P, Delaloge S, Park Y, Eisen A, Bourgeois H, Kemp Z, Jankowski T, Sohn J, Aksoy S, Timcheva C, Park-Simon TW, Anton Torres A, John E, Baria K, Walker G, Gelmon K. 174P Clinical effectiveness and safety of olaparib in BRCA-mutated, HER2-negative metastatic breast cancer in a real-world setting: Phase IIIb LUCY final analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.193] [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: 11/01/2022] Open
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10
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Tutt A, Garber J, Gelber R, Phillips KA, Eisen A, Johannsson O, Rastogi P, Cui K, Im SA, Yerushalmi R, Brufsky A, Taboada M, Rossi G, Yothers G, Singer C, Fein L, Loman N, Cameron D, Campbell C, Geyer C. VP1-2022: Pre-specified event driven analysis of Overall Survival (OS) in the OlympiA phase III trial of adjuvant olaparib (OL) in germline BRCA1/2 mutation (gBRCAm) associated breast cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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11
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Eisen A. In Memorium: Jun Kimura, MD. Muscle Nerve 2022; 65:487-488. [PMID: 35315110 DOI: 10.1002/mus.27536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Andrew Eisen
- University of British Columbia, Vancouver, British Columbia, Canada
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12
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Greenberg BM, Bowen JD, Alvarez E, Rodriguez M, Caggiano AO, Warrington AE, Zhao P, Eisen A. A double-blind, placebo-controlled, single-ascending-dose intravenous infusion study of rHIgM22 in subjects with multiple sclerosis immediately following a relapse. Mult Scler J Exp Transl Clin 2022; 8:20552173221091475. [PMID: 35496758 PMCID: PMC9052243 DOI: 10.1177/20552173221091475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Recombinant human immunoglobulin M22 (rHIgM22) has promoted remyelination in animal models and was well tolerated in people with clinically stable multiple sclerosis. Objective Safety/tolerability of a single rHIgM22 dose was investigated following an acute relapse and to determine whether this enhanced CNS/CSF concentrations. Methods Adults (N = 27) with acute relapse were assigned to rHIgM22 (0.5 or 2.0 mg/kg) or placebo. Study included screening/steroid administration periods and 10 study visits over 6 months. rHIgM22 CSF concentrations were assessed on days 2 and 29. Pharmacokinetic and safety samples were taken for up to 60 days. Assessments included adverse events and other clinical measures. Brain magnetic resonance imaging was performed with/without gadolinium. Results rHIgM22 CSF levels were consistent with dose-dependent concentration on both days 2 and 29. Infusion was generally well tolerated during an acute relapse. Immunogenicity was mild. Most adverse events did not appear to be dose dependent, were mild/moderate, and were events often associated with multiple sclerosis. Conclusion Although limited by high variability and small sample size, the data suggest enhanced CNS uptake associated with a drop in CSF levels. This study demonstrated safety of an antibody directed to myelin and oligodendrocytes in the course of active demyelinating disease. Further research into rHIgM22 is warranted. ClinicalTrials.gov: NCT02398461 https://clinicaltrials.gov/ct2/show/study/NCT02398461?term=M22&draw=2&rank=8
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Affiliation(s)
| | | | | | | | | | | | - Ping Zhao
- Acorda Therapeutics, Inc, Ardsley, NY
- ONO Pharma, Rockville, MD
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13
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Wu JM, Tam MT, Buch K, Khairati F, Wilson L, Bannerman E, Guerrero A, Eisen A, Toyer W, Stevenson T, Robillard JM. The impact of respite care from the perspectives and experiences of people with amyotrophic lateral sclerosis and their care partners: a qualitative study. BMC Palliat Care 2022; 21:26. [PMID: 35227242 PMCID: PMC8886844 DOI: 10.1186/s12904-022-00919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Respite care provides caregiving support to people with amyotrophic lateral sclerosis (ALS) and their care partners by providing the care partner with temporary relief from their caregiving duties. The aim of this study was to explore the impact of respite care through the perspectives and lived experiences of people with ALS and their care partners. Methods Thirty-one dyads (62 participants) of people with ALS and their care partners were assigned to either the control group or the respite care intervention. Respite care was provided in the form of home-based services. Semi-structured interviews were conducted with participants at baseline and after a six-month period to gather perspectives on ALS caregiving, perceptions of respite care, and the respite care experience. Interviews were transcribed and subjected to thematic analysis. Results Caregiving challenges specific to the care partner and the patient-care partnership relationship were identified. Overall, people with ALS and care partners responded positively to in-home respite care and reported improved relationship quality, more time for the care partner to pursue personal commitments or take a break, and improved emotional well-being for both the person with ALS and the care partner. Barriers and concerns were raised surrounding privacy and staff consistency. Conclusion This study highlights respite care as a critical tool to alleviate caregiving challenges and support the needs of people with ALS and their care partners. Engagement with the ALS community and formal evaluations of respite care services should be prioritized in order to minimize barriers and best meet the needs of people with ALS and their care partners.
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14
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Eisen A, Bede P. The strength of corticomotoneuronal drive underlies ALS split phenotypes and reflects early upper motor neuron dysfunction. Brain Behav 2021; 11:e2403. [PMID: 34710283 PMCID: PMC8671797 DOI: 10.1002/brb3.2403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/02/2021] [Accepted: 10/05/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Split phenotypes, (split hand, elbow, leg, and foot), are probably unique to ALS, and are characterized by having a shared peripheral input of both affected and unaffected muscles. This implies an anatomical origin rostral to the spinal cord, primarily within the cerebral cortex. Therefore, split phenotypes are a potential marker of ALS upper motor neuron pathology. However, to date, reports documenting upper motor neuron dysfunction in split phenotypes have been limited to using transcranial magnetic stimulation and cortical threshold tracking techniques. Here, we consider several other potential methodologies that could confirm a primary upper motor neuron pathology in split phenotypes. METHODS We review the potential of: 1. measuring the compound excitatory post-synaptic potential recorded from a single activated motor unit, 2. cortical-muscular coherence, and 3. new advanced modalities of neuroimaging (high-resolution imaging protocols, ultra-high field MRI platforms [7T], and novel Non-Gaussian diffusion models). CONCLUSIONS We propose that muscles involved in split phenotypes are those functionally involved in the human motor repertoire used particularly in complex activities. Their anterior horn cells receive the strongest corticomotoneuronal input. This is also true of the weakest muscles that are the earliest to be affected in ALS. Descriptions of split hand in non-ALS cases and proposals that peripheral nerve or muscle dysfunction may be causative are contentious. Only a few carefully controlled cases of each form of split phenotype, using upper motor neuron directed methodologies, are necessary to prove our postulate.
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Affiliation(s)
- Andrew Eisen
- Division of Neurology, Department of Medicine, University of British Columbia, British Columbia, Canada
| | - Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
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15
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Shiyovich A, Cohen T, Hamdan A, Klempfner R, Skalsky K, Porter A, Orvin K, Kornowski R, Eisen A. Worse outcomes of ACS patients without versus with traditional cardiovascular risk factors. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Approximately 5–15% patients presenting with acute coronary syndrome were found to have no traditional cardiovascular risk factors (RFs). Data regarding the determinants, management and outcomes of these patients are scarce.
Purpose
To evaluate the management, outcomes and time dependent changes of ACS patients without RFs.
Methods
Evaluation of clinical characteristics, management strategies, and outcomes as well as time dependent changes (by 3 time periods: early [2000–2006], mid [2008–2013], and late [2016–2018]) of ACS patients without RFs (diabetes mellitus, hypertension, dyslipidemia, family history of IHD and current or past smoking) or known coronary artery disease, enrolled in the biennial ACS Israeli Surveys (ACSIS) between 2000 and 2018. We compared ACS patients without RFs (RF−) to those ≥1 RFs (RF+).
Results
Overall 583 out of 10,324 (5.6%) eligible ACS patients did not have any RFs (median age 64 [IQR 52–77], 25% females]. The RF− group were older, more educated, with lower BMI and prevalence of another cardiovascular comorbidity and chronic kidney disease compared with the RF+ group. The in-hospital PCI rates were lower among the RF− vs. the RF+ group (55% vs. 66%, respectively p<0.001). Furthermore, lower rate of guideline-recommended medical therapy upon discharge were prescribed in the RF− vs. the RF+ group. The rate of in-hospital complications was greater in the RF− vs. RF+ group (31.4% vs. 26.1%, respectively p=0.006). The rates of 30-day major adverse cardiac events (MACE) were significantly higher among patients with RF− vs. RF+ (18.1% vs.12.8%, respectively p<0.001). Similarly, the rates of 30-day and 1-year all-cause mortality (figure 1) were higher among patients with RF− vs. RF+ (8.7% vs. 4.2%, p<0.001 and 11.9% vs. 7.7% p<0.001 respectively). A trend of decline in the rate of MACE was observed between the early and the late study period in the RF− group (22% vs. 10.7% p=0.002 respectively). One-year mortality did not decrease significantly in the RF− group during the study periods (13.6% vs. 10% early vs. late period respectively p=0.16).
Conclusions
ACS patients without traditional cardiovascular risk factors comprise a unique group with reduced prevalence of comorbidities yet significantly worse short-and long-term outcomes. Additional research to identify unique risk factors and targets for interventions to improve outcomes of this group of patients is warranted.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Shiyovich
- Rabin Medical Center, Medicine E, Petah Tikva, Israel
| | - T Cohen
- Sheba Medical Center, Cardiology, Ramat Gan, Israel
| | - A Hamdan
- Rabin Medical Center, Medicine E, Petah Tikva, Israel
| | - R Klempfner
- Sheba Medical Center, Cardiology, Ramat Gan, Israel
| | - K Skalsky
- Rabin Medical Center, Medicine E, Petah Tikva, Israel
| | - A Porter
- Rabin Medical Center, Medicine E, Petah Tikva, Israel
| | - K Orvin
- Rabin Medical Center, Medicine E, Petah Tikva, Israel
| | - R Kornowski
- Rabin Medical Center, Medicine E, Petah Tikva, Israel
| | - A Eisen
- Rabin Medical Center, Medicine E, Petah Tikva, Israel
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16
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Shechter A, Yelin D, Hamdan A, Vaturi M, Eisen A, Sagie A, Kornowski R, Shapira Y. Cardio-COVID clinic – a one-center experience. Eur Heart J 2021. [PMCID: PMC8767590 DOI: 10.1093/eurheartj/ehab724.2738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Persistent symptoms affect a relatively large portion of coronavirus disease (COVID) survivors. Hence, specific clinics had been established in order to better characterize and manage this emerging entity of Post-COVID, among them our Cardio-COVID Clinic, which is dedicated to the cardiovascular (CV) aspects of the phenomenon. Aim To present the experience of our Cardio-COVID Clinic. Methods Included in this report are 76 adult patients seen at the clinic between June 2020 and March 2021, who have recovered from a polymerase chain reaction (PCR)-confirmed COVID, and who were suspected by their referring physicians to experience ongoing cardiac sequelae. All participants underwent a structured assessment by a single cardiologist, which consisted of history taking, physical examination (PE), electrocardiogram (ECG), trans-thoracic echocardiogram (TTE), and further tests as deemed appropriate, including any combination of Holter, ischemic provocation test, cardiopulmonary exercise test (CPET), cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT). Results Initial visits occurred within a median of 131 days after diagnosis. Most participants (83%) were referred from our general Long-COVID Clinic. About half were males, and the mean age was 53 years. 18% of participants had prior CV conditions, and the majority (72%) had at least one CV risk factor, mostly dyslipidemia. Nearly all participants experienced a symptomatic acute illness, which was graded according to the National Institutes of Health (NIH) criteria as severe in 23% of the study cohort. As for Post-COVID, late symptoms were present in 97% of patients, the most common being dyspnea (57%). While PE was unremarkable in all but 3 patients who exhibited murmurs, ECG findings were revealed in 45% – mostly non-specific ST-T changes (31%) and conduction abnormalities (14%) – and TTE aberrations were discovered in 28% – including pericardial effusion (24%), reduced left ventricular ejection fraction (LVEF) (5%), grade 2 diastolic dysfunction (3%), moderate and up valvular dysfunction (1%), and systolic pulmonary hypertension (1%); right ventricular function was universally normal. Upon conclusion of the work-up, CV diagnoses were made in 8 (11%) patients – including myocarditis (4), myopericarditis (1), inappropriate sinus tachycardia (1), chronotropic incompetence (1), and an aberrant coronary (1). Of note, CPET and CMR had the highest diagnostic yield, in light of 57% positive results on each – followed by CCT, Holter, and provocation test. Interesting as well, among those with abnormal CMR findings, 40% had normal ECG's and TTE's. Also, none of the CV restraints on CPET translated to provocation test anomalies. Conclusion CV symptoms of Post-COVID are highly prevalent, but signify actual CV disease only in a minority of patients. Further research is needed that will help identify predictors for CV morbidity and define optimal clinical pathways. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- A Shechter
- Rabin Medical Center, Petah Tikva, Israel
| | - D Yelin
- Rabin Medical Center, Petah Tikva, Israel
| | - A Hamdan
- Rabin Medical Center, Petah Tikva, Israel
| | - M Vaturi
- Rabin Medical Center, Petah Tikva, Israel
| | - A Eisen
- Rabin Medical Center, Petah Tikva, Israel
| | - A Sagie
- Rabin Medical Center, Petah Tikva, Israel
| | | | - Y Shapira
- Rabin Medical Center, Petah Tikva, Israel
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17
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Shiyovich A, Skalsky K, Steinmetz T, Eisen A, Samara A, Beigel R, Kornowski R, Orvin K. Incidence, determinants and impact of acute kidney injury in ACS patients with versus without diabetes mellitus. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Acute kidney injury (AKI) is a common complication in patients presenting with acute coronary syndrome (ACS), particularly following percutaneous coronary intervention (PCI). Patients with diabetes mellitus (DM) are considered to be at increased risk for AKI in this setting. However, data regarding the incidence, risk factors and outcomes of AKI in diabetic patients compared to non-diabetics presenting with ACS is scarce.
Purpose
To evaluate the incidence, risk factors and outcomes of AKI in patients with vs. without DM who are admitted with ACS.
Methods
ACS patients enrolled in the biannual ACS Israeli Surveys (ACSIS) between 2000 and 2018 were analyzed. AKI was defined as an absolute increase in serum creatinine (≥0.5 mg/dL) or above 1.5 mg/dL or new renal replacement therapy upon admission with ACS. Outcomes included 30-day major adverse cardiovascular events (MACE) and 1-year all-cause mortality.
Results
The current study included a total of 16,879 patients, median age 64 (IQR 54–74), 77% males, 36% with DM. The incidence of AKI was significantly higher among patients with vs. without DM (8.4% vs. 4.7%, p<0.001). The rates of 30-day MACE (40.8% vs. 13.4%, p<0.001) and 1-year mortality (43.7% vs. 10%, p<0.001) were significantly greater among patients who developed vs. those that did not develop AKI respectively yet very similar in diabetics and non-diabetics.
Multivariate analyses (figure 1) adjusted to potential confounders showed similar independent predictors of AKI among patients with and without DM comprising; older age, chronic kidney disease, congestive heart failure, and peripheral arterial disease
Conclusions
Although patients with DM are at greater risk for AKI when admitted with ACS, the independent predictors of AKI and the worse patient outcomes when AKI occurs, are similar and irrespective to DM.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Shiyovich
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - K Skalsky
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - T Steinmetz
- Rabin Medical Center, Nephrology, Petah Tikva, Israel
| | - A Eisen
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - A Samara
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - R Beigel
- Sheba Medical Center, Cardiology, Ramat Gan, Israel
| | - R Kornowski
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - K Orvin
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
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18
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Aviv Y, Shechter A, Richter I, Kornowski R, Ovdat T, Pereg D, Eisen A. Temporal trends in the characteristics, treatment and clinical outcomes of conservatively managed patients with non-ST elevation acute coronary syndrome: ACSIS registry 2000–2016. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Despite advances in percutaneous coronary interventions (PCI), a sub group of acute coronary syndrome (ACS) patients are still managed medically by a conservative approach. We sought to characterize a contemporary, large-scale, real-world cohort of ACS patients treated conservatively via pharmacological management, without PCI.
Methods
Data from the ACS Israeli Survey (ACSIS) accrued between 2000–2016, encompassing all consecutive patients admitted to cardiology wards with an ACS diagnosis. Examined were 3543 conservatively managed patients with non-ST elevation ACS (NSTE-ACS). Patients with ST elevation MI or those referred to bypass surgery were excluded. Primary endpoints were 30-day major adverse cardiovascular events (MACE) and 1-year mortality. The study cohort was divided to 4 time-periods.
Results
Over 2 decades, medically managed NSTE-ACS patients remained of similar age (67±13y, p=0.78), but had more atherosclerotic risk-factors and comorbidities. During time, patients were more often referred to diagnostic angiography and treated with statins, ACE-I/ARBs, and P2Y12 inhibitors (p<0.001 for each). Over time, there were less in-hospital complications such as kidney injury and heart failure. The rate of 30-day MACE decreased (from 20.7% to 10.3%, earliest to latest period, p<0.001). Compared with the earliest period, the latest period was associated with a reduction in 1-year mortality (14.7% to 11.6%; adjusted HR 0.65, 95% CI 0.47–0.90).
Conclusions
Over two decades, in medically managed NSTE-ACS patients, short term prognosis has significantly improved while 1-year mortality demonstrated improvement only recently, likely due to incremental benefits of medical management. Further studies are needed to examine treatment modalities in these unique ACS patients.
Funding Acknowledgement
Type of funding sources: None. Kaplan Meier survival curvesTrends in management and Angiographies
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Affiliation(s)
- Y Aviv
- Rabin Medical Center, Petah Tikva, Israel
| | - A Shechter
- Rabin Medical Center, Petah Tikva, Israel
| | - I Richter
- Rabin Medical Center, Petah Tikva, Israel
| | | | - T Ovdat
- Sheba Medical Center, Ramat Gan, Israel
| | - D Pereg
- Meir Medical Center, Kfar Saba, Israel
| | - A Eisen
- Rabin Medical Center, Petah Tikva, Israel
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Eisen A, Lemon R. The motor deficit of ALS reflects failure to generate muscle synergies for complex motor tasks, not just muscle strength. Neurosci Lett 2021; 762:136171. [PMID: 34391870 DOI: 10.1016/j.neulet.2021.136171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022]
Abstract
Customarily the motor deficits that develop in ALS are considered in terms of muscle weakness. Functional rating scales used to assess ALS in terms of functional decline do not measure the deficits when performing complex motor tasks, that make up the human skilled motor repertoire, best exemplified by tasks requiring skilled hand and finger movement. This repertoire depends primarily upon the strength of direct corticomotoneuronal (CM) connectivity from primary motor cortex to the motor units subserving skilled movements. Our review prompts the question: if accumulating evidence suggests involvement of the CM system in the early stages of ALS, what kinds of motor deficit might be expected to result, and is current methodology able to identify such deficits? We point out that the CM system is organized not in "commands" to individual muscles, but rather encodes the building blocks of complex and intricate movements, which depend upon synergy between not only the prime mover muscles, but other muscles that stabilize the limb during skilled movement. Our knowledge of the functional organization of the CM system has come both from invasive studies in non-human primates and from advanced imaging and neurophysiological techniques in humans, some of which are now being applied in ALS. CM pathology in ALS has consequences not only for muscle strength, but importantly in the failure to generate complex motor tasks, often involving elaborate muscle synergies. Our aim is to encourage innovative methodology specifically directed to assessing complex motor tasks, failure of which is likely a very early clinical deficit in ALS.
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Affiliation(s)
- Andrew Eisen
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - Roger Lemon
- Department of Clinical and Motor Neurosciences, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
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Abstract
The site of origin of amyotrophic lateral sclerosis (ALS), although unsettled, is increasingly recognized as being cortico-fugal, which is a dying-forward process primarily starting in the corticomotoneuronal system. A variety of iterations of this concept date back to over 150 years. Recently, the hallmark TAR DNA-binding protein 43 (TDP-43) pathology, seen in >95% of patients with ALS, has been shown to be largely restricted to corticofugal projecting neurons (“dying forward”). Possibly, soluble but toxic cytoplasmic TDP-43 could enter the axoplasm of Betz cells, subsequently causing dysregulation of nuclear protein in the lower brainstem and spinal cord anterior horn cells. As the disease progresses, cortical involvement in ALS becomes widespread, including or starting with frontotemporal dementia, implying a broader view of ALS as a brain disease. The onset at the motor and premotor cortices should be considered a nidus at the edge of multiple cortical networks which eventually become disrupted, causing failure of a widespread cortical connectome.
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Affiliation(s)
- Andrew Eisen
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
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21
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Itzhaki Ben Zadok O, Eisen A, Shapira Y, Monakier D, Iakobishvili Z, Schwarzenberg S, Abelow A, Ofek H, Kazum S, Hamdan A, Bental T, Sagie A, Kornowski R, Vaturi M. Natural history and disease progression of early cardiac amyloidosis evaluated by echocardiography. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Since the diagnosis of cardiac amyloidosis (CA) is often delayed, echocardiographic findings are frequently indicative of already advanced cardiomyopathy.
Aims
to describe early echocardiographic features in patients subsequently diagnosed with CA and to delineate disease progression.
Methods
Pre-amyloid diagnosis echocardiographic studies were screened for structural and functional parameters and stratified according to the pathogenetic amyloid subtype (immunoglobulin light-chain (AL) or amyloid transthyretin (ATTR)). Abnormalities were defined based on published guidelines.
Results
Our cohort included 75 CA patients of whom 42 (56%) were diagnosed with AL and 33 (44%) with ATTR. Forty-two patients had an earlier echocardiography exam available for review. Patients presented with increased wall thickness (1.3 (IQR 1.0, 1.5)cm) ≥3 years before the diagnosis of CA and relative wall thickness (RWT) was increased (0.47 (IQR 0.41, 0.50)) ≥7 years pre-diagnosis. Between 1 to 3 years before CA diagnosis restrictive left ventricular (LV) filling pattern was present in 19% of patients and LV ejection fraction (LVEF)≤50% was present in 21% of patients. Right ventricular dysfunction was detected concomitantly with disease diagnosis. The echocardiographic phenotype of ATTR versus AL-CA showed increased RWT (0.74 (IQR 0.62, 0.92) vs. 0.62 (IQR 0.54, 0.76), p = 0.004) and LV mass index (144 (IQR 129, 191) vs. 115 (IQR 105, 146)g/m2,p = 0.020) and reduced LVEF (50 (IQR 44, 58) vs. (60 (IQR 53, 60)%, p = 0.009) throughout the time course of CA progression, albeit survival time was similar.
Conclusions
Increased wall thickness and diastolic dysfunction in CA develop over a time course of several years and can be diagnosed in their earlier stages by standard echocardiography
Abstract Figure. Schematic proposed timeline of CA
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Affiliation(s)
| | - A Eisen
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - Y Shapira
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - D Monakier
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - Z Iakobishvili
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - S Schwarzenberg
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - A Abelow
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - H Ofek
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - S Kazum
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - A Hamdan
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - T Bental
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - A Sagie
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - R Kornowski
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - M Vaturi
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
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22
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Tentler JJ, Lang J, Capasso A, Kim DJ, Benaim E, Lee YB, Eisen A, Bagby SM, Hartman SJ, Yacob BW, Gittleman B, Pitts TM, Pelanda R, Eckhardt SG, Diamond JR. RX-5902, a novel β-catenin modulator, potentiates the efficacy of immune checkpoint inhibitors in preclinical models of triple-negative breast Cancer. BMC Cancer 2020; 20:1063. [PMID: 33148223 PMCID: PMC7641792 DOI: 10.1186/s12885-020-07500-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 10/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype with limited systemic treatment options. RX-5902 is a novel anti-cancer agent that inhibits phosphorylated-p68 and thus attenuates nuclear β-catenin signaling. The purpose of this study was to evaluate the ability of β-catenin signaling blockade to enhance the efficacy of anti-CTLA-4 and anti-PD-1 immune checkpoint blockade in immunocompetent, preclinical models of TNBC. METHODS Treatment with RX-5902, anti-PD-1, anti-CTLA-4 or the combination was investigated in BALB/c mice injected with the 4 T1 TNBC cell line. Humanized BALB/c-Rag2nullIl2rγnullSIRPαNOD (hu-CB-BRGS) mice transplanted with a human immune system were implanted with MDA-MB-231 cells. Mice were randomized into treatment groups according to human hematopoietic chimerism and treated with RX-5902, anti-PD-1 or the combination. At sacrifice, bone marrow, lymph nodes, spleen and tumors were harvested for flow cytometry analysis of human immune cells. RESULTS The addition of RX-5902 to CTLA-4 or PD-1 inhibitors resulted in decreased tumor growth in the 4 T1 and human immune system and MDA-MB-231 xenograft models. Immunologic analyses demonstrated a significant increase in the number of activated T cells in tumor infiltrating lymphocytes (TILs) with RX-5902 treatment compared to vehicle (p < 0.05). In the RX-5902/nivolumab combination group, there was a significant increase in the percentage of CD4+ T cells in TILs and increased systemic granzyme B production (p < 0.01). CONCLUSIONS Conclusions: RX-5902 enhanced the efficacy of nivolumab in a humanized, preclinical model of TNBC. Several changes in immunologic profiles were noted in mice treated with RX-5902 and the combination, including an increase in activated TILs and a decrease in human myeloid populations, that are often associated with immunosuppression in a tumor microenvironment. RX-5902 also was shown to potentiate the effects of checkpoint inhibitors of CTLA4 and the PD-1 inhibitor in the 4 T-1 murine TNBC model. These findings indicate that RX-5902 may have important immunomodulatory, as well as anti-tumor activity, in TNBC when combined with a checkpoint inhibitor.
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Affiliation(s)
- John J Tentler
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave, MS8117, Aurora, CO, 80045, USA.
- University of Colorado Cancer Center, Anschutz Medical Campus, 12801 E 17th Ave, MS8117, Aurora, CO, 80045, USA.
| | - Julie Lang
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Anna Capasso
- Dell Medical School, Department of Oncology, University of Texas at Austin, Austin, TX, USA
| | | | - Ely Benaim
- Rexahn Pharmaceuticals Inc., Rockville, MD, USA
| | - Young B Lee
- Rexahn Pharmaceuticals Inc., Rockville, MD, USA
| | | | - Stacey M Bagby
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave, MS8117, Aurora, CO, 80045, USA
| | - Sarah J Hartman
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave, MS8117, Aurora, CO, 80045, USA
| | - Betelehem W Yacob
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave, MS8117, Aurora, CO, 80045, USA
| | - Brian Gittleman
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave, MS8117, Aurora, CO, 80045, USA
| | - Todd M Pitts
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave, MS8117, Aurora, CO, 80045, USA
- University of Colorado Cancer Center, Anschutz Medical Campus, 12801 E 17th Ave, MS8117, Aurora, CO, 80045, USA
| | - Roberta Pelanda
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - S Gail Eckhardt
- Dell Medical School, Department of Oncology, University of Texas at Austin, Austin, TX, USA
| | - Jennifer R Diamond
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave, MS8117, Aurora, CO, 80045, USA
- University of Colorado Cancer Center, Anschutz Medical Campus, 12801 E 17th Ave, MS8117, Aurora, CO, 80045, USA
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23
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Itzhaki Ben Zadok O, Leshem-Lev D, Ben-Gal T, Hamdan A, Schamroth-Pravda N, Steinmetz T, Kandinov I, Kornowski R, Eisen A. Quantitative and functional evaluation of endothelial progenitor cells in patients with cardiac amyloidosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Endothelial microvascular dysfunction is a known mechanism of injury in cardiac amyloidosis (CA), but evidence regarding the level and function of endothelial progenitor cells (EPCs) in patients with CA is lacking.
Methods
Study population included patients with light-chain or transthyretin (ATTR) CA. Patients with diagnosed heart failure and preserved ejection fraction (HFpEF) without monoclonal gammopathy and a 99mTc-DPD scan incompatible with TTR were used as controls. Blood circulating EPCs were assessed quantitatively by the expression of VEGFR-2(+), CD34(+) and CD133(+) using flow cytometry, and functionally by the formation of colony forming units (CFUs). MTT assay was used to demonstrate cell viability. Tests were repeated 3 months following the initiation of amyloid-suppressive therapies (either ATTR-stabilizer or targeted chemotherapy) in CA patients.
Results
Our preliminary cohort included 14 CA patients (median age 74 years, 62% ATTR CA).
Patients with CA vs. patients with HFpEF (n=8) demonstrated lower expression of CD34(+)/VEGFR-2(+) cells [0.51% (IQR 0.4, 0.7) vs. 1.03% (IQR 0.6, 1.4), P=0.043] and CD133(+)/VEGFR-2(+) cells [0.35% (IQR 0.23, 0.52) to 1.07% (IQR 0.6, 1.5), P=0.003]. Functionally, no differences were noted between groups. Following the initiation of amyloid-suppressive therapies in CA patients, we observed the up-regulation of CD34(+)/VEGFR-2(+) cells [2.47% (IQR 2.1, 2.7), P<0.001] and CD133(+)/VEGFR-2(+) cells [1.38% (IQR 1.1, 1.7), P=0.003]. Moreover, functionally, active EPCs were evident microscopically by their ability to form colonies (from 0.5 CFUs [IQR 0, 1.5) to 2 CFUs (IQR 1, 3.5), P=0.023]. EPCs' viability was demonstrated by an MTT assay [0.12 (IQR 0.04, 0.12) to 0.24 (IQR 0.16, 0.3), p=0.014].
Conclusions
These preliminary results demonstrate reduced EPCs levels in CA patients indicating significant microvascular impairment. Amyloid-targeted therapies induce the activation of EPCs, thus possibly promoting endothelial regeneration. These findings may represent a novel mechanism of action of amyloid-suppressive therapies
EPCs in CA patients and during therapy
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - D Leshem-Lev
- Felsenstein Medical Research Center, Petah Tikva, Israel
| | - T Ben-Gal
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - A Hamdan
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | | | - T Steinmetz
- Rabin Medical Center, Department of Nephrology, Petah Tikva, Israel
| | - I Kandinov
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - R Kornowski
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - A Eisen
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
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24
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Skalsky K, Bental T, Vaknin-Assa H, Assali A, Greenberg G, Codner P, Samara A, Ben Gal T, Eisen A, Kornowski R, Perl L. Temporal trends of acute kidney injury in patients undergoing percutaneous coronary intervention over a span of 12 years. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Acute kidney injury (AKI) is a known complication following percutaneous coronary intervention (PCI), and is associated with higher rates of complications. We sought to determine the potential impact of temporal changes on the rates of AKI over time, as well as possible determinants of risk.
Methods
From a large prospective registry of patients undergoing PCI, 20,032 consecutive patients were assessed at two time periods: 2006–2012 and 2012–2018. Of these, included were cases for which data existed regarding change in creatinine levels from baseline to 48 hours after PCI. AKI was defined according to two methods- a relative elevation of ≥25% in serum creatinine or an absolute elevation of ≥0.5 mg/dL in serum creatinine at 48 hours.
Results
15,153 patients were available for final analysis, 7,913 in the first period and 7,240 in the second. Mean age was 65.0y and 66.0y (p<0.01) and baseline creatinine was 1.08 mg/dL and 1.15 mg/dL respectively (p<0.01, table 1).
AKI according to 25% relative rise in serum creatinine was documented in 11.1% in the early period and in 7.3% of the patients in the late period, p<0.01. According to the definition of 0.5 mg/dL absolute rise in serum creatinine, respective rates were 3% and 2.9%, p=0.82 (figure 1). Multivariate analysis demonstrated a lower risk of AKI in the late period (OR- 0.72; CI 0.61–0.85, P<0.01). Factors associated with risk of AKI included reduced ejection fraction (OR-0.98; CI 0.976–0.99, p<0.01), older age (OR-1.01; CI 1.005–1.02, p=0.01) and female gender (OR- 1.73; CI 1.46–2.06, p<0.01).
Conclusions
We have witnessed an improvement in the rates of post-PCI AKI over time. Further research is warranted, to further reduce peri-procedural AKI.
Figure 1. Change in the rates of AKI
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Skalsky
- Rabin Medical Center, Petah Tikva, Israel
| | - T Bental
- Rabin Medical Center, Petah Tikva, Israel
| | | | - A Assali
- Meir Medical Center, Kfar Saba, Israel
| | | | - P Codner
- Rabin Medical Center, Petah Tikva, Israel
| | - A Samara
- Rabin Medical Center, Petah Tikva, Israel
| | - T Ben Gal
- Rabin Medical Center, Petah Tikva, Israel
| | - A Eisen
- Rabin Medical Center, Petah Tikva, Israel
| | | | - L Perl
- Rabin Medical Center, Petah Tikva, Israel
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25
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Webber C, Whitehead M, Eisen A, Holloway CMB, Groome PA. Breast cancer diagnosis and treatment wait times in specialized diagnostic units compared with usual care: a population-based study. Curr Oncol 2020; 27:e377-e385. [PMID: 32905256 PMCID: PMC7467790 DOI: 10.3747/co.27.6115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Breast assessment sites (bass) were developed to provide expedited and coordinated care for patients being evaluated for breast cancer (bca) in Ontario. We compared the diagnostic and treatment intervals for patients diagnosed at a bas and for those diagnosed through a usual care (uc) route. Methods This population-based, cross-sectional study of patients diagnosed with bca in Ontario during 2007-2015 used linked administrative data. "Diagnostic interval" was the time from the earliest cancer-related health care encounter before diagnosis to diagnosis; "treatment interval" was the time from diagnosis to treatment. Diagnosis at a bas was determined from the patient's biopsy and mammography institutions. Interval lengths for the bas and uc groups were compared using multivariable quantile regression, stratified by detection method. Results The diagnostic interval was shorter for patients who were bas-diagnosed than for those who were uc-diagnosed, with adjusted median differences of -4.0 days [95% confidence interval (ci): -3.2 days to -4.9 days] for symptomatic patients and -5.4 days (95% ci: -4.7 days to -6.1 days) for screen-detected patients. That association was modified by stage at diagnosis, with larger differences in patients with early-stage cancers. In contrast, the treatment interval was longer in patients who were bas-diagnosed than in those who were uc-diagnosed, with adjusted median differences of 4.2 days (95% ci: 3.8 days to 4.7 days) for symptomatic patients and 4.2 days (95% ci: 3.7 days to 4.8 days) for screen-detected patients. Conclusions Diagnosis of bca through a bas was associated with a shorter diagnostic interval, but a longer treatment interval. Although efficiencies in the diagnostic interval might help to reduce distress experienced by patients, the longer treatment intervals for patients who are bas-diagnosed remain a cause for concern.
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Affiliation(s)
- C Webber
- The Ottawa Hospital Research Institute and Bruyère Research Institute, Ottawa
| | | | - A Eisen
- Ontario Health (Cancer Care Ontario), Toronto
| | - C M B Holloway
- Ontario Health (Cancer Care Ontario), Toronto
- Department of Surgery, University of Toronto, Toronto
| | - P A Groome
- ices Queen's, Kingston
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, and Department of Public Health Sciences, Queen's University, Kingston, ON
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26
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Shefner JM, Al-Chalabi A, Baker MR, Cui LY, de Carvalho M, Eisen A, Grosskreutz J, Hardiman O, Henderson R, Matamala JM, Mitsumoto H, Paulus W, Simon N, Swash M, Talbot K, Turner MR, Ugawa Y, van den Berg LH, Verdugo R, Vucic S, Kaji R, Burke D, Kiernan MC. A proposal for new diagnostic criteria for ALS. Clin Neurophysiol 2020; 131:1975-1978. [PMID: 32387049 DOI: 10.1016/j.clinph.2020.04.005] [Citation(s) in RCA: 227] [Impact Index Per Article: 56.8] [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: 01/14/2020] [Revised: 04/01/2020] [Accepted: 04/05/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Jeremy M Shefner
- Department of Neurology, Barrow Neurological Institute, Phoenix, USA.
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, Kings College London, London, UK
| | - Mark R Baker
- Department of Clinical Neurophysiology, Royal Victoria Infirmary and Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Mamede de Carvalho
- Physiology Institute, Faculty of Medicine-iMM-CHULN, University of Lisbon, Lisbon, Portugal
| | - Andrew Eisen
- Division of Neurology, University of British Columbia, Vancouver, Canada
| | | | - Orla Hardiman
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Robert Henderson
- University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Jose Manuel Matamala
- Department of Neurological Sciences and Biomedical Neuroscience Institute (BNI), Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Neil Simon
- Northern Clinical School, University of Sydney, Sydney, Australia
| | | | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences University of Oxford, Oxford, UK
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences University of Oxford, Oxford, UK
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| | | | - Renato Verdugo
- Neurology and Psychiatry, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Steven Vucic
- Western Clinical School, University of Sydney, Department of Neurology, Westmead Hospital, Australia
| | - Ryuji Kaji
- National Hospital Organization Utano Hospital, Kyoto, Japan
| | - David Burke
- Department of Neurology, Royal Prince Alfred Hospital and the University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
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27
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Masri BA, Eisen A, Duncan CP, McEwen JA. Tourniquet-induced nerve compression injuries are caused by high pressure levels and gradients - a review of the evidence to guide safe surgical, pre-hospital and blood flow restriction usage. BMC Biomed Eng 2020; 2:7. [PMID: 32903342 PMCID: PMC7422508 DOI: 10.1186/s42490-020-00041-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/20/2020] [Indexed: 12/27/2022] Open
Abstract
Tourniquets in orthopaedic surgery safely provide blood free surgical fields, but their use is not without risk. Tourniquets can result in temporary or permanent injury to underlying nerves, muscles, blood vessels and soft tissues. Advances in safety, accuracy and reliability of surgical tourniquet systems have reduced nerve-related injuries by reducing pressure levels and pressure gradients, but that may have resulted in reduced awareness of potential injury mechanisms. Short-term use of pre-hospital tourniquets is effective in preventing life-threatening blood loss, but a better understanding of the differences between tourniquets designed for pre-hospital vs surgical use will provide a framework around which to develop guidelines for admitting to hospital individuals with pre-applied tourniquets. Recent evidence supports the application of tourniquets for blood flow restriction (BFR) therapy to reduce muscular atrophy, increase muscle strength, and stimulate bone growth. BFR therapy when appropriately prescribed can augment a surgeon’s treatment plan, improving patient outcomes and reducing recovery time. Key risks, hazards, and mechanisms of injury for surgical, BFR therapy, and pre-hospital tourniquet use are identified, and a description is given of how advances in personalized tourniquet systems have reduced tourniquet-related injuries in these broader settings, increasing patient safety and how these advances are improving treatment outcomes.
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Affiliation(s)
- Bassam A Masri
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 207-1099 West 8th Avenue, Vancouver, BC V6H 1C3 Canada
| | - Andrew Eisen
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Clive P Duncan
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 207-1099 West 8th Avenue, Vancouver, BC V6H 1C3 Canada
| | - James A McEwen
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 207-1099 West 8th Avenue, Vancouver, BC V6H 1C3 Canada.,Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada
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28
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Arnaout A, Varela NP, Allarakhia M, Grimard L, Hey A, Lau J, Thain L, Eisen A. Baseline staging imaging for distant metastasis in women with stages I, II, and III breast cancer. ACTA ACUST UNITED AC 2020; 27:e123-e145. [PMID: 32489262 DOI: 10.3747/co.27.6147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background In Ontario, there is no clearly defined standard of care for staging for distant metastasis in women with newly diagnosed and biopsy-confirmed breast cancer whose clinical presentation is suggestive of early-stage disease. This guideline addresses baseline imaging investigations for women with newly diagnosed primary breast cancer who are otherwise asymptomatic for distant metastasis. Methods The medline and embase databases were systematically searched for evidence from January 2000 to April 2019, and the best available evidence was used to draft recommendations relevant to the use of baseline imaging investigation in women with newly diagnosed primary breast cancer who are otherwise asymptomatic. Final approval of this practice guideline was obtained from both the Staging in Early Stage Breast Cancer Advisory Committee and the Report Approval Panel of the Program in Evidence-Based Care. Recommendations These recommendations apply to all women with newly diagnosed primary breast cancer (originating in the breast) who have no symptoms of distant metastasis Staging tests using conventional anatomic imaging [chest radiography, liver ultrasonography, chest-abdomen-pelvis computed tomography (ct)] or metabolic imaging modalities [integrated positron-emission tomography (pet)/ct, integrated pet/magnetic resonance imaging (mri), bone scintigraphy] should not be routinely ordered for women newly diagnosed with clinical stage i or stage ii breast cancer who have no symptoms of distant metastasis, regardless of biomarker status. In women newly diagnosed with stage iii breast cancer, baseline staging tests using either anatomic imaging (chest radiography, liver ultrasonography, chest-abdomen-pelvis ct) or metabolic imaging modalities (pet/ct, pet/mri, bone scintigraphy) should be considered regardless of whether the patient is symptomatic for distant metastasis and regardless of biomarker profile.
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Affiliation(s)
- A Arnaout
- Department of Surgery, The Ottawa Hospital and The University of Ottawa, Ottawa, ON
| | - N P Varela
- Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), and Department of Oncology, McMaster University, Hamilton, ON
| | - M Allarakhia
- Patient Representative, The Ottawa Hospital, Ottawa, ON
| | - L Grimard
- Department of Radiation Medicine, The Ottawa Hospital, Ottawa, ON
| | - A Hey
- Regional Primary Care, Northeast Cancer Centre, Sudbury, ON
| | - J Lau
- Department of Radiology, The University of Ottawa, Ottawa, ON
| | - L Thain
- Ontario Health (Cancer Care Ontario) Regional Imaging, Southlake Regional Health Centre, Newmarket, and Mackenzie Health, Richmond Hill, ON
| | - A Eisen
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON
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Swash M, Eisen A. Hypothesis: amyotrophic lateral sclerosis and environmental pollutants. Muscle Nerve 2020; 62:187-191. [DOI: 10.1002/mus.26855] [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] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Michael Swash
- Barts and The London School of MedicineQueen Mary University of London and Royal London Hospital London UK
- Institute of Neuroscience, University of Lisbon Lisbon Portugal
| | - Andrew Eisen
- Division of NeurologyUniversity of British Columbia Vancouver British Columbia Canada
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Henderson RD, Eisen A. ALS Split Phenotypes - To what extent do they exist? Clin Neurophysiol 2020; 131:847-849. [PMID: 32066103 DOI: 10.1016/j.clinph.2019.12.417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/04/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Robert D Henderson
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston 4006, Brisbane, Australia.
| | - Andrew Eisen
- Emeritus UBC Neurology, 2862 Highbury Street, Vancouver BC, Canada.
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Masucci L, Torres S, Eisen A, Trudeau M, Tyono I, Saunders H, Chan KW, Isaranuwatchai W. Cost-utility analysis of 21-gene assay for node-positive early breast cancer. ACTA ACUST UNITED AC 2019; 26:307-318. [PMID: 31708649 DOI: 10.3747/co.26.4769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background For women with lymph node (ln)-positive, estrogen receptor-positive, and her2 (human epidermal growth factor receptor 2)-negative breast cancer (bca), current guidelines recommend treatment with both hormonal therapy and chemotherapy. The 21-gene Recurrence Score (rs) assay might be helpful in selecting patients with bca who can be spared chemotherapy when they have 1-3 positive lns and a lower risk of recurrence. In the present study, we performed a cost-utility analysis comparing use of the 21-gene rs assay with current practice from the perspective of a Canadian health care payer. Methods A Markov model was developed to determine costs and quality-adjusted life-years (qalys) over a patient's lifetime. Patient outcomes in both study groups were examined based on published clinical trials. Costs were derived primarily from published Canadian sources. Costs and outcomes were discounted at 1.5% annually, and costs are reported in 2016 Canadian dollars. A probabilistic analysis was used, and the model parameters were varied in a sensitivity analysis. Results The results indicate that use of the 21-gene rs assay was less costly ($432 less) and more effective (0.22 qalys) than current practice. The probabilistic analysis revealed that 70% of the 10,000 simulated incremental cost-effectiveness ratios were in the southeast quadrant. The results were sensitive to the probability of a low rs and to the probability of receiving chemotherapy in the low-risk rs category and in current practice. Conclusions Use of the 21-gene rs assay could be a cost-effective strategy for Ontario patients with estrogen receptor-positive, her2-negative early bca and 1-3 positive lns.
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Affiliation(s)
- L Masucci
- Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - S Torres
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON
| | - A Eisen
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON.,Cancer Care Ontario, University of Toronto, Toronto, ON
| | - M Trudeau
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON.,Cancer Care Ontario, University of Toronto, Toronto, ON
| | - I Tyono
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON
| | - H Saunders
- Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - K W Chan
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON.,Cancer Care Ontario, University of Toronto, Toronto, ON.,Canadian Centre for Applied Research in Cancer Control, University of Toronto, Toronto, ON
| | - W Isaranuwatchai
- Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, University of Toronto, Toronto, ON.,Canadian Centre for Applied Research in Cancer Control, University of Toronto, Toronto, ON.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
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Shiyovich A, Shlomo N, Iakobishvili Z, Kornowski R, Eisen A. P4590Temporal trends of the characteristics, management, and clinical outcomes of patients with acute coronary syndrome and multi-vessel disease - the ACSIS registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Multi-vessel coronary artery disease (MVD) is common among patients with acute coronary syndrome (ACS) and is associated with worse outcomes compared with single-vessel disease. Multiple studies focused particularly on patients with ACS and MVD and their results were incorporated into guidelines' recommendations.
Objectives
To examine temporal trends in clinical characteristics, treatment and outcomes of patients presenting with ACS and MVD.
Methods
Time- dependent analysis of patients enrolled in the biennial ACS Israeli Surveys (ACSIS) between 2000 and 2016 according to three time periods: early (2004–2006; n=2,111), mid (2008–2010; n=2,049), and late (2013–2016; n=2,010). MVD was defined as >50% stenosis in ≥2 separate major coronary territories at the index ACS. Clinical outcomes were 30-day MACE (death, unstable angina, myocardial infarction, stroke, stent thrombosis, urgent revascularization) and 30-days and 1-year mortality.
Results
Overall 6,170/15,000 patients (41.1%) had MVD (age 64.5±12.1, males 80%). Patients admitted in the later periods were older with a higher prevalence of cardiovascular risk factors and their treatment (i.e. statins, and hypoglycemic drugs) prior to admission. The rate of CABG has decreased and of MV percutaneous coronary intervention and guideline recommended medical treatment has increased with time. At 30 days, the rates of mortality, MACE and re-infarction have decreased (Figure). A trend of reduction in 1-year mortality was observed with time, yet it did not reach statistical significance (early=9.3%, mid=7.8%, late=7.7%, P=0.13). A multivariate adjusted analysis demonstrated that the mid and late periods were associated with significantly reduced risk for 30-day MACE (OR=0.65 [0.54–0.77] and 0.54 [0.45–0.65], respectively).
Figure 1. Temporal trends in 30-day outcomes of patients with ACS and MVD
Conclusions
During the last decade, the burden of cardiovascular risk factors among ACS patients with MVD has increased, more extensive invasive and medical treatments were provided and significant improvements in 30-day outcomes were observed.
Acknowledgement/Funding
None
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Affiliation(s)
- A Shiyovich
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - N Shlomo
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | | | - R Kornowski
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - A Eisen
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
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Eisen A, Schechter A, Itzhaki Ben Zadok O, Harari E, Shlomo N, Iakobishvili Z, Kornowski R, Zusman O. P3607Temporal trends in the characteristics, management, and clinical outcomes of patients with prior myocardial infarction who are admitted with an acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Patients with prior myocardial infarction (MI) are at increased risk for recurrent cardiovascular events. Advances in treatment in the last decade has improved prognosis of patients with acute coronary syndrome (ACS), yet it is not known whether similar trends exist in patients with prior MI who are admitted with an ACS, a particularly high-risk group.
Methods
Patients admitted with ACS who were enrolled in the ACS Israeli Surveys (ACSIS). Patients were stratified by early (2000–2008) and late (2010–2016) time-periods and by prior MI status. Clinical outcomes included 30-d MACE (death, MI, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1-year mortality.
Results
A total of 15,211 ACS patients were included, of whom 4627 (30%) had a prior MI. These patients were older (67y vs. 63y), more commonly male, had more prior comorbidities, and a higher proportion had a GRACE score>140 (38.4% vs 12.2%). Patients with prior MI received more prior medications such as aspirin, statins, antihypertensives and hypoglycemics. During time, utilization of guideline-recommended therapies such as P2Y12 inhibitors, statins, and PCI had significantly improved in patients with prior MI. However, compared with patients without prior MI, they were still treated less commonly by PCI (61% vs. 74%). Overall, patients with prior MI had a higher 30-d MACE (13.7% vs 17.2%, p<0.001) and 1-year mortality (8.2% vs. 13.1%, p<0.001). In patients with prior MI, during time, 30d MACE nearly halved (22.7% to 11.8%) and 1-year mortality also decreased (15.5% to 10.7%). Upon adjustment, prior MI was independently associated with 1-year mortality (HR 1.13, 95% CI 1.01–1.26, p=0.04) and the late time-period was associated with reduced 1-year mortality (HR 0.75, 95% CI 0.65–0.84, p<0.001).
Conclusion
Patients with prior MI have a worse prognosis after ACS despite being treated with prior medications and improvement in guideline-based therapies. Although still undertreated, their clinical outcome has significantly improved throughout the years.
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Affiliation(s)
- A Eisen
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - A Schechter
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | | | - E Harari
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - N Shlomo
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Z Iakobishvili
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - R Kornowski
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - O Zusman
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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Grinberg T, Bental T, Hammer Y, Assali AR, Vaknin-Assa H, Kornowski R, Eisen A. P3609Temporal trends of the management and outcomes of patients after myocardial infarction according to the risk for recurrent cardiovascular events. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Following Myocardial Infarction (MI), patients are at increased risk for recurrent cardiovascular events, particularly during the immediate period. Yet some patients are at higher risk than others, owing to their clinical characteristics and comorbidities, these high-risk patients are less often treated with guideline-recommended therapies.
Aim
To examine temporal trends in treatment and outcomes of patients with MI according to the TIMI risk score for secondary prevention (TRS2°P), a recently validated risk stratification tool.
Methods
A retrospective cohort study of patients with an acute MI, who underwent percutaneous coronary intervention and were discharged alive between 2004–2016. Temporal trends were examined in the early (2004–2010) and late (2011–2016) time-periods. Patients were stratified by the TRS2°P to a low (≤1), intermediate (2) or high-risk group (≥3). Clinical outcomes included 30-day MACE (death, MI, target vessel revascularization, coronary artery bypass grafting, unstable angina or stroke) and 1-year mortality.
Results
Among 4921 patients, 31% were low-risk, 27% intermediate-risk and 42% high-risk. Compared to low and intermediate-risk patients, high-risk patients were older, more commonly female, and had more comorbidities such as hypertension, diabetes, peripheral vascular disease, and chronic kidney disease. They presented more often with non ST elevation MI and 3-vessel disease. High-risk patients were less likely to receive drug eluting stents and potent anti-platelet drugs, among other guideline-recommended therapies. Evidently, they experienced higher 30-day MACE (8.1% vs. 3.9% and 2.1% in intermediate and low-risk, respectively, P<0.001) and 1-year mortality (10.4% vs. 3.9% and 1.1% in intermediate and low-risk, respectively, P<0.001). During time, comparing the early to the late-period, the use of potent antiplatelets and statins increased among the entire cohort (P<0.001). However, only the high-risk group demonstrated a significantly lower 30-day MACE (P=0.001). During time, there were no differences in 1-year mortality rate among all risk categories.
Temporal trends in 30-day MACE by TRS2°P
Conclusion
Despite a better application of guideline-recommended therapies, high-risk patients after MI are still relatively undertreated. Nevertheless, they demonstrated the most notable improvement in outcomes over time.
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Affiliation(s)
- T Grinberg
- Rabin Medical Center, Petah Tikva, Israel
| | - T Bental
- Rabin Medical Center, Petah Tikva, Israel
| | - Y Hammer
- Rabin Medical Center, Petah Tikva, Israel
| | - A R Assali
- Rabin Medical Center, Petah Tikva, Israel
| | | | | | - A Eisen
- Rabin Medical Center, Petah Tikva, Israel
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Itzhaki Ben Zadok O, Mager A, Leshem-Lev D, Lev E, Kornowski R, Eisen A. 2979The effect of proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors on endothelial progenitor cells. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Endothelial progenitor cells (EPCs) have an important role in the process of vascular repair by promoting re-endothelialization following endothelial injury. We hypothesized that proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors, which reduce cardiovascular events, will increase the level of EPCs and thus affect the process of vascular repair. Therefore, we sought to investigate the effect of PCSK9 inhibitors on circulating EPCs.
Methods
Study population included patients with known stable CAD who were initiated PCSK9 inhibitors. Blood samples were drawn and evaluated for EPCs at baseline and after treatment (1 month). Circulating EPCs were then assessed quantitatively by the expression of VEGFR-2, CD34 and CD133 using flow cytometry, and functionally by the formation of colony forming units (CFUs).
Results
Our preliminary cohort included 12 patients (median age of 69 years), 31% of whom were female. At baseline, total cholesterol and low density lipoprotein levels were 190 (IQR 180, 227) mg/dL and 123 (IQR 107, 154) mg/dL, respectively. Following 1-month of therapy with a PCSK9 inhibitor and along with a decrease in LDL to a median of 58 (IQR 50, 67) mg/dL, we observed an increase in the expression of CD34(+)/VEGFR-2(+) (1.2% (IQR 0.6, 1.6) to 3.0% (IQR 1.2, 4.5), P=0.07) and CD133(+)/VEGFR-2(+) (0.8% (IQR 0.7, 1.4) to 1.7% (IQR 0.6, 4.0), P=0.5). Proliferation of EPCs was confirmed microscopically (1 CFUs (IQR 1, 1.5) to 1.5 CFUs (IQR 1.5, 2.5), P=0.016) (Figure 1) and by an MTT assay (0.16 (IQR 0.12, 0.19) to 0.19 (IQR 0.17, 0.21), p=0.016).
Conclusions
These preliminary results in patients with CAD demonstrate that treatment with PCSK9 inhibitors is associated with higher levels of EPCs, thus promote endothelial repair. This finding may represent a novel mechanism of action of PCSK9 inhibitors, which might have important future clinical implications.
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Affiliation(s)
| | - A Mager
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - D Leshem-Lev
- Felsenstein Medical Research Center, Petah Tikva, Israel
| | - E Lev
- Assuta Medical Center, Department of Cardiology, Ashdod, Israel
| | - R Kornowski
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - A Eisen
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
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Kiernan MC, Ziemann U, Eisen A. Amyotrophic lateral sclerosis: Origins traced to impaired balance between neural excitation and inhibition in the neonatal period. Muscle Nerve 2019; 60:232-235. [PMID: 31233613 DOI: 10.1002/mus.26617] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 12/14/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is an adult onset disease but with an increasingly recognized preclinical prodrome. A wide spectrum of investigative approaches has identified loss of inhibitory function at the heart of ALS. In developing an explanation for the onset of ALS, it remains a consideration that ALS has its origins in neonatal derangement of the γ-aminobutyric acid (GABA)-ergic system, with delayed conversion from excitatory to mature inhibitory GABA and impaired excitation/inhibition balance. If this is so, the resulting chronic excitotoxicity could marginalize cortical network functioning very early in life, laying the path for neurodegeneration. The possibility that adult-onset neurodegenerative conditions might have their roots in early developmental derangements is worthy of consideration, particularly in relation to current models of disease pathogenesis. Unraveling the very early molecular events will be crucial in developing a better understanding of ALS and other adult neurodegenerative disorders. Muscle Nerve, 2019.
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Affiliation(s)
- Matthew C Kiernan
- The University of Sydney School of Medicine Brain and Mind Centre, Building F, Level 4, 94 Mallett Street, Camperdown, New South Wales, 2050, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie-Institute for clinical brain research, University of Tübingen, Tübingen, Germany
| | - Andrew Eisen
- Division of Neurology (Emeritus), Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Eisen A, Kim DJ, Yang J, Wu W, Davis DW. Abstract 428: Phenotyping pancreatic cancer CTCs as biomarkers for RX-3117 clinical trials. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
RX-3117 is an oral, small molecule nucleoside analogue pro-drug being used in combination with nab-paclitaxel in a Ph2 clinical trial for pancreatic cancer. RX-3117 can be transported intracellularly by SLC29A1 (hENT1) and is converted to an active agent by the cancer-enriched enzyme, uridine-cytidine kinase 2 (UCK2) for incorporation into RNA and DNA. This leads to cancer cell apoptosis. We developed an approach to enumerate and phenotype CTCs from pancreatic cancer subjects by quantitative immunofluorescence (QIF) to assess whether CTC numbers, phenotypic features and/or early apoptotic responses to therapy predict or presage clinical response.
Methods:
QIF staining parameters were developed with cancer cell lines sensitive and resistant to RX-3117 utilizing monoclonal antibodies to hENT1 and UCK2. The staining methods were then applied to CTCs isolated from 10 ml anticoagulated blood by dielectrophoretic (DEP) properties that differentiate cancer cells and normal PBMCs using the ApoStream device (ApoCell, TX). In addition to the drug-related markers, CTCs were stained for a panel of either Epithelial or Mesenchymal markers, CD45 and nuclei (DAPI). Phenotyped CTCs were binned into 6 categories defined by whether they were EPI+/-, EMT+/- or CD45+/-. The percentage of cells in each category also positive for hENT1 or UCK2 was determined as was the mean fluorescence intensity of the marker+ sub-population. In addition, assessment of hENT1 and UCK2 expression was performed by qRT-PCR utilizing mRNA isolated from isolated CTCs, the buffy coat from spun blood and in plasma.
Results:
In a pilot study, blood was obtained from five subjects with Stage IV pancreatic cancer on various regimens. CTCs were isolated, enumerated and phenotyped. CTC numbers ranged from 100 – 20,000 per ml. The percentages of UCK2+ cells were higher in EPI+/EMT+ subsets than EPI-/EMT- subsets. The percentages of hENT1+ cells were generally low in all the subsets. hENT1 and UCK2 transcripts were observed at acceptable levels in the cell populations, and borderline, but consistent levels in plasma samples. CEACAM5 transcripts were observed only in one CTC and PBMC fraction from one subject. After normalization vs. housekeeping transcripts, a greater than 2-fold increase of UCK2 was observed in three CTC samples compared to PBMC samples. A greater than 2-fold increase of hENT1 was observed in two CTC samples.
Conclusion:
CTCs from patients with pancreatic cancer can be obtained in numbers suitable for multiparameter phenotyping to identify features that might serve as selective, predictive or prognostic biomarkers in clinical trials. Multiparameter phenotyping of several relevant markers is being performed by quantitative immunofluorescence on CTCs isolated from pancreatic cancer patients in an on-going Ph2 clinical trial of RX-3117 in combination with nab-paclitaxel.
Citation Format: Andrew Eisen, DJ Kim, Jie Yang, Weiguo Wu, Darren W. Davis. Phenotyping pancreatic cancer CTCs as biomarkers for RX-3117 clinical trials [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 428.
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Affiliation(s)
| | - DJ Kim
- 1Rexahn Pharmaceuticals, Rockville, MD
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Eisen A. Abstract 4127: RX-5902 exhibits direct and immunomodulatory anti-tumor activities in melanoma PDX models. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-4127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Nuclear β-catenin promotes deleterious processes in tumors and their microenvironment. Diminishing nuclear β-catenin attenuates these oncogenic processes. RX-5902 is an oral, small molecule inhibitor of β-catenin nuclear translocation mediated by phosphorylated p68 (DDX5). RX-5902 exhibits potent anti-cancer activity in many cancer cell lines, xenograft models in immunodeficient mice and immune competent mice and in patients. This study examines the relative contribution and context of the direct and immunomodulatory effects on the anti-tumor activities of RX-5902.
Methods: Four patient-derived melanoma xenograft models were implanted into either immunodeficient nude mice or NOG mice “humanized” with HLA unmatched CD34+ stem cells with average humanization of 36%. The PDX models were derived from 2 tumors that were clinically unresponsive to an anti-PD-1 agent and 2 tumors obtained prior to any immune treatment. In each category one tumor had BRAF WT and one a V600E mutation. Mice were randomized to receive either vehicle or RX-5902 at 5, 15 or 50 mg/kg po QDx5/Off x2 when implanted tumors reached 100-120 mm3 and began treatment when tumors reached 200mm3. Treatment lasted for 28 days and animals were observed for an additional 14 off therapy.
Results: The tumor growth inhibition data at 50 mg/kg is found in the table below. There was evidence of an immune contribution to the TGI in those tumors derived from subjects who did not benefit from I/O (Nivolumab) therapy. In each category the response was greater in tumors with WT BRAF.
Conclusion: RX-5902 provided greater TGI in the two melanoma PDX models derived from subjects who were resistant to I/O therapy compared to the models from I/O naïve subjects and, regardless, is greater in BRAF WT vs mutant tumors. The RX-5902 immune-mediated anti-tumoral activity may benefit the majority of melanoma subjects with limited response to BRAF-directed and/or I/O therapy.
Citation Format: Andrew Eisen. RX-5902 exhibits direct and immunomodulatory anti-tumor activities in melanoma PDX models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4127.
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Keech J, Beca J, Eisen A, Kennedy E, Kim J, Kouroukis CT, Darling G, Ferguson SE, Finelli A, Petrella TM, Perry JR, Chan K, Gavura S. Impact of a novel prioritization framework on clinician-led oncology drug submissions. ACTA ACUST UNITED AC 2019; 26:e155-e161. [PMID: 31043821 DOI: 10.3747/co.26.4501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background In Canada, requests for public reimbursement of cancer drugs are predominately initiated by pharmaceutical manufacturers. Clinician-led submissions provide a mechanism to initiate the drug funding process when industry does not submit a request for funding consideration. Although such requests are resource-intensive to produce, Cancer Care Ontario (cco) has the capacity to facilitate clinician-led submissions. In 2014, cco began developing a cancer drug prioritization framework that allocates resources to systematically address a growing number of clinician-identified funding gaps with clinician-led submissions. Methods Cancer site-specific drug advisory committees established by cco consist of health care practitioners whose roles include identifying and prioritizing funding gaps. The committees submit their identified gaps to a cross-cancer-site prioritization exercise in which the requests are ranked based on a set of guiding principles derived from health technology assessment. The requests are then sequentially allocated the resources needed to meet submission requirements. Whether the funding gap is of provincial or pan-Canadian relevance determines where the submission is filed for assessment. Results Since its inception, the cco framework has identified 17 funding gaps in 9 cancer sites. In 4 prioritizations, the framework supported 6 submissions. As of June 2018, the framework had contributed to the eventual funding of more than 9 new drug-indication pairs, with more awaiting funding consideration. Conclusions The cco prioritization framework has enabled clinicians to effectively and systematically identify, prioritize, and fill funding gaps not addressed by industry. Ultimately, the framework helps to ensure that patients can access evidence-informed and cost-effective therapies. The framework will continue to evolve as it encounters new challenges, including funding requests for rare indications.
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Affiliation(s)
- J Keech
- Cancer Care Ontario, Toronto, ON.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON
| | - J Beca
- Cancer Care Ontario, Toronto, ON.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON
| | - A Eisen
- Cancer Care Ontario, Toronto, ON.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - E Kennedy
- Cancer Care Ontario, Toronto, ON.,Mount Sinai Hospital, Toronto, ON
| | - J Kim
- Cancer Care Ontario, Toronto, ON.,Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - C T Kouroukis
- Cancer Care Ontario, Toronto, ON.,Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON
| | - G Darling
- Cancer Care Ontario, Toronto, ON.,Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - S E Ferguson
- Cancer Care Ontario, Toronto, ON.,Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - A Finelli
- Cancer Care Ontario, Toronto, ON.,Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - T M Petrella
- Cancer Care Ontario, Toronto, ON.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - J R Perry
- Cancer Care Ontario, Toronto, ON.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - K Chan
- Cancer Care Ontario, Toronto, ON.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - S Gavura
- Cancer Care Ontario, Toronto, ON
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Henderson RD, Garton FC, Kiernan MC, Turner MR, Eisen A. Human cerebral evolution and the clinical syndrome of amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2019; 90:570-575. [PMID: 29666205 PMCID: PMC6581076 DOI: 10.1136/jnnp-2017-317245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Robert D Henderson
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Fleur C Garton
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
| | - Matthew C Kiernan
- Brain & Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Andrew Eisen
- Division of Neurology Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Roth Y, Pell G, Ankry M, Hadad Y, Eisen A, Burnishev Y, Tendler A, Moses E, Zangen A. Comparing rotational-field-dTMS to unidirectional-dTMS in healthy volunteers. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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42
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Mosedale M, Button D, Jackson JP, Freeman KM, Brouwer KR, Caggiano AO, Eisen A, Iaci JF, Parry TJ, Stanulis R, Srinivas M, Watkins PB. Transient Changes in Hepatic Physiology That Alter Bilirubin and Bile Acid Transport May Explain Elevations in Liver Chemistries Observed in Clinical Trials of GGF2 (Cimaglermin Alfa). Toxicol Sci 2019; 161:401-411. [PMID: 29069498 DOI: 10.1093/toxsci/kfx222] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/01/2023] Open
Abstract
GGF2 is a recombinant human neuregulin-1β in development for chronic heart failure. Phase 1 clinical trials of GGF2 were put on hold when transient elevations in serum aminotransferases and total bilirubin were observed in 2 of 43 subjects who received single doses of GGF2 at 1.5 or 0.378 mg/kg. However, aminotransferase elevations were modest and not typical of liver injury sufficient to result in elevated serum bilirubin. Cynomolgus monkeys administered a single 15 mg/kg dose of GGF2 had similar transient elevations in serum aminotransferases and bilirubin as well as transient elevations in serum bile acids. However, no hepatocellular necrosis was observed in liver biopsies obtained during peak elevations. When sandwich-cultured human hepatocytes were treated with GGF2 for up to 72 h at concentrations approximately 0.8-fold average plasma Cmax for the 0.378 mg/kg dose, no cytotoxicity was observed. Gene expression profiling identified approximately 50% reductions in mRNAs coding for bilirubin transporters and bile acid conjugating enzymes, as well as changes in expression of additional genes mimicking the interleukin-6-mediated acute phase response. Similar gene expression changes were observed in GGF2-treated HepG2 cells and primary monkey hepatocytes. Additional studies conducted in sandwich-cultured human hepatocytes revealed a transient and GGF2 concentration-dependent decrease in hepatocyte bile acid content and biliary clearance of taurocholate without affecting biliary taurocholate efflux. Taken together, these data suggest that GGF2 does not cause significant hepatocellular death, but transiently modifies hepatic handling of bilirubin and bile acids, effects that may account for the elevations in serum bilirubin observed in the clinical trial subjects.
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Affiliation(s)
- Merrie Mosedale
- Institute for Drug Safety Sciences, University of North Carolina at Chapel Hill, Research Triangle Park, North Carolina 27709.,Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina 27599
| | | | | | | | | | | | | | | | - Tom J Parry
- Acorda Therapeutics, Ardsley, New York 10502
| | | | | | - Paul B Watkins
- Institute for Drug Safety Sciences, University of North Carolina at Chapel Hill, Research Triangle Park, North Carolina 27709.,Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina 27599
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43
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Wan BA, Ganesh V, Zhang L, Sousa P, Drost L, Lorentz J, Vesprini D, Lee J, Rakovitch E, Lu FI, Eisen A, Yee C, Lam H, Chow E. Response to: The Survival Time of 8376 Male Breast Cancer Patients. Clin Oncol (R Coll Radiol) 2018; 30:818-819. [PMID: 30213703 DOI: 10.1016/j.clon.2018.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/20/2018] [Accepted: 08/21/2018] [Indexed: 11/15/2022]
Affiliation(s)
- B A Wan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - V Ganesh
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - L Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - P Sousa
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - L Drost
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - J Lorentz
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - D Vesprini
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - J Lee
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - E Rakovitch
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - F-I Lu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - A Eisen
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - C Yee
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - H Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - E Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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44
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Eisen A. Central nervous system in motor neuron disease. J Neurol Neurosurg Psychiatry 2018; 89:901-902. [PMID: 29680791 DOI: 10.1136/jnnp-2018-318186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/27/2018] [Indexed: 11/04/2022]
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Abelow A, Hasdai D, Goldenberg I, Eisen A, Beigel R, Shlomo N, Gavriely D, Zusman O, Gottlieb S, Kornowski R, Iakobishvili Z. P5567Treatment of late arrival ST-elevation myocardial infarction in a real world clinical survey. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Abelow
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - D Hasdai
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - I Goldenberg
- Sheba Medical Center, Leviev Heart Center, Ramat Gan, Israel
| | - A Eisen
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - R Beigel
- Sheba Medical Center, Leviev Heart Center, Ramat Gan, Israel
| | - N Shlomo
- Sheba Medical Center, The Israeli Association for Cardiovascular Trials, Ramat Gan, Israel
| | - D Gavriely
- Sheba Medical Center, The Israeli Association for Cardiovascular Trials, Ramat Gan, Israel
| | - O Zusman
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - S Gottlieb
- Shaare Zedek Medical Center, Department of Cardiology, Jerusalem, Israel
| | - R Kornowski
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - Z Iakobishvili
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
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46
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Hammer Y, Iakobishvily Z, Goldenberg I, Shlomo N, Bental T, Hasdai D, Kornowski R, Eisen A. 4059Guideline recommended therapies and clinical outcomes according to the risk for recurrent cardiovascular events after an acute coronary syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Hammer
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | | | - I Goldenberg
- Sheba Medical Center, The Heart Institute, Ramat Gan, Israel
| | - N Shlomo
- Sheba Medical Center, The Heart Institute, Ramat Gan, Israel
| | - T Bental
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - D Hasdai
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - R Kornowski
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
| | - A Eisen
- Rabin Medical Center, Cardiology, Petah Tikva, Israel
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47
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Marcuschamer IA, Iakobishvili Z, Assali A, Vaknin-Assa H, Zusman O, Cohen T, Goldenberg I, Beigel R, Kornowski R, Eisen A. P814Temporal trends analysis of patients with prior coronary artery bypass graft surgery who are admitted with an acute coronary syndrome - the ACSIS registry 2000-2016. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- I A Marcuschamer
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
| | - Z Iakobishvili
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
| | - A Assali
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
| | - H Vaknin-Assa
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
| | - O Zusman
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
| | - T Cohen
- Sheba Medical Center, Cardiology Department, Ramat Gan, Israel
| | - I Goldenberg
- Sheba Medical Center, Cardiology Department, Ramat Gan, Israel
| | - R Beigel
- Sheba Medical Center, Cardiology Department, Ramat Gan, Israel
| | - R Kornowski
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
| | - A Eisen
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
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48
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Porter A, Goldenberg I, Kornowsky R, Eisen A. P3635A temporal trends analysis showing improved outcomes among women with acute coronary syndrome: the ACSIS registry data (2000-2016). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Porter
- Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Dept. of Cardiology, Petah Tikva, Israel
| | - I Goldenberg
- Sheba Medical Center, Cardiology, Ramat Gan, Israel
| | - R Kornowsky
- Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Dept. of Cardiology, Petah Tikva, Israel
| | - A Eisen
- Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Dept. of Cardiology, Petah Tikva, Israel
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49
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Tibes R, Borad MJ, Dutcus CE, Reyderman L, Feit K, Eisen A, Verbel DA, Von Hoff DD. Safety, pharmacokinetics, and preliminary efficacy of E6201 in patients with advanced solid tumours, including melanoma: results of a phase 1 study. Br J Cancer 2018; 118:1580-1585. [PMID: 29867224 PMCID: PMC6008465 DOI: 10.1038/s41416-018-0099-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 02/14/2018] [Accepted: 04/09/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This phase 1 first-in-human study aimed to determine the maximum-tolerated dose (MTD), dose-limiting toxicities, and safety of E6201, and to establish recommended dosing in patients with advanced solid tumours, expanded to advanced melanoma. METHODS Part A (dose escalation): sequential cohorts received E6201 intravenously (IV) over 30 min (once-weekly [qw; days (D)1 + 8 + 15 of a 28-day cycle]), starting at 20 mg/m2, increasing to 720 mg/m2 or the MTD. Part B (expansion): patients with BRAF-mutated or wild-type (WT) melanoma received E6201 320 mg/m2 IV over 60 minutes qw (D1 + 8 + 15 of a 28-day cycle) or 160 mg/m2 IV twice-weekly (D1 + 4 + 8 + 11 + 15 + 18 of a 28-day cycle; BRAF-mutated only). RESULTS MTD in Part A (n = 25) was 320 mg/m2 qw, confirmed in Part B (n = 30). Adverse events included QT prolongation (n = 4) and eye disorders (n = 3). E6201 exposure was dose-related, with PK characterised by extensive distribution and fast elimination. One patient achieved PR during Part A (BRAF-mutated papillary thyroid cancer; 480 mg/m2 qw) and three during Part B (2 BRAF-mutated melanoma; 1 BRAF-WT melanoma; all receiving 320 mg/m2 qw). CONCLUSIONS An intermittent regimen of E6201 320 mg/m2 IV qw for the first 3 weeks of a 28-day cycle was feasible and reasonably well-tolerated in patients with advanced solid tumours, including melanoma with brain metastases, with evidence of clinical efficacy.
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Affiliation(s)
- Raoul Tibes
- Laura & Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA.
| | | | | | | | | | - Andrew Eisen
- Translational Medicine Consulting, Rockville, MD, USA
| | | | - Daniel D Von Hoff
- Translational Genomics Research Institute, Phoenix, AZ, USA.,HonorHealth, Scottsdale, AZ, USA
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50
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Turner MR, Eisen A, Kiernan MC, Ravits J, Swash M. Kinnier Wilson's puzzling features of amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2018; 89:657-666. [PMID: 29122933 DOI: 10.1136/jnnp-2017-317217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Martin R Turner
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Andrew Eisen
- Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, The University of Sydney; Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - John Ravits
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
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