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Jaeger-Ruckstuhl CA, Lo Y, Fulton E, Waltner OG, Shabaneh TB, Simon S, Muthuraman PV, Correnti CE, Newsom OJ, Engstrom IA, Kanaan SB, Bhise SS, Peralta JMC, Ruff R, Price JP, Stull SM, Stevens AR, Bugos G, Kluesner MG, Voillet V, Muhunthan V, Morrish F, Olson JM, Gottardo R, Sarthy JF, Henikoff S, Sullivan LB, Furlan SN, Riddell SR. Signaling via a CD27-TRAF2-SHP-1 axis during naive T cell activation promotes memory-associated gene regulatory networks. Immunity 2024; 57:287-302.e12. [PMID: 38354704 DOI: 10.1016/j.immuni.2024.01.011] [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: 02/27/2023] [Revised: 09/26/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024]
Abstract
The interaction of the tumor necrosis factor receptor (TNFR) family member CD27 on naive CD8+ T (Tn) cells with homotrimeric CD70 on antigen-presenting cells (APCs) is necessary for T cell memory fate determination. Here, we examined CD27 signaling during Tn cell activation and differentiation. In conjunction with T cell receptor (TCR) stimulation, ligation of CD27 by a synthetic trimeric CD70 ligand triggered CD27 internalization and degradation, suggesting active regulation of this signaling axis. Internalized CD27 recruited the signaling adaptor TRAF2 and the phosphatase SHP-1, thereby modulating TCR and CD28 signals. CD27-mediated modulation of TCR signals promoted transcription factor circuits that induced memory rather than effector associated gene programs, which are induced by CD28 costimulation. CD27-costimulated chimeric antigen receptor (CAR)-engineered T cells exhibited improved tumor control compared with CD28-costimulated CAR-T cells. Thus, CD27 signaling during Tn cell activation promotes memory properties with relevance to T cell immunotherapy.
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Affiliation(s)
- Carla A Jaeger-Ruckstuhl
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA.
| | - Yun Lo
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Elena Fulton
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Olivia G Waltner
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Tamer B Shabaneh
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Sylvain Simon
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Pranav V Muthuraman
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Colin E Correnti
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Oliver J Newsom
- Human Biology Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Ian A Engstrom
- Human Biology Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Sami B Kanaan
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Shruti S Bhise
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Jobelle M C Peralta
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Raymond Ruff
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Jason P Price
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Sylvia M Stull
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Andrew R Stevens
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Grace Bugos
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Mitchell G Kluesner
- Human Biology Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Valentin Voillet
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Vishaka Muhunthan
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Fionnuala Morrish
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - James M Olson
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Raphaël Gottardo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; Department of Statistics, University of Washington, Seattle, WA 98195, USA; Swiss Institute of Bioinformatics, University of Lausanne and Lausanne University Hospital, Lausanne 1011, Switzerland
| | - Jay F Sarthy
- Seattle Children's Hospital, Seattle, WA 98105, USA; Basic Science Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Steven Henikoff
- Basic Science Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; Howard Hughes Medical Institute, Seattle, WA 98195, USA
| | - Lucas B Sullivan
- Human Biology Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Scott N Furlan
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Stanley R Riddell
- Translational Sciences and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; Department of Medicine, University of Washington, Seattle, WA 98195, USA.
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Shabaneh TB, Stevens AR, Stull SM, Shimp KR, Seaton BW, Gad EA, Jaeger-Ruckstuhl CA, Simon S, Koehne AL, Price JP, Olson JM, Hoffstrom BG, Jellyman D, Riddell SR. Systemically administered low-affinity HER2 CAR T cells mediate antitumor efficacy without toxicity. J Immunother Cancer 2024; 12:e008566. [PMID: 38325903 DOI: 10.1136/jitc-2023-008566] [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] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND The paucity of tumor-specific targets for chimeric antigen receptor (CAR) T-cell therapy of solid tumors necessitates careful preclinical evaluation of the therapeutic window for candidate antigens. Human epidermal growth factor receptor 2 (HER2) is an attractive candidate for CAR T-cell therapy in humans but has the potential for eliciting on-target off-tumor toxicity. We developed an immunocompetent tumor model of CAR T-cell therapy targeting murine HER2 (mHER2) and examined the effect of CAR affinity, T-cell dose, and lymphodepletion on safety and efficacy. METHODS Antibodies specific for mHER2 were generated, screened for affinity and specificity, tested for immunohistochemical staining of HER2 on normal tissues, and used for HER2-targeted CAR design. CAR candidates were evaluated for T-cell surface expression and the ability to induce T-cell proliferation, cytokine production, and cytotoxicity when transduced T cells were co-cultured with mHER2+ tumor cells in vitro. Safety and efficacy of various HER2 CARs was evaluated in two tumor models and normal non-tumor-bearing mice. RESULTS Mice express HER2 in the same epithelial tissues as humans, rendering these tissues vulnerable to recognition by systemically administered HER2 CAR T cells. CAR T cells designed with single-chain variable fragment (scFvs) that have high-affinity for HER2 infiltrated and caused toxicity to normal HER2-positive tissues but exhibited poor infiltration into tumors and antitumor activity. In contrast, CAR T cells designed with an scFv with low-affinity for HER2 infiltrated HER2-positive tumors and controlled tumor growth without toxicity. Toxicity mediated by high-affinity CAR T cells was independent of tumor burden and correlated with proliferation of CAR T cells post infusion. CONCLUSIONS Our findings illustrate the disadvantage of high-affinity CARs for targets such as HER2 that are expressed on normal tissues. The use of low-affinity HER2 CARs can safely regress tumors identifying a potential path for therapy of solid tumors that exhibit high levels of HER2.
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Affiliation(s)
- Tamer Basel Shabaneh
- Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Andrew R Stevens
- Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Sylvia M Stull
- Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Kristen R Shimp
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Brandon W Seaton
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Ekram A Gad
- Comparative Medicine, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Carla A Jaeger-Ruckstuhl
- Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Sylvain Simon
- Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Amanda L Koehne
- Experimental Histopathology, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Jason P Price
- Molecular Design and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - James M Olson
- Molecular Design and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | - David Jellyman
- Antibody Technology, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Stanley R Riddell
- Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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Stevens AR, Chelvarajah R, Veenith T, Belli A, Davies DJ. In Reply to the Letter to the Editor Regarding "Cerebrospinal Fluid Diversion for Refractory Intracranial Hypertension in Traumatic Brain Injury: A Single Center Experience". World Neurosurg 2023; 180:257-258. [PMID: 38115388 DOI: 10.1016/j.wneu.2023.09.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Andrew R Stevens
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Ramesh Chelvarajah
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, United Kingdom; College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Tonny Veenith
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Anaesthesia and Critical Care, University Hospitals Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Antonio Belli
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - David J Davies
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Stevens AR, Branstetter BF, Gardner P, Pearce TM, Zenonos GA, Arani K. Ecchordosis Physaliphora: Does It Even Exist? AJNR Am J Neuroradiol 2023; 44:889-893. [PMID: 37442592 PMCID: PMC10411852 DOI: 10.3174/ajnr.a7932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023]
Abstract
The term ecchordosis physaliphora (EP) has been used historically to describe a benign notochordal remnant with no growth potential, most commonly occuring in the central clivus. Unfortunately, the radiologic appearance of EP overlaps considerably with the appearance of low-grade chordomas, which do have the potential for growth. In this article, we review new pathologic terminology that better describes this family of diseases, and we propose new radiologic terms that better address the uncertainty of the radiologic diagnosis. The surgical importance of accurate terminology and the implications for patient care are discussed.
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Affiliation(s)
- A R Stevens
- From the Lake Erie College of Osteopathic Medicine (A.R.S.), Erie, Pennsylvania
| | - B F Branstetter
- Departments of Radiology (B.F.B., K.A.)
- Otolaryngology (B.F.B.)
| | | | - T M Pearce
- Pathology (T.M.P.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - K Arani
- Departments of Radiology (B.F.B., K.A.)
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Stevens AR, Gilbody H, Greig J, Usuah J, Alagbe B, Preece A, Soon WC, Chowdhury YA, Toman E, Chelvarajah R, Veenith T, Belli A, Davies DJ. Cerebrospinal Fluid Diversion for Refractory Intracranial Hypertension in Traumatic Brain Injury: A Single Center Experience. World Neurosurg 2023; 176:e265-e272. [PMID: 37207724 DOI: 10.1016/j.wneu.2023.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/27/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Diversion of cerebrospinal fluid (CSF) is a common neurosurgical procedure for control of intracranial pressure (ICP) in the acute phase after traumatic brain injury (TBI), where medical management is insufficient. CSF can be drained via an external ventricular drain (EVD) or, in selected patients, via a lumbar (external lumbar drain [ELD]) drainage catheter. Considerable variability exists in neurosurgical practice on their use. METHODS A retrospective service evaluation was completed for patients receiving CSF diversion for ICP control after TBI, from April 2015 to August 2021. Patients were included whom fulfilled local criteria deeming them suitable for either ELD/EVD. Data were extracted from patient notes, including ICP values pre/postdrain insertion and safety data including infection or clinically/radiologically diagnosed tonsillar herniation. RESULTS Forty-one patients were retrospectively identified (ELD = 30 and EVD = 11). All patients had parenchymal ICP monitoring. Both modalities affected statistically significant decreases in ICP, with relative reductions at 1, 6, and 24 hour pre/postdrainage (at 24-hour ELD P < 0.0001, EVD P < 0.01). Similar rates of ICP control failure, blockage and leak occurred in both groups. A greater proportion of patients with EVD were treated for CSF infection than with ELD. One event of clinical tonsillar herniation is reported, which may have been in part attributable to ELD overdrainage, but which did not result in adverse outcome. CONCLUSIONS The data presented demonstrate that EVD and ELD can be successful in ICP control after TBI, with ELD limited to carefully selected patients with strict drainage protocols. The findings support prospective study to formally determine the relative risk-benefit profiles of CSF drainage modalities in TBI.
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Affiliation(s)
- Andrew R Stevens
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, UK; National Institute of Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC), University Hospitals Birmingham, Edgbaston, Birmingham, UK; Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Helen Gilbody
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Julian Greig
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - John Usuah
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, UK
| | - Basit Alagbe
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, UK
| | - Anne Preece
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, UK
| | - Wai Cheong Soon
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, UK
| | - Yasir A Chowdhury
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, UK
| | - Emma Toman
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, UK; National Institute of Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC), University Hospitals Birmingham, Edgbaston, Birmingham, UK
| | - Ramesh Chelvarajah
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, UK; College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Tonny Veenith
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, UK; Department of Anaesthesia and Critical Care, University Hospitals Birmingham, Edgbaston, Birmingham, UK
| | - Antonio Belli
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, UK; National Institute of Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC), University Hospitals Birmingham, Edgbaston, Birmingham, UK; Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, UK
| | - David J Davies
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, UK; National Institute of Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC), University Hospitals Birmingham, Edgbaston, Birmingham, UK; Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, UK
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Stevens AR, Soon W, Chowdhury YA, Toman E, Yim S, Veenith T, Chelvarajah R, Belli A, Davies D. External Lumbar Drainage for Refractory Intracranial Hypertension in Traumatic Brain Injury: A Systematic Review. Cureus 2022; 14:e30033. [PMID: 36348893 PMCID: PMC9637378 DOI: 10.7759/cureus.30033] [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] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Considerable variation exists in the clinical practice of cerebrospinal fluid diversion for medically refractory intracranial hypertension in patients with acute traumatic brain injury (TBI), which is achievable via lumbar or ventricular drainage. This systematic review sought to compile the available evidence for the efficacy and safety of the use of lumbar drains for intracranial pressure (ICP) control. A systematic review of the literature was performed with the search and data extraction performed by two reviewers independently in duplicate. Nine independent studies were identified, enrolling 230 patients, 159 with TBI. Efficacy for ICP control was observed across all studies, with immediate and sustained effect, reducing medical therapy requirements. Lumbar drainage with medical therapy appears effective when used alone and as an adjunct to ventricular drainage. Safety reporting varied in quality. Clinical or radiological incidents of cerebral herniation (with an unclear relationship to lumbar drainage) were observed in 14/230 patients resulting in one incident of morbidity without adverse patient outcome. The available data is generally poor in quality and volume, but supportive of the efficacy of lumbar drainage for ICP control. Few reports of adverse outcomes are suggestive of, but are insufficient to confirm, the safety of use in the appropriate patient and clinical setting. Further large prospective observational studies are required to generate sufficient support of an acceptable safety profile.
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Chowdhury YA, Stevens AR, Soon WC, Toman E, Veenith T, Chelvarajah R, Belli A, Davies D. Cerebrospinal Fluid Diversion for Refractory Intracranial Hypertension: A United Kingdom and Ireland Survey on Practice Variation. Cureus 2022; 14:e25877. [PMID: 35836457 PMCID: PMC9275783 DOI: 10.7759/cureus.25877] [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] [Accepted: 06/12/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Diversion of cerebrospinal fluid (CSF) in a traumatic brain injury (TBI) is an established means for achieving control of intracranial pressure (ICP), aimed at improving intracranial homeostasis. The literature and anecdotal reports suggest a variation in practice between neurosurgical centres internationally, with current guidelines advocating ventricular drainage over lumbar drainage. We sought to establish the current neurosurgical practice in the United Kingdom regarding the methods of ICP control in TBI. Methods A 20-point survey was distributed electronically to British and Irish neurosurgeons after ratification by the Society of British Neurological Surgeons. Questions were directed at the clinician’s opinion and experience of lumbar drain usage in patients with TBI: frequency, rationale, and experience of complications. Questions on lumbar drain usage in neurovascular patients were asked for practice comparison. Results Thirty-six responses from 21 neurosurgical centres were returned. Twenty-three per cent (23%) of responders reported using lumbar drains for refractory ICP in TBI patients: six units use lumbar drains and 15 do not. Three units showed partial usage, with mixed “yes/no” responses between consultants. Concerns of tonsillar herniation and familiarity with EVD were commonly given reasons against the usage of lumbar drains. Fifty-six per cent (56%) reported use in neurovascular patients. Conclusion This contemporary practice survey demonstrates mixed practice across the UK and within some centres. Responses and survey feedback demonstrate that the use of lumbar drains in TBI is a polarising topic. The variety of practice between and within neurosurgical units supports consideration of the prospective study of CSF diversion methods for control of refractory ICP in patients with TBI.
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Stevens AR, Stickland CA, Harris G, Ahmed Z, Goldberg Oppenheimer P, Belli A, Davies DJ. Raman Spectroscopy as a Neuromonitoring Tool in Traumatic Brain Injury: A Systematic Review and Clinical Perspectives. Cells 2022; 11:1227. [PMID: 35406790 PMCID: PMC8997459 DOI: 10.3390/cells11071227] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 03/17/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 12/22/2022] Open
Abstract
Traumatic brain injury (TBI) is a significant global health problem, for which no disease-modifying therapeutics are currently available to improve survival and outcomes. Current neuromonitoring modalities are unable to reflect the complex and changing pathophysiological processes of the acute changes that occur after TBI. Raman spectroscopy (RS) is a powerful, label-free, optical tool which can provide detailed biochemical data in vivo. A systematic review of the literature is presented of available evidence for the use of RS in TBI. Seven research studies met the inclusion/exclusion criteria with all studies being performed in pre-clinical models. None of the studies reported the in vivo application of RS, with spectral acquisition performed ex vivo and one performed in vitro. Four further studies were included that related to the use of RS in analogous brain injury models, and a further five utilised RS in ex vivo biofluid studies for diagnosis or monitoring of TBI. RS is identified as a potential means to identify injury severity and metabolic dysfunction which may hold translational value. In relation to the available evidence, the translational potentials and barriers are discussed. This systematic review supports the further translational development of RS in TBI to fully ascertain its potential for enhancing patient care.
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Affiliation(s)
- Andrew R. Stevens
- Neuroscience, Trauma and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; (Z.A.); (A.B.); (D.J.D.)
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - Clarissa A. Stickland
- School of Chemical Engineering, University of Birmingham, Birmingham B15 2TT, UK; (C.A.S.); (G.H.); (P.G.O.)
| | - Georgia Harris
- School of Chemical Engineering, University of Birmingham, Birmingham B15 2TT, UK; (C.A.S.); (G.H.); (P.G.O.)
| | - Zubair Ahmed
- Neuroscience, Trauma and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; (Z.A.); (A.B.); (D.J.D.)
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham, Birmingham B15 2TH, UK
- Centre for Trauma Science Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Pola Goldberg Oppenheimer
- School of Chemical Engineering, University of Birmingham, Birmingham B15 2TT, UK; (C.A.S.); (G.H.); (P.G.O.)
| | - Antonio Belli
- Neuroscience, Trauma and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; (Z.A.); (A.B.); (D.J.D.)
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham, Birmingham B15 2TH, UK
- Centre for Trauma Science Research, University of Birmingham, Birmingham B15 2TT, UK
| | - David J. Davies
- Neuroscience, Trauma and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; (Z.A.); (A.B.); (D.J.D.)
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham, Birmingham B15 2TH, UK
- Centre for Trauma Science Research, University of Birmingham, Birmingham B15 2TT, UK
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Davies DJ, Hadis M, Di Pietro V, Lazzarino G, Forcione M, Harris G, Stevens AR, Soon WC, Goldberg Oppenheimer P, Milward M, Belli A, Palin WM. Photobiomodulation reduces hippocampal apoptotic cell death and produces a Raman spectroscopic “signature”. PLoS One 2022; 17:e0264533. [PMID: 35239693 PMCID: PMC8893683 DOI: 10.1371/journal.pone.0264533] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/11/2022] [Indexed: 11/18/2022] Open
Abstract
Apoptotic cell death within the brain represents a significant contributing factor to impaired post-traumatic tissue function and poor clinical outcome after traumatic brain injury. After irradiation with light in the wavelength range of 600–1200 nm (photobiomodulation), previous investigations have reported a reduction in apoptosis in various tissues. This study investigates the effect of 660 nm photobiomodulation on organotypic slice cultured hippocampal tissue of rats, examining the effect on apoptotic cell loss. Tissue optical Raman spectroscopic changes were evaluated. A significantly higher proportion of apoptotic cells 62.8±12.2% vs 48.6±13.7% (P<0.0001) per region were observed in the control group compared with the photobiomodulation group. After photobiomodulation, Raman spectroscopic observations demonstrated 1440/1660 cm-1 spectral shift. Photobiomodulation has the potential for therapeutic utility, reducing cell loss to apoptosis in injured neurological tissue, as demonstrated in this in vitro model. A clear Raman spectroscopic signal was observed after apparent optimal irradiation, potentially integrable into therapeutic light delivery apparatus for real-time dose metering.
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Affiliation(s)
- David J. Davies
- Department of Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham’ Edgbaston, Birmingham, United Kingdom
- * E-mail:
| | - Mohammed Hadis
- Photobiology Research Group, School of Dentistry, College of Medical and Dental Science, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Valentina Di Pietro
- Department of Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Giuseppe Lazzarino
- Department of Chemical Sciences, Laboratory of Biochemistry, University of Catania, Catania, Italy
| | - Mario Forcione
- Department of Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham’ Edgbaston, Birmingham, United Kingdom
| | - Georgia Harris
- Faculty of Chemical and Biological Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Andrew R. Stevens
- Department of Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham’ Edgbaston, Birmingham, United Kingdom
| | - Wai Cheong Soon
- Department of Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Pola Goldberg Oppenheimer
- Faculty of Chemical and Biological Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Michael Milward
- Photobiology Research Group, School of Dentistry, College of Medical and Dental Science, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Antonio Belli
- Department of Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham’ Edgbaston, Birmingham, United Kingdom
| | - William M. Palin
- Photobiology Research Group, School of Dentistry, College of Medical and Dental Science, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
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Stevens AR, Ahmed U, Vigneswara V, Ahmed Z. Pigment Epithelium-Derived Factor Promotes Axon Regeneration and Functional Recovery After Spinal Cord Injury. Mol Neurobiol 2019; 56:7490-7507. [PMID: 31049830 PMCID: PMC6815285 DOI: 10.1007/s12035-019-1614-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/15/2019] [Indexed: 12/14/2022]
Abstract
Although neurons in the adult mammalian CNS are inherently incapable of regeneration after injury, we previously showed that exogenous delivery of pigment epithelium-derived factor (PEDF), a 50-kDa neurotrophic factor (NTF), promoted adult retinal ganglion cell neuroprotection and axon regeneration. Here, we show that PEDF and other elements of the PEDF pathway are highly upregulated in dorsal root ganglion neurons (DRGN) from regenerating dorsal column (DC) injury paradigms when compared with non-regenerating DC injury models. Exogenous PEDF was neuroprotective to adult DRGN and disinhibited neurite outgrowth, whilst overexpression of PEDF after DC injury in vivo promoted significant DC axon regeneration with enhanced electrophysiological, sensory, and locomotor function. Our findings reveal that PEDF is a novel NTF for adult DRGN and may represent a therapeutically useful factor to promote functional recovery after spinal cord injury.
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Affiliation(s)
- Andrew R Stevens
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, Robert Aitken Institute of Clinical Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Umar Ahmed
- King Edward VI Camp Hill School for Boys, Vicarage Road, Kings Heath, Birmingham, B14 7QJ, UK
| | - Vasanthy Vigneswara
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, Robert Aitken Institute of Clinical Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Zubair Ahmed
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, Robert Aitken Institute of Clinical Research, University of Birmingham, Birmingham, B15 2TT, UK.
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Stevens AR, Ng IHX, Helmy A, Hutchinson PJA, Menon DK, Ercole A. Glucose Dynamics of Cortical Spreading Depolarization in Acute Brain Injury: A Systematic Review. J Neurotrauma 2019; 36:2153-2166. [PMID: 30700219 DOI: 10.1089/neu.2018.6175] [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: 12/13/2022] Open
Abstract
Cortical spreading depolarization (CSD) is an emerging mode of secondary neuronal damage in acute brain injury (ABI). Subsequent repolarisation is a metabolic process requiring glucose. Instances of CSD and glucose derangement are both linked to poor neurological outcome, but their causal inter-relationship is not fully defined. This systematic review seeks to evaluate the available human evidence studying CSD and glucose to further understand their dynamic relationship. We conducted a systematic review of studies examining CSD through electrocorticography and cerebral/systemic glucose concentrations in ABI, excluding animal studies. The search yielded 478 articles, of which 13 were eligible. Across 10 manuscripts, 125 patients received simultaneous monitoring, with 1987 CSD episodes observed. Eight of 10 studies observed correlation between CSD and glucose change. Seven of eight studies observed possible cumulative effect of recurrent CSD on glucose derangement and two identified correlation between glycopenia and incidence of CSD. These findings confirm a relationship between CSD and glucose, and suggest it may be cyclical, where CSD causes local glycopenia, which may potentiate further CSD. Positive observations were not common to all studies, likely due to differing methodology or heterogeneity in CSD propensity. Further study is required to delineate the utility of the clinical modulation of serum and cerebral glucose to alter the propensity for CSD following brain injury.
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Affiliation(s)
- Andrew R Stevens
- 1 Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Isabel H X Ng
- 1 Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Adel Helmy
- 2 Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Peter J A Hutchinson
- 2 Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - David K Menon
- 1 Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ari Ercole
- 1 Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
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Silva AHD, Stevens AR, Joseph J, Albanese E. Multifocal Infratentorial Pilocytic Astrocytoma in an Adult Patient. World Neurosurg 2019; 128:230-233. [PMID: 31082554 DOI: 10.1016/j.wneu.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pilocytic astrocytoma is a benign glial tumor typically presenting in children. It is rare for adults to present with pilocytic astrocytoma and even less likely to manifest with multiple foci of lesions especially in nonoptic or hypothalamic locations. CASE DESCRIPTION Our patient was a 37-year old man presenting with varied cranial neuropathies, cerebellar dysfunction, and long tract signs, with imaging demonstrating 3 discrete ill-defined contrast-enhancing lesions affecting the cerebellar peduncles, brainstem, and cervicomedullary junction. Neuronavigation-guided biopsy confirmed World Health Organization grade 1 pilocytic astrocytoma; the patient was treated with radiotherapy. CONCLUSIONS To our knowledge, we believe this is the first reported case with multifocal infratentorial pilocytic astrocytoma on presentation in an adult patient in the absence of a prior history of associated risk factors such as neurofibromatosis 1 or chemoradiotherapeutic intervention.
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Affiliation(s)
- Adikarige H D Silva
- Department of Neurosurgery, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, UK
| | - Andrew R Stevens
- Department of Neurosurgery, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, UK
| | - Jooly Joseph
- Department of Neurosurgery, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, UK
| | - Erminia Albanese
- Department of Neurosurgery, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, UK.
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Asif H, Craven C, Shah SN, Thompson SD, Chari A, Matloob SA, Patel NA, Dyson EW, Haylock-Vize P, Stevens AR, Chan HW, Ekanayake J, Mostafa T, Toma AK, Watkins LD. Intracranial pressure and venous sinus pressure gradients: what happens 3 months after stenting? Fluids Barriers CNS 2015. [PMCID: PMC4582203 DOI: 10.1186/2045-8118-12-s1-o65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Chari A, Dyson EW, Stevens AR, Thompson SD, Craven C, Matloob SA, Chan H, Shah SN, Mostafa T, Patel NA, Ekanayake J, Haylock-Vize P, Toma AK, Watkins LD. Three-hundred cases of Spiegelberg ICP monitoring for hydrocephalus and CSF disorders: the Queen Square experience. Fluids Barriers CNS 2015. [PMCID: PMC4582359 DOI: 10.1186/2045-8118-12-s1-o14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Craven C, Patel NA, Matloob SA, Dyson EW, Chari A, Mostafa T, Thompson SD, Haylock-Vize P, Shah SN, Stevens AR, Chan H, Ekanayake J, Toma AK, Watkins LD. Differential compartment overdrainage syndrome. Fluids Barriers CNS 2015. [PMCID: PMC4582799 DOI: 10.1186/2045-8118-12-s1-p9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Craven C, Patel NA, Khan AA, Thompson SD, Dyson EW, Matloob SA, Chari A, Haylock-Vize P, Shah SN, Stevens AR, Mostafa T, Chan H, Ekanayake J, Toma AK, Watkins LD. Persistent CSF leak post spinal surgery and cerebrospinal fluid dynamic disturbances: cause or consequence? Fluids Barriers CNS 2015. [PMCID: PMC4582218 DOI: 10.1186/2045-8118-12-s1-p11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Chan H, Haylock-Vize P, Dyson E, Chari A, Craven C, Matloob SA, Patel NA, Thompson SD, Shah SN, Stevens AR, Ekanayake J, Toma AK, Watkins L. Cerebrospinal fluid biomarkers in patients with idiopathic normal pressure hydrocephalus with temporary response to shunt insertion. Fluids Barriers CNS 2015. [PMCID: PMC4582316 DOI: 10.1186/2045-8118-12-s1-p7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Craven C, Patel NA, Asif H, Chari A, Dyson EW, Matloob SA, Haylock-Vize P, Thompson SD, Shah SN, Stevens AR, Mostafa T, Chan H, Ekanayake J, Toma AK, Watkins LD. Shunt assistant device deception due to pseudovertical posturing. Fluids Barriers CNS 2015. [PMCID: PMC4582703 DOI: 10.1186/2045-8118-12-s1-p10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
The results of our studies indicated that the avirulent Neff strain of Acanthamoeba was more susceptible to the activity of the anti-metabolite 5-fluorocytosine (5-FC) than was the virulent A-1 strain or a mouse brain reisolate of this strain, designated A-3. Results of competition experiments in which cultures were exposed simultaneously to 5-FC and either uracil, thymidine, or both uracil and thymidine demonstrated that the drug was directed against both deoxyribonucleic acid and ribonucleic acid in the avirulent strain, whereas ribonucleic acid was mainly affected in the virulent amebas. Concentrations >10 mug of 5-FC per ml were amebicidal to the avirulent strain; lower concentrations of the drug, which only affected growth slightly, significantly impaired the capacity of the cells to spontaneously encyst in stationary-phase cultures. On the other hand, the virulent strains were capable of growing in the presence of 5-FC (40 mug/ml) after an initial period of susceptibility. After a few transfers in growth medium lacking the drug, 5-FC-treated virulent amebas exhibited growth parameters typical of untreated cells. However, after successive subcultures in drug-free medium, 5-FC-treated cells lost their resistance and were again susceptible to the drug. This result suggested that the capacity of the cells to develop resistance resulted from a drug-induced mechanism. Spontaneous encystment, which was normally minimal in stationary-phase A-1 or A-3 cultures, was enhanced in A-3 but not A-1 cultures treated with 5-FC (>30 mug/ml). Results obtained from experiments to determine the effectiveness of 5-FC in protecting mice experimentally infected with either A-1 or A-3 amebas indicated that the clinical usefulness of 5-FC may be limited by the capacity of the amebas to develop resistance.
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Stevens AR. Collaboration and data sharing. Science 1995; 270:1741. [PMID: 8525356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Simpson CF, Willaert E, Neal FC, Stevens AR, Young MD. Experimental Naegleria fowleri meningoencephalitis in sheep: light and electron microscopic studies. Am J Vet Res 1982; 43:154-7. [PMID: 7091810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A sheep infected intranasally with Naegleria fowleri of human origin died 7 days after inoculation. The olfactory lobes were distinctly soft and friable. Histologic findings indicated suppurative leptomeningitis and hemorrhagic necrosis in the olfactory lobes. Protozoa were disseminated in the necrotic areas, particularly in perivascular locations; vasculitis was also observed. Meningitis and perivascular cuffing with lymphocytes were evident in the cerebrum, cerebellum, pons, medulla, and cervical spinal cord. Electron microscopy disclosed trophozoites only in the olfactory lobes. The amebae contained a central nucleus with a distinct, electron-dense nucleolus. The cytoplasm contained myelinated figures, lipid-like vacuoles, open vesicles, electron-dense granules, mitochondria, numerous free ribosomes, scant rough endoplasmic reticulum, and occasionally a phagocytized erythrocyte. Trophozoites were grouped close to arterioles, except when phagocytized by a neutrophil or endothelial cell.
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Ma P, Willaert E, Juechter KB, Stevens AR. A case of keratitis due to Acanthamoeba in New York, New York, and features of 10 cases. J Infect Dis 1981; 143:662-7. [PMID: 6972421 DOI: 10.1093/infdis/143.5.662] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A man in New York, New York, contracted keratitis caused by Acanthamoeba castellanii. The diagnosis was delayed because amoebae were not initially suspected as the infectious organism. The culture isolate and the amoebae in corneal sections were identified as A. castellanii by immunofluorescence using antiserum to plasma membranes of this species. With the rapid agar disk diffusion method, the amoebae were shown to e susceptible to pimaricin (0.5%) and resistant to greater than 1,000-micrograms/ml levels of paromomycin, polymyxin B-bacitracin-neomycin, acriflavine, 5-fluorocytosine, amphotericin B, gentamicin, and trimethoprim-sulfamethoxazole. The infection responded to treatment with pimaricin administered with several other drugs. This infection is the eighth case reported in the literature of acanthamoebic keratitis and emphasizes the need for clinicians to consider acanthamoebic infection in the differential diagnosis of eye infections that fail to respond to bacterial, fungal, and viral therapy.
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Stevens AR, Shulman ST, Lansen TA, Cichon MJ, Willaert E. Primary amoebic meningoencephalitis: a report of two cases and antibiotic and immunologic studies. J Infect Dis 1981; 143:193-9. [PMID: 7217717 DOI: 10.1093/infdis/143.2.193] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
In the summer of 1978, two children who had recently been swimming in freshwater lakes in Florida died from primary amoebic meningoencephalitis. Despite early and intensive treatment with amphotericin B, both patients died three to five days after the onset of illness. Amoebae were observed in wet preparations of cerebrospinal fluid and in sections of cerebral tissue and were identified as Naegleria fowleri by the indirect immunofluorescent antibody technique. The amoebae were highly virulent in mice. The isolate of N. fowleri was extremely sensitive in vitro to amphotericin B (minimal inhibitory concentration [MIC], 0.15 microgram/ml), somewhat sensitive to miconazole (MIC, 25 micrograms/ml), and resistant to rifampin (MIC, less than or equal to 100 micrograms/ml). Treatment with amphotericin B (7.5 mg/kg of body weight per day) administered intraperitoneally protected 60% of the mice. Lower doses of amphotericin B alone or in combination with miconazole (100 mg/kg) or rifampin (220 mg/kg) were not protective. These results suggest that amphotericin B remains the single effective agent in treatment of primary amoebic meningoencephalitis.
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Abstract
A strain of Naegleria fowleri, isolated from a child who died of primary amebic meningoencephalitis in Florida, was instilled in the nostrils of a sheep to determine whether livestock are susceptible to infection with free-living amebae. The animal died 7 days later from amebic infection of the central nervous system. N. fowleri were recovered from the brain and spinal cord of the animal. A control, saline-instilled sheep that had been pair-caged with the infected animal remained healthy.
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Abstract
Trophozoites and cysts of amebas were found within the necrotic cornea of an enucleated eye. The organism was identified, by indirect immunofluorescent staining using specific antiserum, to be Acanthamoeba castellani. This case report illustrates the difficulty of clinical diagnosis and typical inefficacy of medical therapy shown in other reports of this rare keratitis.
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Stevens AR, De Jonckheere J, Willaert E. Naegleria lovaniensis new species: isolation and identification of six thermophilic strains of a new species found in association with Naegleria fowleri. Int J Parasitol 1980; 10:51-64. [PMID: 6989774 DOI: 10.1016/0020-7519(80)90064-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
An environmental Naegleria isolate, from a cooling lake receiving thermal additions from an electric power plant, caused both primary amoebic meningoencephalitis (PAM) and pneumonitis in mice after intranasal inoculation. Amoebae, recovered from brains and lungs of mice inoculated with the environmental isolate, produced both brain and lung infections in repeated mouse passages. Electron microscope examination of infected lungs revealed a moderate inflammatory reaction with slight necrosis. Amoebae re-isolated from mice with PAM and pneumonitis were identified as N. fowleri by the indirect immuno-fluorescent antibody technique using anti-N. fowleri serum. The results suggest that in addition to PAM, N. fowleri may be capable of causing subacute and acute respiratory infections in man.
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Willaert E, Stevens AR, Healy GR. Retrospective identification of Acanthamoeba culbertsoni in a case of amoebic meningoencephalitis. J Clin Pathol 1978; 31:717-20. [PMID: 357454 PMCID: PMC1145394 DOI: 10.1136/jcp.31.8.717] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acanthamoeba culbertsoni was identified retrospectively in a case of amoebic meningoencephalitis, previously reported by Jager and Stamm (Lancet, 2, 1343, 1972). This is the second report of this species causing secondary infection in man. Positive results were obtained only with anti-A. culbertsoni sera when the brain sections were stained by the indirect immunofluorescence antibody test with various antisera produced against different Acanthamoeba species. Antiserum raised against purified plasma membranes of A. culbertsoni showed once more its highly specific diagnostic value.
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Abstract
A new species of Acanthamoeba was isolated from a culture of an established line of human choriocarcinoma cells. The identification of this strain, originally called the Oak Ridge strain, and the establishment of a new species for it were based on morphologic, serologic, and immunochemical studies. In general, the structure of the trophozoite did not differ significantly from that of other species of Acanthamoeba, except that a body which more closely resembled a centriole than material described previously as centriolar satellites was observed in trophozoites examined with the electron microscope. The dimensions of the trophozoite were the smallest among the species of Acanthamoeba. The cyst was typical of the genus, but differed from those of other species by its smaller size and the presence of numerous ostioles. Studies of the Oak Ridge strain by immunofluorescence using antisera developed against the isolate and Acanthamoeba culbertsoni, A. castellanii, A. polyphaga, A. rhysodes, A. astronyxis, and A. palestinensis revealed the antigenic uniqueness of the Oak Ridge strain. It was demonstrated by immunoelectrophoretic analyses of the soluble proteins of the Oak Ridge strain that shared approximately 1/2 of its antigenic structure with A. castellanii and A. culbertsoni. The antigenic differences of the isolate from other species of Acanthamoeba were deduced from comparison of the antigenic constitution of these species and the Oak Ridge strain with A. culbertsoni and A. castellanii. Although the strain was initially recognized by its cytopathogenicity for cultures, it did not produce acute infections in mice after intranasal inoculation of 1 X 10(4) ameba/mouse. The foregoing results constituted the basis for the establishment of the Oak Ridge strain as a new species, A. royreba sp. n., in the genus Acanthamoeba.
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Stevens AR, Tyndall RL, Coutant CC, Willaert E. Isolation of the etiological agent of primary amoebic meningoencephalitis from artifically heated waters. Appl Environ Microbiol 1977; 34:701-5. [PMID: 596872 PMCID: PMC242733 DOI: 10.1128/aem.34.6.701-705.1977] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
To determine whether artificial heating of water by power plant discharges facilitates proliferation of the pathogenic free-living amoebae that cause primary amoebic meningoencephalitis, water samples (250 ml) were taken from discharges within 3,000 feet (ca. 914.4 m) of power plants and were processed for amoeba culture. Pathogenic Naegleria fowleri grew out of water samples from two of five lakes and rivers in Florida and from one of eight man-made lakes in Texas. Pathogenic N. fowleri did not grow from water samples taken from cooling towers and control lakes, the latter of which had no associated power plants. The identification of N. fowleri was confirmed by pathogenicity in mice and by indirect immunofluorescence analyses, by using a specific antiserum.
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Stevens AR, Kilpatrick T, Willaert E, Capron A. Serologic analyses of cell-surface antigens of Acanthamoeba spp. with plasma membrane antisera. J Protozool 1977; 24:316-24. [PMID: 328866 DOI: 10.1111/j.1550-7408.1977.tb00986.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Stevens AR, Stein S. Analyses of Pathogenic and nonpathogenic Acanthamoeba and Naegleria for lectin-induced agglutination. J Parasitol 1977; 63:151-2. [PMID: 845725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Willaert E, Stevens AR. Indirect immunofluorescent identification of Acanthamoeba causing meningoencephalitis. Pathol Biol (Paris) 1976; 24:UNKNOWN. [PMID: 790277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The majority of primary amoebic meningoencephalitis cases in man have been caused by Naegleria, although three new cases have been identified due to Acanthamoeba. These cases showed a somewhat chronic course and death occurred 2 to 6 weeks after onset. The etiological agent in two cases was identified as belonging to the group of A. castellanii and the third case was identified as due to A. culbertsoni. The identification was performed post-mortem.
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Willaert E, Stevens AR. Immunoassays of Acanthamoeba castellanii plasma membranes. Preliminary results. Pathol Biol (Paris) 1976; 24:89-91. [PMID: 818599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
To facilitate future diagnosis of Acanthamoeba infections in man, studies have been initiated to elicit antibodies to purified membranes from Acanthamoeba species. Specifically in this communication, preliminary results are reported on A. castellanii. Immunoprecipitation and immunofluorescent analyses suggest that the membrane antisera may allow specific identification at the species level and possibly strain identification.
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Abstract
Differentiation of Acanthamoeba castellanii into dormant cysts occurs spontaneously in stationary phase cultures, or can be induced experimentally by starvation. Although no further increase in cell density occurred after induction in either case, incorporation of [H]thymidine into DNA continued at a reduced rate through the period when differentiated products (cyst wall components) were formed. No net accumulation of DNA occurred during differentiation, indicating that the DNA synthesis occurring at this time was balanced by breakdown. When either 5-fluorodeoxyuridine (FUdR) or hydroxyurea was added to exponentially growing cultures, growth was terminated and the subsequent spontaneous encystment was delayed in comparison with untreated stationary phase cultures. A similar delay was observed for experimentally induced encystment of FUdR-pretreated cells. In all cases, delay of encystment was correlated with inhibition of 32PO4 incorporation into DNA, and unexpectedly also into RNA. Addition of FUdR at zero-time of experimental induction of cells not previously exposed to FUdR, on the other hand, had no effect on encystment or on 32PO4 incorporation. The delay of encystment produced by FUdR and hydroxyurea, therefore, appeared to reflect a requirement for normal synthesis of DNA and/or RNA not only during encystment, but also during the period of exponential growth just before encystment induction.
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Stevens AR, O'Dell WD. In vitro growth and virulence of Acanthamoeba. J Parasitol 1974; 60:884-5. [PMID: 4279280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Roti-Roti LW, Stevens AR. Effect of 5-bromodeoxyuridine on growth, encystment, and excystment of Acanthamoeba castellanii. J Biophys Biochem Cytol 1974; 61:233-7. [PMID: 4274263 PMCID: PMC2109253 DOI: 10.1083/jcb.61.1.233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Stevens AR, O'Dell WD. The influence of growth medium on axenic cultivation of virulent and avirulent Acanthamoeba. Proc Soc Exp Biol Med 1973; 143:474-8. [PMID: 4709012 DOI: 10.3181/00379727-143-37346] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
Alterations in transcription that precede and accompany encystment (E) of suspension grown A. castellanii have been investigated. Comparative studies were performed on cells undergoing spontaneous E in high density stationary phase cultures or after experimental induction of E at low cell densities by deprivation of nutrients in exponential growth. Onset of growth deceleration at high cell densities was accompanied by an increase in the cellular RNA. The maximum RNA content occurred in cells at stationary phase and subsequently declined with the appearance of cysts in the cultures. On the contrary, the RNA content in cells whose growth was immediately terminated by experimental E induction remained at a constant exponential level through 5 h postinduction and then began to decline shortly before the appearance of cysts. The mature cyst formed in stationary phase cultures and after experimental E induction contained an equivalent amount of RNA ( approximately 50% of the exponential value). Comparison of the kinetics of [(3)H]uridine incorporation demonstrated that there was an abrupt reduction in the rate of uridine incorporation into RNA with onset of growth deceleration or after growth termination in experimental E induction. The reduced incorporation of uridine into RNA could not be attributed to to a reduced uptake of the isotope by the cells or an altered capacity of the cells to phosphorylate uridine. Uridine continued to be incorporated into RNA at a reduced rate in cells throughout growth deceleration, in stationary phase, and up to 12 h postexperimental induction. Considered together, these results indicate that a buildup in RNA is not necessary for induction of encystment in acanthamoeba. The accumulated RNA in stationary phase cells appears to be due to the greater reduction in the growth rate than in transcription and the absence of RNA turnover in cells during growth deceleration. Initiation of RNA turnover appears to accompany growth termination and induction of E. The results further demonstrate that the regulation of the rate of transcription is closely coordinated with the control of growth and encystment in acanthamoeba.
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Abstract
A strain of Naegleria gruberi, isolated from a Vero cell culture and designated TS-1, was axenically cultivated in monolayer and mass aerating suspension culture. Cultural conditions for constant growth parameters and high-exponential cell densities were defined. Serum or other supplemented fractions were found essential in both Trypticase-yeast extract-glucose (TYG) and Casitone (CAS)-based media. Monolayer cultures grown in the CAS medium required lower levels of serum to reach maximum stationary densities of amoebae than cultures grown in the TYG medium. Heat-killed (121 C, 10 min) whole cell and cell lysate bacterial fractions were capable of replacing the serum in both the TYG and CAS media. Heat-killed bacterial fractions provided the same levels of growth as attained with serum in TYG medium, whereas the bacterial lysate supported only minimal growth in the same medium. In the CAS medium, both bacterial fractions resulted in the same level of growth which was equal to that obtained in reduced serum content. Strain TS-1 was established in suspension culture with the CAS medium used in monolayer culture. The addition of sheep red blood cells (RBC) or RBC lysate greatly enhanced growth responses. Further modifications resulted in a final medium for suspension culture consisting of Casitone-yeast extract-glucose-vitamin base, supplemented with serum and RBC lysate. This medium supported growth with a mean generation time of 9 h at 30 C and a stationary phase yield of greater than 5 x 10(6) amoebae per ml.
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Abstract
The dependence of nucleolar reformation on RNA synthesis that resumes in late anaphase or early telophase has been investigated in synchronously dividing Amoeba proteus. RNA synthesis was completely inhibited throughout all stages of mitosis and the early hours of interphase with high concentrations of actinomycin D. In such cells, nucleolus-like bodies that bind azure B and pyronin were apparent in the reformed nuclei. The bodies appear as dense, fibrous masses with loosely associated, finely fibrillar material. There are no characteristic granular regions in the reformed structures. It is suggested that the bodies probably represent mainly nucleolar protein and residual RNA which can bring about the reorganization of nucleoli in the absence of postmitotic RNA synthesis.
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