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Cole EJ, Phillips AL, Bentzley BS, Stimpson KH, Nejad R, Barmak F, Veerapal C, Khan N, Cherian K, Felber E, Brown R, Choi E, King S, Pankow H, Bishop JH, Azeez A, Coetzee J, Rapier R, Odenwald N, Carreon D, Hawkins J, Chang M, Keller J, Raj K, DeBattista C, Jo B, Espil FM, Schatzberg AF, Sudheimer KD, Williams NR. Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. Am J Psychiatry 2022; 179:132-141. [PMID: 34711062 DOI: 10.1176/appi.ajp.2021.20101429] [Citation(s) in RCA: 183] [Impact Index Per Article: 91.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depression is the leading cause of disability worldwide, and half of patients with depression have treatment-resistant depression. Intermittent theta-burst stimulation (iTBS) is approved by the U.S. Food and Drug Administration for the treatment of treatment-resistant depression but is limited by suboptimal efficacy and a 6-week duration. The authors addressed these limitations by developing a neuroscience-informed accelerated iTBS protocol, Stanford neuromodulation therapy (SNT; previously referred to as Stanford accelerated intelligent neuromodulation therapy, or SAINT). This protocol was associated with a remission rate of ∼90% after 5 days of open-label treatment. Here, the authors report the results of a sham-controlled double-blind trial of SNT for treatment-resistant depression. METHODS Participants with treatment-resistant depression currently experiencing moderate to severe depressive episodes were randomly assigned to receive active or sham SNT. Resting-state functional MRI was used to individually target the region of the left dorsolateral prefrontal cortex most functionally anticorrelated with the subgenual anterior cingulate cortex. The primary outcome was score on the Montgomery-Åsberg Depression Rating Scale (MADRS) 4 weeks after treatment. RESULTS At the planned interim analysis, 32 participants with treatment-resistant depression had been enrolled, and 29 participants who continued to meet inclusion criteria received either active (N=14) or sham (N=15) SNT. The mean percent reduction from baseline in MADRS score 4 weeks after treatment was 52.5% in the active treatment group and 11.1% in the sham treatment group. CONCLUSIONS SNT, a high-dose iTBS protocol with functional-connectivity-guided targeting, was more effective than sham stimulation for treatment-resistant depression. Further trials are needed to determine SNT's durability and to compare it with other treatments.
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Affiliation(s)
- Eleanor J Cole
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Angela L Phillips
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Brandon S Bentzley
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Katy H Stimpson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Romina Nejad
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Fahim Barmak
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Clive Veerapal
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Naushaba Khan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Kirsten Cherian
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Emily Felber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Randi Brown
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Elizabeth Choi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Sinead King
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Heather Pankow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - James H Bishop
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Azeezat Azeez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - John Coetzee
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Rachel Rapier
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Nicole Odenwald
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - David Carreon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Jessica Hawkins
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Maureen Chang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Jennifer Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Kristin Raj
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Charles DeBattista
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Alan F Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Keith D Sudheimer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors except King and Sudheimer); U.S. Department of Veterans Affairs, Palo Alto, Calif. (Phillips, Azeez, Coetzee); Department of Psychology, Palo Alto University, Palo Alto, Calif. (Stimpson, Cherian, Felber, Brown, Choi); Centre for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway (King); Department of Anatomy, School of Medicine, Southern Illinois University, Carbondale (Sudheimer)
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Phillips AL, Edwards S, Parmesar K, Soltan M, Guckian J. Slack as a virtual undergraduate dermatology community: a pilot study. Clin Exp Dermatol 2021; 46:1028-1037. [PMID: 33583049 PMCID: PMC9213941 DOI: 10.1111/ced.14601] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/26/2021] [Accepted: 02/08/2021] [Indexed: 02/03/2023]
Abstract
Background Dermatology is under‐represented in UK undergraduate curricula, and with a diagnostic and educational toolkit that is heavily centred on face‐to‐face (F2F) clinical examination, dermatology education has been disproportionately affected by the COVID‐19 pandemic. Online channel‐based messaging apps such as Slack offer an opportunity to engage students in remote, multimodal collaborative learning by reproducing a classroom environment in the virtual space. Aim To determine the feasibility, acceptability and proof of concept for an online Slack community in undergraduate dermatology education. Methods Undergraduate medical students participated in an online classroom for a 6‐week programme encompassing case‐based discussions, seminars and journal clubs. The platform was facilitated by junior doctors (n = 10) and patient educators (n = 6). Students and faculty completed a post‐course evaluation. Students additionally completed a pre‐ and post‐intervention dermatology quiz. Mixed methods analyses included quantitative analyses to explore data trends and qualitative phenomenographic analyses to assimilate key underlying themes. Results Students (n = 65) were enrolled to join the platform. The evaluation was completed by students (n = 52) from UK universities (n = 27). The majority of students (n = 27) interacted with the platform as passive observers (≤ 5 active interactions with the channel), with a small group (n = 4) of ‘super‐users’ (≥ 100 active interactions). The overall quality of the course was described as ‘excellent’ by 96% of participants and 100% of faculty. Conclusion A community‐based online classroom can act as an enjoyable, acceptable and collaborative means of delivering dermatology education to undergraduate medical students. Its ease of use and supportive nature may also facilitate patient involvement. Such advances may provide vital safeguards against the reduction in F2F learning that has accompanied the COVID‐19 pandemic.
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Affiliation(s)
- A L Phillips
- Department of Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | - S Edwards
- Emergency Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - K Parmesar
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - M Soltan
- Institute for Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - J Guckian
- Department of Medical Education, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Phillips AL, Cole EJ, Bentzley BS, Stimpson KH, Nejad R, Tischler C, Barmak F, Veerapal C, Khan N, Cherian K, Felber E, Brown R, Choi E, Bishop J, Azeez PA, Coetzee J, Rapier R, Odenwald N, Carreon D, Hawkins J, Chang M, Espil FM, Schatzberg AF, Sudheimer KD, Williams NR. Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT-TRD) induces rapid remission from treatment-resistant depression in a double-blinded, randomized, and controlled trial. Brain Stimul 2020. [DOI: 10.1016/j.brs.2020.06.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Cole EJ, Stimpson KH, Bentzley BS, Gulser M, Cherian K, Tischler C, Nejad R, Pankow H, Choi E, Aaron H, Espil FM, Pannu J, Xiao X, Duvio D, Solvason HB, Hawkins J, Guerra A, Jo B, Raj KS, Phillips AL, Barmak F, Bishop JH, Coetzee JP, DeBattista C, Keller J, Schatzberg AF, Sudheimer KD, Williams NR. Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression. Am J Psychiatry 2020; 177:716-726. [PMID: 32252538 DOI: 10.1176/appi.ajp.2019.19070720] [Citation(s) in RCA: 261] [Impact Index Per Article: 65.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE New antidepressant treatments are needed that are effective, rapid acting, safe, and tolerable. Intermittent theta-burst stimulation (iTBS) is a noninvasive brain stimulation treatment that has been approved by the U.S. Food and Drug Administration for treatment-resistant depression. Recent methodological advances suggest that the current iTBS protocol might be improved through 1) treating patients with multiple sessions per day at optimally spaced intervals, 2) applying a higher overall pulse dose of stimulation, and 3) precision targeting of the left dorsolateral prefrontal cortex (DLPFC) to subgenual anterior cingulate cortex (sgACC) circuit. The authors examined the feasibility, tolerability, and preliminary efficacy of Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), an accelerated, high-dose resting-state functional connectivity MRI (fcMRI)-guided iTBS protocol for treatment-resistant depression. METHODS Twenty-two participants with treatment-resistant depression received open-label SAINT. fcMRI was used to individually target the region of the left DLPFC most anticorrelated with sgACC in each participant. Fifty iTBS sessions (1,800 pulses per session, 50-minute intersession interval) were delivered as 10 daily sessions over 5 consecutive days at 90% resting motor threshold (adjusted for cortical depth). Neuropsychological testing was conducted before and after SAINT. RESULTS One participant withdrew, leaving a sample size of 21. Nineteen of 21 participants (90.5%) met remission criteria (defined as a score <11 on the Montgomery-Åsberg Depression Rating Scale). In the intent-to-treat analysis, 19 of 22 participants (86.4%) met remission criteria. Neuropsychological testing demonstrated no negative cognitive side effects. CONCLUSIONS SAINT, an accelerated, high-dose, iTBS protocol with fcMRI-guided targeting, was well tolerated and safe. Double-blinded sham-controlled trials are needed to confirm the remission rate observed in this initial study.
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Affiliation(s)
- Eleanor J Cole
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Katy H Stimpson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Brandon S Bentzley
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Merve Gulser
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Kirsten Cherian
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Claudia Tischler
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Romina Nejad
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Heather Pankow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Elizabeth Choi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Haley Aaron
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Jaspreet Pannu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Xiaoqian Xiao
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Dalton Duvio
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Hugh B Solvason
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Jessica Hawkins
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Austin Guerra
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Kristin S Raj
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Angela L Phillips
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Fahim Barmak
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - James H Bishop
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - John P Coetzee
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Charles DeBattista
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Jennifer Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Alan F Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Keith D Sudheimer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (all authors), and Department of Psychology (Stimpson, Cherian, Choi, Aaron, Guerra, Phillips), Palo Alto University, Palo Alto, Calif
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Phillips AL, Burr RL, Dunner DL. Repetitive Transcranial Magnetic Stimulation in the Treatment of Bipolar Depression: Experience From a Clinical Setting. J Psychiatr Pract 2020; 26:37-45. [PMID: 31913968 DOI: 10.1097/pra.0000000000000447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive Food and Drug Administration (FDA)-approved treatment for unipolar treatment-resistant depression (TRD). rTMS has been utilized clinically to treat bipolar TRD; however, there remains a lack of evidence and support for effectively utilizing this intervention for bipolar TRD. We retrospectively analyzed data from a group of patients who were treated with rTMS for unipolar or bipolar TRD and describe a case example to further delineate management techniques for employing rTMS in the treatment of bipolar TRD. METHODS Records of 71 patients treated with rTMS for unipolar (n=54) or bipolar (n=17) TRD between 2008 and 2017 were reviewed. The primary outcome of depression severity, the Quick Inventory of Depressive Symptomatology, was completed at baseline and after every 5 sessions throughout the course of 30 treatments. Secondary outcomes involved a comparison of outcomes and clinical characteristics within and between the bipolar and unipolar TRD groups. RESULTS In the total sample, patients' depression improved significantly over the course of treatment. Patients with bipolar TRD showed greater response and remission rates over the course of treatment compared with patients with unipolar TRD, but this difference was not statistically significant. Both groups showed a similar pattern of depression response over treatment time. No manic or hypomanic episodes occurred during any patient's course of rTMS treatment. A case example is provided discussing the timing of rTMS in a patient with bipolar depression to decrease the likelihood of treatment-induced hypomania. LIMITATIONS Limitations included the small overall sample size, the smaller size of the patient group with bipolar TRD compared with the group with unipolar TRD, and the naturalistic setting of this study. CONCLUSIONS Our data suggest that rTMS may be equally effective and safe for patients with both unipolar and bipolar depression. Patients with bipolar TRD showed a similar response profile over treatment time compared with patients with unipolar TRD.
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Phillips AL, Burr RL, Dunner DL. rTMS effects in patients with co-morbid somatic pain and depressive mood disorders. J Affect Disord 2018; 241:411-416. [PMID: 30145511 DOI: 10.1016/j.jad.2018.08.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/14/2018] [Accepted: 08/12/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pain is a common co-morbidity among clinically depressed individuals. We investigated a group of patients who were treated with repetitive transcranial magnetic stimulation (rTMS) for treatment resistant depression (TRD) and who were assessed for severity of both depression and pain at baseline and throughout treatment. METHODS Records of 71 patients treated for TRD with rTMS from 2008 to 2017 were reviewed. Primary outcome measures including depression severity using the Quick Inventory of Depressive Symptomatology (QIDS) and a 0-10 numeric pain rating scale were assessed at baseline and after every 5 sessions throughout the course of 30 treatments. RESULTS In the total sample, pain improved significantly over the course of treatment. Changes within subjects in QIDS were associated with the changes in pain (p = 0.011). TRD patients with higher pain scores at baseline tended to be older, experienced a longer duration of illness, and showed significant differences in QIDS over treatment time as compared with the low baseline pain group. Patients who had failed a serotonin norepinephrine reuptake inhibitor (SNRI) (venlafaxine or duloxetine) trial in the past had less pain at baseline and showed a group difference in pain scores at all time points, which was significant at treatments 20, 25 and 30, compared to patient groups who had never taken these medications or were currently taking these medications. LIMITATIONS Limitations include the potential impact of the discomfort over the treatment site on the scalp, as it is unclear whether patients' assessment of pain included this side effect, and the lack of a control group due to the naturalistic design of this study. CONCLUSION Our data show that pain and depression respond well to rTMS in a TRD population. Pain and depression severity in rTMS patients may be associated over the course of rTMS treatment time-points in individuals with higher levels of baseline pain.
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Affiliation(s)
- Angela L Phillips
- University of Washington School of Nursing, Box 357260, 1959 NE Pacific Street, Seattle, WA 98195, United States.
| | - Robert L Burr
- UW School of Nursing, Box 357266, 1959 NE Pacific Street, Seattle, WA 98195-7266, United States.
| | - David L Dunner
- Center for Anxiety and Depression, 400 Island Corporate Center, 7525 SE 24th St, Mercer Island, WA, United States.
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Phillips AL, Burr R, Dunner DL. rTMS effects in patients with co-morbid somatic pain and depressive mood disorders. Brain Stimul 2018. [DOI: 10.1016/j.brs.2018.07.006] [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: 11/28/2022] Open
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8
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Phillips AL, Burr RL, Dunner DL. Management of treatment resistant bipolar depression with rTMS. Brain Stimul 2018. [DOI: 10.1016/j.brs.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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9
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Swartzendruber A, Newton-Levinson A, Phillips AL, Sales JM. Do Georgia pregnancy resource centers meet national quality service standards for pregnancy testing? A Web content analysis. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gao W, Hodgkinson L, Jin K, Watts CW, Ashton RW, Shen J, Ren T, Dodd IC, Binley A, Phillips AL, Hedden P, Hawkesford MJ, Whalley WR. Deep roots and soil structure. Plant Cell Environ 2016; 39:1662-8. [PMID: 26650587 PMCID: PMC4950291 DOI: 10.1111/pce.12684] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/10/2015] [Accepted: 11/13/2015] [Indexed: 05/18/2023]
Abstract
In this opinion article we examine the relationship between penetrometer resistance and soil depth in the field. Assuming that root growth is inhibited at penetrometer resistances > 2.5 MPa, we conclude that in most circumstances the increases in penetrometer resistance with depth are sufficiently great to confine most deep roots to elongating in existing structural pores. We suggest that deep rooting is more likely related to the interaction between root architecture and soil structure than it is to the ability of a root to deform strong soil. Although the ability of roots to deform strong soil is an important trait, we propose it is more closely related to root exploration of surface layers than deep rooting.
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Affiliation(s)
- W Gao
- China Agricultural University, Beijing, 100193, China
| | - L Hodgkinson
- Lancaster Environment Centre, Lancaster University, Lancaster, LA1 4YQ, UK
| | - K Jin
- Huazhong Agricultural University, Hongshan District, Wuhan, 430070, China
| | - C W Watts
- Rothamsted Research, West Common, Harpenden, St. Albans, AL5 2JQ, UK
| | - R W Ashton
- Rothamsted Research, West Common, Harpenden, St. Albans, AL5 2JQ, UK
| | - J Shen
- China Agricultural University, Beijing, 100193, China
| | - T Ren
- China Agricultural University, Beijing, 100193, China
| | - I C Dodd
- Lancaster Environment Centre, Lancaster University, Lancaster, LA1 4YQ, UK
| | - A Binley
- Lancaster Environment Centre, Lancaster University, Lancaster, LA1 4YQ, UK
| | - A L Phillips
- Rothamsted Research, West Common, Harpenden, St. Albans, AL5 2JQ, UK
| | - P Hedden
- Rothamsted Research, West Common, Harpenden, St. Albans, AL5 2JQ, UK
| | - M J Hawkesford
- Rothamsted Research, West Common, Harpenden, St. Albans, AL5 2JQ, UK
| | - W R Whalley
- Rothamsted Research, West Common, Harpenden, St. Albans, AL5 2JQ, UK
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Kozma CM, Meletiche DM, Phillips AL. The effect of age and sex on cost of inpatient facility encounters among patients with multiple sclerosis. J Med Econ 2015; 18:704-10. [PMID: 25913916 DOI: 10.3111/13696998.2015.1044995] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore the effect of age and sex on cost of all-cause and multiple sclerosis (MS)-related inpatient facility encounters. METHODS Adult patients with an initial MS diagnosis were identified from a national managed-care database (IMS LifeLink Health Plans Database). The analysis included newly diagnosed MS patients with 12 months insurance eligibility before and after their first MS diagnosis. Inpatient facility encounters (stays) were analyzed for all-cause and MS-related events (ICD-9-CM = 340.XX), other demyelinating CNS disease (ICD-9-CM = 341.XX), rehabilitation (ICD-9-CM = V57.89), and a group of symptom-related diagnoses. Costs and length of stay were evaluated using a general linear model controlling for age and sex. RESULTS A total of 57,236 patients met study criteria; 74.3% were female. Mean age for females was 45.5 years and for males it was 47.5 years. In total, 17.0% had an all-cause inpatient stay in the 360-day post index, and 3.2% had an in patient stay with a MS relapse-related diagnosis as primary discharge diagnosis. Additional MS-related diagnoses that led to inpatient stays included other demyelinating CNS disease (0.3%), symptom-related diagnoses (1.0%), and rehabilitation (1.1%). All-cause inpatient cost was higher for males vs females across all age groups; however, cost for females increased at a greater rate as age increased (p = 0.0007). Symptom-related inpatient cost was flat for males, was lower for females than males at an average age of 30, and was greater for females than males at an average age of 60 (p = 0.0199). Cost for MS inpatient stays ($11,931), other demyelinating CNS-related stays ($14,931), and rehabilitation ($23,643) did not differ by age and sex. The average cost for any MS-related relapse inpatient stay was $13,761 and varied with increasing age (p < 0.0001). CONCLUSION Burden of illness for relapse among MS patients is substantial. Costs vary by age and sex depending on the discharge diagnosis. Inclusion of symptom-related and rehabilitation inpatient stays may account for an under-recognized proportion of total expenditures.
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Affiliation(s)
- C M Kozma
- a a Independent Research Consultant , Saint Helena Island , SC , USA
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12
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Phillips AL, Munsell MJ, Menzin J, Dangond F, Locklear JC. A Real-World Assessment of Annual Multiple Sclerosis Prevalence and Disease-Modifying Drug Treatment Rates Using an Administrative Claims Database. Value Health 2014; 17:A392. [PMID: 27200906 DOI: 10.1016/j.jval.2014.08.867] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - M J Munsell
- Boston Health Economics, Inc., Waltham, MA, USA
| | - J Menzin
- Boston Health Economics, Inc., Waltham, MA, USA
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13
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Phillips AL, Edwards NC, Locklear JC. Cost-Effectiveness Evaluation of Data from the Evidence (Evidence of Interferon Dose-Response: European North American Comparative Efficacy) Study. Value Health 2014; 17:A397. [PMID: 27200936 DOI: 10.1016/j.jval.2014.08.895] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - N C Edwards
- Health Services Consulting Corporation, Boxborough, MA, USA
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Phillips AL, Kozma CM, Locklear JC. Using a Panel Survey to Identify Predictors of Disease-Modifying Drug Adherence in Patients with Multiple Sclerosis. Value Health 2014; 17:A400. [PMID: 27200951 DOI: 10.1016/j.jval.2014.08.910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - C M Kozma
- Independent Research Consultant, Saint Helena Island, SC, USA
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15
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Locklear J, Bozkaya D, Migliaccio K, Bramley T, Phillips AL, Mahony M. Evaluation of Patient and Financial Outcomes Associated With Advanced Infertility Treatment Options. Value Health 2014; 17:A519-A520. [PMID: 27201621 DOI: 10.1016/j.jval.2014.08.1619] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - D Bozkaya
- Xcenda, L. L. C., Palm Harbor, FL, USA
| | | | | | | | - M Mahony
- EMD Serono, Inc., Rockland, MA, USA
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16
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Locklear J, Edwards N, Phillips AL. Evaluation of Potential Waste Of Growth Hormone Across Available Growth Hormone Pen Devices And An Electronic Growth Hormone Delivery Device. Value Health 2014; 17:A338. [PMID: 27200612 DOI: 10.1016/j.jval.2014.08.662] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - N Edwards
- Health Services Consulting Corporation, Boxborough, MA, USA
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17
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Phillips AL, Edwards NC, Locklear JC. An Economic Evaluation of Subcutaneous and Intramuscular Interferon Beta-1a in Multiple Sclerosis Using a Direct Head-To-Head Study. Value Health 2014; 17:A397. [PMID: 27200937 DOI: 10.1016/j.jval.2014.08.894] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - N C Edwards
- Health Services Consulting Corporation, Boxborough, MA, USA
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18
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Phillips AL, Edwards NC, Locklear JC. Cost-Effectiveness of Subcutaneous Interferon Beta-1A in a Sub-Population of Multiple Sclerosis Patients (Kurtzke Expanded Disability Status Scale [EDSS]: >3.5-5.0). Value Health 2014; 17:A398. [PMID: 27200942 DOI: 10.1016/j.jval.2014.08.899] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - N C Edwards
- Health Services Consulting Corporation, Boxborough, MA, USA
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19
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Lee S, Phillips AL, Liebler DC, Faustman C. Porcine oxymyoglobin and lipid oxidation in vitro. Meat Sci 2013; 63:241-7. [PMID: 22062184 DOI: 10.1016/s0309-1740(02)00076-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2002] [Revised: 03/25/2002] [Accepted: 03/25/2002] [Indexed: 10/27/2022]
Abstract
The present study was carried out to investigate the effect of dietary α-tocopherol supplementation on porcine oxymyoglobin (OxyMb) and lipid oxidation (TBARS) in model lipid systems, and to determine the influence of 4-hydroxynonenal (4-HNE), a secondary product of lipid oxidation, on porcine OxyMb stability. Porcine metmyoglobin (MetMb) formation was greater in the presence of 4-HNE than the control (P<0.05). Western blot analyses confirmed the covalent modification of myoglobin (Mb) histidine residues by 4-HNE. When combined with microsomes, both equine and porcine OxyMb oxidation increased with time of incubation, and was greater at 37 than at 25 °C (P<0.05). Lower TBARS values were observed in microsomes prepared from vitamin E-supplemented than control pork livers (P<0.05). α-Tocopherol concentration did not affect OxyMb oxidation in microsomes at 25 or 37 °C (P>0.05). These results differ from those observed with beef muscle microsomes where both OxyMb and lipid oxidation were delayed with elevated α-tocopherol levels. These results suggest that the factors affecting Mb and lipid oxidation interactions may be species-dependent.
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Affiliation(s)
- S Lee
- Department of Animal Science, University of Connecticut, Storrs, CT 06269, USA
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20
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Bhattacharya A, Ward DA, Hedden P, Phillips AL, Power JB, Davey MR. Engineering gibberellin metabolism in Solanum nigrum L. by ectopic expression of gibberellin oxidase genes. Plant Cell Rep 2012; 31:945-953. [PMID: 22238061 DOI: 10.1007/s00299-011-1214-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 12/05/2011] [Accepted: 12/12/2011] [Indexed: 05/31/2023]
Abstract
Gibberellins (GAs) control many aspects of plant development, including seed germination, shoot growth, flower induction and growth and fruit expansion. Leaf explants of Solanum nigrum (Black Nightshade; Solanaceae) were used for Agrobacterium-mediated delivery of GA-biosynthetic genes to determine the influence of their encoded enzymes on the production of bioactive GAs and plant stature in this species. Constructs were prepared containing the neomycin phosphotransferase (nptII) gene for kanamycin resistance as a selectable marker, and the GA-biosynthetic genes, their expression under the control of the CaMV 35S promoter. The GA-biosynthetic genes comprised AtGA20ox1, isolated from Arabidopsis thaliana, the product from which catalyses the formation of C(19)-GAs, and MmGA3ox1 and MmGA3ox2, isolated from Marah macrocarpus, which encode functionally different GA 3-oxidases that convert C(19)-GAs to biologically active forms. Increase in stature was observed in plants transformed with AtGA20ox1, MmGA3ox2 and MmGA3ox1 + MmGA3ox2, their presence and expression being confirmed by PCR and RT-PCR, respectively, accompanied by an increase in GA(1) content. Interestingly, MmGA3ox1 alone did not induce a sustained increase in plant height, probably because of only a marginal increase in bioactive GA(1) content in the transformed plants. The results are discussed in the context of regulating plant stature, since this strategy would decrease the use of chemicals to promote plant growth.
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Affiliation(s)
- A Bhattacharya
- Plant and Crop Sciences Division, School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK
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Ivanova JI, Bergman RE, Birnbaum HG, Phillips AL, Stewart M, Meletiche DM. Impact of medication adherence to disease-modifying drugs on severe relapse, and direct and indirect costs among employees with multiple sclerosis in the US. J Med Econ 2012; 15:601-9. [PMID: 22376190 DOI: 10.3111/13696998.2012.667027] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare rates of severe relapse and total direct and indirect costs over a 2-year period between US-based employees with multiple sclerosis (MS) who were adherent and non-adherent to disease-modifying drugs (DMDs). METHODS Employees with ≥1 MS diagnosis (ICD-9-CM: 340.x) and ≥1 DMD pharmacy claim between 1/1/2002-12/31/2007 were identified from a large US administrative claims database. Patients had continuous coverage ≥6 months before (baseline) and ≥24 months after (study period) their index date (first DMD claim). Adherence was measured using medication possession ratio (MPR) over the study period. Patients with MPR ≥80% were considered adherent (n = 448) and those with MPR <80% as non-adherent (n = 200). Multivariate analyses were used to compare rates of severe relapse (inpatient or Emergency Department visit with MS diagnosis) and costs in 2007 dollars between DMD adherent and non-adherent patients. Direct costs were calculated as reimbursements to providers for medical services and prescription drugs excluding DMDs. Indirect costs included disability and medically-related absenteeism costs. RESULTS DMD adherent patients were on average older (43.5 vs 41.8 years, p = 0.015) and more likely to be male (38.6% vs 26.0%, p = 0.002) compared with non-adherent patients. Adherent patients had lower rates of depression, higher rates of previous DMD use, and higher baseline MS-related costs. After adjusting for differences in baseline characteristics, DMD adherent patients had a lower rate of severe relapse (12.4% vs 19.9%, p = 0.013) and lower total (direct and indirect) costs ($14,095 vs $16,638, p = 0.048) over the 2-year study period. CONCLUSIONS In this study, DMD adherence was associated with a significantly lower rate of severe relapse and lower total costs over 2 years. Causality cannot be inferred because adherence and outcomes were measured over the same period. The study was subject to limitations associated with use of claims data and the absence of clinical measures.
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Dijkstra C, Adams E, Bhattacharya A, Page AF, Anthony P, Kourmpetli S, Power JB, Lowe KC, Thomas SG, Hedden P, Phillips AL, Davey MR. Over-expression of a gibberellin 2-oxidase gene from Phaseolus coccineus L. enhances gibberellin inactivation and induces dwarfism in Solanum species. Plant Cell Rep 2008; 27:463-70. [PMID: 17999064 DOI: 10.1007/s00299-007-0471-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 10/08/2007] [Accepted: 10/19/2007] [Indexed: 05/24/2023]
Abstract
Gibberellins (GAs) are endogenous hormones that play a predominant role in regulating plant stature by increasing cell division and elongation in stem internodes. The product of the GA 2-oxidase gene from Phaseolus coccineus (PcGA2ox1) inactivates C(19)-GAs, including the bioactive GAs GA(1 )and GA(4), by 2beta-hydroxylation, reducing the availability of these GAs in plants. The PcGA2ox1 gene was introduced into Solanum melanocerasum and S. nigrum (Solanaceae) by Agrobacterium-mediated transformation with the aim of decreasing the amounts of bioactive GA in these plants and thereby reducing their stature. The transgenic plants exhibited a range of dwarf phenotypes associated with a severe reduction in the concentrations of the biologically active GA(1) and GA(4). Flowering and fruit development were unaffected. The transgenic plants contained greater concentrations of chlorophyll b (by 88%) and total chlorophyll (11%), although chlorophyll a and carotenoid contents were reduced by 8 and 50%, respectively. This approach may provide an alternative to the application of chemical growth retardants for reducing the stature of plants, particularly ornamentals, in view of concerns over the potential environmental and health hazards of such compounds.
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Affiliation(s)
- C Dijkstra
- Plant Sciences Division, School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
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Taliercio E, Allen RD, Essenberg M, Klueva N, Nguyen H, Patil MA, Payton P, Millena ACM, Phillips AL, Pierce ML, Scheffler B, Turley R, Wang J, Zhang D, Scheffler J. Analysis of ESTs from multiple Gossypium hirsutum tissues and identification of SSRs. Genome 2006; 49:306-19. [PMID: 16699550 DOI: 10.1139/g05-115] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In an effort to expand the Gossypium hirsutum L. (cotton) expressed sequence tag (EST) database, ESTs representing a variety of tissues and treatments were sequenced. Assembly of these sequences with ESTs already in the EST database (dbEST, GenBank) identified 9675 cotton sequences not present in GenBank. Statistical analysis of a subset of these ESTs identified genes likely differentially expressed in stems, cotyledons, and drought-stressed tissues. Annotation of the differentially expressed cDNAs tentatively identified genes involved in lignin metabolism, starch biosynthesis and stress response, consistent with pathways likely to be active in the tissues under investigation. Simple sequence repeats (SSRs) were identified among these ESTs, and an inexpensive method was developed to screen genomic DNA for the presence of these SSRs. At least 69 SSRs potentially useful in mapping were identified. Selected amplified SSRs were isolated and sequenced. The sequences corresponded to the EST containing the SSRs, confirming that these SSRs will potentially map the gene represented by the EST. The ESTs containing SSRs were annotated to help identify the genes that may be mapped using these markers.Key words: drought stress, gene annotation, gene mapping, tentative consensus sequence (TC), Xanthomonas campestris.
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Affiliation(s)
- Earl Taliercio
- USDA-ARS, 141 Experiment Station Rd., Stoneville, MS 38756, USA.
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Phillips AL, Walker EL, Martin JE, First MR, Hanto DW, Whiting JF. Quality of life as a predictor of morbidity, mortality, and resource utilization after solid-organ transplant. Transplant Proc 2001; 33:1886. [PMID: 11267554 DOI: 10.1016/s0041-1345(00)02736-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- A L Phillips
- University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Phillips AL, Walker EL, Martin JE, First MR, Hanto DW, Whiting JF. Quality of life as a predictor of morbidity, mortality, and resource utilization after solid organ transplant. Transplant Proc 2001; 33:1922. [PMID: 11267571 DOI: 10.1016/s0041-1345(00)02713-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A L Phillips
- University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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26
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Abstract
The identification of most of the genes involved in the metabolic pathways for gibberellin hormones has helped us to understand these pathways and their regulation. Many of these enzymes are multifunctional and therefore fewer enzymes than might be expected are required to synthesize the various gibberellin structures. However, several of the enzymes are encoded by multiple genes that are regulated differently, adding unexpected genetic complexity. Several endogenous and environmental factors modify the expression of gibberellin biosynthesis genes, including developmental stage, hormonal status and light. A future challenge will be to dissect the complex, interacting pathways that mediate the regulation of gibberellin metabolism.
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Affiliation(s)
- P Hedden
- Crop Production and Improvement Dept, IACR Long Ashton Research Station, University of Bristol Dept of Agricultural Sciences, Long Ashton, Bristol, UK BS41 9AF.
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27
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Curtis IS, Ward DA, Thomas SG, Phillips AL, Davey MR, Power JB, Lowe KC, Croker SJ, Lewis MJ, Magness SL, Hedden P. Induction of dwarfism in transgenic Solanum dulcamara by over-expression of a gibberellin 20-oxidase cDNA from pumpkin. Plant J 2000; 23:329-338. [PMID: 10929126 DOI: 10.1046/j.1365-313x.2000.00784.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The gibberellin (GA) 20-oxidase (CmGA20ox1) from immature pumpkin seed produces predominantly inactive tricarboxylic acid GAs. We expressed CmGA20ox1 under the control of the CaMV 35S promoter in Solanum dulcamara to assess the usefulness of this gene for reducing GA content in transgenic plants. All transgenic plants obtained were semi-dwarfs with smaller, deep-green leaves and highly pigmented stems compared to the wild-type. Such transformants flowered earlier than the wild-type plants and produced more fruit and more seeds per fruit. The transgene was efficiently expressed, producing high levels of CmGA20ox1 transcript and protein. Furthermore, the concentration of GA(1) was reduced in leaves of the transformants to approximately 20% or less of that in the wild-type and to about 40% or less in stems. The concentrations of other 13-hydroxylated GAs were also reduced, except for the tricarboxylic acid, GA(17), which accumulated in the transformants due to 13-hydroxylation of GA(25). By contrast, the concentrations of non-13-hydroxylated GAs, GA(4) and GA(34), were not consistently reduced, indicating that the effect of expressing the pumpkin gene may not be predictable. Transcript abundance for a native GA 20-oxidase gene was higher in the leaves and stems of S. dulcamara transformed with the pumpkin gene than in wild-type, reflecting the feedback control of 20-oxidase gene expression that serves as a homeostatic mechanism for GAs.
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Affiliation(s)
- I S Curtis
- Plant Science Division, School of Biological Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK
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28
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Phillips AL, Means WJ, Kalchayanand N, McCormick RJ, Miller KW. Bovine placental protease specificity toward muscle connective tissue proteins. J Anim Sci 2000; 78:1861-6. [PMID: 10907828 DOI: 10.2527/2000.7871861x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Enzymes currently used to tenderize meat are not substrate-specific, resulting in extensive myofibrillar protein degradation that often produces an undesirable texture. Bovine placental metalloproteases, which selectively hydrolyze connective tissue proteins while leaving myofibrillar proteins intact, may tenderize meat without causing texture problems. Therefore, our objective was to extract and crudely purify bovine metalloproteases from bovine placenta for possible use as tenderizers in meat systems. Enzymes were extracted from homogenized tissue and purified by ammonium sulfate precipitation. Samples were collected before (crude enzyme) and after gel filtration on a Sephadex G-100 column. Spectrophotometric analysis identified one major peak (filtered enzyme). Gelatin, casein, and type I acid-soluble collagen zymography were used to determine substrate specificity. Beef myofibrillar proteins were incubated with crude and filtered enzyme fractions, enzymes quenched, and substrate degradation visualized using SDS-PAGE. Active gelatinases and collagenases exhibiting molecular weights of 57 to 65 kDa were detected on zymograms. Banding patterns from crude enzyme indicated two enzymes with both gelatinase and collagenase activity and a third enzyme with gelatinase activity only. Banding patterns from filtered enzyme indicated two enzymes with both gelatinase and collagenase activity. Proteolytic activity was not detected with casein, actin, or myosin heavy-chain substrates. Due to specificity for collagen and gelatin, these enzymes may be capable of improving the tenderness of certain cuts relatively high in connective tissue, while avoiding myofibrillar protein hydrolysis.
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Affiliation(s)
- A L Phillips
- Department of Animal Science, University of Wyoming, Laramie 82071, USA
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29
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Abstract
Modification of plant hormone biosynthesis through the introduction of bacterial genes is a natural form of genetic engineering, which has been exploited in numerous studies on hormone function. Recently, biosynthetic pathways have been largely elucidated for most of the plant hormone classes, and genes encoding many of the enzymes have been cloned. These advances offer new opportunities to manipulate hormone content in order to study their mode of action and the regulation of their biosynthesis. Furthermore, this technology is providing the means to introduce agriculturally useful traits into crops.
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Affiliation(s)
- P Hedden
- Department of Agricultural Sciences, IACR-Long Ashton Research Station, University of Bristol, Long Ashton, UK.
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30
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Thomas SG, Phillips AL, Hedden P. Molecular cloning and functional expression of gibberellin 2- oxidases, multifunctional enzymes involved in gibberellin deactivation. Proc Natl Acad Sci U S A 1999; 96:4698-703. [PMID: 10200325 PMCID: PMC16395 DOI: 10.1073/pnas.96.8.4698] [Citation(s) in RCA: 357] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A major catabolic pathway for the gibberellins (GAs) is initiated by 2beta-hydroxylation, a reaction catalyzed by 2-oxoglutarate-dependent dioxygenases. To isolate a GA 2beta-hydroxylase cDNA clone we used functional screening of a cDNA library from developing cotyledons of runner bean (Phaseolus coccineus L.) with a highly sensitive tritium-release assay for enzyme activity. The encoded protein, obtained by heterologous expression in Escherichia coli, converted GA9 to GA51 (2beta-hydroxyGA9) and GA51-catabolite, the latter produced from GA51 by further oxidation at C-2. The enzyme thus is multifunctional and is best described as a GA 2-oxidase. The recombinant enzyme also 2beta-hydroxylated other C19-GAs, although only GA9 and GA4 were converted to the corresponding catabolites. Three related cDNAs, corresponding to gene sequences present in Arabidopsis thaliana databases, also encoded functional GA 2-oxidases. Transcripts for two of the Arabidopsis genes were abundant in upper stems, flowers, and siliques, but the third transcript was not detected by Northern analysis. Transcript abundance for the two most highly expressed genes was lower in apices of the GA-deficient ga1-2 mutant of Arabidopsis than in wild-type plants and increased after treatment of the mutant with GA3. This up-regulation of GA 2-oxidase gene expression by GA contrasts GA-induced down-regulation of genes encoding the biosynthetic enzymes GA 20-oxidase and GA 3beta-hydroxylase. These mechanisms would serve to maintain the concentrations of biologically active GAs in plant tissues.
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Affiliation(s)
- S G Thomas
- Institute of Arable Crops Research (IACR)-Long Ashton Research Station, Department of Agricultural Sciences, University of Bristol, Long Ashton, Bristol BS41 9AF, United Kingdom
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31
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Coles JP, Phillips AL, Croker SJ, García-Lepe R, Lewis MJ, Hedden P. Modification of gibberellin production and plant development in Arabidopsis by sense and antisense expression of gibberellin 20-oxidase genes. Plant J 1999; 17:547-56. [PMID: 10205907 DOI: 10.1046/j.1365-313x.1999.00410.x] [Citation(s) in RCA: 172] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Gibberellin (GA) 20-oxidase catalyses consecutive steps late in GA biosynthesis in plants. In Arabidopsis, the enzyme is encoded by a gene family of at least three members (AtGA20ox1, AtGA20ox2 and AtGA20ox3) with differential patterns of expression. The genes are regulated by feedback from bioactive GAs, suggesting that the enzymes may be involved in regulating GA biosynthesis. To investigate this, we produced transgenic Arabidopsis expressing sense or antisense copies of each of the GA 20-oxidase cDNAs. Over-expression of any of the cDNAs gave rise to seedlings with elongated hypocotyls; the plants flowered earlier than controls in both long and short days and were 25% taller at maturity. GA analysis of the vegetative rosettes showed a two- to threefold increase in the level of GA4, indicating that GA 20-oxidase normally limits bioactive GA levels. Plants expressing antisense copies of AtGA20ox1 had short hypocotyls and reduced rates of stem elongation. This was reflected in reduced levels of GA4 in both rosettes and shoot tips. In short days, flowering was delayed and the reduction in the rate of stem elongation was greater. Antisense expression of AtGA20ox2 had no apparent effects in long days, but stem growth in one transgenic line grown in short days was reduced by 20%. Expression of antisense copies of AtGA20ox3 had no visible effect, except for one transgenic line that had short hypocotyls. These results demonstrate that GA levels and, hence, plant growth and development can be modified by manipulation of GA 20-oxidase expression in transgenic plants.
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Affiliation(s)
- J P Coles
- Department of Agricultural Sciences, University of Bristol, Long Ashton, UK
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Williams J, Phillips AL, Gaskin P, Hedden P. Function and substrate specificity of the gibberellin 3beta-hydroxylase encoded by the Arabidopsis GA4 gene. Plant Physiol 1998; 117:559-63. [PMID: 9625708 PMCID: PMC34975 DOI: 10.1104/pp.117.2.559] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/1997] [Accepted: 03/11/1998] [Indexed: 05/18/2023]
Abstract
cDNA corresponding to the GA4 gene of Arabidopsis thaliana L. (Heynh. ) was expressed in Escherichia coli, from which cell lysates converted [14C]gibberellin (GA)9 and [14C]GA20 to radiolabeled GA4 and GA1, respectively, thereby confirming that GA4 encodes a GA 3beta-hydroxylase. GA9 was the preferred substrate, with a Michaelis value of 1 microm compared with 15 microm for GA20. Hydroxylation of these GAs was regiospecific, with no indication of 2beta-hydroxylation or 2,3-desaturation. The capacity of the recombinant enzyme to hydroxylate a range of other GA substrates was investigated. In general, the preferred substrates contained a polar bridge between C-4 and C-10, and 13-deoxy GAs were preferred to their 13-hydroxylated analogs. Therefore, no activity was detected using GA12-aldehyde, GA12, GA19, GA25, GA53, or GA44 as the open lactone (20-hydroxy-GA53), whereas GA15, GA24, and GA44 were hydroxylated to GA37, GA36, and GA38, respectively. The open lactone of GA15 (20-hydroxy-GA12) was hydroxylated but less efficiently than GA15. In contrast to the free acid, GA25 19,20-anhydride was 3beta-hydroxylated to give GA13. 2,3-Didehydro-GA9 and GA5 were converted by recombinant GA4 to the corresponding epoxides 2, 3-oxido-GA9 and GA6.
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Affiliation(s)
- J Williams
- IACR-Long Ashton Research Station, Department of Agricultural Sciences, University of Bristol, Long Ashton, Bristol BS41 9AF, United Kingdom
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33
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MacMillan J, Ward DA, Phillips AL, Sánchez-Beltrán MJ, Gaskin P, Lange T, Hedden P. Gibberellin biosynthesis from gibberellin A12-aldehyde in endosperm and embryos of Marah macrocarpus. Plant Physiol 1997; 113:1369-77. [PMID: 9112781 PMCID: PMC158260 DOI: 10.1104/pp.113.4.1369] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Soluble enzyme preparations from embryos and endosperm of Marah macrocarpus (previously Echinocystis macrocarpa) were incubated with [14C4]gibberellin(GA)12-aldehyde, [14C4]GA12, [14C1] GA9, 2,3-didehydro[14C1]GA9, [14C1]GA20, and [17-13C, 3H]GA5. Embryo preparations converted GA12-aldehyde, GA12, and GA9 to GA4 and GA7; 2,3-didehydroGA9 to GA7; GA5 to GA3; and GA20 (incompletely) to GA1 and GA60, but not to GA3. Endosperm preparations converted GA12-aldehyde and GA12 to GA15, GA24, and GA9, but, unlike embryo preparations, not to GA4 or GA7. However, GA4 and GA7 were formed from GA9 and GA7 was formed from 2,3-didehydroGA9. Metabolism of GA5 to GA3 and GA20 to GA1 was low. 2,3-DidehydroGA9 accumulated when GA9 was incubated with a desalted endosperm preparation. A cDNA clone (M3-8), selected from an embryo-derived cDNA library using a DNA fragment generated by reverse transcriptase polymerase chain reaction, was expressed in Escherichia coli. The fusion protein converted GA12 to GA9 (major) and GA25 (minor); GA53 was metabolized less effectively and only to GA44. Thus, the M3-8 protein is functionally similar to GA 20-oxidases from Arabidopsis thaliana, Spinacia oleracea, and Pisum sativum, but different from that from Cucurbita maxima seeds, to which its amino acid sequence is most closely related. mRNA hybridizing to M3-8 accumulated in embryos and endosperm of M. macrocarpus, but was absent in vegetative tissues.
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Affiliation(s)
- J MacMillan
- Department of Agricultural Sciences, University of Bristol, Long Ashton, Bristol, United Kingdom
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34
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García-Martínez JL, López-Diaz I, Sánchez-Beltrán MJ, Phillips AL, Ward DA, Gaskin P, Hedden P. Isolation and transcript analysis of gibberellin 20-oxidase genes in pea and bean in relation to fruit development. Plant Mol Biol 1997; 33:1073-84. [PMID: 9154988 DOI: 10.1023/a:1005715722193] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
PCR was used with degenerate primers based on conserved amino acid sequences in gibberellin (GA) 20-oxidases to isolate cDNA clones for these enzymes from young seeds of pea (Pisum sativum) and developing embryos of French bean (Phaseolus vulgaris). One GA 20-oxidase cDNA (Ps27-12) was obtained from pea and three (Pv 15-11, Pv73-1 and Pv85-26) from bean. Their identities were confirmed by demonstrating that fusion proteins expressed in Escherichia coli exhibited GA 20-oxidase activity, converting [14C]GA12 to [14C]GA9. The intermediates in this three-step reaction, GA15 and GA24, were also identified as products. The expression proteins from three of the clones (Ps27-12, Pv15-11 and Pv73-1) were also shown to convert GA53 to GA20, as effectively as they did GA12. On the basis of transcript levels measured by northern blot analysis, the pea GA 20-oxidase gene is most highly expressed in young leaves, fully expanded internodes, very young seeds (until 4 days after anthesis) and expanding pods (from 3 days after anthesis at least until day 6). Expression in pods from 3-day-old unpollinated ovaries is higher than in those from pollinated ovaries. Treatment of unpollinated ovaries with GA3 to induce parthenocarpic fruit-set severely reduced the amount of GA 20-oxidase mRNA, whereas treatment with 2,4-D, although inducing fruit-set, did not reduce the levels of these transcripts. Plant decapitation above an unpollinated ovary resulted in very high levels of GA 20-oxidase mRNA in the pod. The three GA 20-oxidase genes from French bean showed very different patterns of expression: Pv 15-1 was expressed in the roots, young leaves, and developing seeds, but most highly in immature cotyledons, while Pv73-1 has a similar expression pattern to Ps27-12, with transcripts found only in young seeds and young leaves, where it was particularly abundant. Transcripts corresponding to Pv85-26 were detected in developing seeds, and just traces in the young leaves. Southern blot analysis indicated that the bean GA 20-oxidases are each encoded by single-copy genes, whereas one more gene, homologous to Ps27-12, could also exist in pea.
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Affiliation(s)
- J L García-Martínez
- Instituto de Biología Molecular y Celular de Plantas, Universidad Politécnica de Valencia-CSIC, Spain
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35
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Phillips AL, Ward DA, Uknes S, Appleford NE, Lange T, Huttly AK, Gaskin P, Graebe JE, Hedden P. Isolation and expression of three gibberellin 20-oxidase cDNA clones from Arabidopsis. Plant Physiol 1995; 108:1049-57. [PMID: 7630935 PMCID: PMC157456 DOI: 10.1104/pp.108.3.1049] [Citation(s) in RCA: 272] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Using degenerate oligonucleotide primers based on a pumpkin (Cucurbita maxima) gibberellin (GA) 20-oxidase sequence, six different fragments of dioxygenase genes were amplified by polymerase chain reaction from arabidopsis thaliana genomic DNA. One of these was used to isolate two different full-length cDNA clones, At2301 and At2353, from shoots of the GA-deficient Arabidopsis mutant ga1-2. A third, related clone, YAP169, was identified in the Database of Expressed Sequence Tags. The cDNA clones were expressed in Escherichia coli as fusion proteins, each of which oxidized GA12 at C-20 to GA15, GA24, and the C19 compound GA9, a precursor of bioactive GAs; the C20 tricarboxylic acid compound GA25 was formed as a minor product. The expression products also oxidized the 13-hydroxylated substrate GA53, but less effectively than GA12. The three cDNAs hybridized to mRNA species with tissue-specific patterns of accumulation, with At2301 being expressed in stems and inflorescences, At2353 in inflorescences and developing siliques, and YAP169 in siliques only. In the floral shoots of the ga1-2 mutant, transcript levels corresponding to each cDNA decreased dramatically after GA3 application, suggesting that GA biosynthesis may be controlled, at least in part, through down-regulation of the expression of the 20-oxidase genes.
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Affiliation(s)
- A L Phillips
- IACR-Long Ashton Research Station, Department of Agricultural Sciences, University of Bristol, United Kingdom
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36
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Huttly AK, Phillips AL. Gibberellin-regulated expression in oat aleurone cells of two kinases that show homology to MAP kinase and a ribosomal protein kinase. Plant Mol Biol 1995; 27:1043-52. [PMID: 7766874 DOI: 10.1007/bf00037031] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
cDNA fragments from ten different protein kinases expressed in Avena sativa aleurone cells were amplified from mRNA by RT-PCR with degenerate primers. These could be classified into five groups: Aspk1-3 showed homology to the Snf1-related protein kinases, Aspk4-5 to a wheat ABA up-regulated protein kinase, Aspk6-8 to the Ca-dependent, calmodulin-independent protein kinase family, Aspk9 encoded a MAP kinase and Aspk10 was closely related to a novel Arabidopsis ribosomal protein kinase. GA caused a rapid increase in transcripts hybridising to Aspk10, while inhibiting the dramatic accumulation of transcripts hybridising to Aspk9 that occurred in the absence of GA.
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Affiliation(s)
- A K Huttly
- IACR-Long Ashton Research Station, Department of Agricultural Sciences, University of Bristol, UK
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37
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Phillips AL, Huttly AK. Cloning of two gibberellin-regulated cDNAs from Arabidopsis thaliana by subtractive hybridization: expression of the tonoplast water channel, gamma-TIP, is increased by GA3. Plant Mol Biol 1994; 24:603-615. [PMID: 8155880 DOI: 10.1007/bf00023557] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The Arabidopsis ga1 mutant has very low levels of endogenous, active gibberellins and thus has an extreme dwarf phenotype; application of GA3 induces stem elongation and flower development. To test the hypothesis that GA action in this system involves changes in gene expression, we have cloned mRNAs whose abundance changes following GA application. A subtraction cloning scheme for the isolation of differentially regulated cDNAs was established, involving hybridization of single-stranded cDNA to biotinylated mRNA. cDNA populations enriched up to 150-fold in GA-regulated sequences were produced and cDNA libraries generated. Screening of these libraries has isolated two clones that identify mRNAs of ca. 1100 and 750 bases whose abundance is markedly increased 24 h after GA application. One of these clones encodes the vegetative form of the Arabidopsis tonoplast intrinsic protein (gamma-TIP), a water channel protein, the expression of which has recently been shown to be correlated with regions of cell expansion. The second clone is expressed only in the inflorescence and encodes a proline- and glycine-rich protein that may be a cell wall component.
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Affiliation(s)
- A L Phillips
- Long Ashton Research Station, Department of Agricultural Sciences, University of Bristol, AFRC Institute of Arable Crops Research, UK
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38
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Kettleborough CA, Phillips AL, Keys AJ, Parry MA. A point mutation in the N-terminus of ribulose-1,5-bisphosphate carboxylase affects ribulose-1,5-bisphosphate binding. Planta 1991; 184:35-39. [PMID: 24193926 DOI: 10.1007/bf00208233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/1990] [Indexed: 06/02/2023]
Abstract
Mutagenesis in vitro of the gene encoding the large subunit of ribulose-1,5-bisphosphate carboxylase/ oxygenase (EC 4.1.1.39) from Anacystis nidulans was used to generate novel enzymes. Two conserved residues, threonine 4 and lysine 11 in the N-terminus were changed. The substitution of threonine 4 with serine or valine had little effect on the kinetic parameters. The substitution of lysine 11 with leucine, which is non-polar, increased the K m for ribulose-1,5-bisphosphate from 82 to 190 μM but its replacement with glutamine, which has polar properties, had no appreciable effect.
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Affiliation(s)
- C A Kettleborough
- AFRC Institute of Arable Crops Research, Rothamsted Experimental Station, AL5 2JQ, Harpenden, Herts, UK
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39
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Huttly AK, Plant AL, Phillips AL, Auffret AD, Gray JC. Nucleotide sequence and transcripts of the pea chloroplast gene encoding CFo subunit III of ATP synthase. Gene 1990; 90:227-33. [PMID: 2129529 DOI: 10.1016/0378-1119(90)90184-s] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The structure and expression of the pea chloroplast atpH gene, encoding ATP synthase CFo subunit III, have been investigated. The atpH gene is situated between the atpI and atpF genes for CFo subunits IV and I, and encodes a hydrophobic polypeptide of 81 amino acid residues which is very similar to subunit III from other species. Analysis of transcripts from the region of chloroplast DNA encoding ATP synthase subunits IV-III-I-alpha shows a complex pattern of transcription, with large transcripts potentially coding for several subunits and also smaller gene-specific transcripts. Two abundant transcripts of 660 nucleotides (nt) and 980 nt specific for atpH were identified. Primer extension and S1 nuclease protection mapping suggested that the 660-nt transcripts were produced by endonucleolytic processing at the sequence, 5'-UGGAAU.
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Affiliation(s)
- A K Huttly
- Botany School, University of Cambridge, U.K
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40
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Kettleborough CA, Parry MA, Burton S, Gutteridge S, Keys AJ, Phillips AL. The role of the N-terminus of the large subunit of ribulose-bisphosphate carboxylase investigated by construction and expression of chimaeric genes. Eur J Biochem 1987; 170:335-42. [PMID: 3121325 DOI: 10.1111/j.1432-1033.1987.tb13704.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The genes for the large and small subunits of ribulose bisphosphate carboxylase/oxygenase (Rubisco) from Anacystis nidulans have been expressed in Escherichia coli under the control of the lac promoter to produce active enzyme. The enzyme can be purified from the cells to yield up to 200 mg Rubisco/l cultured bacteria, and is indistinguishable from the enzyme extracted from A. nidulans. In order to investigate the role of the N-terminus of the large subunit in catalysis, chimaeric genes were constructed where the DNA coding for the 12 N-terminal amino acids in A. nidulans was replaced by DNA encoding the equivalent, but poorly conserved, region of either the wheat or maize large subunit. These genes, in constructs also containing the gene for the A. nidulans small subunit, were expressed in E. coli and produced enzymes with similar catalytic properties to the wild-type Rubisco of A. nidulans. In contrast, when the N-terminal region of the large subunit was replaced by unrelated amino acids encoded by the pUC8 polylinker, enzyme activity of the expressed protein was reduced by 90% under standard assay conditions, due to an approximately tenfold rise in the Km for ribulose 1,5-bisphosphate. This confirms that the N-terminus of the large subunit has a function in catalysis, either directly in substrate binding or in maintaining the integrity of the active site.
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Affiliation(s)
- C A Kettleborough
- Department of Biochemistry, Rothamsted Experimental Station, Harpenden, England
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41
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Gray JC, Bird CR, Courtice GR, Hird SM, Howe CJ, Huttly AK, Phillips AL, Smith AG, Willey DL, Bowman CM. Chloroplast genes for photosynthetic membrane components of higher plants. Biochem Soc Trans 1986; 14:25-7. [PMID: 3007236] [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: 01/03/2023]
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Abstract
DNA from pea and tobacco chloroplasts hybridizes specifically with probes derived from the gene for a membrane component, the a subunit of ATP synthase of the cyanobacterium, Synechococcus 6301. DNA sequence of the hybridizing region of the pea plastid DNA has revealed that it encodes a protein of 247 amino acids related in sequence to the a subunits of ATP synthase of Escherichia coli, Synechococcus and mitochondria. This is the sixth component of chloroplast ATP synthase that is plastid coded. The gene is located upstream from the genes for three other ATP synthase subunits and a transcript of 6 kb contains coding sequences from each of these genes. Thus the subunit a gene is part of a co-transcribed cluster of four ATP synthase genes arranged in the order a:c(or III):b(or I):alpha. Two other ATP synthase genes, those for beta and epsilon subunits, are known to form a separate cluster. These gene arrangements are most closely related to those found in the cyanobacterium, Synechococcus 6301. Hence, this finding provides strong evidence for a common origin for cyanobacteria and plant chloroplasts.
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Affiliation(s)
- A L Cozens
- MRC Laboratory of Molecular Biology, Hills Road, Cambridge CB2 2QH, UK
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Abstract
Three components of the cytochrome b-f complex, cytochrome f, cytochrome b-563 and a 15.2-kDa polypeptide, were labelled with radioactive amino acids in isolated pea chloroplasts incubated in the light with added Mg-ATP. The assembly of cytochrome b-563 (19.5 kDa) into the cytochrome complex required the presence of added Mg-ATP whereas cytochrome f (37.3 kDa) and the 15.2-kDa polypeptide were assembled in its absence. Incorporation of [35S]methionine into the polypeptide chain of cytochrome b-563 and the 15.2-kDa component was confirmed by peptide mapping of the products of partial digestion with papain.
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Abstract
A cytochrome b-f complex has been extracted from pea chloroplast membranes with octyl glucoside and cholate and has been purified by ammonium sulphate fractionation and polyacrylamide gel electrophoresis in the presence of Triton X-100 and sodium deoxycholate. The complex contains cytochromes f and b-563 in a ratio of 1:2, but shows very low levels of the Rieske iron sulphur centre and plastoquinol-plastocyanin oxidoreductase activity. The complex consists of four polypeptides of molecular weights 37300, 34000, 19500 and 15200. The complex is dissociated by electrophoresis in the presence of 2M urea to give pure preparations of cytochrome f and cytochrome b-563, which on sodium dodecylsulphate-polyacrylamide gel electrophoresis give single bands of apparent molecular weights 37300 and 19500 respectively.
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