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Fernandez A, Kielland N, Makda A, Carragher NO, González-García MC, Espinar-Barranco L, González-Vera JA, Orte A, Lavilla R, Vendrell M. A multicomponent reaction platform towards multimodal near-infrared BODIPY dyes for STED and fluorescence lifetime imaging. RSC Chem Biol 2022; 3:1251-1259. [PMID: 36320886 PMCID: PMC9533399 DOI: 10.1039/d2cb00168c] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/25/2022] [Indexed: 11/07/2023] Open
Abstract
We report a platform combining multicomponent reaction synthesis and automated cell-based screening to develop biocompatible NIR-BODIPY fluorophores. From a library of over 60 fluorophores, we optimised compound NIRBD-62c as a multimodal probe with suitable properties for STED super-resolution and fluorescence lifetime imaging. Furthermore, we employed NIRBD-62c for imaging trafficking inside cells and to examine how pharmacological inhibitors can alter the vesicular traffic between intracellular compartments and the plasma membrane.
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Affiliation(s)
- Antonio Fernandez
- Centre for Inflammation Research, The University of Edinburgh Edinburgh UK
- Dpt Organic Chemistry, Faculty of Chemistry, University of Murcia Spain
| | - Nicola Kielland
- Centre for Inflammation Research, The University of Edinburgh Edinburgh UK
- Laboratory of Medicinal Chemistry, Faculty of Pharmacy and Institute of Biomedicine (IBUB), University of Barcelona Spain
| | - Ashraff Makda
- Institute of Genetics and Cancer, The University of Edinburgh Edinburgh UK
| | - Neil O Carragher
- Institute of Genetics and Cancer, The University of Edinburgh Edinburgh UK
| | | | | | - Juan A González-Vera
- Nanoscopy-UGR Laboratory, Facultad de Farmacia, Universidad de Granada Granada Spain
| | - Angel Orte
- Nanoscopy-UGR Laboratory, Facultad de Farmacia, Universidad de Granada Granada Spain
| | - Rodolfo Lavilla
- Laboratory of Medicinal Chemistry, Faculty of Pharmacy and Institute of Biomedicine (IBUB), University of Barcelona Spain
| | - Marc Vendrell
- Centre for Inflammation Research, The University of Edinburgh Edinburgh UK
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2
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Hughes R, Elliott RJR, Li X, Munro AF, Makda A, Carter RN, Morton NM, Fujihara K, Clemons NJ, Fitzgerald R, O’Neill JR, Hupp T, Carragher NO. Multiparametric High-Content Cell Painting Identifies Copper Ionophores as Selective Modulators of Esophageal Cancer Phenotypes. ACS Chem Biol 2022; 17:1876-1889. [PMID: 35696676 PMCID: PMC9295120 DOI: 10.1021/acschembio.2c00301] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Esophageal adenocarcinoma is of increasing global concern due to increasing incidence, a lack of effective treatments, and poor prognosis. Therapeutic target discovery and clinical trials have been hindered by the heterogeneity of the disease, the lack of "druggable" driver mutations, and the dominance of large-scale genomic rearrangements. We have previously undertaken a comprehensive small-molecule phenotypic screen using the high-content Cell Painting assay to quantify the morphological response to a total of 19,555 small molecules across a panel of genetically distinct human esophageal cell lines to identify new therapeutic targets and small molecules for the treatment of esophageal adenocarcinoma. In this current study, we report for the first time the dose-response validation studies for the 72 screening hits from the target-annotated LOPAC and Prestwick FDA-approved compound libraries and the full list of 51 validated esophageal adenocarcinoma-selective small molecules (71% validation rate). We then focus on the most potent and selective hit molecules, elesclomol, disulfiram, and ammonium pyrrolidinedithiocarbamate. Using a multipronged, multitechnology approach, we uncover a unified mechanism of action and a vulnerability in esophageal adenocarcinoma toward copper-dependent cell death that could be targeted in the future.
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Affiliation(s)
- Rebecca
E. Hughes
- Cancer
Research UK Edinburgh Centre, Institute of Genetics & Cancer, The University of Edinburgh, Western General Hospital, Edinburgh EH4 2XR, U.K.
| | - Richard J. R. Elliott
- Cancer
Research UK Edinburgh Centre, Institute of Genetics & Cancer, The University of Edinburgh, Western General Hospital, Edinburgh EH4 2XR, U.K.
| | - Xiaodun Li
- MRC
Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Cambridge CB2 0XZ, U.K.
| | - Alison F. Munro
- Cancer
Research UK Edinburgh Centre, Institute of Genetics & Cancer, The University of Edinburgh, Western General Hospital, Edinburgh EH4 2XR, U.K.
| | - Ashraff Makda
- Cancer
Research UK Edinburgh Centre, Institute of Genetics & Cancer, The University of Edinburgh, Western General Hospital, Edinburgh EH4 2XR, U.K.
| | - Roderick N. Carter
- Centre
for Clinical Brain Sciences, Chancellors Building, University of Edinburgh, Edinburgh EH16 4SB, U.K.
- Centre
for Cardiovascular Science, The Queen’s
Medical Research Institute, Edinburgh BioQuarter, Edinburgh EH16 4TJ, U.K.
| | - Nicholas M. Morton
- Centre
for Cardiovascular Science, The Queen’s
Medical Research Institute, Edinburgh BioQuarter, Edinburgh EH16 4TJ, U.K.
| | - Kenji Fujihara
- Gastrointestinal
Cancer Program, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne 3000, Victoria, Australia
- Sir Peter
MacCallum Department of Oncology, The University
of Melbourne, Parkville 3010, Victoria, Australia
| | - Nicholas J. Clemons
- Gastrointestinal
Cancer Program, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne 3000, Victoria, Australia
- Sir Peter
MacCallum Department of Oncology, The University
of Melbourne, Parkville 3010, Victoria, Australia
| | - Rebecca Fitzgerald
- Early
Cancer Institute, Hutchison Research Centre, University of Cambridge, Cambridge CB2 0XZ, U.K.
| | - J. Robert O’Neill
- Cambridge
Oesophagogastric Centre, Cambridge University
Hospitals Foundation Trust, Cambridge CB2 2QQ, U.K.
| | - Ted Hupp
- Cancer
Research UK Edinburgh Centre, Institute of Genetics & Cancer, The University of Edinburgh, Western General Hospital, Edinburgh EH4 2XR, U.K.
| | - Neil O. Carragher
- Cancer
Research UK Edinburgh Centre, Institute of Genetics & Cancer, The University of Edinburgh, Western General Hospital, Edinburgh EH4 2XR, U.K.
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3
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Marwick JA, Elliott RJR, Longden J, Makda A, Hirani N, Dhaliwal K, Dawson JC, Carragher NO. Application of a High-Content Screening Assay Utilizing Primary Human Lung Fibroblasts to Identify Antifibrotic Drugs for Rapid Repurposing in COVID-19 Patients. SLAS Discov 2021; 26:1091-1106. [PMID: 34078171 PMCID: PMC8458684 DOI: 10.1177/24725552211019405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung imaging and autopsy reports among COVID-19 patients show elevated lung scarring (fibrosis). Early data from COVID-19 patients as well as previous studies from severe acute respiratory syndrome, Middle East respiratory syndrome, and other respiratory disorders show that the extent of lung fibrosis is associated with a higher mortality, prolonged ventilator dependence, and poorer long-term health prognosis. Current treatments to halt or reverse lung fibrosis are limited; thus, the rapid development of effective antifibrotic therapies is a major global medical need that will continue far beyond the current COVID-19 pandemic. Reproducible fibrosis screening assays with high signal-to-noise ratios and disease-relevant readouts such as extracellular matrix (ECM) deposition (the hallmark of fibrosis) are integral to any antifibrotic therapeutic development. Therefore, we have established an automated high-throughput and high-content primary screening assay measuring transforming growth factor-β (TGFβ)-induced ECM deposition from primary human lung fibroblasts in a 384-well format. This assay combines longitudinal live cell imaging with multiparametric high-content analysis of ECM deposition. Using this assay, we have screened a library of 2743 small molecules representing approved drugs and late-stage clinical candidates. Confirmed hits were subsequently profiled through a suite of secondary lung fibroblast phenotypic screening assays quantifying cell differentiation, proliferation, migration, and apoptosis. In silico target prediction and pathway network analysis were applied to the confirmed hits. We anticipate this suite of assays and data analysis tools will aid the identification of new treatments to mitigate against lung fibrosis associated with COVID-19 and other fibrotic diseases.
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Affiliation(s)
- John A Marwick
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.,Centre for Inflammation Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Richard J R Elliott
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - James Longden
- Center for Clinical Brain Sciences, Chancellors Building, University of Edinburgh, Edinburgh, UK
| | - Ashraff Makda
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Nik Hirani
- Centre for Inflammation Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - John C Dawson
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Neil O Carragher
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
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4
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Hughes RE, Elliott RJR, Munro AF, Makda A, O’Neill JR, Hupp T, Carragher NO. High-Content Phenotypic Profiling in Esophageal Adenocarcinoma Identifies Selectively Active Pharmacological Classes of Drugs for Repurposing and Chemical Starting Points for Novel Drug Discovery. SLAS Discov 2020; 25:770-782. [PMID: 32441181 PMCID: PMC7372582 DOI: 10.1177/2472555220917115] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/26/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022]
Abstract
Esophageal adenocarcinoma (EAC) is a highly heterogeneous disease, dominated by large-scale genomic rearrangements and copy number alterations. Such characteristics have hampered conventional target-directed drug discovery and personalized medicine strategies, contributing to poor outcomes for patients. We describe the application of a high-content Cell Painting assay to profile the phenotypic response of 19,555 compounds across a panel of six EAC cell lines and two tissue-matched control lines. We built an automated high-content image analysis pipeline to identify compounds that selectively modified the phenotype of EAC cell lines. We further trained a machine-learning model to predict the mechanism of action of EAC selective compounds using phenotypic fingerprints from a library of reference compounds. We identified a number of phenotypic clusters enriched with similar pharmacological classes, including methotrexate and three other antimetabolites that are highly selective for EAC cell lines. We further identify a small number of hits from our diverse chemical library that show potent and selective activity for EAC cell lines and that do not cluster with the reference library of compounds, indicating they may be selectively targeting novel esophageal cancer biology. Overall, our results demonstrate that our EAC phenotypic screening platform can identify existing pharmacologic classes and novel compounds with selective activity for EAC cell phenotypes.
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Affiliation(s)
- Rebecca E. Hughes
- MRC Institute of Genetics &
Molecular Medicine, The University of Edinburgh, Western General Hospital,
Edinburgh, UK
| | - Richard J. R. Elliott
- MRC Institute of Genetics &
Molecular Medicine, The University of Edinburgh, Western General Hospital,
Edinburgh, UK
| | - Alison F. Munro
- MRC Institute of Genetics &
Molecular Medicine, The University of Edinburgh, Western General Hospital,
Edinburgh, UK
| | - Ashraff Makda
- MRC Institute of Genetics &
Molecular Medicine, The University of Edinburgh, Western General Hospital,
Edinburgh, UK
| | - J. Robert O’Neill
- Cambridge Oesophagogastric Centre,
Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire,
UK
| | - Ted Hupp
- MRC Institute of Genetics &
Molecular Medicine, The University of Edinburgh, Western General Hospital,
Edinburgh, UK
| | - Neil O. Carragher
- MRC Institute of Genetics &
Molecular Medicine, The University of Edinburgh, Western General Hospital,
Edinburgh, UK
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5
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Dawson JC, Serrels B, Byron A, Muir MT, Makda A, García-Muñoz A, von Kriegsheim A, Lietha D, Carragher NO, Frame MC. A Synergistic Anticancer FAK and HDAC Inhibitor Combination Discovered by a Novel Chemical-Genetic High-Content Phenotypic Screen. Mol Cancer Ther 2020; 19:637-649. [PMID: 31784455 PMCID: PMC7611632 DOI: 10.1158/1535-7163.mct-19-0330] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/22/2019] [Accepted: 11/22/2019] [Indexed: 11/16/2022]
Abstract
We mutated the focal adhesion kinase (FAK) catalytic domain to inhibit binding of the chaperone Cdc37 and ATP, mimicking the actions of a FAK kinase inhibitor. We reexpressed mutant and wild-type FAK in squamous cell carcinoma (SCC) cells from which endogenous FAK had been deleted, genetically fixing one axis of a FAK inhibitor combination high-content phenotypic screen to discover drugs that may synergize with FAK inhibitors. Histone deacetylase (HDAC) inhibitors represented the major class of compounds that potently induced multiparametric phenotypic changes when FAK was rendered kinase-defective or inhibited pharmacologically in SCC cells. Combined FAK and HDAC inhibitors arrest proliferation and induce apoptosis in a subset of cancer cell lines in vitro and efficiently inhibit their growth as tumors in vivo Mechanistically, HDAC inhibitors potentiate inhibitor-induced FAK inactivation and impair FAK-associated nuclear YAP in sensitive cancer cell lines. Here, we report the discovery of a new, clinically actionable, synergistic combination between FAK and HDAC inhibitors.
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Affiliation(s)
- John C Dawson
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Bryan Serrels
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam Byron
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Morwenna T Muir
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Ashraff Makda
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Alex von Kriegsheim
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
- Systems Biology Ireland, University College Dublin, Dublin, Ireland
| | - Daniel Lietha
- Cell Signaling and Adhesion Group, Structural Biology Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Neil O Carragher
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom.
| | - Margaret C Frame
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom.
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6
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Warchal SJ, Dawson JC, Shepherd E, Munro AF, Hughes RE, Makda A, Carragher NO. High content phenotypic screening identifies serotonin receptor modulators with selective activity upon breast cancer cell cycle and cytokine signaling pathways. Bioorg Med Chem 2019; 28:115209. [PMID: 31757681 PMCID: PMC6961118 DOI: 10.1016/j.bmc.2019.115209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 02/08/2023]
Abstract
Heterogeneity in disease mechanisms between genetically distinct patients contributes to high attrition rates in late stage clinical drug development. New personalized medicine strategies aim to identify predictive biomarkers which stratify patients most likely to respond to a particular therapy. However, for complex multifactorial diseases not characterized by a single genetic driver, empirical approaches to identifying predictive biomarkers and the most promising therapies for personalized medicine are required. In vitro pharmacogenomics seeks to correlate in vitro drug sensitivity testing across panels of genetically distinct cell models with genomic, gene expression or proteomic data to identify predictive biomarkers of drug response. However, the vast majority of in vitro pharmacogenomic studies performed to date are limited to dose-response screening upon a single viability assay endpoint. In this article we describe the application of multiparametric high content phenotypic screening and the theta comparative cell scoring method to quantify and rank compound hits, screened at a single concentration, which induce a broad variety of divergent phenotypic responses between distinct breast cancer cell lines. High content screening followed by transcriptomic pathway analysis identified serotonin receptor modulators which display selective activity upon breast cancer cell cycle and cytokine signaling pathways correlating with inhibition of cell growth and survival. These methods describe a new evidence-led approach to rapidly identify compounds which display distinct response between different cell types. The results presented also warrant further investigation of the selective activity of serotonin receptor modulators upon breast cancer cell growth and survival as a potential drug repurposing opportunity.
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Affiliation(s)
- Scott J Warchal
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, EH4 2XR Edinburgh, United Kingdom
| | - John C Dawson
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, EH4 2XR Edinburgh, United Kingdom.
| | - Emelie Shepherd
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, EH4 2XR Edinburgh, United Kingdom
| | - Alison F Munro
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, EH4 2XR Edinburgh, United Kingdom
| | - Rebecca E Hughes
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, EH4 2XR Edinburgh, United Kingdom
| | - Ashraff Makda
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, EH4 2XR Edinburgh, United Kingdom
| | - Neil O Carragher
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, EH4 2XR Edinburgh, United Kingdom.
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Johnston HJ, Boys SK, Makda A, Carragher NO, Hulme AN. Inside Cover: Naturally Inspired Peptide Leads: Alanine Scanning Reveals an Actin-Targeting Thiazole Analogue of Bisebromoamide (ChemBioChem 17/2016). Chembiochem 2016. [DOI: 10.1002/cbic.201600435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Heather J. Johnston
- EaStCHEM School of Chemistry; The University of Edinburgh; David Brewster Road Edinburgh EH9 3FJ UK
| | - Sarah K. Boys
- EaStCHEM School of Chemistry; The University of Edinburgh; David Brewster Road Edinburgh EH9 3FJ UK
| | - Ashraff Makda
- Edinburgh Cancer Research Centre; Institute of Genetics and Molecular Medicine; University of Edinburgh; Crewe Road South Edinburgh EH4 2XR UK
| | - Neil O. Carragher
- Edinburgh Cancer Research Centre; Institute of Genetics and Molecular Medicine; University of Edinburgh; Crewe Road South Edinburgh EH4 2XR UK
| | - Alison N. Hulme
- EaStCHEM School of Chemistry; The University of Edinburgh; David Brewster Road Edinburgh EH9 3FJ UK
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Johnston HJ, Boys SK, Makda A, Carragher NO, Hulme AN. Naturally Inspired Peptide Leads: Alanine Scanning Reveals an Actin-Targeting Thiazole Analogue of Bisebromoamide. Chembiochem 2016; 17:1621-7. [PMID: 27304907 PMCID: PMC5096027 DOI: 10.1002/cbic.201600257] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Indexed: 12/29/2022]
Abstract
Systematic alanine scanning of the linear peptide bisebromoamide (BBA), isolated from a marine cyanobacterium, was enabled by solid-phase peptide synthesis of thiazole analogues. The analogues have comparable cytotoxicity (nanomolar) to that of BBA, and cellular morphology assays indicated that they target the actin cytoskeleton. Pathway inhibition in human colon tumour (HCT116) cells was explored by reverse phase protein array (RPPA) analysis, which showed a dose-dependent response in IRS-1 expression. Alanine scanning reveals a structural dependence to the cytotoxicity, actin targeting and pathway inhibition, and allows a new readily synthesised lead to be proposed.
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Affiliation(s)
- Heather J Johnston
- EaStCHEM School of Chemistry, The University of Edinburgh, David Brewster Road, Edinburgh, EH9 3FJ, UK
| | - Sarah K Boys
- EaStCHEM School of Chemistry, The University of Edinburgh, David Brewster Road, Edinburgh, EH9 3FJ, UK
| | - Ashraff Makda
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XR, UK
| | - Neil O Carragher
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XR, UK
| | - Alison N Hulme
- EaStCHEM School of Chemistry, The University of Edinburgh, David Brewster Road, Edinburgh, EH9 3FJ, UK.
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Khan NU, Shakeel N, Makda A, Mallick AS, Ali Memon M, Hashmi SH, Khan UR, Razzak JA. Anaphylaxis: incidence, presentation, causes and outcome in patients in a tertiary-care hospital in Karachi, Pakistan. QJM 2013; 106:1095-101. [PMID: 24082151 PMCID: PMC3840329 DOI: 10.1093/qjmed/hct179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anaphylaxis is a potentially fatal condition requiring immediate resuscitation. Data regarding the epidemiology of anaphylaxis are limited and inconsistent. A reason for the variability was unavailability of a universally acceptable case definition till 2005. We reviewed cases using this new definition AIM To review the incidence, clinical presentation, cause and outcome of anaphylaxis at a tertiary-care centre in a low-income country. DESIGN Retrospective, case series METHODS Chart review of all patients discharged from Aga Khan University Hospital between January 1988 and December 2012 (24 years) with anaphylaxis definition as per second National Institute of Allergy and Infection disease/Food Allergy and Anaphylaxis Network Symposium RESULTS Total of 129 cases were found with mean age of 41.6 years (SD 18.8). Majority of patients had cutaneous features (76.7%), followed by respiratory (68.9%), cardiac (64.3%) and gastrointestinal (20.9%) symptoms, respectively. About 22.4% of patients had positive history for allergens out of which 31% (n = 9) were exposed to the same allergens. The common causes identified for anaphylaxis were drugs (60.5%), food (16.3%) and intravenous contrast (10.9%), respectively. Only 22.5% of cases received epinephrine as a part of their initial management. In four patients (3.1%) the cause of death was attributed to anaphylaxis. CONCLUSION Anaphylaxis is a rare but life-threatening condition. Though cutaneous features are most common, their absence does not exclude the diagnosis. Drugs were the most common cause and epinephrine was not commonly used as first-line agent for its management.
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Affiliation(s)
- N U Khan
- MD, Diplomate American Board of Internal Medicine, Assistant Professor, Department of Emergency Medicine, The Aga Khan University Hospital, P.O. Box # 3500, Stadium Road, Karachi - 74800, Pakistan.
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