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Dequiedt L, Forjaz A, Lo JO, McCarty O, Wu PH, Rosenberg A, Wirtz D, Kiemen A. Three-dimensional reconstruction of fetal rhesus macaque kidneys at single-cell resolution reveals complex inter-relation of structures. bioRxiv 2024:2023.12.07.570622. [PMID: 38106004 PMCID: PMC10723390 DOI: 10.1101/2023.12.07.570622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Kidneys are among the most structurally complex organs in the body. Their architecture is critical to ensure proper function and is often impacted by diseases such as diabetes and hypertension. Understanding the spatial interplay between the different structures of the nephron and renal vasculature is crucial. Recent efforts have demonstrated the value of three-dimensional (3D) imaging in revealing new insights into the various components of the kidney; however, these studies used antibodies or autofluorescence to detect structures and so were limited in their ability to compare the many subtle structures of the kidney at once. Here, through 3D reconstruction of fetal rhesus macaque kidneys at cellular resolution, we demonstrate the power of deep learning in exhaustively labelling seventeen microstructures of the kidney. Using these tissue maps, we interrogate the spatial distribution and spatial correlation of the glomeruli, renal arteries, and the nephron. This work demonstrates the power of deep learning applied to 3D tissue images to improve our ability to compare many microanatomical structures at once, paving the way for further works investigating renal pathologies.
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Affiliation(s)
- Lucie Dequiedt
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University
| | - André Forjaz
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University
| | - Jamie O Lo
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center
| | - Owen McCarty
- Department of Biomedical Engineering, Oregon Health and Sciences University
| | - Pei-Hsun Wu
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University
- Institute for NanoBioTechnology, Johns Hopkins University
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins School of Medicine
| | - Denis Wirtz
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University
- Institute for NanoBioTechnology, Johns Hopkins University
- Department of Pathology, Johns Hopkins School of Medicine
- Department of Oncology, Johns Hopkins School of Medicine
| | - Ashley Kiemen
- Institute for NanoBioTechnology, Johns Hopkins University
- Department of Pathology, Johns Hopkins School of Medicine
- Department of Oncology, Johns Hopkins School of Medicine
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2
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Barbour SJ, Coppo R, Er L, Pillebout E, Russo ML, Alpers CE, Fogo AB, Ferrario F, Jennette JC, Roberts IS, Cook HT, Ding J, Su B, Zhong X, Fervenza FC, Zand L, Peruzzi L, Lucchetti L, Katafuchi R, Shima Y, Yoshikawa N, Ichikawa D, Suzuki Y, Murer L, Wyatt RJ, Park C, Nelson RD, Narus JH, Wenderfer S, Geetha D, Daugas E, Monteiro RC, Nakatani S, Mastrangelo A, Nuutinen M, Koskela M, Weber LT, Hackl A, Pohl M, Pecoraro C, Tsuboi N, Yokoo T, Takafumi I, Fujimoto S, Conti G, Santoro D, Materassi M, Zhang H, Shi S, Liu ZH, Tesar V, Maixnerova D, Avila-Casado C, Bajema I, Barreca A, Becker JU, Comstock JM, Cornea V, Eldin K, Hernandez LH, Hou J, Joh K, Lin M, Messias N, Muda AO, Pagni F, Diomedi-Camassei F, Tokola H, D'Armiento M, Seidl M, Rosenberg A, Sannier A, Soares MF, Wang S, Zeng C, Haas M. Histologic and Clinical Factors Associated with Kidney Outcomes in IgA Vasculitis Nephritis. Clin J Am Soc Nephrol 2024; 19:438-451. [PMID: 38261310 PMCID: PMC11020428 DOI: 10.2215/cjn.0000000000000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Nephritis is a common manifestation of IgA vasculitis and is morphologically indistinguishable from IgA nephropathy. While MEST-C scores are predictive of kidney outcomes in IgA nephropathy, their value in IgA vasculitis nephritis has not been investigated in large multiethnic cohorts. METHODS Biopsies from 262 children and 99 adults with IgA vasculitis nephritis ( N =361) from 23 centers in North America, Europe, and Asia were independently scored by three pathologists. MEST-C scores were assessed for correlation with eGFR/proteinuria at biopsy. Because most patients ( N =309, 86%) received immunosuppression, risk factors for outcomes were evaluated in this group using latent class mixed models to identify classes of eGFR trajectories over a median follow-up of 2.7 years (interquartile range, 1.2-5.1). Clinical and histologic parameters associated with each class were determined using logistic regression. RESULTS M, E, T, and C scores were correlated with either eGFR or proteinuria at biopsy. Two classes were identified by latent class mixed model, one with initial improvement in eGFR followed by a late decline (class 1, N =91) and another with stable eGFR (class 2, N =218). Class 1 was associated with a higher risk of an established kidney outcome (time to ≥30% decline in eGFR or kidney failure; hazard ratio, 5.84; 95% confidence interval, 2.37 to 14.4). Among MEST-C scores, only E1 was associated with class 1 by multivariable analysis. Other factors associated with class 1 were age 18 years and younger, male sex, lower eGFR at biopsy, and extrarenal noncutaneous disease. Fibrous crescents without active changes were associated with class 2. CONCLUSIONS Kidney outcome in patients with biopsied IgA vasculitis nephritis treated with immunosuppression was determined by clinical risk factors and endocapillary hypercellularity (E1) and fibrous crescents, which are features that are not part of the International Study of Diseases of Children classification.
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Affiliation(s)
- Sean J. Barbour
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Renal, Vancouver, British Columbia, Canada
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Lee Er
- BC Renal, Vancouver, British Columbia, Canada
| | | | - Maria Luisa Russo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Charles E. Alpers
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, Washington
| | - Agnes B. Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Franco Ferrario
- Department of Medicine and Surgery, IRCCS San Gerardo, University Milan Bicocca, Monza, Italy
| | - J. Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Ian S.D. Roberts
- Department of Cellular Pathology, Oxford University Hospitals NHS FT, Oxford, United Kingdom
| | | | - Jie Ding
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Baige Su
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xuhui Zhong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | | | - Ladan Zand
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Children's Hospital, AOU Città della Salute della Scienza di Torino, Turin, Italy
| | - Laura Lucchetti
- Division of Nephrology, Bambino Gesù Children's Hospital–IRCCS, Rome, Italy
| | - Ritsuko Katafuchi
- Kidney Unit, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan
| | - Yuko Shima
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Norishige Yoshikawa
- Clinical Research Center, Takatsuki General Hospital, Wakayam Medical University, Takatsuki City, Japan
| | - Daisuke Ichikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Luisa Murer
- Pediatric Nephrology Dialysis and Transplant Unit, Department of Women's and Child's Health, Azienda Ospedaliera-University of Padova, Padua, Italy
| | - Robert J. Wyatt
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Catherine Park
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Raoul D. Nelson
- Division of Pediatric Nephrology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - JoAnn H. Narus
- Pediatrics Clinical Trials Office, University of Utah, Salt Lake City, Utah
| | - Scott Wenderfer
- Division of Pediatric Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
- Texas Children's Hospital, Houston, Texas
| | - Duvuru Geetha
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric Daugas
- Nephrology, Bichat Hospital, AP-HP, Paris, France
- INSERM U1149 and Université Paris Cité, Paris, France
| | - Renato C. Monteiro
- Centre for Research on Inflammation, Bichat Hospital, Inserm and Université Paris Cité, Paris, France
| | - Shinya Nakatani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCC Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Matti Nuutinen
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Medical Research Center Oulu (MRC Oulu), Oulu, Finland
| | - Mikael Koskela
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lutz T. Weber
- Pediatric Nephrology, Faculty of Medicine and University Hospital Cologne, Children's and Adolescents' Hospital, University of Cologne, Cologne, Germany
| | - Agnes Hackl
- Pediatric Nephrology, Faculty of Medicine and University Hospital Cologne, Children's and Adolescents' Hospital, University of Cologne, Cologne, Germany
| | - Martin Pohl
- Medical Center, Department of General Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carmine Pecoraro
- Comitato Tecnico Scientifico per la Ricerca e Innovaziione, A.O. Santobono-Pausilipon, Naples, Italy
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Department of Nephrology and Hypertension, Jikei University School of Medicine, Tokyo, Japan
| | - Ito Takafumi
- Kidney Center, Department of Internal Medicine, Nephrology, Teikyo University School of Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Shouichi Fujimoto
- Division of Dialysis, Department of Nephrology, University of Miyazaki Hospital, Miyazaki, Japan
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, AOU Policlinic G Martino, University of Messina, Messina, Italy
| | - Domenico Santoro
- Nephrology and Dialysis Unit AOU, G. Martino, University of Messina, Messina, Italy
| | - Marco Materassi
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Beijing, China
| | - Sufang Shi
- Kidney Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Vladimir Tesar
- Department of Nephrology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Dita Maixnerova
- Department of Nephrology, 1st Faculty of Medicine, General University Hospital, Prague, Czech Republic
| | | | - Ingeborg Bajema
- Department of Pathology and Medical Biology, University of Groningen, Groningen, The Netherlands
| | - Antonella Barreca
- Pathology Unit, Città della Salute e della Scienza di Torino University Hospital, Turin, Italy
| | - Jan U. Becker
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | | | - Virgilius Cornea
- Department of Pathology, University of Kentucky Medical Center, Lexington, Kentucky
| | - Karen Eldin
- Department of Pathology, Mass General Brigham, Salem Hospital, Salem, Massachusetts
| | | | - Jean Hou
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kensuke Joh
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mercury Lin
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nidia Messias
- Department of Pathology, Washington University in Saint Louis, St. Louis, Missouri
| | | | - Fabio Pagni
- Department of Medicine and Surgery, IRCCS San Gerardo, University Milan Bicocca, Monza, Italy
| | | | - Heikki Tokola
- Pathology, University Oulu and Oulu University Hospital, Oulu, Finland
| | - Maria D'Armiento
- Pathology Section, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maximilian Seidl
- Medical Center-University of Freiburg and Faculty of Medicine, Institute for Surgical Pathology, University of Freiburg, Freiburg, Germany
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aurélie Sannier
- Department of Pathology, AP-HP, Hôpital Bichat, Université Paris Cité, Paris, France
| | - Maria Fernanda Soares
- Department of Cellular Pathology, Oxford University Hospitals NHS FT, Oxford, United Kingdom
| | - Suxia Wang
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Mark Haas
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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Bate S, McGovern D, Costigliolo F, Tan PG, Kratky V, Scott J, Chapman GB, Brown N, Floyd L, Brilland B, Martín-Nares E, Aydın MF, Ilyas D, Butt A, Nic an Riogh E, Kollar M, Lees JS, Yildiz A, Hinojosa-Azaola A, Dhaygude A, Roberts SA, Rosenberg A, Wiech T, Pusey CD, Jones RB, Jayne DR, Bajema I, Jennette JC, Stevens KI, Augusto JF, Mejía-Vilet JM, Dhaun N, McAdoo SP, Tesar V, Little MA, Geetha D, Brix SR. The Improved Kidney Risk Score in ANCA-Associated Vasculitis for Clinical Practice and Trials. J Am Soc Nephrol 2024; 35:335-346. [PMID: 38082490 PMCID: PMC10914211 DOI: 10.1681/asn.0000000000000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/03/2023] [Indexed: 01/27/2024] Open
Abstract
SIGNIFICANCE STATEMENT Reliable prediction tools are needed to personalize treatment in ANCA-associated GN. More than 1500 patients were collated in an international longitudinal study to revise the ANCA kidney risk score. The score showed satisfactory performance, mimicking the original study (Harrell's C=0.779). In the development cohort of 959 patients, no additional parameters aiding the tool were detected, but replacing the GFR with creatinine identified an additional cutoff. The parameter interstitial fibrosis and tubular atrophy was modified to allow wider access, risk points were reweighted, and a fourth risk group was created, improving predictive ability (C=0.831). In the validation, the new model performed similarly well with excellent calibration and discrimination ( n =480, C=0.821). The revised score optimizes prognostication for clinical practice and trials. BACKGROUND Reliable prediction tools are needed to personalize treatment in ANCA-associated GN. A retrospective international longitudinal cohort was collated to revise the ANCA renal risk score. METHODS The primary end point was ESKD with patients censored at last follow-up. Cox proportional hazards were used to reweight risk factors. Kaplan-Meier curves, Harrell's C statistic, receiver operating characteristics, and calibration plots were used to assess model performance. RESULTS Of 1591 patients, 1439 were included in the final analyses, 2:1 randomly allocated per center to development and validation cohorts (52% male, median age 64 years). In the development cohort ( n =959), the ANCA renal risk score was validated and calibrated, and parameters were reinvestigated modifying interstitial fibrosis and tubular atrophy allowing semiquantitative reporting. An additional cutoff for kidney function (K) was identified, and serum creatinine replaced GFR (K0: <250 µ mol/L=0, K1: 250-450 µ mol/L=4, K2: >450 µ mol/L=11 points). The risk points for the percentage of normal glomeruli (N) and interstitial fibrosis and tubular atrophy (T) were reweighted (N0: >25%=0, N1: 10%-25%=4, N2: <10%=7, T0: none/mild or <25%=0, T1: ≥ mild-moderate or ≥25%=3 points), and four risk groups created: low (0-4 points), moderate (5-11), high (12-18), and very high (21). Discrimination was C=0.831, and the 3-year kidney survival was 96%, 79%, 54%, and 19%, respectively. The revised score performed similarly well in the validation cohort with excellent calibration and discrimination ( n =480, C=0.821). CONCLUSIONS The updated score optimizes clinicopathologic prognostication for clinical practice and trials.
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Affiliation(s)
- Sebastian Bate
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - Dominic McGovern
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Renal Medicine, Vasculitis Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Francesca Costigliolo
- Division of Nephrology, Dialysis and Transplantation, University of Genova, Genova, Italy
- Department of Internal Medicine and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Pek Ghe Tan
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Renal Unit, Northern Health, Victoria, Australia
| | - Vojtech Kratky
- 1st Faculty of Medicine, Charles University, Prague, Czechia
- Department of Nephrology, General University Hospital, Prague, Czechia
| | - Jennifer Scott
- Trinity Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Gavin B. Chapman
- University/BHF Centre for Cardiovascular Science, University of Edinburgh and Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nina Brown
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- Renal Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Lauren Floyd
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- Renal Department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Benoit Brilland
- Service de Néphrologie-Dialyse-Transplantation, CHU d’Angers, Angers, France
| | - Eduardo Martín-Nares
- Departments of Immunology and Rheumatology, Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Duha Ilyas
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- Renal, Transplantation and Urology Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Arslan Butt
- Renal Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | | | - Marek Kollar
- Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Jennifer S. Lees
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Abdülmecit Yildiz
- Division of Nephrology, Bursa Uludağ University School of Medicine, Bursa, Turkey
| | - Andrea Hinojosa-Azaola
- Departments of Immunology and Rheumatology, Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ajay Dhaygude
- Renal Department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Stephen A. Roberts
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thorsten Wiech
- University Medical Center Hamburg-Eppendorf, Institute of Pathology, Hamburg, Germany
| | - Charles D. Pusey
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Rachel B. Jones
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Renal Medicine, Vasculitis Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - David R.W. Jayne
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Renal Medicine, Vasculitis Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ingeborg Bajema
- Department of Pathology, Groningen University Medical Center, Groningen, The Netherlands
| | - J. Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kate I. Stevens
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | | | - Juan Manuel Mejía-Vilet
- Departments of Immunology and Rheumatology, Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Neeraj Dhaun
- University/BHF Centre for Cardiovascular Science, University of Edinburgh and Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Stephen P. McAdoo
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Vladimir Tesar
- 1st Faculty of Medicine, Charles University, Prague, Czechia
- Department of Nephrology, General University Hospital, Prague, Czechia
| | - Mark A. Little
- Trinity Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Duruvu Geetha
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Silke R. Brix
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Renal, Transplantation and Urology Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, United Kingdom
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4
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Haq K, Malvica S, Rosenberg A, Kant S. Nephrology picture: C4d positive tubules in severe BK virus nephropathy. J Nephrol 2024; 37:501-503. [PMID: 37878180 DOI: 10.1007/s40620-023-01797-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Kanza Haq
- Division of Nephrology, Comprehensive Transplant Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Silvia Malvica
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sam Kant
- Division of Nephrology, Comprehensive Transplant Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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5
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Salas A, Fatola A, Krimins R, Kamel IR, Geetha D, Fine D, Monroy-Trujillo M, Rosenberg A, Arend L, Timlin H. COVID vaccine-induced lupus nephritis: Case report and review of the literature. Lupus 2024; 33:176-182. [PMID: 38164925 DOI: 10.1177/09612033231222390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Vaccines offer an effective strategy to prevent infectious diseases with minimal adverse effects. On rare occasions, vaccination can disrupt the immune response leading to induction of autoimmune diseases. We describe a case of new-onset lupus nephritis following COVID-19 vaccination with the first dose of the Pfizer vaccine. Her symptoms and lab values improved with steroids, hydroxychloroquine, and mycophenolate mofetil.
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Affiliation(s)
- Antonio Salas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ayotola Fatola
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebecca Krimins
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab R Kamel
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Duvuru Geetha
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Derek Fine
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Manny Monroy-Trujillo
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Avi Rosenberg
- Division of Kidney-Urologic Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lois Arend
- Division of Kidney-Urologic Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Homa Timlin
- Division of Rheumatology, Johns Hopkins University School of Medicine, MD, USA
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6
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Fava A, Buyon J, Magder L, Hodgin J, Rosenberg A, Demeke DS, Rao DA, Arazi A, Celia AI, Putterman C, Anolik JH, Barnas J, Dall'Era M, Wofsy D, Furie R, Kamen D, Kalunian K, James JA, Guthridge J, Atta MG, Monroy Trujillo J, Fine D, Clancy R, Belmont HM, Izmirly P, Apruzzese W, Goldman D, Berthier CC, Hoover P, Hacohen N, Raychaudhuri S, Davidson A, Diamond B, Petri M. Urine proteomic signatures of histological class, activity, chronicity, and treatment response in lupus nephritis. JCI Insight 2024; 9:e172569. [PMID: 38258904 PMCID: PMC10906224 DOI: 10.1172/jci.insight.172569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
Lupus nephritis (LN) is a pathologically heterogenous autoimmune disease linked to end-stage kidney disease and mortality. Better therapeutic strategies are needed as only 30%-40% of patients completely respond to treatment. Noninvasive biomarkers of intrarenal inflammation may guide more precise approaches. Because urine collects the byproducts of kidney inflammation, we studied the urine proteomic profiles of 225 patients with LN (573 samples) in the longitudinal Accelerating Medicines Partnership in RA/SLE cohort. Urinary biomarkers of monocyte/neutrophil degranulation (i.e., PR3, S100A8, azurocidin, catalase, cathepsins, MMP8), macrophage activation (i.e., CD163, CD206, galectin-1), wound healing/matrix degradation (i.e., nidogen-1, decorin), and IL-16 characterized the aggressive proliferative LN classes and significantly correlated with histological activity. A decline of these biomarkers after 3 months of treatment predicted the 1-year response more robustly than proteinuria, the standard of care (AUC: CD206 0.91, EGFR 0.9, CD163 0.89, proteinuria 0.8). Candidate biomarkers were validated and provide potentially treatable targets. We propose these biomarkers of intrarenal immunological activity as noninvasive tools to diagnose LN and guide treatment and as surrogate endpoints for clinical trials. These findings provide insights into the processes involved in LN activity. This data set is a public resource to generate and test hypotheses and validate biomarkers.
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Affiliation(s)
- Andrea Fava
- Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jill Buyon
- New York University School of Medicine, New York, New York, USA
| | | | - Jeff Hodgin
- University of Michigan, Ann Arbor, Michigan, USA
| | - Avi Rosenberg
- Division of Renal Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Deepak A Rao
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Maryland, USA
| | - Arnon Arazi
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Alessandra Ida Celia
- Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
- Università La Sapienza, Rome, Italy
| | - Chaim Putterman
- Albert Einstein College of Medicine, New York, New York, USA
- Azrieli Faculty of Medicine of Bar-Ilan University, Zefat, Israel
| | | | | | - Maria Dall'Era
- University of California, San Francisco, San Francisco, California, USA
| | - David Wofsy
- University of California, San Francisco, San Francisco, California, USA
| | - Richard Furie
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Diane Kamen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Judith A James
- Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Joel Guthridge
- Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Mohamed G Atta
- Division of Nephrology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Derek Fine
- Division of Nephrology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Robert Clancy
- New York University School of Medicine, New York, New York, USA
| | | | - Peter Izmirly
- New York University School of Medicine, New York, New York, USA
| | - William Apruzzese
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Maryland, USA
| | - Daniel Goldman
- Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | | | - Soumya Raychaudhuri
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Maryland, USA
- Broad Institute, Boston, Maryland, USA
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Anne Davidson
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Betty Diamond
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
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Ghag R, Kaushal M, Nwanne G, Knoten A, Kiryluk K, Rosenberg A, Menez S, Bagnasco SM, Sperati CJ, Atta MG, Gaut JP, Williams JC, El-Achkar TM, Arend LJ, Parikh CR, Jain S. Single Nucleus RNA Sequencing of Remnant Kidney Biopsies and Urine Cell RNA Sequencing Reveal Cell Specific Markers of Covid-19 Acute Kidney Injury. bioRxiv 2023:2023.11.10.566497. [PMID: 37986991 PMCID: PMC10659401 DOI: 10.1101/2023.11.10.566497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Acute kidney injury (AKI) in COVID-19 patients is associated with high mortality and morbidity. Critically ill COVID-19 patients are at twice the risk of in-hospital mortality compared to non-COVID AKI patients. We know little about the cell-specific mechanism in the kidney that contributes to worse clinical outcomes in these patients. New generation single cell technologies have the potential to provide insights into physiological states and molecular mechanisms in COVID-AKI. One of the key limitations is that these patients are severely ill posing significant risks in procuring additional biopsy tissue. We recently generated single nucleus RNA-sequencing data using COVID-AKI patient biopsy tissue as part of the human kidney atlas. Here we describe this approach in detail and report deeper comparative analysis of snRNAseq of 4 COVID-AKI, 4 reference, and 6 non-COVID-AKI biopsies. We also generated and analyzed urine transcriptomics data to find overlapping COVID-AKI-enriched genes and their corresponding cell types in the kidney from snRNA-seq data. We identified all major and minor cell types and states by using by using less than a few cubic millimeters of leftover tissue after pathological workup in our approach. Differential expression analysis of COVID-AKI biopsies showed pathways enriched in viral response, WNT signaling, kidney development, and cytokines in several nephron epithelial cells. COVID-AKI profiles showed a much higher proportion of altered TAL cells than non-COVID AKI and the reference samples. In addition to kidney injury and fibrosis markers indicating robust remodeling we found that, 17 genes overlap between urine cell COVID-AKI transcriptome and the snRNA-seq data from COVID-AKI biopsies. A key feature was that several of the distal nephron and collecting system cell types express these markers. Some of these markers have been previously observed in COVID-19 studies suggesting a common mechanism of injury and potentially the kidney as one of the sources of soluble factors with a potential role in disease progression. Translational Statement The manuscript describes innovation, application and discovery that impact clinical care in kidney disease. First, the approach to maximize use of remnant frozen clinical biopsies to inform on clinically relevant molecular features can augment existing pathological workflow for any frozen tissue without much change in the protocol. Second, this approach is transformational in medical crises such as pandemics where mechanistic insights are needed to evaluate organ injury, targets for drug therapy and diagnostic and prognostic markers. Third, the cell type specific and soluble markers identified and validated can be used for diagnoses or prognoses in AKI due to different etiologies and in multiorgan injury.
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8
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Border S, Rosenberg A, Zee J, Levenson R, Jen KY, Sarder P, Fereidouni F. Improving quantification of renal fibrosis using Deep-DUET. Proc SPIE Int Soc Opt Eng 2023; 12471:124710G. [PMID: 37829619 PMCID: PMC10568542 DOI: 10.1117/12.2654651] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Accurate quantification of renal fibrosis has profound importance in the assessment of chronic kidney disease (CKD). Visual analysis of a biopsy stained with trichrome under the microscope by a pathologist is the gold standard for evaluation of fibrosis. Trichrome helps to highlight collagen and ultimately interstitial fibrosis. However, trichrome stains are not always reproducible, can underestimate collagen content and are not sensitive to subtle fibrotic patterns. Using the Dual-mode emission and transmission (DUET) microscopy approach, it is possible to capture both brightfield and fluorescence images from the same area of a tissue stained with hematoxylin and eosin (H&E) enabling reproducible extraction of collagen with high sensitivity and specificity. Manual extraction of spectrally overlapping collagen signals from tubular epithelial cells and red blood cells is still an intensive task. We employed a UNet++ architecture for pixel-level segmentation and quantification of collagen using 760 whole slide image (WSI) patches from six cases of varying stages of fibrosis. Our trained model (Deep-DUET) used the supervised extracted collagen mask as ground truth and was able to predict the extent of collagen signal with a MSE of 0.05 in a holdout testing set while achieving an average AUC of 0.94 for predicting regions of collagen deposits. Expanding this work to the level of the WSI can greatly improve the ability of pathologists and machine learning (ML) tools to quantify the extent of renal fibrosis reproducibly and reliably.
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Affiliation(s)
- Samuel Border
- University of Florida at Gainesville, J. Crayton Pruitt Family Department of Biomedical Engineering
| | | | - Jarcy Zee
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Richard Levenson
- University of California Davis Health, Department of Pathology and Laboratory Medicine
| | - Kuang-Yu Jen
- University of California Davis Health, Department of Pathology and Laboratory Medicine
| | - Pinaki Sarder
- University of Florida at Gainesville, J. Crayton Pruitt Family Department of Biomedical Engineering
| | - Farzad Fereidouni
- University of California Davis Health, Department of Pathology and Laboratory Medicine
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9
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Barbera M, Perera D, Matton A, Mangialasche F, Rosenberg A, Middleton L, Ngandu T, Solomon A, Kivipelto M. Multimodal Precision Prevention - A New Direction in Alzheimer's Disease. J Prev Alzheimers Dis 2023; 10:718-728. [PMID: 37874092 DOI: 10.14283/jpad.2023.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
At least 40% of all dementia has been linked to modifiable risk factors suggesting a clear potential for preventative approaches targeting these factors. Despite the recent promising findings from anti-amyloid monoclonal antibodies, a limited proportion of patients are expected to be eligible for these novel AD treatments. Given the heterogeneous nature of AD and the complex multi-level pathological processes leading to dementia (involving, e.g., shared risk factors, interaction of different pathology mechanisms, and their putative synergistic effects on cognition), targeting a single pathology may not be sufficient to halt or significantly impact disease progression. With exponentially increasing numbers of patients world-wide, in parallel to the unprecedented population ageing, new multimodal therapy approaches targeting several modifiable risk factors and disease mechanisms simultaneously are urgently required. Developing the next generation of combination therapies with lifestyle intervention and pharmacological treatments, implementing the right interventions for the right people at the right time, and defining accessible and sustainable strategies worldwide are crucial. Here, we summarize the state-of-the-art multimodal lifestyle-based approaches, especially findings and lessons learned from the FINGER trial, for prevention and risk reduction of cognitive impairment and dementia. We also discuss some emerging underlying biological mechanisms and the current development of precision prevention approaches. We present an example of a novel trial design combining healthy lifestyle changes with a repurposed putative disease-modifying drug and place this study in the context of the World-Wide FINGERS, the first interdisciplinary network of multimodal trials dedicated to the prevention and risk reduction of cognitive impairment and dementia.
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Affiliation(s)
- M Barbera
- Miia Kivipelto, Address: Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64 Solna, Sweden, , Phone: +46 73-994-0922
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10
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Zheng X, Higdon L, Gaudet A, Shah M, Balistieri A, Li C, Nadai P, Palaniappan L, Yang X, Santo B, Ginley B, Wang XX, Myakala K, Nallagatla P, Levi M, Sarder P, Rosenberg A, Maltzman JS, de Freitas Caires N, Bhalla V. Endothelial Cell-Specific Molecule-1 Inhibits Albuminuria in Diabetic Mice. Kidney360 2022; 3:2059-2076. [PMID: 36591362 PMCID: PMC9802554 DOI: 10.34067/kid.0001712022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/07/2022] [Accepted: 07/19/2022] [Indexed: 01/13/2023]
Abstract
Background Diabetic kidney disease (DKD) is the most common cause of kidney failure in the world, and novel predictive biomarkers and molecular mechanisms of disease are needed. Endothelial cell-specific molecule-1 (Esm-1) is a secreted proteoglycan that attenuates inflammation. We previously identified that a glomerular deficiency of Esm-1 associates with more pronounced albuminuria and glomerular inflammation in DKD-susceptible relative to DKD-resistant mice, but its contribution to DKD remains unexplored. Methods Using hydrodynamic tail-vein injection, we overexpress Esm-1 in DKD-susceptible DBA/2 mice and delete Esm-1 in DKD-resistant C57BL/6 mice to study the contribution of Esm-1 to DKD. We analyze clinical indices of DKD, leukocyte infiltration, podocytopenia, and extracellular matrix production. We also study transcriptomic changes to assess potential mechanisms of Esm-1 in glomeruli. Results In DKD-susceptible mice, Esm-1 inversely correlates with albuminuria and glomerular leukocyte infiltration. We show that overexpression of Esm-1 reduces albuminuria and diabetes-induced podocyte injury, independent of changes in leukocyte infiltration. Using a complementary approach, we find that constitutive deletion of Esm-1 in DKD-resistant mice modestly increases the degree of diabetes-induced albuminuria versus wild-type controls. By glomerular RNAseq, we identify that Esm-1 attenuates expression of kidney disease-promoting and interferon (IFN)-related genes, including Ackr2 and Cxcl11. Conclusions We demonstrate that, in DKD-susceptible mice, Esm-1 protects against diabetes-induced albuminuria and podocytopathy, possibly through select IFN signaling. Companion studies in patients with diabetes suggest a role of Esm-1 in human DKD.
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Affiliation(s)
- Xiaoyi Zheng
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Lauren Higdon
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Veterans Affairs Palo Alto Heath Care System, Palo Alto, California
| | - Alexandre Gaudet
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1019-UMR9017-Center for Infection & Immunity of Lille, Pasteur Institute of Lille, University of Lille, Lille, France
| | - Manav Shah
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Angela Balistieri
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Catherine Li
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Patricia Nadai
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1019-UMR9017-Center for Infection & Immunity of Lille, Pasteur Institute of Lille, University of Lille, Lille, France
| | - Latha Palaniappan
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Xiaoping Yang
- Division of Kidney-Urologic Pathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Briana Santo
- Department of Pathology and Anatomical Sciences, University at Buffalo–The State University of New York, Buffalo, New York
| | - Brandon Ginley
- Department of Pathology and Anatomical Sciences, University at Buffalo–The State University of New York, Buffalo, New York
| | - Xiaoxin X. Wang
- Department of Biochemistry, Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC
| | - Komuraiah Myakala
- Department of Biochemistry, Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC
| | | | - Moshe Levi
- Department of Biochemistry, Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC
| | - Pinaki Sarder
- Department of Pathology and Anatomical Sciences, University at Buffalo–The State University of New York, Buffalo, New York
| | - Avi Rosenberg
- Division of Kidney-Urologic Pathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan S. Maltzman
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Veterans Affairs Palo Alto Heath Care System, Palo Alto, California
| | - Nathalie de Freitas Caires
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1019-UMR9017-Center for Infection & Immunity of Lille, Pasteur Institute of Lille, University of Lille, Lille, France
- Biothelis, Lille, France
| | - Vivek Bhalla
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
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11
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Muacevic A, Adler JR, Alessandro C, Ganz M, Glatt A, Rosenberg A, Wang R, Zimmerman J, Silverberg J, Zyskind I. SARS-CoV-2 Infection in Winter 2021/2022: The Association of Varying Clinical Manifestations With and Without Prior Vaccination. Cureus 2022; 14:e33190. [PMID: 36733791 PMCID: PMC9888590 DOI: 10.7759/cureus.33190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 01/02/2023] Open
Abstract
Importance SARS-CoV-2 is a rapidly evolving virus with many strains. Although vaccines have proven to be effective against earlier strains of the virus, the efficacy of vaccination status against later strains is still an area of active research. Objective To determine if vaccination status was associated with symptomatology due to infection by later strains of SARS-CoV-2. Design This cross-sectional survey was sent to an adult Jewish population from December 2021 to March 2022. Setting This is a population-based study of Jewish communities throughout the tristate area. The subjects were recruited by local Jewish not-for-profit and social service organizations. Participants Surveys were sent to 14,714 adults who were recruited by local Jewish not-for-profit and social service organizations; 966 respondents completed the survey (6.57%). Only participants who received a positive COVID-19 nasal swab 10 weeks since December 1, 2021, were included in the main outcome. Exposure Participants were grouped by vaccine type (i.e., Johnson & Johnson {J&J}, Moderna, or Pfizer) and vaccination status (i.e., unvaccinated, single, full, or booster). Main outcomes and measures The primary study outcome was an association between immunization status and somatological presentation. Symptom severity classes were built using latent class analysis (LCA). Results Out of 14,714 recipients, 966 completed the survey (6.57%). The participants were mainly self-described Ashkenazi Jewish (97%) with a median age of 41. The LCA resulted in four classes: highly symptomatic (HS), less symptomatic (LS), anosmia, and asymptomatic (AS). Vaccinated participants were less likely to be in symptomatic groups than the unvaccinated participants (odds ratio {OR}: 0.326; 95% confidence interval {CI}: 0.157-0.679; p=0.002). Boosted participants were less likely to be in symptomatic groups than fully vaccinated participants (OR: 0.267; 95% CI: 0.122-0.626; p=0.002). Additionally, there was no association between symptomatology and vaccination type (p=0.353). Conclusions and relevance Participants who received COVID-19 vaccinations or booster shots were less likely to be symptomatic after Omicron infection compared to unvaccinated participants and vaccinated participants without boosters, respectively. There's no association between vaccination type and symptomatology. These results enhance our understanding that COVID-19 vaccinations improve clinical symptomatology, even in an unforeseen COVID-19 strain.
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12
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Wang XX, Xie C, Libby AE, Ranjit S, Levi J, Myakala K, Bhasin K, Jones BA, Orlicky DJ, Takahashi S, Dvornikov A, Kleiner DE, Hewitt SM, Adorini L, Kopp JB, Krausz KW, Rosenberg A, McManaman JL, Robertson CE, Ir D, Frank DN, Luo Y, Gonzalez FJ, Gratton E, Levi M. The role of FXR and TGR5 in reversing and preventing progression of Western diet-induced hepatic steatosis, inflammation, and fibrosis in mice. J Biol Chem 2022; 298:102530. [PMID: 36209823 PMCID: PMC9638804 DOI: 10.1016/j.jbc.2022.102530] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
Nonalcoholic steatohepatitis (NASH) is the most common chronic liver disease in the US, partly due to the increasing incidence of metabolic syndrome, obesity, and type 2 diabetes. The roles of bile acids and their receptors, such as the nuclear receptor farnesoid X receptor (FXR) and the G protein-coupled receptor TGR5, on the development of NASH are not fully clear. C57BL/6J male mice fed a Western diet (WD) develop characteristics of NASH, allowing determination of the effects of FXR and TGR5 agonists on this disease. Here we show that the FXR-TGR5 dual agonist INT-767 prevents progression of WD-induced hepatic steatosis, inflammation, and fibrosis, as determined by histological and biochemical assays and novel label-free microscopy imaging techniques, including third harmonic generation, second harmonic generation, and fluorescence lifetime imaging microscopy. Furthermore, we show INT-767 decreases liver fatty acid synthesis and fatty acid and cholesterol uptake, as well as liver inflammation. INT-767 markedly changed bile acid composition in the liver and intestine, leading to notable decreases in the hydrophobicity index of bile acids, known to limit cholesterol and lipid absorption. In addition, INT-767 upregulated expression of liver p-AMPK, SIRT1, PGC-1α, and SIRT3, which are master regulators of mitochondrial function. Finally, we found INT-767 treatment reduced WD-induced dysbiosis of gut microbiota. Interestingly, the effects of INT-767 in attenuating NASH were absent in FXR-null mice, but still present in TGR5-null mice. Our findings support treatment and prevention protocols with the dual FXR-TGR5 agonist INT-767 arrest progression of WD-induced NASH in mice mediated by FXR-dependent, TGR5-independent mechanisms.
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Affiliation(s)
- Xiaoxin X Wang
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, District of Columbia, USA.
| | - Cen Xie
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrew E Libby
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, District of Columbia, USA
| | - Suman Ranjit
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, District of Columbia, USA
| | - Jonathan Levi
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Komuraiah Myakala
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, District of Columbia, USA
| | - Kanchan Bhasin
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, District of Columbia, USA
| | - Bryce A Jones
- Department of Pharmacology and Physiology, Georgetown University, Washington, District of Columbia, USA
| | - David J Orlicky
- Department of Pathology, University of Colorado AMC, Aurora, Colorado, USA
| | - Shogo Takahashi
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, District of Columbia, USA
| | - Alexander Dvornikov
- Department of Biomedical Engineering, Laboratory for Fluorescence Dynamics, University of California at Irvine, Irvine, California, USA
| | - David E Kleiner
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephen M Hewitt
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Jeffrey B Kopp
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Kristopher W Krausz
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - James L McManaman
- The Integrated Physiology Program, University of Colorado AMC, Aurora, Colorado, USA
| | | | - Diana Ir
- Department of Medicine, University of Colorado AMC, Aurora, Colorado, USA
| | - Daniel N Frank
- Department of Medicine, University of Colorado AMC, Aurora, Colorado, USA
| | - Yuhuan Luo
- Department of Medicine, University of Colorado AMC, Aurora, Colorado, USA
| | - Frank J Gonzalez
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Enrico Gratton
- Department of Biomedical Engineering, Laboratory for Fluorescence Dynamics, University of California at Irvine, Irvine, California, USA
| | - Moshe Levi
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, District of Columbia, USA.
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Pearson A, Muzaffar J, Bellile E, Worden F, Chung C, Rosenberg A, Vokes E, Fidler M, Brenner J, Zhai Y, Fu T, Winkler R, Swiecicki P. Phase I/II study of a novel MDM-2 inhibitor (APG-115) in TP53 wild type salivary gland cancers. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01011-5] [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: 11/03/2022]
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14
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Yao Y, Du Jiang P, Chao BN, Cagdas D, Kubo S, Balasubramaniyam A, Zhang Y, Shadur B, NaserEddin A, Folio LR, Schwarz B, Bohrnsen E, Zheng L, Lynberg M, Gottlieb S, Leney-Greene MA, Park AY, Tezcan I, Akdogan A, Gocmen R, Onder S, Rosenberg A, Soilleux EJ, Johnson E, Jackson PK, Demeter J, Chauvin SD, Paul F, Selbach M, Bulut H, Clatworthy MR, Tuong ZK, Zhang H, Stewart BJ, Bosio CM, Stepensky P, Clare S, Ganesan S, Pascall JC, Daumke O, Butcher GW, McMichael AJ, Simon AK, Lenardo MJ. GIMAP6 regulates autophagy, immune competence, and inflammation in mice and humans. J Exp Med 2022; 219:213217. [PMID: 35551368 PMCID: PMC9111091 DOI: 10.1084/jem.20201405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 01/18/2022] [Accepted: 03/16/2022] [Indexed: 11/26/2022] Open
Abstract
Inborn errors of immunity (IEIs) unveil regulatory pathways of human immunity. We describe a new IEI caused by mutations in the GTPase of the immune-associated protein 6 (GIMAP6) gene in patients with infections, lymphoproliferation, autoimmunity, and multiorgan vasculitis. Patients and Gimap6−/− mice show defects in autophagy, redox regulation, and polyunsaturated fatty acid (PUFA)–containing lipids. We find that GIMAP6 complexes with GABARAPL2 and GIMAP7 to regulate GTPase activity. Also, GIMAP6 is induced by IFN-γ and plays a critical role in antibacterial immunity. Finally, we observed that Gimap6−/− mice died prematurely from microangiopathic glomerulosclerosis most likely due to GIMAP6 deficiency in kidney endothelial cells.
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Affiliation(s)
- Yikun Yao
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.,National Institute of Allergy and Infectious Diseases Clinical Genomics Program, Rockville, MD
| | - Ping Du Jiang
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.,National Institute of Allergy and Infectious Diseases Clinical Genomics Program, Rockville, MD
| | - Brittany N Chao
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.,National Institute of Allergy and Infectious Diseases Clinical Genomics Program, Rockville, MD.,Nuffield Department of Medicine Research Building, Roosevelt Drive, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Kennedy Institute of Rheumatology, University of Oxford, Roosevelt Drive, Oxford, UK
| | - Deniz Cagdas
- Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.,Department of Pediatric Immunology, Institute of Child Health, Hacettepe University, Ankara, Turkey.,Ihsan Dogramaci Childrens Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Satoshi Kubo
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.,National Institute of Allergy and Infectious Diseases Clinical Genomics Program, Rockville, MD
| | - Arasu Balasubramaniyam
- Crystallography, Max-Delbrück-Centrum for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Institute for Chemistry and Biochemistry, Freie Universität Berlin, Takustrasse 6, Berlin, Germany
| | - Yu Zhang
- Human Immunological Diseases Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Rockville, MD
| | - Bella Shadur
- Hadassah University Medical Center, Department of Bone Marrow Transplantation and Cancer Immunotherapy, Jerusalem, Israel.,The Garvan Institute of Medical Research, Immunology Division, Darlinghurst, Sydney, Australia.,St Vincent's Clinical School, University of New South Wales, Darlinghurst, Sydney, Australia
| | - Adeeb NaserEddin
- Hadassah University Medical Center, Department of Bone Marrow Transplantation and Cancer Immunotherapy, Jerusalem, Israel
| | - Les R Folio
- Clinical Center, National Institutes of Health, Bethesda, MD
| | - Benjamin Schwarz
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, Rockville, MD
| | - Eric Bohrnsen
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, Rockville, MD
| | - Lixin Zheng
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.,National Institute of Allergy and Infectious Diseases Clinical Genomics Program, Rockville, MD
| | - Matthew Lynberg
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.,National Institute of Allergy and Infectious Diseases Clinical Genomics Program, Rockville, MD
| | - Simone Gottlieb
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.,National Institute of Allergy and Infectious Diseases Clinical Genomics Program, Rockville, MD
| | - Michael A Leney-Greene
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.,Human Immunological Diseases Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Rockville, MD
| | - Ann Y Park
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.,National Institute of Allergy and Infectious Diseases Clinical Genomics Program, Rockville, MD
| | - Ilhan Tezcan
- Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.,Department of Pediatric Immunology, Institute of Child Health, Hacettepe University, Ankara, Turkey.,Ihsan Dogramaci Childrens Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Akdogan
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Rahsan Gocmen
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevgen Onder
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Avi Rosenberg
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.,Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Errin Johnson
- The Dunn School of Pathology, South Parks Road, Oxford, UK
| | - Peter K Jackson
- Baxter Laboratory, Departments of Microbiology & Immunology and Pathology Stanford University School of Medicine, Stanford, CA
| | - Janos Demeter
- Baxter Laboratory, Departments of Microbiology & Immunology and Pathology Stanford University School of Medicine, Stanford, CA
| | - Samuel D Chauvin
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.,National Institute of Allergy and Infectious Diseases Clinical Genomics Program, Rockville, MD
| | - Florian Paul
- Crystallography, Max-Delbrück-Centrum for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Matthias Selbach
- Crystallography, Max-Delbrück-Centrum for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Haydar Bulut
- Crystallography, Max-Delbrück-Centrum for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Institute for Chemistry and Biochemistry, Freie Universität Berlin, Takustrasse 6, Berlin, Germany
| | - Menna R Clatworthy
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Medical Research Council Laboratory of Molecular Biology, Cambridge, UK.,Cellular Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - Zewen K Tuong
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Medical Research Council Laboratory of Molecular Biology, Cambridge, UK.,Cellular Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - Hanlin Zhang
- Kennedy Institute of Rheumatology, University of Oxford, Roosevelt Drive, Oxford, UK
| | - Benjamin J Stewart
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Medical Research Council Laboratory of Molecular Biology, Cambridge, UK.,Cellular Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - Catharine M Bosio
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, Rockville, MD
| | - Polina Stepensky
- Hadassah University Medical Center, Department of Bone Marrow Transplantation and Cancer Immunotherapy, Jerusalem, Israel
| | - Simon Clare
- Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Hinxton, UK
| | - Sundar Ganesan
- Biological Imaging Section, Research Technologies Branch, National Institute of Allergy and Infectious Diseases, Rockville, MD
| | - John C Pascall
- Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Babraham Research Campus, Cambridge, UK
| | - Oliver Daumke
- Crystallography, Max-Delbrück-Centrum for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Institute for Chemistry and Biochemistry, Freie Universität Berlin, Takustrasse 6, Berlin, Germany
| | - Geoffrey W Butcher
- Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Babraham Research Campus, Cambridge, UK
| | - Andrew J McMichael
- Nuffield Department of Medicine Research Building, Roosevelt Drive, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Anna Katharina Simon
- Kennedy Institute of Rheumatology, University of Oxford, Roosevelt Drive, Oxford, UK
| | - Michael J Lenardo
- Molecular Development of the Immune System Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.,National Institute of Allergy and Infectious Diseases Clinical Genomics Program, Rockville, MD
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15
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Zee J, Liu Q, Smith AR, Hodgin JB, Rosenberg A, Gillespie BW, Holzman LB, Barisoni L, Mariani LH. Kidney Biopsy Features Most Predictive of Clinical Outcomes in the Spectrum of Minimal Change Disease and Focal Segmental Glomerulosclerosis. J Am Soc Nephrol 2022; 33:1411-1426. [PMID: 35581011 PMCID: PMC9257823 DOI: 10.1681/asn.2021101396] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/01/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Heterogeneity in disease course and treatment response among patients with MCD/FSGS necessitates a granular evaluation of kidney tissue features. This study aimed to identify histologic and ultrastructural descriptors of structural changes most predictive of clinical outcomes in the Nephrotic Syndrome Study Network (NEPTUNE). METHODS Forty-eight histologic (37 glomerular, 9 tubulointerstitial, 2 vascular) and 20 ultrastructural descriptors were quantified by applying the NEPTUNE Digital Pathology Scoring System to NEPTUNE kidney biopsies. Outcomes included time from biopsy to disease progression, first complete remission of proteinuria, and treatment response. Relative importance of pathology and clinical predictors was obtained from random forest models, and predictive discrimination was assessed. RESULTS Among 224 participants (34% Black, 24% Hispanic), model performance was excellent, with predictive discrimination of 0.9 for disease progression, 0.85 for complete remission, and 0.81 for treatment response. The most predictive descriptors of outcomes included both conventional-e.g., global sclerosis or segmental sclerosis and interstitial fibrosis/tubular atrophy-and novel features, including adhesion, interstitial foam cells, deflation, periglomerular fibrosis, mononuclear white blood cells, endothelial cell abnormalities, microvillous transformation, and acute tubular injury. CONCLUSIONS The most predictive descriptors of clinical outcomes among MCD/FSGS patients reflected structural changes in multiple renal compartments. Reporting these descriptors should be standardized to guide prognostication of proteinuric glomerular diseases.
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Affiliation(s)
- Jarcy Zee
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Qian Liu
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Abigail R Smith
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Jeffrey B Hodgin
- Renal Pathology, Department of Pathology and Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland and Kidney Disease Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Brenda W Gillespie
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Lawrence B Holzman
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura Barisoni
- Department of Pathology, Division of AI and Computational Pathology, and Department of Medicine, Division of Nephrology, Duke University, Durham, North Carolina
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16
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Davidson SR, Adapa S, Lopez‐Santiago I, Dial K, Rowland E, Mykala K, Wang X, Rosenberg A, Levi M, Jones BA. Obeticholic Acid Prevents Fibrosis in a Model of Tubulointerstitial Kidney Disease. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r3613] [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: 11/11/2022]
Affiliation(s)
| | - Sharmila Adapa
- Biochemistry & Molecular and Cellular BiologyGeorgetown UniversityWashingtonDC
| | | | - Katelyn Dial
- Biochemistry & Molecular and Cellular BiologyGeorgetown UniversityWashingtonDC
| | - Emma Rowland
- Biochemistry & Molecular and Cellular BiologyGeorgetown UniversityWashingtonDC
| | - Komuraiah Mykala
- Biochemistry & Molecular and Cellular BiologyGeorgetown UniversityWashingtonDC
| | - Xiaoxin Wang
- Biochemistry & Molecular and Cellular BiologyGeorgetown UniversityWashingtonDC
| | | | - Moshe Levi
- Biochemistry & Molecular and Cellular BiologyGeorgetown UniversityWashingtonDC
| | - Bryce A. Jones
- Pharmacology and PhysiologyGeorgetown UniversityWashingtonDC
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17
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Sindi S, Thunborg C, Rosenberg A, Andersen P, Andrieu S, Broersen LM, Coley N, Couderc C, Duval CZ, Faxen-Irving G, Hagman G, Hallikainen M, Håkansson K, Lehtisalo J, Levak N, Mangialasche F, Pantel J, Kekkonen E, Rydström A, Stigsdotter-Neely A, Wimo A, Ngandu T, Soininen H, Hartmann T, Solomon A, Kivipelto M. Multimodal Preventive Trial for Alzheimer's Disease: MIND-ADmini Pilot Trial Study Design and Progress. J Prev Alzheimers Dis 2022; 9:30-39. [PMID: 35098971 PMCID: PMC8783958 DOI: 10.14283/jpad.2022.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Interventions simultaneously targeting multiple risk factors and mechanisms are most likely to be effective in preventing cognitive impairment. This was indicated in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) testing a multidomain lifestyle intervention among at-risk individuals. The importance of medical food at the early symptomatic disease stage, prodromal Alzheimer’s disease (AD), was emphasized in the LipiDiDiet trial. The feasibility and effects of multimodal interventions in prodromal AD are unclear. Objectives To evaluate the feasibility of an adapted FINGER-based multimodal lifestyle intervention, with or without medical food, among individuals with prodromal AD. Methods MIND-ADmini is a multinational proof-of-concept 6-month randomized controlled trial (RCT), with four trial sites (Sweden, Finland, Germany, France). The trial targeted individuals with prodromal AD defined using the International Working Group-1 criteria, and with vascular or lifestyle-related risk factors. The parallel-group RCT includes three arms: 1) multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management and social stimulation); 2) multimodal lifestyle intervention+medical food (Fortasyn Connect); and 3) regular health advice/ care (control group). Primary outcomes are feasibility and adherence. Secondary outcomes are adherence to the individual intervention domains and healthy lifestyle changes. Results Screening began on 28 September 2017 and was completed on 21 May 2019. Altogether 93 participants were randomized and enrolled. The intervention proceeded as planned. Conclusions For the first time, this pilot trial tests the feasibility and adherence to a multimodal lifestyle intervention, alone or combined with medical food, among individuals with prodromal AD. It can serve as a model for combination therapy trials (non-pharma, nutrition-based and/or pharmacological interventions).
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Affiliation(s)
- S Sindi
- Professor Miia Kivipelto, MD, PhD, Karolinska Institutet, Dept NVS, Division of Clinical Geriatrics, Center for Alzheimer Research QA32, Karolinska vägen 37 A, SE-171 64 Solna, Sweden; Mobile: +46 (0)73 99 409 22,
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18
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Pashankar R, Kim H, Peng X, Rosenberg A, Pruette C. An unusual cause of hypertension and proteinuria: Questions. Pediatr Nephrol 2022; 37:1027-1028. [PMID: 34999979 DOI: 10.1007/s00467-021-05349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Hannah Kim
- Pennsylvania State University College of Medicine, Hershey, PA, USA.
| | - Xiao Peng
- Johns Hopkins University, Baltimore, MD, USA
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19
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Jamshidi P, Levi J, Suarez MJ, Rivera R, Mahoney N, Eberhart CG, Rosenberg A, Rodriguez FJ. Clinicopathologic and Proteomic Analysis of Amyloidomas Involving the Ocular Surface and Adnexa. Am J Clin Pathol 2022; 157:620-627. [PMID: 34698334 PMCID: PMC8973273 DOI: 10.1093/ajcp/aqab161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Ocular amyloidoma is a rare disorder characterized by deposition of insoluble proteinaceous fibrils in the extracellular space of the ocular adnexa. This study details the clinicopathologic features and proteomic characteristics of periocular amyloid deposition. METHODS Specimens (1991-2020) were retrieved and reviewed. All available H&E slides and special stains were reviewed. Proteomic analysis was performed using immunohistochemistry (IHC) for IgG, IgG4, IgA, IgD, IgM, CD20, CD3, CD138, and κ/λ, as well as chromatography-electrospray tandem mass spectrometry on formalin-fixed, paraffin-embedded tissue. RESULTS There were 14 patients (7 men, 7 women). The depositions involved eyelid (n = 3), conjunctiva (n = 8), and orbit (n = 3). All patients were adults with a median age at diagnosis of 56 (range, 39-88) years. The deposits were predominantly λ light chain restricted (n = 6) and mixed light chains (n = 2), and one case was κ predominant. Two of the cases with a mixture of κ and λ light chains had an excess of transthyretin by mass spectrometry. Four of the cases did not have adequate material for proteomic subtyping. CONCLUSIONS Amyloidomas involving ocular adnexa contain a variety of amyloid-related and immunoglobulin-associated peptides. The λ light chain predominates as in other body sites, but mixed patterns and rarely κ light chain restriction may be encountered.
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Affiliation(s)
- Pouya Jamshidi
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, IL, USA
| | | | - Maria Jose Suarez
- Department of Infectious Diseases, Maimonides Medical Center, Brooklyn, NY, USA
| | - Roxana Rivera
- Cincinnati Eye Institute, Cincinnati and Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA
| | - Nicholas Mahoney
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Charles G Eberhart
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Fausto J Rodriguez
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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20
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Jones B, Torrado B, Rosenberg A, Gratton E, Levi M, Ranjit S. Determination of cardiac fibrosis using picrosirius red fluorescence. Biophys J 2022. [DOI: 10.1016/j.bpj.2021.11.1355] [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: 11/29/2022] Open
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21
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Lucarelli N, Yun D, Han D, Ginley B, Moon KC, Rosenberg A, Tomaszewski J, Han SS, Sarder P. Computational Integration of Renal Histology and Urinary Proteomics using Neural Networks. Proc SPIE Int Soc Opt Eng 2022; 12039:120390U. [PMID: 37817878 PMCID: PMC10563119 DOI: 10.1117/12.2613500] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Histological image data and molecular profiles provide context into renal condition. Often, a biopsy is drawn to diagnose or monitor a suspected kidney problem. However, molecular profiles can go beyond a pathologist's ability to see and diagnose. Using AI, we computationally incorporated urinary proteomic profiles with microstructural morphology from renal biopsy to investigate new and existing molecular links to image phenotypes. We studied whole slide images of periodic acid-Schiff stained renal biopsies from 56 DN patients matched with 2,038 proteins measured from each patient's urine. Using Seurat, we identified differentially expressed proteins in patients that developed end-stage renal disease within 2 years of biopsy. Glomeruli, globally sclerotic glomeruli, and tubules were segmented from WSI using our previously published HAIL pipeline. For each glomerulus, 315 handcrafted digital image features were measured, and for tubules, 207 features. We trained fully connected networks to predict urinary protein measurements that were differentially expressed between patients who did/ did not progress to ESRD within 2 years of biopsy. The input to this network was either glomerular or tubular histomorphological features in biopsy. Trained network weights were used as a proxy to rank which morphological features correlated most highly with specific urinary proteins. We identified significant image feature-protein pairs by ranking network weights by magnitude. We also looked at which features on average were most significant in predicting proteins. For both glomeruli and tubules, RGB color values and variance in PAS+ areas (specifically basement membrane for tubules) were, on average, more predictive of molecular profiles than other features. There is a strong connection between molecular profile and image phenotype, which can be elucidated through computational methods. These discovered links can provide insight to disease pathways, and discover new factors contributing to incidence and progression.
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Affiliation(s)
- Nicholas Lucarelli
- Department of Pathology and Anatomical Sciences, University at Buffalo – The State University of New York, Buffalo, New York
| | - Donghwan Yun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dohyun Han
- Proteomics Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Brandon Ginley
- Department of Pathology and Anatomical Sciences, University at Buffalo – The State University of New York, Buffalo, New York
| | - Kyung Chul Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John Tomaszewski
- Department of Pathology and Anatomical Sciences, University at Buffalo – The State University of New York, Buffalo, New York
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pinaki Sarder
- Department of Pathology and Anatomical Sciences, University at Buffalo – The State University of New York, Buffalo, New York
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22
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Antiochos B, Trejo-Zambrano D, Fenaroli P, Rosenberg A, Baer A, Garg A, Sohn J, Li J, Petri M, Goldman DW, Mecoli C, Casciola-Rosen L, Rosen A. The DNA sensors AIM2 and IFI16 are SLE autoantigens that bind neutrophil extracellular traps. eLife 2022; 11:72103. [PMID: 35608258 PMCID: PMC9129876 DOI: 10.7554/elife.72103] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 04/17/2022] [Indexed: 01/12/2023] Open
Abstract
Background Nucleic acid binding proteins are frequently targeted as autoantigens in systemic lupus erythematosus (SLE) and other interferon (IFN)-linked rheumatic diseases. The AIM-like receptors (ALRs) are IFN-inducible innate sensors that form supramolecular assemblies along double-stranded (ds)DNA of various origins. Here, we investigate the ALR absent in melanoma 2 (AIM2) as a novel autoantigen in SLE, with similar properties to the established ALR autoantigen interferon-inducible protein 16 (IFI16). We examined neutrophil extracellular traps (NETs) as DNA scaffolds on which these antigens might interact in a pro-immune context. Methods AIM2 autoantibodies were measured by immunoprecipitation in SLE and control subjects. Neutrophil extracellular traps were induced in control neutrophils and combined with purified ALR proteins in immunofluorescence and DNase protection assays. SLE renal tissues were examined for ALR-containing NETs by confocal microscopy. Results AIM2 autoantibodies were detected in 41/131 (31.3%) SLE patients and 2/49 (4.1%) controls. Our SLE cohort revealed a frequent co-occurrence of anti-AIM2, anti-IFI16, and anti-DNA antibodies, and higher clinical measures of disease activity in patients positive for antibodies against these ALRs. We found that both ALRs bind NETs in vitro and in SLE renal tissues. We demonstrate that ALR binding causes NETs to resist degradation by DNase I, suggesting a mechanism whereby extracellular ALR-NET interactions may promote sustained IFN signaling. Conclusions Our work suggests that extracellular ALRs bind NETs, leading to DNase resistant nucleoprotein fibers that are targeted as autoantigens in SLE. Funding These studies were funded by NIH R01 DE12354 (AR), P30 AR070254, R01 GM 129342 (JS), K23AR075898 (CM), K08AR077100 (BA), the Jerome L. Greene Foundation and the Rheumatology Research Foundation. Dr. Antiochos and Dr. Mecoli are Jerome L. Greene Scholars. The Hopkins Lupus Cohort is supported by NIH grant R01 AR069572. Confocal imaging performed at the Johns Hopkins Microscopy Facility was supported by NIH Grant S10 OD016374.
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Affiliation(s)
- Brendan Antiochos
- Johns Hopkins University School of Medicine, Division of RheumatologyBaltimoreUnited States
| | - Daniela Trejo-Zambrano
- Johns Hopkins University School of Medicine, Division of RheumatologyBaltimoreUnited States
| | - Paride Fenaroli
- Nephrology Unit, Parma University Hospital, Department of Medicine and SurgeryParmaItaly,Johns Hopkins University School of Medicine, Division of PathologyBaltimoreUnited States
| | - Avi Rosenberg
- Johns Hopkins University School of Medicine, Division of PathologyBaltimoreUnited States
| | - Alan Baer
- Johns Hopkins University School of Medicine, Division of RheumatologyBaltimoreUnited States
| | - Archit Garg
- Johns Hopkins University School of Medicine, Department of Biophysics and Biophysical ChemistryBaltimoreUnited States
| | - Jungsan Sohn
- Johns Hopkins University School of Medicine, Division of RheumatologyBaltimoreUnited States,Johns Hopkins University School of Medicine, Department of Biophysics and Biophysical ChemistryBaltimoreUnited States
| | - Jessica Li
- Johns Hopkins University School of Medicine, Division of RheumatologyBaltimoreUnited States
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Division of RheumatologyBaltimoreUnited States
| | - Daniel W Goldman
- Johns Hopkins University School of Medicine, Division of RheumatologyBaltimoreUnited States
| | - Christopher Mecoli
- Johns Hopkins University School of Medicine, Division of RheumatologyBaltimoreUnited States
| | - Livia Casciola-Rosen
- Johns Hopkins University School of Medicine, Division of RheumatologyBaltimoreUnited States
| | - Antony Rosen
- Johns Hopkins University School of Medicine, Division of RheumatologyBaltimoreUnited States,Johns Hopkins University School of Medicine, Division of PathologyBaltimoreUnited States
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23
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Fava A, Rao DA, Mohan C, Zhang T, Rosenberg A, Fenaroli P, Belmont HM, Izmirly P, Clancy R, Monroy Trujillo J, Fine D, Arazi A, Berthier CC, Davidson A, James JA, Diamond B, Hacohen N, Wofsy D, Raychaudhuri S, Apruzzese W, Buyon J, Petri M. Urine Proteomics and Renal Single Cell Transcriptomics Implicate IL-16 in Lupus Nephritis. Arthritis Rheumatol 2021; 74:829-839. [PMID: 34783463 PMCID: PMC9050800 DOI: 10.1002/art.42023] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 10/13/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Current treatments are effective only in 30% of lupus nephritis patients emphasizing the need for novel therapeutic strategies. To develop mechanistic hypotheses and explore novel biomarkers, we analyzed the longitudinal urinary proteomic profiles in patients with lupus nephritis undergoing treatment. METHODS We quantified 1,000 urinary proteins in 30 patients with lupus nephritis at the time of the diagnostic renal biopsy and after 3, 6, and 12 months. The proteins and molecular pathways detected in the urine proteome were then analyzed with respect to baseline clinical features and longitudinal trajectories. The intrarenal expression of candidate biomarkers was evaluated using single cell transcriptomics of renal biopsies from lupus nephritis patients. RESULTS Our analysis revealed multiple biological pathways including chemotaxis, neutrophil activation, platelet degranulation, and extracellular matrix organization that could be noninvasively quantified and monitored in the urine. We identified 237 urinary biomarkers associated with lupus nephritis as compared to controls without SLE. IL-16, CD163, and TGF-β mirrored intrarenal nephritis activity. Response to treatment was paralleled by a reduction of urinary IL-16, a CD4 ligand with proinflammatory and chemotactic properties. Single cell RNA sequencing independently demonstrated that IL16 is the second most expressed cytokine by most infiltrating immune cells in lupus nephritis kidneys. IL-16 producing cells were found at key sites of kidney injury. CONCLUSION Urine proteomics may profoundly change the diagnosis and management of lupus nephritis by noninvasively monitor active intrarenal biological pathways. These findings implicate IL-16 in lupus nephritis pathogenesis designating it as a potentially treatable target and biomarker.
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Affiliation(s)
- Andrea Fava
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Deepak A Rao
- Division of Rheumatology, Immunology, Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Avi Rosenberg
- Division of Renal Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Paride Fenaroli
- Division of Renal Pathology, Johns Hopkins University, Baltimore, MD, USA.,Department of Medicine and Surgery, Nephrology Unit, Parma University Hospital, Parma, Italy
| | | | - Peter Izmirly
- New York University School of Medicine, New York, New York, USA
| | - Robert Clancy
- New York University School of Medicine, New York, New York, USA
| | | | - Derek Fine
- Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | - Arnon Arazi
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | | | - Judith A James
- Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Betty Diamond
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - David Wofsy
- University of California San Francisco, San Francisco, CA, USA
| | - Soumya Raychaudhuri
- Division of Rheumatology, Immunology, Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Data Sciences, Brigham and Women's Hospital, Boston, MA, 02115, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, UK
| | - William Apruzzese
- Division of Rheumatology, Immunology, Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Jill Buyon
- New York University School of Medicine, New York, New York, USA
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
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Fava A, Fenaroli P, Rosenberg A, Bagnasco S, Li J, Monroy-Trujillo J, Fine D, Atta MG, Petri M. History of Proliferative Glomerulonephritis Predicts End Stage Kidney Disease in Pure Membranous Lupus Nephritis. Rheumatology (Oxford) 2021; 61:2483-2493. [PMID: 34664621 DOI: 10.1093/rheumatology/keab775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/08/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pure membranous (class V) lupus nephritis (LN) is considered a less aggressive phenotype, but tissue fibrosis and chronic kidney disease may still develop. This study aimed to elucidate the prognostic value of a history of class switch in pure membranous LN. METHODS We included LN patients with at least two clinically indicated kidney biopsies. New onset of end stage kidney disease (ESKD) was defined as estimated glomerular filtration rate < 15 ml/min/1.73m2, initiation of dialysis, or kidney transplantation. RESULTS Among 220 patients (542 biopsies), 199 (90%) were female, and 118 (54%) were African American, 59 (27%) Caucasian, with median age of 28 years at the first kidney biopsy. Patients with pure class V in a first biopsy converted to proliferative LN in 41% of cases. Pure class V in a repeat biopsy was preceded by proliferative LN in 52%. Trajectory analysis of up to 4 repeat biopsies revealed that ISN class switch may happen at any time, even after multiple biopsies with the same class. New onset ESKD was observed within 2 years in 5/56 (9%) patients with pure class V in a repeat biopsy. All 5 patients had proliferative LN in the first biopsy (log rank p= 0.024). CONCLUSIONS The conversion from proliferative to membranous (and vice-versa) is frequent in SLE. It can occur at any time in the course of disease, limiting the prognostic value of the first biopsy. Evidence of prior proliferative LN is key as it is associated with higher risk of ESKD in non-proliferative LN.
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Affiliation(s)
- Andrea Fava
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paride Fenaroli
- Division of Nephrology, University Hospital, Parma, Italy.,Division of Renal Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Avi Rosenberg
- Division of Renal Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Serena Bagnasco
- Division of Renal Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Jessica Li
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Derek Fine
- Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | - Mohamed G Atta
- Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Shen C, Frakes J, Niu J, Rosenberg A, Weiss J, Caudell J, Jameson K, Said P, Seiwert T. MA03.03 NBTXR3 Activated by SBRT Combined with Nivolumab or Pembrolizumab in Patients With Advanced Cancers: Phase I Trial. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.119] [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: 12/01/2022]
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26
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Altan M, Patnaik A, Barve M, Dunn L, Cobb P, Rosenberg A, Sharma S, Sukari A, Lee Z, Marcondes M, Zalevsky J, Tagliaferri M, Kotzin B, Sacco A. 1026TiP A phase Ib/II, open-label, multicenter, dose-escalation and dose-expansion study of NKTR-255 plus cetuximab as a salvage regimen in patients with solid tumors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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27
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Rosenberg A, Agrawal N, Gooi Z, Blair E, Pearson A, Juloori A, Portugal L, Chin J, Cursio J, Lingen M, Haraf D, Vokes E. 867P A phase I trial of nab-paclitaxel-based induction followed by nab-paclitaxel-based concurrent chemotherapy and re-irradiation in previously treated head and neck squamous cell carcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1277] [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: 11/29/2022] Open
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28
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Vivar O, Shen C, Frakes J, Niu J, Rosenberg A, Weiss J, Caudell J, Jameson K, Said P, Seiwert T. PH-0053 NBTXR3 activated by SBRT combined with nivolumab or pembrolizumab in advanced cancers: phase I trial. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07235-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Rosenberg A, Mangialasche F, Ngandu T, Solomon A, Kivipelto M. Multidomain Interventions to Prevent Cognitive Impairment, Alzheimer's Disease, and Dementia: From FINGER to World-Wide FINGERS. J Prev Alzheimers Dis 2021; 7:29-36. [PMID: 32010923 PMCID: PMC7222931 DOI: 10.14283/jpad.2019.41] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [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: 12/11/2022]
Abstract
Alzheimer’s disease (AD) and dementia are a global public health priority, and prevention has been highlighted as a pivotal component in managing the dementia epidemic. Modifiable risk factors of dementia and AD include lifestyle-related factors, vascular and metabolic disorders, and psychosocial factors. Randomized controlled clinical trials (RCTs) are needed to clarify whether modifying such factors can prevent or postpone cognitive impairment and dementia in older adults. Given the complex, multifactorial, and heterogeneous nature of late-onset AD and dementia, interventions targeting several risk factors and mechanisms simultaneously may be required for optimal preventive effects. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is the first large, long-term RCT to demonstrate that a multidomain lifestyle-based intervention ameliorating vascular and lifestyle-related risk factors can preserve cognitive functioning and reduce the risk of cognitive decline among older adults at increased risk of dementia. To investigate the multidomain intervention in other populations and diverse cultural and geographical settings, the World-Wide FINGERS (WW-FINGERS) network was recently launched (https://alz.org/wwfingers). Within this network, new FINGER-type trials with shared core methodology, but local culture and context-specific adaptations, will be conducted in several countries. The WW-FINGERS initiative facilitates international collaborations, provides a platform for testing multidomain strategies to prevent cognitive impairment and dementia, and aims at generating high-quality scientific evidence to support public health and clinical decision-making. Furthermore, the WW-FINGERS network can support the implementation of preventive strategies and translation of research findings into practice.
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Affiliation(s)
- A Rosenberg
- Miia Kivipelto, Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, 171 64 Solna, Sweden, Phone: +46 (0)73 99 40 922,
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Athavale AM, Hart PD, Itteera M, Cimbaluk D, Patel T, Alabkaa A, Arruda J, Singh A, Rosenberg A, Kulkarni H. Development and Validation of a Deep Learning Model to Quantify Interstitial Fibrosis and Tubular Atrophy From Kidney Ultrasonography Images. JAMA Netw Open 2021; 4:e2111176. [PMID: 34028548 PMCID: PMC8144924 DOI: 10.1001/jamanetworkopen.2021.11176] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
IMPORTANCE Interstitial fibrosis and tubular atrophy (IFTA) is a strong indicator of decline in kidney function and is measured using histopathological assessment of kidney biopsy core. At present, a noninvasive test to assess IFTA is not available. OBJECTIVE To develop and validate a deep learning (DL) algorithm to quantify IFTA from kidney ultrasonography images. DESIGN, SETTING, AND PARTICIPANTS This was a single-center diagnostic study of consecutive patients who underwent native kidney biopsy at John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, between January 1, 2014, and December 31, 2018. A DL algorithm was trained, validated, and tested to classify IFTA from kidney ultrasonography images. Of 6135 Crimmins-filtered ultrasonography images, 5523 were used for training (5122 images) and validation (401 images), and 612 were used to test the accuracy of the DL system. Kidney segmentation was performed using the UNet architecture, and classification was performed using a convolution neural network-based feature extractor and extreme gradient boosting. IFTA scored by a nephropathologist on trichrome stained kidney biopsy slide was used as the reference standard. IFTA was divided into 4 grades (grade 1, 0%-24%; grade 2, 25%-49%; grade 3, 50%-74%; and grade 4, 75%-100%). Data analysis was performed from December 2019 to May 2020. MAIN OUTCOMES AND MEASURES Prediction of IFTA grade was measured using the metrics precision, recall, accuracy, and F1 score. RESULTS This study included 352 patients (mean [SD] age 47.43 [14.37] years), of whom 193 (54.82%) were women. There were 159 patients with IFTA grade 1 (2701 ultrasonography images), 74 patients with IFTA grade 2 (1239 ultrasonography images), 41 patients with IFTA grade 3 (701 ultrasonography images), and 78 patients with IFTA grade 4 (1494 ultrasonography images). Kidney ultrasonography images were segmented with 91% accuracy. In the independent test set, the point estimates for performance matrices showed precision of 0.8927 (95% CI, 0.8682-0.9172), recall of 0.8037 (95% CI, 0.7722-0.8352), accuracy of 0.8675 (95% CI, 0.8406-0.8944), and an F1 score of 0.8389 (95% CI, 0.8098-0.8680) at the image level. Corresponding estimates at the patient level were precision of 0.9003 (95% CI, 0.8644-0.9362), recall of 0.8421 (95% CI, 0.7984-0.8858), accuracy of 0.8955 (95% CI, 0.8589-0.9321), and an F1 score of 0.8639 (95% CI, 0.8228-0.9049). Accuracy at the patient level was highest for IFTA grade 1 and IFTA grade 4. The accuracy (approximately 90%) remained high irrespective of the timing of ultrasonography studies and the biopsy diagnosis. The predictive performance of the DL system did not show significant improvement when combined with baseline clinical characteristics. CONCLUSIONS AND RELEVANCE These findings suggest that a DL algorithm can accurately and independently predict IFTA from kidney ultrasonography images.
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Affiliation(s)
- Ambarish M. Athavale
- Division of Nephrology, Department of Medicine, Cook County Health, Chicago, Illinois
| | - Peter D. Hart
- Division of Nephrology, Department of Medicine, Cook County Health, Chicago, Illinois
| | - Mathew Itteera
- Division of Nephrology, Department of Medicine, Cook County Health, Chicago, Illinois
| | - David Cimbaluk
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Tushar Patel
- Department of Pathology, University of Illinois at Chicago, Chicago
| | - Anas Alabkaa
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Jose Arruda
- Division of Nephrology, University of Illinois at Chicago, Chicago
| | - Ashok Singh
- Division of Nephrology, Department of Medicine, Cook County Health, Chicago, Illinois
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
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Affiliation(s)
- Jody E Hooper
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Meral Uner
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David S Priemer
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Liam Chen
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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32
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Ginley B, Jen KY, Han SS, Rodrigues L, Jain S, Fogo AB, Zuckerman J, Walavalkar V, Miecznikowski JC, Wen Y, Yen F, Yun D, Moon KC, Rosenberg A, Parikh C, Sarder P. Automated Computational Detection of Interstitial Fibrosis, Tubular Atrophy, and Glomerulosclerosis. J Am Soc Nephrol 2021; 32:837-850. [PMID: 33622976 PMCID: PMC8017538 DOI: 10.1681/asn.2020050652] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/14/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Interstitial fibrosis, tubular atrophy (IFTA), and glomerulosclerosis are indicators of irrecoverable kidney injury. Modern machine learning (ML) tools have enabled robust, automated identification of image structures that can be comparable with analysis by human experts. ML algorithms were developed and tested for the ability to replicate the detection and quantification of IFTA and glomerulosclerosis that renal pathologists perform. METHODS A renal pathologist annotated renal biopsy specimens from 116 whole-slide images (WSIs) for IFTA and glomerulosclerosis. A total of 79 WSIs were used for training different configurations of a convolutional neural network (CNN), and 17 and 20 WSIs were used as internal and external testing cases, respectively. The best model was compared against the input of four renal pathologists on 20 new testing slides. Further, for 87 testing biopsy specimens, IFTA and glomerulosclerosis measurements made by pathologists and the CNN were correlated to patient outcome using classic statistical tools. RESULTS The best average performance across all image classes came from a DeepLab version 2 network trained at 40× magnification. IFTA and glomerulosclerosis percentages derived from this CNN achieved high levels of agreement with four renal pathologists. The pathologist- and CNN-based analyses of IFTA and glomerulosclerosis showed statistically significant and equivalent correlation with all patient-outcome variables. CONCLUSIONS ML algorithms can be trained to replicate the IFTA and glomerulosclerosis assessment performed by renal pathologists. This suggests computational methods may be able to provide a standardized approach to evaluate the extent of chronic kidney injury in situations in which renal-pathologist time is restricted or unavailable.
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Affiliation(s)
- Brandon Ginley
- Departments of Pathology and Anatomical Sciences, University at Buffalo - The State University of New York, Buffalo, New York
| | - Kuang-Yu Jen
- Department of Pathology and Laboratory Medicine, University of California at Davis, Sacramento, California
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Luís Rodrigues
- University Clinic of Nephrology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Nephrology Unit, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Sanjay Jain
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Agnes B Fogo
- Departments of Pathology, Microbiology, and Immunology, and Medicine, Vanderbilt University, Nashville, Tennessee
| | - Jonathan Zuckerman
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Vighnesh Walavalkar
- Department of Pathology, University of California at San Francisco, San Francisco, California
| | - Jeffrey C Miecznikowski
- Department of Biostatistics, University at Buffalo - The State University of New York, Buffalo, New York
| | - Yumeng Wen
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Felicia Yen
- Department of Pathology and Laboratory Medicine, University of California at Davis, Sacramento, California
| | - Donghwan Yun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chirag Parikh
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pinaki Sarder
- Departments of Pathology and Anatomical Sciences, University at Buffalo - The State University of New York, Buffalo, New York.,Department of Biomedical Engineering, University at Buffalo - The State University of New York, Buffalo, New York
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Ranjit S, Henriksen K, Dvornikov A, Delsante M, Rosenberg A, Levi M, Gratton E. Quantification of Chronic Renal Parenchymal Injury using Phasor Approach to Autofluorescence Lifetime Imaging. Biophys J 2021. [DOI: 10.1016/j.bpj.2020.11.2212] [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: 12/01/2022] Open
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Drori Y, Pando R, Sefty H, Rosenberg A, Mendelson E, Keinan-Boker L, Shohat T, Mandelboim M, Glatman-Freedman A. Influenza vaccine effectiveness against laboratory-confirmed influenza in a vaccine-mismatched influenza B-dominant season. Vaccine 2020; 38:8387-8395. [PMID: 33243633 DOI: 10.1016/j.vaccine.2020.10.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The 2017-2018 influenza season in Israel was characterized by the predominance of influenza B Yamagata, with a lesser circulation of influenza A(H1N1)pdm09 and influenza A(H3N2). We estimated vaccine effectiveness (VE) of the inactivated influenza vaccine which was selected for use that season. METHODS End-of-season VE and 95% confidence intervals (CI) against laboratory-confirmed influenza-like illness (ILI) were estimated by means of the test-negative design. Age-specific VE analysis was carried out using a moving age interval. RESULTS Specimen were obtained from 1,453 community ILI patients; 610 (42.0%) were influenza-positive, among which 69.7% were B, 17.2% A(H1N1)pdm09 and 13.4% A(H3N2). A 98.6% of molecularly characterized influenza B belonged to the Yamagata lineage. Of the sampled individuals, 1320 were suitable for VE analysis. Of those vaccinated, 90.6% received the inactivated trivalent influenza vaccine (TIV) containing a Victoria lineage influenza B-like virus. VE against influenza A differed by age, with the highest VE of 72.9% (95%CI 31.9-89.2%) observed in children 0.5-14 years old, while all ages VE was 46.6% (95%CI 10.4-68.2%). All ages VE against influenza B was 23.2% (95%CI -10.1-46.4%) with age-specific analysis showing non-significant VE estimates. Utilizing a moving age interval of 15 years, afforded a detailed age-specific insight into influenza VE against the influenza viruses circulating during the 2017-2018 season. CONCLUSIONS The moderate-high 2017-2018 influenza A VE among children and adolescents, supports seasonal influenza vaccination at a young age. The low VE against influenza B in Israel, is most likely the result of influenza B/TIV-mismatch.
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Affiliation(s)
- Y Drori
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - R Pando
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel; Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - H Sefty
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - A Rosenberg
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - E Mendelson
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Keinan-Boker
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel; School of Public Health, University of Haifa, Haifa, Israel
| | - T Shohat
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Mandelboim
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Glatman-Freedman
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Seldon C, Shrivastava G, Jarboe J, Fine J, Conway S, Pretell J, Freedman L, Wolfson A, Zhao W, Kwon D, Rosenberg A, Trent J, Yechieli R. Tumor Necrosis Following Multi-Modality Neoadjuvant Therapy for Sarcoma: A Single Institution Series. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1009] [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: 11/27/2022]
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Ayub S, Al-Duwal Z, Sellers D, Rosenberg A. Primary Cutaneous Follicle Center Lymphoma (PCFCL) with Parotid Gland Involvement. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Primary cutaneous follicle center lymphoma (PCFCL) is the most common primary cutaneous B-cell lymphoma. It arises from mature germinal center B lymphocytes. Here we report two cases of PCFCL with parotid gland involvement.
Methods
First case is a 66-year-old male with an enlarging forehead mass for nine months and a painless nodule on the right pre-auricular skin. Second is a 39-year-old male with a history of a recurring scalp spindle cell B-cell lymphoma now presenting with an enlarging lesion on the scalp and “fullness” in the right neck. There was no nodal or other extranodal involvement found in either case. Skin and parotid gland biopsies were obtained in both cases.
Results
Case one: The skin and parotid gland demonstrated sheets of predominantly medium sized infiltrating lymphoma cells, positive for CD20, Bcl-6, CD5 (dim) and Bcl-2 (dim), and negative for CD10, Bcl-1, and MUM-1. The epidermis was spared.
Case two demonstrated medium sized, spindle shaped lymphoma cells. The skin showed a vague follicular growth pattern, sparing the epidermis. The parotid gland showed diffuse infiltration by lymphoma cells, positive for CD20 and Bcl-6, Bcl-2 (dim) and no definite positivity for CD10.
Fluorescent in situ hybridization for t(14;18) translocation was absent in both cases.
Conclusion
Dissemination of PCFCL to extracutaneous sites is uncommon (~10% of cases) and to our knowledge, has not been reported in the parotid gland. Here we present two unique cases, which in the absence of nodal disease, prove the diagnosis of PCFCL with parotid gland involvement.
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Affiliation(s)
- S Ayub
- Pathology, The MetroHealth System, Cleveland, Ohio, UNITED STATES
| | - Z Al-Duwal
- Pathology, The MetroHealth System, Cleveland, Ohio, UNITED STATES
| | - D Sellers
- Pathology, The MetroHealth System, Cleveland, Ohio, UNITED STATES
| | - A Rosenberg
- Dermatology, The MetroHealth System, Cleveland, Ohio, UNITED STATES
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Le X, Gluck I, Maurice-Dror C, Panwar A, Gold K, Berlin J, Dai T, Grewal J, Nagasaka M, Rosenberg A, Haigentz M, Le Tourneau C, Moreno I, McDevitt M, Patel M, Da Costa D, Lambert S, Li Y, Blaney M, Gillison M. 975TiP Phase Ib trial of ABBV-368 + tilsotolimod in combination with nab-paclitaxel and/or budigalimab (ABBV-181) in patients with recurrent/metastatic head and neck squamous cell carcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1090] [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: 10/23/2022] Open
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Wakashin H, Heymann J, Roshanravan H, Daneshpajouhnejad P, Rosenberg A, Shin MK, Hoek M, Kopp JB. APOL1 renal risk variants exacerbate podocyte injury by increasing inflammatory stress. BMC Nephrol 2020; 21:371. [PMID: 32854642 PMCID: PMC7450955 DOI: 10.1186/s12882-020-01995-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 07/30/2020] [Indexed: 12/13/2022] Open
Abstract
Background Apolipoprotein L1, APOL1, is a trypanosome lytic factor present in human and certain other primates. APOL1 gene variants, present in individuals of recent sub-Saharan African descent, increase risk for glomerular disease and associate with the disease progression, but the molecular mechanisms have not been defined. Objectives We focus on the mechanism how APOL1 variant proteins enhance podocyte injury in the stressed kidney. Methods First, we investigated the expression of APOL1 protein isoform and the localization of APOL1 protein in the kidney. Next, we examined the role of APOL1 in the podocyte stress and the inflammatory signaling in the kidney after hemi-nephrectomy. Results We identified a novel RNA variant that lacks a secretory pathway signal sequence and we found that the predicted APOL1-B3 protein isoform was expressed in human podocytes in vivo and by BAC-APOL1 transgenic mice. APOL1-B3-G2 transgenic mice, carrying a renal risk variant, manifested podocyte injury and increased pro-IL-1β mRNA in isolated glomeruli and increased IL-1β production in the remnant kidney after uninephrectomy. APOL1-B3 interacted with NLRP12, a key regulator of Toll-like receptor signaling. Conclusions These results suggest a possible mechanism for podocyte injury by which one of the APOL1 protein isoforms, APOL1-B3 and its renal risk variants, enhances inflammatory signaling.
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Affiliation(s)
- Hidefumi Wakashin
- Kidney Disease Section, NIDDK, NIH, KDB, 10 Center Dr, 3N116, Bethesda, MD, 20892-1268, USA
| | - Jurgen Heymann
- Kidney Disease Section, NIDDK, NIH, KDB, 10 Center Dr, 3N116, Bethesda, MD, 20892-1268, USA
| | - Hila Roshanravan
- Kidney Disease Section, NIDDK, NIH, KDB, 10 Center Dr, 3N116, Bethesda, MD, 20892-1268, USA
| | | | - Avi Rosenberg
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Myung Kyun Shin
- Merck Research Laboratories, Merck and Company, Kenilworth, New Jersey, USA
| | - Maarten Hoek
- Maze Therapeutics, Redwood City, California, USA
| | - Jeffrey B Kopp
- Kidney Disease Section, NIDDK, NIH, KDB, 10 Center Dr, 3N116, Bethesda, MD, 20892-1268, USA.
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Do W, Elzerman T, de Bree R, Rosenberg A, Forouzanfar T, Van Cann EM. Is low or high body mass index in patients operated for oral squamous cell carcinoma associated with the perioperative complication rate? Int J Oral Maxillofac Surg 2020; 50:591-597. [PMID: 32861557 DOI: 10.1016/j.ijom.2020.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 05/25/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study was to analyse the effect of body mass index (BMI), both low and high values, on the perioperative complication rate in patients with oral squamous cell carcinoma (OSCC). The medical records of 259 patients operated between 2014 and 2017 for OSCC were reviewed. Univariate and multivariate analyses were performed. Sixty of the 259 patients developed 87 complications. Low or high BMI was not associated with the perioperative complication rate. A longer operating time and increased blood loss were associated with a higher perioperative complication rate and higher Clavien-Dindo grade. Low BMI, American Society of Anesthesiologists score 2 and 3, a longer operating time, and increased blood loss were associated with a longer hospital stay. Low BMI was associated with a longer hospital stay. Neither low nor high BMI was associated with the perioperative complication rate. A longer operating time and increased blood loss were associated with a higher perioperative complication rate and higher Clavien-Dindo grade.
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Affiliation(s)
- W Do
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands
| | - T Elzerman
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands
| | - R de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands
| | - T Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - E M Van Cann
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands.
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Ranjit S, Henriksen K, Dvornikov A, Delsante M, Rosenberg A, Levi M, Gratton E. Phasor approach to autofluorescence lifetime imaging FLIM can be a quantitative biomarker of chronic renal parenchymal injury. Kidney Int 2020; 98:1341-1346. [PMID: 32475606 DOI: 10.1016/j.kint.2020.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/21/2020] [Accepted: 02/13/2020] [Indexed: 01/24/2023]
Abstract
Diabetic kidney disease continues to be the leading cause of chronic kidney disease, often advancing to end stage kidney disease. In addition to the well characterized glomerular alterations including mesangial expansion, podocyte injury, and glomerulosclerosis, tubulointerstitial fibrosis is also an important component of diabetic kidney injury. Similarly, tubulointerstitial fibrosis is a critical component of any chronic kidney injury. Therefore, sensitive and quantitative identification of tubulointerstitial fibrosis is critical for the assessment of long-term prognosis of kidney disease. Here, we employed phasor approach to fluorescence lifetime imaging, commonly known as FLIM, to understand tissue heterogeneity and calculate changes in the tissue autofluorescence lifetime signatures due to diabetic kidney disease. FLIM imaging was performed on cryostat sections of snap-frozen biopsy material of patients with diabetic nephropathy. There was an overall increase in phase lifetime (τphase) with increased disease severity. Multicomponent phasor analysis shows the distinctive differences between the different disease states. Thus, phasor autofluorescence lifetime imaging, which does not involve any staining, can be used to understand and evaluate the severity of kidney disease.
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Affiliation(s)
- Suman Ranjit
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, District of Columbia, USA; Laboratory for Fluorescence Dynamics, Department of Biomedical Engineering, University of California - Irvine, Irvine, California, USA.
| | - Kammi Henriksen
- Department of Pathology, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Alexander Dvornikov
- Laboratory for Fluorescence Dynamics, Department of Biomedical Engineering, University of California - Irvine, Irvine, California, USA
| | - Marco Delsante
- Department of Nephrology, Parma University Hospital, Parma, Italy
| | - Avi Rosenberg
- Division of Renal Pathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Moshe Levi
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, District of Columbia, USA.
| | - Enrico Gratton
- Laboratory for Fluorescence Dynamics, Department of Biomedical Engineering, University of California - Irvine, Irvine, California, USA
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Hsu C, Gratton E, Anders R, Rosenberg A, Levi M, Ranjit S. Image Correlation Microscopy Approach to Study Collagen Accumulation for Distinguishing Recurrence in Liver Cancer Patients. Biophys J 2020. [DOI: 10.1016/j.bpj.2019.11.1746] [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: 10/25/2022] Open
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42
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Wu S, Guo H, Horng H, Liu Y, Li H, Daneshpajouhnejad P, Rosenberg A, Albanese C, Ranjit S, Andrews PM, Levi M, Tang Q, Chen Y. Morphological and functional characteristics of aging kidneys based on two-photon microscopy in vivo. J Biophotonics 2020; 13:e201900246. [PMID: 31688977 DOI: 10.1002/jbio.201900246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/02/2019] [Revised: 09/29/2019] [Accepted: 10/29/2019] [Indexed: 05/08/2023]
Abstract
Age-related kidney disease, which is chronic and naturally occurring, is a general term for a set of heterogeneous disorders affecting kidney structures and characterized by a decline in renal function. Age-related renal insufficiency has important implications with regard to body homeostasis, drug toxicity and renal transplantation. In our study, two-photon microscopy was used to image kidney morphological and functional characteristics in an age-related rat model in vivo. The changes in morphology are analyzed based on autofluorescence and Hoechst 33342 labeling in rats with different ages. Structural parameters including renal tubular diameter, cell nuclei density, size and shape are studied and compared with Hematoxylin and Eosin histological analysis. Functional characteristics, such as blood flow, and glomerular filtration rate are studied with high-molecular weight (MW) 500-kDa dextran-fluorescein and low-MW 10-kDa dextran-rhodamine. Results indicate that morphology changes significantly and functional characteristics deteriorate with age. These parameters are potential indicators for evaluating age-related renal morphology and function changes. Combined analyses of these parameters could provide a quantitative, novel method for monitoring kidney diseases and/or therapeutic effects of kidney drugs.
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Affiliation(s)
- Shulian Wu
- Fujian Provincial Key Laboratory of Photonic Technology, Key Laboratory of Optoelectronic Science and Technology for Medicine, College of Photonic and Electronic Engineering, Fujian Normal University, Ministry of Education, Fuzhou, China
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | - Hengchang Guo
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | - Hannah Horng
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | - Yi Liu
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | - Hui Li
- Fujian Provincial Key Laboratory of Photonic Technology, Key Laboratory of Optoelectronic Science and Technology for Medicine, College of Photonic and Electronic Engineering, Fujian Normal University, Ministry of Education, Fuzhou, China
| | | | - Avi Rosenberg
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Christopher Albanese
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC
| | - Suman Ranjit
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC
| | - Peter M Andrews
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC
| | - Moshe Levi
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC
| | - Qinggong Tang
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma
| | - Yu Chen
- Fujian Provincial Key Laboratory of Photonic Technology, Key Laboratory of Optoelectronic Science and Technology for Medicine, College of Photonic and Electronic Engineering, Fujian Normal University, Ministry of Education, Fuzhou, China
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
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Rosenberg A, Uwinshuti FZ, Dworkin M, Nsengimana V, Kankindi E, Niyonsaba M, Uwitonze JM, Kabagema I, Dushime T, Krebs E, Jayaraman S. The epidemiology and prehospital care of motorcycle crashes in a sub-Saharan African urban center. Traffic Inj Prev 2020; 21:488-493. [PMID: 32678676 PMCID: PMC7500827 DOI: 10.1080/15389588.2020.1785623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/16/2019] [Revised: 05/22/2020] [Accepted: 06/17/2020] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Road traffic crashes (RTCs) are common among motorcyclists in Kigali, Rwanda. The Service d'Aide Medicale Urgente (SAMU), a prehospital ambulance service, responds to many of these crashes. We aimed to describe motorcycle-related RTCs managed by SAMU. METHODS SAMU clinical data including demographic information, injury characteristics, and management details were analyzed descriptively for all motorcycle crashes occurring between December 2012 and July 2016. RESULTS Every patient included in this study was injured. These patients all called the ambulance for their injuries after a motorcycle crash. There were 2,912 motorcycle-related RTCs over the study period, representing 26% of all patients managed by SAMU. The incidence of motorcycle crashes in Kigali was 258 crashes per 100,000 people over the 3.5-year study period. The average age was 30 years and 80% were males. The most common injuries were to the lower extremities (n = 958, 33%), head (n = 878, 30%), or upper extremities (n = 453, 16%). Injuries often resulted in fractures of extremities (n = 740, 25%) and external hemorrhage anywhere in the body (unspecified region; n = 660, 23%), yet few were severe based on the Kampala Trauma Score (n = 23, 2%) and Glasgow Coma Scale (n = 42, 1.5%). The most common interventions were provision of diclofenac (n = 1,526, 52.5%), peripheral intravenous (IV) access (n = 1,217, 42%), and administration of IV fluids (n = 1,048, 36%). CONCLUSION Motorcycle-related RTCs represent a large burden of disease for patients treated by SAMU in Kigali, Rwanda. Young men are most at risk of injury, which imposes a financial strain on society. Though injuries occurred frequently, critical trauma cases from motorcycle crashes were uncommon. This may be a result of several initiatives in Rwanda to improve road safety.
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Affiliation(s)
- A Rosenberg
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - F Z Uwinshuti
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - M Dworkin
- School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - V Nsengimana
- Department of Emergency Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - E Kankindi
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - M Niyonsaba
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - J M Uwitonze
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - I Kabagema
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - T Dushime
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - E Krebs
- School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Emergency Medicine, Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania
| | - S Jayaraman
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
- Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia
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Fereidouni F, Todd A, Li Y, Chang CW, Luong K, Rosenberg A, Lee YJ, Chan JW, Borowsky A, Matsukuma K, Jen KY, Levenson R. Dual-mode emission and transmission microscopy for virtual histochemistry using hematoxylin- and eosin-stained tissue sections. Biomed Opt Express 2019; 10:6516-6530. [PMID: 31853414 PMCID: PMC6913420 DOI: 10.1364/boe.10.006516] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 05/23/2023]
Abstract
In the clinical practice of pathology, trichrome stains are commonly used to highlight collagen and to help evaluate fibrosis. Such stains do delineate collagen deposits but are not molecularly specific and can suffer from staining inconsistencies. Moreover, performing histochemical stain evaluation requires the preparation of additional sections beyond the original hematoxylin- and eosin-stained slides, as well as additional staining steps, which together add cost, time, and workflow complications. We have developed a new microscopy approach, termed DUET (DUal-mode Emission and Transmission) that can be used to extract signals that would typically require special stains or advanced optical methods. Our preliminary analysis demonstrates the potential of using the resulting signals to generate virtual histochemical images that resemble trichrome-stained slides and can support clinical evaluation. We demonstrate advantages of this approach over images acquired from conventional trichrome-stained slides and compare them with images created using second harmonic generation microscopy.
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Affiliation(s)
- Farzad Fereidouni
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
| | - Austin Todd
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
| | - Yuheng Li
- Department of Computer Science, UC Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Che-Wei Chang
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
| | - Keith Luong
- Department of Electrical and Computer Engineering, UC Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Avi Rosenberg
- Renal Pathology, Department of Pathology, Johns Hopkins University and Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Yong-Jae Lee
- Department of Computer Science, UC Davis, One Shields Avenue, Davis, CA 95616, USA
| | - James W. Chan
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
| | - Alexander Borowsky
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
| | - Karen Matsukuma
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
| | - Kuang-Yu Jen
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
| | - Richard Levenson
- Department of Pathology and Laboratory Medicine, UC Davis Health, 4400 V Street, Sacramento, CA 95817, USA
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Enquobahrie A, Horvath S, Arikatla S, Rosenberg A, Cleary K, Sharma K. Development and face validation of ultrasound-guided renal biopsy virtual trainer. Healthc Technol Lett 2019; 6:210-213. [PMID: 32038859 PMCID: PMC6952253 DOI: 10.1049/htl.2019.0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/02/2019] [Indexed: 12/02/2022] Open
Abstract
The overall prevalence of chronic kidney disease in the general population is ∼14% with more than 661,000 Americans having a kidney failure. Ultrasound (US)-guided renal biopsy is a critically important tool in the evaluation and management of renal pathologies. This Letter presents KBVTrainer, a virtual simulator that the authors developed to train clinicians to improve procedural skill competence in US-guided renal biopsy. The simulator was built using low-cost hardware components and open source software libraries. They conducted a face validation study with five experts who were either adult/pediatric nephrologists or interventional/diagnostic radiologists. The trainer was rated very highly (>4.4) for the usefulness of the real US images (highest at 4.8), potential usefulness of the trainer in training for needle visualization, tracking, steadiness and hand-eye coordination, and overall promise of the trainer to be useful for training US-guided needle biopsies. The lowest score of 2.4 was received for the look and feel of the US probe and needle compared to clinical practice. The force feedback received a moderate score of 3.0. The clinical experts provided abundant verbal and written subjective feedback and were highly enthusiastic about using the trainer as a valuable tool for future trainees.
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Affiliation(s)
| | - Sam Horvath
- Medical Computing, Kitware Inc, Carrboro, NC, USA
| | | | - Avi Rosenberg
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Karun Sharma
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
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Rosenberg A, Uwinshuti FZ, Dworkin M, Nsengimana V, Kankindi E, Niyonsaba M, Uwitonze JM, Kabagema I, Dushime T, Jayaraman S, Krebs E. Data-driven prehospital training to decrease motorcycle crash deaths in a Sub-Saharan African urban center. Traffic Inj Prev 2019; 20:S207-S208. [PMID: 32296289 PMCID: PMC7158746 DOI: 10.1080/15389588.2019.1665438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- A Rosenberg
- Virginia Commonwealth University Department of Surgery
| | - F Z Uwinshuti
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - M Dworkin
- Thomas Jefferson University, Sidney Kimmel Medical College
| | | | - E Kankindi
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - M Niyonsaba
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - J M Uwitonze
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - I Kabagema
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - T Dushime
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - S Jayaraman
- Virginia Commonwealth University Department of Surgery
| | - E Krebs
- Thomas Jefferson University, Sidney Kimmel Medical College
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Vandenbriele C, Azzu A, Gambaro A, Morosin M, Arachchillage D, Trimlett R, Rosenberg A, Ledot S, Patel B, Price S. P1716Dual antiplatelet therapy on veno arterial ECMO to bleed or not to bleed? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients presenting with INTERMACS-1 cardiogenic shock and necessitating VA-ECMO, often undergo coronary angiography and percutaneous coronary intervention (PCI). Therefore, a substantial subset of VA-ECMO patients will have an indication for dual antiplatelet therapy (DAPT) plus unfractionated heparin (UFH). According to atrial fibrillation registry data, bleeding incidence on DAPT combined with oral anticoagulation is significantly higher as compared to anticoagulation alone. Although it has been reported that the addition of low dose aspirin to UFH did not increase bleeding or transfusion in VenoVenous (VV)-ECMO patients, it remains to be elucidated whether the addition of DAPT to UFH on VA-ECMO-therapy enhances bleeding.
Methods
We report single center data for 100 VA-ECMO patients between 2011 and 2019. VA-ECMO-patients post-surgery were excluded. Patient demographics, blood product transfusions and reported/radiographically diagnosed bleeding or thrombotic complications were analysed. All VA-ECMO patients received UFH, aiming for an anti-Xa levels of at least 0,3 U/ml. Targets were hemoglobin 7 g/dl, fibrinogen 100 mg/dl (or 150 mg/dl when active bleeding) and platelet counts above 50/fL. DAPT-patients were on a low dose aspirin plus a P2Y12-inhibitor (clopidogrel or ticagrelor).
Results
51% Of the VA-ECMO-group received DAPT (59% clopidogrel and 41% ticagrelor). UFH-levels were comparable between both groups. Patients on DAPT were significantly older (DAPT 52.8 vs. Control 41.3; p<0.001) and predominantly male (DAPT 76% vs. Control 63%). Total bleedings (DAPT 52% vs. Control 55%; p=0,68) and major bleedings (BARC score of 3 or more; DAPT 41% vs. Control 45%; p=0,71) did not differ significantly. We observed a significant lower number of clinically or radiographically overt arterial/venous thromboses (DAPT 13.7% vs. Control 36.2%; p=0,02) in the DAPT-group. When comparing fresh frozen plasma (FFP), red blood cell and platelet pool transfusions between both groups, only FFP-tranfusion (DAPT 0.47 units/day vs. Control 1.18 units/day; p=0,047) intends to be lower for the DAPT-group.
DAPT (plus UFH) vs control (plus UFH)
Conclusions
Haemorrhage is frequent during extracorporeal support. However, in our cohort, DAPT on top of UFH in the treatment of VA-ECMO-supported ischemic cardiogenic shock does not increase the risk of major bleeding. Therefore, DAPT should not necessarily be witheld in the setting of VA-ECMO. Interestingly, our data support a lower incidence of overt thromboses and a trend towards less FFP-transfusion. These findings suggest DAPT-induced platelet inhibition being protective against both thrombotic events and posibly consumptive coagulopathy without paying a price for major bleeding.
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Affiliation(s)
- C Vandenbriele
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Azzu
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Gambaro
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - M Morosin
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - D Arachchillage
- Royal Brompton and Harefield NHS Foundation Trust, Haematology, London, United Kingdom
| | - R Trimlett
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Rosenberg
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Ledot
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - B Patel
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Price
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
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Vandenbriele C, Wilson J, Baker A, Azzu A, Gambaro A, Morosin M, Arachchillage D, Rosenberg A, Davies S, Trimlett R, Ledot S, Price S. P1718Veno-arterial ECMO versus Left Impella bleeding complications in cardiogenic shock patients on dual antiplatelet therapy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Selective groups of patients, presenting with INTERMACS-1 cardiogenic shock due to acute ischaemic heart failure, may benefit from mechanical circulatory support (MCS). Patients with biventricular failure, severe septic shock or oxygenation problems should be selected for VA-ECMO, although the left Impella-CP heart pump can be considered as a less invasive alternative in supporting predominantly left ventricular failure. Bleeding issues are a major concern in patients on MCS, especially in this group where triple anticoagulation therapy (unfractionated heparin (UFH) for prevention of pump thrombosis and dual antiplatelet therapy (DAPT) after coronary stenting) is necessitated. We aim to investigate the bleeding and transfusion rate in DAPT-patients on VA-ECMO versus Impella.
Methods
We report single center data for 51 VA-ECMO and 8 Impella patients between 2011 and 2019. Indication for MCS was acute ischaemic cardiogenic shock. Patient demographics, transfusions and reported/radiographically diagnosed bleeding (BARC-classification) complications were analyzed. All patients received UFH and low dose aspirin plus clopidogrel or ticagrelor. Impella flow was at least 2.5 L/min. Transfusion targets were Hb >7 g/dl, fibrinogen >100 mg/dl (or >150 mg/dl when active bleeding) and platelet count >50/fL.
Results
Impella patients were significantly older (VA-ECMO 52.8 vs. Impella 62.4; p=0.02) as compared to the VA-ECMO group. Anti-Xa-levels and length of the MCS-run (mean 7.9 VA-ECMO vs. 6.4 days Impella) were comparable in both groups. Occurrences of minor bleeds was comparable between both groups (mainly oozing from the insertion site in the ImpellaTM group 63% vs. VA-ECMO 72%; p>0.05) but major bleedings with BARC score of 3 or more were significantly lower in the Impella group (13% vs. VA-ECMO 65%; p=0.005). Platelet and red blood cell transfusions were significantly lower in the Impella group (0.1 units of platelets per day vs. 1.1 units of platelets per day on VA-ECMO; p=0.002 and 0.8 units of RBCs per day vs. 2.6 units of RBCs per day on VA-ECMO; p=0.02).
Bleeding/transfusion VA-ECMO vs Impella
Conclusions
Bleeding is a frequent complication of MCS. However, in our cohort, triple anticoagulation in acute cardiogenic shock due to ischaemic left ventricle failure resulted in a lower major bleeding rate when support was given by the left Impella device as compared with VA-ECMO therapy group. As a result, platelet and red blood cell transfusions were lower in the Impella group. These findings are likely to be partly explained by the increased number and size of cannulas in VA-ECMO, as well as the increased risk of haemolysis and consumptive coagulopathy due to the complexity and extensive foreign body surface of the ECMO-circuit. We conclude that Impella support should be considered as a safer option than VA-ECMO with regards to bleeding in patients with ischaemic left ventricular failure who require DAPT and MCS as a bridge to recovery or other definitive therapy.
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Affiliation(s)
- C Vandenbriele
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - J Wilson
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Baker
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Azzu
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Gambaro
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - M Morosin
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - D Arachchillage
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Rosenberg
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Davies
- Royal Brompton and Harefield NHS Foundation Trust, Cardiology, London, United Kingdom
| | - R Trimlett
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Ledot
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Price
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
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Ginley B, Lutnick B, Jen KY, Fogo AB, Jain S, Rosenberg A, Walavalkar V, Wilding G, Tomaszewski JE, Yacoub R, Rossi GM, Sarder P. Computational Segmentation and Classification of Diabetic Glomerulosclerosis. J Am Soc Nephrol 2019; 30:1953-1967. [PMID: 31488606 DOI: 10.1681/asn.2018121259] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 06/17/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Pathologists use visual classification of glomerular lesions to assess samples from patients with diabetic nephropathy (DN). The results may vary among pathologists. Digital algorithms may reduce this variability and provide more consistent image structure interpretation. METHODS We developed a digital pipeline to classify renal biopsies from patients with DN. We combined traditional image analysis with modern machine learning to efficiently capture important structures, minimize manual effort and supervision, and enforce biologic prior information onto our model. To computationally quantify glomerular structure despite its complexity, we simplified it to three components consisting of nuclei, capillary lumina and Bowman spaces; and Periodic Acid-Schiff positive structures. We detected glomerular boundaries and nuclei from whole slide images using convolutional neural networks, and the remaining glomerular structures using an unsupervised technique developed expressly for this purpose. We defined a set of digital features which quantify the structural progression of DN, and a recurrent network architecture which processes these features into a classification. RESULTS Our digital classification agreed with a senior pathologist whose classifications were used as ground truth with moderate Cohen's kappa κ = 0.55 and 95% confidence interval [0.50, 0.60]. Two other renal pathologists agreed with the digital classification with κ1 = 0.68, 95% interval [0.50, 0.86] and κ2 = 0.48, 95% interval [0.32, 0.64]. Our results suggest computational approaches are comparable to human visual classification methods, and can offer improved precision in clinical decision workflows. We detected glomerular boundaries from whole slide images with 0.93±0.04 balanced accuracy, glomerular nuclei with 0.94 sensitivity and 0.93 specificity, and glomerular structural components with 0.95 sensitivity and 0.99 specificity. CONCLUSIONS Computationally derived, histologic image features hold significant diagnostic information that may augment clinical diagnostics.
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Affiliation(s)
| | | | - Kuang-Yu Jen
- Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, California
| | - Agnes B Fogo
- Departments of Pathology, Microbiology, and Immunology and Medicine, Vanderbilt University, Nashville, Tennessee
| | - Sanjay Jain
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vighnesh Walavalkar
- Department of Pathology, University of California San Francisco, San Francisco, California; and
| | | | - John E Tomaszewski
- Departments of Pathology and Anatomical Sciences.,Biomedical Informatics, and
| | - Rabi Yacoub
- Division of Nephrology, Department of Medicine, University at Buffalo-The State University of New York, Buffalo, New York
| | - Giovanni Maria Rossi
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,U.O. Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Dipartimento di Medicina e Chirurgia, Università di Parma
| | - Pinaki Sarder
- Departments of Pathology and Anatomical Sciences, .,Biostatistics.,Biomedical Engineering, and
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50
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Horvath S, Arikatla S, Cleary K, Sharma K, Rosenberg A, Enquobahrie A. Towards an Advanced Virtual Ultrasound-guided Renal Biopsy Trainer. Proc SPIE Int Soc Opt Eng 2019; 10951. [PMID: 31474785 DOI: 10.1117/12.2512871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Ultrasound (US)-guided renal biopsy is a critically important tool in the evaluation and management of non-malignant renal pathologies with diagnostic and prognostic significance. It requires a good biopsy technique and skill to safely and consistently obtain high yield biopsy samples for tissue analysis. This project aims to develop a virtual trainer to help clinicians to improve procedural skill competence in real-time ultrasound-guided renal biopsy. This paper presents a cost-effective, high-fidelity trainer built using low-cost hardware components and open source visualization and interactive simulation libraries: interactive medical simulation toolkit (iMSTK) and 3D Slicer. We used a physical mannequin to simulate the tactile feedback that trainees experience while scanning a real patient and to provide trainees with spatial awareness of the US scanning plane with respect to the patient's anatomy. The ultrasound probe and biopsy needle were modeled using commonly used clinical tools and were instrumented to communicate with the simulator. 3D Slicer was used to visualize an image sliced from a pre-acquired 3-D ultrasound volume based on the location of the probe, with a realistic needle rendering. The simulation engine in iMSTK modeled the interaction between the needle and the virtual tissue to generate visual deformations on the tissue and tactile forces on the needle which are transmitted to the needle that the user holds. Initial testing has shown promising results with respect to quality of simulated images and system responsiveness. Further evaluation by clinicians is planned for the next stage.
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