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Affiliation(s)
- Guozheng Wang
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
- Department of Haematology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Simon Timothy Abrams
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
- Department of Haematology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
- Roald Dahl Haemostasis & Thrombosis Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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2
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Abrams ST, Du M, Shaw RJ, Johnson C, McGuinness D, Schofield J, Yong J, Turtle L, Nicolson PLR, Moxon C, Wang G, Toh CH. Damage-associated cellular markers in the clinical and pathogenic profile of vaccine-induced immune thrombotic thrombocytopenia. J Thromb Haemost 2024; 22:1145-1153. [PMID: 38103733 DOI: 10.1016/j.jtha.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Adenoviral vector-based COVID-19 vaccine-induced immune thrombotic thrombocytopenia (VITT) is rare but carries significant risks of mortality and long-term morbidity. The underlying pathophysiology of severe disease is still not fully understood. The objectives were to explore the pathophysiological profile and examine for clinically informative biomarkers in patients with severe VITT. METHODS Twenty-two hospitalized patients with VITT, 9 pre- and 21 post-ChAdOx1 vaccine controls, were recruited across England, United Kingdom. Admission blood samples were analyzed for cytokine profiles, cell death markers (lactate dehydrogenase and circulating histones), neutrophil extracellular traps, and coagulation parameters. Tissue specimens from deceased patients were analyzed. RESULTS There were strong immune responses characterized by significant elevations in proinflammatory cytokines and T helper 1 and 2 cell activation in patients with VITT. Markers of systemic endothelial activation and coagulation activation in both circulation and organ sections were also significantly elevated. About 70% (n = 15/22) of patients met the International Society for Thrombosis and Haemostasis criteria for disseminated intravascular coagulation despite negligible changes in the prothrombin time. The increased neutrophil extracellular trap formation, in conjunction with marked lymphopenia, elevated lactate dehydrogenase, and circulating histone levels, indicates systemic immune cell injury or death. Both lymphopenia and circulating histone levels independently predicted 28-day mortality in patients with VITT. CONCLUSION The coupling of systemic cell damage and death with strong immune-inflammatory and coagulant responses are pathophysiologically dominant and clinically relevant in severe VITT.
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Affiliation(s)
- Simon T Abrams
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom; Haematology Department, Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Min Du
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Rebecca J Shaw
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom; Roald Dahl Haemostasis and Thrombosis Centre, Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Carla Johnson
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Dagmara McGuinness
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Jeremy Schofield
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom; Roald Dahl Haemostasis and Thrombosis Centre, Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Jun Yong
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom; Roald Dahl Haemostasis and Thrombosis Centre, Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Lance Turtle
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Phillip L R Nicolson
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Haemophilia Comprehensive Care Centre, Queen Elizabeth Hospital, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Christopher Moxon
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Guozheng Wang
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom; Haematology Department, Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom.
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom; Haematology Department, Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom; Roald Dahl Haemostasis and Thrombosis Centre, Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom.
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Schofield J, Abrams ST, Jenkins R, Lane S, Wang G, Toh CH. Amyloid-Fibrinogen Aggregates ("Microclots") Predict Risks of Disseminated Intravascular Coagulation and Mortality. Blood Adv 2024:bloodadvances.2023012473. [PMID: 38507683 DOI: 10.1182/bloodadvances.2023012473] [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] [Received: 12/20/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
Microclots have been associated with various conditions, including post-acute sequelae of SARS-CoV-2 infection. They have been postulated to be amyloid-fibrin(ogen) aggregates, but their role as a prognostic biomarker remains unclear. To examine for their possible clinical utility, blood samples were collected for the first 96 hours from critically ill patients (n=104) admitted to the intensive care unit (ICU). Detection was by staining platelet-poor plasma samples with Thioflavin T and visualized by fluorescent microscopy. Image J software was trained to identify and quantify microclots, which were detected in 44 [42.3%] patients on ICU admission but not in the remaining 60 [57.7%] or in 20 healthy controls [0.0%]. Microclots on admission to ICU were associated with a primary diagnosis of sepsis (microclots present in sepsis=23/44 [52.3%] vs microclots absent in sepsis=19/60 [31.7%], P=0.044). Multicolour immunofluorescence demonstrated that microclots consisted of amyloid-fibrinogen aggregates, which was supported by proteomic analysis. Patients with either a high number or larger-sized microclots had a higher likelihood of developing disseminated intravascular coagulation (DIC) (OR=51.4 [95% CI=6.3-6721.1], P<0.001) and had an increased probability of 28-day mortality (OR=5.3 [95% CI=2.0-15.6], P<0.001). This study concludes that microclots, as defined by amyloid-fibrin(ogen) aggregates, are potentially useful in identifying sepsis and predicting adverse coagulopathic and clinical outcomes.
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Affiliation(s)
- Jeremy Schofield
- Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | | | | | - Steven Lane
- Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | | | - Cheng-Hock Toh
- Liverpool University Hospitals NHS Foundation Trust, United Kingdom
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Dutt T, Toh CH. Shades of Grey-The brain in TTP. Br J Haematol 2024; 204:757-758. [PMID: 38228136 DOI: 10.1111/bjh.19293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024]
Abstract
In their paper, Hannan et al. suggest that new approaches to the management of the acute and remission phases of thrombotic thrombocytopenic purpura should be considered to address white matter changes seen in patients undergoing magnetic resonance imaging. Timely intervention may have significant implications for the long-term physical and mental health of patients. Commentary on: Hannan et al. Cognitive decline in thrombotic thrombocytopenic purpura survivors: The role of white matter health as assessed by MRI. Br J Haematol 2024;204:1005-1016.
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Affiliation(s)
- Tina Dutt
- Department of Haematology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Cheng-Hock Toh
- Department of Haematology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
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Gando S, Levi M, Toh CH. Trauma-induced innate immune activation and disseminated intravascular coagulation. J Thromb Haemost 2024; 22:337-351. [PMID: 37816463 DOI: 10.1016/j.jtha.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/12/2023]
Abstract
Dysregulated innate immunity participates in the pathomechanisms of disseminated intravascular coagulation (DIC) in trauma-induced coagulopathy. Accidental and regulated cell deaths and neutrophil extracellular traps release damage-associated molecular patterns (DAMPs), such as histones, nuclear and mitochondrial DNA, and high-mobility group box 1, into circulation immediately after trauma. DAMP-induced inflammation activation releases tissue factor-bearing procoagulant extracellular vesicles through gasdermin D-mediated pore formation and plasma membrane rupture by regulated cell death. DAMPs also evoke systemic inflammation, platelet, coagulation activation, and impaired fibrinolysis associated with endothelial injury, leading to the dysfunction of anticoagulation systems, which are the main pathophysiological mechanisms of DIC. All these processes induce systemic thrombin generation in vivo, not restricted to the injury sites immediately after trauma. Thrombin generation at the site of injury stops bleeding and maintains homeostasis. However, DIC associated with endothelial injury generates massive thrombin, enhancing protease-activated, receptor-mediated bidirectional interplays between inflammation and coagulation, aggravating the diverse actions of thrombin and disturbing homeostasis. Insufficiently regulated thrombin causes disseminated microvascular thrombosis, resulting in tissue hypoxia due to reduced oxygen delivery, and mitochondrial dysfunction due to DAMPs causes tissue dysoxia. In addition, DAMP-induced calcium influx and overload, as well as neutrophil activation, play a role in endothelial cell injury. Tissue hypoxia and cytotoxicity result in multiple organ dysfunction in DIC after trauma. Controls against dysregulated innate immunity evoking systemic inflammation, thrombin generation, and cytotoxicity are key issues in improving the prognosis of DIC in trauma-induced coagulopathy.
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Affiliation(s)
- Satoshi Gando
- Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan; Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan.
| | - Marcel Levi
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Medicine, University College London Hospitals NHS Foundation Trust, and Cardio-Metabolic Program - NIHR UCLH/UCL BRC London, London, United Kingdom
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom; Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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Yong J, Toh CH. Rethinking coagulation: from enzymatic cascade and cell-based reactions to a convergent model involving innate immune activation. Blood 2023; 142:2133-2145. [PMID: 37890148 DOI: 10.1182/blood.2023021166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
ABSTRACT Advancements in the conceptual thinking of hemostasis and thrombosis have been catalyzed by major developments within health research over several decades. The cascade model of coagulation was first described in the 1960s, when biochemistry gained prominence through innovative experimentation and technical developments. This was followed by the cell-based model, which integrated cellular coordination to the enzymology of clot formation and was conceptualized during the growth period in cell biology at the turn of the millennium. Each step forward has heralded a revolution in clinical therapeutics, both in procoagulant and anticoagulant treatments to improve patient care. In current times, the COVID-19 pandemic may also prove to be a catalyst: thrombotic challenges including the mixed responses to anticoagulant treatment and the vaccine-induced immune thrombotic thrombocytopenia have exposed limitations in our preexisting concepts while simultaneously demanding novel therapeutic approaches. It is increasingly clear that innate immune activation as part of the host response to injury is not separate but integrated into adaptive clot formation. Our review summarizes current understanding of the major molecules facilitating such a cross talk between immunity, inflammation and coagulation. We demonstrate how such effects can be layered upon the cascade and cell-based models to evolve conceptual understanding of the physiology of immunohemostasis and the pathology of immunothrombosis.
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Affiliation(s)
- Jun Yong
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
- The Roald Dahl Haemostasis and Thrombosis Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
- The Roald Dahl Haemostasis and Thrombosis Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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Toh CH. How can we ensure that the right patient gets the right blood at the right time? BMJ 2023; 383:2446. [PMID: 37871957 DOI: 10.1136/bmj.p2446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Affiliation(s)
- Cheng-Hock Toh
- University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, UK
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Jorgensen AL, Orrell C, Waitt C, Toh CH, Sekaggya-Wiltshire C, Hughes DA, Allen E, Okello E, Tatz G, Culeddu G, Asiimwe IG, Semakula JR, Mouton JP, Cohen K, Blockman M, Lamorde M, Pirmohamed M. A "Bundle of Care" to Improve Anticoagulation Control in Patients Receiving Warfarin in Uganda and South Africa: Protocol for an Implementation Study. JMIR Res Protoc 2023; 12:e46710. [PMID: 37467034 PMCID: PMC10398551 DOI: 10.2196/46710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The quality of warfarin anticoagulation among Sub-Saharan African patients is suboptimal. This is due to several factors, including a lack of standardized dosing algorithms, difficulty in providing timely international normalized ratio (INR) results, a lack of patient feedback on their experiences with treatment, a lack of education on adherence, and inadequate knowledge and training of health care workers. Low quality of warfarin anticoagulation, expressed as time in therapeutic range (TTR), is associated with higher adverse event rates, including bleeding and thrombosis, and ultimately, increased morbidity and mortality. Processes and interventions that improve this situation are urgently needed. OBJECTIVE This study aims to evaluate the implementation of the "warfarin bundle," a package of interventions to improve the quality of anticoagulation and thereby clinical outcomes. The primary outcome for this study is TTR over the initial 3 months of warfarin therapy. METHODS Patients aged 18 years or older who are newly initiated on warfarin for venous thromboembolism, atrial fibrillation, or valvular heart disease will be enrolled and followed up for 3 months at clinics in Cape Town, South Africa, and Kampala, Uganda, where the warfarin bundle is implemented. A retrospective review of the clinical records of patients on warfarin treatment before implementation (controls) will be used for comparison. This study uses a mixed methods approach of the implementation of patient- and process-centered activities to improve the quality of anticoagulation. Patient-centered activities include the use of clinical dosing algorithms, adherence support, and root cause analysis, whereas process-centered activities include point-of-care INR testing, staff training, and patient education and training. We will assess the impact of these interventions by comparing the TTR and safety outcomes across the 2 groups, as well as the cost-effectiveness and acceptability of the package. RESULTS We started recruitment in June 2021 and stopped in August 2022, having recruited 167 participants. We obtained ethics approval from the University of Cape Town Faculty of Health Sciences Human Research Ethics Committee, the Provincial Health Research Committees in South Africa, the Joint Clinical Research Centre Institutional Review Board, Kampala, and the University of Liverpool Research Ethics Committee. As of February 2023, data cleaning and formal analysis are underway. We expect to publish the full results by December 2023. CONCLUSIONS We anticipate that the "bundle of care," which includes a clinical algorithm to guide individualized dosing of warfarin, will improve INR control and TTR of patients in Uganda and South Africa. We will use these findings to design a larger, multisite clinical trial across several Sub-Saharan African countries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46710.
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Affiliation(s)
- Andrea L Jorgensen
- Department of Health Data Science, Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Catriona Waitt
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Cheng-Hock Toh
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | | | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, School of Health Sciences, Bangor University, Bangor, United Kingdom
| | - Elizabeth Allen
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Gayle Tatz
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Giovanna Culeddu
- Centre for Health Economics and Medicines Evaluation, School of Health Sciences, Bangor University, Bangor, United Kingdom
| | - Innocent G Asiimwe
- The Wolfson Centre for Personalized Medicine, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Jerome Roy Semakula
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Johannes P Mouton
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Karen Cohen
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Marc Blockman
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Munir Pirmohamed
- The Wolfson Centre for Personalized Medicine, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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Yong J, Abrams ST, Wang G, Toh CH. Cell-free histones and the cell-based model of coagulation. J Thromb Haemost 2023; 21:1724-1736. [PMID: 37116754 DOI: 10.1016/j.jtha.2023.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/26/2023] [Revised: 04/06/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
The cell-based model of coagulation remains the basis of our current understanding of clinical hemostasis and thrombosis. Its advancement on the coagulation cascade model has enabled new prohemostatic and anticoagulant treatments to be developed. In the past decade, there has been increasing evidence of the procoagulant properties of extracellular, cell-free histones (CFHs). Although high levels of circulating CFHs released following extensive cell death in acute critical illnesses, such as sepsis and trauma, have been associated with adverse coagulation outcomes, including disseminated intravascular coagulation, new information has also emerged on how its local effects contribute to physiological clot formation. CFHs initiate coagulation by tissue factor exposure, either by destruction of the endovascular barrier or induction of endoluminal tissue factor expression on endothelia and monocytes. CFHs can also bind prothrombin directly, generating thrombin via the alternative prothrombinase pathway. In amplifying and augmenting the procoagulant signal, CFHs activate and aggregate platelets, increase procoagulant material bioavailability through platelet degranulation and Weibel-Palade body exocytosis, activate intrinsic coagulation via platelet polyphosphate release, and induce phosphatidylserine exposure. CFHs also inhibit protein C activation and downregulate thrombomodulin expression to reduce anti-inflammatory and anticoagulant effects. In consolidating clot formation, CFHs augment the fibrin polymer to confer fibrinolytic resistance and integrate neutrophil extracellular traps into the clot structure. Such new information holds the promise of new therapeutic developments, including improved targeting of immunothrombotic pathologies in acute critical illnesses.
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Affiliation(s)
- Jun Yong
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Simon T Abrams
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK; Liverpool Clinical Laboratories, Liverpool, UK
| | - Guozheng Wang
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK; Liverpool Clinical Laboratories, Liverpool, UK
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK; The Roald Dahl Haemostasis and Thrombosis Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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Abstract
Acute thrombosis and thrombocytopenia pose challenges to the clinician. Thrombocytopenia is naturally viewed as a risk factor for bleeding, and an association with acute thrombosis appears paradoxical. It presents typically as a medical emergency and requires treatment to be started before having confirmatory results. This review supports the attending clinician to recognise and manage conditions that are part of the thrombotic thrombocytopenic syndrome through four illustrative clinical cases. Common themes linking the underlying pathology and treatment are explored to highlight the continued relevance of this rare, but often devastating, presentation.
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Affiliation(s)
| | - Cheng-Hock Toh
- University of Liverpool, Liverpool, UK, and consultant in haematology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Abrams ST, Alhamdi Y, Zi M, Guo F, Du M, Wang G, Cartwright EJ, Toh CH. Extracellular Histone-Induced Protein Kinase C Alpha Activation and Troponin Phosphorylation Is a Potential Mechanism of Cardiac Contractility Depression in Sepsis. Int J Mol Sci 2023; 24:ijms24043225. [PMID: 36834636 PMCID: PMC9967552 DOI: 10.3390/ijms24043225] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
Reduction in cardiac contractility is common in severe sepsis. However, the pathological mechanism is still not fully understood. Recently it has been found that circulating histones released after extensive immune cell death play important roles in multiple organ injury and disfunction, particularly in cardiomyocyte injury and contractility reduction. How extracellular histones cause cardiac contractility depression is still not fully clear. In this work, using cultured cardiomyocytes and a histone infusion mouse model, we demonstrate that clinically relevant histone concentrations cause significant increases in intracellular calcium concentrations with subsequent activation and enriched localization of calcium-dependent protein kinase C (PKC) α and βII into the myofilament fraction of cardiomyocytes in vitro and in vivo. Furthermore, histones induced dose-dependent phosphorylation of cardiac troponin I (cTnI) at the PKC-regulated phosphorylation residues (S43 and T144) in cultured cardiomyocytes, which was also confirmed in murine cardiomyocytes following intravenous histone injection. Specific inhibitors against PKCα and PKCβII revealed that histone-induced cTnI phosphorylation was mainly mediated by PKCα activation, but not PKCβII. Blocking PKCα also significantly abrogated histone-induced deterioration in peak shortening, duration and the velocity of shortening, and re-lengthening of cardiomyocyte contractility. These in vitro and in vivo findings collectively indicate a potential mechanism of histone-induced cardiomyocyte dysfunction driven by PKCα activation with subsequent enhanced phosphorylation of cTnI. These findings also indicate a potential mechanism of clinical cardiac dysfunction in sepsis and other critical illnesses with high levels of circulating histones, which holds the potential translational benefit to these patients by targeting circulating histones and downstream pathways.
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Affiliation(s)
- Simon T. Abrams
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool, Liverpool L69 7BE, UK
- Coagulation Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| | - Yasir Alhamdi
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool, Liverpool L69 7BE, UK
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield S5 7AU, UK
| | - Min Zi
- Institute of Cardiovascular Sciences, Centre for Cardiac Research, University of Manchester, Manchester M13 9PT, UK
| | - Fengmei Guo
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool, Liverpool L69 7BE, UK
- The Medical School, Southeast University, Nanjing 210009, China
| | - Min Du
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool, Liverpool L69 7BE, UK
| | - Guozheng Wang
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool, Liverpool L69 7BE, UK
- Coagulation Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
- Correspondence: (G.W.); (C.-H.T.)
| | - Elizabeth J. Cartwright
- Institute of Cardiovascular Sciences, Centre for Cardiac Research, University of Manchester, Manchester M13 9PT, UK
| | - Cheng-Hock Toh
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool, Liverpool L69 7BE, UK
- Roald Dahl Haemostasis & Thrombosis Centre, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
- Correspondence: (G.W.); (C.-H.T.)
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Senis YA, Toh CH, Lillicrap D. Alan Randolph Giles, MD (1940-2022): dogged pioneer and esteemed hematologist. J Thromb Haemost 2023; 21:397-399. [PMID: 36700494 DOI: 10.1016/j.jtha.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Yotis A Senis
- Université de Strasbourg, Institut National de la Santé et de la Recherche Médicale, Etablissement Français du Sang Grand-Est, Unité Mixte de Recherche-S 1255, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, UK
| | - David Lillicrap
- Department of Pathology & Molecular Medicine, Queen's University, Kingston, Canada
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Grocott MPW, Murphy M, Roberts I, Sayers R, Toh CH. Tranexamic acid for safer surgery: does the evidence support preventative use? Response to Br J Anaesth 2023; 130: e23-e24. Br J Anaesth 2023; 130:e195-e196. [PMID: 36522217 DOI: 10.1016/j.bja.2022.11.010] [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] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Michael P W Grocott
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK; Royal College of Anaesthetists, London, UK
| | - Mike Murphy
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; University of Oxford, Oxford, UK
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, UK.
| | - Rob Sayers
- University of Leicester, Leicester, UK; Royal College of Surgeons of England, London, UK
| | - Cheng-Hock Toh
- University of Liverpool, Liverpool, UK; Royal College of Physicians, London, UK
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14
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Grocott MPW, Murphy M, Roberts I, Sayers R, Toh CH. Tranexamic acid for safer surgery: the time is now. Br J Surg 2022; 109:1182-1183. [PMID: 36058554 PMCID: PMC10364736 DOI: 10.1093/bjs/znac252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 12/31/2022]
Affiliation(s)
| | - Michael P W Grocott
- Royal College of Anaesthetists, London, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
| | - Mike Murphy
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - Rob Sayers
- University of Leicester, Leicester, UK.,Royal College of Surgeons of England, London, UK
| | - Cheng-Hock Toh
- University of Liverpool, Liverpool, UK.,Royal College of Physicians, London, UK
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15
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Grocott MPW, Murphy M, Roberts I, Sayers R, Toh CH. Tranexamic acid for safer surgery: the time is now. Br J Anaesth 2022; 129:459-461. [PMID: 36070986 DOI: 10.1016/j.bja.2022.06.024] [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: 06/14/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 01/06/2023] Open
Abstract
Tranexamic acid reduces surgical bleeding. Consistent with previous research, the POISE-3 (Peri-Operative Ischemic Evaluation-3) trial found that tranexamic acid reduces major bleeding by 25% and with a low probability of any increase in thromboembolic events. Wider tranexamic acid use will improve surgical safety, avoid unnecessary blood use, reduce the risk of transfusion transmitted infections, and save healthcare funds. 'Consideration of tranexamic acid use' should be included in the safe surgery checklist. We have the evidence, and we need to act on it.
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Affiliation(s)
| | - Michael P W Grocott
- Royal College of Anaesthetists, London, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
| | - Mike Murphy
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, UK.
| | - Rob Sayers
- University of Leicester, Leicester, UK; Royal College of Surgeons of England, London, UK
| | - Cheng-Hock Toh
- University of Liverpool, Liverpool, UK; Royal College of Physicians, London, UK
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16
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Abstract
In the new science emanating from the COVID-19 pandemic, effective vaccine development has made a huge difference and saved countless lives. Vaccine roll-out led to the identification of rare cases of severe thrombotic and thrombocytopenic problems in some recipients. This apparent coupling of thrombosis with haemorrhagic potentiation might seem baffling but the ensuing clinical investigation rapidly shed important light on its molecular mechanism. This review outlines the current understanding on the role of adenovirus-based platforms, the immunogenic triggers and the immunothrombotic response underlying vaccine-induced immune thrombotic thrombocytopenia.
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17
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Affiliation(s)
- Cheng-Hock Toh
- University of Liverpool, Liverpool, UK and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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18
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Shaw RJ, Abrams ST, Austin J, Taylor JM, Lane S, Dutt T, Downey C, Du M, Turtle L, Baillie JK, Openshaw PJM, Wang G, Semple MG, Toh CH. Circulating histones play a central role in COVID-19-associated coagulopathy and mortality. Haematologica 2021; 106:2493-2498. [PMID: 33832219 PMCID: PMC8409036 DOI: 10.3324/haematol.2021.278492] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- Rebecca J Shaw
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK; Roald Dahl Haemostasis and Thrombosis Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool
| | - Simon T Abrams
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool
| | - James Austin
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool
| | - Joseph M Taylor
- Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust, Liverpool
| | - Steven Lane
- Department of Biostatistics, University of Liverpool, Liverpool
| | - Tina Dutt
- Roald Dahl Haemostasis and Thrombosis Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool
| | - Colin Downey
- Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust, Liverpool
| | - Min Du
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool
| | - Lance Turtle
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK; Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool
| | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, UK; Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh
| | | | - Guozheng Wang
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool
| | - Malcolm G Semple
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK; Respiratory Medicine, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK; Roald Dahl Haemostasis and Thrombosis Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool.
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19
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Schofield J, Shaw RJ, Lester W, Thomas W, Toh CH, Dutt T. Intracranial hemorrhage in immune thrombotic thrombocytopenic purpura treated with caplacizumab. J Thromb Haemost 2021; 19:1922-1925. [PMID: 33974343 DOI: 10.1111/jth.15363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Jeremy Schofield
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rebecca J Shaw
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Will Lester
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Will Thomas
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Tina Dutt
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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20
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Abstract
The COVID-19 pandemic has been the most significant health crisis in recent global history. Early studies from Wuhan highlighted COVID-19-associated coagulopathy and a significant association with mortality was soon recognised. As research continues across the world, more evidence is emerging of the cross-talk between the innate immune system, coagulation activation and inflammation. Immunothrombosis has been demonstrated to play a key role in the pathophysiology of severe COVID-19, with extracellular histones and neutrophil extracellular traps detected in the plasma and cardiopulmonary tissues of critically ill patients. Targeting the components of immunothrombosis is becoming an important factor in the treatment of patients with COVID-19 infection. Recent studies report outcomes of intermediate and therapeutic anticoagulation in hospitalised patients with varying severities of COVID-19 disease, including optimal dosing and associated bleeding risks. Immunomodulatory therapies, including corticosteroids and IL-6 receptor antagonists, have been demonstrated to significantly reduce mortality in COVID-19 patients. As the pandemic continues, more studies are required to understand the driving factors and upstream mechanisms for coagulopathy and immunothrombosis in COVID-19, and thus potentially develop more targeted therapies for SARS-CoV-2 infection, both in the acute phase and in those who develop longer-term symptom burden.
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Affiliation(s)
- Rebecca J Shaw
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
- The Roald Dahl Haemostasis and Thrombosis Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Simon T Abrams
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Guozheng Wang
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
- The Roald Dahl Haemostasis and Thrombosis Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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21
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Toh CH, Stewart P. Research 2021: never the same again. Future Healthc J 2021; 8:e187. [PMID: 34286182 DOI: 10.7861/fhj.ed.8.2.2] [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: 11/27/2022]
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22
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Moxon C, Alhamdi Y, Storm J, Toh J, Ko JY, Murphy G, Taylor T, Seydel K, Wang G, García-Car G, Molyneux M, Craig A, Abrams S, Toh CH. Parasite histones mediate blood-brain barrier disruption in cerebral malaria. Clin Med (Lond) 2021; 20:s96-s97. [PMID: 32409404 DOI: 10.7861/clinmed.20-2-s96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
| | | | - Janet Storm
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Julien Toh
- University of Sheffield Medical School, Sheffield, UK
| | - Joo Yeon Ko
- Hanyang University College of Medicine, Seoul, South Korea
| | | | | | - Karl Seydel
- Michigan State University, East Lansing, USA
| | | | | | | | - Alister Craig
- Liverpool School of Tropical Medicine, Liverpool, UK
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23
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Wang Z, Cheng ZX, Abrams ST, Lin ZQ, Yates E, Yu Q, Yu WP, Chen PS, Toh CH, Wang GZ. Extracellular histones stimulate collagen expression in vitro and promote liver fibrogenesis in a mouse model via the TLR4-MyD88 signaling pathway. World J Gastroenterol 2020; 26:7513-7527. [PMID: 33384551 PMCID: PMC7754552 DOI: 10.3748/wjg.v26.i47.7513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/08/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver fibrosis progressing to liver cirrhosis and hepatic carcinoma is very common and causes more than one million deaths annually. Fibrosis develops from recurrent liver injury but the molecular mechanisms are not fully understood. Recently, the TLR4-MyD88 signaling pathway has been reported to contribute to fibrosis. Extracellular histones are ligands of TLR4 but their roles in liver fibrosis have not been investigated. AIM To investigate the roles and potential mechanisms of extracellular histones in liver fibrosis. METHODS In vitro, LX2 human hepatic stellate cells (HSCs) were treated with histones in the presence or absence of non-anticoagulant heparin (NAHP) for neutralizing histones or TLR4-blocking antibody. The resultant cellular expression of collagen I was detected using western blotting and immunofluorescent staining. In vivo, the CCl4-induced liver fibrosis model was generated in male 6-week-old ICR mice and in TLR4 or MyD88 knockout and parental mice. Circulating histones were detected and the effect of NAHP was evaluated. RESULTS Extracellular histones strongly stimulated LX2 cells to produce collagen I. Histone-enhanced collagen expression was significantly reduced by NAHP and TLR4-blocking antibody. In CCl4-treated wild type mice, circulating histones were dramatically increased and maintained high levels during the duration of fibrosis-induction. Injection of NAHP not only reduced alanine aminotransferase and liver injury scores, but also significantly reduced fibrogenesis. Since the TLR4-blocking antibody reduced histone-enhanced collagen I production in HSC, the CCl4 model with TLR4 and MyD88 knockout mice was used to demonstrate the roles of the TLR4-MyD88 signaling pathway in CCl4-induced liver fibrosis. The levels of liver fibrosis were indeed significantly reduced in knockout mice compared to wild type parental mice. CONCLUSION Extracellular histones potentially enhance fibrogenesis via the TLR4-MyD88 signaling pathway and NAHP has therapeutic potential by detoxifying extracellular histones.
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Affiliation(s)
- Zhi Wang
- Department of Pathology and Pathophysiology, Medical School, Southeast University, Nanjing 210009, Jiangsu Province, China
- Department of Gastroenterology, Zhongda Hospital, Nanjing 210009, Jiangsu Province, China
| | - Zhen-Xing Cheng
- Department of Pathology and Pathophysiology, Medical School, Southeast University, Nanjing 210009, Jiangsu Province, China
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool L69 7BE, United Kingdom
- Department of Gastroenterology, The First Affiliated Hospital, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Simon T Abrams
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool L69 7BE, United Kingdom
| | - Zi-Qi Lin
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Edwin Yates
- Department of Integrative Biology, University of Liverpool, Liverpool L69 7ZB, United Kingdom
| | - Qian Yu
- Department of Gastroenterology, Zhongda Hospital, Nanjing 210009, Jiangsu Province, China
| | - Wei-Ping Yu
- Department of Pathology and Pathophysiology, Medical School, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Ping-Sheng Chen
- Department of Pathology and Pathophysiology, Medical School, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool L69 7BE, United Kingdom
- Roald Dahl Haemostasis & Thrombosis Ctr, Royal Liverpool University Hospital, Liverpool L69 7BE, United Kingdom
| | - Guo-Zheng Wang
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool L69 7BE, United Kingdom
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24
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Toh CH, Castillo M, Wei KC, Chen PY. MRS as an Aid to Diagnose Malignant Transformation in Low-Grade Gliomas with Increasing Contrast Enhancement. AJNR Am J Neuroradiol 2020; 41:1592-1598. [PMID: 32732270 DOI: 10.3174/ajnr.a6688] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/04/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Increased contrast enhancement has been used as a marker of malignant transformation in low-grade gliomas. This marker has been found to have limited accuracy because many low-grade gliomas with increased contrast enhancement remain grade II. We aimed to investigate whether MR spectroscopy can contribute to the diagnosis of malignant transformation in low-grade gliomas with increased contrast enhancement. MATERIALS AND METHODS Patients with low-grade gliomas who had contemporaneous MR spectroscopy and histopathology for tumor regions with increased contrast enhancement between 2004 and 2015 were retrospectively reviewed. Clinical data collected were sex and age, Karnofsky Performance Scale, histologic subtypes, isocitrate dehydrogenase 1 mutation status, disease duration, adjuvant therapy, and post-radiation therapy duration. Imaging data collected were contrast-enhancement size, whole-tumor size, MR spectroscopy metabolite ratios, and tumor grades of regions with increased contrast enhancement. Diagnostic values of these factors on malignant transformation of low-grade gliomas were statistically analyzed. RESULTS A total of 86 patients with 96 MR spectroscopy studies were included. Tumor grades associated with increased contrast enhancement were grade II (n = 42), grade III (n = 27), and grade IV (n = 27). On multivariate analysis, the NAA/Cho ratio was the only significant factor (P < .001; OR, 7.1; 95% CI, 3.2-16.1) diagnostic of malignant transformation. With 0.222 as the cutoff value, the sensitivity, specificity, and accuracy of NAA/Cho for diagnosing malignant transformation were 94.4%, 83.3%, and 89.6%, respectively. CONCLUSIONS MR spectroscopy complements conventional MR imaging in the diagnosis of malignant transformation in a subgroup of low-grade gliomas with increased contrast enhancement.
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Affiliation(s)
- C H Toh
- From the Departments of Medical Imaging and Intervention (C.H.T.)
| | - M Castillo
- Department of Radiology (M.C.), University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - K-C Wei
- Neurosurgery (K.-C.W., P.-Y.C.), Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - P-Y Chen
- Neurosurgery (K.-C.W., P.-Y.C.), Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
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25
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Cheng Z, Abrams ST, Toh J, Wang SS, Wang Z, Yu Q, Yu W, Toh CH, Wang G. The Critical Roles and Mechanisms of Immune Cell Death in Sepsis. Front Immunol 2020; 11:1918. [PMID: 32983116 PMCID: PMC7477075 DOI: 10.3389/fimmu.2020.01918] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 07/16/2020] [Indexed: 12/23/2022] Open
Abstract
Sepsis was first described by the ancient Greek physicians over 2000 years ago. The pathophysiology of the disease, however, is still not fully understood and hence the mortality rate is still unacceptably high due to lack of specific therapies. In the last decade, great progress has been made by shifting the focus of research from systemic inflammatory response syndrome (SIRS) to multiple organ dysfunction syndrome (MODS). Sepsis has been re-defined as infection-induced MODS in 2016. How infection leads to MODS is not clear, but what mediates MODS becomes the major topic in understanding the molecular mechanisms and developing specific therapies. Recently, the mechanism of infection-induced extensive immune cell death which releases a large quantity of damage-associated molecular patterns (DAMPs) and their roles in the development of MODS as well as immunosuppression during sepsis have attracted much attention. Growing evidence supports the hypothesis that DAMPs, including high-mobility group box 1 protein (HMGB1), cell-free DNA (cfDNA) and histones as well as neutrophil extracellular traps (NETs), may directly or indirectly contribute significantly to the development of MODS. Here, we provide an overview of the mechanisms and consequences of infection-induced extensive immune cell death during the development of sepsis. We also propose a pivotal pathway from a local infection to eventual sepsis and a potential combined therapeutic strategy for targeting sepsis.
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Affiliation(s)
- Zhenxing Cheng
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.,Medical School, Southeast University, Nanjing, China
| | - Simon T Abrams
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Julien Toh
- Wirral University Teaching Hospitals NHS Foundation Trust, Wirral, United Kingdom
| | | | - Zhi Wang
- Medical School, Southeast University, Nanjing, China
| | - Qian Yu
- Medical School, Southeast University, Nanjing, China
| | - Weiping Yu
- Medical School, Southeast University, Nanjing, China
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Guozheng Wang
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.,Medical School, Southeast University, Nanjing, China
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26
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Cheng Z, Abrams ST, Toh J, Wang SS, Downey C, Ge X, Yu Q, Yu W, Wang G, Toh CH. Complexes between C-Reactive Protein and Very Low Density Lipoprotein Delay Bacterial Clearance in Sepsis. J Immunol 2020; 204:2712-2721. [PMID: 32269097 DOI: 10.4049/jimmunol.1900962] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/19/2020] [Indexed: 11/19/2022]
Abstract
C-reactive protein (CRP) can increase up to 1000-fold in blood and form complexes with very low density lipoproteins (VLDL). These complexes are associated with worse outcomes for septic patients, and this suggests a potential pathological role in sepsis. Complex formation is heightened when CRP is over 200 mg/l and levels are associated with the severity of sepsis and blood bacterial culture positivity. Using a mouse bacteremia model, blood bacterial clearance can be delayed by i.v. injection of CRP-VLDL complexes. Complexes are more efficiently taken up by activated U937 cells in vitro and Kupffer cells in vivo than VLDL alone. Both in vitro-generated and naturally occurring CRP-VLDL complexes reduce phagocytosis of bacteria by activated U937 cells. Fcγ and scavenger receptors are involved and a competitive mechanism for clearance of CRP-VLDL complexes and bacteria is demonstrated. Interaction of phosphocholine groups on VLDL with CRP is the major driver for complex formation and phosphocholine can disrupt the complexes to reverse their inhibitory effects on phagocytosis and bacterial clearance. Increased formation of CRP-VLDL complexes is therefore harmful and could be a novel target for therapy in sepsis.
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Affiliation(s)
- Zhenxing Cheng
- Medical School, Southeast University, Nanjing 210009, China
| | - Simon T Abrams
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, United Kingdom
| | - Julien Toh
- Wirral University Teaching Hospital NHS Foundation Trust, Upton, Wirral CH49 5PE, United Kingdom
| | - Susan S Wang
- Royal London Hospital, Whitechapel, London E1 1FR, United Kingdom; and
| | - Colin Downey
- Royal Liverpool University Hospital, University of Liverpool, Liverpool L7 8XP, United Kingdom
| | - Xiaoling Ge
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, United Kingdom
| | - Qian Yu
- Medical School, Southeast University, Nanjing 210009, China
| | - Weiping Yu
- Medical School, Southeast University, Nanjing 210009, China
| | - Guozheng Wang
- Medical School, Southeast University, Nanjing 210009, China;
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, United Kingdom
| | - Cheng-Hock Toh
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, United Kingdom
- Royal Liverpool University Hospital, University of Liverpool, Liverpool L7 8XP, United Kingdom
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27
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Affiliation(s)
- Cheng-Hock Toh
- President (2018–2020) of British Society for Haematology London UK
- Liverpool University Hospitals NHS Foundation Trust London UK
| | - Katy Amberley
- Chief Executive Officer of British Society for Haematology London UK
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28
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Abrams ST, Morton B, Alhamdi Y, Alsabani M, Lane S, Welters ID, Wang G, Toh CH. A Novel Assay for Neutrophil Extracellular Trap Formation Independently Predicts Disseminated Intravascular Coagulation and Mortality in Critically Ill Patients. Am J Respir Crit Care Med 2020; 200:869-880. [PMID: 31162936 DOI: 10.1164/rccm.201811-2111oc] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Rationale: Neutrophil extracellular traps (NETs) are important in the host defense against infection, but they also promote intravascular coagulation and multiorgan failure in animal models. Their clinical significance remains unclear, and available assays for patient care lack specificity and reliability.Objectives: To establish a novel assay and test its clinical significance.Methods: A prospective cohort of 341 consecutive adult ICU patients was recruited. The NET-forming capacity of ICU admission blood samples was semiquantified by directly incubating patient plasma with isolated neutrophils ex vivo. The association of NET-forming capacity with Sequential Organ Failure Assessment scores, disseminated intravascular coagulation, and 28-day mortality was analyzed and compared with available NET assays.Measurements and Main Results: Using the novel assay, we could stratify ICU patients into four groups with absent (22.0%), mild (49.9%), moderate (14.4%), and strong (13.8%) NET formation, respectively. Strong NET formation was predominantly found in sepsis (P < 0.0001). Adjusted by Acute Physiology and Chronic Health Evaluation II score, multivariate regression showed that the degree of NET formation could independently predict disseminated intravascular coagulation and mortality, whereas other NET assays (e.g., cell-free DNA, myeloperoxidase, and myeloperoxidase-DNA complexes) could not. IL-8 concentrations were found to be strongly associated with NET formation, and inhibiting IL-8 significantly attenuated NETosis. Mitogen-activated protein kinase activation by IL-8 has been identified as a major pathway of NET formation in patients.Conclusions: This assay directly measures the NET-forming capacity in patient plasma. This could guide clinical management and enable identification of NET-inducing factors in individual patients for targeted treatment and personalized ICU medicine.
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Affiliation(s)
| | - Ben Morton
- Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.,Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; and
| | | | | | | | - Ingeborg D Welters
- Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, United Kingdom.,Intensive Care Unit and
| | | | - Cheng-Hock Toh
- Institute of Infection and Global Health.,Roald Dahl Haemostasis & Thrombosis Centre, Royal Liverpool University Hospital, Liverpool, United Kingdom
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29
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Abrams S, Morton B, Alhamdi Y, Alsabani M, Cheng Z, Lane S, Welters I, Wang G, Toh CH. A novel assay of neutrophil extracellular trap (NET) formation identifies anti-IL-8 therapies to reduce disseminated intravascular coagulation and mortality in the intensive care unit. Clin Med (Lond) 2020; 20:s114-s115. [PMID: 32409417 PMCID: PMC7243522 DOI: 10.7861/clinmed.20-2-s114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Ben Morton
- Liverpool School of Tropical Medicine, Liverpool, UK
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30
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Semakula JR, Mouton JP, Jorgensen A, Hutchinson C, Allie S, Semakula L, French N, Lamorde M, Toh CH, Blockman M, Sekaggya-Wiltshire C, Waitt C, Pirmohamed M, Cohen K. A cross-sectional evaluation of five warfarin anticoagulation services in Uganda and South Africa. PLoS One 2020; 15:e0227458. [PMID: 31995565 PMCID: PMC6988943 DOI: 10.1371/journal.pone.0227458] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/18/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction Warfarin is the most commonly prescribed oral anticoagulant in sub-Saharan Africa and requires ongoing monitoring. The burden of both infectious diseases and non-communicable diseases is high and medicines used to treat comorbidities may interact with warfarin. We describe service provision, patient characteristics, and anticoagulation control at selected anticoagulation clinics in Uganda and South Africa. Methods We evaluated two outpatient anticoagulation services in Kampala, Uganda and three in Cape Town, South Africa between 1 January and 31 July 2018. We collected information from key staff members about the clinics’ service provision and extracted demographic and clinical data from a sample of patients’ clinic records. We calculated time in therapeutic range (TTR) over the most recent 3-month period using the Rosendaal interpolation method. Results We included three tertiary level, one secondary level and one primary level anticoagulation service, seeing between 30 and 800 patients per month. Care was rendered by nurses, medical officers, and specialists. All healthcare facilities had on-site pharmacies; laboratory INR testing was off-site at two. Three clinics used warfarin dose-adjustment protocols; these were not validated for local use. We reviewed 229 patient clinical records. Most common indications for warfarin were venous thrombo-embolism in 112/229 (49%), atrial fibrillation in 74/229 (32%) and valvular heart disease in 30/229 (13%). Patients were generally followed up monthly. HIV prevalence was 20% and 5% at Ugandan and South African clinics respectively. Cardiovascular comorbidity predominated. Furosemide, paracetamol, enalapril, simvastatin, and tramadol were the most common concomitant drugs. Anticoagulation control was poor at all included clinics with median TTR of 41% (interquartile range 14% to 69%). Conclusions TTR was suboptimal at all included sites, despite frequent patient follow-up. Strategies to improve INR control in sub-Saharan patients taking warfarin are needed. Locally validated warfarin dosing algorithms in Uganda and South Africa may improve INR control.
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Affiliation(s)
- Jerome Roy Semakula
- Infectious Diseases Institute, College of Health Sciences Makerere University, Kampala, Uganda
| | - Johannes P. Mouton
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Andrea Jorgensen
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Claire Hutchinson
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Shaazia Allie
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lynn Semakula
- Infectious Diseases Institute, College of Health Sciences Makerere University, Kampala, Uganda
| | - Neil French
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Mohammed Lamorde
- Infectious Diseases Institute, College of Health Sciences Makerere University, Kampala, Uganda
| | - Cheng-Hock Toh
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Marc Blockman
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Catriona Waitt
- Infectious Diseases Institute, College of Health Sciences Makerere University, Kampala, Uganda
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Karen Cohen
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Toh CH. Enabling an equitable spread of research access, involvement, and funding in the UK. Lancet 2019; 394:2048-2050. [PMID: 31818399 DOI: 10.1016/s0140-6736(19)32685-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/25/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Cheng-Hock Toh
- Roald Dahl Haemostasis & Thrombosis Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; Royal College of Physicians, London NW1 4LE.
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Nicolson PL, Desborough MJ, Hart D, Biss TT, Lowe GC, Toh CH. A HaemSTAR is born; a trainee-led, UK-wide research network in haematology. Clin Med (Lond) 2019; 19:532-533. [PMID: 31732603 DOI: 10.7861/clinmed.2019-0313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Phillip Lr Nicolson
- HaemSTAR, NIHR Haematology Clinical Research Network, University of Birmingham, Birmingham, UK and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Michael Jr Desborough
- HaemSTAR, NIHR Haematology Clinical Research Network and NIHR Oxford Bioresource, Oxford, UK
| | - Daniel Hart
- NIHR Haematology Clinical Research Network and Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tina T Biss
- NIHR Haematology Clinical Research Network and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gillian C Lowe
- NIHR Haematology Clinical Research Network and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Cheng-Hock Toh
- NIHR Haematology Clinical Research Network and Royal Liverpool University Hospital, Liverpool, UK
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Gorman KM, Meyer E, Grozeva D, Spinelli E, McTague A, Sanchis-Juan A, Carss KJ, Bryant E, Reich A, Schneider AL, Pressler RM, Simpson MA, Debelle GD, Wassmer E, Morton J, Sieciechowicz D, Jan-Kamsteeg E, Paciorkowski AR, King MD, Cross JH, Poduri A, Mefford HC, Scheffer IE, Haack TB, McCullagh G, Millichap JJ, Carvill GL, Clayton-Smith J, Maher ER, Raymond FL, Kurian MA, McRae JF, Clayton S, Fitzgerald TW, Kaplanis J, Prigmore E, Rajan D, Sifrim A, Aitken S, Akawi N, Alvi M, Ambridge K, Barrett DM, Bayzetinova T, Jones P, Jones WD, King D, Krishnappa N, Mason LE, Singh T, Tivey AR, Ahmed M, Anjum U, Archer H, Armstrong R, Awada J, Balasubramanian M, Banka S, Baralle D, Barnicoat A, Batstone P, Baty D, Bennett C, Berg J, Bernhard B, Bevan AP, Bitner-Glindzicz M, Blair E, Blyth M, Bohanna D, Bourdon L, Bourn D, Bradley L, Brady A, Brent S, Brewer C, Brunstrom K, Bunyan DJ, Burn J, Canham N, Castle B, Chandler K, Chatzimichali E, Cilliers D, Clarke A, Clasper S, Clayton-Smith J, Clowes V, Coates A, Cole T, Colgiu I, Collins A, Collinson MN, Connell F, Cooper N, Cox H, Cresswell L, Cross G, Crow Y, D’Alessandro M, Dabir T, Davidson R, Davies S, de Vries D, Dean J, Deshpande C, Devlin G, Dixit A, Dobbie A, Donaldson A, Donnai D, Donnelly D, Donnelly C, Douglas A, Douzgou S, Duncan A, Eason J, Ellard S, Ellis I, Elmslie F, Evans K, Everest S, Fendick T, Fisher R, Flinter F, Foulds N, Fry A, Fryer A, Gardiner C, Gaunt L, Ghali N, Gibbons R, Gill H, Goodship J, Goudie D, Gray E, Green A, Greene P, Greenhalgh L, Gribble S, Harrison R, Harrison L, Harrison V, Hawkins R, He L, Hellens S, Henderson A, Hewitt S, Hildyard L, Hobson E, Holden S, Holder M, Holder S, Hollingsworth G, Homfray T, Humphreys M, Hurst J, Hutton B, Ingram S, Irving M, Islam L, Jackson A, Jarvis J, Jenkins L, Johnson D, Jones E, Josifova D, Joss S, Kaemba B, Kazembe S, Kelsell R, Kerr B, Kingston H, Kini U, Kinning E, Kirby G, Kirk C, Kivuva E, Kraus A, Kumar D, Kumar VKA, Lachlan K, Lam W, Lampe A, Langman C, Lees M, Lim D, Longman C, Lowther G, Lynch SA, Magee A, Maher E, Male A, Mansour S, Marks K, Martin K, Maye U, McCann E, McConnell V, McEntagart M, McGowan R, McKay K, McKee S, McMullan DJ, McNerlan S, McWilliam C, Mehta S, Metcalfe K, Middleton A, Miedzybrodzka Z, Miles E, Mohammed S, Montgomery T, Moore D, Morgan S, Morton J, Mugalaasi H, Murday V, Murphy H, Naik S, Nemeth A, Nevitt L, Newbury-Ecob R, Norman A, O’Shea R, Ogilvie C, Ong KR, Park SM, Parker MJ, Patel C, Paterson J, Payne S, Perrett D, Phipps J, Pilz DT, Pollard M, Pottinger C, Poulton J, Pratt N, Prescott K, Price S, Pridham A, Procter A, Purnell H, Quarrell O, Ragge N, Rahbari R, Randall J, Rankin J, Raymond L, Rice D, Robert L, Roberts E, Roberts J, Roberts P, Roberts G, Ross A, Rosser E, Saggar A, Samant S, Sampson J, Sandford R, Sarkar A, Schweiger S, Scott R, Scurr I, Selby A, Seller A, Sequeira C, Shannon N, Sharif S, Shaw-Smith C, Shearing E, Shears D, Sheridan E, Simonic I, Singzon R, Skitt Z, Smith A, Smith K, Smithson S, Sneddon L, Splitt M, Squires M, Stewart F, Stewart H, Straub V, Suri M, Sutton V, Swaminathan GJ, Sweeney E, Tatton-Brown K, Taylor C, Taylor R, Tein M, Temple IK, Thomson J, Tischkowitz M, Tomkins S, Torokwa A, Treacy B, Turner C, Turnpenny P, Tysoe C, Vandersteen A, Varghese V, Vasudevan P, Vijayarangakannan P, Vogt J, Wakeling E, Wallwark S, Waters J, Weber A, Wellesley D, Whiteford M, Widaa S, Wilcox S, Wilkinson E, Williams D, Williams N, Wilson L, Woods G, Wragg C, Wright M, Yates L, Yau M, Nellåker C, Parker M, Firth HV, Wright CF, FitzPatrick DR, Barrett JC, Hurles ME, Al Turki S, Anderson C, Anney R, Antony D, Artigas MS, Ayub M, Balasubramaniam S, Barrett JC, Barroso I, Beales P, Bentham J, Bhattacharya S, Birney E, Blackwood D, Bobrow M, Bochukova E, Bolton P, Bounds R, Boustred C, Breen G, Calissano M, Carss K, Chatterjee K, Chen L, Ciampi A, Cirak S, Clapham P, Clement G, Coates G, Collier D, Cosgrove C, Cox T, Craddock N, Crooks L, Curran S, Curtis D, Daly A, Day-Williams A, Day IN, Down T, Du Y, Dunham I, Edkins S, Ellis P, Evans D, Faroogi S, Fatemifar G, Fitzpatrick DR, Flicek P, Flyod J, Foley AR, Franklin CS, Futema M, Gallagher L, Geihs M, Geschwind D, Griffin H, Grozeva D, Guo X, Guo X, Gurling H, Hart D, Hendricks A, Holmans P, Howie B, Huang L, Hubbard T, Humphries SE, Hurles ME, Hysi P, Jackson DK, Jamshidi Y, Jing T, Joyce C, Kaye J, Keane T, Keogh J, Kemp J, Kennedy K, Kolb-Kokocinski A, Lachance G, Langford C, Lawson D, Lee I, Lek M, Liang J, Lin H, Li R, Li Y, Liu R, Lönnqvist J, Lopes M, Iotchkova V, MacArthur D, Marchini J, Maslen J, Massimo M, Mathieson I, Marenne G, McGuffin P, McIntosh A, McKechanie AG, McQuillin A, Metrustry S, Mitchison H, Moayyeri A, Morris J, Muntoni F, Northstone K, O'Donnovan M, Onoufriadis A, O'Rahilly S, Oualkacha K, Owen MJ, Palotie A, Panoutsopoulou K, Parker V, Parr JR, Paternoster L, Paunio T, Payne F, Pietilainen O, Plagnol V, Quaye L, Quail MA, Raymond L, Rehnström K, Ring S, Ritchie GR, Roberts N, Savage DB, Scambler P, Schiffels S, Schmidts M, Schoenmakers N, Semple RK, Serra E, Sharp SI, Shin SY, Skuse D, Small K, Southam L, Spasic-Boskovic O, St Clair D, Stalker J, Stevens E, St Pourcian B, Sun J, Suvisaari J, Tachmazidou I, Tobin MD, Valdes A, Van Kogelenberg M, Vijayarangakannan P, Visscher PM, Wain LV, Walters JT, Wang G, Wang J, Wang Y, Ward K, Wheeler E, Whyte T, Williams H, Williamson KA, Wilson C, Wong K, Xu C, Yang J, Zhang F, Zhang P, Aitman T, Alachkar H, Ali S, Allen L, Allsup D, Ambegaonkar G, Anderson J, Antrobus R, Armstrong R, Arno G, Arumugakani G, Ashford S, Astle W, Attwood A, Austin S, Bacchelli C, Bakchoul T, Bariana TK, Baxendale H, Bennett D, Bethune C, Bibi S, Bitner-Glindzicz M, Bleda M, Boggard H, Bolton-Maggs P, Booth C, Bradley JR, Brady A, Brown M, Browning M, Bryson C, Burns S, Calleja P, Canham N, Carmichael J, Carss K, Caulfield M, Chalmers E, Chandra A, Chinnery P, Chitre M, Church C, Clement E, Clements-Brod N, Clowes V, Coghlan G, Collins P, Cooper N, Creaser-Myers A, DaCosta R, Daugherty L, Davies S, Davis J, De Vries M, Deegan P, Deevi SV, Deshpande C, Devlin L, Dewhurst E, Doffinger R, Dormand N, Drewe E, Edgar D, Egner W, Erber WN, Erwood M, Everington T, Favier R, Firth H, Fletcher D, Flinter F, Fox JC, Frary A, Freson K, Furie B, Furnell A, Gale D, Gardham A, Gattens M, Ghali N, Ghataorhe PK, Ghurye R, Gibbs S, Gilmour K, Gissen P, Goddard S, Gomez K, Gordins P, Gräf S, Greene D, Greenhalgh A, Greinacher A, Grigoriadou S, Grozeva D, Hackett S, Hadinnapola C, Hague R, Haimel M, Halmagyi C, Hammerton T, Hart D, Hayman G, Heemskerk JW, Henderson R, Hensiek A, Henskens Y, Herwadkar A, Holden S, Holder M, Holder S, Hu F, Huissoon A, Humbert M, Hurst J, James R, Jolles S, Josifova D, Kazmi R, Keeling D, Kelleher P, Kelly AM, Kennedy F, Kiely D, Kingston N, Koziell A, Krishnakumar D, Kuijpers TW, Kumararatne D, Kurian M, Laffan MA, Lambert MP, Allen HL, Lawrie A, Lear S, Lees M, Lentaigne C, Liesner R, Linger R, Longhurst H, Lorenzo L, Machado R, Mackenzie R, MacLaren R, Maher E, Maimaris J, Mangles S, Manson A, Mapeta R, Markus HS, Martin J, Masati L, Mathias M, Matser V, Maw A, McDermott E, McJannet C, Meacham S, Meehan S, Megy K, Mehta S, Michaelides M, Millar CM, Moledina S, Moore A, Morrell N, Mumford A, Murng S, Murphy E, Nejentsev S, Noorani S, Nurden P, Oksenhendler E, Ouwehand WH, Papadia S, Park SM, Parker A, Pasi J, Patch C, Paterson J, Payne J, Peacock A, Peerlinck K, Penkett CJ, Pepke-Zaba J, Perry DJ, Pollock V, Polwarth G, Ponsford M, Qasim W, Quinti I, Rankin S, Rankin J, Raymond FL, Rehnstrom K, Reid E, Rhodes CJ, Richards M, Richardson S, Richter A, Roberts I, Rondina M, Rosser E, Roughley C, Rue-Albrecht K, Samarghitean C, Sanchis-Juan A, Sandford R, Santra S, Sargur R, Savic S, Schulman S, Schulze H, Scott R, Scully M, Seneviratne S, Sewell C, Shamardina O, Shipley D, Simeoni I, Sivapalaratnam S, Smith K, Sohal A, Southgate L, Staines S, Staples E, Stauss H, Stein P, Stephens J, Stirrups K, Stock S, Suntharalingam J, Tait RC, Talks K, Tan Y, Thachil J, Thaventhiran J, Thomas E, Thomas M, Thompson D, Thrasher A, Tischkowitz M, Titterton C, Toh CH, Toshner M, Treacy C, Trembath R, Tuna S, Turek W, Turro E, Van Geet C, Veltman M, Vogt J, von Ziegenweldt J, Vonk Noordegraaf A, Wakeling E, Wanjiku I, Warner TQ, Wassmer E, Watkins H, Webster A, Welch S, Westbury S, Wharton J, Whitehorn D, Wilkins M, Willcocks L, Williamson C, Woods G, Wort J, Yeatman N, Yong P, Young T, Yu P. Bi-allelic Loss-of-Function CACNA1B Mutations in Progressive Epilepsy-Dyskinesia. Am J Hum Genet 2019; 104:948-956. [PMID: 30982612 DOI: 10.1016/j.ajhg.2019.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/04/2019] [Indexed: 12/11/2022] Open
Abstract
The occurrence of non-epileptic hyperkinetic movements in the context of developmental epileptic encephalopathies is an increasingly recognized phenomenon. Identification of causative mutations provides an important insight into common pathogenic mechanisms that cause both seizures and abnormal motor control. We report bi-allelic loss-of-function CACNA1B variants in six children from three unrelated families whose affected members present with a complex and progressive neurological syndrome. All affected individuals presented with epileptic encephalopathy, severe neurodevelopmental delay (often with regression), and a hyperkinetic movement disorder. Additional neurological features included postnatal microcephaly and hypotonia. Five children died in childhood or adolescence (mean age of death: 9 years), mainly as a result of secondary respiratory complications. CACNA1B encodes the pore-forming subunit of the pre-synaptic neuronal voltage-gated calcium channel Cav2.2/N-type, crucial for SNARE-mediated neurotransmission, particularly in the early postnatal period. Bi-allelic loss-of-function variants in CACNA1B are predicted to cause disruption of Ca2+ influx, leading to impaired synaptic neurotransmission. The resultant effect on neuronal function is likely to be important in the development of involuntary movements and epilepsy. Overall, our findings provide further evidence for the key role of Cav2.2 in normal human neurodevelopment.
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Loizou E, Karpha I, Toh CH, Dutt T. Developing today's trainees to become tomorrow's clinical researchers - an innovative collaboration driving improvements in clinical training and research delivery. Future Healthc J 2019; 6:112. [PMID: 31363631 PMCID: PMC6616800 DOI: 10.7861/futurehosp.6-1-s112] [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: 11/27/2022]
Affiliation(s)
- Eleana Loizou
- Haematology, St Helens and Knowsley Teaching Hospitals NHS Trust
| | | | - Cheng-Hock Toh
- University of Liverpool
- Haematology, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Tina Dutt
- Haematology, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
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Scully MF, Toh CH, Hoogendoorn H, Manuel RP, Nesheim ME, Solymoss S, Giles AR. Activation of Protein C and Its Distribution between Its Inhibitors, Protein C Inhibitor, α1-Antitrypsin and α2-Macroglobulin, in Patients with Disseminated intravascular Coagulation. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1651631] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryActivation and inactivation of protein C during the clinical course of disseminated intravascular coagulation (DIC) was studied in three patients by qualitative (Western blotting) and quantitative (ELISA) analysis and the intensity of procoagulant activity monitored by the measurement of thrombin and factor Xa antithrombin III complexes. In one patient, inhibitor complexes of APC with protein C inhibitor (PCI) and α1-antitrypsin (α1-AT) were observed and the latter predominated at presentation. Both disappeared during the development of remission but the loss of α1-AT complexes preceded PCI complexes which on Western blotting appeared to increase in intensity prior to disappearance. The two other patients bled to death from uncontrollable haemorrhage. In both cases, APC/inhibitor complexes with α2-macroglobulin (α2-M) in addition to PCI and αr-AT were detected and persisted until death. Although PCI appeared to be the primary inhibitor in all three cases, α1-antitrypsin and particularly α2-macroglobulin appeared to assume greater roles in the two fatal cases. These data are similar to previous findings in an experimental animal model of DIC that suggested that α2-macroglobulin and α1-antitrypsin become more important inhibitors of APC as the primary inhibitor PCI is consumed in the face of a sustained procoagulant challenge.
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Affiliation(s)
- M F Scully
- The Department of Haematology, Royal Victoria Hospital Montreal, Quebec
| | - C H Toh
- The Departments of Pathology, Biochemistry and Medicine Queen’s University, Kingston, Ontario, Canada
| | - H Hoogendoorn
- The Departments of Pathology, Biochemistry and Medicine Queen’s University, Kingston, Ontario, Canada
| | - R P Manuel
- The Departments of Pathology, Biochemistry and Medicine Queen’s University, Kingston, Ontario, Canada
| | - M E Nesheim
- The Departments of Pathology, Biochemistry and Medicine Queen’s University, Kingston, Ontario, Canada
| | - S Solymoss
- The Department of Haematology, Royal Victoria Hospital Montreal, Quebec
| | - A R Giles
- The Departments of Pathology, Biochemistry and Medicine Queen’s University, Kingston, Ontario, Canada
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Whitworth J, Smith PS, Martin JE, West H, Luchetti A, Rodger F, Clark G, Carss K, Stephens J, Stirrups K, Penkett C, Mapeta R, Ashford S, Megy K, Shakeel H, Ahmed M, Adlard J, Barwell J, Brewer C, Casey RT, Armstrong R, Cole T, Evans DG, Fostira F, Greenhalgh L, Hanson H, Henderson A, Hoffman J, Izatt L, Kumar A, Kwong A, Lalloo F, Ong KR, Paterson J, Park SM, Chen-Shtoyerman R, Searle C, Side L, Skytte AB, Snape K, Woodward ER, Tischkowitz MD, Maher ER, Aitman T, Alachkar H, Ali S, Allen L, Allsup D, Ambegaonkar G, Anderson J, Antrobus R, Armstrong R, Arno G, Arumugakani G, Ashford S, Astle W, Attwood A, Austin S, Bacchelli C, Bakchoul T, Bariana TK, Baxendale H, Bennett D, Bethune C, Bibi S, Bitner-Glindzicz M, Bleda M, Boggard H, Bolton-Maggs P, Booth C, Bradley JR, Brady A, Brown M, Browning M, Bryson C, Burns S, Calleja P, Canham N, Carmichael J, Carss K, Caulfield M, Chalmers E, Chandra A, Chinnery P, Chitre M, Church C, Clement E, Clements-Brod N, Clowes V, Coghlan G, Collins P, Cookson V, Cooper N, Corris P, Creaser-Myers A, DaCosta R, Daugherty L, Davies S, Davis J, De Vries M, Deegan P, Deevi SV, Deshpande C, Devlin L, Dewhurst E, Dixon P, Doffinger R, Dormand N, Drewe E, Edgar D, Egner W, Erber WN, Erwood M, Erwood M, Everington T, Favier R, Firth H, Fletcher D, Flinter F, Frary A, Freson K, Furie B, Furnell A, Gale D, Gardham A, Gattens M, Ghali N, Ghataorhe PK, Ghurye R, Gibbs S, Gilmour K, Gissen P, Goddard S, Gomez K, Gordins P, Graf S, Gräf S, Greene D, Greenhalgh A, Greinacher A, Grigoriadou S, Grozeva D, Hackett S, Hadinnapola C, Hague R, Haimel M, Halmagyi C, Hammerton T, Hart D, Hayman G, Heemskerk JW, Henderson R, Hensiek A, Henskens Y, Herwadkar A, Holden S, Holder M, Holder S, Hu F, Huis in’t Veld A, Huissoon A, Humbert M, Hurst J, James R, Jolles S, Josifova D, Kazmi R, Keeling D, Kelleher P, Kelly AM, Kennedy F, Kiely D, Kingston N, Koziell A, Krishnakumar D, Kuijpers TW, Kuijpers T, Kumararatne D, Kurian M, Laffan MA, Lambert MP, Allen HL, Lango-Allen H, Lawrie A, Lear S, Lees M, Lentaigne C, Liesner R, Linger R, Longhurst H, Lorenzo L, Louka E, Machado R, Ross RM, MacLaren R, Maher E, Maimaris J, Mangles S, Manson A, Mapeta R, Markus HS, Martin J, Masati L, Mathias M, Matser V, Maw A, McDermott E, McJannet C, Meacham S, Meehan S, Megy K, Mehta S, Michaelides M, Millar CM, Moledina S, Moore A, Morrell N, Mumford A, Murng S, Murphy E, Nejentsev S, Noorani S, Nurden P, Oksenhendler E, Othman S, Ouwehand WH, Ouwehand WH, Papadia S, Park SM, Parker A, Pasi J, Patch C, Paterson J, Payne J, Peacock A, Peerlinck K, Penkett CJ, Pepke-Zaba J, Perry D, Perry DJ, Pollock V, Polwarth G, Ponsford M, Qasim W, Quinti I, Rankin S, Rankin J, Raymond FL, Rayner-Matthews P, Rehnstrom K, Reid E, Rhodes CJ, Richards M, Richardson S, Richter A, Roberts I, Rondina M, Rosser E, Roughley C, Roy N, Rue-Albrecht K, Samarghitean C, Sanchis-Juan A, Sandford R, Santra S, Sargur R, Savic S, Schotte G, Schulman S, Schulze H, Scott R, Scully M, Seneviratne S, Sewell C, Shamardina O, Shipley D, Simeoni I, Sivapalaratnam S, Smith KG, Sohal A, Southgate L, Staines S, Staples E, Stark H, Stauss H, Stein P, Stephens J, Stirrups K, Stock S, Suntharalingam J, Talks K, Tan Y, Thachil J, Thaventhiran J, Thomas E, Thomas M, Thompson D, Thrasher A, Tischkowitz M, Titterton C, Toh CH, Toshner M, Treacy C, Trembath R, Tuna S, Turek W, Turro E, Van Geet C, Veltman M, Vogt J, von Ziegenweldt J, Vonk Noordegraaf A, Wakeling E, Wanjiku I, Warner TQ, Wassmer E, Watkins H, Watt C, Webster N, Welch S, Westbury S, Wharton J, Whitehorn D, Wilkins M, Willcocks L, Williamson C, Woods G, Woods G, Wort J, Yeatman N, Yong P, Young T, Yu P. Comprehensive Cancer-Predisposition Gene Testing in an Adult Multiple Primary Tumor Series Shows a Broad Range of Deleterious Variants and Atypical Tumor Phenotypes. Am J Hum Genet 2018; 103:3-18. [PMID: 29909963 PMCID: PMC6037202 DOI: 10.1016/j.ajhg.2018.04.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/25/2018] [Indexed: 12/17/2022] Open
Abstract
Multiple primary tumors (MPTs) affect a substantial proportion of cancer survivors and can result from various causes, including inherited predisposition. Currently, germline genetic testing of MPT-affected individuals for variants in cancer-predisposition genes (CPGs) is mostly targeted by tumor type. We ascertained pre-assessed MPT individuals (with at least two primary tumors by age 60 years or at least three by 70 years) from genetics centers and performed whole-genome sequencing (WGS) on 460 individuals from 440 families. Despite previous negative genetic assessment and molecular investigations, pathogenic variants in moderate- and high-risk CPGs were detected in 67/440 (15.2%) probands. WGS detected variants that would not be (or were not) detected by targeted resequencing strategies, including low-frequency structural variants (6/440 [1.4%] probands). In most individuals with a germline variant assessed as pathogenic or likely pathogenic (P/LP), at least one of their tumor types was characteristic of variants in the relevant CPG. However, in 29 probands (42.2% of those with a P/LP variant), the tumor phenotype appeared discordant. The frequency of individuals with truncating or splice-site CPG variants and at least one discordant tumor type was significantly higher than in a control population (χ2 = 43.642; p ≤ 0.0001). 2/67 (3%) probands with P/LP variants had evidence of multiple inherited neoplasia allele syndrome (MINAS) with deleterious variants in two CPGs. Together with variant detection rates from a previous series of similarly ascertained MPT-affected individuals, the present results suggest that first-line comprehensive CPG analysis in an MPT cohort referred to clinical genetics services would detect a deleterious variant in about a third of individuals.
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Qaddoori Y, Abrams ST, Mould P, Alhamdi Y, Christmas SE, Wang G, Toh CH. Extracellular Histones Inhibit Complement Activation through Interacting with Complement Component 4. J Immunol 2018; 200:4125-4133. [PMID: 29752310 DOI: 10.4049/jimmunol.1700779] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 04/16/2018] [Indexed: 01/15/2023]
Abstract
Complement activation leads to membrane attack complex formation, which can lyse not only pathogens but also host cells. Histones can be released from the lysed or damaged cells and serve as a major type of damage-associated molecular pattern, but their effects on the complement system are not clear. In this study, we pulled down two major proteins from human serum using histone-conjugated beads: one was C-reactive protein and the other was C4, as identified by mass spectrometry. In surface plasmon resonance analysis, histone H3 and H4 showed stronger binding to C4 than other histones, with KD around 1 nM. The interaction did not affect C4 cleavage to C4a and C4b. Because histones bind to C4b, a component of C3 and C5 convertases, their activities were significantly inhibited in the presence of histones. Although it is not clear whether the inhibition was achieved through blocking C3 and C5 convertase assembly or just through reducing their activity, the outcome was that both classical and mannose-binding lectin pathways were dramatically inhibited. Using a high concentration of C4 protein, histone-suppressed complement activity could not be fully restored, indicating C4 is not the only target of histones in those pathways. In contrast, the alternative pathway was almost spared, but the overall complement activity activated by zymosan was inhibited by histones. Therefore, we believe that histones inhibiting complement activation is a natural feedback mechanism to prevent the excessive injury of host cells.
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Affiliation(s)
- Yasir Qaddoori
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, United Kingdom
| | - Simon T Abrams
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, United Kingdom
| | - Paul Mould
- Biomolecular Analysis Core Facility, University of Manchester, Manchester M13 9PT, United Kingdom; and
| | - Yasir Alhamdi
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, United Kingdom
| | - Stephen E Christmas
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, United Kingdom
| | - Guozheng Wang
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, United Kingdom;
| | - Cheng-Hock Toh
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, United Kingdom; .,Roald Dahl Haemostasis and Thrombosis Centre, Royal Liverpool University Hospital, Liverpool L7 8XP, United Kingdom
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Ainsworth S, Slagboom J, Alomran N, Pla D, Alhamdi Y, King SI, Bolton FMS, Gutiérrez JM, Vonk FJ, Toh CH, Calvete JJ, Kool J, Harrison RA, Casewell NR. The paraspecific neutralisation of snake venom induced coagulopathy by antivenoms. Commun Biol 2018; 1:34. [PMID: 30271920 PMCID: PMC6123674 DOI: 10.1038/s42003-018-0039-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/26/2018] [Indexed: 01/19/2023] Open
Abstract
Snake envenoming causes several potentially lethal pathologies. The specific pathology is dictated by the toxin composition of venom, which varies by species, geography and ontogeny. This variation severely restricts the paraspecific efficacy of antivenoms used to treat snakebite victims. With a view to devising pathology-specific snakebite treatments, we assessed the procoagulant activity of 57 snake venoms and investigated the efficacy of various antivenoms. We find that procoagulant venoms act differentially on key steps of the coagulation cascade, and that certain monospecific antivenoms work in a previously unrecognised paraspecific manner to neutralise this activity, despite conventional assumptions of congener-restricted efficacy. Moreover, we demonstrate that the metal chelator EDTA is also capable of neutralising venom-induced lethality in vivo. This study illustrates the exciting potential of developing new, broad-spectrum, toxin-targeting antivenoms capable of treating key snakebite pathologies, and advocates a thorough re-examination of enzyme inhibiting compounds as alternative therapies for treating snakebite victims.
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Affiliation(s)
- Stuart Ainsworth
- Alistair Reid Venom Research Unit, Parasitology Department, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Julien Slagboom
- Alistair Reid Venom Research Unit, Parasitology Department, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
- Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, 1081 LA, The Netherlands
| | - Nessrin Alomran
- Alistair Reid Venom Research Unit, Parasitology Department, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Davinia Pla
- Laboratorio de Venómica Estructural y Funcional, Instituto de Biomedicina de Valencia, CSIC, Valencia, 46010, Spain
| | - Yasir Alhamdi
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK
| | - Sarah I King
- Alistair Reid Venom Research Unit, Parasitology Department, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Fiona M S Bolton
- Alistair Reid Venom Research Unit, Parasitology Department, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, 11501-2060, Costa Rica
| | - Freek J Vonk
- Naturalis Biodiversity Center, 2333 CR, Leiden, The Netherlands
| | - Cheng-Hock Toh
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK
- Roald Dahl Haemostasis and Thrombosis Centre, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK
| | - Juan J Calvete
- Laboratorio de Venómica Estructural y Funcional, Instituto de Biomedicina de Valencia, CSIC, Valencia, 46010, Spain
| | - Jeroen Kool
- Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, 1081 LA, The Netherlands
| | - Robert A Harrison
- Alistair Reid Venom Research Unit, Parasitology Department, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
- Research Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Nicholas R Casewell
- Alistair Reid Venom Research Unit, Parasitology Department, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
- Research Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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Alhamdi Y, Toh CH. Recent advances in pathophysiology of disseminated intravascular coagulation: the role of circulating histones and neutrophil extracellular traps. F1000Res 2017; 6:2143. [PMID: 29399324 PMCID: PMC5785716 DOI: 10.12688/f1000research.12498.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 12/29/2022] Open
Abstract
Disseminated intravascular coagulation (DIC) is an acquired condition that develops as a complication of systemic and sustained cell injury in conditions such as sepsis and trauma. It represents major dysregulation and increased thrombin generation in vivo. A poor understanding and recognition of the complex interactions in the coagulation, fibrinolytic, inflammatory, and innate immune pathways have resulted in continued poor management and high mortality rates in DIC. This review focuses attention on significant recent advances in our understanding of DIC pathophysiology. In particular, circulating histones and neutrophil extracellular traps fulfil established criteria in DIC pathogenesis. Both are damaging to the vasculature and highly relevant to the cross talk between coagulation and inflammation processes, which can culminate in adverse clinical outcomes. These molecules have a strong potential to be novel biomarkers and therapeutic targets in DIC, which is still considered synonymous with 'death is coming'.
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Affiliation(s)
- Yasir Alhamdi
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Roald Dahl Haemostasis & Thrombosis Centre, Royal Liverpool University Hospital, Liverpool, UK
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Abstract
SummaryWe investigated changes in both thrombin activatable fibrinolysis inhibitor (TAFI) antigen levels and its functional effect on in vitro fibrinolysis in normal pregnancy. 152 pregnant women and 31 women in the immediate postpartum period were studied, with pregnancy divided into 6 windows at 4 weekly intervals. As TAFI influences and is in turn influenced by components of the protein C (PC) pathway, its measurements were correlated with levels of soluble thrombomodulin, PC, protein S (PS) and the overall phenotype of activated PC resistance (APCR). Compared with mean TAFI levels at booking gestation (6.6 +1.2 μg/ml), levels peaked at 35-39 weeks gestation (9.6 +2 μg/ml, p = 0.001), followed by a significant drop within 24 hours of delivery (7.2 + 1.1 μg/ml). In functional terms, the mean clot lysis time (CLT) (101 + 13 min at booking) also peaked at 35-39 weeks gestation (141 + 42 min, p = 0.007) and dropped after delivery (99 + 33 min), and was significantly correlated with gestational age (r = 0.410, p = 0.001) and could be abrogated in the presence of an inhibitor to TAFI activation. A significant negative correlation was found between TAFI levels and APCR (r = −0.478, p <0.001), APCRV (r = −0.598; p <0.001), PS (r = −0.490, P <0.001) and PC (r = −0.198, p = 0.02). In summary, there is a significant increase in TAFI levels, which translates into increased CLT during pregnancy. Furthermore, changes in TAFI contribute to the increasing APCR of pregnancy.
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Affiliation(s)
- Hatem A Mousa
- Department of Obstetrics and Gynaecology, University of Liverpool, UK
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Szatmary P, Liu T, Abrams ST, Voronina S, Wen L, Chvanov M, Huang W, Wang G, Criddle DN, Tepikin AV, Toh CH, Sutton R. Systemic histone release disrupts plasmalemma and contributes to necrosis in acute pancreatitis. Pancreatology 2017; 17:884-892. [PMID: 29102149 DOI: 10.1016/j.pan.2017.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 10/01/2017] [Accepted: 10/06/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Clinical and experimental acute pancreatitis feature histone release within the pancreas from innate immune cells and acinar cell necrosis. In this study, we aimed to detail the source of circulating histones and assess their role in the pathogenesis of acute pancreatitis. METHODS Circulating nucleosomes were measured in patient plasma, taken within 24 and 48 h of onset of acute pancreatitis and correlated with clinical outcomes. Using caerulein hyperstimulation, circulating histones were measured in portal, systemic venous and systemic arterial circulation in mice, and the effects of systemic administration of histones in this model were assessed. The sites of actions of circulating histones were assessed by administration of FITC-labelled histones. The effects of histones on isolated pancreatic acinar cells were further assessed by measuring acinar cell death and calcium permeability in vitro. RESULTS Cell-free histones were confirmed to be abundant in human acute pancreatitis and found to derive from pancreatitis-associated liver injury in a rodent model of the disease. Fluorescein isothianate-labelled histones administered systemically targeted the pancreas and exacerbated injury in experimental acute pancreatitis. Histones induce charge- and concentration-dependent plasmalemma leakage and necrosis in isolated pancreatic acinar cells, independent of extracellular calcium. CONCLUSION We conclude that histones released systemically in acute pancreatitis concentrate within the inflamed pancreas and exacerbate injury. Circulating histones may provide meaningful biomarkers and targets for therapy in clinical acute pancreatitis.
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Affiliation(s)
- Peter Szatmary
- NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, L69 3GA, UK; Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool, L69 3BX, UK
| | - Tingting Liu
- NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, L69 3GA, UK; Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK; Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Simon T Abrams
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK
| | - Svetlana Voronina
- Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool, L69 3BX, UK
| | - Li Wen
- NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, L69 3GA, UK
| | - Michael Chvanov
- Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool, L69 3BX, UK
| | - Wei Huang
- NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, L69 3GA, UK; Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Guozheng Wang
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK
| | - David N Criddle
- Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool, L69 3BX, UK
| | - Alexey V Tepikin
- Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool, L69 3BX, UK
| | - Cheng-Hock Toh
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK; Roald Dahl Haemostasis and Thrombosis Centre, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK.
| | - Robert Sutton
- NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, L69 3GA, UK
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Qaddoori Y, Abrams ST, Su D, Liu T, Alhamdi Y, Wang G, Toh CH. Extracellular histones inhibit complement activation through interactions with complement component C4b. Mol Immunol 2017. [DOI: 10.1016/j.molimm.2017.06.067] [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: 10/19/2022]
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Liu T, Huang W, Szatmary P, Abrams ST, Alhamdi Y, Lin Z, Greenhalf W, Wang G, Sutton R, Toh CH. Accuracy of circulating histones in predicting persistent organ failure and mortality in patients with acute pancreatitis. Br J Surg 2017; 104:1215-1225. [PMID: 28436602 PMCID: PMC7938821 DOI: 10.1002/bjs.10538] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/10/2016] [Accepted: 02/14/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Early prediction of acute pancreatitis severity remains a challenge. Circulating levels of histones are raised early in mouse models and correlate with disease severity. It was hypothesized that circulating histones predict persistent organ failure in patients with acute pancreatitis. METHODS Consecutive patients with acute pancreatitis fulfilling inclusion criteria admitted to Royal Liverpool University Hospital were enrolled prospectively between June 2010 and March 2014. Blood samples were obtained within 48 h of abdominal pain onset and relevant clinical data during the hospital stay were collected. Healthy volunteers were enrolled as controls. The primary endpoint was occurrence of persistent organ failure. The predictive values of circulating histones, clinical scores and other biomarkers were determined. RESULTS Among 236 patients with acute pancreatitis, there were 156 (66·1 per cent), 57 (24·2 per cent) and 23 (9·7 per cent) with mild, moderate and severe disease respectively, according to the revised Atlanta classification. Forty-seven healthy volunteers were included. The area under the receiver operating characteristic (ROC) curve (AUC) for circulating histones in predicting persistent organ failure and mortality was 0·92 (95 per cent c.i. 0·85 to 0·99) and 0·96 (0·92 to 1·00) respectively; histones were at least as accurate as clinical scores or biochemical markers. For infected pancreatic necrosis and/or sepsis, the AUC was 0·78 (0·62 to 0·94). Histones did not predict or correlate with local pancreatic complications, but correlated negatively with leucocyte cell viability (r = -0·511, P = 0·001). CONCLUSION Quantitative assessment of circulating histones in plasma within 48 h of abdominal pain onset can predict persistent organ failure and mortality in patients with acute pancreatitis. Early death of immune cells may contribute to raised circulating histone levels in acute pancreatitis.
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Affiliation(s)
- T Liu
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - W Huang
- National Institute for Health Research (NIHR) Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - P Szatmary
- National Institute for Health Research (NIHR) Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - S T Abrams
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Y Alhamdi
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Z Lin
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University, Chengdu, China
| | - W Greenhalf
- National Institute for Health Research (NIHR) Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - G Wang
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - R Sutton
- National Institute for Health Research (NIHR) Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - C H Toh
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Roald Dahl Haemostasis and Thrombosis Centre, Royal Liverpool University Hospital, Liverpool, UK
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Wang G, Alhamdi Y, Toh CH. 143 The roles and mechanisms of pore-forming toxins in cardiac injury. Heart 2017. [DOI: 10.1136/heartjnl-2017-311726.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Toh CH, Alhamdi Y. Role of Coagulation Factor Concentrates in the Operating Room. EMJ 2016. [DOI: 10.33590/emj/10313464] [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: 02/16/2023] Open
Abstract
The use of fresh frozen plasma, cryoprecipitate, and platelets has been the mainstay of approaches to correct coagulopathies that can arise in the perioperative setting. Limitations include the time delay from obtaining results of coagulation screens to the availability of thawed fresh frozen plasma and the potential of fluid overload. With advances in both global haemostatic testing and concentrates of coagulation factors, there are increasing opportunities for innovative practice. However, there remains a paucity of studies that can provide good quality, unbiased evidence. These issues are elaborated here to form the basis for future study.
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Affiliation(s)
- Cheng-Hock Toh
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; Roald Dahl Haemostasis and Thrombosis Centre, Royal Liverpool University Hospital, Liverpool, UK
| | - Yasir Alhamdi
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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Toh CH, Castillo M. Early-Stage Glioblastomas: MR Imaging-Based Classification and Imaging Evidence of Progressive Growth. AJNR Am J Neuroradiol 2016; 38:288-293. [PMID: 27856439 DOI: 10.3174/ajnr.a5015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/23/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE The serial imaging changes describing the growth of glioblastomas from small to large tumors are seldom reported. Our aim was to classify the imaging patterns of early-stage glioblastomas and to define the order of appearance of different imaging patterns that occur during the growth of small glioblastomas. MATERIALS AND METHODS Medical records and preoperative MR imaging studies of patients diagnosed with glioblastoma between 2006 and 2013 were reviewed. Patients were included if their MR imaging studies showed early-stage glioblastomas, defined as small MR imaging lesions detected early in the course of the disease, demonstrating abnormal signal intensity but the absence of classic imaging findings of glioblastoma. Each lesion was reviewed by 2 neuroradiologists independently for location, signal intensity, involvement of GM and/or WM, and contrast-enhancement pattern on MR imaging. RESULTS Twenty-six patients with 31 preoperative MR imaging studies met the inclusion criteria. Early-stage glioblastomas were classified into 3 types and were all hyperintense on FLAIR/T2-weighted images. Type I lesions predominantly involved cortical GM (n = 3). Type II (n = 12) and III (n = 16) lesions involved both cortical GM and subcortical WM. Focal contrast enhancement was present only in type III lesions at the gray-white junction. Interobserver agreement was excellent (κ = 0.95; P < .001) for lesion-type classification. Transformations of lesions from type I to type II and type II to type III were observed on follow-up MR imaging studies. The early-stage glioblastomas of 16 patients were pathologically confirmed after imaging progression to classic glioblastoma. CONCLUSIONS Cortical lesions may be the earliest MR imaging-detectable abnormality in some human glioblastomas. These cortical tumors may progress to involve WM.
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Affiliation(s)
- C H Toh
- From the Department of Medical Imaging and Intervention (C.H.T.), Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - M Castillo
- Department of Radiology (M.C.), University of North Carolina School of Medicine, Chapel Hill, North Carolina
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47
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Benjamin LA, Bryer A, Lucas S, Stanley A, Allain TJ, Joekes E, Emsley H, Turnbull I, Downey C, Toh CH, Brown K, Brown D, Ison C, Smith C, Corbett EL, Nath A, Heyderman RS, Connor MD, Solomon T. Arterial ischemic stroke in HIV: Defining and classifying etiology for research studies. Neurol Neuroimmunol Neuroinflamm 2016; 3:e254. [PMID: 27386505 PMCID: PMC4929887 DOI: 10.1212/nxi.0000000000000254] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/04/2016] [Indexed: 12/13/2022]
Abstract
HIV infection, and potentially its treatment, increases the risk of an arterial ischemic stroke. Multiple etiologies and lack of clear case definitions inhibit progress in this field. Several etiologies, many treatable, are relevant to HIV-related stroke. To fully understand the mechanisms and the terminology used, a robust classification algorithm to help ascribe the various etiologies is needed. This consensus paper considers the strengths and limitations of current case definitions in the context of HIV infection. The case definitions for the major etiologies in HIV-related strokes were refined (e.g., varicella zoster vasculopathy and antiphospholipid syndrome) and in some instances new case definitions were described (e.g., HIV-associated vasculopathy). These case definitions provided a framework for an algorithm to help assign a final diagnosis, and help classify the subtypes of HIV etiology in ischemic stroke.
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Affiliation(s)
- Laura A Benjamin
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Alan Bryer
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Sebastian Lucas
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Alan Stanley
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Theresa J Allain
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Elizabeth Joekes
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Hedley Emsley
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Ian Turnbull
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Colin Downey
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Cheng-Hock Toh
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Kevin Brown
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - David Brown
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Catherine Ison
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Colin Smith
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Elizabeth L Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Avindra Nath
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Robert S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Myles D Connor
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
| | - Tom Solomon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK
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Alhamdi Y, Toh CH. The role of extracellular histones in haematological disorders. Br J Haematol 2016; 173:805-11. [PMID: 27062156 DOI: 10.1111/bjh.14077] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 02/05/2016] [Accepted: 02/06/2016] [Indexed: 12/22/2022]
Abstract
Over the past decades, chromosomal alterations have been extensively investigated for their pathophysiological relevance in haematological malignancies. In particular, epigenetic modifications of intra-nuclear histones are now known as key regulators of healthy cell cycles that have also evolved into novel therapeutic targets for certain blood cancers. Thus, for most haematologists, histones are DNA-chained proteins that are buried deep within chromatin. However, the plot has deepened with recent revelations on the function of histones when unchained and released extracellularly upon cell death or from activated neutrophils as part of neutrophil extracellular traps (NETs). Extracellular histones and NETs are increasingly recognized for profound cytotoxicity and pro-coagulant effects. This article highlights the importance of recognizing this new paradigm of extracellular histones as a key player in host defence through its damage-associated molecular patterns, which could translate into novel diagnostic and therapeutic biomarkers in various haematological and critical disorders.
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Affiliation(s)
- Yasir Alhamdi
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Roald Dahl Haemostasis & Thrombosis Centre, Royal Liverpool University Hospital, Liverpool, UK
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49
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Schoergenhofer C, Schwameis M, Wohlfarth P, Brostjan C, Abrams ST, Toh CH, Jilma B. Granulocyte colony-stimulating factor (G-CSF) increases histone-complexed DNA plasma levels in healthy volunteers. Clin Exp Med 2016; 17:243-249. [PMID: 27002713 PMCID: PMC5403858 DOI: 10.1007/s10238-016-0413-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 11/05/2015] [Accepted: 03/06/2016] [Indexed: 12/24/2022]
Abstract
Granulocyte colony-stimulating factor (G-CSF) is an activator of neutrophil granulocytes. Neutrophil extracellular traps are a defensive mechanism consisting of neutrophils, platelets, DNA, histones and antimicrobial proteins. This study was performed to determine whether G-CSF increases histone-complexed DNA in the plasma of healthy volunteers. In total, 51 healthy volunteers (25 males and 26 females) were treated with G-CSF (18 with 300 µg single dose i.v., 27 with 5 µg/kg s.c. for 4 days) and six participants received a placebo. Histone-complexed DNA was measured by enzyme immunoassay in plasma samples at predefined time points (0, 2, 4, 6, 24 h after single dose, day 1, day 2 and day 5 after repeated doses). Histone levels were quantified by Western blotting. A single dose of G-CSF rapidly increased hc-DNA by about 50 % (p < 0.05 for 2-24 h). After repeated doses the increase was even more pronounced: hc-DNA increased by about 50 % (3.0 ± 0.9, p < 0.001 after 24 h and about fourfold after 96 h (p < 0.001)). A statistical significant increase in histone levels was detected as early as 4 h after G-CSF injection (0.43 ± 0.2 vs. 1.08 ± 0.3 µg/ml; p = 0.034). In the placebo group no significant changes occurred. Moreover, significantly higher levels of hc-DNA were measured in male compared to female subjects (226 ± 43 vs. 84 ± 19, p < 0.001). G-CSF injection substantially increases hc-DNA levels in healthy volunteers. There is a significant gender difference in hc-DNA at the baseline.
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Affiliation(s)
- Christian Schoergenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Schwameis
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Philipp Wohlfarth
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Simon T Abrams
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Cheng-Hock Toh
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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50
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Affiliation(s)
- Yasir Alhamdi
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK
| | - Simon T Abrams
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK
| | - Steven Lane
- Institute of Translational Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - Guozheng Wang
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK
| | - Cheng-Hock Toh
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK
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