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Buyon JP, Masson M, Izmirly CG, Phoon C, Acherman R, Sinkovskaya E, Abuhamad A, Makhoul M, Satou G, Hogan W, Pinto N, Moon-Grady A, Howley L, Donofrio M, Krishnan A, Ahmadzia H, Levasseur S, Paul E, Owens S, Cumbermack K, Matta J, Joffe G, Lindblade C, Haxel C, Kohari K, Copel J, Strainic J, Doan T, Bermudez-Wagner K, Holloman C, Sheth SS, Killen S, Tacy T, Kaplinski M, Hornberger L, Carlucci PM, Izmirly P, Fraser N, Clancy RM, Cuneo BF. Prospective Evaluation of High Titer Autoantibodies and Fetal Home Monitoring in the Detection of Atrioventricular Block Among Anti-SSA/Ro Pregnancies. Arthritis Rheumatol 2024; 76:411-420. [PMID: 37947364 PMCID: PMC11095662 DOI: 10.1002/art.42733] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/18/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE This prospective study of pregnant patients, Surveillance To Prevent AV Block Likely to Occur Quickly (STOP BLOQ), addresses the impact of anti-SSA/Ro titers and utility of ambulatory monitoring in the detection of fetal second-degree atrioventricular block (AVB). METHODS Women with anti-SSA/Ro autoantibodies by commercial testing were stratified into high and low anti-52-kD and/or 60-kD SSA/Ro titers applying at-risk thresholds defined by previous evaluation of AVB pregnancies. The high-titer group performed fetal heart rate and rhythm monitoring (FHRM) thrice daily and weekly/biweekly echocardiography from 17-26 weeks. Abnormal FHRM prompted urgent echocardiography to identify AVB. RESULTS Anti-52-kD and/or 60-kD SSA/Ro met thresholds for monitoring in 261 of 413 participants (63%); for those, AVB frequency was 3.8%. No cases occurred with low titers. The incidence of AVB increased with higher levels, reaching 7.7% for those in the top quartile for anti-60-kD SSA/Ro, which increased to 27.3% in those with a previous child who had AVB. Based on levels from 15 participants with paired samples from both an AVB and a non-AVB pregnancy, healthy pregnancies were not explained by decreased titers. FHRM was considered abnormal in 45 of 30,920 recordings, 10 confirmed AVB by urgent echocardiogram, 7 being second-degree AVB, all <12 hours from normal FHRM and within another 0.75 to 4 hours to echocardiogram. The one participant with second/third-degree and two participants with third-degree AVB were diagnosed by urgent echocardiogram >17 to 72 hours from an FHRM. Surveillance echocardiograms detected no AVB when the preceding interval FHRM recordings were normal. CONCLUSION High-titer antibodies are associated with an increased incidence of AVB. Anti-SSA/Ro titers remain stable over time and do not explain the discordant recurrence rates, suggesting that other factors are required. Fetal heart rate and rhythm (FHRM) with results confirmed by a pediatric cardiologist reliably detects conduction abnormalities, which may reduce the need for serial echocardiograms.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Gary Satou
- University of California, Los Angeles, California
| | | | | | | | - Lisa Howley
- Midwest Fetal Care Center, Children's Minnesota/Allina Health, Minneapolis, Minnesota
| | | | | | | | | | - Erin Paul
- Mount Sinai Hospital, New York City, New York
| | | | | | | | - Gary Joffe
- Perinatal Associates of New Mexico, Rio Rancho, New Mexico
| | | | - Caitlin Haxel
- University of Vermont Children's Hospital, Burlington, Vermont
| | | | | | - James Strainic
- UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Tam Doan
- Baylor School of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Conisha Holloman
- Baylor School of Medicine, Baylor College of Medicine, Houston, Texas
| | - Shreya S Sheth
- Baylor School of Medicine, Baylor College of Medicine, Houston, Texas
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Lynch TA, Malshe A, Colihan S, Meyers J, Li D, Holloman C, Soto-Torres E, Olson-Chen C. Impact of Maternal Obesity on Perinatal Outcomes in Preterm Prelabor Rupture of Membranes ≥34 Weeks. Am J Perinatol 2020; 37:467-474. [PMID: 31739369 DOI: 10.1055/s-0039-1698833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to compare pregnancy outcomes in obese and nonobese women with preterm prelabor rupture of membranes (PPROM) ≥34 weeks. STUDY DESIGN The present study is a secondary analysis of a multicenter retrospective cohort of singletons with PPROM from 2011 to 2017. Women with a delivery body mass index (BMI) ≥30 kg/m2 (obese) were compared with women with a BMI < 30 kg/m2 (nonobese). Pregnancies were stratified based on delivery policies of expectant management until 35 weeks versus immediate delivery ≥34 weeks. The primary outcome was a composite neonatal outcome (neonatal sepsis, antibiotic administration for duration >72 hours after delivery or respiratory support). Univariate analysis and general estimating equations models including maternal age, delivery timing, mode of delivery, hospital, and gestational age were used with p < 0.05 level of significance. RESULTS Among 259 pregnancies, 47% were obese. Pregnant women with obesity had increased composite neonatal outcome versus nonobese pregnancies (adjusted odds ratio [aOR] = 1.48 [95% confidence interval (CI): 1.01-2.17]). Obesity was also associated with increased neonatal antibiotic administration for a duration >72 hours after delivery, respiratory support, ventilation, oxygen supplementation, and surfactant administration. When stratified by delivery policies there was no significant difference in perinatal outcomes based on obesity. CONCLUSION Obese women with PPROM ≥34 weeks have an increased odds of adverse neonatal respiratory and infectious outcomes compared with nonobese women.
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Affiliation(s)
- Tara A Lynch
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester Medical Center, Rochester, New York
| | - Amol Malshe
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester Medical Center, Rochester, New York
| | - Sarah Colihan
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
| | - Jeffrey Meyers
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Dongmei Li
- Department of Clinical and Translational Research, Department of Obstetrics and Gynecology, Department of Public Health Sciences, University of Rochester, Rochester, New York
| | - Conisha Holloman
- Department of Obstetrics and Gynecology, Winnie Palmer Hospital for Women and Babies, Orlando Health, Orlando, Florida
| | - Eleazar Soto-Torres
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Texas-Houston, Houston, Texas
| | - Courtney Olson-Chen
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester Medical Center, Rochester, New York
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Holloman C, Tounsi S, Chen HY, Ward C, Goetzl L, Sibai BM. 239: Degree of obesity on maternal and neonatal morbidity in patients with hypertensive disorders of pregnancy. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Holloman C, Bicocca MJ, Tounsi S, Green J, Alaris M, Ward C, Goetzl L, Ankumah NA, Sibai BM. 26: Postpartum hypertensive disorders of pregnancy: Discharge diagnosis and interval to readmission. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lynch TA, Olson-Chen C, Colihan S, Meyers J, Holloman C, Li D, Link H, Torres P, Kim A, King DJ, Eckman C, Varlamov A, Dexter S, Pressman EK, Soto-Torres E, Malshe A. Preterm Prelabor Rupture of Membranes: Outcomes with Expectant Management until 34 versus 35 Weeks. Am J Perinatol 2019; 36:659-668. [PMID: 30553236 DOI: 10.1055/s-0038-1675647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate outcomes with expectant management of preterm prelabor rupture of membranes (PROM) until 35 weeks versus immediate delivery at ≥34 weeks. STUDY DESIGN This was a multicenter retrospective cohort study of singletons with preterm PROM at >20 weeks from 2011 through 2017. Groups were defined as expectant management until 35 weeks versus immediate delivery at ≥34 weeks. Primary outcome was composite neonatal morbidity: need for respiratory support, culture positive neonatal sepsis, or antibiotic administration for >72 hours. Univariate and general estimating equation models were used with p < 0.05 considered significant. RESULTS A total of 280 mother-infant dyads were included. There was no difference in composite neonatal outcome in pregnancies managed with expectant management compared with immediate delivery (43.4 vs. 37.5%; p = 0.32). Those with expectant management had shorter length of neonatal intensive care unit (NICU) admission but higher rates of neonatal antibiotics for > 72 hours, endometritis, and histological chorioamnionitis. There were no cases of fetal demise, neonatal death, or maternal sepsis, and only three cases of neonatal sepsis. CONCLUSION There is no difference in composite neonatal morbidity in pregnancies with preterm PROM managed with expectant management until 35 weeks as compared with immediate delivery at 34 weeks. Expectant management is associated with a decreased length of NICU admission but increased short-term infectious morbidity.
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Affiliation(s)
- Tara A Lynch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Courtney Olson-Chen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Sarah Colihan
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
| | - Jeffrey Meyers
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Conisha Holloman
- Department of Obstetrics and Gynecology, Winnie Palmer Hospital for Women and Babies, Orlando Health, Orlando, Florida
| | - Dongmei Li
- Department of Clinical and Translational Research, University of Rochester, Rochester, New York.,Department of Obstetrics and Gynecology, Department of Public Health Sciences, University of Rochester, Rochester, New York.,Department of Public Health Sciences, University of Rochester, Rochester, New York
| | - Heather Link
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Paola Torres
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas, Houston, Texas
| | - Annie Kim
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas, Houston, Texas
| | - Devon J King
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
| | | | - Anna Varlamov
- Department of Obstetrics and Gynecology, Winnie Palmer Hospital for Women and Babies, Orlando Health, Orlando, Florida
| | - Scott Dexter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
| | - Eva K Pressman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Eleazar Soto-Torres
- Department of Clinical and Translational Research, University of Rochester, Rochester, New York.,Department of Obstetrics and Gynecology, Department of Public Health Sciences, University of Rochester, Rochester, New York.,Department of Public Health Sciences, University of Rochester, Rochester, New York
| | - Amol Malshe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
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Kostamo K, Peart M, McKenzie N, Holloman C, Carlan SJ, Ge L, Maksem J. Novel Treatment of Small-Cell Neuroendocrine of the Vagina. Case Rep Oncol Med 2018; 2018:9157036. [PMID: 29535879 PMCID: PMC5817301 DOI: 10.1155/2018/9157036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/11/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Primary vaginal small-cell neuroendocrine carcinoma is an extremely rare and highly aggressive malignancy. Eighty-five percent of patients die within one year of diagnosis from metastatic disease despite multimodal therapy. Gene expression profiling of tumor tissue may be useful for treatment options for various malignancies. CASE A 34-year-old nulliparous woman was diagnosed with primary vaginal small-cell neuroendocrine carcinoma. Twenty weeks after the initial visit, she was diagnosed with recurrence and started on chemoradiation based on the results of gene expression profile of tumor tissue. She died 34 months after the initial visit and had a 14-month progression-free survival (PFS). CONCLUSION Gene expression profile of tumor tissue in the management of primary vaginal small-cell neuroendocrine carcinoma may be helpful in extending progression-free survival.
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Affiliation(s)
- Kathryn Kostamo
- Department of Obstetrics and Gynecology, Orlando Regional Healthcare, Orlando, FL, USA
| | - Mishka Peart
- Department of Obstetrics and Gynecology, Orlando Regional Healthcare, Orlando, FL, USA
| | - Nathalie McKenzie
- Gynecologic Oncology, Florida Hospital Medical Group, Maitland, FL, USA
| | - Conisha Holloman
- Department of Obstetrics and Gynecology, Orlando Regional Healthcare, Orlando, FL, USA
| | - S. J. Carlan
- Department of Obstetrics and Gynecology, Orlando Regional Healthcare, Orlando, FL, USA
| | - Li Ge
- Department of Pathology, Orlando Regional Healthcare, Orlando, FL, USA
| | - John Maksem
- Department of Pathology, Orlando Regional Healthcare, Orlando, FL, USA
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Holloman C, Carlan SJ, Sundharkrishnan L, Guzman A, Madruga M. Successful pregnancy after mucinous cystic neoplasm with invasive carcinoma of the pancreas in a patient with polycystic ovarian syndrome: a case report. J Med Case Rep 2017; 11:188. [PMID: 28693619 PMCID: PMC5504786 DOI: 10.1186/s13256-017-1343-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/29/2016] [Accepted: 05/15/2017] [Indexed: 11/21/2022] Open
Abstract
Background The incidence of invasive cancer within a mucinous cystic neoplasm of the pancreas varies between 6 and 36%. Polycystic ovarian syndrome is a disorder characterized by hyperandrogenism and anovulatory infertility. One surgical treatment that can restore endocrine balance and ovulation in polycystic ovarian syndrome is partial ovarian destruction. Successful pregnancies following preconception pancreaticoduodenectomies (Whipple procedures) and chemoradiation to treat pancreatic neoplasms have been reported rarely but none were diagnosed with pre-cancer polycystic ovarian syndrome-associated infertility. Gemcitabine is an antimetabolite drug used for the treatment of pancreatic cancer that can have profound detrimental effects on oogenesis and ovarian function. Whether the ovarian destructive property of gemcitabine could act as a method to restore ovulation potential in polycystic ovarian syndrome is unknown. Case presentation A 40-year-old white American woman with a history of pancreatic cancer treatment with a Whipple procedure and chemoradiation with gemcitabine had a successful pregnancy after years of pre-cancerous anovulatory infertility and polycystic ovarian syndrome. She received no fertility agents and delivered full term via a spontaneous vaginal delivery with no pregnancy complications. Conclusion Gemcitabine treatment for pancreatic cancer may result in resumption of ovulation in women with polycystic ovarian syndrome and these women should be counseled accordingly.
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Affiliation(s)
- Conisha Holloman
- Department of Obstetrics and Gynecology, Orlando Regional Healthcare, 1401 Lucerne Terrace, 2nd floor, Orlando, Fl, 32806, USA
| | - S J Carlan
- Department of Obstetrics and Gynecology, Orlando Regional Healthcare, 1401 Lucerne Terrace, 2nd floor, Orlando, Fl, 32806, USA.
| | | | - Angela Guzman
- Department of Obstetrics and Gynecology, Orlando Regional Healthcare, 1401 Lucerne Terrace, 2nd floor, Orlando, Fl, 32806, USA
| | - Mario Madruga
- Department of Medicine, Orlando Regional Healthcare, Orlando, FL, USA
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Paradise C, Carlan SJ, Holloman C. Spontaneous uterine cornual rupture at 26 weeks' gestation in an interstitial heterotopic pregnancy following in vitro fertilization. J Clin Ultrasound 2016; 44:322-325. [PMID: 26677169 DOI: 10.1002/jcu.22322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/06/2015] [Indexed: 06/05/2023]
Abstract
Interstitial implantation in a heterotopic pregnancy is extremely rare, and despite currently available diagnostic modalities, early identification of an interstitial ectopic pregnancy remains difficult. This report describes a case of spontaneous cornual rupture at 26 weeks' gestation in a woman with diamniotic dichorionic twins that resulted in live births. The patient had previously undergone laparoscopic bilateral salpingectomy, and the pregnancy was conceived with in vitro fertilization. Interstitial implantation in a heterotopic pregnancy can go unrecognized, resulting in increased maternal and infant morbidity and mortality. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:322-325, 2016.
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Affiliation(s)
- Courtney Paradise
- Department of Obstetrics and Gynecology, Orlando Health, Orlando, FL
| | - S J Carlan
- Department of Obstetrics and Gynecology, Orlando Health, Orlando, FL
| | - Conisha Holloman
- Department of Obstetrics and Gynecology, Orlando Health, Orlando, FL
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Adams DR, Yuan H, Holyoak T, Arajs KH, Hakimi P, Markello TC, Wolfe LA, Vilboux T, Burton BK, Fajardo KF, Grahame G, Holloman C, Sincan M, Smith ACM, Wells GA, Huang Y, Vega H, Snyder JP, Golas GA, Tifft CJ, Boerkoel CF, Hanson RW, Traynelis SF, Kerr DS, Gahl WA. Three rare diseases in one Sib pair: RAI1, PCK1, GRIN2B mutations associated with Smith-Magenis Syndrome, cytosolic PEPCK deficiency and NMDA receptor glutamate insensitivity. Mol Genet Metab 2014; 113:161-70. [PMID: 24863970 PMCID: PMC4219933 DOI: 10.1016/j.ymgme.2014.04.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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: 02/28/2014] [Revised: 04/05/2014] [Accepted: 04/06/2014] [Indexed: 01/28/2023]
Abstract
The National Institutes of Health Undiagnosed Diseases Program evaluates patients for whom no diagnosis has been discovered despite a comprehensive diagnostic workup. Failure to diagnose a condition may arise from the mutation of genes previously unassociated with disease. However, we hypothesized that this could also co-occur with multiple genetic disorders. Demonstrating a complex syndrome caused by multiple disorders, we report two siblings manifesting both similar and disparate signs and symptoms. They shared a history of episodes of hypoglycemia and lactic acidosis, but had differing exam findings and developmental courses. Clinical acumen and exome sequencing combined with biochemical and functional studies identified three genetic conditions. One sibling had Smith-Magenis Syndrome and a nonsense mutation in the RAI1 gene. The second sibling had a de novo mutation in GRIN2B, which resulted in markedly reduced glutamate potency of the encoded receptor. Both siblings had a protein-destabilizing homozygous mutation in PCK1, which encodes the cytosolic isoform of phosphoenolpyruvate carboxykinase (PEPCK-C). In summary, we present the first clinically-characterized mutation of PCK1 and demonstrate that complex medical disorders can represent the co-occurrence of multiple diseases.
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Affiliation(s)
- David R Adams
- Undiagnosed Diseases Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA; Medical Genetics Branch, National Human Genome Research Institute, Bethesda, MD, USA.
| | - Hongjie Yuan
- Department of Pharmacology, Emory University School of Medicine, Rollins Research Center, Atlanta, GA, USA
| | - Todd Holyoak
- Department of Biology, University of Waterloo, Waterloo, ON, Canada
| | - Katrina H Arajs
- Department of Biology, University of Waterloo, Waterloo, ON, Canada
| | - Parvin Hakimi
- Department of Biochemistry, Case Western Reserve University, USA; Department of Pediatrics, Case Western Reserve University, USA
| | - Thomas C Markello
- Undiagnosed Diseases Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Lynne A Wolfe
- Undiagnosed Diseases Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Thierry Vilboux
- Medical Genetics Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Barbara K Burton
- Ann and Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karin Fuentes Fajardo
- Undiagnosed Diseases Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - George Grahame
- Center for Inherited Disorders of Energy Metabolism, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Conisha Holloman
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Murat Sincan
- Undiagnosed Diseases Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Ann C M Smith
- Undiagnosed Diseases Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Gordon A Wells
- Department of Chemistry, Emory University, Atlanta, GA, USA; Department of Biochemistry, University of Stellenbosch, South Africa
| | - Yan Huang
- Undiagnosed Diseases Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Hugo Vega
- Undiagnosed Diseases Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - James P Snyder
- Department of Chemistry, Emory University, Atlanta, GA, USA
| | - Gretchen A Golas
- Undiagnosed Diseases Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Cynthia J Tifft
- Undiagnosed Diseases Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Cornelius F Boerkoel
- Undiagnosed Diseases Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Richard W Hanson
- Department of Biochemistry, Case Western Reserve University, USA
| | - Stephen F Traynelis
- Department of Pharmacology, Emory University School of Medicine, Rollins Research Center, Atlanta, GA, USA
| | - Douglas S Kerr
- Department of Biochemistry, Case Western Reserve University, USA; Department of Pediatrics, Case Western Reserve University, USA; Center for Inherited Disorders of Energy Metabolism, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - William A Gahl
- Undiagnosed Diseases Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA; Medical Genetics Branch, National Human Genome Research Institute, Bethesda, MD, USA
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Pierson TM, Yuan H, Marsh ED, Fuentes-Fajardo K, Adams DR, Markello T, Golas G, Simeonov DR, Holloman C, Tankovic A, Karamchandani MM, Schreiber JM, Mullikin JC, Tifft CJ, Toro C, Boerkoel CF, Traynelis SF, Gahl WA. GRIN2A mutation and early-onset epileptic encephalopathy: personalized therapy with memantine. Ann Clin Transl Neurol 2014; 1:190-198. [PMID: 24839611 PMCID: PMC4019449 DOI: 10.1002/acn3.39] [Citation(s) in RCA: 192] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective Early-onset epileptic encephalopathies have been associated with de novo mutations of numerous ion channel genes. We employed techniques of modern translational medicine to identify a disease-causing mutation, analyze its altered behavior, and screen for therapeutic compounds to treat the proband. Methods Three modern translational medicine tools were utilized: (1) high-throughput sequencing technology to identify a novel de novo mutation; (2) in vitro expression and electrophysiology assays to confirm the variant protein's dysfunction; and (3) screening of existing drug libraries to identify potential therapeutic compounds. Results A de novo GRIN2A missense mutation (c.2434C>A; p.L812M) increased the charge transfer mediated by N-methyl-D-aspartate receptors (NMDAs) containing the mutant GluN2A-L812M subunit. In vitro analysis with NMDA receptor blockers indicated that GLuN2A-L812M-containing NMDARs retained their sensitivity to the use-dependent channel blocker memantine; while screening of a previously reported GRIN2A mutation (N615K) with these compounds produced contrasting results. Consistent with these data, adjunct memantine therapy reduced our proband's seizure burden. Interpretation This case exemplifies the potential for personalized genomics and therapeutics to be utilized for the early diagnosis and treatment of infantile-onset neurological disease.
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Affiliation(s)
- Tyler Mark Pierson
- NIH Undiagnosed Diseases Program, NIH Office of Rare Diseases Research and NHGRI, Bethesda, MD, USA ; Neurogenetics Branch, NINDS, NIH, Bethesda, MD, USA ; Department of Pediatrics and Neurology, and the Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hongjie Yuan
- Department of Pharmacology, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric D Marsh
- Division of Neurology, Children's Hospital of Philadelphia and Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Karin Fuentes-Fajardo
- NIH Undiagnosed Diseases Program, NIH Office of Rare Diseases Research and NHGRI, Bethesda, MD, USA
| | - David R Adams
- NIH Undiagnosed Diseases Program, NIH Office of Rare Diseases Research and NHGRI, Bethesda, MD, USA ; Medical Genetics Branch, NHGRI, NIH, Bethesda, MD, USA
| | - Thomas Markello
- NIH Undiagnosed Diseases Program, NIH Office of Rare Diseases Research and NHGRI, Bethesda, MD, USA ; Office of the Clinical Director, NHGRI, NIH, Bethesda, MD, USA
| | - Gretchen Golas
- NIH Undiagnosed Diseases Program, NIH Office of Rare Diseases Research and NHGRI, Bethesda, MD, USA ; Office of the Clinical Director, NHGRI, NIH, Bethesda, MD, USA
| | - Dimitre R Simeonov
- NIH Undiagnosed Diseases Program, NIH Office of Rare Diseases Research and NHGRI, Bethesda, MD, USA
| | - Conisha Holloman
- NIH Undiagnosed Diseases Program, NIH Office of Rare Diseases Research and NHGRI, Bethesda, MD, USA ; Office of the Clinical Director, NHGRI, NIH, Bethesda, MD, USA
| | - Anel Tankovic
- Department of Pharmacology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | | | - Cynthia J Tifft
- NIH Undiagnosed Diseases Program, NIH Office of Rare Diseases Research and NHGRI, Bethesda, MD, USA ; Division of Neurology, Children's Hospital of Philadelphia and Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Camilo Toro
- NIH Undiagnosed Diseases Program, NIH Office of Rare Diseases Research and NHGRI, Bethesda, MD, USA ; Division of Neurology, Children's Hospital of Philadelphia and Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Cornelius F Boerkoel
- NIH Undiagnosed Diseases Program, NIH Office of Rare Diseases Research and NHGRI, Bethesda, MD, USA ; Division of Neurology, Children's Hospital of Philadelphia and Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen F Traynelis
- Department of Pharmacology, Emory University School of Medicine, Atlanta, GA, USA
| | - William A Gahl
- NIH Undiagnosed Diseases Program, NIH Office of Rare Diseases Research and NHGRI, Bethesda, MD, USA ; Division of Neurology, Children's Hospital of Philadelphia and Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Regnier E, Harrison SK, Liu J, Schmoll JT, Edwards CA, Arancon N, Holloman C. Impact of an exotic earthworm on seed dispersal of an indigenous US weed. J Appl Ecol 2008. [DOI: 10.1111/j.1365-2664.2008.01489.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
In studying rates of occurrence and progression of lesions (or tumors), it is typically not possible to obtain exact onset times for each lesion. Instead, data consist of the number of lesions that reach a detectable size between screening examinations, along with measures of the size/severity of individual lesions at each exam time. This interval-censored data structure makes it difficult to properly adjust for the onset time distribution in assessing covariate effects on rates of lesion progression. This article proposes a joint model for the multiple lesion onset and progression process, motivated by cross-sectional data from a study of uterine leiomyoma tumors. By using a joint model, one can potentially obtain more precise inferences on rates of onset, while also performing onset time-adjusted inferences on lesion severity. Following a Bayesian approach, we propose a data augmentation Markov chain Monte Carlo algorithm for posterior computation.
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Affiliation(s)
- D B Dunson
- Biostatistics Branch, National Institute of Environmental Health Sciences, North Carolina 27709, USA.
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Schwing W, Erhard P, Holloman C, Weigel K, Blankshaen S, Anderson J, Siegel C, Seaman D, Valente J, DeOreo P, Weiss M. Thrombotic Events and Pentosidine in Hemodialysis. Hemodial Int 2004. [DOI: 10.1111/j.1492-7535.2004.0085f.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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