1
|
Stukas S, Cooper J, Higgins V, Holmes D, Adeli K, Wellington CL. Pediatric reference intervals for serum neurofilament light and glial fibrillary acidic protein using the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort. Clin Chem Lab Med 2024; 62:698-705. [PMID: 37882772 PMCID: PMC10895925 DOI: 10.1515/cclm-2023-0660] [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: 06/27/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES Blood biomarkers have the potential to transform diagnosis and prognosis for multiple neurological indications. Establishing normative data is a critical benchmark in the analytical validation process. Normative data are important in children as little is known about how brain development may impact potential biomarkers. The objective of this study is to generate pediatric reference intervals (RIs) for serum neurofilament light (NfL), an axonal marker, and glial fibrillary acidic protein (GFAP), an astrocytic marker. METHODS Serum from healthy children and adolescents aged 1 to <19 years were obtained from the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort. Serum NfL (n=300) and GFAP (n=316) were quantified using Simoa technology, and discrete RI (2.5th and 97.5th percentiles) and continuous RI (5th and 95th percentiles) were generated. RESULTS While there was no association with sex, there was a statistically significant (p<0.0001) negative association between age and serum NfL (Rho -0.400) and GFAP (Rho -0.749). Two statistically significant age partitions were generated for NfL: age 1 to <10 years (lower, upper limit; 3.13, 20.6 pg/mL) and 10 to <19 years (1.82, 7.44 pg/mL). For GFAP, three statistically significant age partitions were generated: age 1 to <3.5 years (80.4, 601 pg/mL); 3.5 to <11 years (50.7, 224 pg/mL); and 11 to <19 years (26.2, 119 pg/mL). CONCLUSIONS Taken together with the literature on adults, NfL and GFAP display U-shaped curves with high levels in infants, decreasing levels during childhood, a plateau during adolescence and early adulthood and increasing levels in seniors. These normative data are expected to inform future pediatric studies on the importance of age on neurological blood biomarkers.
Collapse
Affiliation(s)
- Sophie Stukas
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Cooper
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Victoria Higgins
- CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Holmes
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, Providence Health, Vancouver, BC, Canada
| | - Khosrow Adeli
- CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cheryl L. Wellington
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, BC, Canada
- School of Biomedical Engineering (SBME), University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
2
|
Birks P, Al-Zeer B, Holmes D, Elzayat R, Canney M, Djurdjev O, Shao TS, Zheng Y, Silver SA, Levin A. Assessing Discharge Communication and Follow-up of Acute Kidney Injury in British Columbia: A Retrospective Chart Review. Can J Kidney Health Dis 2024; 11:20543581231222064. [PMID: 38322506 PMCID: PMC10845986 DOI: 10.1177/20543581231222064] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/21/2023] [Indexed: 02/08/2024] Open
Abstract
Background and objective Acute kidney injury (AKI) affects up to 20% of hospitalizations and is associated with chronic kidney disease, cardiovascular disease, increased mortality, and increased health care costs. Proper documentation of AKI in discharge summaries is critical for optimal monitoring and treatment of these patients once discharged. Currently, there is limited literature evaluating the quality of discharge communication after AKI. This study aimed to evaluate the accuracy and quality of documentation of episodes of AKI at a tertiary care center in British Columbia, Canada. Methods design setting patients and measurements This was a retrospective chart review study of adult patients who experienced AKI during hospital admission between January 1, 2018, and December 31, 2018. Laboratory data were used to identify all admissions to the cardiac and general medicine ward complicated by AKI defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. A random sample of 300 AKI admissions stratified by AKI severity (eg, stages 1, 2, and 3) were identified for chart review. Patients were excluded if they required ongoing renal replacement therapy after admission, had a history of kidney transplant, died during their admission, or did not have a discharge summary available. Discharge summaries were reviewed for documentation of the following: presence of AKI, severity of AKI, AKI status at discharge, practitioner and laboratory follow-up plans, and medication changes. Results A total of 1076 patients with 1237 AKI admissions were identified. Of the 300 patients selected for discharge summary review, 38 met exclusion criteria. In addition, AKI was documented in 140 (53%) discharge summaries and was more likely to be documented in more severe AKI: stage 1, 38%; stage 2, 51%; and stage 3, 75%. Of those with their AKI documented, 94 (67%) documented AKI severity, and 116 (83%) mentioned the AKI status or trajectory at the time of discharge. A total of 239 (91%) of discharge summaries mentioned a follow-up plan with a practitioner, but only 23 (10%) had documented follow-up with nephrology. Patients with their AKI documented were more likely to have nephrology follow-up than those without AKI documented (17% vs 1%). Regarding laboratory investigations, 92 (35%) of the summaries had documented recommendations. In summaries that included medications typically held during AKI, only about half made specific reference to those medications being held, adjusted, or documented a post-discharge plan for that medication. For those with nonsteroidal anti-inflammatory drugs (NSAIDs) listing, 64% of discharge summaries mentioned holding, and 9% mentioned a discharge plan. For those with angiotensin converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB) listing, 38% mentioned holding these medications, and 46% mentioned a discharge plan. In summaries with diuretics listed, 35% mentioned holding, and 51% included a discharge plan. Conclusions and limitations We found suboptimal quality and completeness of discharge reporting in patients hospitalized with AKI. This may contribute to inadequate follow-up and post-hospitalization care for this patient population. Strategies are required for increasing the presence and quality of AKI reporting in discharge summaries. Limitations include our definition of AKI based on lab criteria, which may have missed some of the injuries that met the criteria based on urine output. Another limitation is that our definition of AKI based on the highest and lowest creatinine during admission may have led to some overclassification. In addition, without outpatient laboratories, it is possible that we have not captured the true baseline creatinine in some patients.
Collapse
Affiliation(s)
- Peter Birks
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Bader Al-Zeer
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Daniel Holmes
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, Canada
| | - Rami Elzayat
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Mark Canney
- Department of Medicine, University of Ottawa, Ontario, Canada
| | | | | | | | - Samuel A. Silver
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Adeera Levin
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
- BC Renal, Vancouver, Canada
| |
Collapse
|
3
|
Salamh PA, Hanney WJ, Boles T, Holmes D, McMillan A, Wagner A, Kolber MJ. Is it Time to Normalize Scapular Dyskinesis? The Incidence of Scapular Dyskinesis in Those With and Without Symptoms: a Systematic Review of the Literature. Int J Sports Phys Ther 2023; V18:558-576. [PMID: 37425102 PMCID: PMC10324350 DOI: 10.26603/001c.74388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background Up to 67% of adults experience shoulder pain in their lifetime. Numerous factors are related to the etiology of shoulder pain, one of which is thought to be scapular dyskinesis (SD). Given the prevalence of SD among the asymptomatic population a concern is that the condition is being medicalized (clinical findings suggested to require treatment but is ultimately a normal finding). Therefore, the purpose of this systematic review was to investigate the prevalence of SD among both symptomatic and asymptomatic populations. Methods A systematic review of the literature up to July of 2021. Relevant studies identified from PubMed, EMBASE, Cochrane and CINAHL were screened utilizing the following inclusion and exclusion criteria; inclusion: (a) individuals being assessed as having SD, including reliability and validity studies (b) subjects aged 18 or older; (c) sport and non-sport participants; (d) no date restriction; (e) symptomatic, asymptomatic, or both populations; (f) all study designs except case reports. Studies were excluded if: (a) they were not published in the English language; (b) they were a case report design; (c) the presence of SD was part of the studies inclusion criteria; (d) data were not present distinguishing the number of subjects with or without SD; (e) they did not define participants as having or not having SD. Methodological quality of the studies was assessed utilizing the Joanna Briggs Institute checklist. Results The search resulted in 11,619 after duplicates were removed with 34 studies ultimately retained for analysis after three were removed due to low quality. A total of 2,365 individuals were studied. Within the studies for the symptomatic athletic and general orthopedic population there were 81% and 57% individuals with SD, respectively, and a total of 60% among both symptomatic groups (sport and general orthopedic population). Within the studies for the asymptomatic athletic and general population there were 42% and 59% individuals with SD, respectively, and a total of 48% among both asymptomatic groups (sport and general orthopedic population). Limitation A strict inclusion and exclusion criteria was used to identify studies that provided the appropriate data for the purpose of this study. There was a lack of consistency for measuring SD across studies. Conclusion A considerable number of individuals with shoulder symptoms do not present with SD. More revealing is the number of asymptomatic individuals who do present with SD, suggesting that SD may be a normal finding among nearly half of the asymptomatic population. Level of Evidence 2a.
Collapse
|
4
|
Zhang Y, Ghosh U, Xie L, Holmes D, Severin KG, Weliky DP. Lipid acyl chain protrusion induced by the influenza virus hemagglutinin fusion peptide detected by NMR paramagnetic relaxation enhancement. Biophys Chem 2023; 299:107028. [PMID: 37247572 DOI: 10.1016/j.bpc.2023.107028] [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: 12/13/2022] [Revised: 04/29/2023] [Accepted: 04/29/2023] [Indexed: 05/31/2023]
Abstract
The glycoprotein spikes of membrane-enveloped viruses include a subunit that catalyzes fusion (joining) of the viral and target cell membranes. For influenza virus, this is subunit 2 of hemagglutinin which has a ∼ 20-residue N-terminal fusion peptide (Fp) region that binds target membrane. An outstanding question is whether there are associated membrane changes important for fusion. Several computational studies have found increased "protrusion" of lipid acyl chains near Fp, i.e. one or more chain carbons are closer to the aqueous region than the headgroup phosphorus. Protrusion may accelerate initial joining of outer leaflets of the two membranes into a stalk intermediate. In this study, higher protrusion probability in membrane with vs. without Fp is convincingly detected by larger Mn2+-associated increases in chain 13C NMR transverse relaxation rates (Γ2's). Data analysis provides a ratio Γ2,neighbor/Γ2,distant for lipids neighboring vs. more distant from the Fp. The calculated ratio depends on the number of Fp-neighboring lipids and the experimentally-derived range of 4 to 24 matches the range of increased protrusion probabilities from different simulations. For samples either with or without Fp, the Γ2 values are well-fitted by an exponential decay as the 13C site moves closer to the chain terminus. The decays correlate with free-energy of protrusion proportional to the number of protruded -CH2 groups, with free energy per -CH2 of ∼0.25 kBT. The NMR data support one major fusion role of the Fp to be much greater protrusion of lipid chains, with highest protrusion probability for chain regions closest to the headgroups.
Collapse
Affiliation(s)
- Yijin Zhang
- Department of Chemistry, Michigan State University, East Lansing, MI 48824, USA
| | - Ujjayini Ghosh
- Department of Chemistry, Michigan State University, East Lansing, MI 48824, USA
| | - Li Xie
- Department of Chemistry, Michigan State University, East Lansing, MI 48824, USA
| | - Daniel Holmes
- Department of Chemistry, Michigan State University, East Lansing, MI 48824, USA
| | - Kathryn G Severin
- Department of Chemistry, Michigan State University, East Lansing, MI 48824, USA
| | - David P Weliky
- Department of Chemistry, Michigan State University, East Lansing, MI 48824, USA.
| |
Collapse
|
5
|
Jena R, Benner F, Delano F, Holmes D, McCracken J, Demir S, Odom AL. A rare isocyanide derived from an unprecedented neutral yttrium(ii) bis(amide) complex. Chem Sci 2023; 14:4257-4264. [PMID: 37123180 PMCID: PMC10132164 DOI: 10.1039/d3sc00171g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/11/2023] [Indexed: 05/02/2023] Open
Abstract
A room temperature stable complex formulated as Y(NHAr*)2 has been prepared, where Ar* = 2,6-(2,4,6-(iPr)3C6H2)C6H3, by KC8 reduction of ClY(NHAr*)2. Based on EPR evidence, Y(NHAr*)2 is an example of a d1 Y(ii) complex with significant delocalization of the unpaired electron density from the metal to the ligand. The isolation of molecular divalent metal complexes is challenging for rare earth elements such as yttrium. In fact, stabilization of the divalent state requires judicious ligand design that allows the metal center to be coordinatively saturated. Divalent rare earth elements tend to be reactive towards various substrates. Interestingly, Y(NHAr*)2 reacts as a radical donor towards t BuNC to generate an unusual yttrium isocyanide complex, CNY(NHAr*)2, based on spectroscopic evidence and single-crystal X-ray diffraction data.
Collapse
Affiliation(s)
- Rashmi Jena
- Michigan State University, Department of Chemistry 578 S. Shaw Ln East Lansing MI USA 48824
| | - Florian Benner
- Michigan State University, Department of Chemistry 578 S. Shaw Ln East Lansing MI USA 48824
| | - Francis Delano
- Michigan State University, Department of Chemistry 578 S. Shaw Ln East Lansing MI USA 48824
| | - Daniel Holmes
- Michigan State University, Department of Chemistry 578 S. Shaw Ln East Lansing MI USA 48824
| | - John McCracken
- Michigan State University, Department of Chemistry 578 S. Shaw Ln East Lansing MI USA 48824
| | - Selvan Demir
- Michigan State University, Department of Chemistry 578 S. Shaw Ln East Lansing MI USA 48824
| | - Aaron L Odom
- Michigan State University, Department of Chemistry 578 S. Shaw Ln East Lansing MI USA 48824
| |
Collapse
|
6
|
Loh MM, Yaxley N, Moore G, Holmes D, Todd S, Smith A, Macdonald E, Semple S, Cherrie M, Patel M, Hamill R, Leckie A, Dancer SJ, Cherrie JW. Measurement of SARS-CoV-2 in air and on surfaces in Scottish hospitals. J Hosp Infect 2023; 133:1-7. [PMID: 36473553 PMCID: PMC9721166 DOI: 10.1016/j.jhin.2022.11.019] [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: 09/04/2022] [Revised: 11/27/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are still uncertainties in our knowledge of the amount of SARS-CoV-2 virus present in the environment - where it can be found, and potential exposure determinants - limiting our ability to effectively model and compare interventions for risk management. AIM This study measured SARS-CoV-2 in three hospitals in Scotland on surfaces and in air, alongside ventilation and patient care activities. METHODS Air sampling at 200 L/min for 20 min and surface sampling were performed in two wards designated to treat COVID-19-positive patients and two non-COVID-19 wards across three hospitals in November and December 2020. FINDINGS Detectable samples of SARS-CoV-2 were found in COVID-19 treatment wards but not in non-COVID-19 wards. Most samples were below assay detection limits, but maximum concentrations reached 1.7×103 genomic copies/m3 in air and 1.9×104 copies per surface swab (3.2×102 copies/cm2 for surface loading). The estimated geometric mean air concentration (geometric standard deviation) across all hospitals was 0.41 (71) genomic copies/m3 and the corresponding values for surface contamination were 2.9 (29) copies/swab. SARS-CoV-2 RNA was found in non-patient areas (patient/visitor waiting rooms and personal protective equipment changing areas) associated with COVID-19 treatment wards. CONCLUSION Non-patient areas of the hospital may pose risks for infection transmission and further attention should be paid to these areas. Standardization of sampling methods will improve understanding of levels of environmental contamination. The pandemic has demonstrated a need to review and act upon the challenges of older hospital buildings meeting current ventilation guidance.
Collapse
Affiliation(s)
- M M Loh
- Institute of Occupational Medicine, Edinburgh, UK.
| | - N Yaxley
- UK Health Security Agency, Porton Down, UK
| | - G Moore
- UK Health Security Agency, Porton Down, UK
| | - D Holmes
- Institute of Occupational Medicine, Edinburgh, UK
| | - S Todd
- Institute of Occupational Medicine, Edinburgh, UK
| | - A Smith
- Institute of Occupational Medicine, Edinburgh, UK
| | | | - S Semple
- Institute for Social Marketing & Health, University of Stirling, Stirling, UK
| | - M Cherrie
- Institute of Occupational Medicine, Edinburgh, UK
| | | | | | | | - S J Dancer
- NHS Lanarkshire, UK; Edinburgh Napier University, UK
| | - J W Cherrie
- Institute of Occupational Medicine, Edinburgh, UK; Heriot Watt University, Edinburgh, UK
| |
Collapse
|
7
|
Cooper JG, Stukas SK, Ghodsi M, Ahmed N, Holmes D, Wellington CL. Reference Intervals for Plasma Biomarkers of Alzheimer’s Disease. Alzheimers Dement 2022. [DOI: 10.1002/alz.064762] [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: 12/24/2022]
Affiliation(s)
| | | | | | - Nyra Ahmed
- University of British Columbia Vancouver BC Canada
| | | | | |
Collapse
|
8
|
Brockman MA, Mwimanzi F, Lapointe HR, Sang Y, Agafitei O, Cheung PK, Ennis S, Ng K, Basra S, Lim LY, Yaseen F, Young L, Umviligihozo G, Omondi FH, Kalikawe R, Burns L, Brumme CJ, Leung V, Montaner JSG, Holmes D, DeMarco ML, Simons J, Pantophlet R, Niikura M, Romney MG, Brumme ZL. Reduced Magnitude and Durability of Humoral Immune Responses to COVID-19 mRNA Vaccines Among Older Adults. J Infect Dis 2022; 225:1129-1140. [PMID: 34888688 PMCID: PMC8689804 DOI: 10.1093/infdis/jiab592] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The magnitude and durability of immune responses to coronavirus disease 2019 (COVID-19) mRNA vaccines remain incompletely characterized in the elderly. METHODS Anti-spike receptor-binding domain (RBD) antibodies, angiotensin-converting enzyme 2 (ACE2) competition, and virus neutralizing activities were assessed in plasma from 151 health care workers and older adults (range, 24-98 years of age) 1 month following the first vaccine dose, and 1 and 3 months following the second dose. RESULTS Older adults exhibited significantly weaker responses than younger health care workers for all humoral measures evaluated and at all time points tested, except for ACE2 competition activity after 1 vaccine dose. Moreover, older age remained independently associated with weaker responses even after correction for sociodemographic factors, chronic health condition burden, and vaccine-related variables. By 3 months after the second dose, all humoral responses had declined significantly in all participants, and remained significantly lower among older adults, who also displayed reduced binding antibodies and ACE2 competition activity towards the Delta variant. CONCLUSIONS Humoral responses to COVID-19 mRNA vaccines are significantly weaker in older adults, and antibody-mediated activities in plasma decline universally over time. Older adults may thus remain at elevated risk of infection despite vaccination.
Collapse
Affiliation(s)
- Mark A Brockman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Francis Mwimanzi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Hope R Lapointe
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Yurou Sang
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Olga Agafitei
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Peter K Cheung
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Siobhan Ennis
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Kurtis Ng
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Simran Basra
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, Canada
- Department of Chemistry, Simon Fraser University, Burnaby, Canada
| | - Li Yi Lim
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, Canada
| | - Fatima Yaseen
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, Canada
| | - Landon Young
- Division of Medical Microbiology and Virology, St Paul’s Hospital, Vancouver, Canada
| | | | - F Harrison Omondi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Rebecca Kalikawe
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Laura Burns
- Division of Medical Microbiology and Virology, St Paul’s Hospital, Vancouver, Canada
| | - Chanson J Brumme
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Victor Leung
- Division of Medical Microbiology and Virology, St Paul’s Hospital, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Daniel Holmes
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, Canada
| | - Mari L DeMarco
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, Canada
| | - Janet Simons
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, Canada
| | - Ralph Pantophlet
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, Canada
| | - Masahiro Niikura
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Marc G Romney
- Division of Medical Microbiology and Virology, St Paul’s Hospital, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Zabrina L Brumme
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| |
Collapse
|
9
|
Lapointe HR, Mwimanzi F, Cheung PK, Sang Y, Yaseen F, Umviligihozo G, Kalikawe R, Speckmaier S, Moran-Garcia N, Datwani S, Duncan MC, Agafitei O, Ennis S, Young L, Ali H, Ganase B, Omondi FH, Dong W, Toy J, Sereda P, Burns L, Costiniuk CT, Cooper C, Anis AH, Leung V, Holmes D, DeMarco ML, Simons J, Hedgcock M, Prystajecky N, Lowe CF, Pantophlet R, Romney MG, Barrios R, Guillemi S, Brumme CJ, Montaner JSG, Hull M, Harris M, Niikura M, Brockman MA, Brumme ZL. People with HIV receiving suppressive antiretroviral therapy show typical antibody durability after dual COVID-19 vaccination, and strong third dose responses. medRxiv 2022. [PMID: 35350205 PMCID: PMC8963693 DOI: 10.1101/2022.03.22.22272793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Longer-term humoral responses to two-dose COVID-19 vaccines remain incompletely characterized in people living with HIV (PLWH), as do initial responses to a third dose. Methods: We measured antibodies against the SARS-CoV-2 spike protein receptor-binding domain, ACE2 displacement and viral neutralization against wild-type and Omicron strains up to six months following two-dose vaccination, and one month following the third dose, in 99 PLWH receiving suppressive antiretroviral therapy, and 152 controls. Results: Though humoral responses naturally decline following two-dose vaccination, we found no evidence of lower antibody concentrations nor faster rates of antibody decline in PLWH compared to controls after accounting for sociodemographic, health and vaccine-related factors. We also found no evidence of poorer viral neutralization in PLWH after two doses, nor evidence that a low nadir CD4+ T-cell count compromised responses. Post-third-dose humoral responses substantially exceeded post-second-dose levels, though anti-Omicron responses were consistently weaker than against wild-type. Nevertheless, post-third-dose responses in PLWH were comparable to or higher than controls. An mRNA-1273 third dose was the strongest consistent correlate of higher post-third-dose responses. Conclusion: PLWH receiving suppressive antiretroviral therapy mount strong antibody responses after two- and three-dose COVID-19 vaccination. Results underscore the immune benefits of third doses in light of Omicron.
Collapse
Affiliation(s)
- Hope R Lapointe
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Francis Mwimanzi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Peter K Cheung
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Yurou Sang
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Fatima Yaseen
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, Canada
| | | | - Rebecca Kalikawe
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Sarah Speckmaier
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Sneha Datwani
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Maggie C Duncan
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Olga Agafitei
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Siobhan Ennis
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Landon Young
- Division of Medical Microbiology and Virology, St. Paul's Hospital, Vancouver, Canada
| | - Hesham Ali
- John Ruedy Clinic, St, Paul's Hospital, Vancouver, Canada
| | - Bruce Ganase
- AIDS Research Program, St. Paul's Hospital, Vancouver, Canada
| | - F Harrison Omondi
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Winnie Dong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Junine Toy
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Paul Sereda
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Laura Burns
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, Canada
| | - Cecilia T Costiniuk
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Curtis Cooper
- Department of Medicine, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
| | - Aslam H Anis
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,CIHR Canadian HIV Trials Network, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | - Victor Leung
- Division of Medical Microbiology and Virology, St. Paul's Hospital, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Daniel Holmes
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Mari L DeMarco
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Janet Simons
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | | | - Natalie Prystajecky
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, Canada
| | - Christopher F Lowe
- Division of Medical Microbiology and Virology, St. Paul's Hospital, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Ralph Pantophlet
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, Canada
| | - Marc G Romney
- Division of Medical Microbiology and Virology, St. Paul's Hospital, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Silvia Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Family Practice, Faculty of Medicine, University of British Columbia, Canada
| | - Chanson J Brumme
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Marianne Harris
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Family Practice, Faculty of Medicine, University of British Columbia, Canada
| | - Masahiro Niikura
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Mark A Brockman
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, Canada
| | - Zabrina L Brumme
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| |
Collapse
|
10
|
Pickard C, Fortin J, Holmes D, Buchweitz J, Lehner A. A novel chemical marker of tremorgenic mycotoxicosis detected by gas-chromatography/mass-spectrometry. WORLD MYCOTOXIN J 2021. [DOI: 10.3920/wmj2020.2633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Tremorgenic mycotoxicosis can arise from dietary exposure to secondary metabolite products of various fungal species, particularly those from the Penicillium genus. Although general toxin screens often rely on gas chromatography-mass spectrometry (GC/MS) and well-developed mass spectral library databases, two principal representative Penicillium mycotoxins, roquefortine and penitrem A, are unamenable to GC/MS owing to high molecular weights, low volatilities and/or high thermal instabilities. Reliance on GC/MS screens alone could therefore inadvertently result in failure to collect evidence of exposure to such tremorgenic mycotoxins. In this report we describe a newly discovered tremorgenic marker compound (TMC), the presence of which correlates highly with conclusive exposure to Penicillium toxins in explanation of clinical manifestations of tremorgenic mycotoxicosis. According to detailed mass spectral deconvolution, the compound is 210.0892 molecular weight, and amenable to GC/MS whether chemically underivatized or derivatized by methylation or trimethylsilylation. 1D and 2D NMR (nuclear magnetic resonance) studies on the isolated compound determined the TMC to be the Penicillium product terrestric acid, C11H14O4, which matches the molecular formula determined by high resolution mass spectrometry and thus provides an excellent target for assessment of mycotoxicosis by GC/MS.
Collapse
Affiliation(s)
- C. Pickard
- Synlab VPG, Unit 8 Temple Point, Bullerthorpe Lane, Leeds, LS15 9JL, United Kingdom
| | - J.S. Fortin
- Michigan State University College of Veterinary Medicine, Department of Pathobiology & Diagnostic Investigation, Michigan State University, Lansing, MI 48910, USA
| | - D. Holmes
- Michigan State University, Max T. Rogers NMR Facility, Department of Chemistry, Lansing, MI 48824, USA
| | - J.P. Buchweitz
- Michigan State University College of Veterinary Medicine, Department of Pathobiology & Diagnostic Investigation, Michigan State University, Lansing, MI 48910, USA
- Michigan State University Veterinary Diagnostic Laboratory, Toxicology Section, Michigan State University, Lansing, MI 48910; USA
| | - A.F. Lehner
- Michigan State University Veterinary Diagnostic Laboratory, Toxicology Section, Michigan State University, Lansing, MI 48910; USA
| |
Collapse
|
11
|
Brumme ZL, Mwimanzi F, Lapointe HR, Cheung P, Sang Y, Duncan MC, Yaseen F, Agafitei O, Ennis S, Ng K, Basra S, Lim LY, Kalikawe R, Speckmaier S, Moran-Garcia N, Young L, Ali H, Ganase B, Umviligihozo G, Omondi FH, Atkinson K, Sudderuddin H, Toy J, Sereda P, Burns L, Costiniuk CT, Cooper C, Anis AH, Leung V, Holmes D, DeMarco ML, Simons J, Hedgcock M, Romney MG, Barrios R, Guillemi S, Brumme CJ, Pantophlet R, Montaner JS, Niikura M, Harris M, Hull M, Brockman MA. Humoral immune responses to COVID-19 vaccination in people living with HIV receiving suppressive antiretroviral therapy. medRxiv 2021:2021.10.03.21264320. [PMID: 34671779 PMCID: PMC8528088 DOI: 10.1101/2021.10.03.21264320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Humoral responses to COVID-19 vaccines in people living with HIV (PLWH) remain incompletely understood. We measured circulating antibodies against the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein, ACE2 displacement and live viral neutralization activities one month following the first and second COVID-19 vaccine doses in 100 adult PLWH and 152 controls. All PLWH were receiving suppressive antiretroviral therapy, with median CD4+ T-cell counts of 710 (IQR 525-935) cells/mm 3 . Nadir CD4+ T-cell counts ranged as low as <10 (median 280; IQR 120-490) cells/mm 3 . After adjustment for sociodemographic, health and vaccine-related variables, HIV infection was significantly associated with 0.2 log 10 lower anti-RBD antibody concentrations (p=0.03) and ∼11% lower ACE2 displacement activity (p=0.02), but not lower viral neutralization (p=0.1) after one vaccine dose. Following two doses however, HIV was no longer significantly associated with the magnitude of any response measured. Rather, older age, a higher burden of chronic health conditions, and having received two ChAdOx1 doses (versus a heterologous or dual mRNA vaccine regimen) were independently associated with lower responses. After two vaccine doses, no significant correlation was observed between the most recent or nadir CD4+ T-cell counts and vaccine responses in PLWH. These results suggest that PLWH with well-controlled viral loads on antiretroviral therapy and CD4+ T-cell counts in a healthy range will generally not require a third COVID-19 vaccine dose as part of their initial immunization series, though other factors such as older age, co-morbidities, vaccine regimen type, and durability of vaccine responses will influence when this group may benefit from additional doses. Further studies of PLWH who are not receiving antiretroviral treatment and/or who have low CD4+ T-cell counts are needed.
Collapse
Affiliation(s)
- Zabrina L. Brumme
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Francis Mwimanzi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Hope R. Lapointe
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Peter Cheung
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Yurou Sang
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Maggie C. Duncan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Fatima Yaseen
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, Canada
| | - Olga Agafitei
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Siobhan Ennis
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Kurtis Ng
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Simran Basra
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, Canada
- Department of Chemistry, Simon Fraser University, Burnaby, Canada
| | - Li Yi Lim
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, Canada
| | - Rebecca Kalikawe
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Sarah Speckmaier
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Landon Young
- Division of Medical Microbiology and Virology, St. Paul’s Hospital, Vancouver, Canada
| | - Hesham Ali
- John Ruedy Clinic, St, Paul’s Hospital, Vancouver, Canada
| | - Bruce Ganase
- AIDS Research Program, St. Paul’s Hospital, Vancouver, Canada
| | | | - F. Harrison Omondi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kieran Atkinson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Hanwei Sudderuddin
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Junine Toy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Laura Burns
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, Canada
| | - Cecilia T. Costiniuk
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Curtis Cooper
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canadas
| | - Aslam H. Anis
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- CIHR Canadian HIV Trials Network, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | - Victor Leung
- Division of Medical Microbiology and Virology, St. Paul’s Hospital, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Daniel Holmes
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Mari L. DeMarco
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Janet Simons
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | | | - Marc G. Romney
- Division of Medical Microbiology and Virology, St. Paul’s Hospital, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Silvia Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Canada
| | - Chanson J. Brumme
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Ralph Pantophlet
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, Canada
| | - Julio S.G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Masahiro Niikura
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Marianne Harris
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Canada
| | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Mark A. Brockman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, Canada
| |
Collapse
|
12
|
Brockman MA, Mwimanzi F, Sang Y, Ng K, Agafitei O, Ennis S, Lapointe H, Young L, Umviligihozo G, Burns L, Brumme C, Leung V, Montaner JS, Holmes D, DeMarco M, Simons J, Niikura M, Pantophlet R, Romney MG, Brumme ZL. Weak humoral immune reactivity among residents of long-term care facilities following one dose of the BNT162b2 mRNA COVID-19 vaccine. medRxiv 2021:2021.03.17.21253773. [PMID: 33791737 PMCID: PMC8010769 DOI: 10.1101/2021.03.17.21253773] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Several Canadian provinces are extending the interval between COVID-19 vaccine doses to increase population vaccine coverage more rapidly. However, immunogenicity of these vaccines after one dose is incompletely characterized, particularly among the elderly, who are at greatest risk of severe COVID-19. Methods We assessed SARS-CoV-2 humoral responses pre-vaccine and one month following the first dose of BNT162b2 mRNA vaccine, in 12 COVID-19 seronegative residents of long-term care facilities (median age, 82 years), 18 seronegative healthcare workers (HCW; median age, 36 years) and 4 convalescent HCW. Total antibody responses to SARS-CoV-2 nucleocapsid (N) and spike protein receptor binding domain (S/RBD) were assessed using commercial immunoassays. We quantified IgG and IgM responses to S/RBD and determined the ability of antibodies to block S/RBD binding to ACE2 receptor using ELISA. Neutralizing antibody activity was also assessed using pseudovirus and live SARS-CoV-2. Results After one vaccine dose, binding antibodies against S/RBD were ~4-fold lower in residents compared to HCW (p<0.001). Inhibition of ACE2 binding was 3-fold lower in residents compared to HCW (p=0.01) and pseudovirus neutralizing activity was 2-fold lower (p=0.003). While six (33%) seronegative HCW neutralized live SARS-CoV-2, only one (8%) resident did (p=0.19). In contrast, convalescent HCW displayed 7- to 20-fold higher levels of binding antibodies and substantial ability to neutralize live virus after one dose. Interpretation Extending the interval between COVID-19 vaccine doses may pose a risk to the elderly due to lower vaccine immunogenicity in this group. We recommend that second doses not be delayed in elderly individuals.
Collapse
Affiliation(s)
- Mark A. Brockman
- Faculty of Health Sciences, Simon Fraser University, Burnaby BC, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver BC, Canada
| | - Francis Mwimanzi
- Faculty of Health Sciences, Simon Fraser University, Burnaby BC, Canada
| | - Yurou Sang
- Faculty of Health Sciences, Simon Fraser University, Burnaby BC, Canada
| | - Kurtis Ng
- Faculty of Health Sciences, Simon Fraser University, Burnaby BC, Canada
| | - Olga Agafitei
- Faculty of Health Sciences, Simon Fraser University, Burnaby BC, Canada
| | - Siobhan Ennis
- Faculty of Health Sciences, Simon Fraser University, Burnaby BC, Canada
| | - Hope Lapointe
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver BC, Canada
| | - Landon Young
- Division of Medical Microbiology and Virology, St. Paul’s Hospital, Vancouver BC, Canada
| | | | - Laura Burns
- Department of Pathology and Laboratory Medicine, St. Paul’s Hospital, Vancouver BC, Canada
| | - Chanson Brumme
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver BC, Canada
- Department of Medicine, University of British Columbia, Vancouver BC, Canada
| | - Victor Leung
- Division of Medical Microbiology and Virology, St. Paul’s Hospital, Vancouver BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada
| | - Julio S.G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver BC, Canada
- Department of Pathology and Laboratory Medicine, St. Paul’s Hospital, Vancouver BC, Canada
| | - Daniel Holmes
- Department of Pathology and Laboratory Medicine, St. Paul’s Hospital, Vancouver BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada
| | - Mari DeMarco
- Department of Pathology and Laboratory Medicine, St. Paul’s Hospital, Vancouver BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada
| | - Janet Simons
- Department of Pathology and Laboratory Medicine, St. Paul’s Hospital, Vancouver BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada
| | - Masa Niikura
- Faculty of Health Sciences, Simon Fraser University, Burnaby BC, Canada
| | - Ralph Pantophlet
- Faculty of Health Sciences, Simon Fraser University, Burnaby BC, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby BC, Canada
| | - Marc G. Romney
- Division of Medical Microbiology and Virology, St. Paul’s Hospital, Vancouver BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada
| | - Zabrina L. Brumme
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver BC, Canada
| |
Collapse
|
13
|
Hara H, Takahashi K, Klaveren D, Ono M, Kawashima H, Kappetein P, Mohr F, Mack M, Holmes D, Morice M, Davierwala P, Head S, Thuijs D, Onuma Y, Serruys P. Ten-year all-cause death after percutaneous or surgical revascularization for men and women with multivessel or left main coronary artery disease: insights from the SYNTAX extended survival study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In patients with complex coronary artery disease (CAD), women favored coronary artery bypass grafting surgery (CABG) compared to percutaneous coronary intervention (PCI) at 5 years in the SYNTAX trial, whereas mortality rates after PCI and CABG were not different in men. On the other hand, poor outcomes of women undergoing PCI were not observed in the PRECOMBAT and BEST trials.
The long-term optimal revascularization strategy according to gender has not been fully evaluated.
Purpose
In the SYNTAX Extended Survival (SYNTAXES) study, no significant difference existed in all-cause death between PCI and CABG at 10 years. This study aimed to assess treatment effect of PCI and CABG for 10-year all-cause death according to gender.
Methods
The SYNTAXES study evaluated vital status up to 10 years in 1,800 patients with de novo three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to treatment with CABG or PCI in the SYNTAX trial, and the pre-specified primary endpoint was all-cause death at 10 years. In this prespecified analysis, all-cause death at 10 years according to gender in patients undergoing PCI or CABG was evaluated.
Results
Of 1800 patients, 402 (22.3%) were women and 1398 (77.7%) were men. In women, the rate of mortality was significantly higher in the PCI arm at 5 years than in the CABG arm (19.3% vs. 10.3%; Log-rank p=0.010, Figure A), but the rates of mortality were not different at 10 years between the PCI and CABG arms (33.0% vs. 32.5%; Log-rank p=0.600, Figure A). In men, the mortality rate tended to be higher in the PCI arm at 10 years than in the CABG arm (27.0% vs. 22.5%; Log-rank p=0.082, Figure B), although the mortality rates were not different at 5 years between the PCI and CABG arms (12.4% vs. 12.3%; Log-rank p=0.957, Figure B).
Conclusion
The efficacy of CABG observed at 5 years disappeared at 10 years in women, whereas the efficacy of CABG became apparent after 5 years in men.
Figure 1
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Erasmus University Medical Centre, Rotterdam, Netherlands, reference: MEC-2016-716
Collapse
Affiliation(s)
- H Hara
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - K Takahashi
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - D Klaveren
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - M Ono
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - H Kawashima
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - P Kappetein
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - F Mohr
- Heart Center of Leipzig, Leipzig, Germany
| | - M Mack
- Baylor University Medical Center, Dallas, United States of America
| | - D Holmes
- Mayo Clinic, Rochester, United States of America
| | - M Morice
- Jacques Cartier Private Hospital, Massy, France
| | | | - S Head
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - D Thuijs
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - Y Onuma
- National University of Ireland, Galway, Ireland
| | - P Serruys
- National University of Ireland, Galway, Ireland
| |
Collapse
|
14
|
Gao C, Wang R, Takahashi K, Kawashima H, Van Geuns R, Onuma Y, Morice M, Davierwala P, Holmes D, Mack M, Mohr F, Kappetein A, Head S, Thuijs D, Serruys P. Treatment of complex coronary artery disease in patients with diabetes mellitus and chronic kidney disease: 10-year results comparing outcomes of CABG and PCI in the SYNTAXES trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension of follow-up of the SYNTAX trial, which was a non-inferiority trial that compared percutaneous coronary intervention (PCI) using first-generation paclitaxel-eluting stents with coronary artery bypass grafting (CABG) in patients with de-novo three-vessel and left main coronary artery disease. The SYNTAXES study is the first randomized trial that reported the complete 10-year data on all-cause death in patients with complex coronary artery disease.
Purpose
Patients with coronary artery disease (CAD) and concomitant diabetes mellitus (DM) or chronic kidney disease (CKD) are more susceptible to major adverse cardiovascular and cerebrovascular events. However, to date, the long-term prognosis and which revascularization strategy was associated with better clinical outcomes for patients with complex coronary artery disease and concomitant with DM and CKD have not been documented.
Methods
In this sub-analysis of the SYNTAXES trial, a total of 1,638 patients were classified into four subgroups according to the DM and CKD status: DM−/CKD− (n=999, 60.1%), DM+/CKD− (n=323, 19.7%), DM−/CKD+ (n=231, 14.1%), and DM+/CKD+ (n=85, 5.2%). The treatment effects of PCI and CABG were analyzed in each subgroup. The primary endpoint was all-cause death at 10 years.
Results
Compared with the DM−/CKD− patients, patients with DM+/CKD+ were older, more often had a history of stroke, hypertension, heart failure, and were more frequently presented with total occlusion, bifurcation lesion and three-vessel disease. At 10 years, patients with DM+/CKD+ had a 3.94-fold higher incidence of all-cause mortality compared with DM−/CKD− individuals (54.1% versus 18.9%, 95% CI [2.85–5.44]). Patients with DM−/CKD+ (38.1%, HR 2.36; 95% CI [1.83–5.44]) or DM+/CKD− (28.2%, HR 1.61; 95% CI [1.26–2.07]) had intermediate risk profile. For DM+/CKD+ patients, compared with PCI, those who underwent CABG were associated with lower incidence of all-cause mortality (64.3% versus 44.2%, adjusted HR 0.52; 95% CI [0.27–0.99], p=0.047, pinteraction=0.443). The number of needed-to-treat to reduce mortality for CABG was 12.
Conclusion
In the SYNTAX population, patients with DM and CKD are at markedly increased risk of long-term mortality rate compared with patients one or neither of these risk factors. For patients with both comorbidities, CABG was associated with better clinical outcome compared with PCI. These findings should be interpreted as hypothesis-generating.
Figure 1. Kaplan-Meier curves showing the clinical events according to treatment and DM/CKD status.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Boston Scientific Corporation
Collapse
Affiliation(s)
- C Gao
- Xijing Hospital of the Fourth Military Medical University, Xi'an, China
| | - R.T Wang
- Xijing Hospital of the Fourth Military Medical University, Xi'an, China
| | | | - H Kawashima
- National University of Ireland, Galway, Ireland
| | - R.J Van Geuns
- University Medical Center St Radboud (UMCN), Nijmegen, Netherlands (The)
| | - Y Onuma
- National University of Ireland, Galway, Ireland
| | - M.C Morice
- ICPS Ramsay-Generale de Sante, Massy, France
| | | | - D Holmes
- Mayo Clinic, Rochester, United States of America
| | - M Mack
- Baylor Scott & White Health, Dallas, United States of America
| | - F Mohr
- Heart Center of Leipzig, Leipzig, Germany
| | - A Kappetein
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - S Head
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - D Thuijs
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - P.W Serruys
- National University of Ireland, Galway, Ireland
| |
Collapse
|
15
|
Hara H, Takahashi K, Ono M, Gao C, Wang R, Kappetein P, Mohr F, Mack M, Holmes D, Morice M, Davierwala P, Head S, Thuijs D, Onuma Y, Serruys P. Impact of periprocedural myocardial infarction on 10-year mortality after percutaneous coronary intervention or coronary artery bypass grafting for multivessel or left main coronary artery disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Periprocedural myocardial infarction (PMI) occurs frequently after both percutaneous coronary intervention (PCI) and bypass grafting surgery (CABG) in patients with complex coronary artery disease (CAD), and PMI has been shown to have a detrimental impact on mortality. On the other hand, long-term impact of PMI on mortality has not been fully evaluated.
Purpose
This study aimed to assess the impact of PMI according to SCAI definition on 10-year all-cause death in patients with complex CAD.
Methods
The SYNTAX Extended Survival (SYNTAXES) study evaluated vital status up to 10 years in 1800 patients with de novo three-vessel disease and/or left main coronary artery disease randomized to treatment with CABG or PCI in the SYNTAX trial. Blood was sampled for creatine kinase (CK) pre- and post-revascularisation, and the cardiac specific MB iso-enzyme (CK-MB) was determined only if the CK ratio ≥2 x the upper limit of normal (ULN). If the CK ratio <2 ULN, CK-MB assessment was not mandated. In this analysis, patients with at least one blood sampling within 48 hours of the procedure were included. PMI was defined as follows; peak CK-MB measured within 48 hours of the procedure ≥10 x ULN, or ≥5 x ULN with new Q-waves in 2 contiguous leads or new persistent left bundle branch block.
Results
Of 1800 patients, 1679 (93.2%) patients were included. Of 877 patients treated with PCI, PMI occurred in 26 patients (3.0%), whereas 14 (1.7%) PMIs were observed in 802 patients treated with CABG. Compared with patients without PMI, patients with PMI presented with unstable angina more frequently (45.0% vs. 28.7, p=0.033), and had a higher rate of bifurcation lesion (87.5% vs. 72.5, p=0.046). PMI was associated with a higher all-cause mortality at 10 years compared with no PMI (55.3% vs. 25.4%; Log-rank p<0.001, Figure), which was mainly driven by a high mortality rate within 1 year. In patients undergoing PCI, the mortality rates were significantly higher in patients with PMI not only within 1 year (Log-rank p<0.001) but also beyond one year (Log-rank p=0.016), compare to patients without PMI (Figure). On the other hand, in patients undergoing CABG, a higher mortality rate in patients with PMI was observed until 1 year (Log-rank p<0.001), but the impact of PMI on mortality beyond one year after CABG subsided (Log-rank p=0.308) (Figure 1).
Conclusion
PMI was associated with a poor prognosis at 10 years. The impact of PMI on mortality was strong within one year. Of note, the impact of PMI on mortality persisted beyond 1 year only in patients undergoing PCI. Patients who were treated with PCI and suffered PMI need careful follow-up beyond one year after revascularization.
Figure 1
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- H Hara
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - K Takahashi
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - M Ono
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - C Gao
- University Hospital Nijmegen, Nijmegen, Netherlands (The)
| | - R Wang
- University Hospital Nijmegen, Nijmegen, Netherlands (The)
| | - P Kappetein
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - F Mohr
- Heart Center of Leipzig, Leipzig, Germany
| | - M Mack
- Baylor University Medical Center, Dallas, United States of America
| | - D Holmes
- Mayo Clinic, Rochester, United States of America
| | - M Morice
- Jacques Cartier Private Hospital, Massy, France
| | | | - S Head
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - D Thuijs
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - Y Onuma
- National University of Ireland, Galway, Ireland
| | - P Serruys
- National University of Ireland, Galway, Ireland
| |
Collapse
|
16
|
Ono M, Takahashi K, Hara H, Gao C, Wang R, Kappetein P, Mohr F, Mack M, Holmes D, Morice M, Davierwala P, Head S, Onuma Y, Thuijs D, Serruys P. Ten-year all-cause death in elderly patients undergoing percutaneous coronary intervention or coronary artery bypass grafting: a prespecified subgroup analysis of the SYNTAX Extended Survival study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Coronary artery disease is the leading cause of death among elderly men and women worldwide. The aging society worldwide will lead to increasing numbers of elderly patients with multivessel coronary artery disease. Although age is recognized as one of the most important factors in a decision-making for revascularization of multivessel coronary artery disease, the very long-term outcomes in patients undergoing revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is still unclear.
Objectives
The aim of the present study was to investigate the association between revascularization strategies and 10-year outcomes in elderly patients.
Methods
The SYNTAX Extended Survival (SYNTAXES) study (NCT 03417050) is an investigator-driven extension of follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries, enrolling 1,800 patients with de novo three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to revascularization strategy with CABG versus PCI in the SYNTAX trial. Patients were divided into two groups according to the prespecified threshold of 70 years old; elderly patients (>70 years) and non-elderly patients (≤70 years). The primary endpoint of this study was all-cause death at 10 years.
Results
Out of 1,800 patients, 575 patients (31.9%) were classified as elderly (>70 years). The mean age ± standard deviation (SD) of the elderly patients and the non-elderly patients was 75.8±3.6 years and 60.1±7.4 years, respectively. Of note, elderly patients were more frequently female than non-elderly patients (33.6% vs. 17.1%, p<0.001). As expected, the elderly patients had higher prevalence of chronic kidney disease (43.4% vs. 7.9%, p<0.001), had higher anatomical SYNTAX score (30.2±11.8 vs 28.0±11.2 p<0.001) when compared to those of the non-elderly patients.
Up to 10 years, all-cause death occurred in 42.7% and 18.9% in the elderly and non-elderly patients, respectively (Log-rank p<0.001). The cubic spline curve showed an exponentially increase in all-cause death at 10 years according to the increase of age both in the PCI arm and the CABG arm. At 10 years, there was no significant difference in the risk of all-cause death between CABG vs. PCI either in elderly patients (41.5% vs. 44.0%; Log-rank p=0.53) or non-elderly patients (16.6% vs. 21.1%; Log-rank p=0.051).
Conclusion
CABG and PCI were equipoise in terms of risk of all-cause death at 10 years in patients with de novo 3VD and/or LMCAD irrespective of their age when stratified according to the prespecified threshold of 70 years old.
Kaplan-Meier curves
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Foundation of Heart Research
Collapse
Affiliation(s)
- M Ono
- Amsterdam UMC, Amsterdam, Netherlands (The)
| | | | - H Hara
- Amsterdam UMC, Amsterdam, Netherlands (The)
| | - C Gao
- Radboud University Medical Center, Department of Cardiology, Nijmegen, Netherlands (The)
| | - R Wang
- Radboud University Medical Center, Department of Cardiology, Nijmegen, Netherlands (The)
| | - P Kappetein
- Erasmus University Medical Centre, Department of Cardiothoracic Surgery, Rotterdam, Netherlands (The)
| | - F Mohr
- Heart Center of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - M Mack
- Baylor University Medical Center, Department of Cardiothoracic Surgery, Dallas, United States of America
| | - D Holmes
- Mayo Clinic, Department of Cardiovascular Diseases and Internal Medicine, Rochester, United States of America
| | - M Morice
- Jacques Cartier Private Hospital, Département of Cardiologie, Massy, France
| | - P Davierwala
- Heart Center of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - S Head
- Erasmus University Medical Centre, Department of Cardiothoracic Surgery, Rotterdam, Netherlands (The)
| | - Y Onuma
- National University of Ireland, Department of Cardiology, Galway, Ireland
| | - D Thuijs
- Erasmus University Medical Centre, Department of Cardiothoracic Surgery, Rotterdam, Netherlands (The)
| | - P Serruys
- Imperial College London, NHLI, London, United Kingdom
| |
Collapse
|
17
|
McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, McKinstry S, Milligan W, Ooi L, Rafiq NM, Sammut T, Sinclair E, Smith M, Baker C, Boulton APR, Collins J, Copley HC, Fearnhead N, Fox H, Mah T, McKenna J, Naruka V, Nigam N, Nourallah B, Perera S, Qureshi A, Saggar S, Sun L, Wang X, Yang DD, Caroll P, Doyle C, Elangovan S, Falamarzi A, Perai KG, Greenan E, Jain D, Lang-Orsini M, Lim S, O'Byrne L, Ridgway P, Van der Laan S, Wong J, Arthur J, Barclay J, Bradley P, Edwin C, Finch E, Hayashi E, Hopkins M, Kelly D, Kelly M, McCartan N, Ormrod A, Pakenham A, Hayward J, Hitchen C, Kishore A, Martins T, Philomen J, Rao R, Rickards C, Burns N, Copeland M, Durand C, Dyal A, Ghaffar A, Gidwani A, Grant M, Gribbon C, Gruhn A, Leer M, Ahmad K, Beattie G, Beatty M, Campbell G, Donaldson G, Graham S, Holmes D, Kanabar S, Liu H, McCann C, Stewart R, Vara S, Ajibola-Taylor O, Andah EJE, Ani C, Cabdi NMO, Ito G, Jones M, Komoriyama A, Patel P, Titu L, Basra M, Gallogly P, Harinath G, Leong SH, Pradhan A, Siddiqui I, Zaat S, Ali A, Galea M, Looi WL, Ng JCK, Atkin G, Azizi A, Cargill Z, China Z, Elliot J, Jebakumar R, Lam J, Mudalige G, Onyerindu C, Renju M, Babu VS, Hussain M, Joji N, Lovett B, Mownah H, Ali B, Cresswell B, Dhillon AK, Dupaguntla YS, Hungwe C, Lowe-Zinola JD, Tsang JCH, Bevan K, Cardus C, Duggal A, Hossain S, McHugh M, Scott M, Chan F, Evans R, Gurung E, Haughey B, Jacob-Ramsdale B, Kerr M, Lee J, McCann E, O'Boyle K, Reid N, Hayat F, Hodgson S, Johnston R, Jones W, Khan M, Linn T, Long S, Seetharam P, Shaman S, Smart B, Anilkumar A, Davies J, Griffith J, Hughes B, Islam Y, Kidanu D, Mushaini N, Qamar I, Robinson H, Schramm M, Tan CY, Apperley H, Billyard C, Blazeby JM, Cannon SP, Carse S, Göpfert A, Loizidou A, Parkin J, Sanders E, Sharma S, Slade G, Telfer R, Huppatz IW, Worley E, Chandramoorthy L, Friend C, Harris L, Jain P, Karim MJ, Killington K, McGillicuddy J, Rafferty C, Rahunathan N, Rayne T, Varathan Y, Verma N, Zanichelli D, Arneill M, Brown F, Campbell B, Crozier L, Henry J, McCusker C, Prabakaran P, Wilson R, Asif U, Connor M, Dindyal S, Math N, Pagarkar A, Saleem H, Seth I, Sharma S, Standfield N, Swartbol T, Adamson R, Choi JE, El Tokhy O, Ho W, Javaid NR, Kelly M, Mehdi AS, Menon D, Plumptre I, Sturrock S, Turner J, Warren O, Crane E, Ferris B, Gadsby C, Smallwood J, Vipond M, Wilson V, Amarnath T, Doshi A, Gregory C, Kandiah K, Powell B, Spoor H, Toh C, Vizor R, Common M, Dunleavy K, Harris S, Luo C, Mesbah Z, Kumar AP, Redmond A, Skulsky S, Walsh T, Daly D, Deery L, Epanomeritakis E, Harty M, Kane D, Khan K, Mackey R, McConville J, McGinnity K, Nixon G, Ang A, Kee JY, Leung E, Norman S, Palaniappan SV, Sarathy PP, Yeoh T, Frost J, Hazeldine P, Jones L, Karbowiak M, Macdonald C, Mutarambirwa A, Omotade A, Runkel M, Ryan G, Sawers N, Searle C, Suresh S, Vig S, Ahmad A, McGartland R, Sim R, Song A, Wayman J, Brown R, Chang LH, Concannon K, Crilly C, Arnold TJ, Burgin A, Cadden F, Choy CH, Coleman M, Lim D, Luk J, Mahankali-Rao P, Prudence-Taylor AJ, Ramakrishnan D, Russell J, Fawole A, Gohil J, Green B, Hussain A, McMenamin L, McMenamin L, Tang M, Azmi F, Benchetrit S, Cope T, Haque A, Harlinska A, Holdsworth R, Ivo T, Martin J, Nisar T, Patel A, Sasapu K, Trevett J, Vernet G, Aamir A, Bird C, Durham-Hall A, Gibson W, Hartley J, May N, Maynard V, Johnson S, Wood CM, O'Brien M, Orbell J, Stringfellow TD, Tenters F, Tresidder S, Cheung W, Grant A, Tod N, Bews-Hair M, Lim ZH, Lim SW, Vella-Baldacchino M, Auckburally S, Chopada A, Easdon S, Goodson R, McCurdie F, Narouz M, Radford A, Rea E, Taylor O, Yu T, Alfa-Wali M, Amani L, Auluck I, Bruce P, Emberton J, Kumar R, Lagzouli N, Mehta A, Murtaza A, Raja M, Dennahy IS, Frew K, Given A, He YY, Karim MA, MacDonald E, McDonald E, McVinnie D, Ng SK, Pettit A, Sim DPY, Berthaume-Hawkins SD, Charnley R, Fenton K, Jones D, Murphy C, Ng JQ, Reehal R, Robinson H, Seraj SS, Shang E, Tonks A, White P, Yeo A, Chong P, Gabriel R, Patel N, Richardson E, Symons L, Aubrey-Jones D, Dawood S, Dobrzynska M, Faulkner S, Griffiths H, Mahmood F, Patel P, Perry M, Power A, Simpson R, Ali A, Brobbey P, Burrows A, Elder P, Ganyani R, Horseman C, Hurst P, Mann H, Marimuthu K, McBride S, Pilsworth E, Powers N, Stanier P, Innes R, Kersey T, Kopczynska M, Langasco N, Patel N, Rajagopal R, Atkins B, Beasley W, Lim ZC, Gill A, Ang HL, Williams H, Yogeswara T, Carter R, Fam M, Fong J, Latter J, Long M, Mackinnon S, McKenzie C, Osmanska J, Raghuvir V, Shafi A, Tsang K, Walker L, Bountra K, Coldicutt O, Fletcher D, Hudson S, Iqbal S, Bernal TL, Martin JWB, Moss-Lawton F, Smallwood J, Vipond M, Cardwell A, Edgerton K, Laws J, Rai A, Robinson K, Waite K, Ward J, Youssef H, Knight C, Koo PY, Lazarou A, Stanger S, Thorn C, Triniman MC, Botha A, Boyles L, Cumming S, Deepak S, Ezzat A, Fowler AJ, Gwozdz AM, Hussain SF, Khan S, Li H, Morrell BL, Neville J, Nitiahpapand R, Pickering O, Sagoo H, Sharma E, Welsh K, Denley S, Khan S, Agarwal M, Al-Saadi N, Bhambra R, Gupta A, Jawad ZAR, Jiao LR, Khan K, Mahir G, Singagireson S, Thoms BL, Tseu B, Wei R, Yang N, Britton N, Leinhardt D, Mahfooz M, Palkhi A, Price M, Sheikh S, Barker M, Bowley D, Cant M, Datta U, Farooqi M, Lee A, Morley G, Amin MN, Parry A, Patel S, Strang S, Yoganayagam N, Adlan A, Chandramoorthy S, Choudhary Y, Das K, Feldman M, France B, Grace R, Puddy H, Soor P, Ali M, Dhillon P, Faraj A, Gerard L, Glover M, Imran H, Kim S, Patrick Y, Peto J, Prabhudesai A, Smith R, Tang A, Vadgama N, Dhaliwal R, Ecclestone T, Harris A, Ong D, Patel D, Philp C, Stewart E, Wang L, Wong E, Xu Y, Ashaye T, Fozard T, Galloway F, Kaptanis S, Mistry P, Nguyen T, Olagbaiye F, Osman M, Philip Z, Rembacken R, Tayeh S, Theodoropoulou K, Herman A, Lau J, Saha A, Trotter M, Adeleye O, Cave D, Gunwa T, Magalhães J, Makwana S, Mason R, Parish M, Regan H, Renwick P, Roberts G, Salekin D, Sivakumar C, Tariq A, Liew I, McDade A, Stewart D, Hague M, Hudson-Peacock N, Jackson CES, James F, Pitt J, Walker EY, Aftab R, Ang JJ, Anwar S, Battle J, Budd E, Chui J, Crook H, Davies P, Easby S, Hackney E, Ho B, Imam SZ, Rammell J, Andrews H, Perry C, Schinle P, Ahmed P, Aquilina T, Balai E, Church M, Cumber E, Curtis A, Davies G, Dennis Y, Dumann E, Greenhalgh S, Kim P, King S, Metcalfe KHM, Passby L, Redgrave N, Soonawalla Z, Waters S, Zornoza A, Gulzar I, Hole J, Hull K, Ishaq H, Karaj J, Kelkar A, Love E, Patel S, Thakrar D, Vine M, Waterman A, Dib NP, Francis N, Hanson M, Ingleton R, Sadanand KS, Sukirthan N, Arnell S, Ball M, Bassam N, Beghal G, Chang A, Dawe V, George A, Huq T, Hussain A, Ikram B, Kanapeckaite L, Khan M, Ramjas D, Rushd A, Sait S, Serry M, Yardimci E, Capella S, Chenciner L, Episkopos C, Karam E, McCarthy C, Moore-Kelly W, Watson N, Ahluwalia V, Barnfield J, Ben-Gal O, Bloom I, Gharatya A, Khodatars K, Merchant N, Moonan A, Moore M, Patel K, Spiers H, Sundaram K, Turner J, Bath MF, Black J, Chadwick H, Huisman L, Ingram H, Khan S, Martin L, Metcalfe M, Sangal P, Seehra J, Thatcher A, Venturini S, Whitcroft I, Afzal Z, Brown S, Gani A, Gomaa A, Hussein N, Oh SY, Pazhaniappan N, Sharkey E, Sivagnanasithiyar T, Williams C, Yeung J, Cruddas L, Gurjar S, Pau A, Prakash R, Randhawa R, Chen L, Eiben I, Naylor M, Osei-Bordom D, Trenear R, Bannard-Smith J, Griffiths N, Patel BY, Saeed F, Abdikadir H, Bennett M, Church R, Clements SE, Court J, Delvi A, Hubert J, Macdonald B, Mansour F, Patel RR, Perris R, Small S, Betts A, Brown N, Chong A, Croitoru C, Grey A, Hickland P, Ho C, Hollington D, McKie L, Nelson AR, Stewart H, Eiben P, Nedham M, Ali I, Brown T, Cumming S, Hunt C, Joyner C, McAlinden C, Roberts J, Rogers D, Thachettu A, Tyson N, Vaughan R, Verma N, Yasin T, Andrew K, Bhamra N, Leong S, Mistry R, Noble H, Rashed F, Walker NR, Watson L, Worsfold M, Yarham E, Abdikadir H, Arshad A, Barmayehvar B, Cato L, Chan-lam N, Do V, Leong A, Sheikh Z, Zheleniakova T, Coppel J, Hussain ST, Mahmood R, Nourzaie R, Prowle J, Sheik-Ali S, Thomas A, Alagappan A, Ashour R, Bains H, Diamond J, Gordon J, Ibrahim B, Khalil M, Mittapalli D, Neo YN, Patil P, Peck FS, Reza N, Swan I, Whyte M, Chaudhry S, Hernon J, Khawar H, O'Brien J, Pullinger M, Rothnie K, Ujjal S, Bhatte S, Curtis J, Green S, Mayer A, Watkinson G, Chapple K, Hawthorne T, Khaliq M, Majkowski L, Malik TAM, Mclauchlan K, En BNW, Parton S, Robinson SD, Saat MI, Shurovi BN, Varatharasasingam K, Ward AE, Behranwala K, Bertelli M, Cohen J, Duff F, Fafemi O, Gupta R, Manimaran M, Mayhew J, Peprah D, Wong MHY, Farmer N, Houghton C, Kandhari N, Khan K, Ladha D, Mayes J, McLennan F, Panahi P, Seehra H, Agrawal R, Ahmed I, Ali S, Birkinshaw F, Choudhry M, Gokani S, Harrogate S, Jamal S, Nawrozzadeh F, Swaray A, Szczap A, Warusavitarne J, Abdalla M, Asemota N, Cullum R, Hartley M, Maxwell-Armstrong C, Mulvenna C, Phillips J, Yule A, Ahmed L, Clement KD, Craig N, Elseedawy E, Gorman D, Kane L, Livie J, Livie V, Moss E, Naasan A, Ravi F, Shields P, Zhu Y, Archer M, Cobley H, Dennis R, Downes C, Guevel B, Lamptey E, Murray H, Radhakrishnan A, Saravanabavan S, Sardar M, Shaw C, Tilliridou V, Wright R, Ye W, Alturki N, Helliwell R, Jones E, Kelly D, Lambotharan S, Scott K, Sivakumar R, Victor L, Boraluwe-Rallage H, Froggatt P, Haynes S, Hung YMA, Keyte A, Matthews L, Evans E, Haray P, John I, Mathivanan A, Morgan L, Oji O, Okorocha C, Rutherford A, Spiers H, Stageman N, Tsui A, Whitham R, Amoah-Arko A, Cecil E, Dietrich A, Fitzpatrick H, Guy C, Hair J, Hilton J, Jawad L, McAleer E, Taylor Z, Yap J, Akhbari M, Debnath D, Dhir T, Elbuzidi M, Elsaddig M, Glace S, Khawaja H, Koshy R, Lal K, Lobo L, McDermott A, Meredith J, Qamar MA, Vaidya A, Acquaah F, Barfi L, Carter N, Gnanappiragasam D, Ji C, Kaminski F, Lawday S, Mackay K, Sulaiman SK, Webb R, Ananthavarathan P, Dalal F, Farrar E, Hashemi R, Hossain M, Jiang J, Kiandee M, Lex J, Mason L, Matthews JH, McGeorge E, Modhwadia S, Pinkney T, Radotra A, Rickard L, Rodman L, Sales A, Tan KL, Bachi A, Bajwa DS, Battle J, Brown LR, Butler A, Calciu A, Davies E, Gardner I, Girdlestone T, Ikogho O, Keelan G, O'Loughlin P, Tam J, Elias J, Ngaage M, Thompson J, Bristow S, Brock E, Davis H, Pantelidou M, Sathiyakeerthy A, Singh K, Chaudhry A, Dickson G, Glen P, Gregoriou K, Hamid H, Mclean A, Mehtaji P, Neophytou G, Potts S, Belgaid DR, Burke J, Durno J, Ghailan N, Hanson M, Henshaw V, Nazir UR, Omar I, Riley BJ, Roberts J, Smart G, Van Winsen K, Bhatti A, Chan M, D'Auria M, Green S, Keshvala C, Li H, Maxwell-Armstrong C, Michaelidou M, Simmonds L, Smith C, Wimalathasan A, Abbas J, Cairns C, Chin YR, Connelly A, Moug S, Nair A, Svolkinas D, Coe P, Subar D, Wang H, Zaver V, Brayley J, Cookson P, Cunningham L, Gaukroger A, Ho M, Hough A, King J, O'Hagan D, Widdison A, Brown R, Brown B, Chavan A, Francis S, Hare L, Lund J, Malone N, Mavi B, McIlwaine A, Rangarajan S, Abuhussein N, Campbell HS, Daniels J, Fitzgerald I, Mansfield S, Pendrill A, Robertson D, Smart YW, Teng T, Yates J, Belgaumkar A, Katira A, Kossoff J, Kukran S, Laing C, Mathew B, Mohamed T, Myers S, Novell R, Phillips BL, Thomas M, Turlejski T, Turner S, Varcada M, Warren L, Wynell-Mayow W, Church R, Linley-Adams L, Osborn G, Saunders M, Spencer R, Srikanthan M, Tailor S, Tullett A, Ali M, Al-Masri S, Carr G, Ebhogiaye O, Heng S, Manivannan S, Manley J, McMillan LE, Peat C, Phillips B, Thomas S, Whewell H, Williams G, Bienias A, Cope EA, Courquin GR, Day L, Garner C, Gimson A, Harris C, Markham K, Moore T, Nadin T, Phillips C, Subratty SM, Brown K, Dada J, Durbacz M, Filipescu T, Harrison E, Kennedy ED, Khoo E, Kremel D, Lyell I, Pronin S, Tummon R, Ventre C, Walls L, Wootton E, Akhtar A, Davies E, El-Sawy D, Farooq M, Gaddah M, Griffiths H, Katsaiti I, Khadem N, Leong K, Williams I, Chean CS, Chudek D, Desai H, Ellerby N, Hammad A, Malla S, Murphy B, Oshin O, Popova P, Rana S, Ward T, Abbott TEF, Akpenyi O, Edozie F, El Matary R, English W, Jeyabaladevan S, Morgan C, Naidu V, Nicholls K, Peroos S, Prowle J, Sansome S, Torrance HD, Townsend D, Brecher J, Fung H, Kazmi Z, Outlaw P, Pursnani K, Ramanujam N, Razaq A, Sattar M, Sukumar S, Tan TSE, Chohan K, Dhuna S, Haq T, Kirby S, Lacy-Colson J, Logan P, Malik Q, McCann J, Mughal Z, Sadiq S, Sharif I, Shingles C, Simon A, Burnage S, Chan SSN, Craig ARJ, Duffield J, Dutta A, Eastwood M, Iqbal F, Mahmood F, Mahmood W, Patel C, Qadeer A, Robinson A, Rotundo A, Schade A, Slade RD, De Freitas M, Kinnersley H, McDowell E, Moens-Lecumberri S, Ramsden J, Rockall T, Wiffen L, Wright S, Bruce C, Francois V, Hamdan K, Limb C, Lunt AJ, Manley L, Marks M, Phillips CFE, Agnew CJF, Barr CJ, Benons N, Hart SJ, Kandage D, Krysztopik R, Mahalingam P, Mock J, Rajendran S, Stoddart MT, Clements B, Gillespie H, Lee S, McDougall R, Murray C, O'Loane R, Periketi S, Tan S, Amoah R, Bhudia R, Dudley B, Gilbert A, Griffiths B, Khan H, McKigney N, Roberts B, Samuel R, Seelarbokus A, Stubbing-Moore A, Thompson G, Williams P, Ahmed N, Akhtar R, Chandler E, Chappelow I, Gil H, Gower T, Kale A, Lingam G, Rutler L, Sellahewa C, Sheikh A, Stringer H, Taylor R, Aglan H, Ashraf MR, Choo S, Das E, Epstein J, Gentry R, Mills D, Poolovadoo Y, Ward N, Bull K, Cole A, Hack J, Khawari S, Lake C, Mandishona T, Perry R, Sleight S, Sultan S, Thornton T, Williams S, Arif T, Castle A, Chauhan P, Chesner R, Eilon T, Kamarajah S, Kambasha C, Lock L, Loka T, Mohammad F, Motahariasl S, Roper L, Sadhra SS, Sheikh A, Toma T, Wadood Q, Yip J, Ainger E, Busti S, Cunliffe L, Flamini T, Gaffing S, Moorcroft C, Peter M, Simpson L, Stokes E, Stott G, Wilson J, York J, Yousaf A, Borakati A, Brown M, Goaman A, Hodgson B, Ijeomah A, Iroegbu U, Kaur G, Lowe C, Mahmood S, Sattar Z, Sen P, Szuman A, Abbas N, Al-Ausi M, Anto N, Bhome R, Eccles L, Elliott J, Hughes EJ, Jones A, Karunatilleke AS, Knight JS, Manson CCF, Mekhail I, Michaels L, Noton TM, Okenyi E, Reeves T, Yasin IH, Banfield DA, Harris R, Lim D, Mason-Apps C, Roe T, Sandhu J, Shafiq N, Stickler E, Tam JP, Williams LM, Ainsworth P, Boualbanat Y, Doull C, Egan E, Evans L, Hassanin K, Ninkovic-Hall G, Odunlami W, Shergill M, Traish M, Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, Printz V, Saito R, Thomas O, Breen H, Kirk S, Kong CH, O'Kane A, Eddama M, Engledow A, Freeman SK, Frost A, Goh C, Lee G, Poonawala R, Suri A, Taribagil P, Brown H, Christie S, Dean S, Gravell R, Haywood E, Holt F, Pilsworth E, Rabiu R, Roscoe HW, Shergill S, Sriram A, Sureshkumar A, Tan LC, Tanna A, Vakharia A, Bhullar S, Brannick S, Dunne E, Frere M, Kerin M, Kumar KM, Pratumsuwan T, Quek R, Salman M, Van Den Berg N, Wong C, Ahluwalia J, Bagga R, Borg CM, Calabria C, Draper A, Farwana M, Joyce H, Khan A, Mazza M, Pankin G, Sait MS, Sandhu N, Virani N, Wong J, Woodhams K, Croghan N, Ghag S, Hogg G, Ismail O, John N, Nadeem K, Naqi M, Noe SM, Sharma A, Tan S, Begum F, Best R, Collishaw A, Glasbey J, Golding D, Gwilym B, Harrison P, Jackman T, Lewis N, Luk YL, Porter T, Potluri S, Stechman M, Tate S, Thomas D, Walford B, Auld F, Bleakley A, Johnston S, Jones C, Khaw J, Milne S, O'Neill S, Singh KKR, Smith R, Swan A, Thorley N, Yalamarthi S, Yin ZD, Ali A, Balian V, Bana R, Clark K, Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
Collapse
|
18
|
Lau KH, Bhat WW, Hamilton JP, Wood JC, Vaillancourt B, Wiegert-Rininger K, Newton L, Hamberger B, Holmes D, Hamberger B, Buell CR. Genome assembly of Chiococca alba uncovers key enzymes involved in the biosynthesis of unusual terpenoids. DNA Res 2020; 27:dsaa013. [PMID: 32642754 PMCID: PMC7433921 DOI: 10.1093/dnares/dsaa013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/29/2020] [Indexed: 11/13/2022] Open
Abstract
Chiococca alba (L.) Hitchc. (snowberry), a member of the Rubiaceae, has been used as a folk remedy for a range of health issues including inflammation and rheumatism and produces a wealth of specialized metabolites including terpenes, alkaloids, and flavonoids. We generated a 558 Mb draft genome assembly for snowberry which encodes 28,707 high-confidence genes. Comparative analyses with other angiosperm genomes revealed enrichment in snowberry of lineage-specific genes involved in specialized metabolism. Synteny between snowberry and Coffea canephora Pierre ex A. Froehner (coffee) was evident, including the chromosomal region encoding caffeine biosynthesis in coffee, albeit syntelogs of N-methyltransferase were absent in snowberry. A total of 27 putative terpene synthase genes were identified, including 10 that encode diterpene synthases. Functional validation of a subset of putative terpene synthases revealed that combinations of diterpene synthases yielded access to products of both general and specialized metabolism. Specifically, we identified plausible intermediates in the biosynthesis of merilactone and ribenone, structurally unique antimicrobial diterpene natural products. Access to the C. alba genome will enable additional characterization of biosynthetic pathways responsible for health-promoting compounds in this medicinal species.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bjoern Hamberger
- Department of Biochemistry and Molecular Biology
- MSU AgBioResearch
| | - C Robin Buell
- Department of Plant Biology
- MSU AgBioResearch
- Plant Resilience Institute, Michigan State University, East Lansing, MI 48824, USA
| |
Collapse
|
19
|
Yousefi R, Sarkar A, Ashtekar KD, Whitehead DC, Kakeshpour T, Holmes D, Reed P, Jackson JE, Borhan B. Mechanistic Insights into the Origin of Stereoselectivity in an Asymmetric Chlorolactonization Catalyzed by (DHQD) 2PHAL. J Am Chem Soc 2020; 142:7179-7189. [PMID: 32202109 DOI: 10.1021/jacs.0c01830] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Electrophilic halofunctionalization reactions have undergone a resurgence sparked by recent discoveries in the field of catalytic asymmetric halocyclizations. To build mechanistic understanding of these asymmetric transformations, a toolbox of analytical methods has been deployed, addressing the roles of catalyst, electrophile (halenium donor), and nucleophile in determining rates and stereopreferences. The test reaction, (DHQD)2PHAL-catalyzed chlorocyclization of 4-arylpent-4-enoic acid with 1,3-dichloro-5,5-dimethylhydantoin (DCDMH), is revealed to be first order in catalyst and chlorenium ion donor and zero order in alkenoic acid substrate under synthetically relevant conditions. The simplest interpretation is that rapid substrate-catalyst binding precedes rate-limiting chlorenium attack, controlling the face selectivity of both chlorine attack and lactone closure. ROESY and DFT studies, aided by crystal structures of carboxylic acids bound by the catalyst, point to a plausible resting state of the catalyst-substrate complex predisposed for asymmetric chlorolactonization. As revealed by our earlier labeling studies, these findings suggest modes of binding in the (DHQD)2PHAL chiral pocket that explain the system's remarkable control over rate- and enantioselection-determining events. Though a comprehensive modeling analysis is beyond the scope of the present work, quantum chemical analysis of the fragments' interactions and candidate reaction paths point to a one-step concerted process, with the nucleophile playing a critical role in activating the olefin for concomitant electrophilic attack.
Collapse
Affiliation(s)
- Roozbeh Yousefi
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| | - Aritra Sarkar
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| | - Kumar Dilip Ashtekar
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| | - Daniel C Whitehead
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| | - Tayeb Kakeshpour
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| | - Daniel Holmes
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| | - Paul Reed
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| | - James E Jackson
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| | - Babak Borhan
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| |
Collapse
|
20
|
Mak NTJJ, Li J, Vasilyeva E, Hiebert J, Guo M, Lustig D, Holmes D, Wiseman SM. Intraoperative parathyroid hormone measurement during parathyroidectomy for treatment of primary hyperparathyroidism: When should you end the operation? Am J Surg 2020; 219:785-789. [PMID: 32169248 DOI: 10.1016/j.amjsurg.2020.02.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 10/30/2019] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The study objective was to evaluate the intraoperative 50% decrease in PTH level ± PTH normalization for its accuracy and efficiency in predicting cure during parathyroidectomy (PTx) for the treatment of primary hyperparathyroidism (PHP). METHODS A retrospective review of patients undergoing PTx was conducted. The timepoints at which the 50% PTH decrease was reached were recorded. The accuracy of intraoperative PTH for predicting cure, defined as normocalcemia at 6 months postoperatively, was evaluated. RESULTS The study population was made up of 248 PHP patients, with 247 patients achieving normocalcemia at 6 months postoperatively. If a 50% PTH decrease was used to indicate operation conclusion, 1 patient would not be cured. Persistent PTH elevation above normal range at T10 had a PPV of 77%, NPV of 99.5%, sensitivity of 95.2% and specificity of 97.3% for predicting the presence of a contralateral pathological parathyroid gland. For the study cohort, 24.5 h of cumulative operating time would be saved if the 50% PTH decrease triggered operation conclusion. DISCUSSION A decrease in the pre-excision PTH level to 50% of the baseline level, or a decrease in the higher of the baseline or pre-excision PTH levels by 50% at 5 or 10 min post pathological parathyroid gland removal, regardless of whether the PTH level normalizes, reliably predicts cure from PHP and should be used to guide the surgeon during parathyroidectomy.
Collapse
Affiliation(s)
- Nicole T J J Mak
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Canada
| | - Jennifer Li
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Canada
| | - Elizaveta Vasilyeva
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Canada
| | - Jake Hiebert
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Canada
| | - Michael Guo
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Canada
| | - Daniel Lustig
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Canada
| | - Daniel Holmes
- Department of Pathology & Laboratory Medicine, St. Paul's Hospital & University of British Columbia, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Canada.
| |
Collapse
|
21
|
Noack T, Thuijs D, Kappetein P, Serruys P, Mohr FW, Morice MC, Mack M, Holmes D, Davierwala P, Head S. Ten Year Survival after Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention: The SYNTAX Extended Survival (SYNTAXES) Study. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705342] [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: 10/24/2022]
|
22
|
Kolberg HC, Uhl V, Massarut S, Holmes D, Liedtke C, Whineray Kelly E, Lövey G, Vaidya JS. Abstract P3-12-22: Targeted intraoperative radiotherapy (TARGIT IORT) during breast conserving surgery for early stage breast cancer in patients with breast augmentation with implants. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-12-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Targeted intraoperative radiotherapy (TARGIT) has become a standard option during breast conserving surgery for selected cases of early breast cancer and over 20,000 patients have been treated in over 300 centers around the world. Although a growing number of patients are presenting with implant breast augmentation, no data has been published regarding the safety of TARGIT with implants in situ. TARGIT IORT as a replacement for whole breast irradiation is an important issue in this context because of the high rates of capsular fibrosis following EBRT in such patients.
Methods: We are reporting a case series of 12 patients who received TARGIT during breast conserving surgery for early breast cancer, had undergone breast augmentation with implants before and wanted their implants to stay in situ. Patients were informed that no published data existed and decided on this approach on an individual basis. 3 patients received additional EBRT after TARGIT IORT because of the presence of EIC or LVI. TARGIT IORT was performed using Intrabeam - 50 kV – X-rays delivering 20 Gy prescribed at the surface of the tumor bed during the initial lumpectomy procedure.
Results:Patient characteristics are given in table 1. Follow-up varied from 78 months to 3 months. 11 patients presented with invasive breast cancer, 1 patient with DCIS. There were no procedure related complications and none of the patients have needed their implant removed. 1/12 patients (ID 7) was diagnosed with a local recurrence in a distant quadrant after 36 months of follow-up. In 11/12 patients no breast-cancer-related events occurred.
Patient characteristicsIDER/PR/HER2GradeSentinel NodesTumor Size (mm)Distance Implant to Tumor (mm)EBRT after IORTFollow up time (months)1pos/pos/neg2pN1mi (sn)95No622pos/neg/neg2pN0 (sn)1913Yes543pos/pos/neg3pN0 (sn)0.85Yes324pos/pos/neg2pN0 (sn)611No155pos/pos/neg3pN0 (sn)71Yes146pos/pos/neg1pN0 (sn)515No117pos/pos/neg2pN0 (sn)7not reportedNo378pos/pos/na1 (DCIS)N/A8not reportedNo789pos/pos/neg2pN0 (sn)15not reportedNo1510pos/neg/neg1pN0 (sn)144No4411pos/pos/neg2pN0 (sn)91No1112pos/pos/neg2pN0 (sn)75No3Table 1
Conclusion: This series of patients with TARGIT during breast conserving surgery for early breast cancer after breast augmentation with implants in situ revealed no safety concerns. Our case series gives some confidence in discussing this option with suitable patients. To expand this series, we are gathering details about other cases from the whole TARGIT group worldwide.
Citation Format: Kolberg H-C, Uhl V, Massarut S, Holmes D, Liedtke C, Whineray Kelly E, Lövey G, Vaidya JS. Targeted intraoperative radiotherapy (TARGIT IORT) during breast conserving surgery for early stage breast cancer in patients with breast augmentation with implants [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-22.
Collapse
Affiliation(s)
- H-C Kolberg
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - V Uhl
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - S Massarut
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - D Holmes
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - C Liedtke
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - E Whineray Kelly
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - G Lövey
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| | - JS Vaidya
- Marienhospital Bottrop, Bottrop, Germany; Summit Medical Center, Emeryville, CA; Centro di Riferimento Oncologico di Aviano, Aviano, Italy; John Wayne Cancer Institute, Santa Monica, CA; Charité - Universitätsmedizin Berlin, Berlin, Germany; Auckland Breast Centre, Auckland, New Zealand; BORAD, Bottrop, Germany; University College London, London, United Kingdom
| |
Collapse
|
23
|
Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S. Abstract P5-09-06: Underdiagnosis of HBOC in breast cancer patients: Are genetic testing guidelines a tool or an obstacle? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-09-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pathogenic genetic variants are estimated to occur in 10-15% of all breast cancer patients, with BRCA 1/2 accounting for 40-50% of pathogenic/likely pathogenic (P/LP) variants. However, it is estimated that <30% of breast cancer patients harboring a BRCA 1/2 variant have been identified, with the percentage being much less for ˜20 other breast cancer associated genes. Reasons for this are multifactorial and include complicated and restrictive testing guidelines developed at a time when the cost of testing was high and guidelines for management were limited. Today, cost has plummeted and there are definitive management guidelines for a broader range of genes. We created a community based Registry to determine the incidence of P/LP variants in breast cancer patients who meet and who do not meet the NCCN 2017 genetic testing criteria.
Methods: An IRB-approved multicenter prospective registry was initiated with 20 community and academic sites experienced incancer genetic testing and counseling.
Eligibility criteria included patients with a breast cancer diagnosis who had not been previously tested. Consecutive patients aged 18-90 were consented and underwent an 80 gene panel test (Invitae –Multi-Cancer Panel). The non-inferiority study was powered to detect a difference in P/LP variant rate of 4 percentage points with statistical significance (p<0.05, Fisher's exact test).
HIPAA compliant electronic case report forms collected information on patient diagnosis, test results, and physician recommendations made after test results were received.
Results: Over 1000 patients were enrolled and data from 910 subjects analyzed to date. 50.4% met NCCN criteria and 49.5% did not. Median age for the enrolled patients is 60.5 and ranged from 22-93. 56.0% of patients were recently diagnosed with breast cancer. 10.9% of patients had a history of a prior non breast cancer. Overall, 8.9% of patients had a pathogenicvariant. 9.6% of patients who met NCCN criteria with test results had a P/LP variant. 8.2% of patients who did not meet criteria had a P/LP variant. The difference of positive cases among the two groups is not statistically significant (P = 0.49)
4.9% of patients had pathogenic variants if only an 11 gene standard breast cancer panel was considered.
The spectrum of mutated genes varied between the two groups, with some overlap.
Conclusions:
There was no statistically significant difference in the number of pathogenic/likely pathogenic variants between those patients who met and those who did not meet NCCN guidelines. Expanded panel testing yields more medically actionable P/LP variants than testing BRCA 1/2 alone or breast cancer panels with 11 genes. This study demonstrates that there will be a significant number of patients with P/LP variants are missed if NCCN guidelines are required for genetic testing. Current NCCN guidelines for the genetic testing of breast cancer patients are an obstacle to identifying patients with P/LP variants and should be removed.
Universal BC Genetic Testing RegistryNCCN Criteria (910 patients analyzed)#/% who have P/LP variants#/% who do not have P/LP variantsPatients who meet guidelines44/459 (9.6%)415/459 (90.4%)Patients who do not meet guidelines37/451 (8.2%)414/451 (91.8%)
Citation Format: Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S. Underdiagnosis of HBOC in breast cancer patients: Are genetic testing guidelines a tool or an obstacle? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-06.
Collapse
Affiliation(s)
- P Beitsch
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Whitworth
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Baron
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - B Rosen
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - G Compagnoni
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Simmons
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - LA Smith
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - D Holmes
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Brown
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Gold
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Clark
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - C Coomer
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - I Grady
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - K Barbosa
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Riley
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - M Kinney
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Lyons
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - H MacDonald
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Kahn
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - A Ruiz
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Patel
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Curcio
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Esplin
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Yang
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| |
Collapse
|
24
|
Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S, Michalski S. Abstract P5-09-03: Expanded panel testing superior to BRCA1/2 and breast cancer panel in patients with breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-09-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The testing of hereditary breast and ovarian cancer (HBOC) patients for BRCA1/2 only was established years ago to identify patients with clinically actionable variants and limit the economic burden. However, the cost of genetic testing has plummeted, and the number of breast cancer-risk genes with management guidelines has expanded. We created a community-based registry to test all breast cancer patients. A primary objective of this registry included accruing and comparing patients who did and did not meet NCCN guidelines and determining if providing all breast cancer patients with comprehensive multi-gene panel testing yields additional clinical value than testing BRCA1/2 alone.
Methods: An IRB-approved multicenter prospective registry was initiated with 20 community-based and academic breast sites, selected to insure geographic and ethnic diversity. Consecutive patients ages 18-90 with current or prior breast cancer were offered testing with an 80-gene panel (Invitae, San Francisco, CA). HIPAA-compliant case report forms collected patient diagnosis, test results, and physician recommendations made after test results.
Results: Over 1,000 patients were enrolled and data on 911 have been analyzed to date. Median age of patients is 60.5 (range 22 to 93). 56.0% were recently diagnosed with breast cancer. Of these patients, 50.54% met NCCN criteria, and 49.5% did not. 10.9% had history of a prior non-breast cancer. The pathogenic/likely pathogenic (P/LP) variant rate for patients on a comprehensive 80-gene panel was 8.9%. When restricted to a guidelines-based 11-gene breast cancer panel (BRCA1/2, ATM, CDH1, CHEK2, NBN, NF1, PTEN, STK11, TP53, PALB2), 4.9% had P/LP variants; when limited to BRCA1/2, 1.6% had P/LP variants. Of all patients with P/LP findings, 93% had variants in cancer-risk genes with established management recommendations (Table 1) and 80% had germline variants conferring eligibility for precision medicine-based cancer treatments, such as PARP inhibitors, through actively enrolling clinical trials.
Conclusions: This study demonstrates that comprehensive panel testing of breast cancer patients provides a higher yield of clinically actionable P/LP variants than BRCA1/2 testing alone. Limited panels may miss clinically relevant P/LP variants, leaving risk for preventable cancers undiscovered and unnecessarily restricting patients' treatment options. These results also suggest that variants in tumor suppressor genes, not previously thought related to breast cancer, may contribute to its etiology. A comprehensive panel strategy reveals untapped clinical utility and can impact breast cancer patient care by informing implementation of precision medicine treatment interventions and guiding long-term medical management and surveillance for patients and their family members.
PatientsVariantsWith breast cancer management guidelines (including variants ATM*, BRCA1*, BRCA2*, CHEK2*, NBN*, NF1, PALB2*, TP53*)45 (56%)46 (55%)With cancer guidelines and clinical management implications (including variants BARD1*, FH, MITF, MSH6*, MUTYH*, PTCH1, RAD50*, RAD51C*, RAD51D*, RB1, RET, VHL)31 (38%)33 (39%)Evidence of actionability accruing (including variants BLM, DIS3L2, RECQL4)5 (6%)5 (6%)Totals8184*P/LP variants in these genes confer potential clinical trial eligibility, e.g. NCT02401347.
Citation Format: Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S, Michalski S. Expanded panel testing superior to BRCA1/2 and breast cancer panel in patients with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-03.
Collapse
Affiliation(s)
- P Beitsch
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Whitworth
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Baron
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - B Rosen
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - G Compagnoni
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Simmons
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - LA Smith
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - D Holmes
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Brown
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Gold
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Clark
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - C Coomer
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - I Grady
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - K Barbosa
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Riley
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - M Kinney
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Lyons
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - H MacDonald
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Kahn
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - A Ruiz
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Patel
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Curcio
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Esplin
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Yang
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Michalski
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| |
Collapse
|
25
|
Seetharaman J, Abramowitz R, Holmes D, Lidestri JP, Schneider DK, Yang X, Hendrickson WA. Microdiffraction beamline NYX at NSLS-II. Acta Crystallogr A Found Adv 2018. [DOI: 10.1107/s0108767318096307] [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: 11/10/2022] Open
|
26
|
Howes S, Charles D, Holmes D, Pedlow K, Wilson I, McDonough S. Older adults’ experience of falls prevention exercise delivered using active gaming and virtual reality. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Holmes D. Book Review: All Blood Counts—a Manual for Blood Conservation and Patient Blood Management. Anaesth Intensive Care 2017. [DOI: 10.1177/0310057x1704500618] [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: 11/16/2022]
|
28
|
Quah C, Holmes D, Khan T, Cockshott S, Lewis J, Stephen A. The variability in Oxford hip and knee scores in the preoperative period: is there an ideal time to score? Ann R Coll Surg Engl 2017; 100:16-20. [PMID: 29022778 DOI: 10.1308/rcsann.2017.0090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background All NHS-funded providers are required to collect and report patient-reported outcome measures for hip and knee arthroplasty. Although there are established guidelines for timing such measures following arthroplasty, there are no specific time-points for collection in the preoperative period. The primary aim of this study was to identify whether there was a significant amount of variability in the Oxford hip and knee scores prior to surgical intervention when completed in the outpatient clinic at the time of listing for arthroplasty or when completed at the preoperative assessment clinic. Methods A prospective cohort study of patients listed for primary hip or knee arthroplasty was conducted. Patients were asked to fill in a preoperative Oxford score in the outpatient clinic at the time of listing. They were then invited to fill in the official outcome measures questionnaire at the preoperative assessment clinic. The postoperative Oxford score was then completed when the patient was seen again at their postoperative follow up in clinic. Results Of the total of 109 patients included in this study period, there were 18 (17%) who had a worse score of 4 or more points difference and 43 (39.4%) who had an improvement of 4 or more points difference when the scores were compared between time of listing at the outpatient and at the preoperative assessment clinic. There was a statistically significant difference (P = 0.0054) in the mean Oxford scores. Conclusions The results of our study suggest that there should be standardisation of timing for completing the preoperative patient-reported outcome measures.
Collapse
Affiliation(s)
- C Quah
- Department of Trauma and Orthopaedic Surgery , Royal Derby Hospital, Derby , UK
| | - D Holmes
- Department of Trauma and Orthopaedic Surgery , Royal Derby Hospital, Derby , UK
| | - T Khan
- Department of Academic Orthopaedics and Trauma, University of Nottingham , Nottingham , UK
| | - S Cockshott
- Department of Trauma and Orthopaedic Surgery , Royal Derby Hospital, Derby , UK
| | - J Lewis
- Department of Trauma and Orthopaedic Surgery , Royal Derby Hospital, Derby , UK
| | - A Stephen
- Department of Trauma and Orthopaedic Surgery , Royal Derby Hospital, Derby , UK
| |
Collapse
|
29
|
Kakeshpour T, Bailey JP, Jenner MR, Howell DE, Staples RJ, Holmes D, Wu JI, Jackson JE. High‐Field NMR Spectroscopy Reveals Aromaticity‐Modulated Hydrogen Bonding in Heterocycles. Angew Chem Int Ed Engl 2017. [DOI: 10.1002/anie.201705023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Tayeb Kakeshpour
- Department of Chemistry Michigan State University East Lansing MI 48824 USA
| | - John P. Bailey
- Chemistry Department Kalamazoo College Kalamazoo MI 49006 USA
| | - Madison R. Jenner
- Department of Chemistry Michigan State University East Lansing MI 48824 USA
| | - Darya E. Howell
- Department of Chemistry Michigan State University East Lansing MI 48824 USA
| | - Richard J. Staples
- Department of Chemistry Michigan State University East Lansing MI 48824 USA
| | - Daniel Holmes
- Department of Chemistry Michigan State University East Lansing MI 48824 USA
| | - Judy I. Wu
- Department of Chemistry University of Houston Houston TX 77204 USA
| | - James E. Jackson
- Department of Chemistry Michigan State University East Lansing MI 48824 USA
| |
Collapse
|
30
|
Kakeshpour T, Bailey JP, Jenner MR, Howell DE, Staples RJ, Holmes D, Wu JI, Jackson JE. High‐Field NMR Spectroscopy Reveals Aromaticity‐Modulated Hydrogen Bonding in Heterocycles. Angew Chem Int Ed Engl 2017. [DOI: 10.1002/ange.201705023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tayeb Kakeshpour
- Department of Chemistry Michigan State University East Lansing MI 48824 USA
| | - John P. Bailey
- Chemistry Department Kalamazoo College Kalamazoo MI 49006 USA
| | - Madison R. Jenner
- Department of Chemistry Michigan State University East Lansing MI 48824 USA
| | - Darya E. Howell
- Department of Chemistry Michigan State University East Lansing MI 48824 USA
| | - Richard J. Staples
- Department of Chemistry Michigan State University East Lansing MI 48824 USA
| | - Daniel Holmes
- Department of Chemistry Michigan State University East Lansing MI 48824 USA
| | - Judy I. Wu
- Department of Chemistry University of Houston Houston TX 77204 USA
| | - James E. Jackson
- Department of Chemistry Michigan State University East Lansing MI 48824 USA
| |
Collapse
|
31
|
Affiliation(s)
- Kelly E. Aldrich
- Department of Chemistry, Michigan State University, 578 South Shaw Lane, East
Lansing, Michigan 48824, United States
| | - Brennan S. Billow
- Department of Chemistry, Michigan State University, 578 South Shaw Lane, East
Lansing, Michigan 48824, United States
| | - Daniel Holmes
- Department of Chemistry, Michigan State University, 578 South Shaw Lane, East
Lansing, Michigan 48824, United States
| | - Ross D. Bemowski
- Department of Chemistry, Michigan State University, 578 South Shaw Lane, East
Lansing, Michigan 48824, United States
| | - Aaron L. Odom
- Department of Chemistry, Michigan State University, 578 South Shaw Lane, East
Lansing, Michigan 48824, United States
| |
Collapse
|
32
|
Ellsworth AA, Magyar CL, Hubbell GE, Theisen CC, Holmes D, Mosey RA. One-pot triflic anhydride-mediated synthesis of 1,2-disubstituted 2-imidazolines from N-(2-haloethyl)amides and amines. Tetrahedron 2016. [DOI: 10.1016/j.tet.2016.08.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
33
|
Iñiguez-Franco F, Auras R, Burgess G, Holmes D, Fang X, Rubino M, Soto-Valdez H. Concurrent solvent induced crystallization and hydrolytic degradation of PLA by water-ethanol solutions. POLYMER 2016. [DOI: 10.1016/j.polymer.2016.07.018] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
34
|
Polsinelli VB, Satchidanand N, Singh R, Holmes D, Izzo JL. Hypertension and aging in rural Haiti: results from a preliminary survey. J Hum Hypertens 2016; 31:138-144. [PMID: 27465982 DOI: 10.1038/jhh.2016.52] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/25/2016] [Accepted: 06/20/2016] [Indexed: 12/31/2022]
Abstract
Cross-sectional studies in the developed countries document strong relationships among age, systolic blood pressure (SBP) and pulse pressure (PP). There is little information about these trends and their impact in underdeveloped countries with different socioeconomic and lifestyle characteristics. We studied a convenience sample of 572 residents of rural Fontaine, Haiti: 193 males and 379 females (mean, s.d.) age 40.2 (17.1) years and performed intake questionnaires and BP measurements in participants' homes. Income and educational achievement were very low but most-recommended lifestyle factors were very favorable: very high physical activity, low dietary fat, virtually no obesity (body mass index 21.8 (4.9)), and low smoking prevalence. Rough estimates of salt intake were high (~13 g per day) as was the overall prevalence of hypertension: 34.4% (23.4% in males, 40.2% in females). SBP and PP were related closely to age (r2=0.28, P<0.001 and r2=0.22, P<0.001); for each decade of age, SBP increased by 7.6 mm Hg. Diastolic BP peaked in the 6th decade (polynomial r2=0.22, P<0.001) and the nadir of PP occurred in the 3rd decade. We conclude that, despite a favorable profile of lifestyle characteristics and no obesity, the prevalence of hypertension and rate of increase in SBP and PP with age in Haiti are at least as high as those of developed countries.
Collapse
Affiliation(s)
- V B Polsinelli
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY, USA
| | - N Satchidanand
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY, USA
| | - R Singh
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY, USA
| | - D Holmes
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY, USA
| | - J L Izzo
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY, USA
| |
Collapse
|
35
|
Liu X, Painter RE, Enesa K, Holmes D, Whyte G, Garlisi CG, Monsma FJ, Rehak M, Craig FF, Smith CA. High-throughput screening of antibiotic-resistant bacteria in picodroplets. Lab Chip 2016; 16:1636-43. [PMID: 27033300 DOI: 10.1039/c6lc00180g] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The prevalence of clinically-relevant bacterial strains resistant to current antibiotic therapies is increasing and has been recognized as a major health threat. For example, multidrug-resistant tuberculosis and methicillin-resistant Staphylococcus aureus are of global concern. Novel methodologies are needed to identify new targets or novel compounds unaffected by pre-existing resistance mechanisms. Recently, water-in-oil picodroplets have been used as an alternative to conventional high-throughput methods, especially for phenotypic screening. Here we demonstrate a novel microfluidic-based picodroplet platform which enables high-throughput assessment and isolation of antibiotic-resistant bacteria in a label-free manner. As a proof-of-concept, the system was used to isolate fusidic acid-resistant mutants and estimate the frequency of resistance among a population of Escherichia coli (strain HS151). This approach can be used for rapid screening of rare antibiotic-resistant mutants to help identify novel compound/target pairs.
Collapse
Affiliation(s)
- X Liu
- Sphere Fluidics Limited, The Jonas Webb Building, Babraham Research Campus, Babraham, Cambridge, CB22 3AT, UK.
| | - R E Painter
- Merck Research Labs, Merck & Co., Inc., 2015 Galloping Hill Road, K15, Kenilworth, NJ07033, USA
| | - K Enesa
- Sphere Fluidics Limited, The Jonas Webb Building, Babraham Research Campus, Babraham, Cambridge, CB22 3AT, UK.
| | - D Holmes
- Sphere Fluidics Limited, The Jonas Webb Building, Babraham Research Campus, Babraham, Cambridge, CB22 3AT, UK.
| | - G Whyte
- School of Engineering & Physical Sciences, Institute of Biological Chemistry, Biophysics & Bioengineering, Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - C G Garlisi
- Merck Research Labs, Merck & Co., Inc., 2015 Galloping Hill Road, K15, Kenilworth, NJ07033, USA
| | - F J Monsma
- Merck Research Labs, Merck & Co., Inc., 2015 Galloping Hill Road, K15, Kenilworth, NJ07033, USA
| | - M Rehak
- Sphere Fluidics Limited, The Jonas Webb Building, Babraham Research Campus, Babraham, Cambridge, CB22 3AT, UK.
| | - F F Craig
- Sphere Fluidics Limited, The Jonas Webb Building, Babraham Research Campus, Babraham, Cambridge, CB22 3AT, UK.
| | - C A Smith
- Sphere Fluidics Limited, The Jonas Webb Building, Babraham Research Campus, Babraham, Cambridge, CB22 3AT, UK.
| |
Collapse
|
36
|
Cembrowski G, Topping K, Versluys K, Tran D, Malick M, Holmes D, Clarke G. The use of serial outpatient complete blood count (CBC) results to derive biologic variation: a new tool to gauge the acceptability of hematology testing. Int J Lab Hematol 2015; 38:111-8. [DOI: 10.1111/ijlh.12443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - K. Topping
- University of Alberta; Edmonton AB Canada
| | | | - D. Tran
- University of Alberta; Edmonton AB Canada
| | - M. Malick
- DynaLIFEDX Laboratories; Edmonton AB Canada
| | - D. Holmes
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver BC Canada
| | - G. Clarke
- University of Alberta; Edmonton AB Canada
| |
Collapse
|
37
|
Ghaffari B, Vanchura BA, Chotana GA, Staples RJ, Holmes D, Maleczka RE, Smith MR. Reversible Borylene Formation from Ring Opening of Pinacolborane and Other Intermediates Generated from Five-Coordinate Tris-Boryl Complexes: Implications for Catalytic C-H Borylation. Organometallics 2015; 34:4732-4740. [PMID: 28190912 DOI: 10.1021/acs.organomet.5b00525] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Catalytic C-H borylation using the five-coordinate tris-boryl complex (dippe)Ir(Bpin)3 (5a, dippe = 1,2-bis(diisopropylphosphino)ethane) has been examined using 31P{1H} and 1H NMR spectroscopy. Compound 5a was shown to react rapidly and reversibly with HBpin to generate a six-coordinate borylene complex, (dippe)Ir(H)-(Bpin)2(BOCMe2CMe2OBpin) (6), whose structure was confirmed by X-ray crystallography. Under catalytic conditions, the H2 generated from C-H borylation converted compound 6 to a series of intermediates. The first is tentatively assigned from 31P{1H} and 1H NMR spectra as (dippe)Ir(H2B3pin3) (7), which is the product of formal H2 addition to compound 5a. As catalysis progressed, compound 7 was converted to a new species with the formula (dippe)Ir(H3B2pin2) (8), which arose from H2 addition to compound 7 with loss of HBpin. Compound 8 was characterized by 31P{1H} and 1H NMR spectroscopy, and its structure was confirmed by X-ray crystallography, where two molecules with different ligand orientations were found in the unit cell. DFT calculations support the formulation of compound 8 as an IrIII agostic borane complex, (dippe)IrH2(Bpin)(η2-HBpin). Compound 8 was gradually converted to (dippe)Ir(H4Bpin) (9), which was characterized by 31P{1H} and 1H NMR spectroscopy and X-ray crystallography. DFT calculations favor its formulation as an agostic borane complex of IrIII with the formula (dippe)IrH3(η2-HBpin). Compound 9 reacted further with H2 to afford the dimeric structure [(dippe)IrH2(μ2-H)]2 (10), which was characterized by 1H NMR and X-ray crystallography. Compounds 7-10 are in equilibrium when H2 and HBpin are present.
Collapse
Affiliation(s)
- Behnaz Ghaffari
- Department of Chemistry, Michigan State University, 578 South Shaw Lane, East Lansing, Michigan 48824-1322 United States
| | - Britt A Vanchura
- Department of Chemistry, Michigan State University, 578 South Shaw Lane, East Lansing, Michigan 48824-1322 United States
| | - Ghayoor A Chotana
- Department of Chemistry, Michigan State University, 578 South Shaw Lane, East Lansing, Michigan 48824-1322 United States
| | - Richard J Staples
- Department of Chemistry, Michigan State University, 578 South Shaw Lane, East Lansing, Michigan 48824-1322 United States
| | - Daniel Holmes
- Department of Chemistry, Michigan State University, 578 South Shaw Lane, East Lansing, Michigan 48824-1322 United States
| | - Robert E Maleczka
- Department of Chemistry, Michigan State University, 578 South Shaw Lane, East Lansing, Michigan 48824-1322 United States
| | - Milton R Smith
- Department of Chemistry, Michigan State University, 578 South Shaw Lane, East Lansing, Michigan 48824-1322 United States
| |
Collapse
|
38
|
Mattman A, Jung B, Hauff K, Burns L, Holmes D, Sandhu S, Paty B. Negative heterophile antibody interference affecting iPTH. Clin Biochem 2015. [DOI: 10.1016/j.clinbiochem.2015.07.084] [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: 11/17/2022]
|
39
|
Affiliation(s)
- Kumar Sanam
- St John Providence Medical Center, Southfield, Michigan
| | | | - Dipak Shah
- St John Providence Medical Center, Southfield, Michigan
| | - Nathan Foster
- St John Providence Medical Center, Southfield, Michigan
| |
Collapse
|
40
|
Raizman JE, Diamandis EP, Holmes D, Stowasser M, Auchus R, Cavalier E. A renin-ssance in primary aldosteronism testing: obstacles and opportunities for screening, diagnosis, and management. Clin Chem 2015; 61:1022-7. [PMID: 26106077 DOI: 10.1373/clinchem.2015.242990] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/13/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Joshua E Raizman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Eleftherios P Diamandis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Clinical Biochemistry, University Health Network, Toronto, Ontario, Canada; Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada;
| | - Daniel Holmes
- Clinical Associate Professor, Department of Pathology and Laboratory Medicine and Head, Clinical Chemistry, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Canada
| | - Michael Stowasser
- Professor, Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Australia
| | - Richard Auchus
- Professor of Internal Medicine and Director, Fellowship Program, Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine University of Michigan Medical School, Ann Arbor, MI
| | - Etienne Cavalier
- Professor and Head, Department of Clinical Chemistry, University of Liège, Liège, Belgium
| |
Collapse
|
41
|
Luo H, DuBois B, Sgambelluri RM, Angelos ER, Li X, Holmes D, Walton JD. Production of (15)N-labeled α-amanitin in Galerina marginata. Toxicon 2015; 103:60-4. [PMID: 26100667 DOI: 10.1016/j.toxicon.2015.06.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/30/2022]
Abstract
α-Amanitin is the major causal constituent of deadly Amanita mushrooms that account for the majority of fatal mushroom poisonings worldwide. It is also an important biochemical tool for the study of its target, RNA polymerase II. The commercial supply of this bicyclic peptide comes from Amanita phalloides, the death cap mushroom, which is collected from the wild. Isotopically labeled amanitin could be useful for clinical and forensic applications, but α-amanitin has not been chemically synthesized and A. phalloides cannot be cultured on artificial medium. Using Galerina marginata, an unrelated saprotrophic mushroom that grows and produces α-amanitin in culture, we describe a method for producing (15)N-labeled α-amanitin using growth media containing (15)N as sole nitrogen source. A key to success was preparing (15)N-enriched yeast extract via a novel method designated "glass bead-assisted maturation." In the presence of the labeled yeast extract and (15)N-NH4Cl, α-amanitin was produced with >97% isotope enrichment. The labeled product was confirmed by HPLC, high-resolution mass spectrometry, and NMR.
Collapse
Affiliation(s)
- Hong Luo
- Department of Energy Plant Research Laboratory, Michigan State University, East Lansing, MI 48824, USA; Key Laboratory for Plant Diversity and Biogeography of East Asia, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming 650201, China.
| | - Brandon DuBois
- Department of Energy Plant Research Laboratory, Michigan State University, East Lansing, MI 48824, USA
| | - R Michael Sgambelluri
- Department of Energy Plant Research Laboratory, Michigan State University, East Lansing, MI 48824, USA; Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI 48824, USA
| | - Evan R Angelos
- Department of Energy Plant Research Laboratory, Michigan State University, East Lansing, MI 48824, USA
| | - Xuan Li
- Department of Energy Plant Research Laboratory, Michigan State University, East Lansing, MI 48824, USA; Department of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming 650091, Yunnan, China
| | - Daniel Holmes
- Department of Chemistry, Michigan State University, East Lansing, MI 48824, USA
| | - Jonathan D Walton
- Department of Energy Plant Research Laboratory, Michigan State University, East Lansing, MI 48824, USA.
| |
Collapse
|
42
|
Vollhardt K, Holmes D, Lee S, Lotz S, Nguyen S, Schaller G, Schmidt-Radde R. (η6-[7]Heliphene)tricarbonylchromium via an Optimized Preparation of [7]Heliphene. SYNTHESIS-STUTTGART 2015. [DOI: 10.1055/s-0034-1380535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
43
|
Abstract
There is a growing body of evidence supporting a bidirectional relationship between parathyroid hormone (PTH) and aldosterone (Aldo). We report a case of secondary hypertension due to concomitant Aldo-producing adenoma (APA) and parathyroid adenoma (PA) requiring both unilateral adrenalectomy and parathyroidectomy.
Collapse
Affiliation(s)
- Katrina Chau
- Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Holmes
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Adrienne Melck
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Clifford Chan-Yan
- Division of Nephrology, University of British Columbia, Vancouver, BC, Canada;
| |
Collapse
|
44
|
Yorke E, Stafford S, Holmes D, Sheth S, Melck A. Aldosterone deficiency after unilateral adrenalectomy for Conn's syndrome: a case report and literature review. Int J Surg Case Rep 2015; 7C:141-4. [PMID: 25604311 PMCID: PMC4336421 DOI: 10.1016/j.ijscr.2015.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/30/2014] [Accepted: 01/03/2015] [Indexed: 11/12/2022] Open
Abstract
We report a case of postoperative hypotension and hyperkalemia in a unilateral adrenalectomy for Conn’s syndrome. We highlight that there are factors that may make certain populations more at risk for developing this complication. Increasing awareness about this complication and its consequences highlights the needfor close monitoring in increased risk patients.
Introduction Approximately 35% of cases of Conn’s syndrome (primary aldosteronism) result from a solitary functioning adrenal adenoma, and these patients are best managed by adrenalectomy. Postoperative hypoaldosteronism after unilateral adrenalectomy is uncommon. Case presentation We present a case and literature review of hypoaldosteronism after unilateral adrenalectomy for Conn’s syndrome, which demonstrates the insidious and sometimes delayed presentation. Discussion In this clinical case we summarize the previously published cases of post-adrenalectomy hypoaldosteronism based on a PUBMED and EBSCOhost search of all peer-reviewed publications (original articles and reviews) on this topic. A few cases of aldosterone insufficiency post-adrenalectomy for Conn’s syndrome were identified. The etiological factors for prolonged selective suppression of aldosterone secretion after unilateral adrenalectomy remain unclear. Conclusion It is important to be aware of the risk of postoperative hypoaldosteronism in this patient population. Close postoperative follow-up is necessary and strongly recommended, especially in patients with certain risk factors. Patients may need mineralocorticoid supplementation during this period.
Collapse
Affiliation(s)
- Ekua Yorke
- Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Sara Stafford
- Department of Endocrinology, Surrey Memorial Hospital, Surrey, British Columbia, Canada
| | - Daniel Holmes
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Sachiv Sheth
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Adrienne Melck
- Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada.
| |
Collapse
|
45
|
Arthur TS, Kato K, Germain J, Guo J, Glans PA, Liu YS, Holmes D, Fan X, Mizuno F. Amorphous V2O5–P2O5 as high-voltage cathodes for magnesium batteries. Chem Commun (Camb) 2015; 51:15657-60. [DOI: 10.1039/c5cc07161e] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A deep investigation of amorphous V2O5–P2O5 powders for magnesium batteries communicates the vital properties to achieving the superior electrochemical performance at a 75 : 25 V2O5 : P2O5 molar ratio.
Collapse
Affiliation(s)
- Timothy S. Arthur
- Materials Research Department
- Toyota Research Institute of North America
- Ann Arbor
- USA
| | - Keiko Kato
- Materials Research Department
- Toyota Research Institute of North America
- Ann Arbor
- USA
| | - Jason Germain
- Materials Research Department
- Toyota Research Institute of North America
- Ann Arbor
- USA
| | - Jinghua Guo
- Advanced Light Source
- Lawrence Berkeley National Lab
- Berkeley
- USA
| | | | - Yi-Sheng Liu
- Advanced Light Source
- Lawrence Berkeley National Lab
- Berkeley
- USA
| | - Daniel Holmes
- Department of Chemistry
- Michigan State University
- East Lansing
- USA
| | - Xudong Fan
- Center for Advanced Microscopy
- Michigan State University
- East Lansing
- USA
| | - Fuminori Mizuno
- Materials Research Department
- Toyota Research Institute of North America
- Ann Arbor
- USA
| |
Collapse
|
46
|
Ashtekar K, Marzijarani NS, Jaganathan A, Holmes D, Jackson JE, Borhan B. A new tool to guide halofunctionalization reactions: the halenium affinity (HalA) scale. J Am Chem Soc 2014; 136:13355-62. [PMID: 25152188 PMCID: PMC4183602 DOI: 10.1021/ja506889c] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [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: 07/12/2014] [Indexed: 01/15/2023]
Abstract
We introduce a previously unexplored parameter-halenium affinity (HalA)- as a quantitative descriptor of the bond strengths of various functional groups to halenium ions. The HalA scale ranks potential halenium ion acceptors based on their ability to stabilize a "free halenium ion". Alkenes in particular but other Lewis bases as well, such as amines, amides, carbonyls, and ether oxygen atoms, etc., have been classified on the HalA scale. This indirect approach enables a rapid and straightforward prediction of chemoselectivity for systems involved in halofunctionalization reactions that have multiple nucleophilic sites. The influences of subtle electronic and steric variations, as well as the less predictable anchimeric and stereoelectronic effects, are intrinsically accounted for by HalA computations, providing quantitative assessments beyond simple "chemical intuition". This combined theoretical-experimental approach offers an expeditious means of predicting and identifying unprecedented reactions.
Collapse
Affiliation(s)
- Kumar
Dilip Ashtekar
- Department
of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| | | | - Arvind Jaganathan
- Engineering
and Process Sciences, The Dow Chemical Company, Midland, Michigan 48674, United States
| | - Daniel Holmes
- Department
of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| | - James E. Jackson
- Department
of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| | - Babak Borhan
- Department
of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| |
Collapse
|
47
|
Badani KK, Thompson DJ, Brown G, Holmes D, Kella N, Albala D, Singh A, Buerki C, Davicioni E, Hornberger J. Effect of a genomic classifier test on clinical practice decisions for patients with high-risk prostate cancer after surgery. BJU Int 2014; 115:419-29. [PMID: 24784420 PMCID: PMC4371645 DOI: 10.1111/bju.12789] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives To evaluate the impact of a genomic classifier (GC) test for predicting metastasis risk after radical prostatectomy (RP) on urologists' decision-making about adjuvant treatment of patients with high-risk prostate cancer. Subjects and Methods Patient case history was extracted from the medical records of each of the 145 patients with pT3 disease or positive surgical margins (PSMs) after RP treated by six high-volume urologists, from five community practices. GC results were available for 122 (84%) of these patients. US board-certified urologists (n = 107) were invited to provide adjuvant treatment recommendations for 10 cases randomly drawn from the pool of patient case histories. For each case, the study participants were asked to make an adjuvant therapy recommendation without (clinical variables only) and with knowledge of the GC test results. Recommendations were made without knowledge of other participants' responses and the presentation of case histories was randomised to minimise recall bias. Results A total of 110 patient case histories were available for review by the study participants. The median patient age was 62 years, 71% of patients had pT3 disease and 63% had PSMs. The median (range) 5-year predicted probability of metastasis by the GC test for the cohort was 3.9 (1–33)% and the GC test classified 72% of patients as having low risk for metastasis. A total of 51 urologists consented to the study and provided 530 adjuvant treatment recommendations without, and 530 with knowledge of the GC test results. Study participants performed a mean of 130 RPs/year and 55% were from community-based practices. Without GC test result knowledge, observation was recommended for 57% (n = 303), adjuvant radiation therapy (ART) for 36% (n = 193) and other treatments for 7% (n = 34) of patients. Overall, 31% (95% CI: 27–35%) of treatment recommendations changed with knowledge of the GC test results. Of the ART recommendations without GC test result knowledge, 40% (n = 77) changed to observation (95% CI: 33–47%) with this knowledge. Of patients recommended for observation, 13% (n = 38 [95% CI: 9–17%]) were changed to ART with knowledge of the GC test result. Patients with low risk disease according to the GC test were recommended for observation 81% of the time (n = 276), while of those with high risk, 65% were recommended for treatment (n = 118; P < 0.001). Treatment intensity was strongly correlated with the GC-predicted probability of metastasis (P < 0.001) and the GC test was the dominant risk factor driving decisions in multivariable analysis (odds ratio 8.6, 95% CI: 5.3–14.3%; P < 0.001). Conclusions Knowledge of GC test results had a direct effect on treatment strategies after surgery. Recommendations for observation increased by 20% for patients assessed by the GC test to be at low risk of metastasis, whereas recommendations for treatment increased by 16% for patients at high risk of metastasis. These results suggest that the implementation of genomic testing in clinical practice may lead to significant changes in adjuvant therapy decision-making for high-risk prostate cancer.
Collapse
|
48
|
McNamara RL, Chung SC, Jernberg T, Holmes D, Roe M, Timmis A, James S, Deanfield J, Fonarow GC, Peterson ED, Jeppsson A, Hemingway H. International comparisons of the management of patients with non-ST segment elevation acute myocardial infarction in the United Kingdom, Sweden, and the United States: The MINAP/NICOR, SWEDEHEART/RIKS-HIA, and ACTION Registry-GWTG/NCDR registries. Int J Cardiol 2014; 175:240-7. [PMID: 24882696 PMCID: PMC4112832 DOI: 10.1016/j.ijcard.2014.04.270] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/30/2014] [Indexed: 01/29/2023]
Abstract
Objectives To compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries. Background Results from clinical trials suggest significant variation in care across the world. However, international comparisons in “real world” registries are limited. Methods We compared the use of in-hospital procedures and discharge medications for patients admitted with NSTEMI from 2007 to 2010 using the unselective MINAP/NICOR [England and Wales (UK); n = 137,009], the unselective SWEDEHEART/RIKS-HIA (Sweden; n = 45,069), and the selective ACTION Registry-GWTG/NCDR [United States (US); n = 147,438] clinical registries. Results Patients enrolled among the three registries were generally similar except those in the US who were younger but had higher rates of smoking, diabetes, hypertension, prior heart failure, and prior MI than in Sweden or in UK. Angiography and percutaneous coronary intervention (PCI) were performed more often in the US (76% and 44%) and Sweden (65% and 42%) relative to the UK (32% and 22%). Discharge betablockers were also prescribed more often in the US (89%) and Sweden (89%) than in the UK (76%). In contrast, discharge statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), and dual antiplatelet agents (among those not receiving PCI) were higher in the UK (92%, 79%, and 71%) than in the US (85%, 65%, 41%) and Sweden (81%, 69%, and 49%). Conclusions The care for patients with NSTEMI differed substantially among the three countries. These differences in care among countries provide an opportunity for future comparative effectiveness research as well as identify opportunities for global quality improvement.
Collapse
Affiliation(s)
- R L McNamara
- Yale University School of Medicine, Cardiovascular Medicine, New Haven, CT, USA.
| | - S C Chung
- Farr Institute of Health Informatics Research @ UCL Partners, University College London, London, UK
| | - T Jernberg
- Dept of Medicine (Huddinge), Cardiology, Karolinska Institutet, and Dept of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - D Holmes
- Duke Clinical Research Institution, Duke University Medical Center, Durham, NC, USA
| | - M Roe
- Duke Clinical Research Institution, Duke University Medical Center, Durham, NC, USA
| | - A Timmis
- National Institute for Health Research, Biomedical Research Unit, Barts Health London, UK
| | - S James
- Dept. of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - G C Fonarow
- Ronald Reagan-UCLA Medical Center, Los Angeles, CA, USA
| | - E D Peterson
- Duke Clinical Research Institution, Duke University Medical Center, Durham, NC, USA
| | - A Jeppsson
- Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Hemingway
- Farr Institute of Health Informatics Research @ UCL Partners, University College London, London, UK
| |
Collapse
|
49
|
Ghosh B, Amado-Sierra MDRI, Holmes D, Maleczka RE. A one-pot allylation-hydrostannation sequence with recycling of the intermediate tin waste. Org Lett 2014; 16:2318-21. [PMID: 24725171 DOI: 10.1021/ol500460u] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A one-pot allylation and hydrostannation of alkynals where the tin byproduct formed in the first step of the reaction is recycled and used in the second step of the sequence is presented. Specifically, a BF3·OEt2-promoted allylstannation of the aldehyde moiety in the alkynal is followed by the introduction of polymethylhydrosiloxane (PMHS) and catalytic B(C6F5)3, which convert the tin byproduct of the allylation into Bu3SnH, which then hydrostannates the alkyne in the molecule. (119)Sn and (11)B NMR data suggest an organotin fluoride species is formed during the allylation step and involved in the tin recycling step.
Collapse
Affiliation(s)
- Banibrata Ghosh
- Department of Chemistry, Michigan State University , 578 S. Shaw Lane, East Lansing, Michigan 48824, United States
| | | | | | | |
Collapse
|
50
|
Vrablík M, Holmes D, Forer B, Juren A, Martinka P, Frohlich J. Use of ezetimibe results in more patients reaching lipid targets without side effects. Cor Vasa 2014. [DOI: 10.1016/j.crvasa.2014.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|