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Riguzzi M, Thaqi Q, Lorch A, Blum D, Peng-Keller S, Naef R. Contextual determinants of guideline-based family support during end-of-life cancer care and subsequent bereavement care: A cross-sectional survey of registered nurses. Eur J Oncol Nurs 2024; 70:102555. [PMID: 38626610 DOI: 10.1016/j.ejon.2024.102555] [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: 11/23/2023] [Accepted: 03/09/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE In end-of-life cancer care, 10-20% of bereaved family members experience adverse mental health effects, including prolonged grief disorder. Despite great efforts, evidence-based recommendations to support their grieving process and well-being are often not successfully adopted into routine clinical care. This study identified facilitators and barriers using implementation science methodology. METHODS 81 registered nurses working in cancer care from four hospitals and three home care services in Switzerland assessed their current family support practices in end-of-life care and bereavement care. They then assessed organisational attributes of their institution and their own individual characteristics and skills regarding literature-based factors of potential relevance. Facilitators and barriers to guideline-based family support were determined using fractional logistic regression. RESULTS Service specialisation in palliative care, a culture that supports change, the availability of family support guidelines, billing/reimbursement of bereavement support services, and individual knowledge of family support and skill were systematically associated with higher adoption of guideline-based family support practices. Lack of privacy with families and insufficient training acted as significant barriers. CONCLUSIONS While several potentially relevant factors have emerged in the literature, certain organisational and individual determinants actually empirically predict guideline-based family support according to nurses in end-of-life cancer care, with some determinants having much stronger implications than others. This provides crucial guidance for focussing quality improvement and implementation efforts through tailored strategies, especially with scarce resources. Furthermore, adoption is lower in bereavement care than in end-of-life care, suggesting a particular need for supportive organisational cultures including specific training and billing/reimbursement options.
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Affiliation(s)
- Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland.
| | - Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland
| | - Anja Lorch
- Department of Medical Oncology and Haematology Clinic, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Centre for Palliative Care, City Hospital Zurich, Tièchestrasse 99, 8037 Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Kirchgasse 9, 8001 Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland
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Seiler A, Amann M, Hertler C, Christ SM, Schettle M, Kaeppeli BM, Jung-Amstutz J, Nigg C, Pestalozzi BC, Imesch P, Dummer R, Blum D, Jenewein J. Effects of dignity therapy on psychological distress and wellbeing of palliative care patients and family caregivers - a randomized controlled study. BMC Palliat Care 2024; 23:73. [PMID: 38486192 PMCID: PMC10938771 DOI: 10.1186/s12904-024-01408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND This study extended the original Dignity Therapy (DT) intervention by including partners and family caregivers (FCs) of terminally-ill cancer patients with the overall aim of evaluating whether DT can mitigate distress in both patients nearing the end of life and their FCs. METHODS In this multicenter, randomized controlled trial (RCT), a total of 68 patients with life expectancy < 6 months and clinically-relevant stress levels (Hospital Anxiety Depression total score; HADStot ≥ 8) including their FCs were randomly assigned to DT, DT + (including their FCs), or standard palliative care (SPC) in a 1:1:1 ratio. Study participants were asked to complete a set of questionnaires pre- and post-intervention. RESULTS The coalesced group (DT and DT +) revealed a significant increase in patients' perceived quality of life (FACIT-Pal-14) following the intervention (mean difference 6.15, SD = 1.86, p < 0.01). We found a statistically significant group-by-time interaction effect: while the HADStot of patients in the intervention group remained stable over the pre-post period, the control group's HADStot increased (F = 4.33, df = 1, 82.9; p < 0.05), indicating a protective effect of DT. Most patients and their FCs found DT useful and would recommend it to other individuals in their situation. CONCLUSIONS The DT intervention has been well-received and shows the potential to increase HRQoL and prevent further mental health deterioration, illness burden and suffering in terminally-ill patients. The DT intervention holds the potential to serve as a valuable tool for facilitating end-of-life conversations among terminally-ill patients and their FCs. However, the implementation of DT within the framework of a RCT in a palliative care setting poses significant challenges. We suggest a slightly modified and less resource-intensive version of DT that is to provide the DT inventory to FCs of terminally-ill patients, empowering them to ask the questions that matter most to them over their loved one's final days. TRIAL REGISTRATION This study was registered with Clinical Trial Registry (ClinicalTrials.gov -Protocol Record NCT02646527; date of registration: 04/01/2016). The CONSORT 2010 guidelines were used for properly reporting how the randomized trial was conducted.
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Affiliation(s)
- Annina Seiler
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Manuel Amann
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Sebastian M Christ
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Markus Schettle
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | | | | | | | - Bernhard C Pestalozzi
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Patrick Imesch
- Department of Gynecology, University Hospital Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Josef Jenewein
- Privatklinik Hohenegg, Meilen, Switzerland
- University of Zurich, Zurich, Switzerland
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3
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Ali M, Garcia P, Lunkes LP, Sciortino A, Thomas M, Heurtaux T, Grzyb K, Halder R, Coowar D, Skupin A, Buée L, Blum D, Buttini M, Glaab E. Single cell transcriptome analysis of the THY-Tau22 mouse model of Alzheimer's disease reveals sex-dependent dysregulations. Cell Death Discov 2024; 10:119. [PMID: 38453894 PMCID: PMC10920792 DOI: 10.1038/s41420-024-01885-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
Alzheimer's disease (AD) progression and pathology show pronounced sex differences, but the factors driving these remain poorly understood. To gain insights into early AD-associated molecular changes and their sex dependency for tau pathology in the cortex, we performed single-cell RNA-seq in the THY-Tau22 AD mouse model. By examining cell type-specific and cell type-agnostic AD-related gene activity changes and their sex-dimorphism for individual genes, pathways and cellular sub-networks, we identified both statistically significant alterations and interpreted the upstream mechanisms controlling them. Our results confirm several significant sex-dependent alterations in gene activity in the THY-Tau22 model mice compared to controls, with more pronounced alterations in females. Both changes shared across multiple cell types and cell type-specific changes were observed. The differential genes showed significant over-representation of known AD-relevant processes, such as pathways associated with neuronal differentiation, programmed cell death and inflammatory responses. Regulatory network analysis of these genes revealed upstream regulators that modulate many of the downstream targets with sex-dependent changes. Most key regulators have been previously implicated in AD, such as Egr1, Klf4, Chchd2, complement system genes, and myelin-associated glycoproteins. Comparing with similar data from the Tg2576 AD mouse model and human AD patients, we identified multiple genes with consistent, cell type-specific and sex-dependent alterations across all three datasets. These shared changes were particularly evident in the expression of myelin-associated genes such as Mbp and Plp1 in oligodendrocytes. In summary, we observed significant cell type-specific transcriptomic changes in the THY-Tau22 mouse model, with a strong over-representation of known AD-associated genes and processes. These include both sex-neutral and sex-specific patterns, characterized by consistent shifts in upstream master regulators and downstream target genes. Collectively, these findings provide insights into mechanisms influencing sex-specific susceptibility to AD and reveal key regulatory proteins that could be targeted for developing treatments addressing sex-dependent AD pathology.
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Affiliation(s)
- Muhammad Ali
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 7 avenue des Hauts Fourneaux, L-4362, Esch-sur-Alzette, Luxembourg
| | - Pierre Garcia
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 7 avenue des Hauts Fourneaux, L-4362, Esch-sur-Alzette, Luxembourg
| | - Laetitia P Lunkes
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 7 avenue des Hauts Fourneaux, L-4362, Esch-sur-Alzette, Luxembourg
| | - Alessia Sciortino
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 7 avenue des Hauts Fourneaux, L-4362, Esch-sur-Alzette, Luxembourg
| | - Melanie Thomas
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 7 avenue des Hauts Fourneaux, L-4362, Esch-sur-Alzette, Luxembourg
| | - Tony Heurtaux
- Department of Life Sciences and Medicine (DLSM), University of Luxembourg, 8 avenue du Swing, L-4367, Belvaux, Luxembourg
- Luxembourg Center of Neuropathology, L-3555, Dudelange, Luxembourg
| | - Kamil Grzyb
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 7 avenue des Hauts Fourneaux, L-4362, Esch-sur-Alzette, Luxembourg
| | - Rashi Halder
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 7 avenue des Hauts Fourneaux, L-4362, Esch-sur-Alzette, Luxembourg
| | - Djalil Coowar
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 7 avenue des Hauts Fourneaux, L-4362, Esch-sur-Alzette, Luxembourg
| | - Alex Skupin
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 7 avenue des Hauts Fourneaux, L-4362, Esch-sur-Alzette, Luxembourg
| | - Luc Buée
- University of Lille, Inserm, CHU Lille, UMR-S1172 Lille Neuroscience & Cognition (LilNCog), Lille, France
- Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
| | - David Blum
- University of Lille, Inserm, CHU Lille, UMR-S1172 Lille Neuroscience & Cognition (LilNCog), Lille, France
- Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
| | - Manuel Buttini
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 7 avenue des Hauts Fourneaux, L-4362, Esch-sur-Alzette, Luxembourg
| | - Enrico Glaab
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 7 avenue des Hauts Fourneaux, L-4362, Esch-sur-Alzette, Luxembourg.
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Thaqi Q, Riguzzi M, Blum D, Peng-Keller S, Lorch A, Naef R. End-of-life and bereavement support to families in cancer care: a cross-sectional survey with bereaved family members. BMC Health Serv Res 2024; 24:155. [PMID: 38303007 PMCID: PMC10832212 DOI: 10.1186/s12913-024-10575-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Losing a close other to cancer is an incisive experience that occurs after a long course of illness and intense family caregiving. Despite an evident need for family engagement and support and guidance on this, patients and family members may not receive the attention and support they need when a family unit is experiencing a disruption by death. A clear understanding of the quality of care that is currently provided and its ability to address family needs is necessary to improve end-of-life and bereavement support to families affected by cancer. The purpose of this study is to investigate the quality of support of end-of-life and bereavement care to families, their (un)met needs, grief experiences, and self-perceived health outcomes. METHODS A multi-center, cross-sectional observational survey study with family members (n = 35) whose close other died of cancer in a health institution or their own home in German-speaking Switzerland. RESULTS Bereaved family members were mostly satisfied with end-of-life care. Information on the grief process and services, and acknowledgment of their grief was experienced as helpful. Most coped with their grief drawing on family resources and exhibited resilience, but they reported unmet needs in relation to family togetherness and caregiving. CONCLUSION This study with a small number of family members indicates that support provided to families across settings and illness trajectories is perceived as helpful, with specific needs related to family support. The findings suggest that improvements should focus on ensuring care that addresses the family as a unit and enables togetherness, mutual reflection, meaningful relationships, preparedness for death, resilience, and benefit-finding. PROTOCOL REGISTRATION https://osf.io/j4kfh .
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Affiliation(s)
- Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Centre for Palliative Care, City Hospital Zurich, Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Zurich, Switzerland
| | - Anja Lorch
- Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006, Zurich, Switzerland.
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.
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5
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Hartnell IJ, Woodhouse D, Jasper W, Mason L, Marwaha P, Graffeuil M, Lau LC, Norman JL, Chatelet DS, Buee L, Nicoll JAR, Blum D, Dorothee G, Boche D. Glial reactivity and T cell infiltration in frontotemporal lobar degeneration with tau pathology. Brain 2024; 147:590-606. [PMID: 37703311 PMCID: PMC10834257 DOI: 10.1093/brain/awad309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 07/23/2023] [Accepted: 08/11/2023] [Indexed: 09/15/2023] Open
Abstract
Frontotemporal lobar degeneration with tau (FTLD-tau) is a group of tauopathies that underlie ∼50% of FTLD cases. Identification of genetic risk variants related to innate/adaptive immunity have highlighted a role for neuroinflammation and neuroimmune interactions in FTLD. Studies have shown microglial and astrocyte activation together with T cell infiltration in the brain of THY-Tau22 tauopathy mice. However, this remains to be confirmed in FTLD-tau patients. We conducted a detailed post-mortem study of FTLD-tau cases including 45 progressive supranuclear palsy with clinical frontotemporal dementia, 33 Pick's disease, 12 FTLD-MAPT and 52 control brains to characterize the link between phosphorylated tau (pTau) epitopes and the innate and adaptive immunity. Tau pathology was assessed in the cerebral cortex using antibodies directed against: Tau-2 (phosphorylated and unphosphorylated tau), AT8 (pSer202/pThr205), AT100 (pThr212/pSer214), CP13 (pSer202), PHF1 (pSer396/pSer404), pThr181 and pSer356. The immunophenotypes of microglia and astrocytes were assessed with phenotypic markers (Iba1, CD68, HLA-DR, CD64, CD32a, CD16 for microglia and GFAP, EAAT2, glutamine synthetase and ALDH1L1 for astrocytes). The adaptive immune response was explored via CD4+ and CD8+ T cell quantification and the neuroinflammatory environment was investigated via the expression of 30 inflammatory-related proteins using V-Plex Meso Scale Discovery. As expected, all pTau markers were increased in FTLD-tau cases compared to controls. pSer356 expression was greatest in FTLD-MAPT cases versus controls (P < 0.0001), whereas the expression of other markers was highest in Pick's disease. Progressive supranuclear palsy with frontotemporal dementia consistently had a lower pTau protein load compared to Pick's disease across tau epitopes. The only microglial marker increased in FTLD-tau was CD16 (P = 0.0292) and specifically in FTLD-MAPT cases (P = 0.0150). However, several associations were detected between pTau epitopes and microglia, supporting an interplay between them. GFAP expression was increased in FTLD-tau (P = 0.0345) with the highest expression in Pick's disease (P = 0.0019), while ALDH1L1 was unchanged. Markers of astrocyte glutamate cycling function were reduced in FTLD-tau (P = 0.0075; Pick's disease: P < 0.0400) implying astrocyte reactivity associated with a decreased glutamate cycling activity, which was further associated with pTau expression. Of the inflammatory proteins assessed in the brain, five chemokines were upregulated in Pick's disease cases (P < 0.0400), consistent with the recruitment of CD4+ (P = 0.0109) and CD8+ (P = 0.0014) T cells. Of note, the CD8+ T cell infiltration was associated with pTau epitopes and microglial and astrocytic markers. Our results highlight that FTLD-tau is associated with astrocyte reactivity, remarkably little activation of microglia, but involvement of adaptive immunity in the form of chemokine-driven recruitment of T lymphocytes.
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Affiliation(s)
- Iain J Hartnell
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Declan Woodhouse
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - William Jasper
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Luke Mason
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Pavan Marwaha
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Manon Graffeuil
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Laurie C Lau
- Clinical and Experimental Sciences, Faculty of Medicine, Sir Henry Wellcome Laboratories, University of Southampton, Southampton O16 6YD, UK
| | - Jeanette L Norman
- Histochemistry Research Unit, Clinical and Experimental Sciences, Faculty of Medicine University of Southampton, Southampton SO16 6YD, UK
| | - David S Chatelet
- Biomedical Imaging Unit, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - Luc Buee
- University of Lille, Inserm, CHU Lille, UMR-S1172—Lille Neurosciences and Cognition, Lille 59045, France
- Alzheimer and Tauopathies, LabEX DISTALZ, Lille 59000, France
| | - James A R Nicoll
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Department of Cellular Pathology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - David Blum
- University of Lille, Inserm, CHU Lille, UMR-S1172—Lille Neurosciences and Cognition, Lille 59045, France
- Alzheimer and Tauopathies, LabEX DISTALZ, Lille 59000, France
| | - Guillaume Dorothee
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, Immune System and Neuroinflammation Laboratory, Hôpital Saint-Antoine, Paris 75012, France
| | - Delphine Boche
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
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Marti L, Hünerwadel E, Hut B, Christ SM, Däster F, Schettle M, Seiler A, Blum D, Hertler C. Characteristics and clinical challenges in patients with substance use disorder in palliative care-experience from a tertiary center in a high-income country. BMC Palliat Care 2024; 23:28. [PMID: 38287302 PMCID: PMC10826251 DOI: 10.1186/s12904-024-01366-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Access to palliative care is often limited for challenging and vulnerable groups, including persons with substance use disorders. However, with optimized healthcare options and liberal substitution policies, this patient group is likely to increase over the upcoming years, and comorbidities will also influence the need for palliative support. Here, we aim at analyzing characteristics and specific challenges associated with substance use disorders (SUD) in palliative care. METHODS We retrospectively reviewed all patients diagnosed with substance use disorder that were treated at our Competence Center Palliative Care within the University Hospital Zurich, Switzerland between 2015 and 2021. Patient characteristics, including age, gender, duration of hospitalization, as well as specific metrics like body mass index, distinct palliative care assessment scores, and in-hospital opioid consumption were retrieved from the electronic patient files. Demographics and clinical data were analyzed by descriptive statistics, and compared to those of a control group of palliative care patients without SUD. An opioid calculator was used to standardize opioid intake based on morphine equivalents for meaningful comparisons. RESULTS The primary characteristics revealed that the majority of individuals were single (56%), had no children (83%), lived alone (39%), and were either unemployed or recipients of a disability pension (in total 50%). Nicotine (89%), opioids (67%), and alcohol (67%) were the most used substances. We identified various comorbidities including psychiatric illnesses alongside SUD (56%), hepatitis A, B, or C (33%), and HIV infection (17%). Patients with SUD were significantly younger (p < 0.5), predominantly male (p < 0.05), and reported a higher prevalence of pain (p < 0.5) compared to the standard cohort of palliative patients. Regarding the challenges most frequently reported by healthcare practitioners, non-compliance, multimorbidity, challenging communication, biographical trauma, lack of social support, and unstable housing situations played a key role. CONCLUSION Patients with SUD represent a complex and vulnerable group dealing with multiple comorbidities that profoundly affect both their physical and psychological well-being. Understanding their unique characteristics is pivotal in providing precise and suitable palliative care.
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Affiliation(s)
| | | | - Bigna Hut
- University of Zurich, Zurich, Switzerland
| | - Sebastian M Christ
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Fabienne Däster
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - Markus Schettle
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - Annina Seiler
- University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - David Blum
- University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - Caroline Hertler
- University of Zurich, Zurich, Switzerland.
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland.
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7
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Riguzzi M, Thaqi Q, Peng-Keller S, Lorch A, Blum D, Naef R. Adoption of evidence-based end-of-life and bereavement support to families in cancer care: A contextual analysis study with health professionals. J Clin Nurs 2024. [PMID: 38291546 DOI: 10.1111/jocn.17033] [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: 05/24/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
AIMS To investigate the level of adoption of evidence-based family engagement and support during end-of-life cancer care and subsequent bereavement and its contextual facilitators and barriers from health professionals' perspectives, and to explore differences between professional groups. DESIGN Contextual analysis using an online cross-sectional survey. METHODS This study was conducted in four Swiss hospitals and three home care oncology and palliative care services. Non-parametric testing was used to investigate the level of adoption and differences between nurses, physicians, occupational- and physiotherapists and psychosocial professionals (chaplains, onco-psychologists and social workers). The STROBE checklist for cross-sectional studies was followed. RESULTS The majority of the 111 participating health professionals were nurses. Adoption was statistically significantly higher during end-of-life care than bereavement, with nurses and physicians reporting higher levels than the other professional groups. Guidance on end-of-life family care was available in about half of the cases, in contrast to a quarter for bereavement care. Self-perceived knowledge, skills and attitudes were moderate to high, with nurses and physicians reporting higher levels than others, except for general skills in working with families. Organisational structures were experienced as rather supportive, with the psychosocial group appraising the organisational context as significantly less conducive to fully implementing end-of-life and bereavement care than others, particularly during the end-of-life phase. CONCLUSION Evidence-based family engagement and support were better adopted during end-of-life care than bereavement. Overall, nurses and physicians felt better enabled to care for families compared to other professional groups. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. PROTOCOL REGISTRATION https://osf.io/j4kfh. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Implementation and quality improvement efforts should focus particularly on the bereavement phase and be tailored to professional groups. IMPACT The findings show that evidence-based family engagement and support practices during end-of-life were rather well adopted in contrast to subsequent bereavement care, with nurses and physicians better enabled than other professionals to provide care. A better understanding of health professionals' contributions and roles in family care is important to build interprofessional capacity for evidence-based end-of-life and bereavement support. REPORTING METHOD The STROBE checklist for reports of cross-sectional studies was followed (von Elm et al., 2007).
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Affiliation(s)
- Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Zurich, Switzerland
| | - Anja Lorch
- Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Centre for Palliative Care, City Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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Siew JJ, Chen HM, Chiu FL, Lee CW, Chang YM, Chen HL, Nguyen TNA, Liao HT, Liu M, Hagar HT, Sun YC, Lai HL, Kuo MH, Blum D, Buée L, Jin LW, Chen SY, Ko TM, Huang JR, Kuo HC, Liu FT, Chern Y. Galectin-3 aggravates microglial activation and tau transmission in tauopathy. J Clin Invest 2024; 134:e165523. [PMID: 37988169 PMCID: PMC10786694 DOI: 10.1172/jci165523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/16/2023] [Indexed: 11/23/2023] Open
Abstract
Alzheimer's disease is characterized by the accumulation of amyloid-β plaques, aggregation of hyperphosphorylated tau (pTau), and microglia activation. Galectin-3 (Gal3) is a β-galactoside-binding protein that has been implicated in amyloid pathology. Its role in tauopathy remains enigmatic. Here, we showed that Gal3 was upregulated in the microglia of humans and mice with tauopathy. pTau triggered the release of Gal3 from human induced pluripotent stem cell-derived microglia in both its free and extracellular vesicular-associated (EV-associated) forms. Both forms of Gal3 increased the accumulation of pathogenic tau in recipient cells. Binding of Gal3 to pTau greatly enhanced tau fibrillation. Besides Gal3, pTau was sorted into EVs for transmission. Moreover, pTau markedly enhanced the number of EVs released by iMGL in a Gal3-dependent manner, suggesting a role of Gal3 in biogenesis of EVs. Single-cell RNA-Seq analysis of the hippocampus of a mouse model of tauopathy (THY-Tau22) revealed a group of pathogenic tau-evoked, Gal3-associated microglia with altered cellular machineries implicated in neurodegeneration, including enhanced immune and inflammatory responses. Genetic removal of Gal3 in THY-Tau22 mice suppressed microglia activation, reduced the level of pTau and synaptic loss in neurons, and rescued memory impairment. Collectively, Gal3 is a potential therapeutic target for tauopathy.
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Affiliation(s)
| | | | - Feng-Lan Chiu
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan
| | | | | | | | | | | | - Mengyu Liu
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, Michigan, USA
| | - Hsiao-Tien Hagar
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, Michigan, USA
| | - Yung-Chen Sun
- Institute of Biochemistry and Molecular Biology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Min-Hao Kuo
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, Michigan, USA
| | - David Blum
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, LiCEND, Lille, France
| | - Luc Buée
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, LiCEND, Lille, France
| | - Lee-Way Jin
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California, USA
| | | | - Tai-Ming Ko
- Institute of Biomedical Sciences
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Jie-Rong Huang
- Institute of Biochemistry and Molecular Biology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hung-Chih Kuo
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan
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Wicki S, Clark IC, Amann M, Christ SM, Schettle M, Hertler C, Theile G, Blum D. Acceptance of Digital Health Technologies in Palliative Care Patients. Palliat Med Rep 2024; 5:34-42. [PMID: 38249831 PMCID: PMC10797306 DOI: 10.1089/pmr.2023.0062] [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] [Accepted: 11/28/2023] [Indexed: 01/23/2024] Open
Abstract
Background Digital health technologies have potential to transform palliative care (PC) services. The global aging population poses unique challenges for PC, which digital health technologies may help overcome. Evaluation of attitudes and perceptions combined with quantification of prior use habits favor an understanding of psychological barriers to PC patient acceptance of digital health technologies including artificial intelligence (AI). Objectives We aimed to evaluate the attitudes and perceptions of PC patients regarding a broad range of digital health technologies used in their routine monitoring and treatment and identify barriers to use. Methods We used a 39-item questionnaire to evaluate acceptance and use of smartphone-based electronic patient report outcome measures, wearables, AI, data privacy, and virtual reality (VR) in 29 female and male PC inpatients. Results A majority of patients indicated an interest in (69.0%) and positive attitude toward (75.9%) digital health technologies. Nearly all (93.1%) patients believe that digital health technologies will become more important in medicine in the future. Most patients would consider using their smartphone (79.3%) or wearable (69.0%) more often for their health. The most feasible technologies were smartphones, wearables, and VR. Barriers to acceptance included unfamiliarity, data security, errors in data interpretation, and loss of personal interaction through AI. Conclusion In this patient survey, acceptance of new technologies in a PC patient population was high, encouraging its use also at the end-of-life.
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Affiliation(s)
- Stefan Wicki
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Ian C. Clark
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Manuel Amann
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Sebastian M. Christ
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Markus Schettle
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Gudrun Theile
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
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10
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Birkner DR, Schettle M, Feuz M, Blum D, Hertler C. Outpatient Palliative Care Service Involvement: A Five-Year Experience from a Tertiary Hospital in Switzerland. Palliat Med Rep 2024; 5:10-19. [PMID: 38249832 PMCID: PMC10797309 DOI: 10.1089/pmr.2023.0052] [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] [Accepted: 11/15/2023] [Indexed: 01/23/2024] Open
Abstract
Background The value of early integration of palliative care has been demonstrated increasingly for the past years in both oncological and nononcological diseases. Outpatient palliative care services might represent a feasible approach to implement supportive care in early disease. In this study, we aimed at evaluating which patients use and benefit from outpatient palliative care services, which symptoms are addressed most, and which support services are installed in this early phase of disease. Methods We retrospectively analyzed the entire patient collective of a recently developed palliative care outpatient clinic within the leading university hospital in Switzerland for a period of five years. Sociodemographics, symptoms, and information on disease as well as patient-reported outcomes were retrieved from the electronic patient files. Demographic and clinical data were analyzed by descriptive statistics between groups and survival was analyzed by means of Kaplan-Meier estimates and log-rank test. Results We report on 642 consultations of 363 patients between 2016 and 2020. Patients had a mean of 1.8 visits (range 1-10), with n = 340 patients (93.7%) of patients suffering from an oncological disease. Overall symptom load was high, with n = 401 (73.7%) of patient-reported outcomes reporting two or more symptoms. Distress levels of 5 or higher were reported in n = 78 (30.4%) of available patient-reported outcomes. Independent of the origin of primary disease and the length of the disease trajectory, patients were referred to the palliative care service in median only four months before death. Conclusion We identify high symptom load and distress in the outpatient palliative patient population. Patients benefitted from supportive medication, improvement of ambulatory support systems and advance care planning, and more than one-third of patients remained in follow-up, indicating a good acceptance of the service. Overcoming the overall late referral could, however, further increase the quality of life at earlier stages of disease.
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Affiliation(s)
| | - Markus Schettle
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Markus Feuz
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - David Blum
- University of Zurich, Zurich, Switzerland
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Caroline Hertler
- University of Zurich, Zurich, Switzerland
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
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11
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Thomae AV, Verweij L, Witt CM, Blum D, Feusi E, Fringer A, Huber M, Roos M, Lal JA, Naef R. Evaluation of a newly developed flipped-classroom course on interprofessional practice in health care for medical students. Med Educ Online 2023; 28:2198177. [PMID: 37021707 PMCID: PMC10081083 DOI: 10.1080/10872981.2023.2198177] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 06/19/2023]
Abstract
Interprofessional education is expected to promote collaborative practice and should therefore be included in health professionals' curricula. Reports on interprofessional curricular development and its evaluation are rare. We therefore undertook a comprehensive quantitative and qualitative evaluation of a new, mandatory course on interprofessional collaboration for medical students during their third year of the Bachelor of Medicine study programme. The newly developed and implemented course spans over six weeks and was designed in a hybrid, flipped-classroom format. It incorporates experience- and case-based learning as well as interactions with other health professionals. Each student completes an eLearning and a clinical workshadowing individually before attending the - due to the pandemic - virtual live lectures. To assess quality and usefulness of teaching-learning formats and course structure to learn about interprofessional collaboration and to develop interprofessional competencies and identity, a quantitative and qualitative evaluation was performed with more than 280 medical students and 26 nurse educators from teaching hospitals using online surveys (open & closed-ended format). Data were analyzed descriptively and using content analysis processes. Students appreciated the flipped-classroom concept, the real-world case-based learning scenarios with interprofessional lecturer teams, and the possibility of an experience-based learning opportunity in the clinical setting including interaction with students and professionals from other health professions. Interprofessional identity did not change during the course. Evaluation data showed that the course is a promising approach for teaching-learning interprofessional competencies to medical students. The evaluation revealed three factors that determined the success of this course, namely, a flipped-classroom concept, the individual workshadowing of medical students with another health professional, mainly nurses, and live sessions with interprofessional teaching-learning teams. The course structure and teaching-learning methods showed potential and could serve as a template for interprofessional course development in other institutions and on other course topics.
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Affiliation(s)
- Anita V. Thomae
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lotte Verweij
- Institute for Implementation Science in Health Care, University of Zurich, Switzerland & Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Claudia M. Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - David Blum
- Competence Center Palliative Care, Department of Radiooncology, University Hospital Zurich, Zurich, Switzerland
| | - Emanuel Feusi
- Institute of Public Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - André Fringer
- Institute of Nursing, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Marion Huber
- Institute of Public Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Melanie Roos
- Faculty of Medicine, Student Affairs, Curricula Development, University of Zurich, Zurich, Switzerland
| | - Jasmin Anita Lal
- Faculty of Medicine, Student Affairs, Curricula Development, University of Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, University of Zurich, Switzerland & Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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Gauvrit T, Benderradji H, Pelletier A, Aboulouard S, Faivre E, Carvalho K, Deleau A, Vallez E, Launay A, Bogdanova A, Besegher M, Le Gras S, Tailleux A, Salzet M, Buée L, Delahaye F, Blum D, Vieau D. Multi-Omics Data Integration Reveals Sex-Dependent Hippocampal Programming by Maternal High-Fat Diet during Lactation in Adult Mouse Offspring. Nutrients 2023; 15:4691. [PMID: 37960344 PMCID: PMC10649590 DOI: 10.3390/nu15214691] [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: 10/05/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Early-life exposure to high-fat diets (HF) can program metabolic and cognitive alterations in adult offspring. Although the hippocampus plays a crucial role in memory and metabolic homeostasis, few studies have reported the impact of maternal HF on this structure. We assessed the effects of maternal HF during lactation on physiological, metabolic, and cognitive parameters in young adult offspring mice. To identify early-programming mechanisms in the hippocampus, we developed a multi-omics strategy in male and female offspring. Maternal HF induced a transient increased body weight at weaning, and a mild glucose intolerance only in 3-month-old male mice with no change in plasma metabolic parameters in adult male and female offspring. Behavioral alterations revealed by a Barnes maze test were observed both in 6-month-old male and female mice. The multi-omics strategy unveiled sex-specific transcriptomic and proteomic modifications in the hippocampus of adult offspring. These studies that were confirmed by regulon analysis show that, although genes whose expression was modified by maternal HF were different between sexes, the main pathways affected were similar with mitochondria and synapses as main hippocampal targets of maternal HF. The effects of maternal HF reported here may help to better characterize sex-dependent molecular pathways involved in cognitive disorders and neurodegenerative diseases.
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Affiliation(s)
- Thibaut Gauvrit
- UMR-S1172, Lille Neurosciences & Cognition, University of Lille, INSERM, CHU Lille, 59000 Lille, France; (T.G.); (H.B.); (E.F.); (K.C.); (A.D.); (A.L.); (A.B.); (L.B.); (D.B.)
- Alzheimer & Tauopathies, LabEX DISTALZ, 59045 Lille, France
| | - Hamza Benderradji
- UMR-S1172, Lille Neurosciences & Cognition, University of Lille, INSERM, CHU Lille, 59000 Lille, France; (T.G.); (H.B.); (E.F.); (K.C.); (A.D.); (A.L.); (A.B.); (L.B.); (D.B.)
- Alzheimer & Tauopathies, LabEX DISTALZ, 59045 Lille, France
| | - Alexandre Pelletier
- The Department of Pharmacology & Biophysics, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA;
| | - Soulaimane Aboulouard
- U1192—Laboratoire Protéomique, Réponse Inflammatoire et Spectrométrie de Masse (PRISM), University of Lille, INSERM, 59000 Lille, France; (S.A.); (M.S.)
| | - Emilie Faivre
- UMR-S1172, Lille Neurosciences & Cognition, University of Lille, INSERM, CHU Lille, 59000 Lille, France; (T.G.); (H.B.); (E.F.); (K.C.); (A.D.); (A.L.); (A.B.); (L.B.); (D.B.)
- Alzheimer & Tauopathies, LabEX DISTALZ, 59045 Lille, France
| | - Kévin Carvalho
- UMR-S1172, Lille Neurosciences & Cognition, University of Lille, INSERM, CHU Lille, 59000 Lille, France; (T.G.); (H.B.); (E.F.); (K.C.); (A.D.); (A.L.); (A.B.); (L.B.); (D.B.)
- Alzheimer & Tauopathies, LabEX DISTALZ, 59045 Lille, France
| | - Aude Deleau
- UMR-S1172, Lille Neurosciences & Cognition, University of Lille, INSERM, CHU Lille, 59000 Lille, France; (T.G.); (H.B.); (E.F.); (K.C.); (A.D.); (A.L.); (A.B.); (L.B.); (D.B.)
- Alzheimer & Tauopathies, LabEX DISTALZ, 59045 Lille, France
| | - Emmanuelle Vallez
- Institut Pasteur de Lille, U1011-EGID, University of Lille, INSERM, CHU Lille, 59000 Lille, France; (E.V.); (A.T.)
| | - Agathe Launay
- UMR-S1172, Lille Neurosciences & Cognition, University of Lille, INSERM, CHU Lille, 59000 Lille, France; (T.G.); (H.B.); (E.F.); (K.C.); (A.D.); (A.L.); (A.B.); (L.B.); (D.B.)
- Alzheimer & Tauopathies, LabEX DISTALZ, 59045 Lille, France
| | - Anna Bogdanova
- UMR-S1172, Lille Neurosciences & Cognition, University of Lille, INSERM, CHU Lille, 59000 Lille, France; (T.G.); (H.B.); (E.F.); (K.C.); (A.D.); (A.L.); (A.B.); (L.B.); (D.B.)
- Alzheimer & Tauopathies, LabEX DISTALZ, 59045 Lille, France
| | - Mélanie Besegher
- US 41-UMS 2014-PLBS, Animal Facility, University of Lille, CNRS, INSERM, CHU Lille, 59000 Lille, France;
| | - Stéphanie Le Gras
- CNRS U7104, INSERM U1258, GenomEast Platform, IGBMC, University of Strasbourg, 67412 Illkirch, France;
| | - Anne Tailleux
- Institut Pasteur de Lille, U1011-EGID, University of Lille, INSERM, CHU Lille, 59000 Lille, France; (E.V.); (A.T.)
| | - Michel Salzet
- U1192—Laboratoire Protéomique, Réponse Inflammatoire et Spectrométrie de Masse (PRISM), University of Lille, INSERM, 59000 Lille, France; (S.A.); (M.S.)
| | - Luc Buée
- UMR-S1172, Lille Neurosciences & Cognition, University of Lille, INSERM, CHU Lille, 59000 Lille, France; (T.G.); (H.B.); (E.F.); (K.C.); (A.D.); (A.L.); (A.B.); (L.B.); (D.B.)
- Alzheimer & Tauopathies, LabEX DISTALZ, 59045 Lille, France
| | - Fabien Delahaye
- Sanofi Precision Medicine and Computational Biology, 94081 Vitry-sur-Seine, France;
| | - David Blum
- UMR-S1172, Lille Neurosciences & Cognition, University of Lille, INSERM, CHU Lille, 59000 Lille, France; (T.G.); (H.B.); (E.F.); (K.C.); (A.D.); (A.L.); (A.B.); (L.B.); (D.B.)
- Alzheimer & Tauopathies, LabEX DISTALZ, 59045 Lille, France
| | - Didier Vieau
- UMR-S1172, Lille Neurosciences & Cognition, University of Lille, INSERM, CHU Lille, 59000 Lille, France; (T.G.); (H.B.); (E.F.); (K.C.); (A.D.); (A.L.); (A.B.); (L.B.); (D.B.)
- Alzheimer & Tauopathies, LabEX DISTALZ, 59045 Lille, France
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13
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Schmidt EB, Blum D, Domeisen Benedetti F, Schlögl M, Strasser F. Tools for guiding interventions to address patient-perceived multidimensional unmet healthcare needs in palliative care: systematic literature review. BMJ Support Palliat Care 2023; 13:e1-e9. [PMID: 33177115 DOI: 10.1136/bmjspcare-2020-002495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/10/2020] [Accepted: 10/20/2020] [Indexed: 11/03/2022]
Abstract
CONTEXT The unmet needs of patients with advanced disease are indicative of the patient centredness of healthcare. By tracking unmet needs in clinical practice, palliative interventions are aligned with patient priorities, and clinicians receive support in intervention delivery decisions for patients with overlapping, complex needs. OBJECTIVE Identify tools used in everyday clinical practice for the purpose of identifying and addressing unmet healthcare needs for patients with advanced disease. METHODS We conducted PubMed and Cumulative Index of Nursing and Allied Health Literature searches to include studies published between 1 January 2008 and 21 April 2020. Three concepts were used in constructing a search statement: (1) patient need, (2) validated instrument and (3) clinical practice. 2313 citations were reviewed according to predefined eligibility, exclusion and inclusion criteria. Data were collected from 17 tools in order to understand how instruments assess unmet need, who is involved in tool completion, the psychometric validation conducted, the tool's relationship to delivering defined palliative interventions, and the number of palliative care domains covered. RESULTS The majority of the 17 tools assessed unmet healthcare needs and had been validated. However, most did not link directly to clinical intervention, nor did they facilitate interaction between clinicians and patients to ensure a patient-reported view of unmet needs. Half of the tools reviewed covered ≤3 dimensions of palliative care. Of the 17 tools evaluated, 4 were compared in depth, but all were determined to be insufficient for the specific clinical applications sought in this research. CONCLUSION A new, validated tool is needed to track unmet healthcare needs and guide interventions for patients with advanced disease.
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Affiliation(s)
- Ellie B Schmidt
- Clinic for Medical Oncology & Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Franzisca Domeisen Benedetti
- Clinic for Medical Oncology & Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- School of Health Professions, Institute of Nursing, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
| | - Mathias Schlögl
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland
| | - Florian Strasser
- Clinic for Medical Oncology & Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Integrated Oncological Rehabiliation & Cancer Fatigue Clinic, Clinic Gais, Gais, Switzerland
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14
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Chou ML, Babamale AO, Walker TL, Cognasse F, Blum D, Burnouf T. Blood-brain crosstalk: the roles of neutrophils, platelets, and neutrophil extracellular traps in neuropathologies. Trends Neurosci 2023; 46:764-779. [PMID: 37500363 DOI: 10.1016/j.tins.2023.06.005] [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: 03/29/2023] [Revised: 06/17/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
Systemic inflammation, neurovascular dysfunction, and coagulopathy often occur concurrently in neuropathologies. Neutrophils and platelets have crucial synergistic roles in thromboinflammation and are increasingly suspected as effector cells contributing to the pathogenesis of neuroinflammatory diseases. In this review, we summarize the roles of platelet-neutrophil interactions in triggering complex pathophysiological events affecting the brain that may lead to the disruption of brain barriers, infiltration of toxic factors into the parenchyma, and amplification of neuroinflammation through the formation of neutrophil extracellular traps (NETs). We highlight the clinical significance of thromboinflammation in neurological disorders and examine the contributions of damage-associated molecular patterns (DAMPs) derived from platelets and neutrophils. These DAMPs originate from both infectious and non-infectious risk factors and contribute to the activation of inflammasomes during brain disorders. Finally, we identify knowledge gaps in the molecular mechanisms underlying neurodegenerative disease pathogenesis and emphasize the potential of interventions targeting platelets and neutrophils to treat neuroinflammatory diseases.
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Affiliation(s)
- Ming-Li Chou
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, New Taipei City 23561, Taiwan; INSERM UMRS 938, Centre de Recherche Saint-Antoine, Immune System and Neuroinflammation Laboratory, Hôpital Saint-Antoine, Paris 75012, France
| | - Abdulkareem Olarewaju Babamale
- Taiwan International Graduate Program in Molecular Medicine, Academia Sinica, Taipei 11266, Taiwan; Department of Zoology, Faculty of Life Sciences, University of Ilorin, Ilorin 240003, Nigeria
| | - Tara L Walker
- Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Fabrice Cognasse
- Etablissement Français du Sang Auvergne-Rhône-Alpes, 42023 Saint-Étienne, France; University Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023 Saint-Etienne, France
| | - David Blum
- University of Lille, INSERM, CHU Lille, UMR-S1172 LilNCog, Lille Neuroscience and Cognition, F-59000 Lille, France; Alzheimer & Tauopathies, LabEx DISTALZ, LiCEND, Lille F-59000, France; NeuroTMULille International Laboratory, University of Lille, F-59000 Lille, France
| | - Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, New Taipei City 23561, Taiwan; International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, New Taipei City 23561, Taiwan; NeuroTMULille International Laboratory, Taipei Medical University, Taipei 10031, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei 11031, Taiwan; Brain and Consciousness Research Centre, Taipei Medical University Shuang Ho Hospital, New Taipei City 23561, Taiwan.
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15
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Christ SM, Hünerwadel E, Hut B, Ahmadsei M, Matthes O, Seiler A, Schettle M, Blum D, Hertler C. Socio-economic determinants for the place of last care: results from the acute palliative care unit of a large comprehensive cancer center in a high-income country in Europe. BMC Palliat Care 2023; 22:114. [PMID: 37550688 PMCID: PMC10408184 DOI: 10.1186/s12904-023-01240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND INTRODUCTION The place of last care carries importance for patients at the end of life. It is influenced by the realities of the social welfare and healthcare systems, cultural aspects, and symptom burden. This study aims to investigate the place of care trajectories of patients admitted to an acute palliative care unit. MATERIALS AND METHODS The medical records of all patients hospitalized on our acute palliative care unit in 2019 were assessed. Demographic, socio-economic and disease characteristics were recorded. Descriptive and inferential statistics were used to identify determinants for place of last care. RESULTS A total of 377 patients were included in this study. Median age was 71 (IQR, 59-81) years. Of these patients, 56% (n = 210) were male. The majority of patients was Swiss (80%; n = 300); about 60% (n = 226) reported a Christian confession; and 77% had completed high school or tertiary education. Most patients (80%, n = 300) had a cancer diagnosis. The acute palliative care unit was the place of last care for 54% of patients. Gender, nationality, religion, health insurance, and highest level of completed education were no predictors for place of last care, yet previous outpatient palliative care involvement decreased the odds of dying in a hospital (OR, 0.301; 95% CI, 0.180-0.505; p-value < 0.001). CONCLUSION More than half of patients admitted for end-of-life care died on the acute palliative care unit. While socio-economic factors did not determine place of last care, previous involvement of outpatient palliative care is a lever to facilitate dying at home.
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Affiliation(s)
- Sebastian M Christ
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | | | - Bigna Hut
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Maiwand Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Matthes
- Department of Consultant Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annina Seiler
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Markus Schettle
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Pelz S, Rho E, Wolfensberger F, Blum D. [Symptom Control in Nephrological Palliative Care]. Praxis (Bern 1994) 2023; 112:516-523. [PMID: 37855651] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Nephrology may have quite a lot in common with with palliative care. Examples of this are the conservative therapy of a terminal chronic kidney disease or dialysis termination. Nevertheless, palliative co-care of patients with chronic kidney disease still happens rather rarely. On the one hand, this might be due to lacking experience regarding the benefits and opportunities of incorporating palliative care in nephrology care, on the other hand, palliative care is often misunderstood as pure "end-of-life" care. By highlighting the whole spectrum of palliative care, we aim to promote these two disciplines in order to integrate palliative care services into the nephrological treatment concept at an early stage.
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Affiliation(s)
- Stefan Pelz
- Kompetenzzentrum Palliative Care, Klinik für Radio-Onkologie, Universitätsspital Zürich
| | - Elena Rho
- Klinik für Nephrologie, Universitätsspital Zürich
| | - Fanny Wolfensberger
- Kompetenzzentrum Palliative Care, Klinik für Radio-Onkologie, Universitätsspital Zürich
| | - David Blum
- Kompetenzzentrum Palliative Care, Klinik für Radio-Onkologie, Universitätsspital Zürich
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17
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Blum D, Vagnildhaug OM, Stene GB, Maddocks M, Sørensen J, Laird BJA, Prado CM, Skeidsvoll Solheim T, Arends J, Hopkinson J, Jones CA, Schlögl M. Top Ten Tips Palliative Care Clinicians Should Know About Cachexia. J Palliat Med 2023; 26:1133-1138. [PMID: 36723498 DOI: 10.1089/jpm.2022.0598] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Cachexia is a multifactorial syndrome that is common in cancer and chronic disease. It is often underdiagnosed and therefore goes untreated or undertreated. Cachexia causes suffering across biopsychosocial domains and affects patients and their loved ones. In this article, a group of clinicians and researchers across cancer care, nutrition, and exercise offers tips about assessment, classification, and management of cachexia, with attention to its stage. The required multimodal management of cachexia mirrors well the interprofessional collaboration that is the mainstay of interdisciplinary palliative care and attention to screening, diagnosis, and management of cachexia is critical to maximize patients' quality of life.
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Affiliation(s)
- David Blum
- Competence Center for Palliative Care, Department of Radiation Oncology, University Hospital Zurich, and University of Zurich UZH, Zurich, Switzerland
| | - Ola Magne Vagnildhaug
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology and Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Guro Birgitte Stene
- Faculty of Medicine and Health Science, Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Jonas Sørensen
- Department of Biomedical Sciences, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology, Centre for Cancer and Organ Diseases, Rigshospitalet, Denmark
| | - Barry J A Laird
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
| | - Carla M Prado
- Division of Human Nutrition, Department of Agricultural, Food and Nutritional Science, University of Alberta, Alberta, Canada
| | - Tora Skeidsvoll Solheim
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Faculty of Medicine and Health Sciences, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jann Arends
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jane Hopkinson
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mathias Schlögl
- Division of Geriatric Medicine, Clinic Barmelweid, Barmelweid, Switzerland
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18
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Christ SM, Willmann J, Heesen P, Kühnis A, Tanadini-Lang S, Looman EL, Ahmadsei M, Blum D, Guckenberger M, Balermpas P, Hertler C, Andratschke N. Mortality during or shortly after Curative-Intent Radio-(Chemo-)Therapy over the last decade at a large comprehensive cancer center. Clin Transl Radiat Oncol 2023; 41:100645. [PMID: 37304171 PMCID: PMC10248528 DOI: 10.1016/j.ctro.2023.100645] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023] Open
Abstract
Background and Introduction Definitive surgical, oncological and radio-oncological treatment may result in significant morbidity and acute mortality. Mortality during or shortly after treatment in patients undergoing curative radio-(chemo)-therapy has not been studied systematically. We reviewed all curative radio-(chemo-)therapies at a large comprehensive cancer center over the last decade. Materials and Methods The institutional record was screened for patients who received curative-intent radio-(chemo-)therapy and deceased during or within 30 days after radiotherapy. Curative therapy was defined as prescribed dosage of EQD2 ≥ 50 Gy for radiotherapy alone and EQD2 ≥ 40 Gy for radiochemotherapies. Data on demographics, disease and treatment were assembled and assessed. Results Of 15,255 radiotherapy courses delivered at our center, 8,515 (56%) were performed with curative-intent. During or within 30 days after radio-(chemo-)therapy, 78 patients died (0.9% of all curative-intent courses). Median age of the deceased patients was 70 (IQR, 62-78) years, and 36% (28/78) were female. Median pre-therapeutic ECOG-PS was 1 (IQR, 0-2) and Charlson-Comorbidity-Index was 3+ (IQR, 2-3+). The most common primary malignancies were head and neck cancer (33/78; 42%) and central nervous system tumors (13/78; 17%). Peritherapeutic mortality varied by primary tumor, with the highest prevalence observed in head and neck and gastrointestinal cancer patients with 2.9% (33/1,144) and 2.4% (8/332), respectively. Among patients with known cause of death (34/78; 44%), tumor progression (12/34; 35%) and pulmonary complications/causes (11/34; 35%) were most common. On multivariable regression analysis, a worse ECOG-PS was associated with a relatively earlier peri-radiotherapeutic death (p = 0.014). Conclusion Mortality during or within 30 days of curative-intent radio-(chemo-)therapy was low, yet highest for head and neck (2.9%) and gastrointestinal tumor (2.4%) patients. Reasons for these findings include rapid tumor progression in some cancers, good patient selection, with ECOG-PS being most useful and predictive for avoiding early mortality. Future research should help refine predictors for peri-RT mortality.
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Affiliation(s)
- Sebastian M. Christ
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Philip Heesen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Anja Kühnis
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Esmeé L. Looman
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Maiwand Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - David Blum
- Competence Center for Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Caroline Hertler
- Competence Center for Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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19
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Seiler A, Pelz S, Wolfensberger F, Hertler C, Schettle M, Schlögl M, Peng-Keller S, Blum D. [End-of-Life Dreams and Visions]. Praxis (Bern 1994) 2023; 112:297-303. [PMID: 37042410 DOI: 10.1024/1661-8157/a004020] [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] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
End-of-Life Dreams and Visions Abstract: End-of life dreams and visions (ELDVs) or so-called death bed phenomena are transcendent experiences at the end of life that can be visual, auditory and/or kinesthetic, and often include visions of (deceased) loved ones, close friends or perceptions of places, travels, bright lights, or music. ELDVs typically occur weeks to hours prior to death and may comfort the dying and prepare spiritually for the end of life. Such experiences are frequently reported by dying individuals, the prevalence varying between 30 and 80%, but in the clinical context ELDVs are usually neglected, but interpreted and treated as pathological changes in the brain that result in, and from, delirium. This article tries to enlighten the occurrence, the contents and meanings of ELDVs in dying persons as opposed to delirium and night dreams using findings from the literature and from clinical observations. Implications of these conclusions for palliative care and the therapeutic relevance of ELDVs when taking care of dying individuals and their loved ones will also be discussed.
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Affiliation(s)
- Annina Seiler
- Klinik für Radio-Onkologie, Kompetenzzentrum Palliative Care, Universitätsspital Zürich, Zürich, Schweiz
| | - Stefan Pelz
- Klinik für Radio-Onkologie, Kompetenzzentrum Palliative Care, Universitätsspital Zürich, Zürich, Schweiz
| | - Fanny Wolfensberger
- Klinik für Radio-Onkologie, Kompetenzzentrum Palliative Care, Universitätsspital Zürich, Zürich, Schweiz
| | - Caroline Hertler
- Klinik für Radio-Onkologie, Kompetenzzentrum Palliative Care, Universitätsspital Zürich, Zürich, Schweiz
| | - Markus Schettle
- Klinik für Radio-Onkologie, Kompetenzzentrum Palliative Care, Universitätsspital Zürich, Zürich, Schweiz
| | - Mathias Schlögl
- Klinik für Geriatrie, Barmelweid, Schweiz
- Universitäre Klinik für Akutgeriatrie, Stadtspital Waid, Zürich, Schweiz
| | | | - David Blum
- Klinik für Radio-Onkologie, Kompetenzzentrum Palliative Care, Universitätsspital Zürich, Zürich, Schweiz
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20
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Launay A, Nebie O, Vijaya Shankara J, Lebouvier T, Buée L, Faivre E, Blum D. The role of adenosine A 2A receptors in Alzheimer's disease and tauopathies. Neuropharmacology 2023; 226:109379. [PMID: 36572177 DOI: 10.1016/j.neuropharm.2022.109379] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 11/13/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Adenosine signals through four distinct G protein-coupled receptors that are located at various synapses, cell types and brain areas. Through them, adenosine regulates neuromodulation, neuronal signaling, learning and cognition as well as the sleep-wake cycle, all strongly impacted in neurogenerative disorders, among which Alzheimer's Disease (AD). AD is a complex form of cognitive deficits characterized by two pathological hallmarks: extracellular deposits of aggregated β-amyloid peptides and intraneuronal fibrillar aggregates of hyper- and abnormally phosphorylated Tau proteins. Both lesions contribute to the early dysfunction and loss of synapses which are strongly associated to the development of cognitive decline in AD patients. The present review focuses on the pathophysiological impact of the A2ARs dysregulation observed in cognitive area from AD patients. We are reviewing not only evidence of the cellular changes in A2AR levels in pathological conditions but also describe what is currently known about their consequences in term of synaptic plasticity, neuro-glial miscommunication and memory abilities. We finally summarize the proof-of-concept studies that support A2AR as credible targets and the clinical interest to repurpose adenosine drugs for the treatment of AD and related disorders. This article is part of the Special Issue on "Purinergic Signaling: 50 years".
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Affiliation(s)
- Agathe Launay
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France; Alzheimer and Tauopathies, LabEx DISTALZ, France
| | - Ouada Nebie
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France; Alzheimer and Tauopathies, LabEx DISTALZ, France
| | - Jhenkruthi Vijaya Shankara
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France; Alzheimer and Tauopathies, LabEx DISTALZ, France
| | - Thibaud Lebouvier
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France; Alzheimer and Tauopathies, LabEx DISTALZ, France; CHU Lille, Memory Clinic, Lille, France
| | - Luc Buée
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France; Alzheimer and Tauopathies, LabEx DISTALZ, France
| | - Emilie Faivre
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France; Alzheimer and Tauopathies, LabEx DISTALZ, France
| | - David Blum
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France; Alzheimer and Tauopathies, LabEx DISTALZ, France.
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21
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Rao SM, Galioto R, Sokolowski M, Pierce M, Penn L, Sturtevant A, Skugor B, Anstead B, Leverenz JB, Schindler D, Blum D, Alberts JL, Posk L. Cleveland Clinic Cognitive Battery (C3B): Normative, Reliability, and Validation Studies of a Self-Administered Computerized Tool for Screening Cognitive Dysfunction in Primary Care. J Alzheimers Dis 2023; 92:1051-1066. [PMID: 36847000 PMCID: PMC10116145 DOI: 10.3233/jad-220929] [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] [Indexed: 02/23/2023]
Abstract
BACKGROUND The self-administered iPad-based Cleveland Clinic Cognitive Battery (C3B) was designed specifically for the efficient screening of cognitive functioning of older adults in a primary care setting. OBJECTIVE 1) Generate regression-based norms from healthy participants to enable demographic corrections to facilitate clinical interpretation; 2) estimate test-retest reliability and practice effects; 3) examine ability to discriminate mild cognitive impairment (MCI) from healthy aging; 4) d etermine validity of screening in a distracting clinical environment; and 5) determine completion rates and patient satisfaction in a primary care setting. METHODS Study 1 (S1) recruited a stratified sample of 428 healthy adults, ages 18-89, to generate regression-based equations. S2 assessed 2-week test-retest reliability and practice effects in 30 healthy elders. S3 recruited 30 MCI patients and 30 demographically-matched healthy controls. In S4, 30 healthy elders self-administered the C3B in a distracting environment and in a quiet private room in counterbalanced order. In a demonstration project, 470 consecutive primary care patients were administered the C3B as part of routine clinical care (S5). RESULTS C3B performance was primarily influenced by age, education, and race (S1), had acceptably high test-retest reliability and minimal practice effects (S2), discriminated MCI from healthy controls (S3), was not negatively impacted by a distracting clinical environment (S4), had high completion rates (>92%) and positive ratings from primary care patients (S5). CONCLUSION The C3B is a computerized cognitive screening tool that is reliable, validated, self-administered, and is conducive to integration into a busy primary care clinical workflow for detecting MCI, early Alzheimer's disease, and other related dementias.
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Affiliation(s)
- Stephen M Rao
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rachel Galioto
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Megan Sokolowski
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Madelyn Pierce
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Penn
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anna Sturtevant
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Blazenka Skugor
- Twinsburg Family Health and Surgery Center, Internal Medicine and Geriatrics Department, Twinsburg, OH, USA
| | - Brent Anstead
- Family Medicine, Hillcrest Hospital, Cleveland Clinic, Mayfield Heights, OH, USA
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - David Schindler
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Qr8 Health, Inc., Cleveland, OH, USA
| | | | - Jay L Alberts
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lori Posk
- Health and Wellness Center, Cleveland Clinic, Vero Beach, FL, USA
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22
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Ngo P, Cossa JP, Gueroult S, Blum D, Pélissier E. Some Additional Data That Might Be Useful for Diastasis Recti Assessment. J Abdom Wall Surg 2023; 2:10923. [PMID: 38312411 PMCID: PMC10831680 DOI: 10.3389/jaws.2023.10923] [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] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/24/2023] [Indexed: 02/06/2024]
Abstract
Background: Diastasis recti (DR) is characterized by separation of both rectus muscles and protrusion of the median bulging, but besides median bulging DR can also entail global abdominal bulging. On other note, DR classification is based on the width of divarication, but measurement values are different at rest and at effort due to muscle contraction. Aim of the study is to provide additional features concerning the type of bulging and the width of divarication. Methods: Findings were retrospectively drawn from the data prospectively collected in the records of a continuous cohort of 105 patients (89 females, 16 males) referred for diastasis and concomitant ventral hernia repair. Results: There was a median bulging alone in 45 (42.9%) cases, a global bulging alone in 18 (17.1%) cases, both types combined in 37 (35.2%) cases and no bulging in 5 (4.8%). On 55 patients with a global bulging, 51 were females. Tape measurements values of DR width were closer to the values measured on the CT scan at leg raise than at rest. The differences were significant at rest as well as at leg raise. Though the difference at rest was highly significant (p = 0.000), the difference at effort was not far from being not significant (p = 0.049). Conclusion: Besides median bulging, presence or absence of the global bulging should be included in DR assessment. The difference between width of divarication at rest and on exertion raises the question of which value should be used for DR classification. The question is worth being debated.
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Affiliation(s)
- P. Ngo
- Institut de la Hernie, Paris, France
| | | | | | - D. Blum
- Établissement Français du Sang de Franche Comté, Besançon, France
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23
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Domeisen Benedetti F, Fringer A, Attoun-Knobel S, Schmidt EB, Strasser F, Schlögl M, Blum D. Development of a tool for palliative care needs assessment and intervention: mixed methods research at a Swiss tertiary oncology clinic. Ann Palliat Med 2023:apm-22-994. [PMID: 37038058 DOI: 10.21037/apm-22-994] [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] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
BACKGROUND Palliative care interventions improve quality-of-life for advanced cancer patients and their caregivers. The frequency and quality of service provision could be improved by a clinical tool that helps oncology professionals to assess unmet needs for palliative care interventions and to structure the interventions delivered. This paper aims to answer the following research question: what do oncology professionals and cancer patients view as important elements in a clinical tool for assessing unmet palliative care needs? Based on the feedback from professionals and patients, we developed and refined an intervention-focused clinical tool for use in cancer care. METHODS This study used a prospective convergent mixed methods design and was carried out at a single tertiary hospital in Switzerland. Healthcare professionals participated in focus groups (n=29) and a Delphi survey (n=73). Patients receiving palliative care were interviewed (n=17). Purposive sampling was used to achieve maximal variation in participant response. Inductive content analysis and descriptive statistics were used to analyze focus group discussions, open-ended survey questions and interview data. Descriptive statistics were used for analyzing quantitative survey items and interviewee characteristics. RESULTS Focus groups and Delphi surveys showed that seven key palliative care interventions were important to oncology professionals. They also valued a tool that could be used by doctors, nurses, or other professionals. Participants did not agree about the best timepoint for assessment. Two versions of a pilot clinical tool were tested in patient interviews. Interviews highlighted the divergent patient needs that must be accommodated in clinical practice. Patients provided confirmation that a clinical tool would be helpful to them. CONCLUSIONS This paper reports on research carried out to understand what elements are most important in a tool that helps oncology professionals to identify patients' unmet needs and provide tailored palliative care interventions. This study demonstrated that professionals and patients alike are interested in a clinical tool. Responses from oncology healthcare professionals helped to identify relevant palliative care interventions, and patients provided constructive input used in designing a tool for use in clinical interactions.
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Affiliation(s)
- Franzisca Domeisen Benedetti
- Institute for Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland; Clinic for Medical Oncology and Hematology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - André Fringer
- Institute for Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Suzanne Attoun-Knobel
- Clinic for Medical Oncology and Hematology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland; Cancer League of Eastern Switzerland, St. Gallen, Switzerland
| | - Ellie B Schmidt
- Clinic for Medical Oncology and Hematology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland; Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Florian Strasser
- Clinic for Medical Oncology and Hematology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland; University of Bern, Bern, Switzerland
| | - Mathias Schlögl
- Division of Geriatric Medicine, Clinic Barmelweid, Barmelweid, Switzerland; University Clinic for Acute Geriatric Care, City Hospital Waid, Zurich, Switzerland
| | - David Blum
- Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
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24
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Altalib H, Grinnell T, Cantu D, Ikedo F, Vieira M, Zhang Y, Blum D. Psychiatric adverse events in three phase III trials of eslicarbazepine acetate for focal seizures. Epilepsia Open 2022; 7:616-632. [PMID: 35908275 PMCID: PMC9712463 DOI: 10.1002/epi4.12635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/28/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Eslicarbazepine acetate (ESL) is a once-daily (QD), oral anti-seizure medication for the treatment of focal (partial-onset) seizures. Here, we evaluate risk factors for the development of psychiatric treatment-emergent adverse events (TEAEs) in clinical trials of adjunctive ESL in adults with focal seizures. METHODS This post-hoc analysis evaluated data pooled from three Phase III, randomized, double-blind, placebo-controlled trials (BIA-2093-301, -302, -304). After an 8-week baseline period, patients were randomized equally to receive placebo, ESL 400 mg (not reported here), 800 mg, or 1200 mg QD (up to 2-week titration; 12-week maintenance; optional open-label extension [OLE]). Incidences of psychiatric TEAEs were evaluated according to three separate criteria: medical history of psychiatric disorders (yes/no); baseline use of psychotropic drugs (yes/no); Montgomery-Åsberg Depression Rating Scale (MADRS) score at baseline (0-6: normal; 7-19: mild depression; 20-34: moderate depression). RESULTS The analysis populations comprised 1251 patients for the controlled study period and 1137 patients for the 1-year OLE. Psychiatric TEAE incidence was similar between patients taking ESL and placebo in the controlled and OLE study periods and was not related to ESL dose. Psychiatric TEAEs generally occurred more frequently in patients with a medical history of psychiatric disorders, using psychotropic drugs, or with depressive symptoms than in those without a history, not using psychotropic drugs, or with no depressive symptoms. Depression and anxiety were the most frequently reported psychiatric TEAEs. SIGNIFICANCE Overall, in clinical trials of ESL in adults with focal seizures, incidences of psychiatric events were not statistically different between patients taking ESL and placebo, were not related to ESL dose, and generally occurred more frequently in patients with baseline psychiatric symptoms or a history of psychiatric disorders. Long-term exposure to ESL was not associated with a marked increase in the incidence of psychiatric TEAEs.
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Affiliation(s)
- Hamada Altalib
- Department of NeurologyYale School of MedicineNew HavenConnecticutUSA
| | - Todd Grinnell
- Sunovion Pharmaceuticals Inc.MarlboroughMassachusettsUSA
| | - David Cantu
- Sunovion Pharmaceuticals Inc.Fort LeeNew JerseyUSA
| | - Fábio Ikedo
- Pharmacovigilance ComplianceBIAL – Portela & Cª, S.A.São Mamede do CoronadoPortugal
| | - Mariana Vieira
- Pharmacovigilance ComplianceBIAL – Portela & Cª, S.A.São Mamede do CoronadoPortugal
| | - Yi Zhang
- Sunovion Pharmaceuticals Inc.MarlboroughMassachusettsUSA
| | - David Blum
- Sunovion Pharmaceuticals Inc.MarlboroughMassachusettsUSA
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25
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Dewaeles E, Carvalho K, Fellah S, Sim J, Boukrout N, Caillierez R, Ramakrishnan H, Van der Hauwaert C, Vijaya Shankara J, Martin N, Massri N, Launay A, Folger JK, de Schutter C, Larrue R, Loison I, Goujon M, Jung M, Le Gras S, Gomez-Murcia V, Faivre E, Lemaire J, Garat A, Beauval N, Maboudou P, Gnemmi V, Gibier JB, Buée L, Abbadie C, Glowacki F, Pottier N, Perrais M, Cunha RA, Annicotte JS, Laumet G, Blum D, Cauffiez C. Istradefylline protects from cisplatin-induced nephrotoxicity and peripheral neuropathy while preserving cisplatin antitumor effects. J Clin Invest 2022; 132:152924. [PMID: 36377661 PMCID: PMC9663157 DOI: 10.1172/jci152924] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Cisplatin is a potent chemotherapeutic drug that is widely used in the treatment of various solid cancers. However, its clinical effectiveness is strongly limited by frequent severe adverse effects, in particular nephrotoxicity and chemotherapy-induced peripheral neuropathy. Thus, there is an urgent medical need to identify novel strategies that limit cisplatin-induced toxicity. In the present study, we show that the FDA-approved adenosine A2A receptor antagonist istradefylline (KW6002) protected from cisplatin-induced nephrotoxicity and neuropathic pain in mice with or without tumors. Moreover, we also demonstrate that the antitumoral properties of cisplatin were not altered by istradefylline in tumor-bearing mice and could even be potentiated. Altogether, our results support the use of istradefylline as a valuable preventive approach for the clinical management of patients undergoing cisplatin treatment.
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Affiliation(s)
- Edmone Dewaeles
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France.,University of Lille, INSERM, CHU Lille, UMR-S1172 LilNCog, Lille Neuroscience and Cognition, Lille, France
| | - Kévin Carvalho
- University of Lille, INSERM, CHU Lille, UMR-S1172 LilNCog, Lille Neuroscience and Cognition, Lille, France.,Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
| | - Sandy Fellah
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Jaewon Sim
- Department of Physiology, Michigan State University, East Lansing, Michigan, USA.,Cell and Molecular Biology Graduate program, Michigan State University, East Lansing, Michigan, USA
| | - Nihad Boukrout
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Raphaelle Caillierez
- University of Lille, INSERM, CHU Lille, UMR-S1172 LilNCog, Lille Neuroscience and Cognition, Lille, France.,Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
| | | | - Cynthia Van der Hauwaert
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France.,CHU Lille, Département de la Recherche en Santé, Lille, France
| | - Jhenkruthi Vijaya Shankara
- University of Lille, INSERM, CHU Lille, UMR-S1172 LilNCog, Lille Neuroscience and Cognition, Lille, France.,Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
| | - Nathalie Martin
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Noura Massri
- Department of Physiology, Michigan State University, East Lansing, Michigan, USA.,Cell and Molecular Biology Graduate program, Michigan State University, East Lansing, Michigan, USA
| | - Agathe Launay
- University of Lille, INSERM, CHU Lille, UMR-S1172 LilNCog, Lille Neuroscience and Cognition, Lille, France.,Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
| | - Joseph K. Folger
- Department of Physiology, Michigan State University, East Lansing, Michigan, USA
| | - Clémentine de Schutter
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Romain Larrue
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France.,CHU Lille, Service de Toxicologie et Génopathies, Lille, France
| | - Ingrid Loison
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Marine Goujon
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Matthieu Jung
- University of Strasbourg, CNRS UMR 7104, INSERM U1258 – GenomEast Platform – IGBMC – Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch, France
| | - Stéphanie Le Gras
- University of Strasbourg, CNRS UMR 7104, INSERM U1258 – GenomEast Platform – IGBMC – Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch, France
| | - Victoria Gomez-Murcia
- University of Lille, INSERM, CHU Lille, UMR-S1172 LilNCog, Lille Neuroscience and Cognition, Lille, France.,Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
| | - Emilie Faivre
- University of Lille, INSERM, CHU Lille, UMR-S1172 LilNCog, Lille Neuroscience and Cognition, Lille, France.,Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
| | - Julie Lemaire
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Anne Garat
- CHU Lille, Service de Toxicologie et Génopathies, Lille, France.,University of Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPact de l’Environnement Chimique sur la Santé Humaine (IMPECS), Lille, France
| | - Nicolas Beauval
- CHU Lille, Service de Toxicologie et Génopathies, Lille, France.,University of Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPact de l’Environnement Chimique sur la Santé Humaine (IMPECS), Lille, France
| | - Patrice Maboudou
- CHU Lille, Service de Biochimie Automatisée, Protéines et Biologie Prédictive, Lille, France
| | - Viviane Gnemmi
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France.,CHU Lille, Service d’Anatomopathologie, Lille, France
| | - Jean-Baptiste Gibier
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France.,CHU Lille, Service d’Anatomopathologie, Lille, France
| | - Luc Buée
- University of Lille, INSERM, CHU Lille, UMR-S1172 LilNCog, Lille Neuroscience and Cognition, Lille, France.,Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
| | - Corinne Abbadie
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Francois Glowacki
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France.,CHU Lille, Service de Néphrologie, Lille, France
| | - Nicolas Pottier
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France.,CHU Lille, Service de Toxicologie et Génopathies, Lille, France
| | - Michael Perrais
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Rodrigo A. Cunha
- CNC, Center for Neuroscience and Cell Biology, University of Coimbra, Rua Larga, Faculty of Medicine Building-Polo 1, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Jean-Sébastien Annicotte
- University of Lille, INSERM, CNRS, CHU Lille, Institut Pasteur de Lille, INSERM U1283-UMR8199 – EGID, Lille, France.,University of Lille, INSERM, CHU Lille, Institut Pasteur de Lille, RID-AGE-Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Geoffroy Laumet
- Department of Physiology, Michigan State University, East Lansing, Michigan, USA
| | - David Blum
- University of Lille, INSERM, CHU Lille, UMR-S1172 LilNCog, Lille Neuroscience and Cognition, Lille, France.,Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
| | - Christelle Cauffiez
- University of Lille, INSERM, CNRS, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
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26
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French JA, Cleary E, Dlugos D, Farfel G, Farrell K, Gidal B, Grzeskowiak CL, Gurrell R, Harden C, Stalvey TJ, Tsai J, Wirrell EC, Blum D, Fountain N. Considerations for determining the efficacy of new antiseizure medications in children age 1 month to younger than 2 years. Epilepsia 2022; 63:2664-2670. [PMID: 35835554 PMCID: PMC9804346 DOI: 10.1111/epi.17366] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Drug treatment for children with epilepsy should, ideally, be governed by evidence from adequate and well-controlled clinical studies. However, these studies are difficult to conduct, and so direct evidence supporting the informed use of specific drugs is often lacking. The Research Roundtable for Epilepsy (RRE) met in 2020 to align on an approach to therapy development for focal seizures in children age 1 month <2 years of age. METHODS The RRE reviewed the regulatory landscape, epidemiology, seizure semiology, antiseizure medicine pharmacology, and safety issues applicable to this population. RESULTS After reviewing evidence, the conclusion was that pediatric efficacy trials would be impracticable to conduct but a waiver of the regulatory requirement to conduct any study would lead to an absence of information to guide dosing in a critical population. Review of available data and discussion of RRE attendees led to the conclusion that the requirements for extrapolation of efficacy from older children down to infants from age 1 month to <2 years old appeared to be met. After the RRE, the US Food and Drug Administration (FDA) approved brivaracetam for use in children with focal epilepsy above the age of 1 month in August 2021 and lacosamide in October 2021, both based on the principle of extrapolation from data in older children. SIGNIFICANCE These recommendations should result in more rapid accessibility of antiseizure medications for infants.
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Affiliation(s)
| | | | - Dennis Dlugos
- Departments of Neurology and PediatricsChildren's Hospital of Philadelphia, PerelmanPhiladelphiaPennsylvaniaUSA
| | - Gail Farfel
- Zogenix, a UCB CompanyEmeryvilleCaliforniaUSA
| | - Kathleen Farrell
- Research and New Therapies ProgramEpilepsy Foundation of AmericaMarylandUSA
| | - Barry Gidal
- University of Wisconsin School of PharmacyMadisonWisconsinUSA
| | | | | | - Cynthia Harden
- Clinical Development DivisionXenon Pharmaceuticals Inc.BurnabyBritish ColumbiaCanada
| | | | | | - Elaine C. Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | | | - Nathan Fountain
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
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27
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Stocchi F, Peckham EL, De Pandis MF, Sciarappa K, Kleiman R, Agbo F, Olanow CW, Blum D, Navia B. A Randomized Thorough QT Study of Apomorphine Sublingual Film in Patients With Parkinson's Disease. Clin Pharmacol Drug Dev 2022; 11:1068-1077. [PMID: 35899977 PMCID: PMC9541463 DOI: 10.1002/cpdd.1147] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/29/2022] [Indexed: 01/26/2023]
Abstract
A randomized thorough QT study was conducted to assess the effects of apomorphine sublingual film (SL-APO) on corrected QT interval (QTc) and other cardiac conduction parameters in patients with Parkinson's disease (PD) and "OFF" episodes. Patients were titrated to an SL-APO dose that resulted in FULL "ON," followed by up to two additional doses (maximum 60 mg), then randomized at the highest tolerated dose to a treatment sequence of SL-APO, placebo, and moxifloxacin (400 mg, positive control) in a three-way crossover design. Changes from baseline in time-matched, placebo-adjusted Fridericia-corrected QTc interval (ΔΔQTcF) and Bazett-corrected QTc interval (ΔΔQTcB) were analyzed from postdose electrocardiograms. Forty patients were randomized and received single doses of study treatments. Upper limits of 90% confidence intervals (CIs) for ΔΔQTcF of SL-APO were below the 10-millisecond regulatory threshold at all prespecified timepoints, demonstrating no clinically significant effect on QTcF. Lower limits of 90% CIs for ΔΔQTcF of moxifloxacin exceeded the 5-millisecond regulatory threshold at all timepoints up to 3 hours, confirming assay sensitivity. SL-APO had no clinically meaningful effects on QTcB, PR/QRS intervals, heart rate, or electrocardiogram-derived morphology (EudraCT identifier: 2016-001762-29; ClinicalTrials.gov identifier: NCT03187301).
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Affiliation(s)
- Fabrizio Stocchi
- University San Raffaele and Institute for Research and Medical Care, IRCCS San Raffaele PisanaRomeItaly
| | | | | | - Ken Sciarappa
- Sunovion Pharmaceuticals Inc.MarlboroughMassachusettsUSA
| | | | - Felix Agbo
- Sunovion Pharmaceuticals Inc.TeaneckNew JerseyUSA
| | - C. Warren Olanow
- Mount Sinai School of MedicineNew YorkNew YorkUSA,ClintrexSarasotaFloridaUSA
| | - David Blum
- Sunovion Pharmaceuticals Inc.MarlboroughMassachusettsUSA
| | - Bradford Navia
- Sunovion Pharmaceuticals Inc.MarlboroughMassachusettsUSA
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28
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Bertin E, Martinez A, Fayoux A, Carvalho K, Carracedo S, Fernagut PO, Koch-Nolte F, Blum D, Bertrand SS, Boué-Grabot E. Increased surface P2X4 receptors by mutant SOD1 proteins contribute to ALS pathogenesis in SOD1-G93A mice. Cell Mol Life Sci 2022; 79:431. [PMID: 35852606 PMCID: PMC9296432 DOI: 10.1007/s00018-022-04461-5] [Citation(s) in RCA: 8] [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] [Received: 03/29/2022] [Revised: 05/27/2022] [Accepted: 06/30/2022] [Indexed: 12/26/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal motoneuron (MN) disease characterized by protein misfolding and aggregation leading to cellular degeneration. So far neither biomarker, nor effective treatment has been found. ATP signaling and P2X4 receptors (P2X4) are upregulated in various neurodegenerative diseases. Here we show that several ALS-related misfolded proteins including mutants of SOD1 or TDP-43 lead to a significant increase in surface P2X4 receptor density and function in vitro. In addition, we demonstrate in the spinal the cord of SOD1-G93A (SOD1) mice that misfolded SOD1-G93A proteins directly interact with endocytic adaptor protein-2 (AP2); thus, acting as negative competitors for the interaction between AP2 and P2X4, impairing constitutive P2X4 endocytosis. The higher P2X4 surface density was particularly observed in peripheral macrophages of SOD1 mice before the onset and during the progression of ALS symptoms positioning P2X4 as a potential early biomarker for ALS. P2X4 expression was also upregulated in spinal microglia of SOD1 mice during ALS and affect microglial inflammatory responses. Importantly, we report using double transgenic SOD1 mice expressing internalization-defective P2X4mCherryIN knock-in gene or invalidated for the P2X4 gene that P2X4 is instrumental for motor symptoms, ALS progression and survival. This study highlights the role of P2X4 in the pathophysiology of ALS and thus its potential for the development of biomarkers and treatments. We also decipher the molecular mechanism by which misfolded proteins related to ALS impact P2X4 trafficking at early pathological stage in cells expressing-P2X4.
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Affiliation(s)
- Eléonore Bertin
- Univ. Bordeaux, CNRS, IMN, UMR 5293, 33000, Bordeaux, France
| | - Audrey Martinez
- Univ. Bordeaux, CNRS, IMN, UMR 5293, 33000, Bordeaux, France
| | - Anne Fayoux
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, 33000, Bordeaux, France
| | - Kevin Carvalho
- Univ. Lille, Inserm, CHU Lille, U1172, LilNCog, Lille, France.,"Alzheimer & Tauopathies", LabEx DISTALZ, 59000, Lille, France
| | - Sara Carracedo
- Univ. Bordeaux, CNRS, IMN, UMR 5293, 33000, Bordeaux, France
| | | | - Friedrich Koch-Nolte
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - David Blum
- Univ. Lille, Inserm, CHU Lille, U1172, LilNCog, Lille, France.,"Alzheimer & Tauopathies", LabEx DISTALZ, 59000, Lille, France
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29
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Delila L, Nebie O, Le NTN, Barro L, Chou M, Wu Y, Watanabe N, Takahara M, Buée L, Blum D, Devos D, Burnouf T. Neuroprotective activity of a virus-safe nanofiltered human platelet lysate depleted of extracellular vesicles in Parkinson's disease and traumatic brain injury models. Bioeng Transl Med 2022; 8:e10360. [PMID: 36684076 PMCID: PMC9842020 DOI: 10.1002/btm2.10360] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 02/21/2022] [Revised: 05/15/2022] [Accepted: 06/07/2022] [Indexed: 01/25/2023] Open
Abstract
Brain administration of human platelet lysates (HPL) is a potential emerging biotherapy of neurodegenerative and traumatic diseases of the central nervous system. HPLs being prepared from pooled platelet concentrates, thereby increasing viral risks, manufacturing processes should incorporate robust virus-reduction treatments. We evaluated a 19 ± 2-nm virus removal nanofiltration process using hydrophilic regenerated cellulose hollow fibers on the properties of a neuroprotective heat-treated HPL (HPPL). Spiking experiments demonstrated >5.30 log removal of 20-22-nm non-enveloped minute virus of mice-mock particles using an immuno-quantitative polymerase chain reaction assay. The nanofiltered HPPL (NHPPL) contained a range of neurotrophic factors like HPPL. There was >2 log removal of extracellular vesicles (EVs), associated with decreased expression of pro-thrombogenic phosphatidylserine and procoagulant activity. LC-MS/MS proteomics showed that ca. 80% of HPPL proteins, including neurotrophins, cytokines, and antioxidants, were still found in NHPPL, whereas proteins associated with some infections and cancer-associated pathways, pro-coagulation and EVs, were removed. NHPPL maintained intact neuroprotective activity in Lund human mesencephalic dopaminergic neuron model of Parkinson's disease (PD), stimulated the differentiation of SH-SY5Y neuronal cells and showed preserved anti-inflammatory function upon intranasal administration in a mouse model of traumatic brain injury (TBI). Therefore, nanofiltration of HPL is feasible, lowers the viral, prothrombotic and procoagulant risks, and preserves the neuroprotective and anti-inflammatory properties in neuronal pre-clinical models of PD and TBI.
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Affiliation(s)
- Liling Delila
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical EngineeringTaipei Medical UniversityTaipeiTaiwan
| | - Ouada Nebie
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical EngineeringTaipei Medical UniversityTaipeiTaiwan,Univ. Lille, Inserm, CHU‐Lille, U1172, Lille Neuroscience & CognitionLilleFrance,Alzheimer & TauopathiesLabex DISTALZLilleFrance
| | - Nhi Thao Ngoc Le
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical EngineeringTaipei Medical UniversityTaipeiTaiwan
| | - Lassina Barro
- International PhD Program in Biomedical Engineering, College of Biomedical EngineeringTaipei Medical UniversityTaipeiTaiwan,Present address:
National Center of Blood TransfusionOuagadougouBurkina Faso
| | - Ming‐Li Chou
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical EngineeringTaipei Medical UniversityTaipeiTaiwan,Present address:
Institute of Clinical Medicine, National Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Yu‐Wen Wu
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical EngineeringTaipei Medical UniversityTaipeiTaiwan
| | | | | | - Luc Buée
- Univ. Lille, Inserm, CHU‐Lille, U1172, Lille Neuroscience & CognitionLilleFrance,Alzheimer & TauopathiesLabex DISTALZLilleFrance,NeuroTMULilleLille Neuroscience & CognitionLilleFrance
| | - David Blum
- Univ. Lille, Inserm, CHU‐Lille, U1172, Lille Neuroscience & CognitionLilleFrance,Alzheimer & TauopathiesLabex DISTALZLilleFrance,NeuroTMULilleLille Neuroscience & CognitionLilleFrance
| | - David Devos
- Univ. Lille, Inserm, CHU‐Lille, U1172, Lille Neuroscience & CognitionLilleFrance,NeuroTMULilleLille Neuroscience & CognitionLilleFrance
| | - Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical EngineeringTaipei Medical UniversityTaipeiTaiwan,International PhD Program in Biomedical Engineering, College of Biomedical EngineeringTaipei Medical UniversityTaipeiTaiwan,NeuroTMULilleTaipei Medical UniversityTaipeiTaiwan,International PhD Program in Cell Therapy and Regeneration MedicineTaipei Medical UniversityTaipeiTaiwan,PhD Program in Graduate Institute of Mind Brain and Consciousness, College of Humanities and Social SciencesTaipei Medical UniversityTaipeiTaiwan,Neuroscience Research CenterTaipei Medical UniversityTaipeiTaiwan
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30
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Wang LH, Lin CY, Lin YM, Buée L, Sergeant N, Blum D, Chern Y, Wang GS. Calpain-2 Mediates MBNL2 Degradation and a Developmental RNA Processing Program in Neurodegeneration. J Neurosci 2022; 42:5102-5114. [PMID: 35606145 PMCID: PMC9233439 DOI: 10.1523/jneurosci.2006-21.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/24/2022] [Accepted: 05/03/2022] [Indexed: 12/24/2022] Open
Abstract
Increasing loss of structure and function of neurons and decline in cognitive function is commonly seen during the progression of neurologic diseases, although the causes and initial symptoms of individual diseases are distinct. This observation suggests a convergence of common degenerative features. In myotonic dystrophy type 1 (DM1), the expression of expanded CUG RNA induces neurotransmission dysfunction before axon and dendrite degeneration and reduced MBNL2 expression associated with aberrant alternative splicing. The role of loss of function of MBNL2 in the pathogenesis of neurodegeneration and the causal mechanism of neurodegeneration-reduced expression of MBNL2 remain elusive. Here, we show that increased MBNL2 expression is associated with neuronal maturation and required for neuronal morphogenesis and the fetal to adult developmental transition of RNA processing. Neurodegenerative conditions including NMDA receptor (NMDAR)-mediated excitotoxicity and dysregulated calcium homeostasis triggered nuclear translocation of calpain-2, thus resulting in MBNL2 degradation and reversal of MBNL2-regulated RNA processing to developmental patterns. Nuclear expression of calpain-2 resembled its developmental pattern and was associated with MBNL2 degradation. Knock-down of calpain-2 expression or inhibition of calpain-2 nuclear translocation prevented neurodegeneration-reduced MBNL2 expression and dysregulated RNA processing. Increased calpain-2 nuclear translocation associated with reduced MBNL2 expression and aberrant RNA processing occurred in models for DM1 and Alzheimer's disease (AD) including EpA960/CaMKII-Cre mice of either sex and female APP/PS1 and THY-Tau22 mice. Our results identify a regulatory mechanism for MBNL2 downregulation and suggest that calpain-2-mediated MBNL2 degradation accompanied by re-induction of a developmental RNA processing program may be a converging pathway to neurodegeneration.SIGNIFICANCE STATEMENT Neurologic diseases share many features during disease progression, such as cognitive decline and brain atrophy, which suggests a common pathway for developing degenerative features. Here, we show that the neurodegenerative conditions glutamate-induced excitotoxicity and dysregulated calcium homeostasis induced translocation of the cysteine protease calpain-2 into the nucleus, resulting in MBNL2 degradation and reversal of MBNL2-regulated RNA processing to an embryonic pattern. Knock-down or inhibition of nuclear translocation of calpain-2 prevented MBNL2 degradation and maintained MBNL2-regulated RNA processing in the adult pattern. Models of myotonic dystrophy and Alzheimer's disease (AD) also showed calpain-2-mediated MBNL2 degradation and a developmental RNA processing program. Our studies suggest MBNL2 function disrupted by calpain-2 as a common pathway, thus providing an alternative therapeutic strategy for neurodegeneration.
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Affiliation(s)
- Lee-Hsin Wang
- Taiwan International Graduate Program in Interdisciplinary Neuroscience, National Yang Ming Chiao Tung University and Academia Sinica, Taipei, 11529, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 11529, Taiwan
| | - Chien-Yu Lin
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 11529, Taiwan
| | - Yu-Mei Lin
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 11529, Taiwan
| | - Luc Buée
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-S1172, "Alzheimer & Tauopathies", University of Lille, 59045, Lille, France
| | - Nicolas Sergeant
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-S1172, "Alzheimer & Tauopathies", University of Lille, 59045, Lille, France
| | - David Blum
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-S1172, "Alzheimer & Tauopathies", University of Lille, 59045, Lille, France
| | - Yijuang Chern
- Taiwan International Graduate Program in Interdisciplinary Neuroscience, National Yang Ming Chiao Tung University and Academia Sinica, Taipei, 11529, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 11529, Taiwan
- Program in Molecular Medicine, National Yang Ming Chiao Tung University and Academia Sinica, Taipei, 11529, Taiwan
| | - Guey-Shin Wang
- Taiwan International Graduate Program in Interdisciplinary Neuroscience, National Yang Ming Chiao Tung University and Academia Sinica, Taipei, 11529, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 11529, Taiwan
- Program in Molecular Medicine, National Yang Ming Chiao Tung University and Academia Sinica, Taipei, 11529, Taiwan
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Paiva I, Cellai L, Meriaux C, Poncelet L, Nebie O, Saliou JM, Lacoste AS, Papegaey A, Drobecq H, Le Gras S, Schneider M, Malik EM, Müller CE, Faivre E, Carvalho K, Gomez-Murcia V, Vieau D, Thiroux B, Eddarkaoui S, Lebouvier T, Schueller E, Tzeplaeff L, Grgurina I, Seguin J, Stauber J, Lopes LV, Buee L, Buée-Scherrer V, Cunha RA, Ait-Belkacem R, Sergeant N, Annicotte JS, Boutillier AL, Blum D. Caffeine intake exerts dual genome-wide effects on hippocampal metabolism and learning-dependent transcription. J Clin Invest 2022; 132:149371. [PMID: 35536645 PMCID: PMC9197525 DOI: 10.1172/jci149371] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/05/2022] [Indexed: 12/01/2022] Open
Abstract
Caffeine is the most widely consumed psychoactive substance in the world. Strikingly, the molecular pathways engaged by its regular consumption remain unclear. We herein addressed the mechanisms associated with habitual (chronic) caffeine consumption in the mouse hippocampus using untargeted orthogonal omics techniques. Our results revealed that chronic caffeine exerts concerted pleiotropic effects in the hippocampus at the epigenomic, proteomic, and metabolomic levels. Caffeine lowered metabolism-related processes (e.g., at the level of metabolomics and gene expression) in bulk tissue, while it induced neuron-specific epigenetic changes at synaptic transmission/plasticity-related genes and increased experience-driven transcriptional activity. Altogether, these findings suggest that regular caffeine intake improves the signal-to-noise ratio during information encoding, in part through fine-tuning of metabolic genes, while boosting the salience of information processing during learning in neuronal circuits.
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Affiliation(s)
- Isabel Paiva
- Laboratoire de Neuroscience Cognitives et Adaptatives, University of Strasbourg, CNRS, UMR7364, Strasbourg, France
| | | | - Céline Meriaux
- Alzheimer and Tauopathies, Inserm UMR-S1172, Lille, France
| | | | - Ouada Nebie
- Alzheimer and Tauopathies, Inserm UMR-S1172, Lille, France
| | | | | | | | - Hervé Drobecq
- CIIL - Centre d'Infection et d'Immunité de Lille (CIIL), Inserm 1019, Lille, France
| | - Stéphanie Le Gras
- GenomEast Platform, University Strasbourg, CNRS UMR 7104, Inserm U1258, Lille, France
| | - Marion Schneider
- PharmaCenter Bonn, Pharmaceutical Institute, University of Bonn, Bonn, Germany
| | - Enas M Malik
- PharmaCenter Bonn, Pharmaceutical Institute, University of Bonn, Bonn, Germany
| | - Christa E Müller
- PharmaCenter Bonn, Pharmaceutical Institute, University of Bonn, Bonn, Germany
| | - Emilie Faivre
- Alzheimer and Tauopathies, Inserm UMR-S1172, Lille, France
| | - Kevin Carvalho
- Alzheimer and Tauopathies, Inserm UMR-S1172, Lille, France
| | | | - Didier Vieau
- Alzheimer and Tauopathies, Inserm UMR-S1172, Lille, France
| | - Bryan Thiroux
- Alzheimer and Tauopathies, Inserm UMR-S1172, Lille, France
| | | | | | - Estelle Schueller
- Laboratoire de Neuroscience Cognitives et Adaptatives, Université de Strasbourg, Strasbourg, France
| | - Laura Tzeplaeff
- Laboratoire de Neuroscience Cognitives et Adaptatives, University of Strasbourg, Strasbourg, France
| | - Iris Grgurina
- Laboratoire de Neuroscience Cognitives et Adaptatives, Université de Strasbourg, Strasbourg, France
| | - Jonathan Seguin
- Laboratoire de Neuroscience Cognitives et Adaptatives, Université de Strasbourg, Strasbourg, France
| | | | - Luisa V Lopes
- Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal
| | - Luc Buee
- Alzheimer and Tauopathies, Inserm UMR-S1172, Lille, France
| | | | - Rodrigo A Cunha
- Center for Neuroscience of Coimbra, University of Coimbra, Coimbra, Portugal
| | | | | | | | - Anne-Laurence Boutillier
- Laboratoire de Neuroscience Cognitives et Adaptatives, Université de Strasbourg, Strasbourg, France
| | - David Blum
- INSERM U837, University Lille-Nord de France, UDSL, Lille, France
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Rousset M, Humez S, Laurent C, Buée L, Blum D, Cens T, Vignes M, Charnet P. Mammalian Brain Ca2+ Channel Activity Transplanted into Xenopus laevis Oocytes. Membranes 2022; 12:membranes12050496. [PMID: 35629822 PMCID: PMC9146698 DOI: 10.3390/membranes12050496] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 02/01/2023]
Abstract
Several mutations on neuronal voltage-gated Ca2+ channels (VGCC) have been shown to cause neurological disorders and contribute to the initiation of epileptic seizures, migraines, or cerebellar degeneration. Analysis of the functional consequences of these mutations mainly uses heterologously expressed mutated channels or transgenic mice which mimic these pathologies, since direct electrophysiological approaches on brain samples are not easily feasible. We demonstrate that mammalian voltage-gated Ca2+ channels from membrane preparation can be microtransplanted into Xenopus oocytes and can conserve their activity. This method, originally described to study the alteration of GABA receptors in human brain samples, allows the recording of the activity of membrane receptors and channels with their native post-translational processing, membrane environment, and regulatory subunits. The use of hippocampal, cerebellar, or cardiac membrane preparation displayed different efficacy for transplanted Ca2+ channel activity. This technique, now extended to the recording of Ca2+ channel activity, may therefore be useful in order to analyze the calcium signature of membrane preparations from unfixed human brain samples or normal and transgenic mice.
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Affiliation(s)
- Matthieu Rousset
- IBMM, UMR 5247 CNRS, Université de Montpellier, ENSCM, 1919 Route de Mende, 34293 Montpellier, France; (T.C.); (M.V.)
- Correspondence: (M.R.); (P.C.); Tel.: +33-467-613-666 (M.R. & P.C.)
| | - Sandrine Humez
- Lille Neuroscience & Cognition, Université de Lille, F-59000 Lille, France; (S.H.); (C.L.); (L.B.); (D.B.)
- Inserm UMR_S1172, Jean-Pierre Aubert Research Centre, F-59000 Lille, France
- Lille Neuroscience & Cognition, Alzheimer & Tauopathies, CHU-Lille, F-59000 Lille, France
| | - Cyril Laurent
- Lille Neuroscience & Cognition, Université de Lille, F-59000 Lille, France; (S.H.); (C.L.); (L.B.); (D.B.)
- Inserm UMR_S1172, Jean-Pierre Aubert Research Centre, F-59000 Lille, France
- Lille Neuroscience & Cognition, Alzheimer & Tauopathies, CHU-Lille, F-59000 Lille, France
| | - Luc Buée
- Lille Neuroscience & Cognition, Université de Lille, F-59000 Lille, France; (S.H.); (C.L.); (L.B.); (D.B.)
- Inserm UMR_S1172, Jean-Pierre Aubert Research Centre, F-59000 Lille, France
- Lille Neuroscience & Cognition, Alzheimer & Tauopathies, CHU-Lille, F-59000 Lille, France
| | - David Blum
- Lille Neuroscience & Cognition, Université de Lille, F-59000 Lille, France; (S.H.); (C.L.); (L.B.); (D.B.)
- Inserm UMR_S1172, Jean-Pierre Aubert Research Centre, F-59000 Lille, France
- Lille Neuroscience & Cognition, Alzheimer & Tauopathies, CHU-Lille, F-59000 Lille, France
| | - Thierry Cens
- IBMM, UMR 5247 CNRS, Université de Montpellier, ENSCM, 1919 Route de Mende, 34293 Montpellier, France; (T.C.); (M.V.)
| | - Michel Vignes
- IBMM, UMR 5247 CNRS, Université de Montpellier, ENSCM, 1919 Route de Mende, 34293 Montpellier, France; (T.C.); (M.V.)
| | - Pierre Charnet
- IBMM, UMR 5247 CNRS, Université de Montpellier, ENSCM, 1919 Route de Mende, 34293 Montpellier, France; (T.C.); (M.V.)
- Correspondence: (M.R.); (P.C.); Tel.: +33-467-613-666 (M.R. & P.C.)
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Christ SM, Schettle M, Willmann J, Ahmadsei M, Seiler A, Blum D, Guckenberger M, Andratschke N, Hertler C. Validation and extension of the METSSS score in a metastatic cancer patient cohort after palliative radiotherapy within the last phase of life. Clin Transl Radiat Oncol 2022; 34:107-111. [PMID: 35496816 PMCID: PMC9038557 DOI: 10.1016/j.ctro.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/03/2022] [Accepted: 04/10/2022] [Indexed: 12/02/2022] Open
Abstract
Predictive tools are intended to improve decision-making and personalize treatment. The “METSSS score” was proposed to predict survival after palliative radiotherapy. An extension of the “METSSS score” to radiotherapy during end-of-life proved valid. To assess the real quality of the tool, its routine use in clinical practice is encouraged.
Introduction and background Choosing the right treatment for the right patient in a setting of metastatic cancer disease remains a challenge. To facilitate clinical decision-making, predictive tools have been developed to personalize treatment. Here, we aim to assess the use of the recently proposed “METSSS score” as a prognostic tool for overall survival of cancer patients after palliative radiotherapy in the last phase of life. Methods All patients treated with palliative radiotherapy at the end-of-life at the Department of Radiation Oncology of the University Hospital Zurich between January 2010 and December 2019 were included in this study. Data on demographics, diagnosis, treatment and comorbidities was extracted from the treatment planning and the electronical medical records system. To statistically assess the validity of the “METSSS score”, the mortality risk score was calculated, followed by stratification of all patients to prognostic risk groups. The prediction of the 1-year overall survival estimates was subsequently calculated. Results Over the past decade, 274 patients have received palliative radiotherapy during the end-of-life period. One third of patients was female (34%, n = 93). The most frequent primary tumor was lung cancer (n = 121, 44%), and 55% of patients (n = 152) had no comorbidities according to the Charlson-Deyo comorbidity index. The most common radiotherapy site was the brain and eye region (42%, n = 115). The median actual overall survival of all patients was 40 days from the start of radiotherapy. The “METSSS score” survival model predicted that 269 patients (98.1%) belong into the high-risk, four patients (1.5%) into the medium-risk, and one patient (0.4%) into the low-risk group. The predicted median 1-year overall survival was 10%. Discussion The METSSS score correctly predicted the survival of our end-of-life patient cohort by assigning them into the highest risk category, and it can therefore serve as a decision-making tool when assigning patient to symptomatic radiotherapy.
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Seiler A, Schettle M, Amann M, Gaertner S, Wicki S, Christ SM, Theile G, Feuz M, Hertler C, Blum D. Virtual Reality Therapy in Palliative Care: A Case Series. J Palliat Care 2022:8258597221086767. [PMID: 35293818 DOI: 10.1177/08258597221086767] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Virtual reality (VR) opens a variety of therapeutic options to improve symptom burden in patients with advanced disease. Until to date, only few studies have evaluated the use of VR therapy in the context of palliative care. This case series aims to evaluate the feasibility and acceptability of VR therapy in a population of palliative care patients. METHODS In this single-site case series, we report on six palliative care patients undergoing VR therapy. The VR therapy consisted of a one-time session ranging between 20 to 60 minutes depending on the patient's needs and the content chosen for the VR sessions. A semi-structured survey was conducted and the Edmonton Symptom Assessment System (ESAS) and the Distress Thermometer were performed pre- and post-intervention. RESULTS Overall, VR therapy was well accepted by all patients. Five out of six patients reported having appreciated VR therapy. There were individual differences of perceived effects using VR therapy. The semi-structured survey revealed that some patients felt a temporary detachment from their body and that patients were able to experience the VR session as a break from omnipresent worries and the hospital environment ("I completely forgot where I am"). There was a considerable reduction in the total ESAS score post-treatment (T0 ESASTot = 27.2; T1 ESASTot = 18.8) and a slightly reduction in distress (T0 DTTot = 4.4; T1 DTTot = 3.8). However, two patients were more tired after the intervention.Significance of Results: Our preliminary results demonstrate that VR therapy is acceptable, feasible and safe for use within a palliative care population and appears to be a viable treatment option. Clinical trials are both warranted and necessary to confirm any therapeutic effects of VR therapy, as is the need to tailor VR systems better for use in palliative care settings.
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Affiliation(s)
- A Seiler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - M Schettle
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - M Amann
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Sophie Gaertner
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Wicki
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
- Internal Medicine Centre, Hirslanden Klinik Aarau, Switzerland
| | - S M Christ
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - G Theile
- Clinic Susenberg, Zurich, Switzerland
| | - M Feuz
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - C Hertler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - D Blum
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
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35
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Gauvrit T, Benderradji H, Buée L, Blum D, Vieau D. Early-Life Environment Influence on Late-Onset Alzheimer’s Disease. Front Cell Dev Biol 2022; 10:834661. [PMID: 35252195 PMCID: PMC8891536 DOI: 10.3389/fcell.2022.834661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/27/2022] [Indexed: 12/30/2022] Open
Abstract
With the expand of the population’s average age, the incidence of neurodegenerative disorders has dramatically increased over the last decades. Alzheimer disease (AD) which is the most prevalent neurodegenerative disease is mostly sporadic and primarily characterized by cognitive deficits and neuropathological lesions such as amyloid -β (Aβ) plaques and neurofibrillary tangles composed of hyper- and/or abnormally phosphorylated Tau protein. AD is considered a complex disease that arises from the interaction between environmental and genetic factors, modulated by epigenetic mechanisms. Besides the well-described cognitive decline, AD patients also exhibit metabolic impairments. Metabolic and cognitive perturbations are indeed frequently observed in the Developmental Origin of Health and Diseases (DOHaD) field of research which proposes that environmental perturbations during the perinatal period determine the susceptibility to pathological conditions later in life. In this review, we explored the potential influence of early environmental exposure to risk factors (maternal stress, malnutrition, xenobiotics, chemical factors … ) and the involvement of epigenetic mechanisms on the programming of late-onset AD. Animal models indicate that offspring exposed to early-life stress during gestation and/or lactation increase both AD lesions, lead to defects in synaptic plasticity and finally to cognitive impairments. This long-lasting epigenetic programming could be modulated by factors such as nutriceuticals, epigenetic modifiers or psychosocial behaviour, offering thus future therapeutic opportunity to protect from AD development.
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Affiliation(s)
- Thibaut Gauvrit
- Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience and Cognition, Université de Lille, Lille, France
- Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
| | - Hamza Benderradji
- Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience and Cognition, Université de Lille, Lille, France
- Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
| | - Luc Buée
- Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience and Cognition, Université de Lille, Lille, France
- Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
| | - David Blum
- Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience and Cognition, Université de Lille, Lille, France
- Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
| | - Didier Vieau
- Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience and Cognition, Université de Lille, Lille, France
- Alzheimer and Tauopathies, LabEx DISTALZ, Lille, France
- *Correspondence: Didier Vieau,
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Benderradji H, Kraiem S, Courty E, Eddarkaoui S, Bourouh C, Faivre E, Rolland L, Caron E, Besegher M, Oger F, Boschetti T, Carvalho K, Thiroux B, Gauvrit T, Nicolas E, Gomez-Murcia V, Bogdanova A, Bongiovanni A, Muhr-Tailleux A, Lancel S, Bantubungi K, Sergeant N, Annicotte JS, Buée L, Vieau D, Blum D, Buée-Scherrer V. Impaired Glucose Homeostasis in a Tau Knock-In Mouse Model. Front Mol Neurosci 2022; 15:841892. [PMID: 35250480 PMCID: PMC8889017 DOI: 10.3389/fnmol.2022.841892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Alzheimer’s disease (AD) is the leading cause of dementia. While impaired glucose homeostasis has been shown to increase AD risk and pathological loss of tau function, the latter has been suggested to contribute to the emergence of the glucose homeostasis alterations observed in AD patients. However, the links between tau impairments and glucose homeostasis, remain unclear. In this context, the present study aimed at investigating the metabolic phenotype of a new tau knock-in (KI) mouse model, expressing, at a physiological level, a human tau protein bearing the P301L mutation under the control of the endogenous mouse Mapt promoter. Metabolic investigations revealed that, while under chow diet tau KI mice do not exhibit significant metabolic impairments, male but not female tau KI animals under High-Fat Diet (HFD) exhibited higher insulinemia as well as glucose intolerance as compared to control littermates. Using immunofluorescence, tau protein was found colocalized with insulin in the β cells of pancreatic islets in both mouse (WT, KI) and human pancreas. Isolated islets from tau KI and tau knock-out mice exhibited impaired glucose-stimulated insulin secretion (GSIS), an effect recapitulated in the mouse pancreatic β-cell line (MIN6) following tau knock-down. Altogether, our data indicate that loss of tau function in tau KI mice and, particularly, dysfunction of pancreatic β cells might promote glucose homeostasis impairments and contribute to metabolic changes observed in AD.
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Affiliation(s)
- Hamza Benderradji
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Sarra Kraiem
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Emilie Courty
- Univ. Lille, INSERM, CNRS, CHU Lille, Institut Pasteur de Lille, Inserm U1283-UMR8199—EGID, Lille, France
| | - Sabiha Eddarkaoui
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Cyril Bourouh
- Univ. Lille, INSERM, CNRS, CHU Lille, Institut Pasteur de Lille, Inserm U1283-UMR8199—EGID, Lille, France
| | - Emilie Faivre
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Laure Rolland
- Univ. Lille, INSERM, CNRS, CHU Lille, Institut Pasteur de Lille, Inserm U1283-UMR8199—EGID, Lille, France
| | - Emilie Caron
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Development and Plasticity of the Neuroendocrine Brain, Lille, France
| | - Mélanie Besegher
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41—UMS 2014—PLBS, Animal Facility, Lille, France
| | - Frederik Oger
- Univ. Lille, INSERM, CNRS, CHU Lille, Institut Pasteur de Lille, Inserm U1283-UMR8199—EGID, Lille, France
| | - Theo Boschetti
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Kévin Carvalho
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Bryan Thiroux
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Thibaut Gauvrit
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Emilie Nicolas
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France
| | - Victoria Gomez-Murcia
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Anna Bogdanova
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Antonino Bongiovanni
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41—UMS 2014—PLBS, BioImaging Center Lille, Lille, France
| | - Anne Muhr-Tailleux
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France
| | - Steve Lancel
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167—RID-AGE—Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Kadiombo Bantubungi
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France
| | - Nicolas Sergeant
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Jean-Sebastien Annicotte
- Univ. Lille, INSERM, CNRS, CHU Lille, Institut Pasteur de Lille, Inserm U1283-UMR8199—EGID, Lille, France
| | - Luc Buée
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Didier Vieau
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - David Blum
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
- *Correspondence: David Blum
| | - Valérie Buée-Scherrer
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog—Lille Neuroscience & Cognition, Lille, France
- Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
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Gomez-Murcia V, Carvalho K, Thiroux B, Caillierez R, Besegher M, Sergeant N, Buée L, Faivre E, Blum D. Impact of chronic doxycycline treatment in the APP/PS1 mouse model of Alzheimer's disease. Neuropharmacology 2022; 209:108999. [PMID: 35181375 DOI: 10.1016/j.neuropharm.2022.108999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 12/17/2022]
Abstract
Due to the pathophysiological complexity of Alzheimer's disease, multitarget approaches able to mitigate several pathogenic mechanisms are of interest. Previous studies have pointed to the neuroprotective potential of Doxycycline (Dox), a safe and inexpensive second-generation tetracycline. Dox has been particularly reported to slow down aggregation of misfolded proteins but also to mitigate neuroinflammatory processes. Here, we have evaluated the pre-clinical potential of Dox in the APP/PS1 mouse model of amyloidogenesis. Dox was provided to APP/PS1 mice from the age of 8 months, when animals already exhibit amyloid pathology and memory deficits. Spatial memory was then evaluated from 9 to 10 months of age. Our data demonstrated that Dox moderately improved the spatial memory of APP/PS1 mice without exerting major effect on amyloid lesions. While Dox did not alleviate overall glial reactivity, we could evidence that it rather enhanced the amyloid-dependent upregulation of several neuroinflammatory markers such as CCL3 and CCL4. Finally, Dox exerted differentially regulated the levels of synaptic proteins in the hippocampus and the cortex of APP/PS1 mice. Overall, these observations support that chronic Dox delivery does not provide major pathophysiological improvements in the APP/PS1 mouse model.
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Affiliation(s)
- Victoria Gomez-Murcia
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog - Lille Neuroscience & Cognition, Lille, France; Alzheimer &Tauopathies, LabEx DISTALZ, France
| | - Kevin Carvalho
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog - Lille Neuroscience & Cognition, Lille, France; Alzheimer &Tauopathies, LabEx DISTALZ, France
| | - Bryan Thiroux
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog - Lille Neuroscience & Cognition, Lille, France; Alzheimer &Tauopathies, LabEx DISTALZ, France
| | - Raphaëlle Caillierez
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog - Lille Neuroscience & Cognition, Lille, France; Alzheimer &Tauopathies, LabEx DISTALZ, France
| | - Melanie Besegher
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, Animal Facility, F-59000, Lille, France
| | - Nicolas Sergeant
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog - Lille Neuroscience & Cognition, Lille, France; Alzheimer &Tauopathies, LabEx DISTALZ, France
| | - Luc Buée
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog - Lille Neuroscience & Cognition, Lille, France; Alzheimer &Tauopathies, LabEx DISTALZ, France
| | - Emile Faivre
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog - Lille Neuroscience & Cognition, Lille, France; Alzheimer &Tauopathies, LabEx DISTALZ, France
| | - David Blum
- Univ. Lille, Inserm, CHU Lille, U1172 LilNCog - Lille Neuroscience & Cognition, Lille, France; Alzheimer &Tauopathies, LabEx DISTALZ, France.
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38
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Nyam-Erdene A, Nebie O, Delila L, Buée L, Devos D, Chou SY, Blum D, Burnouf T. Characterization and Chromatographic Isolation of Platelet Extracellular Vesicles from Human Platelet Lysates for Applications in Neuroregenerative Medicine. ACS Biomater Sci Eng 2021; 7:5823-5835. [PMID: 34846835 DOI: 10.1021/acsbiomaterials.1c01226] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/25/2022]
Abstract
Human platelet lysates (HPLs) made from clinical-grade platelet concentrates are currently evaluated in the preclinical models of Parkinson's disease, Alzheimer's disease, traumatic brain injury, and others, as a new polyvalent neuroprotective biotherapy of the central nervous system. However, the presence and content of extracellular vesicles (EVs) in HPLs and their potential contribution to the neuroprotective and neurorestorative activities of HPLs are still unknown. We, therefore, characterized the EVs present in four different HPL preparations and after purification by size-exclusion chromatography. We then tested the effect of the isolated EVs on neuronal cell repair. We identified that all four HPLs contained a high and similar amount of EVs (1011 to 1012/mL) with a mean size ranging from ca. 50 to 300 nm and a negative zeta potential as determined by nanoparticle tracking analysis and dynamic light scattering. Western blot analysis revealed that the EVs present in HPLs expressed the clusters of differentiation 41 (CD41) and 61 (CD61) characteristic of platelets. These EVs were efficiently isolated from HPL proteins by Sepharose CL-2B size-exclusion column chromatography as confirmed by total protein determination and protein profile by sodium dodecyl sulfate polyacrylamide gel electrophoresis, with 73-85% recovery and maintenance of their size, negative zeta potential, and CD41 and CD61 expression. Interestingly, the EVs purified from the four HPLs exhibited a differential capacity to promote cell growth and migration in a wound-healing assay using SH-SY5Y neuronal cells, and one EV preparation stimulated network formation in primary neuronal cultures. These data indicated that the EVs present in HPLs have different neuroregenerative capacities and that some EV preparations may have interesting applications as a stand-alone therapy for usage in neuroregenerative medicine.
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Affiliation(s)
- Ariunjargal Nyam-Erdene
- International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 101, Taiwan
| | - Ouada Nebie
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
| | - Liling Delila
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
| | - Luc Buée
- Université de Lille, Inserm U1172, CHU-Lille, Lille Neuroscience & Cognition, Lille 59000, France.,Alzheimer & Tauopathies, Labex DISTALZ, Lille 59000, France.,NeuroTMULille International Laboratory, Université de Lille, Lille 59000, France
| | - David Devos
- Université de Lille, Inserm U1172, CHU-Lille, Lille Neuroscience & Cognition, Lille 59000, France.,NeuroTMULille International Laboratory, Université de Lille, Lille 59000, France
| | - Szu-Yi Chou
- Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan.,NeuroTMULille International Laboratory, Taipei Medical University, Taipei 101, Taiwan
| | - David Blum
- Université de Lille, Inserm U1172, CHU-Lille, Lille Neuroscience & Cognition, Lille 59000, France.,Alzheimer & Tauopathies, Labex DISTALZ, Lille 59000, France.,NeuroTMULille International Laboratory, Université de Lille, Lille 59000, France
| | - Thierry Burnouf
- International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 101, Taiwan.,Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan.,NeuroTMULille International Laboratory, Taipei Medical University, Taipei 101, Taiwan.,International PhD Program in Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.,Brain and Consciousness Research Centre, TMU Shuang Ho Hospital, New Taipei City 106, Taiwan
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39
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Nebie O, Carvalho K, Barro L, Delila L, Faivre E, Renn TY, Chou ML, Wu YW, Nyam-Erdene A, Chou SY, Buée L, Hu CJ, Peng CW, Devos D, Blum D, Burnouf T. Human platelet lysate biotherapy for traumatic brain injury: preclinical assessment. Brain 2021; 144:3142-3158. [PMID: 34086871 PMCID: PMC8634089 DOI: 10.1093/brain/awab205] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/13/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
Traumatic brain injury (TBI) leads to major brain anatomopathological damages underlined by neuroinflammation, oxidative stress and progressive neurodegeneration, ultimately leading to motor and cognitive deterioration. The multiple pathological events resulting from TBI can be addressed not by a single therapeutic approach, but rather by a synergistic biotherapy capable of activating a complementary set of signalling pathways and providing synergistic neuroprotective, anti-inflammatory, antioxidative, and neurorestorative activities. Human platelet lysate might fulfil these requirements as it is composed of a plethora of biomolecules readily accessible as a TBI biotherapy. In the present study, we tested the therapeutic potential of human platelet lysate using in vitro and in vivo models of TBI. We first prepared and characterized platelet lysate from clinical-grade human platelet concentrates. Platelets were pelletized, lysed by three freeze-thaw cycles, and centrifuged. The supernatant was purified by 56°C 30 min heat treatment and spun to obtain the heat-treated platelet pellet lysate that was characterized by ELISA and proteomic analyses. Two mouse models were used to investigate platelet lysate neuroprotective potential. The injury was induced by an in-house manual controlled scratching of the animals' cortex or by controlled cortical impact injury. The platelet lysate treatment was performed by topical application of 60 µl in the lesioned area, followed by daily 60 µl intranasal administration from Day 1 to 6 post-injury. Platelet lysate proteomics identified over 1000 proteins including growth factors, neurotrophins, and antioxidants. ELISA detected several neurotrophic and angiogenic factors at ∼1-50 ng/ml levels. We demonstrate, using two mouse models of TBI, that topical application and intranasal platelet lysate consistently improved mouse motor function in the beam and rotarod tests, mitigated cortical neuroinflammation, and oxidative stress in the injury area, as revealed by downregulation of pro-inflammatory genes and the reduction in reactive oxygen species levels. Moreover, platelet lysate treatment reduced the loss of cortical synaptic proteins. Unbiased proteomic analyses revealed that heat-treated platelet pellet lysate reversed several pathways promoted by both controlled cortical impact and cortical brain scratch and related to transport, postsynaptic density, mitochondria or lipid metabolism. The present data strongly support, for the first time, that human platelet lysate is a reliable and effective therapeutic source of neurorestorative factors. Therefore, brain administration of platelet lysate is a therapeutical strategy that deserves serious and urgent consideration for universal brain trauma treatment.
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Affiliation(s)
- Ouada Nebie
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of
Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog—Lille Neuroscience and
Cognition, Lille F-59000, France
- Alzheimer and Tauopathies, LabEx DISTALZ, LiCEND, Lille F-59000,
France
| | - Kevin Carvalho
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog—Lille Neuroscience and
Cognition, Lille F-59000, France
- Alzheimer and Tauopathies, LabEx DISTALZ, LiCEND, Lille F-59000,
France
| | - Lassina Barro
- International PhD Program in Biomedical Engineering, Taipei Medical
University, Taipei, 11031, Taiwan
| | - Liling Delila
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of
Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
| | - Emilie Faivre
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog—Lille Neuroscience and
Cognition, Lille F-59000, France
- Alzheimer and Tauopathies, LabEx DISTALZ, LiCEND, Lille F-59000,
France
| | - Ting-Yi Renn
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical
University, Taipei, 11031, Taiwan
| | - Ming-Li Chou
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of
Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University,
Taipei, Taiwan
| | - Yu-Wen Wu
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of
Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
| | - Ariunjargal Nyam-Erdene
- International PhD Program in Biomedical Engineering, Taipei Medical
University, Taipei, 11031, Taiwan
| | - Szu-Yi Chou
- NeuroTMULille International Laboratory, Taipei Medical
University, Taipei, 11031, Taiwan
- PhD Program for Neural Regenerative Medicine, College of Medical Science and
Technology, Taipei Medical University and National Health Research
Institutes, Taipei, 11031, Taiwan
- Graduate Institute of Neural Regenerative Medicine, College of Medical Science
and Technology, Taipei Medical University, Taipei, 11031, Taiwan
| | - Luc Buée
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog—Lille Neuroscience and
Cognition, Lille F-59000, France
- Alzheimer and Tauopathies, LabEx DISTALZ, LiCEND, Lille F-59000,
France
- NeuroTMULille International Laboratory, Univ. Lille, Lille,
F-59000 France
| | - Chaur-Jong Hu
- NeuroTMULille International Laboratory, Taipei Medical
University, Taipei, 11031, Taiwan
- PhD Program for Neural Regenerative Medicine, College of Medical Science and
Technology, Taipei Medical University and National Health Research
Institutes, Taipei, 11031, Taiwan
- Graduate Institute of Neural Regenerative Medicine, College of Medical Science
and Technology, Taipei Medical University, Taipei, 11031, Taiwan
- Dementia Center, Department of Neurology, Shuang Ho Hospital, Taipei Medical
University, New Taipei City, 23561, Taiwan
- Neurology, School of Medicine, College of Medicine, Taipei Medical
University, Taipei, 11031, Taiwan
| | - Chih-Wei Peng
- International PhD Program in Biomedical Engineering, Taipei Medical
University, Taipei, 11031, Taiwan
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei
Medical University, Taipei, 11031, Taiwan
| | - David Devos
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog—Lille Neuroscience and
Cognition, Lille F-59000, France
- NeuroTMULille International Laboratory, Univ. Lille, Lille,
F-59000 France
| | - David Blum
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog—Lille Neuroscience and
Cognition, Lille F-59000, France
- Alzheimer and Tauopathies, LabEx DISTALZ, LiCEND, Lille F-59000,
France
- Graduate Institute of Neural Regenerative Medicine, College of Medical Science
and Technology, Taipei Medical University, Taipei, 11031, Taiwan
| | - Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of
Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
- International PhD Program in Biomedical Engineering, Taipei Medical
University, Taipei, 11031, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University,
Taipei, Taiwan
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei
Medical University, Taipei, 11031, Taiwan
- International PhD Program in Cell Therapy and Regeneration, College of
Medicine, Taipei Medical University, Taipei, 11031, Taiwan
- Brain and Consciousness Research Centre, Taipei Medical University Shuang Ho
Hospital, New Taipei City, 23561, Taiwan
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40
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Fu S, Piccioni DE, Liu H, Lukas RV, Kesari S, Aregawi D, Hong DS, Yamaguchi K, Whicher K, Zhang Y, Chen YL, Poola N, Eddy J, Blum D. A phase I study of the WT2725 dosing emulsion in patients with advanced malignancies. Sci Rep 2021; 11:22355. [PMID: 34785698 PMCID: PMC8595891 DOI: 10.1038/s41598-021-01707-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/19/2021] [Indexed: 11/09/2022] Open
Abstract
WT2725 is a Wilms' tumor gene 1 (WT1)-derived-oligopeptide vaccine designed to induce WT1-specific cytotoxic T-lymphocytes against WT1+ tumors in human leukocyte antigen (HLA)-A*0201+ and/or HLA-A*0206+ patients. Here, we report the results of a phase I study of WT2725. In this phase I, open-label, dose-escalation and expansion two-part study, the WT2725 dosing emulsion was administered as a monotherapy to patients with advanced malignancies known to overexpress WT1, including glioblastoma. In part 1, 44 patients were sequentially allocated to four doses: 0.3 mg (n = 5), 0.9 mg (n = 5), 3 mg (n = 6), and 9 mg (n = 28). In part 2, 18 patients were allocated to two doses: 18 mg (n = 9) and 27 mg (n = 9). No dose-limiting toxicities were observed, so the maximum tolerated dose was not reached. Median progression-free survival was 58 (95% confidence interval [CI] 56-81) days (~ 2 months) across all patients with solid tumors; median overall survival was 394 days (13.0 months) (95% CI 309-648). Overall immune-related response rate in solid tumor patients was 7.5% (95% CI 2.6-19.9); response was most prominent in the glioblastoma subgroup. Overall, 62.3% of patients were considered cytotoxic T-lymphocyte responders; the proportion increased with increasing WT2725 dosing emulsion dose. WT2725 dosing emulsion was well tolerated. Preliminary tumor response and biological marker data suggest that WT2725 dosing emulsion may exert antitumor activity in malignancies known to overexpress the WT1 protein, particularly glioblastoma, and provide a rationale for future clinical development.Trial registration: NCT01621542.
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Affiliation(s)
- Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - David E. Piccioni
- grid.266100.30000 0001 2107 4242UCSD Moores Cancer Center, San Diego, CA USA
| | - Hongtao Liu
- grid.412578.d0000 0000 8736 9513University of Chicago Medical Center, Chicago, IL USA
| | - Rimas V. Lukas
- grid.16753.360000 0001 2299 3507Northwestern University, Chicago, IL USA ,Lou and Jean Malnati Brain Tumor Institute, Chicago, IL USA
| | - Santosh Kesari
- Saint John’s Cancer Institute and Pacific Neuroscience Institute, Santa Monica, CA USA
| | - Dawit Aregawi
- grid.240473.60000 0004 0543 9901Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA USA
| | - David S. Hong
- grid.240145.60000 0001 2291 4776Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Kenichiro Yamaguchi
- grid.417741.00000 0004 1797 168XSumitomo Dainippon Pharma Co., Ltd., Tokyo, Japan
| | - Kate Whicher
- grid.419756.8Sunovion Pharmaceuticals Inc., Marlborough, MA USA
| | - Yi Zhang
- grid.419756.8Sunovion Pharmaceuticals Inc., Marlborough, MA USA
| | - Yu-Luan Chen
- grid.419756.8Sunovion Pharmaceuticals Inc., Marlborough, MA USA
| | - Nagaraju Poola
- grid.419756.8Sunovion Pharmaceuticals Inc., Marlborough, MA USA ,Present Address: Otsuka Pharmaceuticals, Princeton, NJ USA
| | - John Eddy
- grid.419756.8Sunovion Pharmaceuticals Inc., Marlborough, MA USA ,Present Address: Morphic Therapeutic, Waltham, MA USA
| | - David Blum
- grid.419756.8Sunovion Pharmaceuticals Inc., Marlborough, MA USA
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41
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Abstract
[Figure: see text].
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Affiliation(s)
- David Blum
- Lille Neuroscience & Cognition, Inserm UMR-S1172, Alzheimer & Tauopathies, LabEx DISTALZ, Lille Cedex, France
| | - Luísa V Lopes
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Blum D, Eychmüller S. [The Broad Spectrum of Palliative Care]. Praxis (Bern 1994) 2021; 110:829-830. [PMID: 34814725 DOI: 10.1024/1661-8157/a003776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- David Blum
- Kompetenzzentrum Palliative Care, Klinik für Radio-Onkologie Universitätsspital Zürich, Zürich
| | - Steffen Eychmüller
- Universitäres Zentrum für Palliative Care, Universitätsspital, Inselspital Bern, Bern
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Abstract
Digital Palliative Care Abstract. Palliative care is becoming more and more digital. This article illuminates how digital approaches can help identify patients who qualify for palliative care offers and who wish to make use of them. Digital approaches can be used to monitor patients through apps and wearables, but digital methods are also becoming more important in psychosocial and spiritual support. One case demonstrates the therapeutic use of virtual reality. Work organization is digital, and teaching has also become digital during the corona crisis. In spite of all the advantages, however, the potential risks of digitization must also be considered.
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Affiliation(s)
- Manuel Amann
- Kompetenzzentrum Palliative Care, Klinik für Radio-Onkologie, Universitätsspital Zürich, Zürich
| | - David Blum
- Kompetenzzentrum Palliative Care, Klinik für Radio-Onkologie, Universitätsspital Zürich, Zürich
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44
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Guninski RS, Blum D, Guckenberger M. [Palliative Radiotherapy - An Important Tool in the Event Of Painful Bone Metastases]. Praxis (Bern 1994) 2021; 110:892-896. [PMID: 34814712 DOI: 10.1024/1661-8157/a003778] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Palliative Radiotherapy - An Important Tool in the Event Of Painful Bone Metastases Abstract. Many cancer patients suffer from metastases at an advanced stage, especially bone metastases, which are the third most frequent site of metastases and often occur in prostate, breast and lung carcinomas. Potential consequences are pain, pathological fractures and myelon compression with loss of function. Often there is a rapid reduction in the quality of life of the already burdened patients. Treatment is performed in an interdisciplinary setting with oncologists, radiation oncologists, palliative care and pain physicians as well as surgeons. Local radiotherapy is an established treatment option in order to achieve rapid, uncomplicated symptom control with few side effects and an improvement in the quality of life. Analgesic radiotherapy for bone metastases has been shown to have a response rate of up to 60-80 %.
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Affiliation(s)
- Ricarda Stella Guninski
- Interdisziplinäres Zentrum für Hochpräzisions-Radiotherapie, Klinik für Radio-Onkologie, Universitätsspital Zürich, Universität Zürich, Zürich
| | - David Blum
- Kompetenzzentrum für Palliative Care, Klinik für Radio-Onkologie, Universitätsspital Zürich, Universität Zürich, Zürich
| | - Matthias Guckenberger
- Interdisziplinäres Zentrum für Hochpräzisions-Radiotherapie, Klinik für Radio-Onkologie, Universitätsspital Zürich, Universität Zürich, Zürich
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45
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Schettle M, Blum D. [Pain, Opioids and Their Crisis: Noisy and Silent Symptoms]. Praxis (Bern 1994) 2021; 110:887-891. [PMID: 34814726 DOI: 10.1024/1661-8157/a003780] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pain, Opioids and Their Crisis: Noisy and Silent Symptoms Abstract. Pain is a common reason for consultation in family practice and palliative care. The article addresses an update of the WHO guidelines and the benefits and disadvantages of opioids in palliative care. In addition to the "loud symptom" of pain, fatigue, depression and anxiety can be referred to as "silent symptoms" which are easily forgotten in the fast-paced daily practice. In the case of inadequate symptom control, co-care should be provided by specialized palliative care services in the outpatient or, if necessary, inpatient setting. In addition, psychosocial and, if desired, spiritual support should be offered with the involvement of relatives.
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Affiliation(s)
- Markus Schettle
- Kompetenzzentrum Palliative Care, Klinik für Radio-Onkologie, Universitätsspital Zürich, Zürich
| | - David Blum
- Kompetenzzentrum Palliative Care, Klinik für Radio-Onkologie, Universitätsspital Zürich, Zürich
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46
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Christ SM, Blum D. [Cachexia - A Cluster of Losses]. Praxis (Bern 1994) 2021; 110:881-885. [PMID: 34814713 DOI: 10.1024/1661-8157/a003789] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cachexia - A Cluster of Losses Abstract. Cachexia occurs in Cancer and other incurable diseases. Cachexia is regularly underdiagnosed and undertreated. The syndrome is defined by weight-loss, which is also caused by loss of muscle mass. The underlying cause is reason a systemic inflammation. It is associated with symptoms such as loss of appetite and is causing distress in patients and their families. Adequate staging and a multimodal therapy include treatment of the underlying disease, supportive measures and nutrition and exercise issues. At the end of life, symptom control and psychosocial support are most important.
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Affiliation(s)
- Sebastian M Christ
- Klinik für Radio-Onkologie, Universitätsspital Zürich, Universität Zürich, Zürich
| | - David Blum
- Kompetenzzentrum Palliative Care, Klinik für Radio-Onkologie, Universitätsspital Zürich, Universität Zürich, Zürich
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Goodman W, Bagnall AM, Ashley L, Azizoddin D, Muehlensiepen F, Blum D, Bennett MI, Allsop M. The extent of engagement with telehealth approaches by patients with advanced cancer: A systematic review (Preprint). JMIR Cancer 2021; 8:e33355. [PMID: 35175205 PMCID: PMC8895292 DOI: 10.2196/33355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/03/2021] [Accepted: 01/12/2022] [Indexed: 01/19/2023] Open
Abstract
Background Telehealth approaches are increasingly being used to support patients with advanced diseases, including cancer. Evidence suggests that telehealth is acceptable to most patients; however, the extent of and factors influencing patient engagement remain unclear. Objective The aim of this review is to characterize the extent of engagement with telehealth interventions in patients with advanced, incurable cancer reported in the international literature. Methods This systematic review was registered with PROSPERO (International Prospective Register of Systematic Reviews) and is reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. A comprehensive search of databases was undertaken for telehealth interventions (communication between a patient with advanced cancer and their health professional via telehealth technologies), including MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Sociological Abstracts, and Web of Science, from the inception of each electronic database up until December 31, 2020. A narrative synthesis was conducted to outline the design, population, and context of the studies. A conceptual framework of digital engagement comprising quantitative behavioral measures (frequency, amount, duration, and depth of use) framed the analysis of engagement with telehealth approaches. Frequency data were transformed to a percentage (actual patient engagement as a proportion of intended engagement), and the interventions were characterized by intensity (high, medium, and low intended engagement) and mode of delivery for standardized comparisons across studies. Results Of the 19,676 identified papers, 40 (0.2%) papers covering 39 different studies were eligible for inclusion, dominated by US studies (22/39, 56%), with most being research studies (26/39, 67%). The most commonly reported measure of engagement was frequency (36/39, 92%), with substantial heterogeneity in the way in which it was measured. A standardized percentage of actual patient engagement was derived from 17 studies (17/39, 44%; n=1255), ranging from 51% to 100% with a weighted average of 75.4% (SD 15.8%). A directly proportional relationship was found between intervention intensity and actual patient engagement. Higher engagement occurred when a tablet, computer, or smartphone app was the mode of delivery. Conclusions Understanding engagement for people with advanced cancer can guide the development of telehealth approaches from their design to monitoring as part of routine care. With increasing telehealth use, the development of meaningful and context- and condition-appropriate measures of telehealth engagement is needed to address the current heterogeneity in reporting while improving the understanding of optimal implementation of telehealth for oncology and palliative care. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews) CRD42018117232; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018117232
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Affiliation(s)
- William Goodman
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Laura Ashley
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Desiree Azizoddin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | | | - David Blum
- Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Michael I Bennett
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Matthew Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
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Brigas HC, Ribeiro M, Coelho JE, Gomes R, Gomez-Murcia V, Carvalho K, Faivre E, Costa-Pereira S, Darrigues J, de Almeida AA, Buée L, Dunot J, Marie H, Pousinha PA, Blum D, Silva-Santos B, Lopes LV, Ribot JC. IL-17 triggers the onset of cognitive and synaptic deficits in early stages of Alzheimer's disease. Cell Rep 2021; 36:109574. [PMID: 34469732 DOI: 10.1016/j.celrep.2021.109574] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [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: 08/27/2020] [Revised: 06/09/2021] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
Neuroinflammation in patients with Alzheimer's disease (AD) and related mouse models has been recognized for decades, but the contribution of the recently described meningeal immune population to AD pathogenesis remains to be addressed. Here, using the 3xTg-AD model, we report an accumulation of interleukin-17 (IL-17)-producing cells, mostly γδ T cells, in the brain and the meninges of female, but not male, mice, concomitant with the onset of cognitive decline. Critically, IL-17 neutralization into the ventricles is sufficient to prevent short-term memory and synaptic plasticity deficits at early stages of disease. These effects precede blood-brain barrier disruption and amyloid-beta or tau pathology, implying an early involvement of IL-17 in AD pathology. When IL-17 is neutralized at later stages of disease, the onset of short-memory deficits and amyloidosis-related splenomegaly is delayed. Altogether, our data support the idea that cognition relies on a finely regulated balance of "inflammatory" cytokines derived from the meningeal immune system.
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Affiliation(s)
- Helena C Brigas
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Miguel Ribeiro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Joana E Coelho
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Rui Gomes
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal; Faculdade de Ciências de Lisboa, Universidade de Lisboa, 1749-016 Lisboa, Portugal
| | - Victoria Gomez-Murcia
- Université Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, 59000 Lille, France; Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Kevin Carvalho
- Université Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, 59000 Lille, France; Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Emilie Faivre
- Université Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, 59000 Lille, France; Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Sara Costa-Pereira
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Julie Darrigues
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Afonso Antunes de Almeida
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Luc Buée
- Université Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, 59000 Lille, France; Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Jade Dunot
- Université Côte d'Azur, CNRS, UMR 7275, Institute of Molecular and Cellular Pharmacology (IPMC), Valbonne, France
| | - Hélène Marie
- Université Côte d'Azur, CNRS, UMR 7275, Institute of Molecular and Cellular Pharmacology (IPMC), Valbonne, France
| | - Paula A Pousinha
- Université Côte d'Azur, CNRS, UMR 7275, Institute of Molecular and Cellular Pharmacology (IPMC), Valbonne, France
| | - David Blum
- Université Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, 59000 Lille, France; Alzheimer & Tauopathies, LabEx DISTALZ, Lille, France
| | - Bruno Silva-Santos
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Luísa V Lopes
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal.
| | - Julie C Ribot
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal.
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Hartnell IJ, Blum D, Nicoll JAR, Dorothee G, Boche D. Glial cells and adaptive immunity in frontotemporal dementia with tau pathology. Brain 2021; 144:724-745. [PMID: 33527991 DOI: 10.1093/brain/awaa457] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/06/2020] [Accepted: 10/17/2020] [Indexed: 12/12/2022] Open
Abstract
Neuroinflammation is involved in the aetiology of many neurodegenerative disorders including Alzheimer's disease, Parkinson's disease and motor neuron disease. Whether neuroinflammation also plays an important role in the pathophysiology of frontotemporal dementia is less well known. Frontotemporal dementia is a heterogeneous classification that covers many subtypes, with the main pathology known as frontotemporal lobar degeneration. The disease can be categorized with respect to the identity of the protein that causes the frontotemporal lobar degeneration in the brain. The most common subgroup describes diseases caused by frontotemporal lobar degeneration associated with tau aggregation, also known as primary tauopathies. Evidence suggests that neuroinflammation may play a role in primary tauopathies with genome-wide association studies finding enrichment of genetic variants associated with specific inflammation-related gene loci. These loci are related to both the innate immune system, including brain resident microglia, and the adaptive immune system through possible peripheral T-cell involvement. This review discusses the genetic evidence and relates it to findings in animal models expressing pathogenic tau as well as to post-mortem and PET studies in human disease. Across experimental paradigms, there seems to be a consensus regarding the involvement of innate immunity in primary tauopathies, with increased microglia and astrocyte density and/or activation, as well as increases in pro-inflammatory markers. Whilst it is less clear as to whether inflammation precedes tau aggregation or vice versa; there is strong evidence to support a microglial contribution to the propagation of hyperphosphorylated in tau frontotemporal lobar degeneration associated with tau aggregation. Experimental evidence-albeit limited-also corroborates genetic data pointing to the involvement of cellular adaptive immunity in primary tauopathies. However, it is still unclear whether brain recruitment of peripheral immune cells is an aberrant result of pathological changes or a physiological aspect of the neuroinflammatory response to the tau pathology.
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Affiliation(s)
- Iain J Hartnell
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Blum
- University of Lille, Inserm, CHU-Lille, UMR-S 1172-Lille Neuroscience and Cognition, Lille, France.,Alzheimer & Tauopathies, LabEx DISTALZ, France
| | - James A R Nicoll
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Guillaume Dorothee
- Inserm, Sorbonne University, UMRS 938 Saint-Antoine Research Center, Immune System and Neuroinflammation Laboratory, Hôpital Saint-Antoine, Paris, France
| | - Delphine Boche
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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50
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Schlögl M, Iyer AS, Riese F, Blum D, O'Hare L, Kulkarni T, Pautex S, Schildmann J, Swetz KM, Kumar P, Jones CA. Top Ten Tips Palliative Care Clinicians Should Know About Prognostication in Oncology, Dementia, Frailty, and Pulmonary Diseases. J Palliat Med 2021; 24:1391-1397. [PMID: 34264746 DOI: 10.1089/jpm.2021.0327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Prognostication has been described as "Medicine's Lost Art." Taken with diagnosis and treatment, prognostication is the third leg on which medical care rests. As research leads to additional beneficial treatments for vexing conditions like cancer, dementia, and lung disease, prognostication becomes even more difficult. This article, written by a group of palliative care clinicians with backgrounds in geriatrics, pulmonology, and oncology, aims to offer a useful framework for consideration of prognosis in these conditions. This article will serve as the first in a three-part series on prognostication in adults and children.
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Affiliation(s)
- Mathias Schlögl
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Zurich, Switzerland.,University Clinic for Acute Geriatric Care, City Hospital Waid Zurich, Zurich, Switzerland
| | - Anand S Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Medicine, Center for Outcomes and Effectiveness Research and Education, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Florian Riese
- University Research Priority Program "Dynamics of Healthy Aging," University of Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lanier O'Hare
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tejaswini Kulkarni
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sophie Pautex
- Division of Palliative Medicine, Department of Geriatrics and Rehabilitation, University of Geneva, University Hospital Geneva, Geneva, Switzerland
| | - Jan Schildmann
- Interdisciplinary Center for Health Sciences, Institute for History and Ethics of Medicine, Martin Luther University, Halle-Wittenberg, Germany
| | - Keith M Swetz
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pallavi Kumar
- Division of Hematology Oncology, Department of Medicine, Ruth and Raymond Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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