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Raghavan A, Vishnubala D, Iqbal A, Hunter R, Marino K, Eastwood D, Nykjaer C, Pringle A. UK Nurses Delivering Physical Activity Advice: What Are the Challenges and Possible Solutions? A Qualitative Study. Int J Environ Res Public Health 2023; 20:7113. [PMID: 38063543 PMCID: PMC10706598 DOI: 10.3390/ijerph20237113] [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] [Received: 10/06/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023]
Abstract
There are a multitude of health benefits gained from regular physical activity (PA). Currently, PA advice implementation from NHS nurses is inadequate despite their ever-increasing role in lifestyle and preventive medicine. By assessing their knowledge of current PA guidance, this study proposed to investigate the issues with regular PA advice being given and expand upon nurses' proposed barriers and solutions. A qualitative approach using semi structured interviews was undertaken between March and August 2023 involving 13 NHS nurses. Thematic analysis was undertaken using Braun and Clarke's six step approach. Four themes and fifteen subthemes emerged as barriers and solutions in delivering PA advice. Intrinsic barriers included a lack of nurse knowledge on the topic and PA being seen as an afterthought. Extrinsic barriers included time pressures and a lack of staff engagement. Solutions involved increasing staff awareness of guidelines through teaching, policy, encouraging staff to be active and optimising PA advice delivery through a piecemeal approach and utilising online and visual resources. This study displayed an insight into nurses' thoughts on their consultations with patients regarding PA, and proposed several barriers and solutions. Further work is needed to improve nurses' PA knowledge and to assess the proposed strategies to improve its delivery.
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Affiliation(s)
| | - Dane Vishnubala
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK; (D.V.); (D.E.); (C.N.)
- School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Adil Iqbal
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield HD3 3EA, UK;
| | - Ruth Hunter
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York YO31 8HE, UK;
| | | | - David Eastwood
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK; (D.V.); (D.E.); (C.N.)
- Musculoskeletal Department, Locala Health and Wellbeing, Huddersfield HD1 4EW, UK
| | - Camilla Nykjaer
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK; (D.V.); (D.E.); (C.N.)
| | - Andy Pringle
- Clinical Exercise and Rehabilitation Research Centre, School of Sport and Exercise Science, University of Derby, Derby DE22 1GB, UK;
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Eastwood D, Owen C, Phillips G, Williams S, Brown J, Gardner AJ, Hendricks S, Johnston RD, Stokes K, Tadmor D, Till K, Whitehead S, Jones B. Incidence of concussion in men's Super League, Championship, and Academy rugby league matches between 2016 and 2022. J Sci Med Sport 2023; 26:539-544. [PMID: 37718192 DOI: 10.1016/j.jsams.2023.09.001] [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: 04/12/2023] [Revised: 08/09/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To quantify the incidence of concussion and compare between playing levels in male rugby league. DESIGN Retrospective cohort. METHODS Between 2016 and 2022, medically diagnosed concussions in Super League, Championship, and Academy competitions were reported to the Rugby Football League via club medical staff. Anonymised data were analysed using generalised linear mixed-effects models by season, month, and between competitions. RESULTS Overall, 1403 concussions were identified from 104,209 player-match hours. Concussion incidence for Super League, Championship, and Academy was 15.5, 10.5, and 14.3 per 1000 player-match hours, respectively. Championship concussion incidence was significantly lower than the Super League (p < 0.001) and Academy (p < 0.001). No significant differences were identified between years for Super League (range: 13.3 to 18.8 per 1000 player-match hours) and Championship (range: 8.4 to 12.1 per 1000 player-match hours). In Academy (range: 9.6 to 20.5 per 1000 player-match hours), concussion incidence was significantly greater in 2021 compared to earlier years (2016, p = 0.01 and 2017, p = 0.03). No significant differences were identified between months for any competition. CONCLUSIONS The incidence of concussion is greater in Super League and Academy compared to the Championship. Academy concussion incidence has increased over time. Different factors between and within competitions, such as changes to medical standards and knowledge, could have influenced the identification and diagnosis of concussion.
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Affiliation(s)
- David Eastwood
- Centre for Health and Injury and Illness Prevention in Sport, University of Bath, United Kingdom; Wakefield Trinity Rugby League Club, United Kingdom
| | - Cameron Owen
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; England Performance Unit, Rugby Football League, United Kingdom
| | - Gemma Phillips
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; England Performance Unit, Rugby Football League, United Kingdom; Hull Kingston Rovers, United Kingdom
| | - Sean Williams
- Centre for Health and Injury and Illness Prevention in Sport, University of Bath, United Kingdom; UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, United Kingdom
| | - James Brown
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Institute of Sport and Exercise Medicine, Stellenbosch University, South Africa; Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Andrew J Gardner
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Sharief Hendricks
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Rich D Johnston
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Australia; Sport Performance Recovery Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Australia
| | - Keith Stokes
- Centre for Health and Injury and Illness Prevention in Sport, University of Bath, United Kingdom; Rugby Football Union, United Kingdom; UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, United Kingdom
| | - Daniel Tadmor
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; Leeds Rhinos Rugby League Club, United Kingdom
| | - Kevin Till
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; Leeds Rhinos Rugby League Club, United Kingdom
| | - Sarah Whitehead
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; England Performance Unit, Rugby Football League, United Kingdom; Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa; School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Australia; Premiership Rugby, United Kingdom.
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Eastwood D, Varney J, Pringle A, Vishnubala D. Physical Activity Clinical Champions: a peer-to-peer physical activity education programme in England. Br J Sports Med 2023; 57:897-898. [PMID: 37385717 DOI: 10.1136/bjsports-2023-107269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Affiliation(s)
- David Eastwood
- Moving Healthcare Professionals Programme, Office for Health Improvement and Disparities, London, UK
| | - Justin Varney
- Director of Public Health, Birmingham City Council, Birmingham, Birmingham, UK
| | - Andy Pringle
- Clinical Exercise and Rehabilitation Research Centre, School of Human Sciences, University of Derby, Derby, UK
| | - Dane Vishnubala
- Moving Healthcare Professionals Programme, Office for Health Improvement and Disparities, London, UK
- School of Biomedical Sciences, University of Leeds, Leeds, UK
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Vishnubala D, Iqbal A, Marino K, Pandya T, Salman D, Pringle A, Nykjaer C, Bazira P, Eastwood D, Finn G. Creating a sport and exercise medicine undergraduate syllabus: a delphi study. BMC Med Educ 2023; 23:179. [PMID: 36959591 PMCID: PMC10035170 DOI: 10.1186/s12909-023-04139-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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Sport and Exercise Medicine (SEM) is a growing speciality in the United Kingdom (UK). This growth has not been replicated in SEM teaching at an undergraduate level and SEM-related topics in schools of medicine in the UK are under-represented. As SEM continues to develop as a specialty it is important to consider how it is embedded at all levels of training. The aim of this project was to establish a consensus on SEM-related skills and knowledge relevant for undergraduate medical students in the UK, ultimately creating a curriculum of learning objectives (LOs). METHODS A modified Delphi survey was utilised to seek consensus on LOs suitable for incorporation into UK medical school curricula. An expert panel with adequate knowledge in the field was recruited. The initial curriculum was created by the research team using already established postgraduate SEM curricula. All learning objectives were sent to the expert panel for opinions in phases. Levels of agreement and comments made by the expert panel were reviewed after each phase until a consensus on each learning objective was made. RESULTS The expert panel was made up of 45 individuals, with 35 also completing phase 2 (78% retention rate). The initial curriculum contained 58 learning objectives separated into 9 themes. In phase 1 31% (18/58) were accepted outright, 48% (28/58) were altered and 19% (11/58) were rejected. Two additional learning objectives were added. Of the 49 LOs included in phase 2, 98% (48/49) were accepted. The final curriculum was made up of 9 sub-themes and 48 LOs. CONCLUSION Sport and Exercise Medicine is a broad ranging and rapidly growing speciality. It is important to establish SEM education in all levels of medical education, including undergraduate level. This is the first published version of a Delphi SEM curriculum for undergraduate medical teaching.
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Affiliation(s)
- Dane Vishnubala
- Hull York Medical School, York, UK.
- University of Leeds, Leeds, UK.
- School of Public Health/MSK lab, Imperial College London, London, UK.
- University of York, Heslington, York, YO105DD, UK.
| | | | | | - Tej Pandya
- Royal Bolton Hospital, Minerva Road, Farnworth, BL4OJR, UK
| | - David Salman
- School of Public Health/MSK lab, Imperial College London, London, UK
| | - Andy Pringle
- Sport Outdoor and Exercise Science, University of Derby, Derby, UK
| | - Camilla Nykjaer
- Faculty of Biological Sciences, University of Leeds, Leeds, UK
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Lockyer K, Gao F, Francis RJ, Eastwood D, Khatri B, Stebbings R, Derrick JP, Bolgiano B. Higher mass meningococcal group C-tetanus toxoid vaccines conjugated with carbodiimide correlate with greater immunogenicity. Vaccine 2020; 38:2859-2869. [PMID: 32089463 DOI: 10.1016/j.vaccine.2020.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/20/2020] [Accepted: 02/05/2020] [Indexed: 10/25/2022]
Abstract
To examine the link between meningococcal C (MenC) vaccine size and immunogenic response, a panel of MenC glycoconjugate vaccines were prepared differing in chain length, molar mass and hydrodynamic volume. The preparations consisted of different lengths of MenC polysaccharide (PS) covalently linked to monomeric purified tetanus toxoid (TT) carrier protein using the coupling reagent ethylcarbodiimide hydrochloride (EDC). Size exclusion chromatography with multi-angle light scattering (SEC-MALS) and viscometry analysis confirmed that the panel of MenC-TT conjugates spanned masses of 191,500 to 2,348,000 g/mol, and hydrodynamic radii ranging from 12.1 to 47.9 nm. The two largest conjugates were elliptical in shape, whereas the two smallest conjugates were more spherical. The larger conjugates appeared to fit a model described by multiple TTs with cross-linked PS, typical of lattice-like networks described previously for TT conjugates, while the smaller conjugates were found to fit a monomeric or dimeric TT configuration. The effect of vaccine conjugate size on immune responses was determined using a two-dose murine immunization. The two larger panel vaccine conjugates produced higher anti-MenC IgG1 and IgG2b titres after the second dose. Larger vaccine conjugate size also stimulated greater T-cell proliferative responses in an in vitro recall assay, although cytokines indicative of a T-helper response were not measurable. In conclusion, larger MenC-TT conjugates up to 2,348,000 g/mol produced by EDC chemistry correlate with greater humoral and cellular murine immune responses. These observations suggest that conjugate size can be an important modulator of immune response.
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Affiliation(s)
- Kay Lockyer
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Hertfordshire EN6 3QG, UK.
| | - Fang Gao
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Hertfordshire EN6 3QG, UK
| | - Robert J Francis
- Division of Analytical Biological Services, NIBSC, Blanche Lane, South Mimms, Hertfordshire EN6 3QG, UK
| | - David Eastwood
- Division of Biotherapeutics, NIBSC, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK
| | - Bhagwati Khatri
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Hertfordshire EN6 3QG, UK
| | - Richard Stebbings
- Division of Biotherapeutics, NIBSC, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK
| | - Jeremy P Derrick
- Lydia Becker Institute of Immunology and Inflammation, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, UK
| | - Barbara Bolgiano
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Hertfordshire EN6 3QG, UK
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Boyd C, Luskin K, Eastwood D, Conti M, Mohammed A. The Obesity Paradox and Predictors of Thirty Day Mortality in a Single Center Heart Failure Population. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Eastwood D, Dyson K, Andrew E, Bernard S, Smith K. Exercise-related out of hospital cardiac arrest in Victoria, Australia. Resuscitation 2018. [DOI: 10.1016/j.resuscitation.2018.07.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Hall W, Eastwood D, Kilari D, Van Wickle J, Raychaudhuri R, Borkenhagen J, See W, Lawton C. Androgen Deprivation Therapy (ADT) and Radiation Therapy (RT) Alone As Compared With Trimodality Therapy With ADT, RT, and Surgery in Men With High Risk, Nonmetastatic Adenocarcinoma of the Prostate. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Calder P, Shaw S, Roberts A, Tennant S, Sedki I, Hanspal R, Eastwood D. A comparison of functional outcome between amputation and extension prosthesis in the treatment of congenital absence of the fibula with severe limb deformity. J Child Orthop 2017; 11:318-325. [PMID: 28904639 PMCID: PMC5584502 DOI: 10.1302/1863-2548.11.160264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Complete fibula absence often presents with significant lower-limb deformity. Parental counselling regarding management is paramount in achieving the optimum functional outcome. Amputation offers a single surgical event with minimal complications. This study compares outcomes with an amputation protocol to those using an extension prosthesis. METHOD Thirty-two patients were identified. Nine patients (2 males, 7 females; median age at assessment of 23.5 years) used an extension prosthesis. Twenty-three patients (16 males, 7 females; median age at assessment of eight years) underwent 25 amputations during childhood. Mobility was assessed using SIGAM and K scores. Quality of life was assessed using the PedsQL inventory questionnaire; pain by a verbal severity score. RESULTS The 19 Syme and one Boyd amputation in 19 patients were performed early (mean age 15 months). Four Syme and one trans-tibial amputation in four patients took place in older children (mean age 6.6 years). Only two underwent tibial kyphus correction to aid prosthetic fitting. K scores were significantly higher (mean 4 vs 2) and pain scores lower in the amputation group allowing high impact activity compared with community ambulation with an extension prosthesis. The SIGAM and PedsQL scores were all better in the amputation group, but not significantly so. CONCLUSION Childhood amputation for severe limb length inequality and foot deformity in congenital fibula absence offers excellent short-term functional outcome with prosthetic support. The tibial kyphus does not need routine correction and facilitates prosthetic suspension. Accommodative extension prostheses offer reasonable long-term function but outcome scores are lower.
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Affiliation(s)
- P. Calder
- The Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London HA7 4LP, UK,Correspondence should be sent to: Mr P. Calder, The Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London HA7 4LP, UK. E-mail:
| | - S. Shaw
- The Limb Rehabilitation Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London HA7 4LP, UK
| | - A. Roberts
- Academic Department for Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, Epsom, Surrey, KT18 6JW, UK
| | - S. Tennant
- The Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London HA7 4LP, UK
| | - I. Sedki
- The Limb Rehabilitation Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London HA7 4LP, UK
| | - R. Hanspal
- The Limb Rehabilitation Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London HA7 4LP, UK
| | - D. Eastwood
- The Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London HA7 4LP, UK
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Dhand R, Khamoo D, Eastwood D. A STUDY OF HEAD INJURY ADVICE ON RETURN TO SPORT IN ACCIDENT AND EMERGENCY. Br J Sports Med 2016. [DOI: 10.1136/bjsports-2016-096952.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Miura J, Charlson J, Gamblin T, Eastwood D, Banerjee A, Johnston F, Turaga K. Impact of chemotherapy on survival in surgically resected retroperitoneal sarcoma. Eur J Surg Oncol 2015; 41:1386-92. [DOI: 10.1016/j.ejso.2015.07.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/22/2015] [Accepted: 07/16/2015] [Indexed: 11/28/2022] Open
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Vessillier S, Eastwood D, Fox B, Sathish J, Sethu S, Dougall T, Thorpe SJ, Thorpe R, Stebbings R. Cytokine release assays for the prediction of therapeutic mAb safety in first-in man trials--Whole blood cytokine release assays are poorly predictive for TGN1412 cytokine storm. J Immunol Methods 2015; 424:43-52. [PMID: 25960173 PMCID: PMC4768082 DOI: 10.1016/j.jim.2015.04.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 03/20/2015] [Revised: 04/29/2015] [Accepted: 04/29/2015] [Indexed: 12/29/2022]
Abstract
The therapeutic monoclonal antibody (mAb) TGN1412 (anti-CD28 superagonist) caused near-fatal cytokine release syndrome (CRS) in all six volunteers during a phase-I clinical trial. Several cytokine release assays (CRAs) with reported predictivity for TGN1412-induced CRS have since been developed for the preclinical safety testing of new therapeutic mAbs. The whole blood (WB) CRA is the most widely used, but its sensitivity for TGN1412-like cytokine release was recently criticized. In a comparative study, using group size required for 90% power with 5% significance as a measure of sensitivity, we found that WB and 10% (v/v) WB CRAs were the least sensitive for TGN1412 as these required the largest group sizes (n = 52 and 79, respectively). In contrast, the peripheral blood mononuclear cell (PBMC) solid phase (SP) CRA was the most sensitive for TGN1412 as it required the smallest group size (n = 4). Similarly, the PBMC SP CRA was more sensitive than the WB CRA for muromonab-CD3 (anti-CD3) which stimulates TGN1412-like cytokine release (n = 4 and 4519, respectively). Conversely, the WB CRA was far more sensitive than the PBMC SP CRA for alemtuzumab (anti-CD52) which stimulates FcγRI-mediated cytokine release (n = 8 and 180, respectively). Investigation of potential factors contributing to the different sensitivities revealed that removal of red blood cells (RBCs) from WB permitted PBMC-like TGN1412 responses in a SP CRA, which in turn could be inhibited by the addition of the RBC membrane protein glycophorin A (GYPA); this observation likely underlies, at least in part, the poor sensitivity of WB CRA for TGN1412. The use of PBMC SP CRA for the detection of TGN1412-like cytokine release is recommended in conjunction with adequately powered group sizes for dependable preclinical safety testing of new therapeutic mAbs.
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Affiliation(s)
- S Vessillier
- National Institute for Biological Standards and Control, Biotherapeutics Group, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, United Kingdom.
| | - D Eastwood
- National Institute for Biological Standards and Control, Biotherapeutics Group, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, United Kingdom
| | - B Fox
- National Institute for Biological Standards and Control, Biotherapeutics Group, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, United Kingdom
| | - J Sathish
- MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, University of Liverpool, Sherrington Buildings, Ashton Street, Liverpool L69 3GE, United Kingdom
| | - S Sethu
- MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, University of Liverpool, Sherrington Buildings, Ashton Street, Liverpool L69 3GE, United Kingdom
| | - T Dougall
- National Institute for Biological Standards and Control, Biotherapeutics Group, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, United Kingdom
| | - S J Thorpe
- National Institute for Biological Standards and Control, Biotherapeutics Group, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, United Kingdom
| | - R Thorpe
- National Institute for Biological Standards and Control, Biotherapeutics Group, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, United Kingdom
| | - R Stebbings
- National Institute for Biological Standards and Control, Biotherapeutics Group, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, United Kingdom; MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, University of Liverpool, Sherrington Buildings, Ashton Street, Liverpool L69 3GE, United Kingdom; Medimmune, Aaron Klug Building, Granta Park, Cambridge CB21 6GH, United Kingdom.
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Graff TM, Singavi AK, Schmidt W, Eastwood D, Drobyski WR, Horowitz M, Palmer J, Pasquini M, Rizzo DJ, Saber W, Hari P, Fenske TS. Safety of outpatient autologous hematopoietic cell transplantation for multiple myeloma and lymphoma. Bone Marrow Transplant 2015; 50:947-53. [PMID: 25867651 DOI: 10.1038/bmt.2015.46] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 01/18/2015] [Accepted: 02/03/2015] [Indexed: 12/22/2022]
Abstract
Autologous hematopoietic cell transplantation (Auto-HCT) is commonly an in-patient procedure. However, Auto-HCT is increasingly being offered on an outpatient basis. To better characterize the safety of outpatient Auto-HCT, we compared the outcome of 230 patients who underwent Auto-HCT on an in-patient vs outpatient basis for myeloma or lymphoma within a single transplant program. All outpatient transplants occurred in a cancer center day hospital. Hematopoietic recovery occurred earlier in the outpatient cohort, with median time to neutrophil recovery of 10 vs 11 days (P<0.001) and median time to platelet recovery of 19 vs 20 days (P=0.053). Fifty-one percent of the outpatient cohort never required admission, with this percentage increasing in later years. Grade 3-4 non-hematologic toxicities occurred in 29% of both cohorts. Non-relapse mortality at 1 year was 0% in the outpatient cohort and 1.5% in the in-patient cohort (P=0.327). Two-year PFS was 62% for outpatient vs 54% for in-patient (P=0.155). One- and two-year OS was 97% and 83% for outpatient vs 91% and 80% for in-patient, respectively (P=0.271). We conclude that, with daily outpatient evaluation and aggressive supportive care, outpatient Auto-HCT can result in excellent outcomes for myeloma and lymphoma patients.
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Affiliation(s)
- T M Graff
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - A K Singavi
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - W Schmidt
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - D Eastwood
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - W R Drobyski
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M Horowitz
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Palmer
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - M Pasquini
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - D J Rizzo
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - W Saber
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - P Hari
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - T S Fenske
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
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Reed DM, Paschalaki KE, Starke RD, Mohamed NA, Sharp G, Fox B, Eastwood D, Bristow A, Ball C, Vessillier S, Hansel TT, Thorpe SJ, Randi AM, Stebbings R, Mitchell JA. An autologous endothelial cell:peripheral blood mononuclear cell assay that detects cytokine storm responses to biologics. FASEB J 2015; 29:2595-602. [PMID: 25746794 DOI: 10.1096/fj.14-268144] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/13/2015] [Indexed: 11/11/2022]
Abstract
There is an urgent unmet need for human tissue bioassays to predict cytokine storm responses to biologics. Current bioassays that detect cytokine storm responses in vitro rely on endothelial cells, usually from umbilical veins or cell lines, cocultured with freshly isolated peripheral blood mononuclear cells (PBMCs) from healthy adult volunteers. These assays therefore comprise cells from 2 separate donors and carry the disadvantage of mismatched tissues and lack the advantage of personalized medicine. Current assays also do not fully delineate mild (such as Campath) and severe (such as TGN1412) cytokine storm-inducing drugs. Here, we report a novel bioassay where endothelial cells grown from stem cells in the peripheral blood (blood outgrowth endothelial cells) and PBMCs from the same donor can be used to create an autologous coculture bioassay that responds by releasing a plethora of cytokines to authentic TGN1412 but only modestly to Campath and not to control antibodies such as Herceptin, Avastin, and Arzerra. This assay performed better than the traditional mixed donor assay in terms of cytokine release to TGN1412 and, thus, we suggest provides significant advancement and a definitive system by which biologics can be tested and paves the way for personalized medicine.
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Affiliation(s)
- Daniel M Reed
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
| | - Koralia E Paschalaki
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
| | - Richard D Starke
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
| | - Nura A Mohamed
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
| | - Giles Sharp
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
| | - Bernard Fox
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
| | - David Eastwood
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
| | - Adrian Bristow
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
| | - Christina Ball
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
| | - Sandrine Vessillier
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
| | - Trevor T Hansel
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
| | - Susan J Thorpe
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
| | - Anna M Randi
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
| | - Richard Stebbings
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
| | - Jane A Mitchell
- *Department of Cardiothoracic Pharmacology, Vascular Biology Section, National Heart and Lung Institute, and Vascular Sciences, National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom; Qatar Foundation Research and Development Division, Doha, Qatar; National Institute for Biological Standards and Control, Potters Bar, United Kingdom; Imperial Clinical Respiratory Research Unit, St. Mary's Hospital, London, United Kingdom; and Medimmune, Cambridge, United Kingdom
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Vessillier S, Eastwood D, Fox B, Swaminathan S, Sathish J, Thorpe S, Thorpe R, Stebbings R. Glycophorin a blocks the response to TGN1412 in whole blood cytokine release assays. Toxicol Lett 2014. [DOI: 10.1016/j.toxlet.2014.06.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vessillier S, Eastwood D, Thorpe S, Stebbings R. Cytokine release assays post TGN1412. Toxicol Lett 2014. [DOI: 10.1016/j.toxlet.2014.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Eastwood D, Bird C, Dilger P, Hockley J, Findlay L, Poole S, Thorpe SJ, Wadhwa M, Thorpe R, Stebbings R. Severity of the TGN1412 trial disaster cytokine storm correlated with IL-2 release. Br J Clin Pharmacol 2013; 76:299-315. [PMID: 23701319 PMCID: PMC3731604 DOI: 10.1111/bcp.12165] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 04/21/2013] [Indexed: 12/31/2022] Open
Abstract
Aim To determine if cytokine release with a solid phase assay is predictive of adverse responses for a range of therapeutic mAbs. Methods Cytokine ELISAs and a multi-array system were used to compare responses generated by different therapeutic mAbs using a solid phase assay. Flow cytometry was employed to determine the cellular source of those cytokines. Results Only TGN1412 and muromonab-CD3 stimulated CD4+ T-cell mediated cytokine release characterized by significant (all P < 0.0001) IFNγ, TNFα, IL-2, IL-4, IL-5, IL-10, IL-12, IL-13, IL-17 and IL-22 release, comparable with T-cell mitogen. Significantly greater (P < 0.0001) IL-2 release with TGN1412 (2894–6051 pg ml−1) compared with muromonab-CD3 (62–262 pg ml−1) differentiated otherwise comparable cytokine responses. Likewise, TGN1412 stimulated significantly more (P = 0.0001) IL-2 producing CD4+ T-cells than muromonab-CD3 and induced Th1, Th2, Th17 and Th22 subsets that co-release this cytokine. Significant TNFα release was observed with bevacizumab (P = 0.0001), trastuzumab (P = 0.0031) and alemtuzumab (P = 0.0177), but no significant IL-2 release. TGN1412 and muromonab-CD3 caused pro-inflammatory cytokine release despite significantly (both P < 0.0001) increasing numbers of T-cells with a regulatory phenotype. Conclusions The severity of the adverse response to TGN1412 compared with muromonab-CD3 and other therapeutic mAbs correlates with the level of IL-2 release.
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Affiliation(s)
- David Eastwood
- Biotherapeutics Group, NIBSC, Potters Bar, Hertfordshire, UK
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Kapfhamer J, Strawn E, Eastwood D, Szabo A. Pregnancy rate in women with primary infertility based on self-reported stress level at the time of initial infertility consultation with a reproductive specialist. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ackman J, Altiok H, Flanagan A, Peer M, Graf A, Krzak J, Hassani S, Eastwood D, Harris GF. Long-term follow-up of Van Nes rotationplasty in patients with congenital proximal focal femoral deficiency. Bone Joint J 2013; 95-B:192-8. [PMID: 23365028 DOI: 10.1302/0301-620x.95b2.30853] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Van Nes rotationplasty may be used for patients with congenital proximal focal femoral deficiency (PFFD). The lower limb is rotated to use the ankle and foot as a functional knee joint within a prosthesis. A small series of cases was investigated to determine the long-term outcome. At a mean of 21.5 years (11 to 45) after their rotationplasty, a total of 12 prosthetic patients completed the Short-Form (SF)-36, Faces Pain Scale-Revised, Harris hip score, Oswestry back pain score and Prosthetic Evaluation Questionnaires, as did 12 age- and gender-matched normal control participants. A physical examination and gait analysis, computerised dynamic posturography (CDP), and timed 'Up & Go' testing was also completed. Wilcoxon Signed rank test was used to compare each PFFD patient with a matched control participant with false discovery rate of 5%. There were no differences between the groups in overall health and well-being on the SF-36. Significant differences were seen in gait parameters in the PFFD group. Using CDP, the PFFD group had reduced symmetry in stance, and reduced end point and maximum excursions. Patients who had undergone Van Nes rotationplasty had a high level of function and quality of life at long-term follow-up, but presented with significant differences in gait and posture compared with the control group.
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Affiliation(s)
- J Ackman
- Shriners Hospitals for Children, Chicago, Illinois 60707, USA
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Ball C, Fox B, Hufton S, Sharp G, Poole S, Stebbings R, Eastwood D, Findlay L, Parren PWHI, Thorpe R, Bristow A, Thorpe SJ. Antibody C Region Influences TGN1412-like Functional Activity In Vitro. J I 2012; 189:5831-40. [DOI: 10.4049/jimmunol.1201795] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
The failure of regulatory science to keep pace with and support the development of new biological medicines was very publically highlighted in March 2006 when the first-in-man Phase I clinical trial of the immunomodulatory CD28-specific monoclonal antibody (mAb) TGN1412 ended in disaster when all six volunteers suffered a life-threatening adverse reaction termed a 'Cytokine Storm'. The poor predictive value of standard pre-clinical safety tests and animal models applied to TGN1412 demonstrated the need for a new generation of immunotoxicity assays and animal models that are both sensitive and predictive of clinical outcome in man. The non-predictive result obtained from pre-clinical safety testing in cynomolgus macaques has now been attributed to a lack of CD28 expression on CD4+ effector memory T-cells that therefore cannot be stimulated by TGN1412. In contrast, high levels of CD28 are expressed on human CD4+ effector memory T-cells, the source of most TGN1412-stimulated pro-inflammatory cytokines. Standard in vitro safety tests with human cells were also non-predictive as they did not replicate in vivo presentation of TGN1412. It was subsequently shown that, if an immobilized therapeutic mAb-based assay or endothelial cell co-culture assay was used to evaluate TGN1412, then these would have predicted a pro-inflammatory response in man. New in vitro assays based on these approaches are now being applied to emerging therapeutics to hopefully prevent a repeat of the TGN1412 incident. It has emerged that the mechanism of pro-inflammatory cytokine release stimulated by TGN1412 is different to that of other therapeutic mAbs, such that standard pro-inflammatory markers such as TNFα and IL-8 are not discriminatory. Rather, IL-2 release and lymphoproliferation are optimal readouts of a TGN1412-like pro-inflammatory response.
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Affiliation(s)
- R Stebbings
- Biotherapeutics Group, NIBSC, Potters Bar, Hertfordshire EN6 3QG, UK.
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Shamji M, Moon ES, Glennie R, Soroceanu A, Lin C, Bailey C, Simmonds A, Fehlings M, Dodwell E, Dold A, El-Hawary R, Hashem M, Dold A, Dold A, Jones S, Bailey C, Karadimas S, Whitehurst D, Norton J, Norton J, Manson N, Kesani A, Bednar D, Lundine K, Hartig D, Fichadi A, Fehlings M, Kim S, Harris S, Lin C, Gill J, Abraham E, Shamji M, Choi S, Goldstein C, Wang Z, McCabe M, Noonan V, Nadeau M, Ferrara S, Kelly A, Melnyk A, Arora D, Quateen A, Dea N, Ranganathan A, Zhang Y, Casha S, Rajamanickam K, Santos A, Santos A, Wilson J, Wilson J, Street J, Wilson J, Lewis R, Noonan V, Street J, El-Hawary R, Egge N, Lin C, Schouten R, Lin C, Kim A, Kwon B, Huang E, Hwang P, Allen K, Jing L, Mata B, Gabr M, Richardson W, Setton L, Karadimas S, Fehlings M, Fleming J, Bailey C, Gurr K, Bailey S, Siddiqi F, Lawendy A, Sanders D, Staudt M, Canacari E, Brown E, Robinson A, McGuire K, Chrysostoum C, Rampersaud YR, Dvorak M, Thomas K, Boyd M, Gurr K, Bailey S, Nadeau M, Fisher C, Batke J, Street J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Vaccaro A, Chapman J, Arnold P, Shaffrey C, Kopjar B, Snyder B, Wright J, Lewis S, Zeller R, El-Hawary R, Moroz P, Bacon S, Jarzem P, Hedden D, Howard J, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, Bodin N, d’Amato C, Harris C, Smith J, Parent E, Hill D, Hedden D, Moreau M, Mahood J, Lewis S, Bodrogi A, Abbas H, Goldstein S, Bronstein Y, Bacon S, Chua S, Magana S, Van Houwelingen A, Halpern E, Jhaveri S, Lewis S, Lim A, Leelapattana P, Fleming J, Siddiqqi F, Bailey S, Gurr K, Moon ES, Satkunendrarajah K, Fehlings M, Noonan V, Dvorak M, Bryan S, Aronyk K, Fox R, Nataraj A, Pugh J, Elliott R, McKeon M, Abraham E, Fleming J, Gurr K, Bailey S, Siddiqi F, Bailey C, Davis G, Rogers M, Staples M, Quan G, Batke J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Shamji M, Hurlbert R, Jacobs W, Duplessis S, Casha S, Jha N, Hewson S, Massicotte E, Kopjar B, Mortaz S, Coyte P, Rampersaud Y, Rampersaud Y, Goldstein S, Andrew B, Modi H, Magana S, Lewis S, Roffey D, Miles I, Wai E, Manson N, Eastwood D, Elliot R, McKeon M, Bains I, Yong E, Sutherland G, Hurlbert R, Rampersaud Y, Chan V, Persaud O, Koshkin A, Brull R, Hassan N, Petis S, Kowalczuk M, Petrisor B, Drew B, Bhandari M, DiPaola C, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, McLachlin S, Bailey S, Gurr K, Bailey C, Dunning C, Fehlings M, Vaccaro A, Wing P, Itshayek E, Biering-Sorensen F, Dvorak M, McLachlin S, Bailey S, Gurr K, Dunning C, Bailey C, Bradi A, Pokrupa R, Batke J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Kelly A, Wen T, Kingwell S, Chak J, Singh V, Cripton P, Fisher C, Dvorak M, Oxland T, Wali Z, Yen D, Alfllouse A, Alzahrani A, Jiang H, Mahood J, Kortbeek F, Fox R, Nataraj A, Street J, Boyd M, Paquette S, Kwon B, Batke J, Dvorak M, Fisher C, Reddy R, Rampersaud R, Hurlbert J, Yong W, Casha S, Zygun D, McGowan D, Bains I, Yong V, Hurlbert R, Mendis B, Chakraborty S, Nguyen T, Tsai E, Chen A, Atkins D, Noonan V, Drew B, Tsui D, Townson A, Dvorak M, Chen A, Atkins D, Noonan V, Drew B, Dvorak M, Craven C, Ford M, Ahn H, Drew B, Fehlings M, Kiss A, Vaccaro A, Harrop J, Grossman R, Frankowski R, Guest J, Dvorak M, Aarabi B, Fehlings M, Noonan V, Cheung A, Sun B, Dvorak M, Vaccaro A, Harrop J, Massicotte E, Dvorak M, Fisher C, Rampersaud R, Lewis S, Fehlings M, Marais L, Noonan V, Queyranne M, Fehlings M, Dvorak M, Atkins D, Hurlbert R, Fox R, Fourney D, Johnson M, Fehlings M, Ahn H, Ford M, Yee A, Finkelstein J, Tsai E, Bailey C, Drew B, Paquet J, Parent S, Christie S, Dvorak M, Noonan V, Cheung A, Sun B, Dvorak M, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, Bodin N, d’Amato C, Harris C, Smith J, Lange J, DiPaola C, Lapinsky A, Connolly P, Eck J, Rabin D, Zeller R, Lewis S, Lee R, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, DiPaola C, Street J, Bodrogi A, Goldstein S, Sofia M, Lewis S, Shin J, Tung K, Ahn H, Lee R, Batke J, Ghag R, Noonan V, Dvorak M, Goyal T, Littlewood J, Bains I, Cho R, Thomas K, Swamy G. Canadian Spine Society abstracts1.1.01 Supraspinal modulation of gait abnormalities associated with noncompressive radiculopathy may be mediated by altered neurotransmitter sensitivity1.1.02 Neuroprotective effects of the sodium-glutamate blocker riluzole in the setting of experimental chronic spondylotic myelopathy1.1.03 The effect of timing to decompression in cauda equina syndrome using a rat model1.2.04 Intraoperative waste in spine surgery: incidence, cost and effectiveness of an educational program1.2.05 Looking beyond the clinical box: the health services impact of surgical adverse events1.2.06 Brace versus no brace for the treatment of thoracolumbar burst fractures without neurologic injury: a multicentre prospective randomized controlled trial1.2.07 Adverse event rates in surgically treated spine injuries without neurologic deficit1.2.08 Functional and quality of life outcomes in geriatric patients with type II odontoid fracture: 1-year results from the AOSpine North America Multi-Center Prospective GOF Study1.3.09 National US practices in pediatric spinal fusion: in-hospital complications, length of stay, mortality, costs and BMP utilization1.3.10 Current trends in the surgical treatment of adolescent idiopathic scoliosis in Canada1.3.11 Sagittal spinopelvic parameters help predict the risk of proximal junctional kyphosis for children treated with posterior distraction-based implants1.4.12 Correlations between changes in surface topography and changes in radiograph measurements from before to 6 months after surgery in adolescents with idiopathic scoliosis1.4.13 High upper instrumented vertebra (UIV) sagittal angle is associated with UIV fracture in adult deformity corrections1.4.14 Correction of adult idiopathic scoliosis using intraoperative skeletal traction1.5.01 Cauda equina: using management protocols to reduce delays in diagnosis1.5.02 Predicting the need for tracheostomy in patients with acute traumatic spinal cord injury1.5.03 A novel animal model of cervical spondylotic myelopathy: an opportunity to identify new therapeutic targets1.5.04 A review of preference-based measures of health-related quality of life in spinal cord injury research1.5.05 Predicting postoperative neuropathic pain following surgery involving nerve root manipulation based on intraoperative electromyographic activity1.5.06 Detecting positional injuries in prone spinal surgery1.5.07 Percutaneous thoracolumbar stabilization for trauma: surgical morbidity, clinical outcomes and revision surgery1.5.08 Systemic inflammatory response syndrome in spinal cord injury patients: Does its presence at admission affect patient outcomes?2.1.15 One hundred years of spine surgery — a review of the evolution of our craft and practice in the spine surgical century [presentation]2.1.16 Prevalence of preoperative MRI findings of adjacent segment disc degeneration in patients undergoing anterior cervical discectomy and fusion2.1.17 Adverse event rates of surgically treated cervical spondylopathic myelopathy2.1.18 Morphometricand dynamic changes in the cervical spine following anterior cervical discectomy and fusion and cervical disc arthroplasty2.1.19 Is surgery for cervical spondylotic myelopathy cost-effective? A cost–utility analysis based on data from the AO Spine North American Prospective Multicentre CSM Study2.2.20 Cost–utility of lumbar decompression with or without fusion for patients with symptomatic degenerative lumbar spondylolisthesis (DLS)2.2.21 Minimally invasive surgery lumbar fusion for low-grade isthmic and degenerative spondylolisthesis: 2- to 5-year follow-up2.2.22 Results and complications of posterior-only reduction and fusion for high-grade spondylolisthesis2.3.23 Fusion versus no fusion in patients with central lumbar spinal stenosis and foraminal stenosis undergoing decompression surgery: comparison of outcomes at baseline and follow-up2.3.24 Two-year results of interspinous spacers (DIAM) as an alternative to arthrodesis for lumbar degenerative disorders2.3.25 Treatment of herniated lumbar disc by sequestrectomy or conventional discectomy2.4.26 No sustained benefit of continuous epidural analgesia for minimally invasive lumbar fusion: a randomized double-blinded placebo controlled study2.4.27 Evidence and current practice in the radiologic assessment of lumbar spine fusion2.4.28 Wiltse versus midline approach for decompression and fusion of the lumbar spine2.5.09 The effect of soft tissue restraints following type II odontoid fractures in the elderly — a biomechanical study2.5.10 Development of an international spinal cord injury (SCI) spinal column injury basic data set2.5.11 Evaluation of instrumentation techniques for a unilateral facet perch and fracture using a validated soft tissue injury model2.5.12 Decreasing neurologic consequences in patients with spinal infection: the testing of a novel diagnostic guideline2.5.13 Prospective analysis of adverse events in surgical treatment of degenerative spondylolisthesis2.5.14 Load transfer characteristics between posterior fusion devices and the lumbar spine under anterior shear loading: an in vitro investigation2.5.15 Preoperative predictive clinical and radiographic factors influencing functional outcome after lumbar discectomy2.5.16 A Thoracolumbar Injury Classification and Severity Score (TLICS) of 4: What should we really do?3.1.29 Adverse events in emergent oncologic spine surgery: a prospective analysis3.1.30 En-bloc resection of primary spinal and paraspinal tumours with critical vascular involvement3.1.31 The treatment impact of minocycline on quantitative MRI in acute spinal cord injury3.1.32 Benefit of minocycline in spinal cord injury — results of a double-blind randomized placebo-controlled study3.2.33 Improvement of magnetic resonance imaging correlation with unilateral motor or sensory deficits using diffusion tensor imaging3.2.34 Comparing care delivery for acute traumatic spinal cord injury in 2 Canadian centres: How do the processes of care differ?3.2.35 Improving access to early surgery: a comparison of 2 centres3.3.36 The effects of early surgical decompression on motor recovery after traumatic spinal cord injury: results of a Canadian multicentre study3.3.37 A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors3.3.38 Effect of motor score on adverse events and quality of life in patients with traumatic spinal cord injury3.4.39 The impact of facet dislocation on neurologic recovery after cervical spinal cord injury: an analysis of data on 325 patients from the Surgical Trial in Acute Spinal Cord Injury Study (STASCIS)3.4.40 Toward a more precise understanding of the epidemiology of traumatic spinal cord injury in Canada3.4.41 Access to care (ACT) for traumatic SCI: a survey of acute Canadian spine centres3.4.42 Use of the Spine Adverse Events Severity (SAVES) instrument for traumatic spinal cord injury3.5.17 Does the type of distraction-based growing system for early onset scoliosis affect postoperative sagittal alignment?3.5.18 Comparison of radiation exposure during thoracolumbar fusion using fluoroscopic guidance versus anatomic placement of pedicle screws3.5.19 Skeletal traction for intraoperative reduction in adolescent idiopathic scoliosis3.5.20 Utility of intraoperative cone-beam computed tomography (O-ARM) and stereotactic navigation in acute spinal trauma surgery3.5.21 Use of a central compression rod to reduce thoracic level spinal osteotomies3.5.22 ICD-10 coding accuracy for spinal cord injured patients3.5.23 Feasibility of patient recruitment in acute SCI trials3.5.24 Treatment of adult degenerative scoliosis with DLIF approaches. Can J Surg 2012. [DOI: 10.1503/cjs.012212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Findlay L, Sharp G, Fox B, Ball C, Robinson CJ, Bird C, Stebbings R, Eastwood D, Wadhwa M, Poole S, Thorpe R, Thorpe SJ. Endothelial cells co-stimulate peripheral blood mononuclear cell responses to monoclonal antibody TGN1412 in culture. Cytokine 2011; 55:141-51. [DOI: 10.1016/j.cyto.2011.03.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 03/18/2011] [Indexed: 12/01/2022]
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Eastwood D, Findlay L, Poole S, Bird C, Wadhwa M, Moore M, Burns C, Thorpe R, Stebbings R. Monoclonal antibody TGN1412 trial failure explained by species differences in CD28 expression on CD4+ effector memory T-cells. Br J Pharmacol 2010; 161:512-26. [PMID: 20880392 PMCID: PMC2990151 DOI: 10.1111/j.1476-5381.2010.00922.x] [Citation(s) in RCA: 190] [Impact Index Per Article: 13.6] [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: 01/19/2010] [Revised: 03/26/2010] [Accepted: 03/30/2010] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE In 2006, a life-threatening 'cytokine storm', not predicted by pre-clinical safety testing, rapidly occurred in all six healthy volunteers during the phase I clinical trial of the CD28 superagonist monoclonal antibody (mAb) TGN1412. To date, no unequivocal explanation for the failure of TGN1412 to stimulate profound cytokine release in vitro or in vivo in species used for pre-clinical safety testing has been established. Here, we have identified a species difference almost certainly responsible for this disparate immunopharmacology. EXPERIMENTAL APPROACH Polychromatic flow cytometry and intracellular cytokine staining were employed to dissect the in vitro immunopharmacology of TGN1412 and other therapeutic mAbs at the cellular level to identify differences between humans and species used for pre-clinical safety testing. KEY RESULTS In vitro IL-2 and IFN-γ release from CD4+ effector memory T-cells were key indicators of a TGN1412-type response. This mechanism of cytokine release differed from that of other therapeutic mAbs, which can cause adverse reactions, because these other mAbs stimulate cytokine release primarily from natural killer cells. In contrast to humans, CD28 is not expressed on the CD4+ effector memory T-cells of all species used for pre-clinical safety testing, so cannot be stimulated by TGN1412. CONCLUSIONS AND IMPLICATIONS It is likely that activation of CD4+ effector memory T-cells by TGN1412 was responsible for the cytokine storm. Lack of CD28 expression on the CD4+ effector memory T-cells of species used for pre-clinical safety testing of TGN1412 offers an explanation for the failure to predict a 'cytokine storm' in humans.
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Affiliation(s)
- D Eastwood
- Biotherapeutics Group, NIBSC, Potters Bar, Hertfordshire, UK
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Abstract
Highly active anti-retroviral therapy has transformed HIV into a chronic disease with a long-term asymptomatic phase. As a result, emphasis is shifting to other effects of the virus, aside from immunosuppression and mortality. We have reviewed the current evidence for an association between HIV infection and poor fracture healing. The increased prevalence of osteoporosis and fragility fractures in HIV patients is well recognised. The suggestion that this may be purely as a result of highly active anti-retroviral therapy has been largely rejected. Apart from directly impeding cellular function in bone remodelling, HIV infection is known to cause derangement in the levels of those cytokines involved in fracture healing (particularly tumour necrosis factor-α) and appears to impair the blood supply of bone. Many other factors complicate this issue, including a reduced body mass index, suboptimal nutrition, the effects of anti-retroviral drugs and the avoidance of operative intervention because of high rates of wound infection. However, there are sound molecular and biochemical hypotheses for a direct relationship between HIV infection and impaired fracture healing, and the rewards for further knowledge in this area are extensive in terms of optimised fracture management, reduced patient morbidity and educated resource allocation. Further investigation in this area is overdue.
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Affiliation(s)
- J. Richardson
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - A. M. Hill
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - C. J. C. Johnston
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - A. McGregor
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - A. R. Norrish
- Tropical Surgery Research and Training Unit, Beit CURE Hospital, P. O. Box 36391, Lusaka, Zambia
| | - D. Eastwood
- Department of Orthopaedics, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
| | - C. B. D. Lavy
- Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford 0X3 7LD, UK
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Lawal A, Ghobrial R, Te H, Artinian L, Eastwood D, Schiano TD. Comparison of hepatitis C histological recurrence rates and patient survival between split and deceased donor liver transplantation. Transplant Proc 2008; 39:3261-5. [PMID: 18089367 DOI: 10.1016/j.transproceed.2007.08.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 08/08/2007] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Controversy exists as to whether there is an increased severity or frequency of recurrent hepatitis C viral (HCV) infection in recipients of adult living donor liver transplantation (LDLT) grafts. We sought to examine the time to histological recurrence and survival in HCV (+) patients who underwent split liver transplantation (SLT), which is technically similar to what occurs in the LDLT procedure. METHODS Twenty four HCV (+) adult recipients were identified through the UNOS database as having had SLT procedures at three centers: Mount Sinai Medical Center, University of Chicago, and University of California at Los Angeles. Of these, 17 patients with comprehensive data were matched to 32 HCV (+) patients who underwent whole deceased donor liver transplantation (DDLT) during the same time period. Outcome and time to initial HCV recurrence as documented by liver biopsy were assessed. Liver biopsy was performed when clinically indicated. RESULTS Patients who had SLT were significantly older (P=.01). There was no difference in number of rejection episodes (P=.40). Fifteen of 17 SLT (88%) versus 24/32 DDLT (75%) patients had documented HCV recurrence by biopsy (P=.46). The time to median cumulative incidence of recurrence of HCV post-liver transplantation was 12.6 months (SLT) versus 39.8 months (DDLT) patients. There was no difference in survival between SLT and DDLT patients (47 vs 70 months, P=.62) nor in cumulative incidence of histological HCV recurrence at 1, 2, and 3 years (P=.198, .919, and .806, respectively). CONCLUSION There is no difference in the cumulative incidence of histological recurrence of HCV post-liver transplant or in survival between recipients of deceased donor and split liver transplants.
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Affiliation(s)
- A Lawal
- Department of Liver Diseases and Transplantation, Mount Sinai Medical Center, Recanati/Miller Transplantation Institute, New York, NY 10029, USA
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Stebbings R, Findlay L, Edwards C, Eastwood D, Bird C, North D, Mistry Y, Dilger P, Liefooghe E, Cludts I, Fox B, Tarrant G, Robinson J, Meager T, Dolman C, Thorpe SJ, Bristow A, Wadhwa M, Thorpe R, Poole S. “Cytokine Storm” in the Phase I Trial of Monoclonal Antibody TGN1412: Better Understanding the Causes to Improve PreClinical Testing of Immunotherapeutics. J Immunol 2007; 179:3325-31. [PMID: 17709549 DOI: 10.4049/jimmunol.179.5.3325] [Citation(s) in RCA: 214] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The CD28-specific mAb TGN1412 rapidly caused a life-threatening "cytokine storm" in all six healthy volunteers in the Phase I clinical trial of this superagonist, signaling a failure of preclinical safety testing. We report novel in vitro procedures in which TGN1412, immobilized in various ways, is presented to human white blood cells in a manner that stimulates the striking release of cytokines and profound lymphocyte proliferation that occurred in vivo in humans. The novel procedures would have predicted the toxicity of this superagonist and are now being applied to emerging immunotherapeutics and to other therapeutics that have the potential to act upon the immune system. Data from these novel procedures, along with data from in vitro and in vivo studies in nonhuman primates, suggest that the dose of TGN1412 given to human volunteers was close to the maximum immunostimulatory dose and that TGN1412 is not a superagonist in nonhuman primates.
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Affiliation(s)
- Richard Stebbings
- Biotherapeutics Group, National Institute for Biological Standards and Control, Potters Bar, Hertfordshire, United Kingdom
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von Drygalski A, Savatski L, Eastwood D, Klein J, Adamson JW. The rate of marrow recovery and extent of donor engraftment following transplantation of ex vivo-expanded bone marrow cells are independently influenced by the cytokines used for expansion. Stem Cells Dev 2006; 14:564-75. [PMID: 16305341 DOI: 10.1089/scd.2005.14.564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Successful stem cell transplantation depends on cell dose, and this is particularly true for placental/cord blood transplantation in which it has been clearly shown that both the success of engraftment as well as the speed of white cell and platelet recovery are dependent on the nucleated cell dose in the graft. Thus, if stem cell numbers could be increased, the speed as well as the likelihood of engraftment might be improved. We studied the effect of two different cytokine combinations--kit ligand (KL), interleukin-3 (IL-3), and Flt-3 ligand supplemented with thrombopoietin and IL-11 (combination 1) or granulocyte/macrophage colony-stimulating factor (GM-CSF) and G-CSF (combination 2)--for their ability to affect speed and extent of engraftment using limited numbers (5 x 10(4)) of murine bone marrow (BM) light-density (LD) cells or their progeny expanded ex vivo in the presence one or the other cytokine combination for 6 days. With combination 1, we found that speed of platelet recovery was enhanced, but at the expense of white blood cell (WBC) recovery and percent donor engraftment. Furthermore, the cytokine combination that best maintained donor engraftment, combination 2, did so at the expense of platelet recovery. In no case was percent donor engraftment improved over 5 x 10(4) unmanipulated LD BM cells. These results are consistent with the interpretation that immediate recovery of blood cells of different lineages and longterm donor engraftment are separate functions that can be influenced by the choice of cytokines used during the ex vivo expansion process.
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Affiliation(s)
- A von Drygalski
- The Blood Research Institute of BloodCenter of Wisconsin, Milwaukee, WI 53201, USA
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Hidvegi NC, Sales KM, Izadi D, Ong J, Kellam P, Eastwood D, Butler PEM. A low temperature method of isolating normal human articular chondrocytes. Osteoarthritis Cartilage 2006; 14:89-93. [PMID: 16242358 DOI: 10.1016/j.joca.2005.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2004] [Accepted: 08/16/2005] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Numerous methods for isolation of human chondrocytes are reported in the literature, most based on isolation from animal cartilage. Normal human articular cartilage (NHAC) poses particular problems for isolating chondrocytes when compared to animal or other types of human cartilage: a hardy matrix, combined with few and friable chondrocytes makes isolation difficult. Our objective was to develop an efficient method of isolating chondrocytes from NHAC without jeopardising the viability of these cells. DESIGN In this study we demonstrate that lowering the enzymatic digestion temperature to 27 degrees C increases cell yield and chondrocyte viability. We then optimised this low temperature isolation of chondrocytes from NHAC by comparing the relative efficacies of trypsin and protease and hyaluronidase in combination with different types of collagenase (I, II and XI) at releasing chondrocytes from their surrounding cartilaginous matrix. Enzymes were tested at different concentrations and for differing times. Outcome measures included determining the amount of cartilage digested, the number of viable chondrocytes isolated per gram of cartilage and cell adherence rates. CONCLUSIONS From these set of experiments, the method that maximised cell yield without jeopardising cell viability proved to be a two stage process: pre-digestion step using trypsin for 15 min; followed by overnight digestion with a combination of two types of collagenase (types I and II) and at a lower temperature of 27 degrees C. This has resulted in an efficient and robust method of releasing chondrocytes from cartilage, without jeopardising the viability of these cells.
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Affiliation(s)
- N C Hidvegi
- Department of Plastic Surgery, Royal Free Hospital School of Medicine, London, UK.
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Eastwood D, Gilmour KC, Nistala K, Meaney C, Chapel H, Sherrell Z, Webster AD, Davies EG, Jones A, Gaspar HB. Prevalence of SAP gene defects in male patients diagnosed with common variable immunodeficiency. Clin Exp Immunol 2004; 137:584-8. [PMID: 15320910 PMCID: PMC1809139 DOI: 10.1111/j.1365-2249.2004.02581.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The molecular basis of common variable immunodeficiency (CVID) is undefined, and diagnosis requires exclusion of other diseases including X-linked lymphoproliferative disease (XLP). This rare disorder of immunedysregulation presents typically after Epstein-Barr virus infection and results from defects in the SAP (SLAM associated protein) gene. SAP mutations have been found in a few patients diagnosed previously as CVID, suggesting that XLP may mimic CVID, but no large-scale analysis of CVID patients has been undertaken. We therefore analysed 60 male CVID and hypogammaglobulinaemic patients for abnormalities in SAP protein expression and for mutations in the SAP gene. In this study only one individual, who was found later to have an X-linked family history, was found to have a genomic mutation leading to abnormal SAP cDNA and protein expression. These results demonstrate that SAP defects are rarely observed in CVID patients. We suggest that routine screening of SAP may only be necessary in patients with other suggestive clinical features.
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Affiliation(s)
- D Eastwood
- Molecular Immunology Unit, Institute of Child Health, University College London, London, UK
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Affiliation(s)
- David Eastwood
- Institute of Child Health, University College London, UK
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Akasheh M, Eastwood D, Vesole DH. Engraftment syndrome after autologous hematopoietic stem cell transplant supported by granulocyte-colony-stimulating factor (G-CSF) versus granulocyte-macrophage colony-stimulating factor (GM-CSF). Bone Marrow Transplant 2003; 31:113-6. [PMID: 12621492 DOI: 10.1038/sj.bmt.1703784] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The engraftment syndrome (ES) is a phenomenon observed in some patients undergoing autologous hematopoietic stem cell transplant (AHSCT). ES is characterized by fever, rash, capillary leak, and pulmonary infiltrates occurring at the onset of engraftment. Prior studies have suggested that the administration of hematopoietic growth factors post-transplant results in the increased frequency of ES. However, the relative contribution of granulocyte colony-stimulating factor (G-CSF) vs granulocyte-macrophage colony-stimulating factor (GM-CSF) to the development of ES remains unknown. A total of 152 consecutive patients who were treated with high-dose chemotherapy and AHSCT supported by either G-CSF or GM-CSF were analyzed retrospectively. In all, 20 patients developed ES, an incidence of 13%. ES was seen more frequently in patients who received GM-CSF (GM-CSF 24% vs G-CSF 4%, p=0.0001). The highest incidence of ES was observed in breast cancer patients (42% of breast cancer patients; 70% of all ES cases). Comparison of the incidence of ES by the priming regimen used comprising either of the growth factors revealed no significant association (p=0.8224). This study demonstrates that the incidence of ES is higher using GM-CSF, particularly in patients with breast cancer. It suggests that it might be advantageous to administer only G-CSF in breast cancer patients undergoing AHSCT to reduce ES-related morbidity.
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Affiliation(s)
- M Akasheh
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Soyemi O, Eastwood D, Zhang L, Li H, Karunamuni J, Gemperline P, Synowicki RA, Myrick ML. Design and Testing of a Multivariate Optical Element: The First Demonstration of Multivariate Optical Computing for Predictive Spectroscopy. Anal Chem 2001. [DOI: 10.1021/ac010612h] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Keever-Taylor CA, Klein JP, Eastwood D, Bredeson C, Margolis DA, Burns WH, Vesole DH. Factors affecting neutrophil and platelet reconstitution following T cell-depleted bone marrow transplantation: differential effects of growth factor type and role of CD34(+) cell dose. Bone Marrow Transplant 2001; 27:791-800. [PMID: 11477435 DOI: 10.1038/sj.bmt.1702872] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2000] [Accepted: 01/30/2001] [Indexed: 11/08/2022]
Abstract
We have performed univariate and multivariate analysis to determine the factors that affect the kinetics of neutrophil and platelet recovery in 546 recipients of T cell-depleted (TCD) marrow allografts. All patients received marrow depleted of mature CD3(+) T cells by complement-mediated lysis using T(10)B(9)-1A3 (n = 489) or Muromonab-Orthoclone OKT3 (n = 57) monoclonal antibodies. Neutrophil engraftment to 0.5 x 10(9)/1 and platelet engraftment to 20 x 10(9)/l were assessed as endpoints. Factors significantly affecting neutrophil or platelet engraftment in the univariate analysis included patient age, T cell dose, anti-thymocyte globulin use, gender, diagnosis at transplant, CMV serostatus, HLA mismatch, CD34 cell dose (n = 249), and growth factor use and type. These variables were included in the multivariate Cox proportional hazards regression model. The results showed that a faster rate of neutrophil engraftment was independently associated with CD34(+) cell dose > or = 5 x 10(6)/kg and most strongly with growth factor administration. Faster platelet engraftment was associated with transplantation for chronic leukemia, CD34(+) cell dose > or = 2 x 10(6)/kg, an HLA matched related donor, and the absence of growth factor use. G-CSF had a higher relative risk (RR) of enhancing neutrophil engraftment than GM-CSF and significantly delayed platelet engraftment. The combined use of G-CSF + GM-CSF was similar to G-CSF alone. The enhancing effect of G-CSF for neutrophil recovery was most striking for patients who engrafted to 0.5 x 10(9)/1 at or before day 12 (RR = 9.5, P < 0.0001) compared to patients who received no growth factor. Conversely, the delaying effect of G-CSF on platelet engraftment was strongest for patients engrafting on or before day 25 (RR = 0.4, P = 0.0004). Of the independent variables affecting engraftment kinetics in recipients of TCD marrow allografts only growth factor, and to a limited extent, CD34(+) cell dose can be controlled by the clinician. A higher CD34(+) cell dose enhances the rate of both neutrophil and platelet engraftment whereas for G-CSF the benefits of myeloid growth factor use in enhancing neutrophil recovery may be partly offset by a delay in platelet engraftment.
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Affiliation(s)
- C A Keever-Taylor
- Bone Marrow Transplant Program, Medical College of Wisconsin, Milwaukee, WI, USA
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Soyemi O, Eastwood D, Zhang L, Li H, Karunamuni J, Gemperline P, Synowicki RA, Myrick ML. Design and Testing of a Multivariate Optical Element: The First Demonstration of Multivariate Optical Computing for Predictive Spectroscopy. Anal Chem 2001. [DOI: 10.1021/ac0012896] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- O. Soyemi
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina 29208, Department of Chemistry and Biochemistry, East Carolina University, Greenville, North Carolina 27258, and J. A. Woollam Company Inc., 645 M Street, Suite 102, Lincoln, Nebraska 68508
| | - D. Eastwood
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina 29208, Department of Chemistry and Biochemistry, East Carolina University, Greenville, North Carolina 27258, and J. A. Woollam Company Inc., 645 M Street, Suite 102, Lincoln, Nebraska 68508
| | - L. Zhang
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina 29208, Department of Chemistry and Biochemistry, East Carolina University, Greenville, North Carolina 27258, and J. A. Woollam Company Inc., 645 M Street, Suite 102, Lincoln, Nebraska 68508
| | - H. Li
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina 29208, Department of Chemistry and Biochemistry, East Carolina University, Greenville, North Carolina 27258, and J. A. Woollam Company Inc., 645 M Street, Suite 102, Lincoln, Nebraska 68508
| | - J. Karunamuni
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina 29208, Department of Chemistry and Biochemistry, East Carolina University, Greenville, North Carolina 27258, and J. A. Woollam Company Inc., 645 M Street, Suite 102, Lincoln, Nebraska 68508
| | - P. Gemperline
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina 29208, Department of Chemistry and Biochemistry, East Carolina University, Greenville, North Carolina 27258, and J. A. Woollam Company Inc., 645 M Street, Suite 102, Lincoln, Nebraska 68508
| | - R. A. Synowicki
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina 29208, Department of Chemistry and Biochemistry, East Carolina University, Greenville, North Carolina 27258, and J. A. Woollam Company Inc., 645 M Street, Suite 102, Lincoln, Nebraska 68508
| | - M. L. Myrick
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina 29208, Department of Chemistry and Biochemistry, East Carolina University, Greenville, North Carolina 27258, and J. A. Woollam Company Inc., 645 M Street, Suite 102, Lincoln, Nebraska 68508
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Myrick ML, Soyemi O, Li H, Zhang L, Eastwood D. Spectral tolerance determination for multivariate optical element design. Fresenius J Anal Chem 2001; 369:351-5. [PMID: 11293715 DOI: 10.1007/s002160000642] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Recent reports from our laboratory have described a method for all-optical multivariate chemometric prediction from optical spectroscopy. The concept behind this optical approach is that a spectral pattern (a regression vector) can be encoded into the spectrum of an optical filter. The key element of these measurement schemes is the multivariate optical element (MOE), a multiwavelength interference-based spectral discriminator that is tied to the regression vector of a particular measurement. The fabrication of these MOEs is a complex operation that requires precise techniques. However, to date, no quantitative means of determining the allowable design/ manufacturing errors for MOEs has existed. The purpose of the present report is to show how the spectroscopy of a sample is used to define the accuracy with which MOEs must be designed and manufactured. We conclude this report with a general treatment of spectral tolerance and a worked example. The worked example is based on actual experimental measurements. We show how the spectral bandpass is defined operationally in a real problem, and how the statistics of the theoretical regression vector influence both the bandpass and the minimum tolerances. In the experimental example, we demonstrate that tolerances range continuously between 1 (totally tolerant) to approximately 10(-3) (0.1% T) in this problem.
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Affiliation(s)
- M L Myrick
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia 29208, USA
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Eastwood D. E. A. Shipton, Pain: Acute and Chronic. Br J Anaesth 1999. [DOI: 10.1093/bja/83.6.977-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hadji F, Eastwood D, Fear S, Corfield HJ. The impact of audit in a district general hospital on post-operative nausea and vomiting after major gynaecological surgery. Eur J Anaesthesiol 1998; 15:595-9. [PMID: 9785076 DOI: 10.1046/j.1365-2346.1998.00369.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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An audit of post-operative nausea and vomiting (PONV) was undertaken in 935 female patients who used morphine patient-controlled analgesia (PCA) for pain relief after major gynaecological operations in a district general hospital. We investigated retrospectively five different antiemetic policies and a reference group without policy from January 1993 to July 1995. The department's computerized audit system was used to analyse the observations. At the beginning of the audit, the incidence of nausea and vomiting was as high as 71.5%. But as a consequence of this audit, a departmental policy was adopted 3 years later, which had an incidence of PONV of only 51.7%. During this time the compliance with antiemetic protocols increased from 41% to 76%. There was significantly less PONV if an antiemetic protocol was followed (P = 0.002). This emphasizes the importance of corporate involvement in the development, formulation and evaluation of departmental protocols if compliance is to be high. We conclude that audit as a corporate effort improves the acceptance of departmental protocols. This reduces PONV significantly irrespective of the type of antiemetic drug used.
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Affiliation(s)
- F Hadji
- Arrowe Park Hospital, Upton, Wirral, UK
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Abstract
Caudal epidural injection is a simple procedure that carries a low risk of complications. The whoosh test (injection of air into the caudal epidural space with simultaneous auscultation over the thoracolumbar spine) has been recommended as an aid to correct needle placement. A 1-year prospective study, using fluoroscopic imaging to identify needle position, was conducted to compare the sensitivity and specificity of the whoosh test with that of clinical impression alone in assessing correct needle placement in the caudal space. Of 131 patients studied, correct needle placement was achieved in 121 on the first attempt (92%). Clinical impression alone had a sensitivity of 94% and a specificity of 20%. The whoosh test had a sensitivity of 80% and a specificity of 60%. The whoosh test is superior to clinical judgment in detecting incorrect caudal needle placement.
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Affiliation(s)
- D Eastwood
- Department of Anaesthetics, Arrowe Park Hospital, Upton, Wirral, Merseyside, UK
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Wang Y, Holden JM, Rao AM, Eklund PC, Venkateswaran UD, Eastwood D, Lidberg RL, Dresselhaus G, Dresselhaus MS. Optical absorption and photoluminescence in pristine and photopolymerized C60 solid films. Phys Rev B Condens Matter 1995; 51:4547-4556. [PMID: 9979301 DOI: 10.1103/physrevb.51.4547] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Hashemi-Nejad A, Manktelow A, Eastwood D. Loosening and migration of Exeter THR. J Bone Joint Surg Br 1994; 76:507. [PMID: 8175875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
A simple modification to the method of regional anaesthesia known as Bier's block is presented. This was applied to patients with Colles' fractures. In a controlled trial the technique produced anaesthesia more quickly than the other method.
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Dyas AC, Eden PJ, Eastwood D, Bentley S, Burdon DW, Alexander-Williams J, Keighley MR. Sources of staphylococcal wound sepsis in surgical patients. J Hosp Infect 1982; 3:345-50. [PMID: 6190866 DOI: 10.1016/0195-6701(82)90066-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Keighley MR, Eastwood D, Ambrose NS, Allan RN, Burdon DW. Incidence and microbiology of abdominal and pelvic abscess in Crohn's disease. Gastroenterology 1982; 83:1271-5. [PMID: 7129031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The incidence of abdominal and pelvic abscess is reported from a consecutive series of 111 patients undergoing 124 resections for Crohn's disease. Preoperative abscesses were found as a complication of Crohn's disease in 13 patients (10%) and 8 were clinically unsuspected. The majority of preoperative abscesses were confined to one site (localized to bowel, psoas sheath, pelvis, or in the abdominal wall). All preoperative abscesses occurred in patients requiring an emergency or urgent operation. Patients with a preoperative abscess had significantly lower serum albumin levels and significantly increased serum alkaline phosphatase values than the patients without an abscess. Postoperative abscesses occurred in 17 patients (14%) and six were multiple. Five of the postoperative abscesses occurred in patients who had had a preoperative abscess; these recurrent abscesses all presented 6-14 wk after an uncomplicated initial operation. The principal bacterial isolates were Escherichia coli (54%), Bacteroides fragilis (44%), enterococci (41%), and viridans streptococci (31%). The incidence of abscess was unrelated to the use of preoperative steroid therapy.
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