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Nilsson K, Klevebro F, Sunde B, Rouvelas I, Lindblad M, Szabo E, Halldestam I, Smedh U, Wallner B, Johansson J, Johnsen G, Aahlin EK, Johannessen HO, Alexandersson von Döbeln G, Hjortland GO, Wang N, Shang Y, Borg D, Quaas A, Bartella I, Bruns C, Schröder W, Nilsson M. Oncological outcomes of standard versus prolonged time to surgery after neoadjuvant chemoradiotherapy for oesophageal cancer in the multicentre, randomised, controlled NeoRes II trial. Ann Oncol 2023; 34:1015-1024. [PMID: 37657554 DOI: 10.1016/j.annonc.2023.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The optimal time to surgery (TTS) after neoadjuvant chemoradiotherapy (nCRT) for oesophageal cancer is unknown and has traditionally been 4-6 weeks in clinical practice. Observational studies have suggested better outcomes, especially in terms of histological response, after prolonged delay of up to 3 months after nCRT. The NeoRes II trial is the first randomised trial to compare standard to prolonged TTS after nCRT for oesophageal cancer. PATIENTS AND METHODS Patients with resectable, locally advanced oesophageal cancer were randomly assigned to standard delay of surgery of 4-6 weeks or prolonged delay of 10-12 weeks after nCRT. The primary endpoint was complete histological response of the primary tumour in patients with adenocarcinoma (AC). Secondary endpoints included histological tumour response, resection margins, overall and progression-free survival in all patients and stratified by histologic type. RESULTS Between February 2015 and March 2019, 249 patients from 10 participating centres in Sweden, Norway and Germany were randomised: 125 to standard and 124 to prolonged TTS. There was no significant difference in complete histological response between AC patients allocated to standard (21%) compared to prolonged (26%) TTS (P = 0.429). Tumour regression, resection margins and number of resected lymph nodes, total and metastatic, did not differ between the allocated interventions. The first quartile overall survival in patients allocated to standard TTS was 26.5 months compared to 14.2 months after prolonged TTS (P = 0.003) and the overall risk of death during follow-up was 35% higher after prolonged delay (hazard ratio 1.35, 95% confidence interval 0.94-1.95, P = 0.107). CONCLUSION Prolonged TTS did not improve histological complete response or other pathological endpoints, while there was a strong trend towards worse survival, suggesting caution in routinely delaying surgery for >6 weeks after nCRT.
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Affiliation(s)
- K Nilsson
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm; Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - F Klevebro
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm; Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - B Sunde
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm; Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - I Rouvelas
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm; Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - M Lindblad
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm; Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - E Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro
| | | | - U Smedh
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg
| | - B Wallner
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå
| | - J Johansson
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - G Johnsen
- Department of Gastrointestinal Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim
| | - E K Aahlin
- Department of GI and HPB Surgery, University Hospital of Northern Norway, Tromsø
| | - H-O Johannessen
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - G Alexandersson von Döbeln
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm; Medical Unit of Head, Neck, Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - G O Hjortland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - N Wang
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm
| | - Y Shang
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm
| | - D Borg
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - A Quaas
- Institute of Pathology, University of Cologne, Cologne
| | - I Bartella
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - C Bruns
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - W Schröder
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - M Nilsson
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm; Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm.
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Szabo E, Ashina S, Melo-Carrillo A, Bolo NR, Borsook D, Burstein R. Peripherally acting anti-CGRP monoclonal antibodies alter cortical gray matter thickness in migraine patients: A prospective cohort study. Neuroimage Clin 2023; 40:103531. [PMID: 37866119 PMCID: PMC10623369 DOI: 10.1016/j.nicl.2023.103531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Abstract
Migraine is underpinned by central nervous system neuroplastic alterations thought to be caused by the repetitive peripheral afferent barrage the brain receives during the headache phase (cortical hyperexcitability). Calcitonin gene-related peptide monoclonal antibodies (anti-CGRP-mAbs) are highly effective migraine preventative treatments. Their ability to alter brain morphometry in treatment-responders vs. non-responders is not well understood. Our aim was to determine the effects of the anti-CGRP-mAb galcanezumab on cortical thickness after 3-month treatment of patients with high-frequency episodic or chronic migraine. High-resolution magnetic resonance imaging was performed pre- and post-treatment in 36 migraine patients. In this group, 19 patients were classified responders (≥50 % reduction in monthly migraine days) and 17 were considered non-responders (<50 % reduction in monthly migraine days). Following cross-sectional processing to analyze the baseline differences in cortical thickness, two-stage longitudinal processing and symmetrized percent change were conducted to investigate treatment-related brain changes. At baseline, no significant differences were found between the responders and non-responders. After 3-month treatment, decreased cortical thickness (compared to baseline) was observed in the responders in regions of the somatosensory cortex, anterior cingulate cortex, medial frontal cortex, superior frontal gyrus, and supramarginal gyrus. Non-responders demonstrated decreased cortical thickness in the left dorsomedial cortex and superior frontal gyrus. We interpret the cortical thinning seen in the responder group as suggesting that reduction in head pain could lead to changes in neural swelling and dendritic complexity and that such changes reflect the recovery process from maladaptive neural activity. This conclusion is further supported by our recent study showing that 3 months after treatment initiation, the incidence of premonitory symptoms and prodromes that are followed by headache decreases but not the incidence of the premonitory symptoms or prodromes themselves (that is, cortical thinning relates to reductions in the nociceptive signals in the responders). We speculate that a much longer recovery period is required to allow the brain to return to a more 'normal' functioning state whereby prodromes and premonitory symptoms no longer occur.
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Affiliation(s)
- Edina Szabo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA
| | - Sait Ashina
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA
| | - Nicolas R Bolo
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - David Borsook
- Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Kim A(J, Szabo E, Lunde CE, Comptdaer G, Zurakowski D, Sieberg CB, Holmes SA. Quantitative sensory testing in a magnetic resonance environment: considerations for thermal sensitivity and patient safety. Front Pain Res (Lausanne) 2023; 4:1223239. [PMID: 37766817 PMCID: PMC10520956 DOI: 10.3389/fpain.2023.1223239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Quantitative sensory testing (QST) is often used to understand the perceptual basis of acute and chronic conditions, including pain. As the need grows for developing a mechanistic understanding of neurological pathways underlying perception in the basic and clinical sciences, there is a greater need to adapt techniques such as QST to the magnetic resonance (MR) environment. No studies have yet evaluated the impact of the MR environment on the perception of thermal stimuli. This study aimed to evaluate the differences in temperature sensitivity outside an MR environment and during an MRI scanning session. We hypothesized that there would be a difference in how participants reported their pain sensitivity between the two environments. Methods Healthy participants underwent thermal QST outside the MR scanning environment, where they were asked to rate the temperature of a noxious stimulus at which they perceived their pain to be 7/10, using a Likert scale ranging from 0 to 10. Participants repeated this procedure inside a 3.0 T MRI approximately 30 min later. We repeated our investigation in a clinical cohort of participants with a chronic pain condition. Results There were statistically significant changes of 1.1°C in thermal sensitivity between environments. This increase in pain threshold was found in healthy participants and replicated in the clinical cohort. Discussion Findings can be applied toward improving MR safety, the resolution of brain pathways underlying pain mechanisms, and to more broadly comment on the impact of the MR environment on investigations that integrate perception-influenced processes.
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Affiliation(s)
- Ayeong (Jenny) Kim
- Department of Anesthesiology, Critical Care, and Pain Medicine, Pain and Affective Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Edina Szabo
- Department of Anesthesiology, Critical Care, and Pain Medicine, Pain and Affective Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Claire E. Lunde
- Department of Anesthesiology, Critical Care, and Pain Medicine, Pain and Affective Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Nuffield Department of Women’s & Reproductive Health, Oxford University, Oxford, United Kingdom
| | - Gabriela Comptdaer
- Department of Anesthesiology, Critical Care, and Pain Medicine, Pain and Affective Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Christine B. Sieberg
- Department of Anesthesiology, Critical Care, and Pain Medicine, Pain and Affective Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Scott A. Holmes
- Department of Anesthesiology, Critical Care, and Pain Medicine, Pain and Affective Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Pediatric Pain Pathway Lab, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
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Patko E, Szabo E, Vaczy A, Molitor D, Tari E, Li L, Csutak A, Toth G, Reglodi D, Atlasz T. Protective Effects of Pituitary Adenylate-Cyclase-Activating Polypeptide on Retinal Vasculature and Molecular Responses in a Rat Model of Moderate Glaucoma. Int J Mol Sci 2023; 24:13256. [PMID: 37686074 PMCID: PMC10487862 DOI: 10.3390/ijms241713256] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Despite the high probability of glaucoma-related blindness, its cause is not fully understood and there is no efficient therapeutic strategy for neuroprotection. Vascular factors have been suggested to play an important role in glaucoma development and progression. Previously, we have proven the neuroprotective effects of pituitary adenylate-cyclase-activating polypeptide (PACAP) eye drops in an inducible, microbeads model in rats that is able to reproduce many clinically relevant features of human glaucoma. In the present study, we examined the potential protective effects of PACAP1-38 on the retinal vasculature and the molecular changes in hypoxia. Ocular hypertension was induced by injection of microbeads into the anterior chamber, while control rats received PBS. PACAP dissolved in vehicle (1 µg/drop) or vehicle treatment was started one day after the injections for four weeks three times a day. Retinal degeneration was assessed with optical coherence tomography (OCT), and vascular and molecular changes were assessed by immunofluorescence labeling. HIF1-α and VEGF-A protein levels were measured by Western blot. OCT images proved severe retinal degeneration in the glaucomatous group, while PACAP1-38 eye drops had a retinoprotective effect. Vascular parameters were deteriorated and molecular analysis suggested hypoxic conditions in glaucoma. PACAP treatment exerted a positive effect against these alterations. In summary, PACAP could prevent the severe damage to the retina and its vasculature induced by ocular hypertension in a microbeads model.
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Affiliation(s)
- Evelin Patko
- Department of Anatomy, ELKH-PTE PACAP Research Team, Medical School, University of Pecs, 7624 Pecs, Hungary
| | - Edina Szabo
- Department of Anatomy, ELKH-PTE PACAP Research Team, Medical School, University of Pecs, 7624 Pecs, Hungary
| | - Alexandra Vaczy
- Department of Anatomy, ELKH-PTE PACAP Research Team, Medical School, University of Pecs, 7624 Pecs, Hungary
| | - Dorottya Molitor
- Department of Anatomy, ELKH-PTE PACAP Research Team, Medical School, University of Pecs, 7624 Pecs, Hungary
| | - Eniko Tari
- Department of Anatomy, ELKH-PTE PACAP Research Team, Medical School, University of Pecs, 7624 Pecs, Hungary
| | - Lina Li
- Department of Anatomy, ELKH-PTE PACAP Research Team, Medical School, University of Pecs, 7624 Pecs, Hungary
| | - Adrienne Csutak
- Department of Ophthalmology, Clinical Centre, Medical School, University of Pecs, 7632 Pecs, Hungary
| | - Gabor Toth
- Department of Medical Chemistry, Albert Szent-Györgyi Medical School, University of Szeged, 6720 Szeged, Hungary
- MTA-SZTE Biomimetic Systems Research Group, Albert Szent-Györgyi Medical School, University of Szeged, 6720 Szeged, Hungary
| | - Dora Reglodi
- Department of Anatomy, ELKH-PTE PACAP Research Team, Medical School, University of Pecs, 7624 Pecs, Hungary
| | - Tamas Atlasz
- Department of Anatomy, ELKH-PTE PACAP Research Team, Medical School, University of Pecs, 7624 Pecs, Hungary
- Department of Sportbiology, Faculty of Sciences, University of Pecs, 7624 Pecs, Hungary
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Szabo E, Comptdaer G, Kim A(J, Lunde CE, Borsook D, Holmes SA, Sieberg CB. Alterations In Resting-State Low-Frequency Fluctuation In Patients With Surgically Confirmed Endometriosis. The Journal of Pain 2023. [DOI: 10.1016/j.jpain.2023.02.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Ashina S, Melo-Carrillo A, Toluwanimi A, Bolo N, Szabo E, Borsook D, Burstein R. Galcanezumab effects on incidence of headache after occurrence of triggers, premonitory symptoms, and aura in responders, non-responders, super-responders, and super non-responders. J Headache Pain 2023; 24:26. [PMID: 36927366 PMCID: PMC10018924 DOI: 10.1186/s10194-023-01560-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The goal of this observational, open-label, cohort study was to determine whether prophylactic migraine treatment with galcanezumab, a peripherally acting drug, alters the incidence of premonitory symptoms, and/or occurrence of headache after exposure to triggers or aura episodes in treatment-responders (≥ 50% reduction in monthly migraine days [MMD]), super-responders (≥ 70%), non-responders (< 50%) and super non-responders (< 30%). METHODS Participants were administered electronic daily headache diaries to document migraine days and associated symptoms one month before and during the three months of treatment. Questionnaires were used to identify conscious prodromal and trigger events that were followed by headache prior to vs. after 3 months of treatment. RESULTS After 3 months of galcanezumab treatment, (a) the incidence of premonitory symptoms that were followed by headache decreased by 48% in the 27 responders vs. 28% in the 19 non-responders, and by 50% in the 11 super-responders vs. 12% in the 8 super non-responders; (b) the incidence of visual and sensory aura that were followed by headache was reduced in responders, non-responders, and super-responders, but not in super non-responders; (c) the number of triggers followed by headache decreased by 38% in responders vs. 13% in non-responders, and by 31% in super-responders vs. 4% in super non-responders; and (d) some premonitory symptoms (e.g., cognitive impairment, irritability, fatigue) and triggers (e.g., stress, sleeping too little, bright light, aura) were followed by headache only in super non-responders. CONCLUSIONS Mechanistically, these findings suggest that even a mild decrease in migraine frequency is sufficient to partially reverse the excitability and responsivity of neurons involved in the generation of certain triggers and potentially premonitory symptoms of migraine. TRIAL REGISTRATION ClinicalTrials.gov: NCT04271202. Registration date: February 10, 2020.
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Affiliation(s)
- Sait Ashina
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Anesthesia, Harvard Medical School, Boston, MA, USA.,Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Ajayi Toluwanimi
- Clinical Research Center, Beth Israel Deaconess Medical Boston, Boston, MA, USA
| | - Nicolas Bolo
- Departments of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Edina Szabo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - David Borsook
- Departments of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Departments of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Department of Anesthesia, Harvard Medical School, Boston, MA, USA. .,Center for Life Science, Room 649, 3 Blackfan Circle, Boston, MA, 02215, USA.
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Ashina S, Melo-Carrillo A, Szabo E, Borsook D, Burstein R. Pre-treatment non-ictal cephalic allodynia identifies responders to prophylactic treatment of chronic and episodic migraine patients with galcanezumab: A prospective quantitative sensory testing study (NCT04271202). Cephalalgia 2023; 43:3331024221147881. [PMID: 36786278 DOI: 10.1177/03331024221147881] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Migraine is a complex neurological disorder involving generalized abnormalities in processing sensory information. Adopting evidence that central sensitization imposes major hurdles in the treatment of migraine, we hypothesized that it is the non-ictal (rather than ictal) allodynia that may determine the outcome of migraine prevention with peripherally-acting drugs. METHODS To test this hypothesis, we used Quantitative Sensory Testing to determine whether it is possible to identify a patient's response to prophylactic treatment with galcanezumab based on presence/absence of cephalic and/or extracephalic allodynia during the pre-treatment non-ictal phase of migraine. RESULTS Using strict criteria for allodynia (heat 32-40°C, cold 32-20°C, mechanical <60 g), we report that (a) the incidence of pre-treatment non-ictal cephalic allodynia was 21% in the 24 responders (>50% decrease in monthly migraine days) and 85% in the 19 non-responders; (b) the incidence of non-ictal extracephalic allodynia distinguishes responders from non-responders less accurately; and that (c) the incidence of non-ictal cephalic allodynia was similar in the chronic migraine and high-frequency episodic migraine groups. CONCLUSIONS Clinically, the findings suggest that presence/absence of non-ictal allodynia can be used to identify galcanezumab responders with nearly 80% accuracy and galcanezumab non-responders with nearly 85% accuracy. Mechanistically, the presence of non-ictal allodynia (reflecting a state of activity-independent central sensitization) in both chronic migraine and high-frequency episodic migraine patients raises the possibility that the state of non-ictal allodynia may be attributed to physiological properties of central trigeminovascular neurons that are due to the genetic load of the individual patient rather than their migraine frequency.
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Affiliation(s)
- Sait Ashina
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Beth Israel Deaconess Medical Center Comprehensive Headache Center, Boston, MA, USA.,Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Beth Israel Deaconess Medical Center Comprehensive Headache Center, Boston, MA, USA
| | - Edina Szabo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David Borsook
- Departments of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Departments of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Beth Israel Deaconess Medical Center Comprehensive Headache Center, Boston, MA, USA
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Szabo E, Timmers I, Borsook D, Simons LE, Sieberg CB. Altered anterior insula functional connectivity in adolescent and young women with endometriosis-associated pain: Pilot resting-state fMRI study. Eur J Paediatr Neurol 2022; 41:80-90. [PMID: 36375399 PMCID: PMC9722632 DOI: 10.1016/j.ejpn.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/12/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Endometriosis is the leading cause of chronic pelvic pain. Alterations in brain functional connectivity have been reported in adult women with endometriosis-associated pain (EAP), however, it is still unknown if similar patterns of changes exist in adolescents. METHODS In this pilot study, resting-state fMRI scans were obtained from 11 adolescent and young women with EAP and 14 healthy female controls. Using a seed-to-voxel approach, we investigated functional connectivity between the anterior insula, medial prefrontal cortex, and the rest of the brain. Furthermore, we explored whether potential functional connectivity differences were correlated with clinical characteristics including disease duration, pain intensity, and different psychosocial factors (pain catastrophizing, fear of pain, functional disability, anxiety, and depression). RESULTS Our findings revealed that patients with EAP demonstrated significantly decreased connectivity between the right anterior insula and two clusters: one in the right cerebellum, and one in the left middle frontal gyrus compared to controls. Additionally, functional connectivity between the right anterior insula and the right cerebellum was positively associated with pain intensity levels. In patients with EAP, brain changes were also correlated with state anxiety and fear of pain. CONCLUSIONS Our results are relevant not only for understanding the brain characteristics underlying EAP at a younger age, but also in enhancing future pain treatment efforts by supporting the involvement of the central nervous system in endometriosis.
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Affiliation(s)
- Edina Szabo
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Inge Timmers
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David Borsook
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Christine B Sieberg
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Silginer M, Papa E, Szabo E, Vasella F, Pruschy M, Stroh C, Roth P, Weiss T, Weller M. P10.20.A Mechanisms of synergistic glioma growth suppression by radiotherapy and MET inhibition. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Glioblastoma remains to be one of the most lethal solid cancers. Despite multi-modal therapy including surgery as safely feasible, radiotherapy and chemotherapy with the alkylating agent temozolomide, the median survival of affected patients is still limited to approximately one year on a population level. Thus, novel therapies are urgently needed. There is increasing interest in the role of the HGF/MET pathway in the response of glioblastoma to radiotherapy since MET may be involved in radioresistance via proinvasive and DNA damage response pathways.
Material and Methods
Here we assessed the role of the MET pathway in the response to radiotherapy in vitro and in vivo in syngeneic mouse glioma models and explored potential modes of action responsible for the synergistic effects of MET pathway inhibition and irradiation on tumor growth in vivo.
Results
Murine glioma cells express HGF and MET and show increased MET phosphorylation upon exposure to exogenous HGF. In vitro, glioma cell viability and proliferation are not affected by pharmacological MET inhibition using tepotinib or genetic MET inhibition using CRISPR/Cas9-engineered Met gene knockout and sensitization to irradiation by MET inhibition is not seen. In vivo, the combination of MET inhibition with focal radiotherapy mediates prolonged survival of syngeneic orthotopic glioma-bearing mice compared with either treatment alone. Complementary studies demonstrate that synergy is lost when gliomas are established and treated in immunodeficient mice, but also if MET gene expression is disrupted in the tumor of wildtype mice. Combination therapy suppresses a set of pro-inflammatory mediators that are upregulated by radiotherapy alone and which are positively regulated by transforming growth factor (TGF)-β. In line with this data, ex vivo analysis of mouse brains reveal increased TGF-β pathway activity upon irradiation alone that is counteracted by concomitant MET inhibition.
Conclusion
In summary, we demonstrate synergistic suppression of syngeneic glioma growth by irradiation and MET inhibition that requires MET expression in the tumor as well as an intact immune system. Clinical evaluation of this combined treatment approach in newly diagnosed glioblastoma is warranted.
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Affiliation(s)
- M Silginer
- University and University Hospital Zurich , Zürich , Switzerland
| | - E Papa
- University and University Hospital Zurich , Zürich , Switzerland
| | - E Szabo
- University and University Hospital Zurich , Zürich , Switzerland
| | - F Vasella
- University and University Hospital Zurich , Zürich , Switzerland
| | - M Pruschy
- University and University Hospital Zurich , Zürich , Switzerland
| | - C Stroh
- University and University Hospital Zurich , Zürich , Switzerland
| | - P Roth
- University and University Hospital Zurich , Zürich , Switzerland
| | - T Weiss
- University and University Hospital Zurich , Zürich , Switzerland
| | - M Weller
- University and University Hospital Zurich , Zürich , Switzerland
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10
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Szabo E, Chang YC, Shulman J, Sieberg CB, Sethna NF, Borsook D, Holmes SA, Lebel AA. Alterations in the structure and function of the brain in adolescents with new daily persistent headache: A pilot
MRI
study. Headache 2022; 62:858-869. [DOI: 10.1111/head.14360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/29/2022] [Accepted: 06/03/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Edina Szabo
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
| | | | - Julie Shulman
- Department of Physical Therapy and Occupational Therapy Boston Children's Hospital Boston Massachusetts USA
| | - Christine B. Sieberg
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
| | - Navil F. Sethna
- Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital Boston Massachusetts USA
| | - David Borsook
- Department of Psychiatry Massachusetts General Hospital Boston Massachusetts USA
- Department of Radiology Massachusetts General Hospital Boston Massachusetts USA
- Department of Anesthesiology Harvard Medical School Boston Massachusetts USA
| | - Scott A. Holmes
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
- Pediatric Pain Pathway Lab, Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
| | - Alyssa A. Lebel
- Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital Boston Massachusetts USA
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11
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Baksa D, Szabo E, Kocsel N, Galambos A, Edes AE, Pap D, Zsombok T, Magyar M, Gecse K, Dobos D, Kozak LR, Bagdy G, Kokonyei G, Juhasz G. Circadian Variation of Migraine Attack Onset Affects fMRI Brain Response to Fearful Faces. Front Hum Neurosci 2022; 16:842426. [PMID: 35355585 PMCID: PMC8959375 DOI: 10.3389/fnhum.2022.842426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Previous studies suggested a circadian variation of migraine attack onset, although, with contradictory results – possibly because of the existence of migraine subgroups with different circadian attack onset peaks. Migraine is primarily a brain disorder, and if the diversity in daily distribution of migraine attack onset reflects an important aspect of migraine, it may also associate with interictal brain activity. Our goal was to assess brain activity differences in episodic migraine subgroups who were classified according to their typical circadian peak of attack onset. Methods Two fMRI studies were conducted with migraine without aura patients (n = 31 in Study 1, n = 48 in Study 2). Among them, three subgroups emerged with typical Morning, Evening, and Varying start of attack onset. Whole brain activity was compared between the groups in an implicit emotional processing fMRI task, comparing fearful, sad, and happy facial stimuli to neutral ones. Results In both studies, significantly increased neural activation was detected to fearful (but not sad or happy) faces. In Study 1, the Evening start group showed increased activation compared to the Morning start group in regions involved in emotional, self-referential (left posterior cingulate gyrus, right precuneus), pain (including left middle cingulate, left postcentral, left supramarginal gyri, right Rolandic operculum) and sensory (including bilateral superior temporal gyrus, right Heschl’s gyrus) processing. While in Study 2, the Morning start group showed increased activation compared to the Varying start group at a nominally significant level in regions with pain (right precentral gyrus, right supplementary motor area) and sensory processing (bilateral paracentral lobule) functions. Conclusion Our fMRI studies suggest that different circadian attack onset peaks are associated with interictal brain activity differences indicating heterogeneity within migraine patients and alterations in sensitivity to threatening fearful stimuli. Circadian variation of migraine attack onset may be an important characteristic to address in future studies and migraine prophylaxis.
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Affiliation(s)
- Daniel Baksa
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
- Department of Personality and Clinical Psychology, Institute of Psychology, Faculty of Humanities and Social Sciences, Pázmány Péter Catholic University, Budapest, Hungary
| | - Edina Szabo
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Center for Pain and the Brain (PAIN Research Group), Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Natalia Kocsel
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Attila Galambos
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Andrea Edit Edes
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Dorottya Pap
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
| | - Terezia Zsombok
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
| | - Mate Magyar
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Kinga Gecse
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Dora Dobos
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Lajos Rudolf Kozak
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Gyorgy Bagdy
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Gyongyi Kokonyei
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Gabriella Juhasz
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- *Correspondence: Gabriella Juhasz,
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12
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Patko E, Szabo E, Toth D, Tornoczky T, Bosnyak I, Vaczy A, Atlasz T, Reglodi D. Distribution of PACAP and PAC1 Receptor in the Human Eye. J Mol Neurosci 2022; 72:2176-2187. [PMID: 35253081 PMCID: PMC9726800 DOI: 10.1007/s12031-022-01985-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/08/2022] [Indexed: 12/16/2022]
Abstract
Pituitary adenylate cyclase-activating polypeptide (PACAP) is a neuropeptide with widespread distribution and diverse biological functions. Several studies show that PACAP has strong cytoprotective effects mediated mostly through its specific PAC1 receptor (PAC1-R) and it plays important roles in several pathological conditions. Its distribution and altered expression are known in various human tissues, but there is no descriptive data about PACAP and its receptors in the human eyebulb. Since PACAP38 is the dominant form of the naturally occurring PACAP, our aim was to investigate the distribution of PACAP38-like immunoreactivity in the human eye and to describe the presence of PAC1-R. Semiquantitative evaluation was performed after routine histology and immunohistochemical labeling on human eye sections. Our results showed high level of immunopositivity in the corneal epithelium and endothelium. Within the vascular layer, the iris and the ciliary body had strong immunopositivity for both PACAP and PAC1-R. Several layers of the retina showed immunoreactivity for PACAP and PAC1-R, but the ganglion cell layer had a special pattern in the immunolabeling. Labeling was observed in the neuropil within the optic nerve in both cases and glial cells displayed immunoreactivity for PAC1-R. In summary, our study indicates the widespread occurrence of PACAP and its specific receptor in the human eye, implying that the results from in vitro and animal studies have translational value and most probably are also present in the human eye.
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Affiliation(s)
- Evelin Patko
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Team, University of Pecs, 7624 Pecs, Hungary
| | - Edina Szabo
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Team, University of Pecs, 7624 Pecs, Hungary
| | - Denes Toth
- Department of Forensic Medicine, Medical School, University of Pecs, 7624 Pecs, Hungary
| | - Tamas Tornoczky
- Department of Pathology, Medical School and Clinical Center, University of Pecs, 7624 Pecs, Hungary
| | - Inez Bosnyak
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Team, University of Pecs, 7624 Pecs, Hungary
| | - Alexandra Vaczy
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Team, University of Pecs, 7624 Pecs, Hungary
| | - Tamas Atlasz
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Team, University of Pecs, 7624 Pecs, Hungary ,Szentagothai Research Center, Medical School, University of Pecs, 7624 Pecs, Hungary ,Department of Sportbiology, University of Pecs, 7624 Pecs, Hungary
| | - Dora Reglodi
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Team, University of Pecs, 7624 Pecs, Hungary ,Szentagothai Research Center, Medical School, University of Pecs, 7624 Pecs, Hungary
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13
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Szabo E, Patko E, Vaczy A, Molitor D, Csutak A, Toth G, Reglodi D, Atlasz T. Retinoprotective Effects of PACAP Eye Drops in Microbead-Induced Glaucoma Model in Rats. Int J Mol Sci 2021; 22:8825. [PMID: 34445531 PMCID: PMC8396165 DOI: 10.3390/ijms22168825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 01/29/2023] Open
Abstract
Glaucoma is associated with increased intraocular pressure (IOP), causing the apoptosis of retinal ganglion cells (RGCs) and the loss of their axons leading to blindness. Pituitary adenylate cyclase activating polypeptide (PACAP) is neuroprotective in several neural injuries, including retinopathies. The aim of this study was to investigate the effects of PACAP1-38 eye drops in a model of glaucoma. IOP was elevated bilaterally by injections of microbeads to block the aqueous humor outflow. The control groups received the same volume of saline. Animals were treated with PACAP1-38 (1 µg/drop, 3 × 1 drop/day) or vehicle for 4 weeks starting one day after the injections. Retinal morphology by histology and optical coherence tomography, function by electroretinography, and IOP changes were analyzed. Animals were sacrificed 8 weeks after the injections. Microbeads injections induced a significant increase in the IOP, while PACAP1-38 treatment lowered it to normal levels (~10 mmHg). Significant retinal degeneration and functional impairment were observed in the microbead-injected group without PACAP1-38 treatment. In the microbeads + PACAP1-38 group, the retinal morphology and functionality were close to the normal values. In summary, our results show that PACAP1-38, given in form of eye drops, is neuroprotective in glaucoma, providing the basis for potential future therapeutic administration.
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Affiliation(s)
- Edina Szabo
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs Medical School, 7624 Pecs, Hungary; (E.S.); (E.P.); (A.V.); (D.M.); (D.R.)
| | - Evelin Patko
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs Medical School, 7624 Pecs, Hungary; (E.S.); (E.P.); (A.V.); (D.M.); (D.R.)
| | - Alexandra Vaczy
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs Medical School, 7624 Pecs, Hungary; (E.S.); (E.P.); (A.V.); (D.M.); (D.R.)
| | - Dorottya Molitor
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs Medical School, 7624 Pecs, Hungary; (E.S.); (E.P.); (A.V.); (D.M.); (D.R.)
| | - Adrienne Csutak
- Department of Ophthalmology, Clinical Centre, University of Pecs Medical School, 7632 Pecs, Hungary;
| | - Gabor Toth
- Department of Medical Chemistry, Faculty of Medicine, University of Szeged, 6720 Szeged, Hungary;
| | - Dora Reglodi
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs Medical School, 7624 Pecs, Hungary; (E.S.); (E.P.); (A.V.); (D.M.); (D.R.)
- Szentagothai Research Center, University of Pecs, 7624 Pecs, Hungary
| | - Tamas Atlasz
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs Medical School, 7624 Pecs, Hungary; (E.S.); (E.P.); (A.V.); (D.M.); (D.R.)
- Szentagothai Research Center, University of Pecs, 7624 Pecs, Hungary
- Department of Sportbiology, University of Pecs, 7624 Pecs, Hungary
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14
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Szabo BG, Lakatos B, Bobek I, Szabo E, Szlavik J, Vályi-Nagy I. Invasive fungal infections among critically ill adult COVID-19 patients: First experiences from the national centre in Hungary. J Mycol Med 2021; 31:101198. [PMID: 34428666 PMCID: PMC8364220 DOI: 10.1016/j.mycmed.2021.101198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 08/01/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Data suggests that invasive fungal infections (IFI) might complicate COVID-19. Our goal was to describe characteristics of IFI among critically ill COVID-19 adults. METHODS A retrospective observational case-series analysis was done between March-July 2020. Consecutive patients with critical COVID-19 were eligible, and have been included when proven or putative/probable IFI could be confirmed during their course. For COVID-19 diagnosis, ECDC definitions and WHO severity criteria were followed. Candidaemia was diagnosed according to the ESCMID 2012 guideline. Invasive pulmonary aspergillosis (IPA) was defined following EORTC/MSG, ECMM/ISHAM and modified AspICU criteria. Outcome variables were rates of IFIs, in-hospital all-cause mortality, rate and time to negative respiratory SARS-CoV-2 PCR. RESULTS From 90 eligible patients, 20 (22.2%) fulfilled criteria for IFI. Incidence rate for IFI was 2.02 per 100 patient-days at ICU. Patients were mostly elderly males with significant comorbidities, requiring mechanical ventilation because of ARDS. IFI could be classified as candidaemia in 7/20 (40%), putative/probable IPA in 16/20 (80.0%). Isolated species of candidaemia episodes were Candida albicans (4/9, 44.4%), Candida glabrata (3/9, 33.3%), Candida parapsilosis (1/9, 11.1%), Candida metapsilosis (1/9, 11.1%). Mold isolates from lower respiratory tract were Aspergillus fumigatus, BAL galactomannan positivity was prevalent (16/20, 80.0%). Mortality was 12/20 (60.0%) with a median time to death of 31.0±37.0 (5-89) days. Only 9/20 (45.0%) patients reached SARS-CoV-2 PCR negativity after a median time of 20.0±12.0 (3-38) days. CONCLUSION In this small cohort of critically ill COVID-19 adults, morbidity and mortality related to invasive fungal infections proved to be significant.
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Affiliation(s)
- Balint Gergely Szabo
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus (H-1097 Albert Florian ut 5‑7.), Budapest, Hungary; Semmelweis University, School of PhD Studies (H-1085 Ulloi ut 26.), Budapest, Hungary.
| | - Botond Lakatos
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus (H-1097 Albert Florian ut 5‑7.), Budapest, Hungary
| | - Ilona Bobek
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus (H-1097 Albert Florian ut 5‑7.), Budapest, Hungary
| | - Edina Szabo
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus (H-1097 Albert Florian ut 5‑7.), Budapest, Hungary
| | - Janos Szlavik
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus (H-1097 Albert Florian ut 5‑7.), Budapest, Hungary
| | - István Vályi-Nagy
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus (H-1097 Albert Florian ut 5‑7.), Budapest, Hungary
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15
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Kvarik T, Reglodi D, Werling D, Vaczy A, Kovari P, Szabo E, Kovacs K, Hashimoto H, Ertl T, Gyarmati J, Atlasz T. The Protective Effects of Endogenous PACAP in Oxygen-Induced Retinopathy. J Mol Neurosci 2021; 71:2546-2557. [PMID: 33895966 PMCID: PMC8602170 DOI: 10.1007/s12031-021-01846-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/06/2021] [Accepted: 04/13/2021] [Indexed: 12/17/2022]
Abstract
Pituitary adenylate cyclase–activating polypeptide (PACAP) is a neuropeptide having trophic and protective functions in neural tissues, including the retina. Previously, we have shown that intravitreal PACAP administration can maintain retinal structure in the animal model of retinopathy of prematurity (ROP). The purpose of this study is to examine the development of ROP in PACAP-deficient and wild-type mice to reveal the function of endogenous PACAP. Wild-type and PACAP-knockout (KO) mouse pups at postnatal day (PD) 7 were maintained at 75% oxygen for 5 consecutive days then returned to room air on PD12 to develop oxygen-induced retinopathy (OIR). On PD15, animals underwent electroretinography (ERG) to assess visual function. On PD16, eyes were harvested for either immunohistochemistry to determine the percentage of the central avascular retinal area or molecular analysis to assess angiogenesis proteins by array kit and anti-apoptotic protein kinase B (Akt) change by western blot. Retinas of PACAP-deficient OIR mice showed a greater central avascular area than that of the wild types. ERG revealed significantly decreased b-wave amplitude in PACAP KO compared to their controls. Several angiogenic proteins were upregulated due to OIR, and 11 different proteins markedly increased in PACAP-deficient mice, whereas western blot analysis revealed a reduction in Akt phosphorylation, suggesting an advanced cell death in the lack of PACAP. This is the first study to examine the endogenous effect of PACAP in the OIR model. Previously, we have shown the beneficial effect of exogenous local PACAP treatment in the rat OIR model. Together with the present findings, we suggest that PACAP could be a novel retinoprotective agent in ROP.
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Affiliation(s)
- Timea Kvarik
- Department of Anatomy, MTA-PTE PACAP Research Team, Medical School, University of Pecs, Pecs, Hungary.,Department of Obstetrics and Gynecology, Medical School, University of Pecs, Pecs, Hungary
| | - Dora Reglodi
- Department of Anatomy, MTA-PTE PACAP Research Team, Medical School, University of Pecs, Pecs, Hungary
| | - Dora Werling
- Department of Anatomy, MTA-PTE PACAP Research Team, Medical School, University of Pecs, Pecs, Hungary
| | - Alexandra Vaczy
- Department of Anatomy, MTA-PTE PACAP Research Team, Medical School, University of Pecs, Pecs, Hungary
| | - Petra Kovari
- Department of Anatomy, MTA-PTE PACAP Research Team, Medical School, University of Pecs, Pecs, Hungary
| | - Edina Szabo
- Department of Anatomy, MTA-PTE PACAP Research Team, Medical School, University of Pecs, Pecs, Hungary
| | - Krisztina Kovacs
- Department of Biochemistry and Medical Chemistry, Medical School, University of Pecs, Pecs, Hungary
| | - Hitoshi Hashimoto
- Laboratory of Molecular Neuropharmacology, Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
| | - Tibor Ertl
- Department of Obstetrics and Gynecology, Medical School, University of Pecs, Pecs, Hungary
| | - Judit Gyarmati
- Department of Obstetrics and Gynecology, Medical School, University of Pecs, Pecs, Hungary
| | - Tamas Atlasz
- Department of Anatomy, MTA-PTE PACAP Research Team, Medical School, University of Pecs, Pecs, Hungary. .,Department of Sportbiology, University of Pecs, Pecs, Hungary.
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16
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Lunde CE, Szabo E, Holmes SA, Borsook D, Sieberg CB. Commentary: Novel Use of Offset Analgesia to Assess Adolescents and Adults with Treatment Resistant Endometriosis-Associated Pain. J Pain Res 2020; 13:2775-2782. [PMID: 33204144 PMCID: PMC7660453 DOI: 10.2147/jpr.s276135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/10/2020] [Indexed: 12/18/2022] Open
Abstract
Background and Objective Endometriosis, affecting approximately 176 million adults and adolescents worldwide, is a debilitating condition in which uterine tissue grows outside the uterus. The condition costs the US economy approximately $78 billion annually in pain-related disability. By understanding the neural underpinnings of endometriosis-associated pain (EAP) and risk factors for chronification, translational research methods could lessen diagnostic delays and maximize successful pain remediation. This can be accomplished by the novel use of a known method, offset analgesia (OA), to better elucidate the neural mechanisms that may contribute to and maintain EAP. This commentary will provide justification and rationale for the use of OA in the study of EAP. Conclusion Utilizing an OA paradigm in patients with endometriosis, especially adolescents, may (1) provide insight into neural mechanisms contributing to pain maintenance, which could capture those at-risk for the transition to chronic pelvic pain, (2) provide a metric for the development of future centrally mediated treatment options for this population, and (3) elucidate the brain changes that result in resistance to treatment and pain chronification.
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Affiliation(s)
- Claire E Lunde
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA.,Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, Oxfordshire, UK
| | - Edina Szabo
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Scott A Holmes
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - David Borsook
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Christine B Sieberg
- Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Biobehavioral Pediatric Pain Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Abstract
PACAP is a neuropeptide with widespread distribution and diverse biological functions. It has strong cytoprotective effects mediated mainly through specific PAC1 receptors. Experimental data show protective effects of PACAP in the retina and cornea in several pathological conditions. Although intravitreal injections are a common practice in some ocular diseases, delivery of therapeutic agents in the form of eye drops would be more convenient and would lead to fewer side effects. We have previously shown that PACAP, in the form of eye drops, is able to pass through the ocular barriers and can exert retinoprotective effects. As eye drops represent a promising form of administration of PACAP in ocular diseases, it is important to investigate the stability of PACAP in solutions used in eye drops. In this study, the stability of PACAP1-27 and PACAP1-38 in eye drops was measured in four common media and a commercially available artificial tear solution at both room temperature and +4 °C. Mass spectrometry results show that the highest stability was gained with PACAP1-38 in water and 0.9% saline solution at +4 °C, representing 80–90% drug persistence after 2 weeks. PACAP1-38 in the artificial tear showed very fast degradation at room temperature, but was stable at +4 °C. In summary, PACAP1-38 has higher stability than PACAP1-27, with highest stability at +4 °C in water solution, but both peptides in each medium can be stored for relatively longer periods without significant degradation. These data can provide reference for future therapeutic use of PACAP in eye drops.
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Affiliation(s)
- Anita K Kovacs
- Department of Medical Chemistry, Faculty of Medicine, University of Szeged, Dom Sq 8, Szeged, H-6720, Hungary
| | - Tamas Atlasz
- Department of Anatomy, MTA-PTE PACAP Research Group, Medical School, University of Pecs, Szigeti str 12, Pecs, H-7624, Hungary. .,Department of Sportbiology, University of Pecs, Ifjusag str 6, Pecs, H-7624, Hungary.
| | - Dora Werling
- Department of Anatomy, MTA-PTE PACAP Research Group, Medical School, University of Pecs, Szigeti str 12, Pecs, H-7624, Hungary.,Department of Ophthalmology, Medical School, University of Pecs, Rakoczi str 2, Pecs, H-7623, Hungary
| | - Edina Szabo
- Department of Anatomy, MTA-PTE PACAP Research Group, Medical School, University of Pecs, Szigeti str 12, Pecs, H-7624, Hungary
| | - Dora Reglodi
- Department of Anatomy, MTA-PTE PACAP Research Group, Medical School, University of Pecs, Szigeti str 12, Pecs, H-7624, Hungary
| | - Gabor K Toth
- Department of Medical Chemistry, Faculty of Medicine, University of Szeged, Dom Sq 8, Szeged, H-6720, Hungary
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18
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Bowron J, Ariyaratne A, Luzzi MDC, Szabo E, Finney CAM. Suppressive mechanisms by Heligmosomoides polygyrus-induced Tregs in C57BL/6 mice change over time and differ to that of naïve mice. Eur J Immunol 2020; 50:1167-1173. [PMID: 32311083 DOI: 10.1002/eji.201948392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/24/2020] [Accepted: 04/15/2020] [Indexed: 11/12/2022]
Abstract
Disrupting or harnessing immune suppression is leading to new therapeutic avenues in a number of immune-related diseases. Understanding the suppressive functions of regulatory T cells (Tregs) in different environments is therefore key. Parasitic worms are strong inducers of Tregs and previous research has suggested that parasite-induced Tregs are stronger suppressors than naïve Tregs. In strains susceptible to the intestinal worm Heligmosomoides polygyrus, like C57BL/6 mice, it has been hypothesized that increased Treg suppression downregulates both Th1 and Th2 responses, leading to chronic infections and high worm burden. Here, we show that the suppressive capacity of Tregs is no different between cells from infected and/or naive animals. In vitro suppression induced by CD4+ CD25+ Tregs (Peyers' Patches or the mesenteric lymph nodes), isolated early (day 7, tissue dwelling phase) or late (day 21, luminal phase) during infection was similar to that induced by cells from naïve animals. Suppression was CTLA-4 dependent in Tregs from acute but not chronic infection or in Tregs from naïve animals. This highlights the versatility of Tregs and the importance of extensive Treg characterization prior to potential in vivo manipulation of this cell type.
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Affiliation(s)
- Joel Bowron
- Faculty of Science, Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Anupama Ariyaratne
- Faculty of Science, Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mayara de Cassia Luzzi
- Faculty of Science, Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Edina Szabo
- Faculty of Science, Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Constance A M Finney
- Faculty of Science, Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada
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Toth D, Szabo E, Tamas A, Juhasz T, Horvath G, Fabian E, Opper B, Szabo D, Maugeri G, D'Amico AG, D'Agata V, Vicena V, Reglodi D. Protective Effects of PACAP in Peripheral Organs. Front Endocrinol (Lausanne) 2020; 11:377. [PMID: 32765418 PMCID: PMC7381171 DOI: 10.3389/fendo.2020.00377] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/12/2020] [Indexed: 12/21/2022] Open
Abstract
Pituitary adenylate cyclase activating polypeptide (PACAP) is a neuropeptide widely distributed in the nervous system, where it exerts strong neuroprotective effects. PACAP is also expressed in peripheral organs but its peripheral protective effects have not been summarized so far. Therefore, the aim of the present paper is to review the existing literature regarding the cytoprotective effects of PACAP in non-neuronal cell types, peripheral tissues, and organs. Among others, PACAP has widespread expression in the digestive system, where it shows protective effects in various intestinal pathologies, such as duodenal ulcer, small bowel ischemia, and intestinal inflammation. PACAP is present in both the exocrine and endocrine pancreas as well as liver where it reduces inflammation and steatosis by interfering with hepatic pathology related to obesity. It is found in several exocrine glands and also in urinary organs, where, with its protective effects being mainly published regarding renal pathologies, PACAP is protective in numerous conditions. PACAP displays anti-inflammatory effects in upper and lower airways of the respiratory system. In the skin, it is involved in the development of inflammatory pathology such as psoriasis and also has anti-allergic effects in a model of contact dermatitis. In the non-neuronal part of the visual system, PACAP showed protective effects in pathological conditions of the cornea and retinal pigment epithelial cells. The positive role of PACAP has been demonstrated on the formation and healing processes of cartilage and bone where it also prevents osteoarthritis and rheumatoid arthritis development. The protective role of PACAP was also demonstrated in the cardiovascular system in different pathological processes including hyperglycaemia-induced endothelial dysfunction and age-related vascular changes. In the heart, PACAP protects against ischemia, oxidative stress, and cardiomyopathies. PACAP is also involved in the protection against the development of pre-senile systemic amyloidosis, which is presented in various peripheral organs in PACAP-deficient mice. The studies summarized here provide strong evidence for the cytoprotective effects of the peptide. The survival-promoting effects of PACAP depend on a number of factors which are also shortly discussed in the present review.
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Affiliation(s)
- Denes Toth
- Department of Forensic Medicine, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
| | - Edina Szabo
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
| | - Andrea Tamas
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
| | - Tamas Juhasz
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Department of Biomedical and Biotechnological Sciences, Section of Human Anatomy and Histology, University of Catania, Catania, Italy
| | - Gabriella Horvath
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
| | - Eszter Fabian
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
| | - Balazs Opper
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
| | - Dora Szabo
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Grazia Maugeri
- Department of Biomedical and Biotechnological Sciences, Section of Human Anatomy and Histology, University of Catania, Catania, Italy
| | - Agata G. D'Amico
- Department of Drug Sciences, University of Catania, Catania, Italy
| | - Velia D'Agata
- Department of Biomedical and Biotechnological Sciences, Section of Human Anatomy and Histology, University of Catania, Catania, Italy
| | - Viktoria Vicena
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
| | - Dora Reglodi
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
- *Correspondence: Dora Reglodi
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20
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Reglodi D, Atlasz T, Jungling A, Szabo E, Kovari P, Manavalan S, Tamas A. Alternative Routes of Administration of the Neuroprotective Pituitary Adenylate Cyclase Activating Polypeptide. Curr Pharm Des 2019; 24:3892-3904. [PMID: 30417775 DOI: 10.2174/1381612824666181112110934] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 09/26/2018] [Revised: 10/26/2018] [Accepted: 11/05/2018] [Indexed: 11/22/2022]
Abstract
Pituitary adenylate cyclase activating polypeptide (PACAP) is a neuropeptide with diverse actions, including strong neurotrophic and neuroprotective effects. The aim of our present review is to provide a summary of the different approaches how in vivo neuroprotective effects can be achieved, emphasizing the potential translational values for future therapeutic applications. In the central nervous system, PACAP has been shown to have in vivo protective effects in models of cerebral ischemia, Parkinson's and Alzheimer's disease, Huntington chorea, traumatic brain and spinal cord injury and different retinal pathologies. PACAP passes through the bloodbrain barrier and therefore, systemic administration can affect the nervous system and lead to neuroprotective effects. This review summarizes results obtained in neuronal injury studies via local, such as intracerebral, intrathecal, intracerebroventricular, intravitreal and systemic treatments, such as intravenous, intraperitoneal and subcutaneous administration of PACAP. A few other options are summarized, like intranasal and eye drops treatments, as well as difficulties and side effects of different treatments are also discussed.
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Affiliation(s)
- Dora Reglodi
- Department of Anatomy, MTA-PTE PACAP Research Team, Centre for Neuroscience, University of Pecs Medical School, Pecs, Hungary
| | - Tamas Atlasz
- Department of Anatomy, MTA-PTE PACAP Research Team, Centre for Neuroscience, University of Pecs Medical School, Pecs, Hungary.,Department of Sportbiology, University of Pecs, Pecs, Hungary; Janos Szentagothai Research Center, University of Pecs, Pecs, Hungary
| | - Adel Jungling
- Department of Anatomy, MTA-PTE PACAP Research Team, Centre for Neuroscience, University of Pecs Medical School, Pecs, Hungary
| | - Edina Szabo
- Department of Anatomy, MTA-PTE PACAP Research Team, Centre for Neuroscience, University of Pecs Medical School, Pecs, Hungary
| | - Petra Kovari
- Department of Anatomy, MTA-PTE PACAP Research Team, Centre for Neuroscience, University of Pecs Medical School, Pecs, Hungary
| | - Sridharan Manavalan
- Department of Anatomy, MTA-PTE PACAP Research Team, Centre for Neuroscience, University of Pecs Medical School, Pecs, Hungary.,Department of Basic Sciences, National University of Health Sciences, Pinellas Park, Florida, United States
| | - Andrea Tamas
- Department of Anatomy, MTA-PTE PACAP Research Team, Centre for Neuroscience, University of Pecs Medical School, Pecs, Hungary
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21
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Vaczy A, Kovari P, Kovacs K, Farkas K, Szabo E, Kvarik T, Kocsis B, Fulop B, Atlasz T, Reglodi D. Protective Role of Endogenous PACAP in Inflammation-induced Retinal Degeneration. Curr Pharm Des 2019; 24:3534-3542. [PMID: 30246634 DOI: 10.2174/1381612824666180924141407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Pituitary adenylate Cyclase-Activating Polypeptide (PACAP) is a neuroprotective peptide that has been shown to exert protective effects in different models of neurodegenerative diseases, including retinal degenerations. Data obtained from PACAP-deficient (PACAP KO) mice provide evidence that endogenous PACAP has a neuroprotective role in different pathologies. PACAP KO mice show enhanced sensitivity to different insults, such as oxidative stress, hypoxia and inflammation. The aim of the present study was to investigate the protective effects of endogenous PACAP in retinal inflammation. METHODS Endotoxin-induced eye inflammation was induced by intraperitoneal injection of lipopolysaccharide (LPS) in PACAP KO and wild-type (Wt) mice. After LPS treatment, retinas were processed for histological examination. To detect the alterations of different proteins and cytokines, immunohistochemical, western blot and cytokine array were used. We also performed dark-adapted electroretinography (ERG) to detect the functional differences. RESULTS The thickness of nearly all layers was significantly less in LPS-injected PACAP KO mice compared to Wt animals. Increased expression of Glial Fibrillary Acidic Protein (GFAP) was induced in Müller glial cells after LPS treatment, which was more intense in PACAP KO mice. The levels of pAkt and pGSK were decreased in PACAP KO group during inflammation. LPS treatment significantly increased cytokines (sICAM-1, JE, TIMP-1) in both treated groups, but it was more expressed in PACAP KO animals. Furthermore, ERG responses were disturbed after LPS injection in PACAP KO mice. CONCLUSION Our results showed that endogenous PACAP has a protective role in LPS-caused retinal inflammation.
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Affiliation(s)
- Alexandra Vaczy
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Medical School, Pecs, Hungary
| | - Petra Kovari
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Medical School, Pecs, Hungary
| | - Krisztina Kovacs
- Department of Biochemistry and Medical Chemistry, University of Pecs, Medical School, Pecs, Hungary
| | - Kinga Farkas
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Medical School, Pecs, Hungary
| | - Edina Szabo
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Medical School, Pecs, Hungary
| | - Timea Kvarik
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Medical School, Pecs, Hungary
| | - Bela Kocsis
- Department of Medical Microbiology and Immunology, University of Pecs, Medical School, Pecs, Hungary
| | - Balazs Fulop
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Medical School, Pecs, Hungary
| | - Tamas Atlasz
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Medical School, Pecs, Hungary.,Department of Sportbiology, University of Pecs, Pecs, Hungary.,Janos Szentagothai Research Center, University of Pecs, Pecs, Hungary
| | - Dora Reglodi
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Medical School, Pecs, Hungary
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22
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Edes AE, McKie S, Szabo E, Kokonyei G, Pap D, Zsombok T, Magyar M, Csepany E, Hullam G, Szabo AG, Kozak LR, Bagdy G, Juhasz G. Increased activation of the pregenual anterior cingulate cortex to citalopram challenge in migraine: an fMRI study. BMC Neurol 2019; 19:237. [PMID: 31615444 PMCID: PMC6794781 DOI: 10.1186/s12883-019-1478-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/27/2019] [Indexed: 01/03/2023] Open
Abstract
Background The anterior cingulate cortex (ACC) is a key structure of the pain processing network. Several structural and functional alterations of this brain area have been found in migraine. In addition, altered serotonergic neurotransmission has been repeatedly implicated in the pathophysiology of migraine, although the exact mechanism is not known. Thus, our aim was to investigate the relationship between acute increase of brain serotonin (5-HT) level and the activation changes of the ACC using pharmacological challenge MRI (phMRI) in migraine patients and healthy controls. Methods Twenty-seven pain-free healthy controls and six migraine without aura patients participated in the study. All participant attended to two phMRI sessions during which intravenous citalopram, a selective serotonin reuptake inhibitor (SSRI), or placebo (normal saline) was administered. We used region of interest analysis of ACC to compere the citalopram evoked activation changes of this area between patients and healthy participants. Results Significant difference in ACC activation was found between control and patient groups in the right pregenual ACC (pgACC) during and after citalopram infusion compared to placebo. The extracted time-series showed that pgACC activation increased in migraine patients compared to controls, especially in the first 8–10 min of citalopram infusion. Conclusions Our results demonstrate that a small increase in 5-HT levels can lead to increased phMRI signal in the pregenual part of the ACC that is involved in processing emotional aspects of pain. This increased sensitivity of the pgACC to increased 5-HT in migraine may contribute to recurring headache attacks and increased stress-sensitivity in migraine.
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Affiliation(s)
- Andrea Edit Edes
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary.,Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Shane McKie
- Faculty of Biological, Medical and Human Sciences Platform Sciences, Enabling Technologies and Infrastructure, Faculty of Biological, Medical and Human Sciences Research and Innovation, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - Edina Szabo
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary.,Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Gyongyi Kokonyei
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Dorottya Pap
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Terezia Zsombok
- Department of Neurology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Mate Magyar
- Department of Neurology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Eva Csepany
- Department of Neurology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Gabor Hullam
- Department of Measurement and Information Systems, Budapest University of Technology and Economics, Faculty of Electrical Engineering and Informatics, Budapest, Hungary
| | | | | | - Gyorgy Bagdy
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.,MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Gabriella Juhasz
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary. .,Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary. .,Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biological, Medical and Human Sciences, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK.
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23
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Edes AE, McKie S, Szabo E, Kokonyei G, Pap D, Zsombok T, Hullam G, Gonda X, Kozak LR, McFarquhar M, Anderson IM, Deakin JFW, Bagdy G, Juhasz G. Spatiotemporal brain activation pattern following acute citalopram challenge is dose dependent and associated with neuroticism: A human phMRI study. Neuropharmacology 2019; 170:107807. [PMID: 31593709 DOI: 10.1016/j.neuropharm.2019.107807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The initial effects of selective serotonin reuptake inhibitors (SSRIs) in the human living brain are poorly understood. We carried out a 3T resting state fMRI study with pharmacological challenge to determine the brain activation changes over time following different dosages of citalopram. METHODS During the study, 7.5 mg i.v. citalopram was administered to 32 healthy subjects. In addition, 11.25 mg citalopram was administered to a subset of 9 subjects to investigate the dose-response. Associations with neuroticism (assessed by the NEO PI-R) of the emerging brain activation to citalopram was also investigated. RESULTS Citalopram challenge evoked significant activation in brain regions that are part of the default mode network, the visual network and the sensorimotor network, extending to the thalamus, and midbrain. Most effects appeared to be dose-dependent and this was statistically significant in the middle cingulate gyrus. Individual citalopram-induced brain responses were positively correlated with neuroticism scores and its subscales in specific brain areas; anxiety subscale scores in thalamus and midbrain and self-consciousness scores in middle cingulate gyrus. There were no sex differences. LIMITATIONS We investigated only healthy subjects and we used a relatively low sample size in the 11.25 mg citalopram analysis. DISCUSSION Our results suggest that SSRIs acutely induce an increased arousal-like state of distributed cortical and subcortical systems that is mediated by enhanced serotonin neurotransmission according to levels of neuroticism and underpins trait sensitivity to environmental stimuli and stressors. Studies in depression are needed to determine how therapeutic effects eventually emerge. This article is part of the special issue entitled 'Serotonin Research: Crossing Scales and Boundaries'.
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Affiliation(s)
- Andrea Edit Edes
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Shane McKie
- Faculty of Biological, Medical and Human Sciences Platform Sciences, Enabling Technologies & Infrastructure, Faculty of Biological, Medical and Human Sciences Research and Innovation, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Edina Szabo
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary; Doctoral School of Psychology, ELTE Eotvos Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eotvos Loránd University, Budapest, Hungary
| | - Gyongyi Kokonyei
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary; Institute of Psychology, ELTE Eotvos Loránd University, Budapest, Hungary
| | - Dorottya Pap
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Terezia Zsombok
- Department of Neurology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Gabor Hullam
- Department of Measurement and Information Systems, Budapest University of Technology and Economics, Faculty of Electrical Engineering and Informatics, Budapest, Hungary
| | - Xenia Gonda
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary; Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Lajos R Kozak
- MR Research Center, Semmelweis University, Budapest, Hungary
| | - Martyn McFarquhar
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biological, Medical and Human Sciences, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Ian M Anderson
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biological, Medical and Human Sciences, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - J F William Deakin
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biological, Medical and Human Sciences, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Gyorgy Bagdy
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Gabriella Juhasz
- SE-NAP2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary; Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biological, Medical and Human Sciences, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
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24
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Atlasz T, Werling D, Song S, Szabo E, Vaczy A, Kovari P, Tamas A, Reglodi D, Yu R. Retinoprotective Effects of TAT-Bound Vasoactive Intestinal Peptide and Pituitary Adenylate Cyclase Activating Polypeptide. J Mol Neurosci 2019. [PMID: 30542799 DOI: 10.1007/s12031-018-1229-5/figures/7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase activating polypeptide (PACAP) belong to the same peptide family and exert a variety of biological functions. Both PACAP and VIP have protective effects in several tissues. While PACAP is known to be a stronger retinoprotective peptide, VIP has very potent anti-inflammatory effects. The need for a non-invasive therapeutic approach has emerged and PACAP has been shown to be retinoprotective when administered in the form of eye drops as well. The cell penetrating peptide TAT is composed of 11 amino acids and tagging of TAT at the C-terminus of neuropeptides PACAP/VIP can enhance the traversing ability of the peptides through the biological barriers. We hypothesized that TAT-bound PACAP and VIP could be more effective in exerting retinoprotective effects when given in eye drops, by increasing the traversing efficacy and enhancing the activation of the PAC1 receptor. Rats were subjected to bilateral carotid artery occlusion (BCCAO), and retinas were processed for histological analysis 14 days later. The efficiency of the TAT-bound peptides to reach the retina was assessed as well as their cAMP increasing ability. Our present study provides evidence, for the first time, that topically administered PACAP and VIP derivatives (PACAP-TAT and VIP-TAT) attenuate ischemic retinal degeneration via the PAC1 receptor presumably due to a multifactorial protective mechanism.
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Affiliation(s)
- Tamas Atlasz
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Group, University of Pecs, Pecs, Hungary.
- Department of Sportbiology, University of Pecs, Pecs, Hungary.
- Janos Szentagothai Research Center, University of Pecs, Pecs, Hungary.
| | - D Werling
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Group, University of Pecs, Pecs, Hungary
| | - S Song
- Institute of Biomedicine, Jinan University, Guangzhou, China
| | - E Szabo
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Group, University of Pecs, Pecs, Hungary
| | - A Vaczy
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Group, University of Pecs, Pecs, Hungary
| | - P Kovari
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Group, University of Pecs, Pecs, Hungary
| | - A Tamas
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Group, University of Pecs, Pecs, Hungary
| | - D Reglodi
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Group, University of Pecs, Pecs, Hungary
| | - Rongjie Yu
- Institute of Biomedicine, Jinan University, Guangzhou, China.
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Atlasz T, Werling D, Song S, Szabo E, Vaczy A, Kovari P, Tamas A, Reglodi D, Yu R. Retinoprotective Effects of TAT-Bound Vasoactive Intestinal Peptide and Pituitary Adenylate Cyclase Activating Polypeptide. J Mol Neurosci 2018; 68:397-407. [PMID: 30542799 PMCID: PMC6581923 DOI: 10.1007/s12031-018-1229-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 09/20/2018] [Accepted: 11/21/2018] [Indexed: 12/19/2022]
Abstract
Vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase activating polypeptide (PACAP) belong to the same peptide family and exert a variety of biological functions. Both PACAP and VIP have protective effects in several tissues. While PACAP is known to be a stronger retinoprotective peptide, VIP has very potent anti-inflammatory effects. The need for a non-invasive therapeutic approach has emerged and PACAP has been shown to be retinoprotective when administered in the form of eye drops as well. The cell penetrating peptide TAT is composed of 11 amino acids and tagging of TAT at the C-terminus of neuropeptides PACAP/VIP can enhance the traversing ability of the peptides through the biological barriers. We hypothesized that TAT-bound PACAP and VIP could be more effective in exerting retinoprotective effects when given in eye drops, by increasing the traversing efficacy and enhancing the activation of the PAC1 receptor. Rats were subjected to bilateral carotid artery occlusion (BCCAO), and retinas were processed for histological analysis 14 days later. The efficiency of the TAT-bound peptides to reach the retina was assessed as well as their cAMP increasing ability. Our present study provides evidence, for the first time, that topically administered PACAP and VIP derivatives (PACAP-TAT and VIP-TAT) attenuate ischemic retinal degeneration via the PAC1 receptor presumably due to a multifactorial protective mechanism.
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Affiliation(s)
- Tamas Atlasz
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Group, University of Pecs, Pecs, Hungary. .,Department of Sportbiology, University of Pecs, Pecs, Hungary. .,Janos Szentagothai Research Center, University of Pecs, Pecs, Hungary.
| | - D Werling
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Group, University of Pecs, Pecs, Hungary
| | - S Song
- Institute of Biomedicine, Jinan University, Guangzhou, China
| | - E Szabo
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Group, University of Pecs, Pecs, Hungary
| | - A Vaczy
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Group, University of Pecs, Pecs, Hungary
| | - P Kovari
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Group, University of Pecs, Pecs, Hungary
| | - A Tamas
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Group, University of Pecs, Pecs, Hungary
| | - D Reglodi
- Department of Anatomy, Medical School, MTA-PTE PACAP Research Group, University of Pecs, Pecs, Hungary
| | - Rongjie Yu
- Institute of Biomedicine, Jinan University, Guangzhou, China.
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Mian I, Nichols S, Abernethy A, Carson K, Maignon K, Torres A, Snider J, Frampton G, Li G, Sharon E, Szabo E, Thomas A. P1.12-15 Distinctive Clinical Characteristics of SCLC in Never-Smokers. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.850] [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: 10/28/2022]
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27
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Le Rhun E, von Achenbach C, Lohmann B, Silginer M, Schneider H, Meetze K, Szabo E, Weller M. P04.11 Profound sensitivity of glioblastoma cells to apoptosis induction by TG02, a novel oral multi-cyclin-dependent kinase inhibitor. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Le Rhun
- University Hospital and University of Zurich, Zurich, Switzerl
| | - C von Achenbach
- University Hospital and University of Zurich, Zurich, Switzerl
| | - B Lohmann
- University Hospital and University of Zurich, Zurich, Switzerl
| | - M Silginer
- University Hospital and University of Zurich, Zurich, Switzerl
| | - H Schneider
- University Hospital and University of Zurich, Zurich, Switzerl
| | - K Meetze
- Tragara Pharmaceuticals, Carlsbad, CA, United States
| | - E Szabo
- University Hospital and University of Zurich, Zurich, Switzerl
| | - M Weller
- University Hospital and University of Zurich, Zurich, Switzerl
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28
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Szabo E, Demuth B, Nagy B, Molnar K, Farkas A, Szabo B, Balogh A, Hirsch E, Nagy B, Marosi G, Nagy ZK. Scaled-up preparation of drug-loaded electrospun polymer fibres and investigation of their continuous processing to tablet form. EXPRESS POLYM LETT 2018. [DOI: 10.3144/expresspolymlett.2018.37] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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29
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Wanjura V, Szabo E, Österberg J, Ottosson J, Enochsson L, Sandblom G. Morbidity of cholecystectomy and gastric bypass in a national database. Br J Surg 2017; 105:121-127. [DOI: 10.1002/bjs.10666] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/02/2017] [Accepted: 07/10/2017] [Indexed: 01/23/2023]
Abstract
Abstract
Background
There is a strong association between obesity and gallstones. However, there is no clear evidence regarding the optimal order of Roux-en-Y gastric bypass (RYGB) and cholecystectomy when both procedures are clinically indicated.
Methods
Based on cross-matched data from the Swedish Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (GallRiks; 79 386 patients) and the Scandinavian Obesity Surgery Registry (SOReg; 36 098 patients) from 2007 to 2013, complication rates, reoperation rates and operation times related to the timing of RYGB and cholecystectomy were explored.
Results
There was a higher aggregate complication risk when cholecystectomy was performed after RYGB rather than before (odds ratio (OR) 1·35, 95 per cent c.i. 1·09 to 1·68; P = 0·006). A complication after the first procedure independently increased the complication risk of the following procedure (OR 2·02, 1·44 to 2·85; P < 0·001). Furthermore, there was an increased complication risk when cholecystectomy was performed at the same time as RYGB (OR 1·72, 1·14 to 2·60; P = 0·010). Simultaneous cholecystectomy added 61·7 (95 per cent c.i. 56·1 to 67·4) min (P < 0·001) to the duration of surgery.
Conclusion
Cholecystectomy should be performed before, not during or after, RYGB.
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Affiliation(s)
- V Wanjura
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - E Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - J Österberg
- Department of Surgery, Mora Hospital, Mora, Sweden
| | - J Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Lindesberg, Sweden
| | - L Enochsson
- Department of Surgical and Perioperative Sciences, Division of Surgery, Sunderby Hospital, Umeå University, Umeå, Sweden
| | - G Sandblom
- Department of Surgical Gastroenterology, Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden
- Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
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30
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Kesarwala A, Kim C, Jones J, Kaushal A, Roper N, Hoang C, Szabo E, Connolly M, Padiernos E, Cultraro C, Waris M, Gao S, Steinberg S, Khan J, Rajan A, Guha U. Radiation As a Local Ablative Therapy Option for Oligoprogressive EGFR-Mutant Non-Small Cell Lung Cancer after Treatment with Osimertinib. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1719] [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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31
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Magyar M, Gonda X, Pap D, Edes A, Galambos A, Baksa D, Kocsel N, Szabo E, Bagdy G, Elliott R, Kokonyei G, Juhasz G. Decreased Openness to Experience Is Associated with Migraine-Type Headaches in Subjects with Lifetime Depression. Front Neurol 2017; 8:270. [PMID: 28690582 PMCID: PMC5479922 DOI: 10.3389/fneur.2017.00270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/26/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction Migraine and depression frequently occur as comorbid conditions, and it has been hypothesized that migraine with and without depression may have a different genetic background. A distinct personality trait constellation has been described in migraineurs. Less attention, however, was paid to personality differences in migraineurs with and without depression which may also shed light on differences in the neurobiological, background. The aim of our study was to investigate big five personality traits, headaches, and lifetime depression (DEP) in a large European general population sample. Methods Relationship between DEP, Big Five Inventory personality traits, and headaches identified by the ID-Migraine Questionnaire were investigated in 3,026 individuals from Budapest and Manchester with multivariate and logistic regression analyses. Results Both DEP and migraine(ID) showed differences in personality traits. Neuroticism was an independent risk factor for both conditions while a significant interaction effect appeared between the two in the case of openness. Namely, subjects with migraine(ID) and without DEP scored higher on openness compared to those who had depression. Conclusion While we confirmed previous results that high neuroticism is a risk factor for both depression and migraine, openness to experience was significantly lower in the co-occurrence of migraine and depression. Our results suggest that increased openness, possibly manifested in optimal or advantageous cognitive processing of pain experience in migraine may decrease the risk of co-occurrence of depression and migraine and thus may provide valuable insight for newer prevention and intervention approaches in the treatment of these conditions.
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Affiliation(s)
- Mate Magyar
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.,Department of Neurology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.,Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Dorottya Pap
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.,Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Andrea Edes
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.,Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Attila Galambos
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.,Faculty of Education and Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Daniel Baksa
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.,MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Natalia Kocsel
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.,Faculty of Education and Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Edina Szabo
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.,Faculty of Education and Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Gyorgy Bagdy
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.,Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Gyongyi Kokonyei
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.,Faculty of Education and Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Gabriella Juhasz
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.,Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.,Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom
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32
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Erlandson MC, Wong AKO, Szabo E, Vilayphiou N, Zulliger MA, Adachi JD, Cheung AM. Muscle and Myotendinous Tissue Properties at the Distal Tibia as Assessed by High-Resolution Peripheral Quantitative Computed Tomography. J Clin Densitom 2017; 20:226-232. [PMID: 27956336 DOI: 10.1016/j.jocd.2016.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 09/13/2016] [Accepted: 10/31/2016] [Indexed: 01/17/2023]
Abstract
High-resolution peripheral quantitative computed tomography (HR-pQCT) quantifies bone microstructure and density at the distal tibia where there is also a sizable amount of myotendinous (muscle and tendon) tissue (MT); however, there is no method for the quantification of MT. This study aimed (1) to assess the feasibility of using HR-pQCT distal tibia scans to estimate MT properties using a custom algorithm, and (2) to determine the relationship between MT properties at the distal tibia and mid-leg muscle density (MD) obtained from pQCT. Postmenopausal women from the Hamilton cohort of the Canadian Multicenter Osteoporosis Study had a single-slice (2.3 ± 0.5 mm) 66% site pQCT scan measuring muscle cross-sectional area (MCSA) and MD. A standard HR-pQCT scan was acquired at the distal tibia. HR-pQCT-derived MT cross-sectional area (MTCSA) and MT density (MTD) were calculated using a custom algorithm in which thresholds (34.22-194.32 mg HA/cm3) identified muscle seed volumes and were iteratively expanded. Pearson and Bland-Altman plots were used to assess correlations and systematic differences between pQCT- and HR-pQCT-derived muscle properties. Among 45 women (mean age: 74.6 ± 8.5 years, body mass index: 25.9 ± 4.3 kg/m2), MTD was moderately correlated with mid-leg MD across the 2 modalities (r = 0.69-0.70, p < 0.01). Bland-Altman analyses revealed no evidence of directional bias for MTD-MD. HR-pQCT and pQCT measures of MTCSA and MCSA were moderately correlated (r = 0.44, p < 0.01). Bland-Altman plots for MTCSA revealed that larger MCSAs related to larger discrepancy between the distal and the mid-leg locations. This is the first study to assess the ability of HR-pQCT to measure MT size, density, and morphometry. HR-pQCT-derived MTD was moderately correlated with mid-leg MD from pQCT. This relationship suggests that distal MT may share common properties with muscle throughout the length of the leg. Future studies will assess the value of HR-pQCT-derived MT properties in the context of falls, mobility, and balance.
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Affiliation(s)
- M C Erlandson
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - A K O Wong
- Department of Medicine and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - E Szabo
- Department of Medicine and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | | | | | - J D Adachi
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - A M Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
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33
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Lohmann B, Szabo E. P08.34 Targeting glioma stem cells with interferon-β. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.223] [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: 11/12/2022] Open
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34
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Werling D, Banks WA, Salameh TS, Kvarik T, Kovacs LA, Vaczy A, Szabo E, Mayer F, Varga R, Tamas A, Toth G, Biro Z, Atlasz T, Reglodi D. Passage through the Ocular Barriers and Beneficial Effects in Retinal Ischemia of Topical Application of PACAP1-38 in Rodents. Int J Mol Sci 2017; 18:ijms18030675. [PMID: 28335564 PMCID: PMC5372685 DOI: 10.3390/ijms18030675] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/08/2017] [Accepted: 03/12/2017] [Indexed: 01/14/2023] Open
Abstract
The neuropeptide pituitary adenylate cyclase activating polypeptide (PACAP) has two active forms, PACAP1-27 and PACAP1-38. Among the well-established actions are PACAP’s neurotrophic and neuroprotective effects, which have also been proven in models of different retinopathies. The route of delivery is usually intravitreal in studies proving PACAP’s retinoprotective effects. Recently, we have shown that PACAP1-27 delivered as eye drops in benzalkonium-chloride was able to cross the ocular barriers and exert retinoprotection in ischemia. Since PACAP1-38 is the dominant form of the naturally occurring PACAP, our aim was to investigate whether the longer form is also able to cross the barriers and exert protective effects in permanent bilateral common carotid artery occlusion (BCCAO), a model of retinal hypoperfusion. Our results show that radioactive PACAP1-38 eye drops could effectively pass through the ocular barriers to reach the retina. Routine histological analysis and immunohistochemical evaluation of the Müller glial cells revealed that PACAP1-38 exerted retinoprotective effects. PACAP1-38 attenuated the damage caused by hypoperfusion, apparent in almost all retinal layers, and it decreased the glial cell overactivation. Overall, our results confirm that PACAP1-38 given in the form of eye drops is a novel protective therapeutic approach to treat retinal diseases.
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Affiliation(s)
- Dora Werling
- Department of Anatomy, University of Pecs, Medical School, Pecs 7624, Hungary.
- Department of Ophthalmology, University of Pecs, Pecs 7624, Hungary.
| | - William A Banks
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA.
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98122, USA.
| | - Therese S Salameh
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA.
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98122, USA.
| | - Timea Kvarik
- Department of Anatomy, University of Pecs, Medical School, Pecs 7624, Hungary.
| | - Laszlo Akos Kovacs
- Department of Anatomy, University of Pecs, Medical School, Pecs 7624, Hungary.
| | - Alexandra Vaczy
- Department of Anatomy, University of Pecs, Medical School, Pecs 7624, Hungary.
| | - Edina Szabo
- Department of Anatomy, University of Pecs, Medical School, Pecs 7624, Hungary.
| | - Flora Mayer
- Department of Anatomy, University of Pecs, Medical School, Pecs 7624, Hungary.
| | - Rita Varga
- Department of Anatomy, University of Pecs, Medical School, Pecs 7624, Hungary.
| | - Andrea Tamas
- Department of Anatomy, University of Pecs, Medical School, Pecs 7624, Hungary.
| | - Gabor Toth
- Department of Medical Chemistry, University of Szeged, Szeged 6720, Hungary.
| | - Zsolt Biro
- Department of Ophthalmology, University of Pecs, Pecs 7624, Hungary.
| | - Tamas Atlasz
- Department of Anatomy, University of Pecs, Medical School, Pecs 7624, Hungary.
- Department of Sportbiology, University of Pecs, Pecs 7624, Hungary.
- Janos Szentagothai Research Center, University of Pecs, Pecs 7624, Hungary.
| | - Dora Reglodi
- Department of Anatomy, University of Pecs, Medical School, Pecs 7624, Hungary.
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35
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Stenberg E, Szabo E, Ottosson J, Näslund I. Outcomes of laparoscopic gastric bypass in a randomized clinical trial compared with a concurrent national database. Br J Surg 2017; 104:562-569. [PMID: 28239833 DOI: 10.1002/bjs.10448] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/24/2016] [Accepted: 10/31/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND RCTs are the standard for assessing medical interventions, but they may not be feasible and their external validity is sometimes questioned. This study aimed to compare results from an RCT on mesenteric defect closure during laparoscopic gastric bypass with those from a national database containing data on the same procedure, to shed light on the external validity of the RCT. METHODS Patients undergoing laparoscopic gastric bypass surgery within an RCT conducted between 1 May 2010 and 14 November 2011 were compared with those who underwent the same procedure in Sweden outside the RCT over the same time interval. Primary endpoints were severe complications within 30 days and surgery for small bowel obstruction within 4 years. RESULTS Some 2507 patients in the RCT were compared with 8485 patients in the non-RCT group. There were no differences in severe complications within 30 days in the group without closure of the mesenteric defect (odds ratio (OR) for RCT versus non-RCT 0·94, 95 per cent c.i. 0·64 to 1·36; P = 0·728) or in the group with closure of the defect (OR 1·34, 0·96 to 1·86; P = 0·087). There were no differences between the RCT and non-RCT cohorts in reoperation rates for small bowel obstruction in the mesenteric defect non-closure (cumulative incidence 10·9 versus 9·4 per cent respectively; hazard ratio (HR) 1·20, 95 per cent c.i. 0·99 to 1·46; P = 0·065) and closure (cumulative incidence 5·7 versus 7·0 per cent; HR 0·82, 0·62 to 1·07; P = 0·137) groups. The relative risk for small bowel obstruction without mesenteric defect closure compared with closure was 1·91 in the RCT group and 1·39 in the non-RCT group. CONCLUSION The efficacy of mesenteric defect closure was similar in the RCT and national registry, providing evidence for the external validity of the RCT.
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Affiliation(s)
- E Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - E Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - J Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - I Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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36
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Szende A, Bussey B, Szabo E, Klastersky J, Tomey O, Mueller U, Gabriel S, Tang B. Budgetary impact of lipegfilgrastim to the Mexican healthcare system. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30467-7] [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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37
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Brahme NN, Szabo E. Cancer prevention in the era of precision oncology. Clin Pharmacol Ther 2016; 101:575-577. [PMID: 28032900 DOI: 10.1002/cpt.566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 01/11/2023]
Abstract
Cancer is a highly heterogeneous disease, both between and within different target organs. Precision cancer prevention requires understanding the molecular pathways leading to cancer on a "per-person" level, identification of individuals most at risk for developing cancer, and tailoring interventions to accommodate pathogenesis, risk, and individual responses to interventions. This commentary will discuss how an investment in precision prevention research can accelerate cancer prevention agent development-the key to reducing cancer incidence and mortality.
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Affiliation(s)
- N N Brahme
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - E Szabo
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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38
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Kokonyei G, Szabo E, Kocsel N, Edes A, Eszlari N, Pap D, Magyar M, Kovacs D, Zsombok T, Elliott R, Anderson IM, William Deakin JF, Bagdy G, Juhasz G. Rumination in migraine: Mediating effects of brooding and reflection between migraine and psychological distress. Psychol Health 2016; 31:1481-1497. [PMID: 27616579 PMCID: PMC5062042 DOI: 10.1080/08870446.2016.1235166] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 09/05/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The relationship between migraine and psychological distress has been consistently reported in cross-sectional and longitudinal studies. We hypothesised that a stable tendency to perseverative thoughts such as rumination would mediate the relationship between migraine and psychological distress. Design and Main Outcomes Measures: Self-report questionnaires measuring depressive rumination, current psychological distress and migraine symptoms in two independent European population cohorts, recruited from Budapest (N = 1139) and Manchester (N = 2004), were used. Structural regression analysis within structural equation modelling was applied to test the mediational role of brooding and reflection, the components of rumination, between migraine and psychological distress. Sex, age and lifetime depression were controlled for in the analysis. RESULTS Migraine predicted higher brooding and reflection scores, and brooding proved to be a mediator between migraine and psychological distress in both samples, while reflection mediated the relationship significantly only in the Budapest sample. CONCLUSIONS Elevated psychological distress in migraine is partially attributed to ruminative response style. Further studies are needed to expand our findings to clinical samples and to examine how rumination links to the adjustment to migraine.
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Affiliation(s)
- Gyongyi Kokonyei
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Edina Szabo
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Natalia Kocsel
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Andrea Edes
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Nora Eszlari
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- Faculty of Pharmacy, Department of Pharmacodynamics, Semmelweis University, Budapest, Hungary
| | - Dorottya Pap
- Faculty of Pharmacy, Department of Pharmacodynamics, Semmelweis University, Budapest, Hungary
| | - Mate Magyar
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- Faculty of Medicine, Department of Neurology, Semmelweis University, Budapest, Hungary
| | - David Kovacs
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- Faculty of Pharmacy, Department of Pharmacodynamics, Semmelweis University, Budapest, Hungary
| | - Terezia Zsombok
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- Faculty of Medicine, Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Ian Muir Anderson
- Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - John Francis William Deakin
- Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Gyorgy Bagdy
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- Faculty of Pharmacy, Department of Pharmacodynamics, Semmelweis University, Budapest, Hungary
| | - Gabriella Juhasz
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- Faculty of Pharmacy, Department of Pharmacodynamics, Semmelweis University, Budapest, Hungary
- Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Vaczy A, Reglodi D, Somoskeoy T, Kovacs K, Lokos E, Szabo E, Tamas A, Atlasz T. The Protective Role of PAC1-Receptor Agonist Maxadilan in BCCAO-Induced Retinal Degeneration. J Mol Neurosci 2016; 60:186-94. [PMID: 27566170 DOI: 10.1007/s12031-016-0818-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/10/2016] [Indexed: 12/19/2022]
Abstract
A number of studies have proven that pituitary adenylate cyclase activating polypeptide (PACAP) is protective in neurodegenerative diseases. Permanent bilateral common carotid artery occlusion (BCCAO) causes severe degeneration in the rat retina. In our previous studies, protective effects were observed with PACAP1-38, PACAP1-27, and VIP but not with their related peptides, glucagon, or secretin in BCCAO. All three PACAP receptors (PAC1, VPAC1, VPAC2) appear in the retina. Molecular and immunohistochemical analysis demonstrated that the retinoprotective effects are most probably mainly mediated by the PAC1 receptor. The aim of the present study was to investigate the retinoprotective effects of a selective PAC1-receptor agonist maxadilan in BCCAO-induced retinopathy. Wistar rats were used in the experiment. After performing BCCAO, the right eye was treated with intravitreal maxadilan (0.1 or 1 μM), while the left eye was injected with vehicle. Sham-operated rats received the same treatment. Two weeks after the operation, retinas were processed for standard morphometric and molecular analysis. Intravitreal injection of 0.1 or 1 μM maxadilan caused significant protection in the thickness of most retinal layers and the number of cells in the GCL compared to the BCCAO-operated eyes. In addition, 1 μM maxadilan application was more effective than 0.1 μM maxadilan treatment in the ONL, INL, IPL, and the entire retina (OLM-ILM). Maxadilan treatment significantly decreased cytokine expression (CINC-1, IL-1α, and L-selectin) in ischemia. In summary, our histological and molecular analysis showed that maxadilan, a selective PAC1 receptor agonist, has a protective role in BCCAO-induced retinal degeneration, further supporting the role of PAC1 receptor conveying the retinoprotective effects of PACAP.
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Affiliation(s)
- A Vaczy
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Pecs, Hungary
| | - D Reglodi
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Pecs, Hungary
| | - T Somoskeoy
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Pecs, Hungary
| | - K Kovacs
- Department of Biochemistry and Medical Chemistry, University of Pecs, Pecs, Hungary
| | - E Lokos
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Pecs, Hungary
| | - E Szabo
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Pecs, Hungary
| | - A Tamas
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Pecs, Hungary
| | - T Atlasz
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pecs, Pecs, Hungary. .,Department of Sportbiology, University of Pecs, Ifjusag Street 6, Pecs, H-7624, Hungary. .,Janos Szentagothai Research Center, University of Pecs, Pecs, Hungary.
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Eisinger A, Magi A, Gyurkovics M, Szabo E, Demetrovics Z, Kokonyei G. [Iowa Gambling Task: illustration of a behavioral measurement]. Neuropsychopharmacol Hung 2016; 18:45-55. [PMID: 27038870] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The Iowa Gambling Task is a behavioral measurement which was developed to examine decision-making based on the Somatic Marker Hypothesis. Participants have to make series of choices altogether 100 times from four decks of cards. The decks have different characteristics with regards to gains and losses. After the initial analyses - with a focus on patients with damage to the ventromedial prefrontal cortex - the tool soon became one of the most frequently used technique of measuring hot executive functions. It is also used to measure impulsivity. Structures involved in decision-making constitute the neural basis of the Task. IGT is applied in several different disorders (in connection with decision-making and impulsivity as well). In recent years different versions have been developed, and these modifications may have different effects on IGT performance, and may also influence what the Task measures exactly. With growing empirical evidence several questions have arisen in connection with the composition of the decks (gain-loss magnitude vs. frequency, prominent deck B phenomenon) which suggest to use other indexes as well besides the net scores.
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Carter CA, Rajan A, Keen C, Szabo E, Khozin S, Thomas A, Brzezniak C, Guha U, Doyle LA, Steinberg SM, Xi L, Raffeld M, Tomita Y, Lee MJ, Lee S, Trepel JB, Reckamp KL, Koehler S, Gitlitz B, Salgia R, Gandara D, Vokes E, Giaccone G. Selumetinib with and without erlotinib in KRAS mutant and KRAS wild-type advanced nonsmall-cell lung cancer. Ann Oncol 2016; 27:693-9. [PMID: 26802155 DOI: 10.1093/annonc/mdw008] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/27/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND KRAS mutations in NSCLC are associated with a lack of response to epidermal growth factor receptor inhibitors. Selumetinib (AZD6244; ARRY-142886) is an oral selective MEK kinase inhibitor of the Ras/Raf/MEK/ERK pathway. PATIENTS AND METHODS Advanced nonsmall-cell lung cancer (NSCLC) patients failing one to two prior regimens underwent KRAS profiling. KRAS wild-type patients were randomized to erlotinib (150 mg daily) or a combination of selumetinib (150 mg daily) with erlotinib (100 mg daily). KRAS mutant patients were randomized to selumetinib (75 mg b.i.d.) or the combination. The primary end points were progression-free survival (PFS) for the KRAS wild-type cohort and objective response rate (ORR) for the KRAS mutant cohort. Biomarker studies of ERK phosphorylation and immune subsets were carried out. RESULTS From March 2010 to May 2013, 89 patients were screened; 41 KRAS mutant and 38 KRAS wild-type patients were enrolled. Median PFS in the KRAS wild-type arm was 2.4 months [95% confidence interval (CI) 1.3-3.7] for erlotinib alone and 2.1 months (95% CI 1.8-5.1) for the combination. The ORR in the KRAS mutant group was 0% (95% CI 0.0% to 33.6%) for selumetinib alone and 10% (95% CI 2.1% to 26.3%) for the combination. Combination therapy resulted in increased toxicities, requiring dose reductions (56%) and discontinuation (8%). Programmed cell death-1 expression on regulatory T cells (Tregs), Tim-3 on CD8+ T cells and Th17 levels were associated with PFS and overall survival in patients receiving selumetinib. CONCLUSIONS This study failed to show improvement in ORR or PFS with combination therapy of selumetinib and erlotinib over monotherapy in KRAS mutant and KRAS wild-type advanced NSCLC. The association of immune subsets and immune checkpoint receptor expression with selumetinib may warrant further studies.
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Affiliation(s)
- C A Carter
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda
| | - A Rajan
- Medical Oncology Branch, Center for Cancer Research
| | - C Keen
- Medical Oncology Branch, Center for Cancer Research
| | - E Szabo
- Lung & Upper Aerodigestive Cancer Research Group Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda
| | - S Khozin
- Medical Oncology Branch, Center for Cancer Research
| | - A Thomas
- Medical Oncology Branch, Center for Cancer Research
| | - C Brzezniak
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda
| | - U Guha
- Medical Oncology Branch, Center for Cancer Research
| | - L A Doyle
- Cancer Therapy Evaluation Program, National Institutes of Health, Bethesda
| | - S M Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research
| | - L Xi
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda
| | - M Raffeld
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda
| | - Y Tomita
- Medical Oncology Branch, Center for Cancer Research
| | - M J Lee
- Medical Oncology Branch, Center for Cancer Research
| | - S Lee
- Medical Oncology Branch, Center for Cancer Research
| | - J B Trepel
- Medical Oncology Branch, Center for Cancer Research
| | - K L Reckamp
- Department of Hematology and Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte
| | - S Koehler
- Department of Hematology and Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte
| | - B Gitlitz
- Department of Internal Medicine, University of Southern California, Los Angeles
| | - R Salgia
- Radiation and Cellular Oncology, University of Chicago, Medicine and Biological Sciences, Chicago
| | - D Gandara
- Division of Hematology and Oncology, University of California at Davis Cancer Center, Sacramento
| | - E Vokes
- Radiation and Cellular Oncology, University of Chicago, Medicine and Biological Sciences, Chicago
| | - G Giaccone
- Medical Oncology Branch, Center for Cancer Research Lombardi Comprehensive Cancer Center, Georgetown University, Washington, USA
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Klevebro F, Johnsen G, Johnson E, Viste A, Myrnäs T, Szabo E, Jacobsen AB, Friesland S, Tsai JA, Persson S, Lindblad M, Lundell L, Nilsson M. Morbidity and mortality after surgery for cancer of the oesophagus and gastro-oesophageal junction: A randomized clinical trial of neoadjuvant chemotherapy vs. neoadjuvant chemoradiation. Eur J Surg Oncol 2015; 41:920-6. [PMID: 25908010 DOI: 10.1016/j.ejso.2015.03.226] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 02/08/2015] [Accepted: 03/05/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare the incidence and severity of postoperative complications after oesophagectomy for carcinoma of the oesophagus and gastro-oesophageal junction (GOJ) after randomized accrual to neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy (nCRT). BACKGROUND Neoadjuvant therapy improves long-term survival after oesophagectomy. To date, evidence is insufficient to determine whether combined nCT, or nCRT alone, is the most beneficial. METHODS Patients with carcinoma of the oesophagus or GOJ, resectable with a curative intention, were enrolled in this multicenter trial conducted at seven centres in Sweden and Norway. Study participants were randomized to nCT or nCRT followed by surgery with two-field lymphadenectomy. Three cycles of cisplatin/5-fluorouracil was administered in all patients, while 40 Gy of concomitant radiotherapy was administered in the nCRT group. RESULTS Of the randomized 181 patients, 91 were assigned to nCT and 90 to nCRT. One-hundred-and-fifty-five patients, 78 nCT and 77 nCRT, underwent resection. There was no statistically significant difference between the groups in the incidence of surgical or nonsurgical complications (P-value = 0.69 and 0.13, respectively). There was no 30-day mortality, while the 90-day mortality was 3% (2/78) in the nCT group and 6% (5/77) in the nCRT group (P = 0.24). The median Clavien-Dindo complication severity grade was significantly higher in the nCRT group (P = 0.001). CONCLUSION There was no significant difference in the incidence of complications between patients randomized to nCT and nCRT. However, complications were significantly more severe after nCRT. REGISTRATION TRIAL DATABASE The trial was registered in the Clinical Trials Database (registration number NCT01362127).
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Affiliation(s)
- F Klevebro
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
| | - G Johnsen
- Department of Gastrointestinal Surgery, St Olavs Hospital, Trondheim University Hospital, Norway
| | - E Johnson
- Department of Paediatric and Gastrointestinal Surgery, Ullevål University Hospital, Oslo, Norway
| | - A Viste
- Department of Acute and Gastrointestinal Surgery Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway
| | - T Myrnäs
- Department of Surgery, Umeå University Hospital, Umeå, Sweden
| | - E Szabo
- Department of Surgery, Örebro University Hospital, Sweden
| | - A-B Jacobsen
- Department of Oncology, Oslo University Hospital, Norway
| | - S Friesland
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - J A Tsai
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - S Persson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - M Lindblad
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - L Lundell
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - M Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
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Szabo E, Kovács R, Plangár I, Tokés T, Polanek R, Czifrus S, Bencsik D, Hideghéty K. PO-1074 Vertebrate model to examine the biological effectiveness of different radiation qualities. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41066-7] [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: 10/23/2022]
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Veronesi G, Lazzeroni M, Szabo E, Brown PH, DeCensi A, Guerrieri-Gonzaga A, Bellomi M, Radice D, Grimaldi MC, Spaggiari L, Bonanni B. Long-term effects of inhaled budesonide on screening-detected lung nodules. Ann Oncol 2015; 26:1025-1030. [PMID: 25672894 DOI: 10.1093/annonc/mdv064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/31/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A previously carried out randomized phase IIb, placebo-controlled trial of 1 year of inhaled budesonide, which was nested in a lung cancer screening study, showed that non-solid and partially solid lung nodules detected by low-dose computed tomography (LDCT), and not immediately suspicious for lung cancer, tended to regress. Because some of these nodules may be slow-growing adenocarcinoma precursors, we evaluated long-term outcomes (after stopping the 1-year intervention) by annual LDCT. PATIENTS AND METHODS We analyzed the evolution of target and non-target trial nodules detected by LDCT in the budesonide and placebo arms up to 5 years after randomization. The numbers and characteristics of lung cancers diagnosed during follow-up were also analyzed. RESULTS The mean maximum diameter of non-solid nodules reduced significantly (from 5.03 mm at baseline to 2.61 mm after 5 years) in the budesonide arm; there was no significant size change in the placebo arm. The mean diameter of partially solid lesions also decreased significantly, but only by 0.69 mm. The size of solid nodules did not change. Neither the number of new lesions nor the number of lung cancers differed in the two arms. CONCLUSIONS Inhaled budesonide given for 1 year significantly decreased the size of non-solid nodules detected by screening LDCT after 5 years. This is of potential importance since some of these nodules may progress slowly to adenocarcinoma. However, further studies are required to assess clinical implications. CLINICAL TRIAL NUMBER NCT01540552.
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Affiliation(s)
| | - M Lazzeroni
- Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | - E Szabo
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda
| | - P H Brown
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, USA
| | - A DeCensi
- Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy; Division of Medical Oncology, Ospedali Galliera, Genoa
| | - A Guerrieri-Gonzaga
- Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | - M Bellomi
- Division of Radiology, European Institute of Oncology, Milan; University of Milan, Milan
| | - D Radice
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - M C Grimaldi
- Division of Radiology, European Institute of Oncology, Milan
| | - L Spaggiari
- Divisions of Thoracic Surgery; University of Milan, Milan
| | - B Bonanni
- Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
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Szabo E. Oregonator generalization as a minimal model of quorum sensing in Belousov–Zhabotinsky reaction with catalyst confinement in large populations of particles. RSC Adv 2015. [DOI: 10.1039/c5ra12841b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The Oregonator demonstrates that quorum sensing in populations of Belousov–Zhabotinsky oscillators arises from modification of the stoichiometry by catalyst confinement.
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Affiliation(s)
- E. Szabo
- Department of Earth and Planetary Sciences
- Harvard University
- Cambridge
- USA
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Tritschler I, Seystahl K, Szabo E, Tabatabai G, Weller M. CS-35 * TGF- INDUCES AND BMP SUPPRESSES VEGF RELEASE DEPENDING ON SMAD2/3 VERSUS SMAD1/5/8 SIGNALING IN GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou242.35] [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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Seystahl K, Tritschler I, Szabo E, Tabatabai G, Weller M. P01.21 * DIFFERENTIAL REGULATION OF TGF- -INDUCED, ALK-5-MEDIATED VEGF RELEASE BY SMAD2/3 VERSUS SMAD1/5/8 SIGNALING IN GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.114] [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: 11/13/2022] Open
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Codo P, Weller M, Meister G, Szabo E, Steinle A, Wolter M, Reifenberger G, Roth P. P02.04 * MICRORNA-MEDIATED DOWN-REGULATION OF NKG2D LIGAND EXPRESSION REDUCES GLIOMA CELL IMMUNOGENICITY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.120] [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: 11/12/2022] Open
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Veronesi G, Lazzeroni M, Szabo E, Brown P, De Censi A, Guerrieri-Gonzaga A, Bellomi M, Radice D, Grimaldi M, Spaggiari L, Bonanni B. Long-Term Effects of Inhaled Budesonide on Screening-Detected Lung Nodules. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu351.2] [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: 11/13/2022] Open
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Nigil Haroon N, Cheung A, Szabo E, Raboud J, Anton A, Josse R, Inman R. AB1082 High-Resolution Peripheral Quantitative CT (HRPQCT) in Ankylosing Spondylitis Reveals Diminished Bone Strength and Volumetric Bmd. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4315] [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: 11/03/2022]
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