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Hashmi H, Hansen DK, Peres LC, Puglianini OC, Freeman C, De Avila G, Sidana S, Shune L, Sborov DW, Davis J, Wagner C, Kocoglu MH, Atrash S, Voorhees P, Simmons G, Ferreri C, Kalariya N, Anderson Jr LD, Afrough A, Dima D, Khouri J, McGuirk J, Locke FL, Baz R, Patel KK, Alsina M. Factors associated with refractoriness or early progression after idecabtagene vicleucel in patients with relapsed/ refractory multiple myeloma: US Myeloma Immunotherapy Consortium real world experience. Haematologica 2024; 109:1514-1524. [PMID: 37855036 PMCID: PMC11063864 DOI: 10.3324/haematol.2023.283888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023] Open
Abstract
While response rates and survival outcomes have been very promising for idecabtagene vicleucel (ide-cel), a proportion of patients do not respond or relapse early after this B-cell maturation antigen (BCMA) targeted chimeric antigen receptor (CAR) T-cell therapy. Understanding the characteristics of these patients is important for patient selection and development of novel strategies to improve outcomes. We evaluated factors associated with early progression (progression or death due to myeloma ≤3 months after CAR T-cell infusion) in patients treated with standard of care ide-cel at 11 US academic centers. Among 211 patients that received ide-cel, 43 patients had a progressive event ≤3 months of infusion. Patients with a history of extramedullary disease, prior BCMA targeted therapy, elevated ferritin at lymphodepletion, use of bridging therapy, Hispanic ethnicity, plasma cell leukemia and t(4;14) were more likely to progress ≤3 months of infusion (P<0.05). Of these risk factors for early progression identified in univariate analyses, history of extramedullary disease, prior BCMA targeted therapy, elevated ferritin at lymphodepletion, plasma cell leukemia, and t(4;14) were associated with worse progression-free survival (PFS) in multivariable analysis. Presence of three or more of these factors had a significant negative impact on PFS (P<0.001; median PFS for ≥3 factors, 3.2 months vs. 0 factors, 14.1 months). This study helps identify patients at high risk of early progression after CAR T-cell therapy who may benefit from specific interventions pre and post CAR T-cell therpy to improve outcomes.
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Affiliation(s)
- Hamza Hashmi
- Medical University of South Carolina, Charleston, SC
| | - Doris K. Hansen
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Lauren C. Peres
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | - Ciara Freeman
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | - Surbhi Sidana
- Stanford University School of Medicine, Stanford, CA
| | - Leyla Shune
- The University of Kansas Medical Center, Kansas City, KA
| | - Douglas W. Sborov
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - James Davis
- Medical University of South Carolina, Charleston, SC
| | - Charlotte Wagner
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - Mehmet H. Kocoglu
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | | | | | - Gary Simmons
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA
| | | | - Nilesh Kalariya
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Aimaz Afrough
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | | | | | - Joseph McGuirk
- The University of Kansas Medical Center, Kansas City, KA
| | | | - Rachid Baz
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Krina K. Patel
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Melissa Alsina
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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Afrough A, Hashmi H, Hansen DK, Sidana S, Ahn C, Peres LC, Dima D, Freeman CL, Puglianini OC, Kocoglu MH, Atrash S, Voorhees PM, Shune L, McGuirk JP, Simmons G, Sborov DW, Davis JA, Kaur G, Sannareddy A, Ferreri CJ, Gaballa MR, Goldsmith S, Nadeem O, Midha S, Wagner CB, Locke FL, Patel KK, Khouri J, Anderson LD, Lin Y. Real-world impact of bridging therapy on outcomes of ide-cel for myeloma in the U.S. Myeloma Immunotherapy Consortium. Blood Cancer J 2024; 14:63. [PMID: 38609386 PMCID: PMC11015040 DOI: 10.1038/s41408-024-00993-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 04/14/2024] Open
Affiliation(s)
- Aimaz Afrough
- Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Hamza Hashmi
- Medical University of South Carolina, Charleston, SC, USA
| | - Doris K Hansen
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Surbhi Sidana
- Stanford University School of Medicine, Stanford, CA, USA
| | - Chul Ahn
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Lauren C Peres
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Danai Dima
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA
| | - Ciara L Freeman
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | - Mehmet H Kocoglu
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | | | | | - Leyla Shune
- The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Gary Simmons
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
| | - Douglas W Sborov
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - James A Davis
- Medical University of South Carolina, Charleston, SC, USA
| | - Gurbakhash Kaur
- Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Aishwarya Sannareddy
- Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - Omar Nadeem
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Charlotte B Wagner
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | - Krina K Patel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Khouri
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA
| | - Larry D Anderson
- Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Yi Lin
- Mayo Clinic, Rochester, MN, USA
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Sidana S, Peres LC, Hashmi H, Hosoya H, Ferreri C, Khouri J, Dima D, Atrash S, Voorhees P, Simmons G, Sborov DW, Kalariya N, Hovanky V, Bharadwaj S, Miklos D, Wagner C, Kocoglu MH, Kaur G, Davis JA, Midha S, Janakiram M, Freeman C, Alsina M, Locke F, Gonzalez R, Lin Y, McGuirk J, Afrough A, Shune L, Patel KK, Hansen DK. Idecabtagene vicleucel chimeric antigen receptor T-cell therapy for relapsed/refractory multiple myeloma with renal impairment. Haematologica 2024; 109:777-786. [PMID: 37731379 PMCID: PMC10905101 DOI: 10.3324/haematol.2023.283940] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023] Open
Abstract
We evaluated patients with relapsed multiple myeloma with renal impairment (RI) treated with standard of care idecabtagene vicleucel (ide-cel), as outcomes with chimeric antigen receptor (CAR) T-cell therapy are unknown in this population. RI was defined as creatinine clearance (CrCl) <50 mL/min. CrCl of <30 mL/min or dialysis dependence were defined as severe RI. The study cohort included 214 patients, 28 (13%) patients with RI, including 11 patients severe RI (dialysis, N=1). Patients with RI were older, more likely to be female and had higher likelihood of having Revised International Staging System stage 3 disease. Rates and severity of cytokine release syndrome (89% vs. 84%, grade ≥3: 7% vs. 2%) and immune effector cell-associated neurotoxicity syndrome (23% vs. 20%) were similar in patients with and without RI, respectively. Patients with RI had higher incidence of short-term grade ≥3 cytopenias, although cytopenias were similar by 3 months following CAR T-cell therapy. Renal function did not worsen after CAR T-cell therapy in patients with RI. Response rates (93% vs. 82%) and survival outcomes (median progression-free survival: 9 vs. 8 months; P=0.26) were comparable in patients with and without RI, respectively. Treatment with ide-cel is feasible in patients with RI, with a comparable safety and efficacy profile as patients without RI, with notable exception of higher short-term high-grade cytopenias.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Gary Simmons
- Virginia Commonwealth University Massey Cancer Center
| | | | | | | | | | | | | | - Mehmet H Kocoglu
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center
| | - Gurbakhash Kaur
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center
| | | | | | | | | | | | | | | | | | | | - Aimaz Afrough
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center
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Peres LC, Oswald LB, Dillard CM, De Avila G, Nishihori T, Blue BJ, Freeman CL, Locke FL, Alsina M, Castaneda Puglianini O, Shune L, Sborov DW, Wagner C, Dima D, Hashmi H, Davis JA, Kocoglu MH, Badros AZ, Atrash S, Simmons G, Kalariya N, Ferreri C, Anderson LD, Afrough A, Kaur G, Lin Y, Liu L, Nadeem O, Voorhees P, Khouri J, McGuirk J, Sidana S, Hansen DK, Patel K. Racial and ethnic differences in clinical outcomes among patients with multiple myeloma treated with CAR T-cell therapy. Blood Adv 2024; 8:251-259. [PMID: 37855718 PMCID: PMC10918426 DOI: 10.1182/bloodadvances.2023010894] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/24/2023] [Accepted: 09/05/2023] [Indexed: 10/20/2023] Open
Abstract
ABSTRACT Idecabtagene vicleucel (ide-cel) was the first chimeric antigen receptor T-cell therapy to gain US Food and Drug Administration approval for patients with relapsed/refractory multiple myeloma (RRMM). The clinical outcomes of standard of care (SOC) ide-cel in racially and ethnically diverse populations have been understudied. This study pooled data from 207 patients with RRMM (28% patients of racial and ethnic minority groups) treated with SOC ide-cel across 11 institutions to examine racial and ethnic differences in the incidence of toxicities and adverse events, response to ide-cel, and survival. This study included 22 (11%) Hispanic, 36 (17%) non-Hispanic Black, and 149 (72%) non-Hispanic White patients with RRMM. Compared with Hispanic and non-Hispanic White patients, non-Hispanic Black patients had higher median levels of C-reactive protein (1.0, 0.8, and 3.5 mg/dL, respectively; P = .02) and baseline ferritin (362.0 vs 307.0 vs 680.5, respectively; P = .08) and were more likely to develop cytokine release syndrome (77%, 85%, and 97%, respectively; P = .04). Although best overall response rate was lower among Hispanic patients (59%) than among non-Hispanic Black (86%) and White patients (86%; P = .01), there were no racial and ethnic differences in progression-free or overall survival. We provide, to our knowledge, the first and largest investigation of clinical outcomes of SOC ide-cel by race and ethnicity. Despite differences in safety and response to ide-cel, our findings encourage the use of ide-cel in all patients with RRMM. These findings should be confirmed in larger samples of diverse patients with RRMM, with longer follow-up time.
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Affiliation(s)
- Lauren C. Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Laura B. Oswald
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Christen M. Dillard
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gabriel De Avila
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Brandon J. Blue
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Ciara L. Freeman
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Frederick L. Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Melissa Alsina
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Omar Castaneda Puglianini
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Leyla Shune
- Division of Hematologic Malignancies and Cellular Therapeutics, The University of Kansas Medical Center, Kansas City, KS
| | - Douglas W. Sborov
- Division of Hematology and Hematologic Malignancies, The University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - Charlotte Wagner
- Division of Hematology and Hematologic Malignancies, The University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - Danai Dima
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, OH
| | - Hamza Hashmi
- Department of Hematology and Bone Marrow Transplant, Medical University of South Carolina, Charleston, SC
| | - James A. Davis
- Department of Pharmacy, Medical University of South Carolina, Charleston, SC
| | - Mehmet H. Kocoglu
- Division of Hematology/Oncology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Ashraf Z. Badros
- Division of Hematology/Oncology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Shebli Atrash
- Department of Hematologic Oncology and Blood Disorders, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Gary Simmons
- Cellular Immunotherapies and Transplant Program, Virginia Commonwealth University Massey Cancer Center, Richmond, VA
| | - Nilesh Kalariya
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher Ferreri
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Larry D. Anderson
- Myeloma, Waldenstrom’s, and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Aimaz Afrough
- Myeloma, Waldenstrom’s, and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Gurbakhash Kaur
- Myeloma, Waldenstrom’s, and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Omar Nadeem
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Peter Voorhees
- Department of Hematologic Oncology and Blood Disorders, Atrium Health Levine Cancer Institute, Charlotte, NC
| | - Jack Khouri
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, OH
| | - Joseph McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, The University of Kansas Medical Center, Kansas City, KS
| | - Surbhi Sidana
- Division of Bone Marrow Transplantation and Cellular Therapy, Stanford University School of Medicine, Stanford, CA
| | - Doris K. Hansen
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Krina Patel
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
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Simmons G, Sabo R, Aziz M, Martin E, Bernard RJ, Sriparna M, McIntire C, Krieger E, Brophy DF, Natarajan R, Fowler A, Roberts CH, Toor A. INTRAVENOUS VITAMIN C SUPPLEMENTATION IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS: SALUTARY IMPACT ON CLINICAL OUTCOMES. medRxiv 2023:2023.10.24.23297165. [PMID: 37961224 PMCID: PMC10635184 DOI: 10.1101/2023.10.24.23297165] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Intravenous (IV) vitamin C improves organ function and reduces inflammation in sepsis, an inflammatory state like the post-hematopoietic stem cell transplant (SCT) milieu. The safety and efficacy of parenteral vitamin C after allogeneic hematopoietic stem cell transplant (HSCT) were evaluated in a phase I/II trial and clinical outcomes compared with a propensity score - matched historical control. Methods Patients with advanced hematologic malignancies were enrolled in a phase 2 clinical trial, receiving IV vitamin C, 50mg/kg/d, divided into 3 doses given on days 1-14 after HSCT, followed by 500 mg bid oral from day 15 until 6 months post-SCT. Results 55 patients received IV vitamin C: these include 10/10 HLA-MRD and MUD (n=48) and 9/10 HLA MUD recipients (n=7). All patients enrolled were deficient in vitamin C at day 0 and had restoration to normal levels for the remainder of the course. Vitamin C recipients had lower non-relapse mortality (11% vs. 25%, p-value = 0.07) and consequently, improved survival compared to historical controls (82% vs 62% p=0.06), with no attributable grade 3 and 4 toxicities to vitamin C. Patients with myeloid malignancies had improved survival (83% vs. 54%, p=0.02) and non-relapse mortality (NRM) (10% vs. 37%, p=0.009), as well as chronic GVHD, with similar relapse rates compared to controls. Conclusions In patients undergoing allogeneic HSCT the administration of IV vitamin C is safe and reduces non-relapse mortality improving overall survival. Randomized trials are needed to confirm the utility of this easily available and inexpensive therapy.
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Affiliation(s)
- Gary Simmons
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Roy Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - May Aziz
- School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
| | - Erika Martin
- School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
| | - Robyn J Bernard
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Manjari Sriparna
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Cody McIntire
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Elizabeth Krieger
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia
| | - Donald F Brophy
- School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
| | - Ramesh Natarajan
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Alpha Fowler
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | | | - Amir Toor
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
- Lehigh Valley Health Network, Allentown, Pennsylvania
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Toor A, Simmons G, Sabo R, Aziz M, Martin E, Bernard R, Sriparna M, McIntire C, Kreiger E, Brophy D, Natarajan R, Fowler A, Roberts C. Intravenous Vitamin C Supplementation in Allogeneic Hematopoietic Cell Transplant Recipients: Salutary Impact on Clinical Outcomes. Res Sq 2023:rs.3.rs-3538792. [PMID: 37986783 PMCID: PMC10659544 DOI: 10.21203/rs.3.rs-3538792/v1] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Intravenous (IV) vitamin C improves organ function and reduces inflammation in sepsis, an inflammatory state like the post-hematopoietic stem cell transplant (HCT) milieu. The safety and efficacy of parenteral vitamin C after allogeneic HCT were evaluated in a phase I/II trial. Clinical outcomes were compared with a propensity score - matched historical control. Methods Patients with advanced hematologic malignancies received IV vitamin C, 50mg/kg/d, divided into 3 doses given on days 1-14 after HCT, followed by 500 mg bid oral from day 15 until 6 months post-SCT. Results 55 patients received IV vitamin C. All patients were deficient in vitamin C at day 0. Vitamin C recipients had lower non-relapse mortality (NRM) (p = 0.07) and improved survival compared to historical controls (p=0.06), with no attributable grade 3 and 4 toxicities. Vitamin C recipients had similar relapse rate and acute graft versus host disease (GVHD) (p=0.35), but lower severe chronic GVHD (p=0.35). Patients with myeloid malignancies had improved survival (p=0.02) and NRM (p=0.009), as well as chronic GVHD, with similar relapse rates compared to controls. Conclusions In patients undergoing allogeneic HCT the administration of IV vitamin C is safe and reduces non-relapse mortality and chronic GVHD improving overall survival.
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Affiliation(s)
- Amir Toor
- Virginia Commonwealth University Massey Cancer Center
| | - Gary Simmons
- Virginia Commonwealth University Massey Cancer Center
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Ferreri CJ, Hildebrandt MAT, Hashmi H, Shune LO, McGuirk JP, Sborov DW, Wagner CB, Kocoglu MH, Rapoport A, Atrash S, Voorhees PM, Khouri J, Dima D, Afrough A, Kaur G, Anderson LD, Simmons G, Davis JA, Kalariya N, Peres LC, Lin Y, Janakiram M, Nadeem O, Alsina M, Locke FL, Sidana S, Hansen DK, Patel KK, Castaneda Puglianini OA. Real-world experience of patients with multiple myeloma receiving ide-cel after a prior BCMA-targeted therapy. Blood Cancer J 2023; 13:117. [PMID: 37558706 PMCID: PMC10412575 DOI: 10.1038/s41408-023-00886-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/26/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
Most patients with multiple myeloma experience disease relapse after treatment with a B-cell maturation antigen-targeted therapy (BCMA-TT), and data describing outcomes for patients treated with sequential BCMA-TT are limited. We analyzed clinical outcomes for patients infused with standard-of-care idecabtagene vicleucel, an anti-BCMA chimeric antigen receptor (CAR) T-cell therapy, at 11 US medical centers. A total of 50 patients with prior BCMA-TT exposure (38 antibody-drug conjugate, 7 bispecific, 5 CAR T) and 153 patients with no prior BCMA-TT were infused with ide-cel, with a median follow-up duration of 4.5 and 6.0 months, respectively. Safety outcomes between cohorts were comparable. The prior BCMA-TT cohort had a lower overall response rate (74% versus 88%; p = 0.021), median duration of response (7.4 versus 9.6 months; p = 0.03), and median progression-free survival (3.2 months versus 9.0 months; p = 0.0002) compared to the cohort without prior BCMA-TT. All five patients who received a prior anti-BCMA CAR T responded to ide-cel, and survival outcomes were best for this subgroup. In conclusion, treatment with ide-cel yielded meaningful clinical responses in real-world patients exposed to a prior BCMA-TT, though response rates and durability were suboptimal compared to those not treated with a prior BCMA-TT.
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Affiliation(s)
| | | | - Hamza Hashmi
- Medical University of South Carolina, Charleston, SC, USA
| | - Leyla O Shune
- The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Douglas W Sborov
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Charlotte B Wagner
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - M Hakan Kocoglu
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Aaron Rapoport
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | | | | | - Jack Khouri
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA
| | - Danai Dima
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA
| | - Aimaz Afrough
- Myeloma, Waldenstrom's, and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Gurbakhash Kaur
- Myeloma, Waldenstrom's, and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Larry D Anderson
- Myeloma, Waldenstrom's, and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Gary Simmons
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
| | - James A Davis
- Medical University of South Carolina, Charleston, SC, USA
| | - Nilesh Kalariya
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lauren C Peres
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Yi Lin
- Mayo Clinic, Rochester, MN, USA
| | | | - Omar Nadeem
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Melissa Alsina
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Surbhi Sidana
- Stanford University School of Medicine, Stanford, CA, USA
| | - Doris K Hansen
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Krina K Patel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Zelikson V, Sabo R, Serrano M, Aqeel Y, Ward S, Al Juhaishi T, Aziz M, Krieger E, Simmons G, Roberts C, Reed J, Buck G, Toor A. Allogeneic haematopoietic cell transplants as dynamical systems: influence of early-term immune milieu on long-term T-cell recovery. Clin Transl Immunology 2023; 12:e1458. [PMID: 37457614 PMCID: PMC10345185 DOI: 10.1002/cti2.1458] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/11/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Objectives Immune recovery following haematopoietic cell transplantation (HCT) functions as a dynamical system. Reducing the duration of intense immune suppression and augmenting antigen presentation has the potential to optimise T-cell reconstitution, potentially influencing long-term outcomes. Methods Based on donor-derived T-cell recovery, 26 patients were adaptively randomised between mycophenolate mofetil (MMF) administered for 30-day post-transplant with filgrastim for cytokine support (MMF30 arm, N = 11), or MMF given for 15 days with sargramostim (MMF15 arm, N = 15). All patients underwent in vivo T-cell depletion with 5.1 mg kg-1 antithymocyte globulin (administered over 3 days, Day -9 through to Day -7) and received reduced intensity 450 cGy total body irradiation (3 fractions on Day -1 and Day 0). Patients underwent HLA-matched related and unrelated donor haematopoietic cell transplantation (HCT). Results Clinical outcomes were equivalent between the two groups. The MMF15 arm demonstrated superior T-cell, as well as T-cell subset recovery and a trend towards superior T-cell receptor (TCR) diversity in the first month with this difference persisting through the first year. T-cell repertoire recovery was more rapid and sustained, as well as more diverse in the MMF15 arm. Conclusion The long-term superior immune recovery in the MMF15 arm, administered GMCSF, is consistent with a disproportionate impact of early interventions in HCT. Modifying the 'immune-milieu' following allogeneic HCT is feasible and may influence long-term T-cell recovery.
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Affiliation(s)
- Viktoriya Zelikson
- Department of Internal MedicineVirginia Commonwealth UniversityRichmondVAUSA
| | - Roy Sabo
- Department of BiostatisticsVirginia Commonwealth UniversityRichmondVAUSA
| | - Myrna Serrano
- Department of Microbiology and ImmunologyVirginia Commonwealth UniversityRichmondVAUSA
| | - Younus Aqeel
- Department of Internal MedicineVirginia Commonwealth UniversityRichmondVAUSA
| | - Savannah Ward
- Department of Internal MedicineVirginia Commonwealth UniversityRichmondVAUSA
| | - Taha Al Juhaishi
- Department of Internal MedicineVirginia Commonwealth UniversityRichmondVAUSA
| | - May Aziz
- Department of PharmacyVirginia Commonwealth UniversityRichmondVAUSA
| | - Elizabeth Krieger
- Department of PediatricsVirginia Commonwealth UniversityRichmondVAUSA
| | - Gary Simmons
- Department of Internal MedicineVirginia Commonwealth UniversityRichmondVAUSA
| | - Catherine Roberts
- Department of Internal MedicineVirginia Commonwealth UniversityRichmondVAUSA
| | - Jason Reed
- Department of PhysicsVirginia Commonwealth UniversityRichmondVAUSA
| | - Gregory Buck
- Department of BiostatisticsVirginia Commonwealth UniversityRichmondVAUSA
| | - Amir Toor
- Department of Internal MedicineVirginia Commonwealth UniversityRichmondVAUSA
- Lehigh Valley Topper Cancer InstituteAllentownPAUSA
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9
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Hansen DK, Sidana S, Peres LC, Colin Leitzinger C, Shune L, Shrewsbury A, Gonzalez R, Sborov DW, Wagner C, Dima D, Hashmi H, Kocoglu MH, Atrash S, Simmons G, Kalariya N, Ferreri C, Afrough A, Kansagra A, Voorhees P, Baz R, Khouri J, Alsina M, McGuirk J, Locke FL, Patel KK. Idecabtagene Vicleucel for Relapsed/Refractory Multiple Myeloma: Real-World Experience From the Myeloma CAR T Consortium. J Clin Oncol 2023; 41:2087-2097. [PMID: 36623248 PMCID: PMC10082273 DOI: 10.1200/jco.22.01365] [Citation(s) in RCA: 68] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/02/2022] [Accepted: 11/21/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Idecabtagene vicleucel (ide-cel) is an autologous B-cell maturation antigen-directed chimeric antigen receptor T-cell therapy approved for relapsed/refractory multiple myeloma (RRMM) on the basis of the phase II pivotal KarMMa trial, which demonstrated best overall and ≥ complete response rates of 73% and 33%, respectively. We report clinical outcomes with standard-of-care (SOC) ide-cel under the commercial Food and Drug Administration label. METHODS Data were retrospectively collected from patients with RRMM who underwent leukapheresis as of February 28, 2022, at 11 US institutions with intent to receive SOC ide-cel. Toxicities were graded per American Society for Transplantation and Cellular Therapy guidelines and managed according to each institution's policies. Responses were graded on the basis of the International Myeloma Working Group response criteria. RESULTS One hundred fifty-nine of 196 leukapheresed patients received ide-cel by data cutoff. One hundred twenty (75%) infused patients would have been ineligible for participation in the KarMMa clinical trial because of comorbidities at the time of leukapheresis. Any grade and grade ≥ 3 cytokine release syndrome and neurotoxicity occurred in 82/3% and 18/6%, respectively. Best overall and ≥ complete response rates were 84% and 42%, respectively. At a median follow-up of 6.1 months from chimeric antigen receptor T infusion, the median progression-free survival was 8.5 months (95% CI, 6.5 to not reached) and the median overall survival was 12.5 months (95% CI, 11.3 to not reached). Patients with previous exposure to B-cell maturation antigen-targeted therapy, high-risk cytogenetics, Eastern Cooperative Oncology Group performance status ≥ 2 at lymphodepletion, and younger age had inferior progression-free survival on multivariable analysis. CONCLUSION The safety and efficacy of ide-cel in patients with RRMM in the SOC setting were comparable with those in the phase II pivotal KarMMa trial despite most patients (75%) not meeting trial eligibility criteria.
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Affiliation(s)
- Doris K. Hansen
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Surbhi Sidana
- Stanford University School of Medicine, Stanford, CA
| | - Lauren C. Peres
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | - Leyla Shune
- The University of Kansas Medical Center, Kansas City, KS
| | | | | | - Douglas W. Sborov
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - Charlotte Wagner
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - Danai Dima
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH
| | - Hamza Hashmi
- Medical University of South Carolina, Charleston, SC
| | - Mehmet H. Kocoglu
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | | | - Gary Simmons
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA
| | - Nilesh Kalariya
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Aimaz Afrough
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - Ankit Kansagra
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | | | - Rachid Baz
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Jack Khouri
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH
| | - Melissa Alsina
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Joseph McGuirk
- The University of Kansas Medical Center, Kansas City, KS
| | | | - Krina K. Patel
- The University of Texas MD Anderson Cancer Center, Houston, TX
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10
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Tarlinton RE, Legione AR, Sarker N, Fabijan J, Meers J, McMichael L, Simmons G, Owen H, Seddon JM, Dick G, Ryder JS, Hemmatzedah F, Trott DJ, Speight N, Holmes N, Loose M, Emes RD. Differential and defective transcription of koala retrovirus indicates the complexity of host and virus evolution. J Gen Virol 2022; 103. [PMID: 35762858 DOI: 10.1099/jgv.0.001749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Koala retrovirus (KoRV) is unique amongst endogenous (inherited) retroviruses in that its incorporation to the host genome is still active, providing an opportunity to study what drives this fundamental process in vertebrate genome evolution. Animals in the southern part of the natural range of koalas were previously thought to be either virus-free or to have only exogenous variants of KoRV with low rates of KoRV-induced disease. In contrast, animals in the northern part of their range universally have both endogenous and exogenous KoRV with very high rates of KoRV-induced disease such as lymphoma. In this study we use a combination of sequencing technologies, Illumina RNA sequencing of 'southern' (south Australian) and 'northern' (SE QLD) koalas and CRISPR enrichment and nanopore sequencing of DNA of 'southern' (South Australian and Victorian animals) to retrieve full-length loci and intregration sites of KoRV variants. We demonstrate that koalas that tested negative to the KoRV pol gene qPCR, used to detect replication-competent KoRV, are not in fact KoRV-free but harbour defective, presumably endogenous, 'RecKoRV' variants that are not fixed between animals. This indicates that these populations have historically been exposed to KoRV and raises questions as to whether these variants have arisen by chance or whether they provide a protective effect from the infectious forms of KoRV. This latter explanation would offer the intriguing prospect of being able to monitor and selectively breed for disease resistance to protect the wild koala population from KoRV-induced disease.
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Affiliation(s)
- R E Tarlinton
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - A R Legione
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
| | - N Sarker
- School of Veterinary Science, The University of Queensland, Brisbane, Australia
| | - J Fabijan
- Longleat Safari Park, Durrel Wildlife Conservation Trust, UK
| | - J Meers
- School of Veterinary Science, The University of Queensland, Brisbane, Australia
| | - L McMichael
- School of Veterinary Science, The University of Queensland, Brisbane, Australia
| | - G Simmons
- School of Veterinary Science, The University of Queensland, Brisbane, Australia
| | - H Owen
- School of Veterinary Science, The University of Queensland, Brisbane, Australia
| | - J M Seddon
- School of Veterinary Science, The University of Queensland, Brisbane, Australia
| | - G Dick
- Longleat Safari Park, Durrel Wildlife Conservation Trust, UK
| | - J S Ryder
- Garston Veterinary Group, Somerset, UK
| | - F Hemmatzedah
- School of Animal and Veterinary Sciences, University of Adelaide, Adelaide, Australia
| | - D J Trott
- School of Animal and Veterinary Sciences, University of Adelaide, Adelaide, Australia
| | - N Speight
- School of Animal and Veterinary Sciences, University of Adelaide, Adelaide, Australia
| | - N Holmes
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - M Loose
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - R D Emes
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
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11
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Hansen DK, Sidana S, Peres L, Shune L, Sborov DW, Hashmi H, Kocoglu MH, Atrash S, Simmons G, Kalariya N, Ferreri CJ, Afrough A, Kansagra AJ, Voorhees PM, Alsina M, McGuirk J, Locke FL, Patel KK. Idecabtagene vicleucel (Ide-cel) chimeric antigen receptor (CAR) T-cell therapy for relapsed/refractory multiple myeloma (RRMM): Real-world experience. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8042 Background: Ide-cel, a BCMA directed CAR T-cell therapy, was FDA approved 3/26/2021 for the treatment of RRMM after 4 prior lines of therapy. We evaluated the real-world outcomes of patients treated with standard of care ide-cel under the commercial FDA label. Methods: Ten US academic centers contributed data to this effort independent of the manufacturer. As of 1/10/2022, 138 patients were leukapheresed with overall manufacturing failure in 6 (4%). 108 patients were infused ≥ 30 days prior to data-cut off and constitute the study population for this retrospective analysis. Results: Table describes the study population compared to the pivotal KarMMa-1 trial (Munshi et al, NEJM 2021). Patients in our study were less likely to have ECOG PS of 0/1 (77%) and more likely to be penta-refractory (41%). 67% of patients would not have met eligibility criteria for KarMMa. Common reasons for ineligibility (> 1 reason in 22% patients) were co-morbidities (28%), cytopenias (22%), prior therapy with alloSCT/CAR-T/other BCMA therapy (19%), CNS myeloma/non-measurable disease/plasma cell leukemia (13%), and fitness (12%). 81% of patients received bridging therapy. Toxicity was comparable to that seen in KarMMa-1. Cytokine release syndrome (CRS) was seen in 82% (> grade 3: 4%) and immune effector cell-associated neurotoxicity syndrome (ICANS) in 15% (> grade 3: 5%) of patients, respectively. Tocilizumab and steroids were used in 72% and 25% of patients, respectively. Infections were seen in 34% of patients. Day 30 response was evaluable in 104 patients. Response rates were: ≥ partial response, 83%; ≥ very good partial response, 64%; and ≥ complete response (CR), 34%. 11% of patients have died by data cut-off, 7 due to disease progression and 5 due to other causes (1 grade 5 CRS, 1 hemophagocytic lymphohistiocytosis, 1 progressive neurological weakness, 2 COVID-19). Conclusions: This multicenter retrospective study delineates the real-world outcomes of ide-cel CAR T-cell therapy for RRMM. Despite more patients being penta-refractory and less fit compared to the pivotal KarMMa trial, safety and 30-day responses in the real-world setting (overall response rate: 83%, CR: 34%) are comparable to the clinical trial population. Follow-up is ongoing and updated data will be presented. [Table: see text]
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Affiliation(s)
- Doris K. Hansen
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | - Lauren Peres
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Leyla Shune
- The University of Kansas Cancer Center, Kansas City, KS
| | - Douglas W. Sborov
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - Hamza Hashmi
- Medical University of South Carolina, Charleston, SC
| | - Mehmet H. Kocoglu
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | | | - Gary Simmons
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA
| | - Nilesh Kalariya
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Aimaz Afrough
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - Ankit J. Kansagra
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | | | - Melissa Alsina
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | | | - Krina K. Patel
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX
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12
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Khorasanchi A, Ansari AM, Bottinor W, Simmons G, Abbate A, Toor AA. Transient left ventricular dysfunction following chimeric antigen receptor T‐cell‐mediated encephalopathy: A form of stress cardiomyopathy. eJHaem 2022; 3:231-234. [PMID: 35846197 PMCID: PMC9175695 DOI: 10.1002/jha2.369] [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] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022]
Abstract
Chimeric antigen receptor (CAR) T‐cell therapy represents a new strategy in treating lymphoid malignancies, such as relapsed‐refractory diffuse large B‐cell lymphoma (DLBCL). Several toxicities including cytokine release syndrome (CRS), neurotoxicity, and cardiovascular toxicity have been linked to CAR T‐cell therapy. Transient impairment in left ventricular systolic function is described after CAR‐T, however, the mechanism remains poorly understood. This paper reports the clinical presentation and outcome of two patients with relapsed‐refractory DLBCL who experienced encephalopathy and CRS following CAR T‐cell therapy and developed transient left ventricular dysfunction consistent with stress cardiomyopathy.
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Affiliation(s)
- Adam Khorasanchi
- Department of Internal Medicine Massey Cancer Center, Virginia Commonwealth University Richmond Virginia USA
| | - Amir M. Ansari
- Department of Internal Medicine Massey Cancer Center, Virginia Commonwealth University Richmond Virginia USA
| | - Wendy Bottinor
- Division of Cardiology Virginia Commonwealth University Richmond Virginia USA
| | - Gary Simmons
- Department of Internal Medicine Massey Cancer Center, Virginia Commonwealth University Richmond Virginia USA
| | - Antonio Abbate
- Division of Cardiology Virginia Commonwealth University Richmond Virginia USA
| | - Amir A. Toor
- Department of Internal Medicine Massey Cancer Center, Virginia Commonwealth University Richmond Virginia USA
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13
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Zelikson V, Simmons G, Raman N, Krieger E, Rebiero A, Hawks K, Aziz M, Roberts C, Chesney A, Reed J, Gress R, Toor A. Dynamical Systems Modeling of Early-Term Immune Reconstitution with Different Antithymocyte Globulin Administration Schedules in Allogeneic Stem Cell Transplantation. Transplant Cell Ther 2022; 28:85.e1-85.e9. [PMID: 34688968 PMCID: PMC8820845 DOI: 10.1016/j.jtct.2021.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
Alloreactivity forms the basis of allogeneic hematopoietic cell transplantation (HCT), with donor-derived T cell response to recipient antigens mediating clinical responses either in part or entirely. These encompass the different manifestations of graft-versus-host disease (GVHD), infection risk, and disease response. While the latter is contingent on disease biology and thus may be less predictable, the former 2 manifestations are more likely to be directly proportional to the magnitude of donor-derived T cell recovery. Herein we explore the quantitative aspects of immune cell recovery following allogeneic HCT and clinical outcomes in 2 cohorts of HLA-matched allograft recipients who received rabbit antithymocyte globulin (ATG) on different schedules (days -9 to -7 versus days -3 to -1). Monocyte as well as donor-derived T cell (ddCD3) recovery was superior in those given ATG early in the course of disease (days -9/-7). This difference was related to a more rapid rate of ddCD3 recovery, driven largely by CD3+/CD8+ cells in the first month post-transplantation. Early monocyte recovery was associated with later T cell recovery and improved survival. In contrast, rapid and early ddCD3 expansion out of proportion to monocyte recovery was associated with a high likelihood of acute GVHD and poor survival. This analytic methodology demonstrates that modeling "early-term immune reconstitution" following HCT yields insights that may be useful in the management of post-transplantation immunosuppression and adaptive cellular therapy to optimize clinical outcomes. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Viktoriya Zelikson
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Gary Simmons
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Natasha Raman
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Elizabeth Krieger
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia
| | - Anatevka Rebiero
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Kelly Hawks
- Massey Cancer Center, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
| | - May Aziz
- Massey Cancer Center, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
| | - Catherine Roberts
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia
| | - Alden Chesney
- Department of Physics, Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Jason Reed
- Experimental Transplant and Immunology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | | | - Amir Toor
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
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14
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Tarlinton RE, Fabijan J, Hemmatzadeh F, Meers J, Owen H, Sarker N, Seddon JM, Simmons G, Speight N, Trott DJ, Woolford L, Emes RD. Transcriptomic and genomic variants between koala populations reveals underlying genetic components to disorders in a bottlenecked population. CONSERV GENET 2021. [DOI: 10.1007/s10592-021-01340-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractHistorical hunting pressures on koalas in the southern part of their range in Australia have led to a marked genetic bottleneck when compared with their northern counterparts. There are a range of suspected genetic disorders such as testicular abnormalities, oxalate nephrosis and microcephaly reported at higher prevalence in these genetically restricted southern animals. This paper reports analysis of differential expression of genes from RNAseq of lymph nodes, SNPs present in genes and the fixation index (population differentiation due to genetic structure) of these SNPs from two populations, one in south east Queensland, representative of the northern genotype and one in the Mount Lofty Ranges South Australia, representative of the southern genotype. SNPs that differ between these two populations were significantly enriched in genes associated with brain diseases. Genes which were differentially expressed between the two populations included many associated with brain development or disease, and in addition a number associated with testicular development, including the androgen receptor. Finally, one of the 8 genes both differentially expressed and with a statistical difference in SNP frequency between populations was SLC26A6 (solute carrier family 26 member 6), an anion transporter that was upregulated in SA koalas and is associated with oxalate transport and calcium oxalate uroliths in humans. Together the differences in SNPs and gene expression described in this paper suggest an underlying genetic basis for several disorders commonly seen in southern Australian koalas, supporting the need for further research into the genetic basis of these conditions, and highlighting that genetic selection in managed populations may need to be considered in the future.
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15
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Fabijan J, Sarker N, Speight N, Owen H, Meers J, Simmons G, Seddon J, Emes RD, Tarlinton R, Hemmatzadeh F, Woolford L, Trott DJ. Pathological Findings in Koala Retrovirus-positive Koalas (Phascolarctos cinereus) from Northern and Southern Australia. J Comp Pathol 2020; 176:50-66. [PMID: 32359636 DOI: 10.1016/j.jcpa.2020.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/29/2020] [Accepted: 02/06/2020] [Indexed: 01/05/2023]
Abstract
Koala retrovirus (KoRV) infection shows differences in prevalence and load between northern and southern Australian koala populations; however, the effect of this on diseases such as lymphoma and chlamydial disease is unclear. This study compared clinicopathological findings, haematology and splenic lymphoid area of KoRV-positive koalas from northern (Queensland [Qld], n = 67) and southern (South Australia [SA], n = 92) populations in order to provide further insight into KoRV pathogenesis. Blood was collected for routine haematology and for measurement of KoRV proviral load by quantitative polymerase chain reaction (qPCR). Plasma samples were assessed for KoRV viral load by reverse transcriptase qPCR and conjunctival and cloacal swabs were collected for measurement of the load of Chlamydia pecorum (qPCR). During necropsy examination, spleen was collected for lymphoid area analysis. Lymphoma was morphologically similar between the populations and occurred in koalas with the highest KoRV proviral and viral loads. Severe ocular chlamydial disease was observed in both populations, but urinary tract disease was more severe in Qld, despite similar C. pecorum loads. No associations between KoRV and chlamydial disease severity or load were observed, except in SA where viral load correlated positively with chlamydial disease severity. In both populations, proviral and viral loads correlated positively with lymphocyte and metarubricyte counts and correlated negatively with erythrocyte and neutrophil counts. Splenic lymphoid area was correlated positively with viral load. This study has shown further evidence for KoRV-induced oncogenesis and highlighted that lymphocytes and splenic lymphoid tissue may be key sites for KoRV replication. However, KoRV infection appears to be highly complex and continued investigation is required to fully understand its pathogenesis.
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Affiliation(s)
- J Fabijan
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia.
| | - N Sarker
- School of Veterinary Sciences, The University of Queensland, Gatton, Queensland, Australia
| | - N Speight
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia
| | - H Owen
- School of Veterinary Sciences, The University of Queensland, Gatton, Queensland, Australia
| | - J Meers
- School of Veterinary Sciences, The University of Queensland, Gatton, Queensland, Australia
| | - G Simmons
- School of Veterinary Sciences, The University of Queensland, Gatton, Queensland, Australia
| | - J Seddon
- School of Veterinary Sciences, The University of Queensland, Gatton, Queensland, Australia
| | - R D Emes
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, UK
| | - R Tarlinton
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, UK
| | - F Hemmatzadeh
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia
| | - L Woolford
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia
| | - D J Trott
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, Australia
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16
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Rasheed M, Simmons G, Fisher B, Leslie K, Reed J, Roberts C, Natarajan R, Fowler A, Toor A. Reduced plasma ascorbic acid levels in recipients of myeloablative conditioning and hematopoietic cell transplantation. Eur J Haematol 2019; 103:329-334. [PMID: 31267566 DOI: 10.1111/ejh.13287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 12/11/2022]
Abstract
Hematopoietic cell transplantation (HCT) conditioned using myeloablative conditioning (MAC) is complicated by end organ injury due to endothelial dysfunction and graft versus host disease. Mucositis and oxidant injury results in micronutrient deficiency. Ascorbic acid (AA) levels were measured in 15 patients undergoing HCT conditioned with MAC (11 allogeneic and four autologous HCT). Ascorbate levels declined postconditioning to 27.3 μMol/L (±14.1) by day 0 (P = .03 compared with pretransplant baseline), reaching a nadir level of 21.5 (±13.8) on day 14 (P = .003) post-transplant. Patients undergoing allogeneic HCT continued to have low AA levels to day 60 post-transplant. The role of AA in maintaining endothelial function and hematopoietic as well as T-cell recovery is provided, developing the rationale for repletion of vitamin C following HCT.
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Affiliation(s)
- Mahmood Rasheed
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Gary Simmons
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Bernard Fisher
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Kevin Leslie
- Department of Physics, Virginia Commonwealth University, Richmond, Virginia
| | - Jason Reed
- Department of Physics, Virginia Commonwealth University, Richmond, Virginia
| | - Catherine Roberts
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Ramesh Natarajan
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Alpha Fowler
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Amir Toor
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
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17
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Claiborne J, Bandyopathyay D, Roberts C, Hawks K, Aziz M, Simmons G, Wiedl C, Chung H, Clark W, McCarty J, Toor A. Managing post allograft relapse of myeloid neoplasms: azacitidine and donor lymphocyte infusions as salvage therapy. Leuk Lymphoma 2019; 60:2733-2743. [DOI: 10.1080/10428194.2019.1605066] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- John Claiborne
- Bone Marrow Transplant Program, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Dipankar Bandyopathyay
- Bone Marrow Transplant Program, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Catherine Roberts
- Bone Marrow Transplant Program, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Kelly Hawks
- Bone Marrow Transplant Program, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - May Aziz
- Bone Marrow Transplant Program, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Gary Simmons
- Bone Marrow Transplant Program, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Christina Wiedl
- Bone Marrow Transplant Program, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Harold Chung
- Bone Marrow Transplant Program, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - William Clark
- Bone Marrow Transplant Program, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - John McCarty
- Bone Marrow Transplant Program, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Amir Toor
- Bone Marrow Transplant Program, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
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Sarker N, Fabijan J, Emes RD, Hemmatzadeh F, Meers J, Moreton J, Owen H, Seddon JM, Simmons G, Speight N, Trott D, Woolford L, Tarlinton RE. Identification of stable reference genes for quantitative PCR in koalas. Sci Rep 2018; 8:3364. [PMID: 29463845 PMCID: PMC5820254 DOI: 10.1038/s41598-018-21723-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/09/2018] [Indexed: 11/17/2022] Open
Abstract
To better understand host and immune response to diseases, gene expression studies require identification of reference genes with stable expression for accurate normalisation. This study describes the identification and testing of reference genes with stable expression profiles in koala lymph node tissues across two genetically distinct koala populations. From the 25 most stable genes identified in transcriptome analysis, 11 genes were selected for verification using reverse transcription quantitative PCR, in addition to the commonly used ACTB and GAPDH genes. The expression data were analysed using stable genes statistical software - geNorm, BestKeeper, NormFinder, the comparative ΔCt method and RefFinder. All 13 genes showed relative stability in expression in koala lymph node tissues, however Tmem97 and Hmg20a were identified as the most stable genes across the two koala populations.
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Affiliation(s)
- N Sarker
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - J Fabijan
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - R D Emes
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, United Kingdom.,Advanced Data Analysis Centre (ADAC), University of Nottingham, Sutton Bonington, United Kingdom
| | - F Hemmatzadeh
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - J Meers
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - J Moreton
- Advanced Data Analysis Centre (ADAC), University of Nottingham, Sutton Bonington, United Kingdom
| | - H Owen
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - J M Seddon
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - G Simmons
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - N Speight
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - D Trott
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - L Woolford
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - R E Tarlinton
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, United Kingdom.
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McKee J, Clark N, Shapter F, Simmons G. A new look at the origins of gibbon ape leukemia virus. Virus Genes 2017; 53:165-172. [DOI: 10.1007/s11262-017-1436-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
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20
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Pantuck AJ, Pettaway CA, Dreicer R, Corman J, Katz A, Ho A, Aronson W, Clark W, Simmons G, Heber D. A randomized, double-blind, placebo-controlled study of the effects of pomegranate extract on rising PSA levels in men following primary therapy for prostate cancer. Prostate Cancer Prostatic Dis 2015; 18:242-8. [PMID: 26169045 DOI: 10.1038/pcan.2015.32] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 06/02/2015] [Accepted: 06/02/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The primary objective of this study was to compare the effects of pomegranate juice on PSA doubling times (PSADT) in subjects with rising PSA levels after primary therapy for prostate cancer. METHODS Double-blind, placebo-controlled multi-institutional study, evaluated the effects of pomegranate liquid extract on serum PSA levels. The primary end point of this study was change in serum PSADT. Additional secondary and exploratory objectives were to evaluate the safety of pomegranate juice and to determine the interaction of manganese superoxide dismutase (MnSOD) AA genotype and pomegranate treatment on PSADT. RESULTS One-hundred eighty-three eligible subjects were randomly assigned to the active and placebo groups with a ratio of 2:1 (extract N=102; placebo N=64; juice N=17). The majority of adverse events were of moderate or mild grade. Median PSADT increased from 11.1 months at baseline to 15.6 months in the placebo group (P<0.001) compared with an increase from 12.9 months at baseline to 14.5 months in the extract group (P=0.13) and an increase from 12.7 at baseline to 20.3 in the juice group (P=0.004). However, none of these changes were statistically significant between the three groups (P>0.05). Placebo AA patients experienced a 1.8 month change in median PSADT from 10.9 months at baseline to 12.7 months (P=0.22), while extract patients experienced a 12 month change in median PSADT from 13.6 at baseline to 25.6 months (P=0.03). CONCLUSIONS Compared with placebo, pomegranate extract did not significantly prolong PSADT in prostate cancer patients with rising PSA after primary therapy. A significant prolongation in PSADT was observed in both the treatment and placebo arms. Men with the MnSOD AA genotype may represent a group that is more sensitive to the antiproliferative effects of pomegranate on PSADT; however, this finding requires prospective hypothesis testing and validation.
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Affiliation(s)
- A J Pantuck
- Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - C A Pettaway
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - R Dreicer
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | - J Corman
- Virginia Mason Medical Center, Seattle, WA, USA
| | - A Katz
- Winthrop University Hospital, Garden City, NY, USA
| | - A Ho
- Winthrop University Hospital, Garden City, NY, USA
| | - W Aronson
- 1] Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA [2] VA Medical Center Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - W Clark
- Alaska Clinical Research Center, Anchorage, AL, USA
| | - G Simmons
- Five Valleys Urology, Missoula, MT, USA
| | - D Heber
- 1] Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA [2] Department of Medicine and Clinical Nutrition, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
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22
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Qi D, May L, Zimmerman B, Peng P, Atillasoy E, Shelburne S, Simmons G, Brown J, Cooper S. A randomized, double-blind, placebo-controlled, efficacy and safety study of acetaminophen 1000 mg and acetaminophen 650 mg in postoperative dental pain. The Journal of Pain 2012. [DOI: 10.1016/j.jpain.2012.01.306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Moor CT, Roberts SA, Simmons G, Briggs S, Morris AJ, Smith J, Heffernan H. Extended-spectrum beta-lactamase (ESBL)-producing enterobacteria: factors associated with infection in the community setting, Auckland, New Zealand. J Hosp Infect 2008; 68:355-62. [PMID: 18353497 DOI: 10.1016/j.jhin.2008.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 02/01/2008] [Indexed: 11/15/2022]
Abstract
We aimed to document the epidemiology of extended-spectrum beta-lactamase (ESBL)-producing enterobacteria in the Auckland community and identify factors associated with infection using a case-control study design. ESBL-producing enterobacteria were isolated from 107 infected patients, for which demographic and clinical data were available for 98 cases (92%). Escherichia coli was the predominant organism (82%), with urine as the commonest source (97%). Compared with a control group infected with ESBL-negative enterobacteria, factors significantly associated with infection on univariate analysis were: living in a residential care home (RCH); recent admission to hospital 'M'; recent antibiotic use; older age (>75 years); presence of a urinary catheter; and a history of comorbid chronic obstructive pulmonary disease (COPD), cardiovascular disease, neurological disease or recurrent urinary tract infection. On multivariate analysis, residence in RCH and COPD remained significant associations. Pulsed-field gel electrophoresis typing of the ESBL-producing E. coli identified a common strain. We concluded that residence in RCH and a history of COPD are significant associations with ESBL-producing enterobacterial infection in the Auckland community. Several spatial clusters in RCHs and a common strain suggest point-source outbreaks. A substantial number of community cases did not live in an RCH nor had been recently hospitalised, suggesting the independent generation of ESBL-producing enterobacteria in the broader community.
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Affiliation(s)
- C T Moor
- Auckland Regional Public Health Service, Auckland, New Zealand
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26
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McDonald WL, Jamaludin R, Mackereth G, Hansen M, Humphrey S, Short P, Taylor T, Swingler J, Dawson CE, Whatmore AM, Stubberfield E, Perrett LL, Simmons G. Characterization of a Brucella sp. strain as a marine-mammal type despite isolation from a patient with spinal osteomyelitis in New Zealand. J Clin Microbiol 2006; 44:4363-70. [PMID: 17035490 PMCID: PMC1698438 DOI: 10.1128/jcm.00680-06] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Naturally acquired infection of humans with a marine mammal-associated Brucella sp. has only been reported once previously in a study describing infections of two patients from Peru. We report the isolation and characterization of a strain of Brucella from a New Zealand patient that appears most closely related to strains previously identified from marine mammals. The isolate was preliminarily identified as Brucella suis using conventional bacteriological tests in our laboratory. However, the results profile was not an exact match, and the isolate was forwarded to four international reference laboratories for further identification. The reference laboratories identified the isolate as either B. suis or B. melitensis by traditional bacteriological methods in three laboratories and by a molecular test in the fourth laboratory. Molecular characterization by PCR, PCR-restriction fragment length polymorphism, and DNA sequencing of the bp26 gene; IS711; the omp genes omp25, omp31, omp2a, and omp2b; IRS-PCR fragments I, III, and IV; and five housekeeping gene fragments was conducted to resolve the discrepant identification of the isolate. The isolate was identified to be closely related to a Brucella sp. originating from a United States bottlenose dolphin (Tursiops truncatus) and common seals (Phoca vitulina).
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Affiliation(s)
- W L McDonald
- Investigation and Diagnostic Centre, Biosecurity New Zealand, Ministry of Agriculture and Forestry, Ward St., Wallaceville, New Zealand.
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27
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Unicomb LE, Simmons G, Merritt T, Gregory J, Nicol C, Jelfs P, Kirk M, Tan A, Thomson R, Adamopoulos J, Little CL, Currie A, Dalton CB. Sesame seed products contaminated with Salmonella: three outbreaks associated with tahini. Epidemiol Infect 2006; 133:1065-72. [PMID: 16274503 PMCID: PMC2870340 DOI: 10.1017/s0950268805004085] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2004] [Indexed: 11/06/2022] Open
Abstract
In November 2002, the first of three outbreaks of Salmonella Montevideo infection in Australia and New Zealand was identified in New South Wales, Australia. Affected persons were interviewed, and epidemiologically linked retail outlets inspected. Imported tahini was rapidly identified as the source of infection. The contaminated tahini was recalled and international alerts posted. A second outbreak was identified in Australia in June-July 2003 and another in New Zealand in August 2003. In a total of 68 S. Montevideo infections, 66 cases were contacted. Fifty-four (82%) reported consumption of sesame seed-based foods. Laboratory analyses demonstrated closely related PFGE patterns in the S. Montevideo isolates from human cases and sesame-based foods imported from two countries. On the basis of our investigations sesame-based products were sampled in other jurisdictions and three products in Canada and one in the United Kingdom were positive for Salmonella spp., demonstrating the value of international alerts when food products have a wide distribution and a long shelf life. A review of the controls for Salmonella spp. during the production of sesame-based products is recommended.
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Affiliation(s)
- L E Unicomb
- OzFoodNet, Hunter Population Health, Wallsend, New South Wales (NSW), Australia
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Calder L, Simmons G, Thornley C, Taylor P, Pritchard K, Greening G, Bishop J. An outbreak of hepatitis A associated with consumption of raw blueberries. Epidemiol Infect 2003; 131:745-51. [PMID: 12948375 PMCID: PMC2870016 DOI: 10.1017/s0950268803008586] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This report describes the epidemiology, investigation and control of a hepatitis A (HAV) outbreak in New Zealand. Descriptive and analytical epidemiology, virology, product traceback and an orchard investigation were carried out. A case-control study revealed that 56% of 39 cases had consumed raw blueberries, compared with 14% of 71 controls (odds ratio 7.6; 95% confidence intervals 2.6-22.4). Traceback of product through retailers and wholesalers implicated a single commercial orchard. Hepatitis A virus was detected by reverse transcriptase polymerase chain reaction in faecal specimens from cases as well as a blueberry product from the orchard. Presence of hepatitis A virus was confirmed by DNA hybridization and sequencing of PCR products. Sanitary audit of the orchard revealed multiple opportunities for contamination of blueberries by pickers. This outbreak highlights the need for food safety programmes in the berry fruit industry.
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Affiliation(s)
- L Calder
- Public Health Community Services, Auckland District Health Board, Private Bag 92065, Auckland, New Zealand
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Vyakarnam A, Eyeson J, Teo I, Zuckerman M, Babaahmady K, Schuitemaker H, Shaunak S, Rostron T, Rowland-Jones S, Simmons G, Clapham P. Evidence for a post-entry barrier to R5 HIV-1 infection of CD4 memory T cells. AIDS 2001; 15:1613-26. [PMID: 11546935 DOI: 10.1097/00002030-200109070-00003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV-1 strains R5 and X4 can infect CD4 memory T cells in vivo. Anti-CD3/28 stimulation induces beta-chemokines and CCR5 down-regulation and renders these cells resistant to R5 HIV-1 infection. Here we describe an additional cellular mechanism that blocks productive R5 HIV-1 infection of CD4 memory T cells. METHODS Blood-derived CD4 memory T cells and CD4 T-cell clones were infected with primary R5 and X4 HIV-1 strains. Virus replication was correlated with CCR5 expression and beta-chemokine production. Virus entry and infectivity were measured by PCR for early and late products of HIV reverse transcription respectively. RESULTS R5 strains were up to 1000-fold less infectious than X4 viruses for CD4 memory T cells. This resistance was independent of CCR5 levels and of the Delta-32 mutation and the CCR2-V64I/CCR5-59653T linked mutations. Blocking endogenous beta-chemokines relieved minimally this restriction. At the single cell level, CD4 memory cells were either permissive or non-permissive for R5 HIV-1 infection. R5 HIV titre was up to 10-fold lower than X4 virus titre even in a permissive clone. However, R5 viruses replicated as efficiently as X4 viruses in the permissive clone when neutralizing anti-beta chemokine antibodies were added. Non-permissive cells blocked a post-entry step of the virus life-cycle and expressed early but not late HIV transcripts. Neutralizing anti-beta chemokine antibodies promoted R5 virus replication marginally in the non-permissive clone. CONCLUSION Some blood memory CD4 T cells retard R5 HIV-1 replication via endogenous beta-chemokines whereas others block productive R5 HIV-1 infection by an additional mechanism that interferes with a post-entry step of the virus life cycle. These natural barriers might contribute to lower pathogenicity of R5 HIV-1 strains for CD4 memory T cells than X4 viruses that emerge late in disease.
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Affiliation(s)
- A Vyakarnam
- Department of Immunology, GKT School of Medicine and Dentistry, The Rayne Institute, London, UK
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Abstract
BACKGROUND Recent studies have suggested there are a large number of potentially preventable deaths in Australian hospitals. AIM This study aimed to document antecedent factors in hospital deaths in an attempt to identify potentially preventative factors. METHODS The study was conducted at three separate acute hospitals. Demographics of all deaths were recorded over a 6-month period as well as antecedent factors present within 0-8 and 8-48 h of all deaths including vital sign abnormalities, cardiorespiratory arrests and admission to intensive care. Separate analysis was performed on 'not for resuscitation' deaths. RESULTS There were a total of 778 deaths, of which 549 (71%) were 'not for resuscitation'. There were 171 (22%) deaths preceded by arrest and 160 (21%) preceded by admission to intensive care. Of the remaining deaths, 30% had severely abnormal physiological abnormalities documented. This incidence was 50% in the non-do not resuscitate (DNR) subgroup. Concern about the patient's condition was expressed in the patient's notes by attending nursing staff and junior medical staff in approximately one-third of non-DNR deaths. Hypotension (30%) and tachypnoea (17%) were the most common antecedents in the non-DNR deaths. CONCLUSION There is a high incidence of serious vital sign abnormalities in the period before potentially preventable hospital deaths. These antecedents may identify patients who would benefit from earlier intervention.
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Affiliation(s)
- K M Hillman
- University of New South Wales, Liverpool Hospital, Australia.
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Simmons G, Greening G, Gao W, Campbell D. Raw oyster consumption and outbreaks of viral gastroenteritis in New Zealand: evidence for risk to the public's health. Aust N Z J Public Health 2001; 25:234-40. [PMID: 11494991 DOI: 10.1111/j.1467-842x.2001.tb00568.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the relationship between consumption of raw Pacific half shell oysters and outbreaks of Norwalk-like virus (NLV) gastroenteritis in Auckland in the last third of 1999. METHOD Ten outbreaks were investigated as retrospective cohorts using standardised questionnaires relating to food and drink exposures. Trace back of oysters and site inspections of implicated commercial growing areas were performed. Virological analyses compared oysters linked to outbreaks and faecal samples from cases. RESULTS Eighty-six cases were identified, of whom 32 (37.2%) were confirmed NLV positive on faecal analysis. The summary risk estimate for illness among oyster consumers for all outbreaks was RR 8.23 (95% CI 4.55-14.90; p< 0.001) and in five of seven outbreaks permitting statistical analysis, the risk for those consuming raw oysters was greater than five-fold that of non-consumers. NLVs were identified in two batches of oysters from different growing areas, implicated in four outbreaks. In both the strain (Genogroup II/3 'Mexico-like virus') from cases matched that in the oysters from the same harvest batch. CONCLUSION The epidemiological and virological evidence implicates oysters as the source of a number of outbreaks of NLV gastroenteritis. This is the first time NLVs have been identified in commercially farmed Pacific oysters in New Zealand. Sewage effluent from recreational boats was the likely source of faecal contamination of growing waters in one site. IMPLICATIONS Combined use of virological and epidemiological methods have proved invaluable in investigating NLV outbreaks. Further research is needed into enteric viral contamination of commercial oyster farms.
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Affiliation(s)
- G Simmons
- Auckland District Health Board, Public Health Protection, New Zealand.
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Blanpain C, Buser R, Power CA, Edgerton M, Buchanan C, Mack M, Simmons G, Clapham PR, Parmentier M, Proudfoot AE. A chimeric MIP-1alpha/RANTES protein demonstrates the use of different regions of the RANTES protein to bind and activate its receptors. J Leukoc Biol 2001; 69:977-85. [PMID: 11404385] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
Human RANTES (CCL5) and MIP-1alpha (CCL3) bind and activate several CC chemokine receptors. RANTES is a high-affinity ligand for CCR1 and CCR5, and it binds CCR3 with moderate affinity and CCR4 with low affinity. MIP-1alpha has similar binding characteristics to RANTES except that it does not bind to CCR3. Here we have generated a chimera of human MIP-1alpha and RANTES, called MIP/RANTES, consisting of the eight amino terminal residues of MIP-1alpha preceding the CC motif, and the remainder of the sequence is RANTES. The chimera is able to induce chemotaxis of human monocytes. MIP/RANTES has >100-fold reduction in binding to CCR1 and does not bind to CCR3 but retains full, functional binding to CCR5. It has equivalent affinity for CCR5 to MIP-1alpha and RANTES, binding with an IC(50) of 1.12 nM, and is able to mobilize calcium and induce endocytosis of CCR5 in PBMC in a manner equi-potent to RANTES. It also retains the ability to inhibit R5 using HIV-1 strains. Therefore, we conclude that the amino terminus of RANTES is not involved in CCR5 binding, but it is essential for CCR1 and CCR3.
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Affiliation(s)
- C Blanpain
- IRIBHN Université Libre de Bruxelles, Campus Erasme, Bruxelles, Belgium
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Hayman A, Moss T, Simmons G, Arnold C, Holmes EC, Naylor-Adamson L, Hawkswell J, Allen K, Radford J, Nguyen-Van-Tam J, Balfe P. Phylogenetic analysis of multiple heterosexual transmission events involving subtype b of HIV type 1. AIDS Res Hum Retroviruses 2001; 17:689-95. [PMID: 11429109 DOI: 10.1089/088922201750236960] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Between 1996 and 1999 thirteen cases of HIV infection were detected in Doncaster, a small town in the north of England (population approximately 250,000). A complex network of shared sexual histories involving local nightclubs linked these cases, with the only known risk factor being heterosexual intercourse. A series of frozen blood samples was collected in 1998-1999 and amplified by PCR to generate full-length gp120 clones. Sequencing demonstrated that all the transmission events in this heterosexual group involved the B subtype of HIV-1. When relationships between the samples were assessed it became clear that these 13 cases represented at least three separate strains of HIV-1, indicating that HIV is well established in this community. Eleven of the 13 cases were related, forming two distinct groups. Further investigation revealed that one group contained five patients whose general health was good and who were not receiving HAART. In contrast, the second group of six patients, including the putative index case, were symptomatic, receiving HAART, and may have been infected with a CXCR-4-utilizing virus. Several of the cases that were linked by genetic criteria were not linked by contact tracing, implying that further undiagnosed cases may exist in this community. To our knowledge, this is the largest outbreak of HIV studied within the heterosexual community in the United Kingdom to date, suggesting that this route of infection is becoming more common within the United Kingdom.
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Affiliation(s)
- A Hayman
- Department of Virology, Windeyer Institute, RDUCMS, London W1T 4JF, UK
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Cook C, Simmons G, Swinburn B, Stewart J. Changing risk behaviours for non-communicable disease in New Zealand working men--is workplace intervention effective? N Z Med J 2001; 114:175-8. [PMID: 11396664] [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: 02/20/2023]
Abstract
AIMS To evaluate the effectiveness of a health promotion programme targeting dietary behaviours and physical activity among male hourly-paid workers and to explore demographic and attitudinal influences on dietary patterns at baseline. METHODS A controlled field trial compared workers at one intervention and one control worksite. The intervention comprised nutrition displays in the cafeteria and monthly 30-minute workshops for six months. Key outcome measures at six and twelve-months were self-reported dietary and lifestyle behaviours, nutrition knowledge, body mass index (BMI), waist circumference and blood pressure. RESULTS 132 men at the intervention site and 121 men at the control site participated in the study and a high retention rate (94% at 6-months and 89% at 12-months) was achieved. At baseline, 40% of the total sample (253) were obese, 30% had elevated blood pressure, 59% indicated an excessive fat intake and 92% did not meet the recommended vegetable and fruit intake. The intervention reduced fat intake, increased vegetable intake and physical activity, improved nutrition knowledge and reduced systolic blood pressure when compared to the control site. There was no difference in change in mean BMI or waist circumference. Reduction in BMI was associated with reduction in fat intake. DISCUSSION Low intensity workplace intervention can significantly improve reported health behaviours and nutrition knowledge although the impact on more objective measures of risk was variable. A longer duration or more intensive intervention may be required to achieve further reduction in risk factors.
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Affiliation(s)
- C Cook
- Auckland District Health Board.
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Simmons G, Martin D, Stewart J, Jones N, Calder L, Bremner D. Carriage of Neisseria meningitidis among household contacts of patients with meningococcal disease in New Zealand. Eur J Clin Microbiol Infect Dis 2001; 20:237-42. [PMID: 11399012 DOI: 10.1007/pl00011260] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aims of this study were to estimate carriage prevalence, identify factors predictive of carriage, and compare strains of Neisseria meningitidis isolated from patients with meningococcal disease and their household contacts. A total of 954 contacts of 160 patients had a nasopharyngeal swab and an interview relating to factors associated with carriage. The carriage prevalence was 20.4% for Neisseria meningitidis, 11.3% for serogroup B, and 2.6% for serogroup C. Age-standardised carriage was higher in Maori (36.8%) than in Pacific Island (21.5%) or European/other (11.1%) ethnic groups. Factors associated with carriage were smoking, with personal smokers (odds ratio [OR] 2.5) and passive smokers (OR 1.6) having a higher carriage risk than those in smoke-free houses; ethnicity, with Maoris having a higher carriage risk than those of non-Maori or non-Pacific Island ethnicity (OR 2.2); gender, with males at higher risk than females (OR 1.7); and age, with 0-4-year-olds less likely and 15-24-year-olds more likely to be carriers than those over 25 years. Strong patient-contact clustering by meningococcal strain (chi-square1 = 16.7, P=0.00004) suggested an important role for the household setting in transmission. The low carriage prevalence of serogroup B Neisseria meningitidis among household contacts may reflect its low transmissibility but high virulence. No direct relationship was found between prevalence of ethnic-specific carriage and the incidence of meningococcal disease.
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Affiliation(s)
- G Simmons
- Auckland Healthcare Public Health Protection Service. New Zealand.
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Abstract
One-hundred and twenty-five domestic roof-collected rainwater supplies in four rural Auckland districts were investigated in a cross-sectional survey to determine water quality. Samples of cold faucet water were analysed for physico-chemical and microbiological determinands, including metals (zinc, copper and lead), bacterial indicator organisms--heterotrophic plate count (HPC), total coilforms (TC), faecal coliforms (FC), enterococci (ENT), bacterial pathogens including Salmonella spp., Legionella spp., Campylobacter spp., Aeromonas spp. and the protozoa, Cryptosporidium and Giardia. Twenty-two supplies (17.6%) exceeded one or more of the maximum acceptable values (MAV) or maximum guideline values for chemical determinands of the New Zealand Drinking Water Standards (NZDWS) and 70 (56.0%) supplies exceeded the microbiological criteria of < 1 FC/100 mL. Eighteen supplies (14.4%) exceeded the NZDWS MAV for lead of 0.01 mg/L and three (2.4%) exceeded that for copper, of 2 mg/L. Those supplies with lead or galvanised iron comprising part of the roof or collecting system were more likely to show lead contamination (p = 0.019) as were those supplies with a pH less than 7 (p = 0.013). The presence of the indicator organisms HPC, TC, FC and ENT were all significantly correlated with one another. Aeromonas spp. were identified in 20 (16.0%) supplies. There was a positive association between the presence of Aeromonas and the bacterial indicator organisms. Households reporting at least one member with gastrointestinal symptoms in the month prior to sampling, were more likely to have Aeromonas spp. identified in their water supply than those households without symptoms (odds ratio 3.22, 95% CI 1.15-9.01, p = 0.021). Salmonella typhimurium was detected in one of 115 (0.9%) supplies. Legionella spp. and Campylobacter spp. were not detected. There were 50 supplies sampled for protozoa (sampling criteria: > or = 30 FC or > or = 60 ENT). Cryptosporidium oocysts were detected in 2 (4%) of these. Giardia was not detected. This study demonstrates that roof-collected rainwater systems provide potable supplies of relatively poor physiochemical and microbiological quality in the Auckland area. Further research is required on Aeromonas spp. as potential indicators of both microbiological quality and health risk along with design and maintenance strategies to minimise contamination of potable roof-collected rainwater supplies.
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Affiliation(s)
- G Simmons
- Auckland Healthcare Public Health Protection, Private Bag 92 605, Symonds St, Auckland, New Zealand.
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Goodey A, Lavigne JJ, Savoy SM, Rodriguez MD, Curey T, Tsao A, Simmons G, Wright J, Yoo SJ, Sohn Y, Anslyn EV, Shear JB, Neikirk DP, McDevitt JT. Development of multianalyte sensor arrays composed of chemically derivatized polymeric microspheres localized in micromachined cavities. J Am Chem Soc 2001; 123:2559-70. [PMID: 11456925 DOI: 10.1021/ja003341l] [Citation(s) in RCA: 159] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The development of a chip-based sensor array composed of individually addressable polystyrene-poly(ethylene glycol) and agarose microspheres has been demonstrated. The microspheres are selectively arranged in micromachined cavities localized on silicon wafers. These cavities are created with an anisotropic etch and serve as miniaturized reaction vessels and analysis chambers. A single drop of fluid provides sufficient analysis media to complete approximately 100 assays in these microetch pits. The cavities possess pyramidal pit shapes with trans-wafer openings that allows for both fluid flow through the microreactors/analysis chambers and optical access to the chemically sensitive microspheres. Identification and quantitation of analytes occurs via colorimetric and fluorescence changes to receptor and indicator molecules that are covalently attached to termination sites on the polymeric microspheres. Spectral data are extracted from the array efficiently using a charge-coupled device allowing for the near-real-time digital analysis of complex fluids. The power and utility of this new microbead array detection methodology is demonstrated here for the analysis of complex fluids containing a variety of important classes of analytes including acids, bases, metal cations, metabolic cofactors, and antibody reagents.
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Affiliation(s)
- A Goodey
- Department of Chemistry & Biochemistry, Institute for Cellular & Molecular Biology, Center for Nanostructured Materials, The University of Texas at Austin, Austin, TX 78712, USA
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Lifshitz DA, Beck SD, Barret E, Simmons G, Chang L, Lingeman JE, Shalhav AL. Laparoscopic transverse hemicystectomy with ileocystoplasty in a porcine model. J Endourol 2001; 15:199-203. [PMID: 11325093 DOI: 10.1089/089277901750134601] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The ideal replacement for bladder tissue is yet to be described, although multiple alternatives have been studied. Currently, enterocystoplasty, despite its limitations, is considered the gold standard for bladder augmentation. This study evaluated the feasibility, safety, and morbidity of laparoscopic ileocystoplasty in a large-animal model. MATERIALS AND METHODS In eight minipigs, laparoscopy was performed using four ports. A segment of ileum was delivered through a 3-cm umbilical incision and detubularized and refashioned using standard open surgical technique. Laparoscopic hemicystectomy was then performed, followed by laparoscopic suturing of the ileal patch to the bladder. The bladder was drained with a Foley catheter, but no pelvic drain was placed. All animals were followed for for a minimum of 3 months. Preoperative and postoperative evaluation included measurement of bladder capacity, ultrasound imaging of the kidneys, blood counts, and serum electrolyte and creatinine measurements. Two of the animals were sacrificed at 3 months and one at 6 months, and the bladders were harvested. RESULTS Eight animals underwent ileocystoplasty without intraoperative or postoperative complications. The average operating and anastomosis time was 250 minutes and 96 minutes, respectively. All animals had normal preoperative blood values that remained normal during follow-up. Bladder capacity decreased initially to 71% of the baseline volume and then increased to 83% and 117% at 3 and 6 months. One of three animals sacrificed was noted to have a right midureteral stricture. CONCLUSIONS We developed a reliable laparoscopic technique for ileocystoplasty that may extend the advantages of laparoscopy, including better cosmesis and reduced risk of postoperative adhesions, to bladder augmentation.
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Affiliation(s)
- D A Lifshitz
- Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana, USA
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Calder L, Gao W, Simmons G. Tuberculosis: reasons for diagnostic delay in Auckland. N Z Med J 2000; 113:483-5. [PMID: 11198539] [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: 02/19/2023]
Abstract
AIMS First, to quantify the interval between the onset of symptoms and the start of anti-tuberculous treatment in a series of Auckland tuberculosis patients. Second, to examine the help-seeking behaviour of the patients and the responses of the health-care providers whom they consulted about their symptoms. Third, to identify potentially modifiable reasons for delayed presentation or diagnosis. METHODS 100 patients with tuberculosis (TB) were interviewed using a questionnaire which sought symptom duration and help-seeking behaviour. The doctors whom they consulted were surveyed about their diagnostic, therapeutic and referral responses. RESULTS Delayed presentation by patients ('patient delay') was found in smokers, patients who reported cough, patients who hoped their symptoms would go away on their own, and patients reporting fear of what would be found on diagnosis. 'Doctor delay' (the interval from first consultation with a doctor to start of treatment) was longer than that found in most published series and was a more important component of total delay than delayed presentation by patients. Longer doctor delay was found if patients had pre-existing lung disease or consulted multiple doctors, and if doctors did not inquire into past exposure to TB or request a chest X-ray. CONCLUSIONS Awareness programmes for high-risk communities are needed to encourage early reporting of symptoms. Continuing medical education for general practitioners is needed to encourage vigilance for TB and earlier use of diagnostic tests in patients who have symptoms of TB and are in high-risk groups.
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Affiliation(s)
- L Calder
- Community Services, Auckland Healthcare, Auckland.
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Campbell DM, Simmons G. Whither the public health function? N Z Med J 2000; 113:448-9. [PMID: 11194767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Simmons G, Reeves JD, Hibbitts S, Stine JT, Gray PW, Proudfoot AE, Clapham PR. Co-receptor use by HIV and inhibition of HIV infection by chemokine receptor ligands. Immunol Rev 2000; 177:112-26. [PMID: 11138769 DOI: 10.1034/j.1600-065x.2000.17719.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Human and simian immunodeficiency viruses (HIV and SIV) require a seven transmembrane chemokine (7TM) receptor in addition to CD4 for efficient entry into cells. CCR5 and CXCR4 act as major co-receptors for non-syncytium-inducing and syncytium-inducing strains respectively. We have examined the co-receptor requirement for HIV-1 infection of cells of macrophage lineage. Both CCR5 and CXCR4 can operate as functional co-receptors for infection in these cell types. Other co-receptors utilised by multi-co-receptor-using strains of HIV-1, including CCR3 and STRL33, were not used for macrophage infection. HIV-2 and SIV strains, however, can replicate in both peripheral blood mononuclear cells (PBMCs) and other primary cell types such as fibroblasts independently of CCR5 or CXCR4. HIV co-receptors, particularly CCR5, will be major targets for new therapeutics in this decade. We have therefore investigated different chemokines and derivatives that bind co-receptors for their capacity to inhibit HIV infection. These included derivatives of a CCR5 ligand, RANTES, with modified N-termini as well as Kaposi's sarcoma-associated herpesvirus-encoded chemokines that bind a wide range of co-receptors, including CCR5, CXCR4, CCR3 and CCR8, as well as the orphan 7TM receptors GPR1 and STRL33. One compound, aminooxypentane or AOP-RANTES, was a particularly potent inhibitor of HIV infection on PBMCs, macrophages and CCR5+ cell lines and demonstrated the great promise of therapeutic strategies aimed at CCR5.
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Affiliation(s)
- G Simmons
- Wohl Virion Centre, Department of Molecular Pathology, Windeyer Institute of Medical Sciences, University College London, UK.
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Affiliation(s)
- J D Reeves
- Department of Molecular Pathology, Windeyer Institute of Medical Sciences, Royal Free and University College Medical School University College London, UK
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Sabroe I, Peck MJ, Van Keulen BJ, Jorritsma A, Simmons G, Clapham PR, Williams TJ, Pease JE. A small molecule antagonist of chemokine receptors CCR1 and CCR3. Potent inhibition of eosinophil function and CCR3-mediated HIV-1 entry. J Biol Chem 2000; 275:25985-92. [PMID: 10854442 DOI: 10.1074/jbc.m908864199] [Citation(s) in RCA: 175] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a small molecule chemokine receptor antagonist, UCB35625 (the trans-isomer J113863 published by Banyu Pharmaceutical Co., patent WO98/04554), which is a potent, selective inhibitor of CCR1 and CCR3. Nanomolar concentrations of UCB35625 were sufficient to inhibit eosinophil shape change responses to MIP-1alpha, MCP-4, and eotaxin, while greater concentrations could inhibit the chemokine-induced internalization of both CCR1 and CCR3. UCB35625 also inhibited the CCR3-mediated entry of the human immunodeficiency virus-1 primary isolate 89.6 into the glial cell line, NP-2 (IC(50) = 57 nm). Chemotaxis of transfected cells expressing either CCR1 or CCR3 was inhibited by nanomolar concentrations of the compound (IC(50) values of CCR1-MIP-1alpha = 9.6 nm, CCR3-eotaxin = 93.7 nm). However, competitive ligand binding assays on the same transfectants revealed that considerably larger concentrations of UCB35625 were needed for effective ligand displacement than were needed for the inhibition of receptor function. Thus, it appears that the compound may interact with a region present in both receptors that inhibits the conformational change necessary to initiate intracellular signaling. By virtue of its potency at the two major eosinophil chemokine receptors, UCB35625 is a prototypic therapy for the treatment of eosinophil-mediated inflammatory disorders, such as asthma and as an inhibitor of CCR3-mediated human immunodeficiency virus-1 entry.
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Affiliation(s)
- I Sabroe
- Leukocyte Biology Section, Biomedical Sciences Division, Sir Alexander Fleming Building, Imperial College School of Medicine, South Kensington, London SW7 2AZ, United Kingdom
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Abstract
Carriage of Neisseria lactamica among household contacts of meningococcal disease (MCD) cases was investigated during an epidemic in Auckland, New Zealand. The overall carriage rate for N. lactamica was 10.5% (95% CI 7.4-13.5%) with a peak carriage rate in 2-year-olds of 61.5% (95% CI 26.6-88.1%). Factors associated with a significant (P < 0.05) increase in the likelihood of carriage included runny nose, the number of people per bedroom and youth. Genetic analysis of isolates revealed a striking correlation of strains within the same household but a high level of diversity between households, suggesting that household contact is an important factor in acquisition. For household contacts aged less than 5 years, there was a higher rate of carriage amongst those in contact with MCD cases under 8 years old than for contacts of cases aged 8 years and over. It is likely that development of MCD is a reflection of the nature and intensity of the exposure to a virulent strain of N. meningitidis, coupled with an absence of host resistance among those individuals not carrying N. lactamica.
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Affiliation(s)
- G Simmons
- Auckland Healthcare Public Health Protection, New Zealand
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46
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Simmons G, Jones N, Calder L. Equivalence of ceftriaxone and rifampicin in eliminating nasopharyngeal carriage of serogroup B Neisseria meningitidis. J Antimicrob Chemother 2000; 45:909-11. [PMID: 10837450 DOI: 10.1093/jac/45.6.909] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The efficacy of ceftriaxone in eliminating nasopharyngeal carriage of Neisseria meningitidis was compared with that of rifampicin during an epidemic of serogroup B meningococcal disease in Auckland, New Zealand. Household contacts of cases had a throat swab taken and were randomized to treatment. Carriers had a repeat swab taken 6 days later to determine efficacy of treatment. Ceftriaxone (98.2%) was equivalent to rifampicin (97.6%) in eliminating serogroup B N. meningitidis. It is cheaper than rifampicin and has the advantage of full compliance and fewer contraindications, but its acceptability by patients may limit its use as a first-line prophylactic agent.
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Affiliation(s)
- G Simmons
- Auckland Healthcare Public Health Protection, Auckland, New Zealand.
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47
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Elsner J, Mack M, Brühl H, Dulkys Y, Kimmig D, Simmons G, Clapham PR, Schlöndorff D, Kapp A, Wells TN, Proudfoot AE. Differential activation of CC chemokine receptors by AOP-RANTES. J Biol Chem 2000; 275:7787-94. [PMID: 10713092 DOI: 10.1074/jbc.275.11.7787] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RANTES (regulated on activation normal T cell expressed) has been found at elevated levels in biological fluids from patients with a wide range of allergic and autoimmune diseases and is able to attract several subtypes of leukocytes including eosinophils and monocytes into inflamed tissue. Amino-terminal modifications of RANTES produce receptor antagonists which are candidates for blocking this cellular recruitment. Met-RANTES has been shown to modulate inflammation in vivo, while AOP-RANTES is a potent inhibitor of R5 human immunodeficiency virus type 1 (HIV-1) strains and has been shown to down-modulate CCR5 and prevent recycling of the receptor. We have studied the effect of AOP-RANTES in eosinophil activation and have found that it is able to efficiently elicit eosinophil effector functions through CCR3, as measured by the release of reactive oxygen species and calcium mobilization, whereas Met-RANTES is inactive in these assays. AOP-RANTES is found to inhibit CCR3-mediated HIV-1 infection with moderate potency, in contrast to its potent inhibition of CCR5-mediated HIV-1 infection. Furthermore, we have investigated the abilities of these modified proteins to down-modulate CCR1 and CCR3 from the surface of monocytes and eosinophils. We show here that AOP-RANTES is much less effective than RANTES in down-modulation of CCR1. Surprisingly, recycling of CCR1 was minimal after incubation with RANTES while there was complete recycling with AOP-RANTES. In the case of CCR3, no significant difference was found between RANTES and AOP-RANTES in down-modulation and recycling. It therefore appears that trafficking of RANTES receptors follows different patterns, which opens up potential new targets for therapeutic intervention.
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Affiliation(s)
- J Elsner
- Department of Dermatology and Allergology, Hannover Medical University, 30449 Hannover, Germany
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48
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Stine JT, Wood C, Hill M, Epp A, Raport CJ, Schweickart VL, Endo Y, Sasaki T, Simmons G, Boshoff C, Clapham P, Chang Y, Moore P, Gray PW, Chantry D. KSHV-encoded CC chemokine vMIP-III is a CCR4 agonist, stimulates angiogenesis, and selectively chemoattracts TH2 cells. Blood 2000; 95:1151-7. [PMID: 10666184] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Kaposi's sarcoma-associated herpesvirus (KSHV) encodes 3 genes that are homologous to cellular chemokines. vMIP-III, the product of open reading frame K4.1, is the most distantly related to human chemokines and has yet to be characterized. We have examined the interaction of vMIP-III with chemokine receptors, its expression in KS lesions, and its in ovo angiogenic properties. We show expression of vMIP-III in KS lesions and demonstrate the stimulation of angiogenesis by this chemokine, like vMIP-I and vMIP-II, in the chick chorioallantoic membrane assay. vMIP-III does not block human immunodeficiency virus entry through the coreceptors CCR3, CCR5, or CXCR4. However, vMIP-III is an agonist for the cellular chemokine receptor CCR4. CCR4 is expressed by TH2-type T cells. Consistent with this, vMIP-III preferentially chemoattracts this cell type. Because of these biologic properties and because it is expressed in KS lesions, vMIP-III may play an important role in the pathobiology of KS. (Blood. 2000;95:1151-1157)
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MESH Headings
- Allantois/blood supply
- Animals
- CHO Cells
- Cell Line
- Chemokines, CC/genetics
- Chemokines, CC/immunology
- Chemokines, CC/pharmacology
- Chemokines, CC/physiology
- Chemotaxis/drug effects
- Chemotaxis/physiology
- Chick Embryo
- Chorion/blood supply
- Cricetinae
- HIV/drug effects
- HIV/physiology
- Herpesvirus 8, Human/genetics
- Herpesvirus 8, Human/immunology
- Humans
- Neovascularization, Physiologic/drug effects
- Neovascularization, Physiologic/physiology
- Open Reading Frames
- Receptors, CCR4
- Receptors, Chemokine/agonists
- Recombinant Proteins/immunology
- Recombinant Proteins/pharmacology
- Sarcoma, Kaposi/immunology
- Sarcoma, Kaposi/pathology
- Sarcoma, Kaposi/virology
- Th1 Cells/drug effects
- Th1 Cells/physiology
- Th2 Cells/drug effects
- Th2 Cells/physiology
- Transfection
- Viral Proteins
- Virus Replication/drug effects
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Affiliation(s)
- J T Stine
- ICOS Corporation, Bothell, WA 98021, USA
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Dejucq N, Simmons G, Clapham PR. Expanded tropism of primary human immunodeficiency virus type 1 R5 strains to CD4(+) T-cell lines determined by the capacity to exploit low concentrations of CCR5. J Virol 1999; 73:7842-7. [PMID: 10438877 PMCID: PMC104314 DOI: 10.1128/jvi.73.9.7842-7847.1999] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) non-syncytium-inducing (NSI) strains predominantly use the chemokine receptor CCR5, while syncytium-inducing (SI) strains use CXCR4. In vitro, SI isolates infect and replicate in a range of CD4(+) CXCR4(+) T-cell lines, whereas NSI isolates usually do not. Here we describe three NSI strains that are able to infect two CD4(+) T-cell lines, Molt4 and SupT1. For one strain, a variant of JRCSF selected in vitro, replication on Molt4 was previously shown to be conferred by a single amino-acid change in the V1 loop (M.T. Boyd et al., J. Virol. 67:3649-3652, 1993). On CD4(+) cell lines expressing different coreceptors, these strains use CCR5 predominantly and do not replicate in CCR5-negative peripheral blood mononuclear cells derived from individuals homozygous for Delta32 CCR5. Furthermore, infection of Molt4 and SupT1 by each of these three strains is potently inhibited by ligands for CCR5, including 2D7, a monoclonal antibody specific for CCR5. CCR5 mRNA was present in both Molt4 and SupT1 by reverse transcription-PCR, although CCR5 protein could not be detected either on the cell surface or in intracellular vesicles. The expanded tropism of the three strains shown here is therefore not due to adaptation to a new coreceptor but due to the capacity to exploit extremely low levels of CCR5 on Molt4 and SupT1 cells. This novel tropism observed for a subset of primary HIV-1 isolates may represent an extended tropism to new CD4(+) cell types in vivo.
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Affiliation(s)
- N Dejucq
- Section of Virology, Chester Beatty Laboratories, Institute of Cancer Research, London SW3 6JB, United Kingdom
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50
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Reeves JD, Hibbitts S, Simmons G, McKnight A, Azevedo-Pereira JM, Moniz-Pereira J, Clapham PR. Primary human immunodeficiency virus type 2 (HIV-2) isolates infect CD4-negative cells via CCR5 and CXCR4: comparison with HIV-1 and simian immunodeficiency virus and relevance to cell tropism in vivo. J Virol 1999; 73:7795-804. [PMID: 10438870 PMCID: PMC104307 DOI: 10.1128/jvi.73.9.7795-7804.1999] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cell surface receptors exploited by human immunodeficiency virus (HIV) and simian immunodeficiency virus (SIV) for infection are major determinants of tropism. HIV-1 usually requires two receptors to infect cells. Gp120 on HIV-1 virions binds CD4 on the cell surface, triggering conformational rearrangements that create or expose a binding site for a seven-transmembrane (7TM) coreceptor. Although HIV-2 and SIV strains also use CD4, several laboratory-adapted HIV-2 strains infect cells without CD4, via an interaction with the coreceptor CXCR4. Moreover, the envelope glycoproteins of SIV of macaques (SIV(MAC)) can bind to and initiate infection of CD4(-) cells via CCR5. Here, we show that most primary HIV-2 isolates can infect either CCR5(+) or CXCR4(+) cells without CD4. The efficiency of CD4-independent infection by HIV-2 was comparable to that of SIV, but markedly higher than that of HIV-1. CD4-independent HIV-2 strains that could use both CCR5 and CXCR4 to infect CD4(+) cells were only able to use one of these receptors in the absence of CD4. Our observations therefore indicate (i) that HIV-2 and SIV envelope glycoproteins form a distinct conformation that enables contact with a 7TM receptor without CD4, and (ii) the use of CD4 enables a wider range of 7TM receptors to be exploited for infection and may assist adaptation or switching to new coreceptors in vivo. Primary CD4(-) fetal astrocyte cultures expressed CXCR4 and supported replication by the T-cell-line-adapted ROD/B strain. Productive infection by primary X4 strains was only triggered upon treatment of virus with soluble CD4. Thus, many primary HIV-2 strains infect CCR5(+) or CXCR4(+) cell lines without CD4 in vitro. CD4(-) cells that express these coreceptors in vivo, however, may still resist HIV-2 entry due to insufficient coreceptor concentration on the cell surface to trigger fusion or their expression in a conformation nonfunctional as a coreceptor. Our study, however, emphasizes that primary HIV-2 strains carry the potential to infect CD4(-) cells expressing CCR5 or CXCR4 in vivo.
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Affiliation(s)
- J D Reeves
- The Wohl Virion Centre, Department of Molecular Pathology, Windeyer Institute of Medical Sciences, University College London, London, United Kingdom.
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