1
|
Crooks R, Davidson L, Elliott K, O'Hara G, Gibson E, Kelly R, McAleese J, Masih I. Bedside physician led US-guided supra-clavicular lymph node biopsy and ROSE (rapid on-site evaluation): SVC obstruction swift management in lung cancer. Respir Med Case Rep 2024; 49:101978. [PMID: 38623376 PMCID: PMC11017039 DOI: 10.1016/j.rmcr.2024.101978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/21/2023] [Accepted: 01/05/2024] [Indexed: 04/17/2024] Open
Abstract
Superior vena cava obstruction (SVCO) is an oncological emergency and can often be linked to an underlying lung malignancy. Due to the potential life-threatening risks associated with SVCO, it necessitates urgent diagnosis and management. In this report, we discuss 3 case studies where the use of ultrasound-guided supraclavicular lymph node biopsy was used to obtain a biopsy from patients with SVCO, followed by rapid on-site evaluation (ROSE). The benefits of this technique ensure a more rapid histological diagnosis, while also involving a less invasive procedure for the patient. The histological diagnosis is essential in improving patient outcomes when treating those with SVCO as the recommended treatments vary depending on the underlying type of lung malignancy. Having this information can help the clinician swiftly employ the optimal treatment pathway for the patient.
Collapse
Affiliation(s)
- R. Crooks
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| | - L. Davidson
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| | - K. Elliott
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| | - G. O'Hara
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| | - Eddie Gibson
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| | - R. Kelly
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| | - J. McAleese
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| | - I. Masih
- Departments of Respiratory, Radiology and Histology, Antrim Hospital, Ireland
| |
Collapse
|
2
|
Sowole L, Kainth R, Tuudah C, Delmonte Sen A, Price N, O'Hara G. High-consequence infectious diseases: the conception and development of a multi-disciplinary, interprofessional simulation training programme. J Hosp Infect 2024; 147:87-97. [PMID: 38403083 DOI: 10.1016/j.jhin.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND High-consequence infectious diseases (HCIDs) represent a group of acute infectious diseases with the potential to impact healthcare systems and public health profoundly. Effective management requires a system-based strategy focused on early detection, initiation of infection prevention and control measures, and appropriate use of personal protective equipment (PPE). Inadequate training in the safe use of HCID PPE, and lack of familiarity with key processes such as HCID waste and spills management, exacerbates the risk posed to healthcare workers (HCWs). Enhanced training opportunities are required to ensure that staff are equipped with the necessary knowledge and capabilities to protect themselves from pathogen exposure and infection. AIM To create a bespoke interprofessional HCID simulation training programme. METHODS A detailed learning needs analysis was undertaken, which identified multiple areas amenable to educational intervention. A full-day HCID simulation programme was developed, providing HCWs the opportunity to practice and gain proficiency in various domains. FINDINGS Six interprofessional participants took part in the HCID simulation programme pilot. All six (100%) participants felt that the stated learning objectives had been achieved, and five and one participants found the programme to be extremely useful (83%) or very useful (17%), respectively. Following refinement based on pilot feedback, a further six courses have been run for 38 participants, of whom 97% found the programme to be extremely useful or very useful. CONCLUSION The development of a training intervention in the low-frequency, high-risk field of HCIDs had a positive impact. Given the disproportionate impact on HCWs at times of HCID outbreaks, more investment is needed to keep the workforce upskilled.
Collapse
Affiliation(s)
- L Sowole
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK; Simulation and Interactive Learning Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - R Kainth
- Simulation and Interactive Learning Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - C Tuudah
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Delmonte Sen
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK; Simulation and Interactive Learning Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - N Price
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G O'Hara
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
3
|
Gan J, Patel J, Ainsworth E, Patel A, O'Hara G, Elowaidy A. Case series of perianal and pelvic MRI imaging findings in monkeypox. BJR Case Rep 2023; 9:20220109. [PMID: 37576001 PMCID: PMC10412917 DOI: 10.1259/bjrcr.20220109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/05/2022] Open
Abstract
Monkeypox is a viral infection historically rarely seen in humans, but currently the focus of international attention due to a multi-country outbreak outside endemic countries of Central and West Africa, where cases are typically confined. Perianal pain and lesions have recently been recognised as a feature of monkeypox. We present a case series of the imaging findings of patients with monkeypox, including active proctitis, anal canal inflammation, and perianal inflammation. The aim is to increase awareness of perianal and rectal monkeypox MRI imaging features during this current outbreak.
Collapse
Affiliation(s)
- Jason Gan
- Guys and St Thomas Hospital, London, United Kingdom
| | - Janki Patel
- Guys and St Thomas Hospital, London, United Kingdom
| | | | - Aatish Patel
- Guys and St Thomas Hospital, London, United Kingdom
| | | | | |
Collapse
|
4
|
Fink DL, Callaby H, Luintel A, Beynon W, Bond H, Lim EY, Gkrania-Klotsas E, Heskin J, Bracchi M, Rathish B, Milligan I, O'Hara G, Rimmer S, Peters JR, Payne L, Mody N, Hodgson B, Lewthwaite P, Lester R, Woolley SD, Sturdy A, Whittington A, Johnson L, Jacobs N, Quartey J, Ai Payne B, Crowe S, Elliott IA, Harrison T, Cole J, Beard K, Cusack TP, Jones I, Banerjee R, Rampling T, Dunning J. Clinical features and management of individuals admitted to hospital with monkeypox and associated complications across the UK: a retrospective cohort study. Lancet Infect Dis 2023; 23:589-597. [PMID: 36566771 DOI: 10.1016/s1473-3099(22)00806-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The scale of the 2022 global mpox (formerly known as monkeypox) outbreak has been unprecedented. In less than 6 months, non-endemic countries have reported more than 67 000 cases of a disease that had previously been rare outside of Africa. Mortality has been reported as rare but hospital admission has been relatively common. We aimed to describe the clinical and laboratory characteristics and outcomes of individuals admitted to hospital with mpox and associated complications, including tecovirimat recipients. METHODS In this cohort study, we undertook retrospective review of electronic clinical records and pathology data for all individuals admitted between May 6, and Aug 3, 2022, to 16 hospitals from the Specialist and High Consequence Infectious Diseases Network for Monkeypox. The hospitals were located in ten cities in England and Northern Ireland. Inclusion criteria were clinical signs consistent with mpox and MPXV DNA detected from at least one clinical sample by PCR testing. Patients admitted solely for isolation purposes were excluded from the study. Key outcomes included admission indication, complications (including pain, secondary infection, and mortality) and use of antibiotic and anti-viral treatments. Routine biochemistry, haematology, microbiology, and virology data were also collected. Outcomes were assessed in all patients with available data. FINDINGS 156 individuals were admitted to hospital with complicated mpox during the study period. 153 (98%) were male and three (2%) were female, with a median age of 35 years (IQR 30-44). Gender data were collected from electronic patient records, which encompassed full formal review of clincian notes. The prespecified options for data collection for gender were male, female, trans, non-binary, or unknown. 105 (71%) of 148 participants with available ethnicity data were of White ethnicity and 47 (30%) of 155 were living with HIV with a median CD4 count of 510 cells per mm3 (IQR 349-828). Rectal or perianal pain (including proctitis) was the most common indication for hospital admission (44 [28%] of 156). Severe pain was reported in 89 (57%) of 156, and secondary bacterial infection in 82 (58%) of 142 individuals with available data. Median admission duration was 5 days (IQR 2-9). Ten individuals required surgery and two cases of encephalitis were reported. 38 (24%) of the 156 individuals received tecovirimat with early cessation in four cases (two owing to hepatic transaminitis, one to rapid treatment response, and one to patient choice). No deaths occurred during the study period. INTERPRETATION Although life-threatening mpox appears rare in hospitalised populations during the current outbreak, severe mpox and associated complications can occur in immunocompetent individuals. Analgesia and management of superimposed bacterial infection are priorities for patients admitted to hospital. FUNDING None.
Collapse
Affiliation(s)
- Douglas L Fink
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK; Division of Infection and Immunity, University College London, London, UK.
| | - Helen Callaby
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Wiltshire, UK
| | - Akish Luintel
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | - William Beynon
- Department of Infectious Diseases, Belfast Health and Social Care Trust, Belfast, UK
| | - Helena Bond
- Department of Infectious Diseases, Belfast Health and Social Care Trust, Belfast, UK
| | - Eleanor Y Lim
- Department of Infectious Diseases, Cambridge University Hospitals, Cambridge, UK
| | | | - Jospeh Heskin
- Department of HIV/GUM, Chelsea and Westminster Hospital, London, UK
| | | | - Balram Rathish
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Iain Milligan
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Geraldine O'Hara
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stephanie Rimmer
- Department of Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joanna R Peters
- Department of Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Lara Payne
- Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust, London, UK
| | - Nisha Mody
- Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust, London, UK
| | - Bethany Hodgson
- Department of Infectious Diseases, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Penny Lewthwaite
- Department of Infectious Diseases, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rebecca Lester
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Stephen D Woolley
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ann Sturdy
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, UK
| | - Ashley Whittington
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, UK
| | - Leann Johnson
- Department of Infectious Diseases, North Manchester General Hospital, Manchester, UK
| | - Nathan Jacobs
- Department of Infectious Diseases, North Manchester General Hospital, Manchester, UK
| | - John Quartey
- Department of Infection and Tropical Medicine, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK
| | - Brendan Ai Payne
- Department of Infection and Tropical Medicine, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK
| | - Stewart Crowe
- Department of Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ivo Am Elliott
- Department of Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Thomas Harrison
- Department of Infectious Diseases, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Joby Cole
- Department of Infectious Diseases, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Katie Beard
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tomas-Paul Cusack
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Imogen Jones
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Rishi Banerjee
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Tommy Rampling
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Wiltshire, UK; Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation Trust, London UK
| | - Jake Dunning
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK; Division of Infection and Immunity, University College London, London, UK; Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Gedela K, Da Silva Fontoura D, Salam A, Gorman G, Golden J, O'Hara G, Elowaidy A, Tittle V, Girometti N, Whitlock G, Patel S, Suchak T, Nugent D, Asboe D, Boffito M, McOwan A. Infectious Proctitis due to Human Mpox. Clin Infect Dis 2023; 76:e1424-e1427. [PMID: 36052417 DOI: 10.1093/cid/ciac713] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [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: 06/23/2022] [Revised: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 11/14/2022] Open
Abstract
We describe 2 cases of infectious proctitis secondary to human monkeypox in patients presenting with rectal pain. These cases highlight the importance of multidisciplinary management of monkeypox and in expanding case definitions and enabling clinical recognition in patients presenting without skin rash.
Collapse
Affiliation(s)
- Keerti Gedela
- Department of HIV/GUM, Chelsea & Westminster Hospital, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Dayana Da Silva Fontoura
- Department of Infectious Diseases, Guys and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Alex Salam
- Department of Infectious Diseases, Guys and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Gerry Gorman
- Department of HIV/GUM, Chelsea & Westminster Hospital, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - John Golden
- Department of HIV/GUM, Chelsea & Westminster Hospital, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Geraldine O'Hara
- Department of Infectious Diseases, Guys and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Ahmed Elowaidy
- Department of Clinical Radiology, Guys and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Victoria Tittle
- Department of HIV/GUM, Chelsea & Westminster Hospital, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Nicolo Girometti
- Department of HIV/GUM, Chelsea & Westminster Hospital, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Gary Whitlock
- Department of HIV/GUM, Chelsea & Westminster Hospital, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Sheel Patel
- Department of HIV/GUM, Chelsea & Westminster Hospital, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | | | - Diarmuid Nugent
- Department of HIV/GUM, Chelsea & Westminster Hospital, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - David Asboe
- Department of HIV/GUM, Chelsea & Westminster Hospital, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Marta Boffito
- Department of HIV/GUM, Chelsea & Westminster Hospital, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Alan McOwan
- Department of HIV/GUM, Chelsea & Westminster Hospital, National Health Service (NHS) Foundation Trust, London, United Kingdom
| |
Collapse
|
6
|
Patel H, O'Hara G, Brown A. 613. Novel use of Ritonavir boosting to achieve therapeutic itraconazole levels in disseminated Histoplasmosis. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Itraconazole is a poorly soluble antifungal drug with variable pharmacokinetics. Serum levels vary between patients and over time, due to absorption issues and drug-drug interactions. Itraconazole suspension has more predictable absorption than capsules, but is poorly tolerated. Newer formulations dispersing drug in polymer aim to improve bioavailability, but are costly and not widely available. Standard therapy for histoplasmosis is induction with liposomal amphotericin B (LAmB) followed by 12+ months of itraconazole therapy with target pre-dose levels of 1-4 mg/L.
Methods
A 33yo M presented with weight loss, fever and dyspnoea, having returned to the UK from Nicaragua. He had been taking adalimumab for Crohn’s disease, quiescent for years following a prior small bowel resection. Empiric antifungal therapy with LAmB was commmenced, prior to confirmation of disseminated histoplasmosis by urinary antigen and blood culture. His course was complicated by significant bowel inflammation, requiring subtotal colectomy and end-ileostomy. Since surgery, he has had a high output stoma, with rapid transit time and reduced absorption.
Results
Despite itraconazole dose titration to 300mg TDS, levels were generally < 0.5 mg/L and maximum serum itraconazole level achieved was 0.64 mg/L. The patient was trained with a view to self-OPAT LAmB.
On day 117 of antifungal therapy, ritonavir 100mg once daily was added. Four days after this, itraconazole level was 1.39 mg/L (from 0.34 mg/L) and maintained target concentration even after a switch from itraconazole suspension to capsules (Fig.1) with significant fungal marker response (Fig. 2). Figure 1.Itraconazole dosing and levels pre- and post-ritonavir
Total daily itraconazole dose (suspension followed by capsules) was mapped over time. There is a period where LAmB alone was used surrounding the colorectal surgery. Serum itraconazole levels dramatically increased 2 days after the introduction of ritonavir 100mg once daily and remained above target trough even after switching to itraconazole capsules. Figure 2.Fungal marker (B-D-glucan and Histoplasma urinary Ag) response to antifungal therapy
The response of serum beta-D-glucan and quantitative urinary Histoplasma antigen EIA (Miravista Labs) is represented alongside concurrent antifungal therapy. Of note, the first four urinary Histoplasma Ag levels were reporte as above the limit of detection (> 20 ng/mL) and are represented here as an arbitrary value of 25 ng/mL.
Conclusion
Use of ritonavir alone to boost itraconazole has not previously been described. It avoids the longer-term complications of intravenous access and adverse renal and other effects of LAmB. Itraconazole is both a substrate and inhibitor of cytochrome P450 3A4 (CYP3A4) and inhibits P-glycoprotein, resulting in considerable drug:drug interactions. Ritonavir is a more potent inhibitor of CYP3A4. Use of ritonavir-boosted itraconazole amounted to a 99% reduction in cost vs LAmB over 6 months. It may offer a reliable and cost-effective method of boosting itraconazole where other drug:drug interactions do not preclude its use.
Disclosures
All Authors: No reported disclosures.
Collapse
Affiliation(s)
- Hasinaa Patel
- Guy's & St Thomas' NHS Foundation Trust , London, England , United Kingdom
| | - Geraldine O'Hara
- Guys and St Thomas' NHS Trust , London, England , United Kingdom
| | - Aisling Brown
- Guy's & St Thomas' NHS Foundation Trust , London, England , United Kingdom
| |
Collapse
|
7
|
Abstract
Cases of monkeypox, a double-stranded DNA virus that is closely related to smallpox, have recently increased in non-endemic countries, prompting fears of a new health emergency. Tens of thousands of cases have now been reported globally, with the majority of locations not having historically reported monkeypox. Here we review the epidemiology, transmission, diagnosis, management and prevention of monkeypox.
Collapse
Affiliation(s)
- Anna Daunt
- AGuy's and St Thomas' NHS Foundation Trust, London, UK,Address for correspondence: Dr Anna Daunt, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
| | | |
Collapse
|
8
|
Hookham L, Fisher C, Manson JJ, Morgan M, O'Hara G, Riley P, Tattersall RS, Goodman AL. Understanding the diagnosis and management of multisystem inflammatory syndrome in adults (MIS-A) in the UK: results of a national Delphi process. Clin Med (Lond) 2022; 22:266-270. [PMID: 38589087 DOI: 10.7861/clinmed.2021-0700] [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] [Indexed: 12/23/2022]
Abstract
Infection with SARS-CoV-2 may trigger a delayed hyper-inflammatory illness in children called paediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS-TS). A similar syndrome is increasingly recognised in adults termed multisystem inflammatory syndrome in adults (MIS-A) and may present acutely to medical or surgical specialties with severe symptoms, such as acute abdominal pain or cardiogenic shock. No national guidelines exist in the UK for the management of MIS-A and there is limited evidence to guide treatment plans. We undertook a national Delphi process to elicit opinions from experts in hyperinflammation about the diagnosis and management of MIS-A with the dual aim of improving recognition and producing a management guideline. Colleagues in paediatrics successfully initiated a national consensus management document that facilitated regional multidisciplinary referral and follow-up pathways for children with PIMS-TS, and we propose a similar system be developed for adult patients across the UK. This would facilitate better recognition and treatment of MIS-A across the multiple specialties to which it may present as well as enable follow-up with specialty services post-discharge.
Collapse
Affiliation(s)
| | - Corinne Fisher
- University College Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Phil Riley
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | | |
Collapse
|
9
|
Dognin N, Salaun E, Champagne C, O'Hara G, Paradis J, Faroux L, Philippon F, Beaudoin J, O'Connor K, Bernier M, Rodès-Cabau J, Champagne J. PERCUTANEOUS LEFT ATRIAL APPENDAGE CLOSURE IN PATIENTS WITH HEMOSTASIS DISORDERS AND ANTICOAGULANT CONTRAINDICATION. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
10
|
Dognin N, Racine H, Plourde B, Molin F, O'Hara G, Champagne J, Sarrazin J, Steinberg C, Nault I, Roy K, Blier L, Philippon F. ACUTE PACING THRESHOLD ELEVATION DURING SIMULTANEOUS L0EADLESS PACEMAKER IMPLANTATION AND ATRIOVENTRICULAR NODE ABLATION. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
11
|
Seow J, Graham C, Merrick B, Acors S, Pickering S, Steel KJA, Hemmings O, O'Byrne A, Kouphou N, Galao RP, Betancor G, Wilson HD, Signell AW, Winstone H, Kerridge C, Huettner I, Jimenez-Guardeño JM, Lista MJ, Temperton N, Snell LB, Bisnauthsing K, Moore A, Green A, Martinez L, Stokes B, Honey J, Izquierdo-Barras A, Arbane G, Patel A, Tan MKI, O'Connell L, O'Hara G, MacMahon E, Douthwaite S, Nebbia G, Batra R, Martinez-Nunez R, Shankar-Hari M, Edgeworth JD, Neil SJD, Malim MH, Doores KJ. Longitudinal observation and decline of neutralizing antibody responses in the three months following SARS-CoV-2 infection in humans. Nat Microbiol 2020; 5:1598-1607. [PMID: 33106674 PMCID: PMC7610833 DOI: 10.1038/s41564-020-00813-8] [Citation(s) in RCA: 876] [Impact Index Per Article: 219.0] [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: 07/08/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
Antibody responses to SARS-CoV-2 can be detected in most infected individuals 10-15 d after the onset of COVID-19 symptoms. However, due to the recent emergence of SARS-CoV-2 in the human population, it is not known how long antibody responses will be maintained or whether they will provide protection from reinfection. Using sequential serum samples collected up to 94 d post onset of symptoms (POS) from 65 individuals with real-time quantitative PCR-confirmed SARS-CoV-2 infection, we show seroconversion (immunoglobulin (Ig)M, IgA, IgG) in >95% of cases and neutralizing antibody responses when sampled beyond 8 d POS. We show that the kinetics of the neutralizing antibody response is typical of an acute viral infection, with declining neutralizing antibody titres observed after an initial peak, and that the magnitude of this peak is dependent on disease severity. Although some individuals with high peak infective dose (ID50 > 10,000) maintained neutralizing antibody titres >1,000 at >60 d POS, some with lower peak ID50 had neutralizing antibody titres approaching baseline within the follow-up period. A similar decline in neutralizing antibody titres was observed in a cohort of 31 seropositive healthcare workers. The present study has important implications when considering widespread serological testing and antibody protection against reinfection with SARS-CoV-2, and may suggest that vaccine boosters are required to provide long-lasting protection.
Collapse
Affiliation(s)
- Jeffrey Seow
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Carl Graham
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Blair Merrick
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sam Acors
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Suzanne Pickering
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Kathryn J A Steel
- Centre for Inflammation Biology and Cancer Immunology, Department of Inflammation Biology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Oliver Hemmings
- Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Aoife O'Byrne
- Centre for Inflammation Biology and Cancer Immunology, Department of Inflammation Biology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Neophytos Kouphou
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Rui Pedro Galao
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Gilberto Betancor
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Harry D Wilson
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Adrian W Signell
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Helena Winstone
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Claire Kerridge
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Isabella Huettner
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Jose M Jimenez-Guardeño
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Maria Jose Lista
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Nigel Temperton
- Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent, Chatham, UK
| | - Luke B Snell
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Karen Bisnauthsing
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Amelia Moore
- Guy's and St Thomas' R&D Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Adrian Green
- Guy's and St Thomas' R&D Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lauren Martinez
- Guy's and St Thomas' R&D Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Brielle Stokes
- Guy's and St Thomas' R&D Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Johanna Honey
- Guy's and St Thomas' R&D Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Alba Izquierdo-Barras
- Guy's and St Thomas' R&D Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gill Arbane
- Department of Intensive Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Amita Patel
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark Kia Ik Tan
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lorcan O'Connell
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Geraldine O'Hara
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eithne MacMahon
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sam Douthwaite
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gaia Nebbia
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rahul Batra
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rocio Martinez-Nunez
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Manu Shankar-Hari
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
- Department of Intensive Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan D Edgeworth
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stuart J D Neil
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Michael H Malim
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Katie J Doores
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK.
| |
Collapse
|
12
|
O'Hara G, Mokaya J, Hau JP, Downs LO, McNaughton AL, Karabarinde A, Asiki G, Seeley J, Matthews PC, Newton R. Liver function tests and fibrosis scores in a rural population in Africa: a cross-sectional study to estimate the burden of disease and associated risk factors. BMJ Open 2020; 10:e032890. [PMID: 32234740 PMCID: PMC7170602 DOI: 10.1136/bmjopen-2019-032890] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Liver disease is a major cause of morbidity and mortality in sub-Saharan Africa, but its prevalence, distribution and aetiology have not been well characterised. We therefore set out to examine liver function tests (LFTs) and liver fibrosis scores in a rural African population. DESIGN We undertook a cross-sectional survey of LFTs. We classified abnormal LFTs based on reference ranges set in America and in Africa. We derived fibrosis scores (aspartate aminotransferase (AST) to Platelet Ratio Index (APRI), fibrosis-4, gamma-glutamyl transferase (GGT) to platelet ratio (GPR), red cell distribution width to platelet ratio and S-index). We collected information about alcohol intake, and infection with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). SETTING We studied a population cohort in South-Western Uganda. PARTICIPANTS Data were available for 8099 adults (median age 30 years; 56% female). RESULTS The prevalence of HBV, HCV and HIV infection was 3%, 0.2% and 8%, respectively. The prevalence of abnormal LFTs was higher based on the American reference range compared with the African reference range (eg, for AST 13% vs 3%, respectively). Elevated AST/ALT ratio was significantly associated with self-reported alcohol consumption (p<0.001), and the overall prevalence of AST/ALT ratio >2 was 11% (suggesting alcoholic hepatitis). The highest prevalence of fibrosis was predicted by the GPR score, with 24% of the population falling above the threshold for fibrosis. There was an association between the presence of HIV or HBV and raised GPR (p=0.005) and S-index (p<0.001). By multivariate analysis, elevated LFTs and fibrosis scores were most consistently associated with older age, male sex, being under-weight, HIV or HBV infection and alcohol consumption. CONCLUSIONS Further work is required to determine normal reference ranges for LFTs in this setting, to evaluate the specificity and sensitivity of fibrosis scores and to determine the aetiology of liver disease.
Collapse
Affiliation(s)
- Geraldine O'Hara
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jolynne Mokaya
- Nuffied Department of Medicine, University of Oxford, Oxford, UK
| | - Jeffrey P Hau
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Louise O Downs
- Nuffied Department of Medicine, University of Oxford, Oxford, UK
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Alex Karabarinde
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Gershim Asiki
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Philippa C Matthews
- Nuffied Department of Medicine, University of Oxford, Oxford, UK
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- NIHR BRC, John Radcliffe Hospital, Oxford, UK
| | - Robert Newton
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
- Department of Health Sciences, University of York, York, UK
| |
Collapse
|
13
|
Steinberg C, Cheung C, Wan D, Staples J, Philippon F, Laksman Z, Sarrazin J, Bennett M, Plourde B, Deyell M, Andrade J, Roy K, Yeung-Lai-Wah J, Molin F, Hawkins N, Blier L, Nault I, O'Hara G, Krahn A, Champagne J, Chakrabarti S. DRIVING RESTRICTIONS AND EARLY ARRHYTHMIAS IN PATIENTS RECEIVING A PRIMARY PREVENTION IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR (DREAM-ICD STUDY). Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
14
|
Kiwan C, AlTurki A, Greiss I, Kus T, Montigny M, Ayala-Paredes F, Sarrazin J, Garcia MB, Breton R, O'Hara G, Sami M, Brulotte S, Dion D, Houde G, Sandrin F, Palaic M, Chow C, Boudreault C, Essebag V, Huynh T. THE IMPACT OF KNOWLEDGE TRANSLATION AND INTEGRATED CARDIOVASCULAR CARE ON EMERGENCY ROOM VISITS OF PATIENTS WITH ATRIAL FIBRILLATION: INSIGHTS FROM THE INTEGRATED-FACILITER PROGRAM. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
15
|
Steinberg C, Sanchez M, Philippon F, O'Hara G, Molin F, Sarrazin J, Nault I, Blier L, Roy K, Plourde B, Champagne J. A NOVEL FORM OF WEARABLE ECG SENSORS FOR CONTINUOUS AMBULATORY RHYTHM MONITORING: PROOF OF CONCEPT AND ASSESSMENT OF SIGNAL QUALITY. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
16
|
Mokaya J, McNaughton AL, Burbridge L, Maponga T, O'Hara G, Andersson M, Seeley J, Matthews PC. A blind spot? Confronting the stigma of hepatitis B virus (HBV) infection - A systematic review. Wellcome Open Res 2018; 3:29. [PMID: 30483598 PMCID: PMC6234740 DOI: 10.12688/wellcomeopenres.14273.2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Stigma, poverty, and lack of knowledge present barriers to the diagnosis and treatment of chronic infection, especially in resource-limited settings. Chronic Hepatitis B virus (HBV) infection is frequently asymptomatic, but accounts for a substantial long-term burden of morbidity and mortality. In order to improve the success of diagnostic, treatment and preventive strategies, it is important to recognise, investigate and tackle stigma. We set out to assimilate evidence for the nature and impact of stigma associated with HBV infection, and to suggest ways to tackle this challenge. Methods: We carried out a literature search in PubMed using the search terms ‘hepatitis B’, ‘stigma’ to identify relevant papers published between 2007 and 2017 (inclusive), with a particular focus on Africa. Results: We identified a total of 32 articles, of which only two studies were conducted in Africa. Lack of knowledge of HBV was consistently identified, and in some settings there was no local word to describe HBV infection. There were misconceptions about HBV infection, transmission and treatment. Healthcare workers provided inaccurate information to individuals diagnosed with HBV, and poor understanding resulted in lack of preventive measures. Stigma negatively impacted on help-seeking, screening, disclosure, prevention of transmission, and adherence to treatment, and had potential negative impacts on mental health, wellbeing, employment and relationships. Conclusion: Stigma is a potentially major barrier to the successful implementation of preventive, diagnostic and treatment strategies for HBV infection, and yet we highlight a ‘blind spot’, representing a lack of data and limited recognition of this challenge. There is a need for more research in this area, to identify and evaluate interventions that can be used effectively to tackle stigma, and to inform collaborative efforts between patients, clinical services, policy makers, traditional healers, religious leaders, charity organisations and support groups.
Collapse
Affiliation(s)
- Jolynne Mokaya
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Anna L McNaughton
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Lela Burbridge
- Department of Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tongai Maponga
- Department of Virology, University of Stellenbosch, Tygerberg Hospital, Bellville, Cape Town , 7500, South Africa
| | - Geraldine O'Hara
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Monique Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, 51/59 Nakiwogo Rd, Entebbe, Uganda
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK.,Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
| |
Collapse
|
17
|
Mokaya J, McNaughton AL, Burbridge L, Maponga T, O'Hara G, Andersson M, Seeley J, Matthews PC. A blind spot? Confronting the stigma of hepatitis B virus (HBV) infection - A systematic review. Wellcome Open Res 2018; 3:29. [PMID: 30483598 DOI: 10.12688/wellcomeopenres.14273.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Stigma, poverty, and lack of knowledge present barriers to the diagnosis and treatment of chronic infection, especially in resource-limited settings. Chronic Hepatitis B virus (HBV) infection is frequently asymptomatic, but accounts for a substantial long-term burden of morbidity and mortality. In order to improve the success of diagnostic, treatment and preventive strategies, it is important to recognise, investigate and tackle stigma. We set out to assimilate evidence for the nature and impact of stigma associated with HBV infection, and to suggest ways to tackle this challenge. Methods: We carried out a literature search in PubMed using the search terms 'hepatitis B', 'stigma' to identify relevant papers published between 2007 and 2017 (inclusive), with a particular focus on Africa. Results: We identified a total of 32 articles, of which only two studies were conducted in Africa. Lack of knowledge of HBV was consistently identified, and in some settings there was no local word to describe HBV infection. There were misconceptions about HBV infection, transmission and treatment. Healthcare workers provided inaccurate information to individuals diagnosed with HBV, and poor understanding resulted in lack of preventive measures. Stigma negatively impacted on help-seeking, screening, disclosure, prevention of transmission, and adherence to treatment, and had potential negative impacts on mental health, wellbeing, employment and relationships. Conclusion: Stigma is a potentially major barrier to the successful implementation of preventive, diagnostic and treatment strategies for HBV infection, and yet we highlight a 'blind spot', representing a lack of data and limited recognition of this challenge. There is a need for more research in this area, to identify and evaluate interventions that can be used effectively to tackle stigma, and to inform collaborative efforts between patients, clinical services, policy makers, traditional healers, religious leaders, charity organisations and support groups.
Collapse
Affiliation(s)
- Jolynne Mokaya
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Anna L McNaughton
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK
| | - Lela Burbridge
- Department of Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tongai Maponga
- Department of Virology, University of Stellenbosch, Tygerberg Hospital, Bellville, Cape Town , 7500, South Africa
| | - Geraldine O'Hara
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Monique Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, 51/59 Nakiwogo Rd, Entebbe, Uganda
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK.,Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX1 3SY, UK
| |
Collapse
|
18
|
Philippon F, O'Hara G, Connolly S, Thibault B, Champagne J, Sarrazin J, Molin F, Nault I, Blier L, Healey J. THE SIMPLE TRIAL: A LARGE ICD IMPLANT COHORT SHOWING A LOW RATE OF INFECTION. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
19
|
Bolinger B, Sims S, Swadling L, O'Hara G, de Lara C, Baban D, Saghal N, Lee LN, Marchi E, Davis M, Newell E, Capone S, Folgori A, Barnes E, Klenerman P. Adenoviral Vector Vaccination Induces a Conserved Program of CD8(+) T Cell Memory Differentiation in Mouse and Man. Cell Rep 2015; 13:1578-88. [PMID: 26586434 PMCID: PMC4670868 DOI: 10.1016/j.celrep.2015.10.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 06/02/2014] [Revised: 09/09/2015] [Accepted: 10/10/2015] [Indexed: 02/02/2023] Open
Abstract
Following exposure to vaccines, antigen-specific CD8+ T cell responses develop as long-term memory pools. Vaccine strategies based on adenoviral vectors, e.g., those developed for HCV, are able to induce and sustain substantial CD8+ T cell populations. How such populations evolve following vaccination remains to be defined at a transcriptional level. We addressed the transcriptional regulation of divergent CD8+ T cell memory pools induced by an adenovector encoding a model antigen (beta-galactosidase). We observe transcriptional profiles that mimic those following infection with persistent pathogens, murine and human cytomegalovirus (CMV). Key transcriptional hallmarks include upregulation of homing receptors and anti-apoptotic pathways, driven by conserved networks of transcription factors, including T-bet. In humans, an adenovirus vaccine induced similar CMV-like phenotypes and transcription factor regulation. These data clarify the core features of CD8+ T cell memory following vaccination with adenovectors and indicate a conserved pathway for memory development shared with persistent herpesviruses. Adenovector vaccination induces two transcriptionally distinct CD8 memory responses The sustained response induced by adenovectors and CMV is closely related The core molecular features are shared tightly in mouse and man Adenovaccines in humans induce a CD8 response that recapitulates these core features
Collapse
Affiliation(s)
- Beatrice Bolinger
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford OX1 3SY, UK; Department Biomedicine, University of Basel, 4056 Basel, Switzerland.
| | - Stuart Sims
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford OX1 3SY, UK
| | - Leo Swadling
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford OX1 3SY, UK
| | - Geraldine O'Hara
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford OX1 3SY, UK
| | - Catherine de Lara
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford OX1 3SY, UK
| | - Dilair Baban
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Natasha Saghal
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Lian Ni Lee
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford OX1 3SY, UK
| | - Emanuele Marchi
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford OX1 3SY, UK
| | - Mark Davis
- Department of Microbiology and Immunology, Stanford University, Stanford, CA 94305, USA
| | - Evan Newell
- Singapore Institute for Clinical Sciences, Agency of Science Technology and Research (A(∗)STAR), Singapore 138632, Singapore
| | | | | | - Ellie Barnes
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford OX1 3SY, UK; NIHR Biomedical Research Centre, Oxford OX3 9DU, UK
| | - Paul Klenerman
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford OX1 3SY, UK; NIHR Biomedical Research Centre, Oxford OX3 9DU, UK
| |
Collapse
|
20
|
Ta V, Montigny M, Greiss I, Dion D, Breton R, Barrero M, Essebag V, Sarrazin J, Kus T, Ayala-Paredes F, Brulotte S, Sandrin F, Palaic M, Houde G, O'Hara G, Philippon F, Boudreault C, Huynh T. MANAGEMENT OF PATIENTS WITH ATRIAL FIBRILLATION BY FAMILY MEDICINE GROUPS IN QUÉBEC: INSIGHTS FROM THE I-FACILITER STUDY. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
21
|
Nault I, Plourde B, Sarrazin J, O'Hara G, Philippon F, Blier L, Molin F, Champagne J. VALIDATION OF A NOVEL SINGLE LEAD HEART RHYTHM MONITOR. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
22
|
Abstract
On 23 March 2014, the World Health Organization confirmed an outbreak of Ebola virus disease in Guinea. By August 2014, a delayed international response resulted in an unprecedented humanitarian emergency occurring in Guinea, Liberia and Sierra Leone. In this outbreak, over 26,000 people have been infected with Ebola virus and more than 10,000 have died. Médecins Sans Frontières led the emergency response on the ground treating over 5,000 confirmed cases of Ebola. This article reflects on challenges faced working in an Ebola treatment centre and what future research may offer.
Collapse
Affiliation(s)
- Geraldine O'Hara
- London School of Hygiene and Tropical Medicine, London, UK, and medical doctor, Médecins Sans Frontières, Ebola Treatment Centre, Kailahun, Sierra Leone
| |
Collapse
|
23
|
Barrett J, O'Hara G, Nundoll A, Price N, Milburn H, Breen R. M42 Increasing Complexity Of Treating Tb In Older Patients. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
24
|
Dulac A, Sarrazin J, Nault I, O'Hara G, Philippon F, Molin F, Blier L, Champagne J. COMPARISON OF PULMONARY VEIN ISOLATION USING THE FIRST-GENERATION ARCTIC FRONT CRYOBALLOON VERSUS THE MOST RECENT ARCTIC FRONT ADVANCE CRYOBALLOON FOR PAROXYSMAL ATRIAL FIBRILLATION. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
25
|
Beverley PCL, Ruzsics Z, Hey A, Hutchings C, Boos S, Bolinger B, Marchi E, O'Hara G, Klenerman P, Koszinowski UH, Tchilian EZ. A novel murine cytomegalovirus vaccine vector protects against Mycobacterium tuberculosis. J Immunol 2014; 193:2306-16. [PMID: 25070842 PMCID: PMC4134927 DOI: 10.4049/jimmunol.1302523] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Tuberculosis remains a global health problem so that a more effective vaccine than bacillus Calmette–Guérin is urgently needed. Cytomegaloviruses persist lifelong in vivo and induce powerful immune and increasing (“inflationary”) responses, making them attractive vaccine vectors. We have used an m1–m16-deleted recombinant murine CMV (MCMV) expressing Mycobacterium tuberculosis Ag 85A to show that infection of mice with this recombinant significantly reduces the mycobacterial load after challenge with M. tuberculosis, whereas control empty virus has a lesser effect. Both viruses induce immune responses to H-2d–restricted epitopes of MCMV pp89 and M18 Ags characteristic of infection with other MCMVs. A low frequency of 85A-specific memory cells could be revealed by in vivo or in vitro boosting or after challenge with M. tuberculosis. Kinetic analysis of M. tuberculosis growth in the lungs of CMV-infected mice shows early inhibition of M. tuberculosis growth abolished by treatment with NK-depleting anti–asialo ganglio-N-tetraosylceramide Ab. Microarray analysis of the lungs of naive and CMV-infected mice shows increased IL-21 mRNA in infected mice, whereas in vitro NK assays indicate increased levels of NK activity. These data indicate that activation of NK cells by MCMV provides early nonspecific protection against M. tuberculosis, potentiated by a weak 85A-specific T cell response, and they reinforce the view that the innate immune system plays an important role in both natural and vaccine-induced protection against M. tuberculosis.
Collapse
Affiliation(s)
- Peter C L Beverley
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, United Kingdom; and
| | - Zsolt Ruzsics
- Max von Pettenkofer Institute, Ludwig Maximilians University, D-80336 Munich, Germany
| | - Ariann Hey
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, United Kingdom; and
| | - Claire Hutchings
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, United Kingdom; and
| | - Simone Boos
- Max von Pettenkofer Institute, Ludwig Maximilians University, D-80336 Munich, Germany
| | - Beatrice Bolinger
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, United Kingdom; and
| | - Emanuele Marchi
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, United Kingdom; and
| | - Geraldine O'Hara
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, United Kingdom; and
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, United Kingdom; and
| | - Ulrich H Koszinowski
- Max von Pettenkofer Institute, Ludwig Maximilians University, D-80336 Munich, Germany
| | - Elma Z Tchilian
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, United Kingdom; and
| |
Collapse
|
26
|
Nigam A, Talajic M, Roy D, Nattel S, Lambert J, Nozza A, Jones P, O'Hara G, Kopecky S, Brophy J, Tardif J. Multicentre Trial of Fish Oil for the Reduction of Atrial Fibrillation Recurrence, Inflammation and Oxidative Stress: the Atrial Fibrillation Fish Oil Research Study. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
27
|
Roy K, Champagne J, Sarrazin J, Nault I, O'Hara G, Blier L, Molin F, Philippon F. ICD Generator Change With a Functional Sprint Fidelis Lead: Reuse It or Not? Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
28
|
Steinberg C, Sarrazin J, Champagne J, Philippon F, Nault I, Molin F, Blier L, O'Hara G. High Annual Incidence of New Riata Insulation Defects in a Prospective Cohort. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
29
|
Steinberg C, Sarrazin J, Champagne J, Philippon F, Molin F, Nault I, Blier L, O'Hara G. High Voltage Testing of Riata Defibrillation Leads With Insulation Defects - a Single Center Experience. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
30
|
Steinberg C, Sarrazin J, Champagne J, Philippon F, Molin F, Nault I, Blier L, O'Hara G. Pa/Lateral Chest X-Ray Is Non-Inferior to Fluoroscopy for the Detection of Insulation Defects in Riata Defibrillation Leads. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
31
|
Steinberg C, Sarrazin J, Bouchard M, Philippon F, O'Hara G, Molin F, Nault I, Blier L, Champagne J. 765 High Prevalence of Riata Insulation Defects Detected by Systematic PA/Lateral Chest-X Ray - A Single Center Experience. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
32
|
Barnes E, Folgori A, Capone S, Swadling L, Aston S, Kurioka A, Meyer J, Huddart R, Smith K, Townsend R, Brown A, Antrobus R, Ammendola V, Naddeo M, O'Hara G, Willberg C, Harrison A, Grazioli F, Esposito ML, Siani L, Traboni C, Oo Y, Adams D, Hill A, Colloca S, Nicosia A, Cortese R, Klenerman P. Novel adenovirus-based vaccines induce broad and sustained T cell responses to HCV in man. Sci Transl Med 2012. [PMID: 22218690 DOI: 10.1126/scitranslmed.300315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Currently, no vaccine exists for hepatitis C virus (HCV), a major pathogen thought to infect 170 million people globally. Many studies suggest that host T cell responses are critical for spontaneous resolution of disease, and preclinical studies have indicated a requirement for T cells in protection against challenge. We aimed to elicit HCV-specific T cells with the potential for protection using a recombinant adenoviral vector strategy in a phase 1 study of healthy human volunteers. Two adenoviral vectors expressing NS proteins from HCV genotype 1B were constructed based on rare serotypes [human adenovirus 6 (Ad6) and chimpanzee adenovirus 3 (ChAd3)]. Both vectors primed T cell responses against HCV proteins; these T cell responses targeted multiple proteins and were capable of recognizing heterologous strains (genotypes 1A and 3A). HCV-specific T cells consisted of both CD4+ and CD8+ T cell subsets; secreted interleukin-2, interferon-γ, and tumor necrosis factor-α; and could be sustained for at least a year after boosting with the heterologous adenoviral vector. Studies using major histocompatibility complex peptide tetramers revealed long-lived central and effector memory pools that retained polyfunctionality and proliferative capacity. These data indicate that an adenoviral vector strategy can induce sustained T cell responses of a magnitude and quality associated with protective immunity and open the way for studies of prophylactic and therapeutic vaccines for HCV.
Collapse
Affiliation(s)
- Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Mokrani B, Champagne J, Philippon F, O'Hara G, Naults I, Zannad N, Molin F, Blier L, Sarrazin J. 344 Pulmonary vein isolation for paroxysmal atrial fibrillation using cryoballoon: The initial canadian experience. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
34
|
Mokrani B, Champagne J, Sarrazin J, Philippon F, O'Hara G, Gingras M, Zannad N, Blier L, Molin F, Naults I. 584 Silent cerebral thromboembolic lesions on MRI following atrial fibrillation ablation with different technologies. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
35
|
Mokrani B, Molin F, O'Hara G, Blier L, Champagne J, Sarrazin J, Naults I, Zannad N, Philippon F. 561 Percutaneous lead extraction using the evolution™ system: A single centre experience. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
36
|
Mokrani B, Sarrazin J, Naults I, O'Hara G, Zannad N, Blier L, Philippon F, Molin F, Champagne J. 270 Short-term results of pulmonary vein isolation for paroxysmal atrial fibrillation using duty-cycled bipolar and unipolar radiofrequency energy: The initial Québec experience. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
37
|
Mokrani B, Sarrazin J, Champagne J, Naults I, Zannad N, Blier L, Philippon F, Molin F, O'Hara G. 345 Prospective study comparing duty-cycled bipolar and unipolar radiofrequency to pulmonary vein isolation by point-by-point ablation and cryoballoon ablation. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
38
|
Sarrazin J, Philippon F, Tessier M, Guimond J, Nadeau M, Molin F, Champagne J, Trottier M, Nault I, Blier L, O'Hara G. 555 18F-FDG PET/CT as a new imaging modality for diagnosis of cardiac device infections (PET-ID). Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
39
|
Hutchinson S, Sims S, O'Hara G, Silk J, Gileadi U, Cerundolo V, Klenerman P. A dominant role for the immunoproteasome in CD8+ T cell responses to murine cytomegalovirus. PLoS One 2011; 6:e14646. [PMID: 21304910 PMCID: PMC3033404 DOI: 10.1371/journal.pone.0014646] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 01/06/2011] [Indexed: 01/08/2023] Open
Abstract
Murine cytomegalovirus (MCMV) is an important animal model of human cytomegalovirus (HCMV), a β-Herpesvirus that infects the majority of the world's population and causes disease in neonates and immunocompromised adults. CD8+ T cells are a major part of the immune response to MCMV and HCMV. Processing of peptides for presentation to CD8+ T cells may be critically dependent on the immunoproteasome, expression of which is affected by MCMV. However, the overall importance of the immunoproteasome in the generation of immunodominant peptides from MCMV is not known. We therefore examined the role of the immunoproteasome in stimulation of CD8+ T cell responses to MCMV – both conventional memory responses and those undergoing long-term expansion or “inflation”. We infected LMP7−/− and C57BL/6 mice with MCMV or with newly-generated recombinant vaccinia viruses (rVVs) encoding the immunodominant MCMV protein M45 in either full-length or epitope-only minigene form. We analysed CD8+ T cell responses using intracellular cytokine stain (ICS) and MHC Class I tetramer staining for a panel of MCMV-derived epitopes. We showed a critical role for immunoproteasome in MCMV affecting all epitopes studied. Interestingly we found that memory “inflating” epitopes demonstrate reduced immunoproteasome dependence compared to non-inflating epitopes. M45-specific responses induced by rVVs remain immunoproteasome-dependent. These results help to define a critical restriction point for CD8+ T cell epitopes in natural cytomegalovirus (CMV) infection and potentially in vaccine strategies against this and other viruses.
Collapse
Affiliation(s)
- Sarah Hutchinson
- Nuffield Department of Clinical Medicine, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, United Kingdom
| | - Stuart Sims
- Nuffield Department of Clinical Medicine, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, United Kingdom
| | - Geraldine O'Hara
- Nuffield Department of Clinical Medicine, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, United Kingdom
| | - Jon Silk
- Weatherall Institute of Molecular Medicine, Molecular Immunology Group, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Uzi Gileadi
- Weatherall Institute of Molecular Medicine, Molecular Immunology Group, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Vincenzo Cerundolo
- Weatherall Institute of Molecular Medicine, Molecular Immunology Group, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Paul Klenerman
- Nuffield Department of Clinical Medicine, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, United Kingdom
- * E-mail:
| |
Collapse
|
40
|
O'Hara G. On the front line: The Somalia diary. Assoc Med J 2007. [DOI: 10.1136/sbmj.070132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
41
|
Champagne J, Cantin B, Philippon E, Gilbert M, O'Hara G, Molin F, Robitaille M, Dagenais G. 11.3 Prevalence, prognostic and electrocardiographic patterns of the brugada syndrome in the quebec cardiovascular study. Europace 2003. [DOI: 10.1016/eupace/4.supplement_1.a18-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - B. Cantin
- Quebec Heart Institute, Quebec City, Canada
| | | | - M. Gilbert
- Quebec Heart Institute, Quebec City, Canada
| | - G. O'Hara
- Quebec Heart Institute, Quebec City, Canada
| | - F. Molin
- Quebec Heart Institute, Quebec City, Canada
| | | | | |
Collapse
|
42
|
Champagne J, Boucher G, O'Hara G, Philippon F, Molin F, Blier L, Gilbert M. 9.7 Outcome of patients with hemodynamically stable ventricular tachycardia. Europace 2003. [DOI: 10.1016/eupace/4.supplement_1.a16-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - G. Boucher
- Quebec Heart Institute, Quebec City, Canada
| | - G. O'Hara
- Quebec Heart Institute, Quebec City, Canada
| | | | - F. Molin
- Quebec Heart Institute, Quebec City, Canada
| | - L. Blier
- Quebec Heart Institute, Quebec City, Canada
| | - M. Gilbert
- Quebec Heart Institute, Quebec City, Canada
| |
Collapse
|
43
|
Champagne J, Molin E, O'Hara G, Philippon F, Gilbert M, Charbonneau L, Chahine M. 11.2 Utility and role of a teaching program for physicians to identify brugada syndrome: experience of the quebec heart institute with a French canadian population. Europace 2003. [DOI: 10.1016/eupace/4.supplement_1.a18-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - E. Molin
- Quebec Heart Institute, Quebec City, Canada
| | - G. O'Hara
- Quebec Heart Institute, Quebec City, Canada
| | | | - M. Gilbert
- Quebec Heart Institute, Quebec City, Canada
| | | | - M. Chahine
- Quebec Heart Institute, Quebec City, Canada
| |
Collapse
|
44
|
Champagne J, O'Hara G, Molin F, Philippon F, Chahine M, Poirier P, Charbonneau L, Gilbert M. 11.8 Utility of the I.V. procainamide test to unmask a concealed form of Brugada syndrome. Europace 2003. [DOI: 10.1016/eupace/4.supplement_1.a19-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - G. O'Hara
- Quebec Heart Institute, Quebec City, Canada
| | - F. Molin
- Quebec Heart Institute, Quebec City, Canada
| | | | - M. Chahine
- Quebec Heart Institute, Quebec City, Canada
| | - P. Poirier
- Quebec Heart Institute, Quebec City, Canada
| | | | - M. Gilbert
- Quebec Heart Institute, Quebec City, Canada
| |
Collapse
|
45
|
|
46
|
Langdeau JB, Blier L, Turcotte H, O'Hara G, Boulet LP. Electrocardiographic findings in athletes: the prevalence of left ventricular hypertrophy and conduction defects. Can J Cardiol 2001; 17:655-9. [PMID: 11420576] [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
OBJECTIVES To determine whether there are electrocardiographic differences or distinctive abnormalities between athletes and sedentary subjects, and to verify the relationship between vagal activity measured by heart rate variability (SD of all normal-to-normal intervals [SDNN]) and possible electrocardiographic abnormalities. SUBJECTS AND METHODS Resting electrocardiograms and heart rate variability measurements were performed separately during a single visit on 100 athletes and 50 nonathlete control subjects aged 18 to 55 years. The athletes were from the following various sports disciplines: long-distance running, mountain biking, cross-country skiing, biathlon, speed skating, swimming and triathlon. RESULTS AND CONCLUSIONS There were significantly longer RR intervals, PR intervals and QT intervals in athletes than in control subjects (all P<0.05). The QRS complex and QTc did not show significant differences (both P>0.05). The prevalence of left ventricular hypertrophy (LVH) and incomplete right bundle branch block (IRBBB) was 10% and 7%, respectively, in athletes, but these conditions were absent in control subjects; among athletes, 2% presented with both conditions. LVH and IRBBB were more common among long-distance runners (six of 14 and four of 14, respectively) and could be attributed to normal, long term adaptation to intense, repeated exercise. LVH was related to age (P=0.04), whereas IRBBB was influenced by the number of years of training in the respective sports discipline (P=0.03). The mean SDNN value was significantly more elevated in athletes (P=0.0001), reflecting a higher parasympathetic tone than in sedentary control subjects. However, there was no relationship between vagal activity and LVH or IRBBB (both P>0.05).
Collapse
|
47
|
Lessard E, Yessine MA, Hamelin BA, Gauvin C, Labbé L, O'Hara G, LeBlanc J, Turgeon J. Diphenhydramine alters the disposition of venlafaxine through inhibition of CYP2D6 activity in humans. J Clin Psychopharmacol 2001; 21:175-84. [PMID: 11270914 DOI: 10.1097/00004714-200104000-00009] [Citation(s) in RCA: 57] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CYP2D6 is the major enzyme involved in the metabolism of venlafaxine. Subjects with a low CYP2D6 activity have increased plasma concentrations of venlafaxine that may predispose them to cardiovascular side effects. In vitro and in vivo studies showed that diphenhydramine, a nonprescription antihistamine, can inhibit CYP2D6 activity. Therefore, the authors investigated in this study a potential drug interaction between diphenhydramine and venlafaxine. Fifteen male volunteers, nine with the extensive metabolizer (EM) and six with the poor metabolizer (PM) phenotype of CYP2D6, received venlafaxine hydrochloride 18.75 mg orally every 12 hours for 48 hours on two occasions (1 week apart): once alone and once during the concomitant administration of diphenhydramine hydrochloride (50 mg every 12 hours). Blood and urine samples were collected for 12 hours under steady-state conditions. In EMs, diphenhydramine decreased venlafaxine oral clearance from 104+/-60 L/hr to 43+/-23 L/hr (mean +/- SD; p < 0.05) without any effect on renal clearance (4+/-1 L/hr during venlafaxine alone and 4+/-2 L/hr during venlafaxine plus diphenhydramine). In PMs, coadministration of diphenhydramine did not cause significant changes in oral clearance and partial metabolic clearances of venlafaxine to its various metabolites. Diphenhydramine disposition was only slightly affected by genetically determined low CYP2D6 activity or concomitant administration of venlafaxine. In conclusion, diphenhydramine, at therapeutic doses, inhibits CYP2D6-mediated metabolism of venlafaxine in humans. Clinically significant interactions could be encountered during the concomitant administration of diphenhydramine and other antidepressant or antipsychotic drugs that are substrates of CYP2D6.
Collapse
Affiliation(s)
- E Lessard
- Quebec Heart Institute, Laval Hospital, Canada
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Labbé L, O'Hara G, Lefebvre M, Lessard E, Gilbert M, Adedoyin A, Champagne J, Hamelin B, Turgeon J. Pharmacokinetic and pharmacodynamic interaction between mexiletine and propafenone in human beings. Clin Pharmacol Ther 2000; 68:44-57. [PMID: 10945315 DOI: 10.1067/mcp.2000.108023] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [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: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Mexiletine and propafenone are often used concomitantly and are metabolized by the same cytochrome P450 isozymes, namely CYP2D6, CYP1A2, and probably CYP3A4. Our objective was to study the potential pharmacokinetic and electrophysiological interactions between mexiletine and propafenone. METHODS Fifteen healthy volunteers, 8 extensive metabolizers and 7 poor metabolizers of CYP2D6, received oral doses of mexiletine 100 mg two times daily from day 1 to day 8 and oral doses of propafenone 150 mg two times daily from day 5 to day 12. Interdose studies were performed at steady-state on mexiletine alone (day 4), mexiletine plus propafenone (day 8), and propafenone alone (day 12). RESULTS In subjects in the extensive metabolizer group, coadministration of propafenone decreased oral clearances of R-(-)-mexiletine (from 41+/-11 L/h to 28+/-7 L/h) and S-(+)-mexiletine (from 43+/-15 L/h to 29+/-11 L/h) to an extent such that these values were no longer different between the extensive and the poor metabolizer groups. Propafenone coadministration also decreased partial metabolic clearances of mexiletine to hydroxymethylmexiletine, p-hydroxymexiletine, and m-hydroxymexiletine in extensive metabolizers by 71%, 67%, and 73%, respectively. In contrast, propafenone did not alter the kinetics of mexiletine enantiomers in subjects in the poor metabolizer group except for a slight decrease in the formation of hydroxymethylmexiletine. Pharmacokinetic parameters of propafenone were not changed during concomitant administration of mexiletine in subjects of either phenotype. Finally, electrocardiographic parameters (QRS duration, QTc, RR, and PR intervals) were not modified during the combined administration of the drugs. CONCLUSION Propafenone is a potent CYP2D6 inhibitor that may cause an increase in plasma concentrations of coadministered CYP2D6 substrates.
Collapse
Affiliation(s)
- L Labbé
- Quebec Heart Institute, Faculty of Pharmacy, Laval University, and the Quebec Toxicology Center, CHUQ, Sainte Foy, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Lessard E, Hamelin BA, Labbé L, O'Hara G, Bélanger PM, Turgeon J. Involvement of CYP2D6 activity in the N-oxidation of procainamide in man. Pharmacogenetics 1999; 9:683-96. [PMID: 10634131 DOI: 10.1097/01213011-199912000-00003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Occurrence of a lupus-like syndrome in a significant number of patients treated with procainamide has limited the clinical use of this antiarrhythmic drug. In-vitro studies conducted in our laboratory have demonstrated that CYP2D6 is the major cytochrome P450 isozyme involved in the formation of N-hydroxyprocainamide, a metabolite potentially involved in the drug-induced lupus erythematosus syndrome observed with procainamide. In the current study, we evaluated the role of CYP2D6 activity in the in-vivo oxidation of procainamide in man. Nineteen healthy individuals, 13 with high (extensive metabolizers) and six with low (poor metabolizers) CYP2D6 activity, received a single 500 mg oral dose of procainamide hydrochloride on two occasions, once alone (period 1) and once during the concomitant administration of the selective inhibitor quinidine (50 mg four times daily; period 2). Blood and urine samples were collected over 36 h after drug administration of procainamide and analysed for procainamide and its major metabolites (N-acetylprocainamide, desethylprocainamide, N-acetyl-desethylprocainamide, p-aminobenzoic acid and its N-acetylated derivative, and nitroprocainamide). No differences were observed in the oral and renal clearances of procainamide between extensive metabolizers and poor metabolizers during either study period. However, partial metabolic clearance of procainamide to desethylprocainamide was significantly greater in extensive metabolizers than in poor metabolizers during both periods. Most importantly, the urinary excretion of nitroprocainamide during period 1 was measurable in 7/13 extensive metabolizers but in none of the poor metabolizers. During the concomitant administration of quinidine, nitroprocainamide could not be detected in the urine of any individuals tested. Therefore, our results suggest that CYP2D6 is involved in the in-vivo aliphatic amine deethylation and N-oxidation of procainamide at its arylamine function in man. Further studies are needed to demonstrate whether a low CYP2D6 activity, either genetically determined or pharmacologically modulated, could prevent drug-induced lupus erythematosus syndrome observed during chronic therapy with procainamide.
Collapse
Affiliation(s)
- E Lessard
- Quebec Heart Institute, Laval Hospital, and Laval University, Ste-Foy, Canada
| | | | | | | | | | | |
Collapse
|
50
|
Lessard E, Yessine MA, Hamelin BA, O'Hara G, LeBlanc J, Turgeon J. Influence of CYP2D6 activity on the disposition and cardiovascular toxicity of the antidepressant agent venlafaxine in humans. Pharmacogenetics 1999; 9:435-43. [PMID: 10780263] [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: 02/16/2023]
Abstract
According to in-vitro studies with microsomes from human livers and from yeast expression systems with high CYP2D6 activity, the major oxidation pathway of venlafaxine is catalysed by CYP2D6. In this study, we investigated the role of the CYP2D6 polymorphism and the effects of low-dose quinidine, a selective inhibitor of, CYP2D6, on the disposition of venlafaxine. Fourteen healthy men, eight with the extensive metabolizer and six with the poor metabolizer phenotype were administered venlafaxine hydrochloride 18.75 mg orally every 12 h for 48 h on two occasions (1 week apart); once alone and once during the concomitant administration of quinidine sulfate 100 mg every 12 h. Blood and urine samples were collected under steady-state conditions over one dosing interval (12 h). When venlafaxine was administered alone, the oral clearance of venlafaxine was more than fourfold less in poor metabolizers compared to extensive metabolizers (P < 0.05). This was mainly due to a decreased capability of poor metabolizers to form O-desmethylated metabolites at the position 4 of the aromatic moiety. In extensive metabolizers, quinidine decreased venlafaxine oral clearance from 100 +/- 62 l/h to 17 +/- 5 l/h (mean +/- SD; P < 0.05) without any effects on renal clearance (4 +/- 1 l/h during venlafaxine alone and 4 +/- 1 l/h during venlafaxine plus quinidine). In these individuals, the sequential metabolism of venlafaxine to O-desmethylvenlafaxine and to N,O-didesmethylvenlafaxine was inhibited by quinidine coadministration so that metabolic clearances to O-desmethylated metabolites decreased from 43 +/- 32 l/h to 2 +/- 1 l/h (P < 0.05). In poor metabolizers, coadministration of quinidine did not cause significant changes in oral clearance and partial metabolic clearances of venlafaxine to its various metabolites. Decreased CYP2D6 activity could also be associated with cardiovascular toxicity as observed in four patients during treatment with the drug. Thus, genetically determined or pharmacologically altered CYP2D6 activity represents a major determinant of venlafaxine disposition in humans.
Collapse
Affiliation(s)
- E Lessard
- Quebec Heart Institute, Laval Hospital, Ste-Foy, Canada
| | | | | | | | | | | |
Collapse
|