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Newman H, MacFarland SP, Brodeur GM, Olson T, Bhojwani D, Stokke J, Kovach AE, Clark ME, Luo M, Li M, Shah A, Hunger SP. B-cell acute lymphoblastic leukemia and juvenile xanthogranuloma in a patient with ETV6 thrombocytopenia and leukemia predisposition syndrome: novel clinical presentation and perspective. Haematologica 2024; 109:1624-1627. [PMID: 38031764 PMCID: PMC11063871 DOI: 10.3324/haematol.2023.284151] [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: 08/23/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
Not available.
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Affiliation(s)
- Haley Newman
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Suzanne P MacFarland
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Garrett M Brodeur
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Timothy Olson
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Deepa Bhojwani
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA; Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Jamie Stokke
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA; Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Alexandra E Kovach
- Keck School of Medicine of University of Southern California, Los Angeles, CA; Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Mary Egan Clark
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Minjie Luo
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Marilyn Li
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Amish Shah
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Stephen P Hunger
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
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2
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Newman H, Li Y, Huang YV, Elgarten CW, Myers RM, Ruiz J, Zheng DJ, Leahy AB, Aftandilian C, Arnold SD, Bona K, Gramatges MM, Heneghan MB, Maloney KW, Modi AJ, Mody RJ, Morgan E, Rubnitz J, Winick N, Wilkes JJ, Seif AE, Fisher BT, Aplenc R, Getz KD. Household income and health-related quality of life in children receiving treatment for acute myeloid leukemia: Potential impact of selection bias in health equity research. Cancer Med 2024; 13:e6966. [PMID: 38572962 PMCID: PMC10993703 DOI: 10.1002/cam4.6966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Examine the influence of household income on health-related quality of life (HRQOL) among children with newly diagnosed acute myeloid leukemia (AML). DESIGN Secondary analysis of data prospectively collected from pediatric patients receiving treatment for AML at 14 hospitals across the United States. EXPOSURE Household income was self-reported on a demographic survey. The examined mediators included the acuity of presentation and treatment toxicity. OUTCOME Caregiver proxy reported assessment of patient HRQOL from the Peds QL 4.0 survey. RESULT Children with AML (n = 131) and caregivers were prospectively enrolled to complete PedsQL assessments. HRQOL scores were better for patients in the lowest versus highest income category (mean ± SD: 76.0 ± 14 household income <$25,000 vs. 59.9 ± 17 income ≥$75,000; adjusted mean difference: 11.2, 95% CI: 2.2-20.2). Seven percent of enrolled patients presented with high acuity (ICU-level care in the first 72 h), and 16% had high toxicity (any ICU-level care); there were no identifiable differences by income, refuting mediating roles in the association between income and HRQOL. Enrolled patients were less likely to be Black/African American (9.9% vs. 22.2%), more likely to be privately insured (50.4% vs. 40.7%), and more likely to have been treated on a clinical trial (26.7% vs. 18.5%) compared to eligible unenrolled patients not enrolled. Evaluations of potential selection bias on the association between income and HRQOL suggested differences in HRQOL may be smaller than observed or even in the opposing direction. CONCLUSIONS While primary analyses suggested lower household income was associated with superior HRQOL, differential participation may have biased these results. Future studies should partner with patients/families to identify strategies for equitable participation in clinical research.
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Affiliation(s)
- Haley Newman
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Yimei Li
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology, and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Yuan‐Shung V. Huang
- Department of Biomedical and Health InformaticsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Caitlin W. Elgarten
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Regina M. Myers
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jenny Ruiz
- Division of Hematology‐Oncology, Department of PediatricsUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Daniel J. Zheng
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Alison Barz Leahy
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Catherine Aftandilian
- Division of Pediatric Hematology‐Oncology, Stem Cell Transplant and Regenerative Medicine, Department of PediatricsStanford UniversityStanfordCaliforniaUSA
| | - Staci D. Arnold
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaEmory University School of MedicineAtlantaGeorgiaUSA
| | - Kira Bona
- Division of Population Sciences, Department of Pediatric OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - M. Monica Gramatges
- Division of Pediatric Hematology‐Oncology, Department of PediatricsTexas Children's Hospital, Baylor College of MedicineHoustonTexasUSA
| | - Mallorie B. Heneghan
- Division of Pediatric Hematology‐Oncology, Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | - Kelly W. Maloney
- Department of Pediatrics‐Hematology/Oncology and Bone Marrow Transplant, University of Colorado Cancer CenterChildren's Hospital ColoradoAuroraColoradoUSA
| | - Arunkumar J. Modi
- Division of Hematology Oncology, Department of PediatricsUniversity of Arkansas for Medical Sciences, Arkansas Children's HospitalLittle RockArkansasUSA
| | - Rajen J. Mody
- Department of PediatricsUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Elaine Morgan
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jeffrey Rubnitz
- Department of OncologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Naomi Winick
- Department of Pediatric Hematology OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Jennifer J. Wilkes
- Division of Cancer and Blood Disorders, Department of PediatricsUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Alix E. Seif
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Childhood Cancer ResearchChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Brian T. Fisher
- Center for Childhood Cancer ResearchChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Division of Infectious Disease, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Richard Aplenc
- Division of Oncology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Childhood Cancer ResearchChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Kelly D. Getz
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology, and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Newman H, Clark ME, Wong D, Wu J, Brodeur GM, Hunger SP, Tasian SK, Olson T, Warren JT, Teachey DT, Bona K, Schubert J, Golenberg N, Patel M, Denenberg EH, Fanning EA, Chen J, Luke T, Charles S, Gallo D, Cao K, Fu W, Fan Z, Surrey LF, Wertheim G, Luo M, MacFarland SP, Li MM, Zhong Y. Genomic profiling of pediatric hematologic malignancies and diagnosis of cancer predisposition syndromes: tumor-only versus paired tumor-normal sequencing. Haematologica 2024. [PMID: 38385299 DOI: 10.3324/haematol.2023.284855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Indexed: 02/23/2024] Open
Abstract
Not available.
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Affiliation(s)
- Haley Newman
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mary Egan Clark
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Derek Wong
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jinhua Wu
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Garrett M Brodeur
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Stephen P Hunger
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sarah K Tasian
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Timothy Olson
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julia T Warren
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Division of Hematology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - David T Teachey
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kira Bona
- Department of Pediatric Oncology, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Jeffrey Schubert
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Netta Golenberg
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Maha Patel
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Elizabeth H Denenberg
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Elizabeth A Fanning
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jiani Chen
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Tamara Luke
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sarah Charles
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Daniel Gallo
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kajia Cao
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Weixuan Fu
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Zhiqian Fan
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lea F Surrey
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Gerald Wertheim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Minjie Luo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Suzanne P MacFarland
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Marilyn M Li
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Yiming Zhong
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
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4
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Newman H, Hunger SP. Future of Treatment of Adolescents and Young Adults With ALL: A Vision for Collaboration and Equity. J Clin Oncol 2024; 42:665-674. [PMID: 37890130 DOI: 10.1200/jco.23.01351] [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: 06/25/2023] [Revised: 08/03/2023] [Accepted: 08/30/2023] [Indexed: 10/29/2023] Open
Abstract
Over the past several decades, survival of children with ALL has improved dramatically with treatment regimens refined through cooperative group trials. Despite aggressive treatment and iterative therapy changes for adolescents and young adults (AYAs), improvement has not been as promising. Comparisons between pediatric and adult clinical trials have consistently demonstrated superior outcomes for AYAs treated on pediatric ALL protocols, leading to the implementation of pediatric-inspired ALL protocols by several groups worldwide and/or expansion of the age limit of pediatric trials to include the full spectrum of the AYA population. Despite these efforts, AYAs in both pediatric and adult settings continue to have inferior survival compared with younger children with ALL. Real-world data suggest that uptake of pediatric-style treatment is variable, and even with identical pediatric-style treatment, AYAs still fare worse than younger children. As we enter an era of immunotherapy and precision medicine for newly diagnosed ALL, now is an opportune time to consider how best to approach future therapy for AYA patients. Comparisons of pediatric and adult treatment approaches and subanalyses of AYA patients will help guide harmonization of treatment. The focus of the next stage of ALL therapy for AYA should not only involve novel treatment approaches but also standardization and optimization of supportive care measures, psychosocial support, adherence interventions, oncofertility treatment, and survivorship care. All these efforts should simultaneously work to address health disparities to ensure that a future of improved outcomes is experienced equitably for all AYA patients.
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Affiliation(s)
- Haley Newman
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Division of Oncology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stephen P Hunger
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Division of Oncology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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5
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Tan K, Xu J, Chen C, Vincent T, Pölönen P, Hu J, Yoshimura S, Yu W, Sussman J, Chen CH, Li E, Diorio C, Shraim R, Newman H, Uppuluri L, Li A, Chen G, Bandyopadhyay S, Wu D, Ding YY, Xu J, Lim T, Hsu M, Thadi A, Ahn KJ, Wu CY, Peng J, Sun Y, Wang A, Mehta R, Frank D, Meyer L, Loh M, Raetz E, Chen Z, Wood B, Devidas M, Dunsmore K, Winter S, Chang TC, Wu G, Pounds S, Zhang N, Carroll W, Hunger S, Bernt K, Yang J, Mullighan C, Teachey D. Identification and targeting of treatment resistant progenitor populations in T-cell Acute Lymphoblastic Leukemia. Res Sq 2023:rs.3.rs-3487715. [PMID: 37961674 PMCID: PMC10635362 DOI: 10.21203/rs.3.rs-3487715/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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Refractoriness to initial chemotherapy and relapse after remission are the main obstacles to cure in T-cell Acute Lymphoblastic Leukemia (T-ALL). Biomarker guided risk stratification and targeted therapy have the potential to improve outcomes in high-risk T-ALL; however, cellular and genetic factors contributing to treatment resistance remain unknown. Previous bulk genomic studies in T-ALL have implicated tumor heterogeneity as an unexplored mechanism for treatment failure. To link tumor subpopulations with clinical outcome, we created an atlas of healthy pediatric hematopoiesis and applied single-cell multiomic (CITE-seq/snATAC-seq) analysis to a cohort of 40 cases of T-ALL treated on the Children's Oncology Group AALL0434 clinical trial. The cohort was carefully selected to capture the immunophenotypic diversity of T-ALL, with early T-cell precursor (ETP) and Near/Non-ETP subtypes represented, as well as enriched with both relapsed and treatment refractory cases. Integrated analyses of T-ALL blasts and normal T-cell precursors identified a bone-marrow progenitor-like (BMP-like) leukemia sub-population associated with treatment failure and poor overall survival. The single-cell-derived molecular signature of BMP-like blasts predicted poor outcome across multiple subtypes of T-ALL within two independent patient cohorts using bulk RNA-sequencing data from over 1300 patients. We defined the mutational landscape of BMP-like T-ALL, finding that NOTCH1 mutations additively drive T-ALL blasts away from the BMP-like state. We transcriptionally matched BMP-like blasts to early thymic seeding progenitors that have low NR3C1 expression and high stem cell gene expression, corresponding to a corticosteroid and conventional cytotoxic resistant phenotype we observed in ex vivo drug screening. To identify novel targets for BMP-like blasts, we performed in silico and in vitro drug screening against the BMP-like signature and prioritized BMP-like overexpressed cell-surface (CD44, ITGA4, LGALS1) and intracellular proteins (BCL-2, MCL-1, BTK, NF-κB) as candidates for precision targeted therapy. We established patient derived xenograft models of BMP-high and BMP-low leukemias, which revealed vulnerability of BMP-like blasts to apoptosis-inducing agents, TEC-kinase inhibitors, and proteasome inhibitors. Our study establishes the first multi-omic signatures for rapid risk-stratification and targeted treatment of high-risk T-ALL.
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Affiliation(s)
- Kai Tan
- Children's Hospital of Philadelphia
| | | | | | | | | | | | | | - Wenbao Yu
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia
| | | | - Chia-Hui Chen
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia
| | - Elizabeth Li
- Divsion of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia
| | | | | | | | | | - Alexander Li
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia
| | | | | | - David Wu
- Graduate Group in Genomics and Computational Biology, Perelman School of Medicine
| | | | - Jessica Xu
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia
| | - Tristan Lim
- Perelman School of Medicine, University of Pennsylvania
| | - Miles Hsu
- Perelman School of Medicine, University of Pennsylvania
| | - Anusha Thadi
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia
| | - Kyung Jin Ahn
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia
| | - Chi-Yun Wu
- Graduate Group in Genomics and Computational Biology, Perelman School of Medicine
| | | | | | - Alice Wang
- Graduate Group in Genomics and Computational Biology, Perelman School of Medicine, University of Pennsylvania
| | - Rushabh Mehta
- Graduate Group in Cell & Molecular Biolgy, Perelman School of Medicine, University of Pennsylvania
| | | | - Lauren Meyer
- The Ben Town Center for Childhood Cancer Research, Seattle Children's Hospital
| | | | | | | | | | | | - Kimberly Dunsmore
- Division of Oncology, University of Virginia Children's Hospital, Charlottesville
| | | | | | - Gang Wu
- St Jude Children's Research Hospital
| | | | | | | | | | | | - Jun Yang
- St. Jude Children's Research Hospital
| | | | - David Teachey
- University of Pennsylvania, Children's Hospital of Philadelphia
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Schuelke MR, Bassiri H, Behrens EM, Canna S, Croy C, DiNofia A, Gollomp K, Grupp S, Lambert M, Lambrix A, Maude SL, Myers R, Newman H, Petrosa W, Seif A, Sullivan KE, Teachey DT, Diorio C. Emapalumab for the treatment of refractory cytokine release syndrome in pediatric patients. Blood Adv 2023; 7:5603-5607. [PMID: 37721859 PMCID: PMC10514204 DOI: 10.1182/bloodadvances.2023010712] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/27/2023] [Indexed: 09/20/2023] Open
Affiliation(s)
- Matthew R. Schuelke
- Pediatrics Residency Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Hamid Bassiri
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Edward M. Behrens
- Division of Rheumatology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Scott Canna
- Division of Rheumatology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Colleen Croy
- Department of Pharmacy, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Amanda DiNofia
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Kandace Gollomp
- Division of Hematology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Stephan Grupp
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Michele Lambert
- Division of Hematology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Arathi Lambrix
- Department of Pharmacy, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Shannon L. Maude
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Regina Myers
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Haley Newman
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Whitney Petrosa
- Immune Dysregulation Program, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Alix Seif
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Kathleen E. Sullivan
- Division of Immunology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - David T. Teachey
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Caroline Diorio
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Gabrielsson A, Tromans S, Newman H, Triantafyllopoulou P, Hassiotis A, Bassett P, Watkins L, Sawhney I, Cooper M, Griffiths L, Pullen A, Roy A, Angus-Leppan H, Rh T, Kinney M, Tittensor P, Shankar R. Awareness of social care needs in people with epilepsy and intellectual disability. Epilepsy Behav 2023; 145:109296. [PMID: 37336133 DOI: 10.1016/j.yebeh.2023.109296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Nearly a quarter of people with intellectual disability (ID) have epilepsy with large numbers experiencing drug-resistant epilepsy, and premature mortality. To mitigate epilepsy risks the environment and social care needs, particularly in professional care settings, need to be met. PURPOSE To compare professional care groups as regards their subjective confidence and perceived responsibility when managing the need of people with ID and epilepsy. METHOD A multi-agency expert panel developed a questionnaire with embedded case vignettes with quantitative and qualitative elements to understand training and confidence in the health and social determinants of people with ID and epilepsy. The cross-sectional survey was disseminated amongst health and social care professionals working with people with ID in the UK using an exponential non-discriminative snow-balling methodology. Group comparisons were undertaken using suitable statistical tests including Fisher's exact, Kruskal-Wallis, and Mann-Whitney. Bonferroni correction was applied to significant (p < 0.05) results. Content analysis was conducted and relevant categories and themes were identified. RESULTS Social and health professionals (n = 54) rated their confidence to manage the needs of people with ID and epilepsy equally. Health professionals showed better awareness (p < 0.001) of the findings/recommendations of the latest evidence on premature deaths and identifying and managing epilepsy-related risks, including the relevance of nocturnal monitoring. The content analysis highlighted the need for clearer roles, improved care pathways, better epilepsy-specific knowledge, increased resources, and better multi-disciplinary work. CONCLUSIONS A gap exists between health and social care professionals in awareness of epilepsy needs for people with ID, requiring essential training and national pathways.
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Affiliation(s)
- A Gabrielsson
- Hertfordshire Partnership University NHS Trust, Hatfield, UK
| | - S Tromans
- University of Leicester, Leicester, UK; Leicestershire Partnership NHS Trust, Leicester, UK
| | - H Newman
- University of Plymouth Peninsula School of Medicine, Plymouth, UK
| | | | | | | | - L Watkins
- University of South Wales, Pontypridd, UK; Swansea Bay University Health Board, Port Talbot, UK
| | - I Sawhney
- Hertfordshire Partnership University NHS Trust, Hatfield, UK
| | - M Cooper
- National Development Team for Inclusion Bath, UK
| | - L Griffiths
- National Development Team for Inclusion Bath, UK
| | | | - A Roy
- Coventry and Warwickshire Partnership Trust, Birmingham, UK
| | | | | | - M Kinney
- Belfast Health and Social Trust, Belfast, UK
| | - P Tittensor
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - R Shankar
- University of Plymouth Peninsula School of Medicine, Plymouth, UK; Cornwall Partnership NHS Foundation Trust, Truro, UK.
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8
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Newman H, Teachey DT. PI3king apart a rare disease with targeted therapy. Blood 2023; 141:963-964. [PMID: 36862438 DOI: 10.1182/blood.2022019105] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Affiliation(s)
- Haley Newman
- Children's Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
| | - David T Teachey
- Children's Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
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9
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Newman H, Li Y, Liu H, Myers RM, Tam V, DiNofia A, Wray L, Rheingold SR, Callahan C, White C, Baniewicz D, Winestone LE, Kadauke S, Diorio C, June CH, Getz KD, Aplenc R, Teachey DT, Maude SL, Grupp SA, Bona K, Leahy AB. Impact of poverty and neighborhood opportunity on outcomes for children treated with CD19-directed CAR T-cell therapy. Blood 2023; 141:609-619. [PMID: 36351239 PMCID: PMC9979709 DOI: 10.1182/blood.2022017866] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/08/2022] [Accepted: 09/25/2022] [Indexed: 11/11/2022] Open
Abstract
Children living in poverty experience excessive relapse and death from newly diagnosed acute lymphoblastic leukemia (ALL). The influence of household poverty and neighborhood social determinants on outcomes from chimeric antigen receptor (CAR) T-cell therapy for relapsed/refractory (r/r) leukemia is poorly described. We identified patients with r/r CD19+ ALL/lymphoblastic lymphoma treated on CD19-directed CAR T-cell clinical trials or with commercial tisagenlecleucel from 2012 to 2020. Socioeconomic status (SES) was proxied at the household level, with poverty exposure defined as Medicaid-only insurance. Low-neighborhood opportunity was defined by the Childhood Opportunity Index. Among 206 patients aged 1 to 29, 35.9% were exposed to household poverty, and 24.9% had low-neighborhood opportunity. Patients unexposed to household poverty or low-opportunity neighborhoods were more likely to receive CAR T-cell therapy with a high disease burden (>25%), a disease characteristic associated with inferior outcomes, as compared with less advantaged patients (38% vs 30%; 37% vs 26%). Complete remission (CR) rate was 93%, with no significant differences by household poverty (P = .334) or neighborhood opportunity (P = .504). In multivariate analysis, patients from low-opportunity neighborhoods experienced an increased hazard of relapse as compared with others (P = .006; adjusted hazard ratio [HR], 2.3; 95% confidence interval [CI], 1.3-4.1). There was no difference in hazard of death (P = .545; adjusted HR, 1.2; 95% CI, 0.6-2.4). Among children who successfully receive CAR T-cell therapy, CR and overall survival are equitable regardless of proxied SES and neighborhood opportunity. Children from more advantaged households and neighborhoods receive CAR T-cell therapy with a higher disease burden. Investigation of multicenter outcomes and access disparities outside of clinical trial settings is warranted.
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Affiliation(s)
- Haley Newman
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Yimei Li
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Hongyan Liu
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Regina M. Myers
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Vicky Tam
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Amanda DiNofia
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Lisa Wray
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Susan R. Rheingold
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Colleen Callahan
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Claire White
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Diane Baniewicz
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Lena E. Winestone
- Division of Allergy, Immunology, and Blood & Marrow Transplant, Department of Pediatrics, UCSF Benioff Children’s Hospitals, San Francisco, CA
| | - Stephan Kadauke
- Division of Transfusion Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Caroline Diorio
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Carl H. June
- Parker Institute for Cancer Immunotherapy, University of Pennsylvania, Philadelphia, PA
| | - Kelly D. Getz
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Richard Aplenc
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - David T. Teachey
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Shannon L. Maude
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Stephan A. Grupp
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kira Bona
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Allison Barz Leahy
- Division of Oncology and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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10
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Diorio C, Shraim R, Myers R, Behrens EM, Canna S, Bassiri H, Aplenc R, Burudpakdee C, Chen F, DiNofia AM, Gill S, Gonzalez V, Lambert MP, Leahy AB, Levine BL, Lindell RB, Maude SL, Melenhorst JJ, Newman H, Perazzelli J, Seif AE, Lacey SF, June CH, Barrett DM, Grupp SA, Teachey DT. Comprehensive Serum Proteome Profiling of Cytokine Release Syndrome and Immune Effector Cell-Associated Neurotoxicity Syndrome Patients with B-Cell ALL Receiving CAR T19. Clin Cancer Res 2022; 28:3804-3813. [PMID: 35705524 PMCID: PMC9444956 DOI: 10.1158/1078-0432.ccr-22-0822] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/06/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To study the biology and identify markers of severe cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) in children after chimeric antigen receptor T-cell (CAR T) treatment. EXPERIMENTAL DESIGN We used comprehensive proteomic profiling to measure over 1,400 serum proteins at multiple serial timepoints in a cohort of patients with B-cell acute lymphoblastic leukemia treated with the CD19-targeted CAR T CTL019 on two clinical trials. RESULTS We identified fms-like tyrosine kinase 3 (FLT3) and mast cell immunoglobulin-like receptor 1 (MILR1) as preinfusion predictive biomarkers of severe CRS. We demonstrated that CRS is an IFNγ-driven process with a protein signature overlapping with hemophagocytic lymphohistiocytosis (HLH). We identified IL18 as a potentially targetable cytokine associated with the development of ICANS. CONCLUSIONS We identified preinfusion biomarkers that can be used to predict severe CRS with a sensitivity, specificity, and accuracy superior to the current gold standard of disease burden. We demonstrated the fundamental role of the IFNγ pathway in driving CRS, suggesting CRS and carHLH are overlapping rather than distinct phenomena, an observation with important treatment implications. We identified IL18 as a possible targetable cytokine in ICANS, providing rationale for IL18 blocking therapies to be translated into clinical trials in ICANS.
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Affiliation(s)
- Caroline Diorio
- Immune Dysregulation Frontier Program, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rawan Shraim
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, PA, USA
| | - Regina Myers
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Edward M Behrens
- Immune Dysregulation Frontier Program, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Division of Rheumatology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Scott Canna
- Immune Dysregulation Frontier Program, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Division of Rheumatology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hamid Bassiri
- Immune Dysregulation Frontier Program, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Richard Aplenc
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Chakkapong Burudpakdee
- Immune Dysregulation Frontier Program, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Fang Chen
- Center for Cellular Immunotherapies, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Amanda M. DiNofia
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Saar Gill
- Center for Cellular Immunotherapies, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Vanessa Gonzalez
- Center for Cellular Immunotherapies, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Michele P. Lambert
- Immune Dysregulation Frontier Program, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Division of Hematology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Allison Barz Leahy
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bruce L Levine
- Center for Cellular Immunotherapies, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Robert B. Lindell
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Shannon L Maude
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Center for Cellular Immunotherapies, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J. Joseph Melenhorst
- Center for Cellular Immunotherapies, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Haley Newman
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jessica Perazzelli
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alix E. Seif
- Immune Dysregulation Frontier Program, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Simon F. Lacey
- Center for Cellular Immunotherapies, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Carl H. June
- Center for Cellular Immunotherapies, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Stephan A. Grupp
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David T. Teachey
- Immune Dysregulation Frontier Program, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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11
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Diorio C, Murray R, Naniong M, Barrera L, Camblin A, Chukinas J, Coholan L, Edwards A, Fuller T, Gonzales C, Grupp SA, Ladd A, Le M, Messana A, Musenge F, Newman H, Poh YC, Poulin H, Ryan T, Shraim R, Tasian SK, Vincent T, Young L, Zhang Y, Ciaramella G, Gehrke J, Teachey DT. Cytosine base editing enables quadruple-edited allogeneic CART cells for T-ALL. Blood 2022; 140:619-629. [PMID: 35560156 PMCID: PMC9373016 DOI: 10.1182/blood.2022015825] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [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: 02/07/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
Abstract
Allogeneic chimeric antigen receptor T-cell (CART) therapies require multiple gene edits to be clinically tractable. Most allogeneic CARTs have been created using gene editing techniques that induce DNA double-stranded breaks (DSBs), resulting in unintended on-target editing outcomes with potentially unforeseen consequences. Cytosine base editors (CBEs) install C•G to T•A point mutations in T cells, with between 90% and 99% efficiency to silence gene expression without creating DSBs, greatly reducing or eliminating undesired editing outcomes following multiplexed editing as compared with clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9). Using CBE, we developed 7CAR8, a CD7-directed allogeneic CART created using 4 simultaneous base edits. We show that CBE, unlike CRISPR-Cas9, does not impact T-cell proliferation, lead to aberrant DNA damage response pathway activation, or result in karyotypic abnormalities following multiplexed editing. We demonstrate 7CAR8 to be highly efficacious against T-cell acute lymphoblastic leukemia (T-ALL) using multiple in vitro and in vivo models. Thus, CBE is a promising technology for applications requiring multiplexed gene editing and can be used to manufacture quadruple-edited 7CAR8 cells, with high potential for clinical translation for relapsed and refractory T-ALL.
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Affiliation(s)
- Caroline Diorio
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
| | | | | | | | | | - John Chukinas
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Tori Fuller
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Stephan A Grupp
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
| | | | | | | | | | - Haley Newman
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
| | | | | | - Theresa Ryan
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Rawan Shraim
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sarah K Tasian
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
| | - Tiffaney Vincent
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | | | - David T Teachey
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
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12
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Newman H, Long JM, Zelley K, Baldino S, Li MM, Maxwell KN, MacFarland SP. Looking closely at overgrowth: Constitutional mosaicism in PTEN hamartoma tumor syndrome. Clin Genet 2022; 102:557-559. [PMID: 35923098 DOI: 10.1111/cge.14202] [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] [Received: 06/16/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Haley Newman
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jessica M Long
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristin Zelley
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sarah Baldino
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Marilyn M Li
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kara N Maxwell
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Suzanne P MacFarland
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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13
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Horta F, Newman H, Vargas-ordaz E, Cadarso V, Nosrati R, Neild A, Vollenhoven B, Mercer S, Catt S. P-237 Non-invasive metabolic live cell imaging of early embryo development using adapted confocal microscopy; a safety study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is it safe to use metabolic imaging to measure nicotinamide adenine dinucleotide (NADH) associated auto-fluorescence during embryo development using adapted confocal microscopy?
Summary answer
Non-invasive metabolic imaging is safe as no differences were observed between controls and illuminated embryos in terms of embryo development, blastocyst formation and implantation potential.
What is known already
Developing non-invasive methods that are reliable to assess oocyte and embryo quality has been a significant aim for assisted reproductive technologies. Changes in metabolic activity could lead to cell death or abnormal embryo development and low implantation potential. This could potentially be predicted by incorporating non-invasive measurements of metabolism. Metabolic imaging in embryos has been investigated through complex methodologies, however, scientific evidence for its utility during embryo development using simple technology remains unexplored. Measurements of metabolic activity could be a useful tool as the auto-fluorescence of molecules such as NADH is a straightforward representation of mitochondrial function.
Study design, size, duration
Super-ovulated female mice (n = 30) were subjected to mating with 10 males. In-vivo produced embryos collected at the 2-cell stage were divided in control group (n = 151), sham control group (n = 151) and illuminated group (n = 152). Illuminated embryos were assessed for NADH levels during embryo development every 3 hours using arbitrary units of autofluorescence (AU). Produced blastocysts were assessed for total cell and inner-cell-mass (ICM) number (Oct4 immuno-staining) and implantation potential through outgrowth assays in separate experiments.
Participants/materials, setting, methods
F1 (CBA/C57Bl6) mouse strain was used. NADH auto-fluorescence levels were measured during embryo development using adapted confocal microcopy (Olympus FV1200). A confocal Z-stacking function was used to record 15 focal planes using a 20x/0.95NA air objective of entire embryos, opening the confocal pinhole system completely. Then, images were collected and analysed using FIJI software (version: 2.0.0-rc-69/1.52n;ImageJ). Blastocyst cell number, formation rates and outgrowth rates for 4 days post blastocyst formation were compared between study groups.
Main results and the role of chance
Embryo culture experiments showed no significant differences in blastocyst formation rates between study groups (Control: 71.7%; Sham: 64.9%; Illuminated 71.7%; p > 0.05). Similarly, the total number of cells (Control: 82.9±5.6; Sham: 76.5±3.3; Illuminated: 77.1±4.2; ± Standard error of mean [SEM]) and ICM cells (Control: 10.8±1.3; Sham: 9.4±0.7; Illuminated: 11.9±0.8; ± SEM) did not differ between groups (p > 0.05). Outgrowth assays presented similar outgrowth areas during day5 to day8 post-blastocyst development between study groups (p > 0.05). Illuminated embryos presented significantly different NADH activity levels during embryo development, particularly between the 2-cell stage (987.1±36.2AU), morulae stage (1226±31.5AU) and blastocyst stage (649±42.9AU; ± SEM; p < 0.05). Embryos that did not reach the blastocyst stage presented a significantly different NADH activity profile during embryo development compared to those that did(p < 0.05). Additionally, abnormal embryos also presented significantly decreased NADH activity levels at the 2-cell stage (Normal: 987.1±36.2; abnormal: 726.9±121.7AU; p < 0.05) to the morulae stage (Normal: 1226±31.5; Abnormal:893.3±189AU; p < 0.05). Our study indicates that measuring NADH activity levels during early embryo development present no negative effects in embryo developmental rates, blastocyst formation and implantation potential. Thus, non-invasive measurements of NADH could be applied to determine embryo metabolic activity during embryo development using simple technology and imaging techniques.
Limitations, reasons for caution
The study was conducted using a mouse model focused in early embryo development and implantation potential. Thus, studies on live birth are required to fully assess safety to further validate potential wider applications. Validation in ageing models is also required to assess potential applications for embryo selection.
Wider implications of the findings
Non-invasive measurements of metabolic activity could be applied to determine embryo metabolic activity using simple and safe technology. Further applications could link the use of simple non-invasive metabolic imaging with the latest time-lapse technology and artificial intelligence applications.
Trial registration number
N/A
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Affiliation(s)
- F Horta
- Monash University, Obstetrics and Gynaecology , Melbourne, Australia
- Monash IVF, Research and ARTs , Melbourne, Australia
| | - H Newman
- Monash University, Obstetrics and Gynaecology , Melbourne, Australia
| | - E Vargas-ordaz
- Monash University, Mechanical and Aerospace Engineering , Melbourne, Australia
| | - V Cadarso
- Monash University, Mechanical and Aerospace Engineering , Melbourne, Australia
| | - R Nosrati
- Monash University, Mechanical and Aerospace Engineering , Melbourne, Australia
| | - A Neild
- Monash University, Mechanical and Aerospace Engineering , Melbourne, Australia
| | - B Vollenhoven
- Monash University, Obstetrics and Gynaecology , Melbourne, Australia
| | - S Mercer
- Monash University, Monash Microimaging , Melbourne, Australia
| | - S Catt
- Monash University, Obstetrics and Gynaecology , Melbourne, Australia
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14
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Newman H, Li Y, Liu H, Tam V, Myers RM, DiNofia AM, Callahan C, White CM, Baniewicz D, Kadauke S, Diorio C, Teachey DT, Rheingold SR, Getz KD, June CH, Aplenc R, Maude SL, Grupp SA, Bona K, Barz Leahy AE. Impact of socioeconomic status on survival after CD19 CART therapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7013 Background: CD19-directed chimeric antigen receptor T cell (CART) therapy has dramatically improved survival for children with relapsed/refractory (r/r) B-cell acute lymphoblastic leukemia (B-ALL). While significant socioeconomic (SES) outcome disparities exist for children with newly diagnosed B-ALL, the impact of SES on CART access and outcomes is poorly described. Using the largest single-center pediatric CART experience, we investigated the hypothesis that poverty-exposed children would have inferior survival outcomes compared to unexposed children. Methods: Retrospective cohort study of US pediatric patients treated on CD19 CART clinical trials or with commercial tisagenlecleucel at Children's Hospital of Philadelphia from 2012-2020. Poverty was the primary exposure, defined at the household-level by insurance status (public vs private). Neighborhood opportunity was defined by census-derived Childhood Opportunity Index (COI) (low [q1-2] vs high [q3-4]). Overall survival (OS) and relapse-free survival (RFS) were evaluated by Kaplan Meier methods, and association with exposures by Cox regression models. Results: Among 206 patients, 36% were household poverty exposed, 24.9% low COI, 21.4% identified as Hispanic, 7.3% non-Hispanic Black, 63.6% non-Hispanic White, and 7.7% non-Hispanic Other. Household-poverty exposure was similar between local and referred patients (32.4% vs 36.7%). Patients unexposed to poverty at the household level or with high COI presented to CART with high disease burden (37.1% vs 26%, p = 0.049, 37.9% vs. 29.7%, p = 0.002). In multivariate analysis adjusting for age, race/ethnicity, disease burden, relapse status, and inotuzumab exposure, there were no significant differences in OS by householdverty (HR 0.86, 95%CI 0.50-1.48, p = 0.575) or low COI (HR 1.03, 95%CI 0.53-1.99, p = 0.932). Low COI was associated with inferior RFS (HR 2.26, 95%CI 1.34-8.80, p = 0.002). There was no significant difference in RFS by household-poverty (HR 0.84, 95%CI 0.48-1.44, p = 0.520). Conclusions: Household poverty was not associated with inferior survival outcomes in pediatric patients who received CART for r/r B-ALL. Patients with low neighborhood opportunity had increased hazard of relapse, a finding that requires investigation of the COI components underlying this association. Patients of higher proxied SES were more likely to have high disease burden, an access inequity potentially reflecting referral pattern bias or greater ability of advantaged families to advocate for CART. Future institutional and multi-center studies should utilize patient-reported social determinants of health to investigate mechanisms driving these disparities and guide care delivery interventions to improve equity in access and outcomes. Clinical trials: NCT01626495, NCT02435849, NCT02374333, NCT02228096, NCT02906371
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Affiliation(s)
- Haley Newman
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Yimei Li
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Hongyan Liu
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Vicky Tam
- University of Pennsylvania, Philadelphia, PA
| | | | | | - Colleen Callahan
- Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Claire M White
- Cancer Immunotherapy Program, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Diane Baniewicz
- Cancer Immunotherapy Program, The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | - Susan R. Rheingold
- Children's Hospital of Philadelphia/Perelman School of Medicine, Philadelphia, PA
| | - Kelly D. Getz
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Shannon L. Maude
- Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Stephan A. Grupp
- Pediatric Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kira Bona
- Dana-Farber Cancer Institute/Children's Hospital Boston, Boston, MA
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15
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Leahy AB, Devine KJ, Li Y, Liu H, Myers R, DiNofia A, Wray L, Rheingold SR, Callahan C, Baniewicz D, Patino M, Newman H, Hunger SP, Grupp SA, Barrett DM, Maude SL. Impact of high-risk cytogenetics on outcomes for children and young adults receiving CD19-directed CAR T-cell therapy. Blood 2022; 139:2173-2185. [PMID: 34871373 PMCID: PMC8990372 DOI: 10.1182/blood.2021012727] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [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: 05/27/2021] [Accepted: 11/24/2021] [Indexed: 11/20/2022] Open
Abstract
Chimeric antigen receptor (CAR) T-cell therapy can induce durable remissions of relapsed/refractory B-acute lymphoblastic leukemia (ALL). However, case reports suggested differential outcomes mediated by leukemia cytogenetics. We identified children and young adults with relapsed/refractory CD19+ ALL/lymphoblastic lymphoma treated on 5 CD19-directed CAR T-cell (CTL019 or humanized CART19) clinical trials or with commercial tisagenlecleucel from April 2012 to April 2019. Patients were hierarchically categorized according to leukemia cytogenetics: High-risk lesions were defined as KMT2A (MLL) rearrangements, Philadelphia chromosome (Ph+), Ph-like, hypodiploidy, or TCF3/HLF; favorable as hyperdiploidy or ETV6/RUNX1; and intermediate as iAMP21, IKZF1 deletion, or TCF3/PBX1. Of 231 patients aged 1 to 29, 74 (32%) were categorized as high risk, 28 (12%) as intermediate, 43 (19%) as favorable, and 86 (37%) as uninformative. Overall complete remission rate was 94%, with no difference between strata. There was no difference in relapse-free survival (RFS; P = .8112), with 2-year RFS for the high-risk group of 63% (95% confidence interval [CI], 52-77). There was similarly no difference seen in overall survival (OS) (P = .5488), with 2-year OS for the high-risk group of 70% (95% CI, 60-82). For patients with KMT2A-rearranged infant ALL (n = 13), 2-year RFS was 67% (95% CI, 45-99), and OS was 62% (95% CI, 40-95), with multivariable analysis demonstrating no increased risk of relapse (hazard ratio, 0.70; 95% CI, 0.21-2.90; P = .7040) but a higher proportion of relapses associated with myeloid lineage switch and a 3.6-fold increased risk of all-cause death (95% CI, 1.04-12.75; P = .0434). CTL019/huCART19/tisagenlecleucel are effective at achieving durable remissions across cytogenetic categories. Relapsed/refractory patients with high-risk cytogenetics, including KMT2A-rearranged infant ALL, demonstrated high RFS and OS probabilities at 2 years.
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Affiliation(s)
- Allison Barz Leahy
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
- Penn Center for Cancer Care Innovation, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Kaitlin J Devine
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Yimei Li
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Hongyan Liu
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA; and
| | - Regina Myers
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Amanda DiNofia
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lisa Wray
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Susan R Rheingold
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Colleen Callahan
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Diane Baniewicz
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Maria Patino
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Haley Newman
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Stephen P Hunger
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Stephan A Grupp
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - David M Barrett
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Shannon L Maude
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Cellular Immunotherapies, Perelman School of Medicine, Philadelphia, PA
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16
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Tsukahara K, Lindell RB, Newman H, Lerman BJ, Kersun LS, Piccione J. Successful whole lung lavage in a child with pulmonary alveolar proteinosis secondary to hematologic malignancy. Pediatr Pulmonol 2022; 57:308-310. [PMID: 34644455 PMCID: PMC8665118 DOI: 10.1002/ppul.25718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 01/03/2023]
Abstract
Pulmonary alveolar proteinosis (PAP) describes the accumulation of surfactant in the alveolar space. Secondary PAP has been reported in a variety of diseases, and in rare cases has been associated with hematologic malignancy. Treatment for PAP is based on the underlying disease process, and may include whole lung lavage, inhaled or subcutaneous granulocyte-macrophage colony-stimulating factor, or statins. PAP secondary to hematologic malignancy has been reported to demonstrate poor response to whole lung lavage. We report a case of successful treatment of a pediatric patient with acute myeloid leukemia and secondary PAP using whole lung lavage.
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Affiliation(s)
- Katharine Tsukahara
- Division of Pulmonary and Sleep Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert B Lindell
- Division of Critical Care Medicine, Department of Anesthesia and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Haley Newman
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Benjamin J Lerman
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Leslie S Kersun
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph Piccione
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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17
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Newman H, Catt S, Vining B, Vollenhoven B, Horta F. DNA repair and response to sperm DNA damage in oocytes and embryos, and the potential consequences in ART: a systematic review. Mol Hum Reprod 2021; 28:6483093. [PMID: 34954800 DOI: 10.1093/molehr/gaab071] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Sperm DNA damage is considered a predictive factor for the clinical outcomes of patients undergoing ART. Laboratory evidence suggests that zygotes and developing embryos have adopted specific response and repair mechanisms to repair DNA damage of paternal origin. We have conducted a systematic review in accordance with guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to identify and review the maternal mechanisms used to respond and repair sperm DNA damage during early embryonic development, how these mechanisms operate and their potential clinical implications. The literature search was conducted in Ovid MEDLINE and Embase databases until May 2021. Out of 6297 articles initially identified, 36 studies were found to be relevant through cross referencing and were fully extracted. The collective evidence in human and animal models indicate that the early embryo has the capacity to repair DNA damage within sperm by activating maternally driven mechanisms throughout embryonic development. However, this capacity is limited and likely declines with age. The link between age and decreased DNA repair capacity could explain decreased oocyte quality in older women, poor reproductive outcomes in idiopathic cases, and patients who present high sperm DNA damage. Ultimately, further understanding mechanisms underlying the maternal repair of sperm DNA damage could lead to the development of targeted therapies to decrease sperm DNA damage, improved oocyte quality to combat incoming DNA insults or lead to development of methodologies to identify individual spermatozoa without DNA damage.
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Affiliation(s)
- H Newman
- Education Program in Reproduction & Development, Department of Obstetrics and Gynecology, Monash University, Melbourne, VIC 3168, Australia
| | - S Catt
- Education Program in Reproduction & Development, Department of Obstetrics and Gynecology, Monash University, Melbourne, VIC 3168, Australia
| | - B Vining
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, VIC 3168, Australia.,Department of Molecular and Translational Science, Monash University, Melbourne, VIC, 3800, Australia
| | - B Vollenhoven
- Education Program in Reproduction & Development, Department of Obstetrics and Gynecology, Monash University, Melbourne, VIC 3168, Australia.,Monash IVF, Melbourne, VIC, 3168, Australia.,Women's and Newborn Program, Monash Health, VIC, 3169, Australia
| | - F Horta
- Education Program in Reproduction & Development, Department of Obstetrics and Gynecology, Monash University, Melbourne, VIC 3168, Australia.,Monash IVF, Melbourne, VIC, 3168, Australia
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18
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Affiliation(s)
- Haley Newman
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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19
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Leahy AB, Newman H, Li Y, Liu H, Myers R, DiNofia A, Dolan JG, Callahan C, Baniewicz D, Devine K, Wray L, Aplenc R, June CH, Grupp SA, Rheingold SR, Maude SL. CD19-targeted chimeric antigen receptor T-cell therapy for CNS relapsed or refractory acute lymphocytic leukaemia: a post-hoc analysis of pooled data from five clinical trials. Lancet Haematol 2021; 8:e711-e722. [PMID: 34560014 DOI: 10.1016/s2352-3026(21)00238-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND CNS relapse of acute lymphocytic leukaemia is difficult to treat. Durable remissions of relapsed or refractory B-cell acute lymphocytic leukaemia have been observed following treatment with CD19-directed chimeric antigen receptor (CAR) T cells; however, most trials have excluded patients with active CNS disease. We aimed to assess the safety and activity of CAR T-cell therapy in patients with a history of CNS relapsed or refractory B-cell acute lymphocytic leukaemia. METHODS In this post-hoc analysis, we included 195 patients (aged 1-29 years; 110 [56%] male and 85 [44%] female) with relapsed or refractory CD19-positive acute lymphocytic leukaemia or lymphocytic lymphoma from five clinical trials (Pedi CART19, 13BT022, ENSIGN, ELIANA, and 16CT022) done at the Children's Hospital of Philadelphia (Philadelphia, PA, USA), in which participants received CD19-directed CAR T-cell therapy between April 17, 2012, and April 16, 2019. The trials required control of CNS disease at enrolment and infusion and excluded treatment in the setting of acute neurological toxic effects (>grade 1 in severity) or parenchymal lesions deemed to increase the risk of neurotoxicity. 154 patients from Pedi CART19, ELIANA, ENSIGN, and 16CT022 received tisagenlecleucel and 41 patients from the 13BT022 trial received the humanised CD19-directed CAR, huCART19. We categorised patients into two strata on the basis of CNS status at relapse or within the 12 months preceding CAR T-cell infusion-either CNS-positive or CNS-negative disease. Patients with CNS-positive disease were further divided on the basis of morphological bone marrow involvement-either combined bone marrow and CNS involvement, or isolated CNS involvement. Endpoints were the proportion of patients with complete response at 28 days after infusion, Kaplan-Meier analysis of relapse-free survival and overall survival, and the incidence of cytokine release syndrome and neurotoxicity. FINDINGS Of all 195 patients, 66 (34%) were categorised as having CNS-positive disease and 129 (66%) as having CNS-negative disease, and 43 (22%) were categorised as having isolated CNS involvement. The median length of follow-up was 39 months (IQR 25-49) in the CNS-positive stratum and 36 months (18-49) in the CNS-negative stratum. The proportion of patients in the CNS-positive stratum with a complete response at 28 days after infusion was similar to that in the CNS-negative stratum (64 [97%] of 66 vs 121 [94%] of 129; p=0·74), with no significant difference in relapse-free survival (60% [95% CI 49-74] vs 60% [51-71]; p=0·50) or overall survival (83% [75-93] vs 71% [64-79]; p=0·39) at 2 years between the two groups. Overall survival at 2 years was significantly higher in patients with isolated CNS involvement compared with those with bone marrow involvement (91% [82-100] vs 71% [64-78]; p=0·046). The incidence and severity of neurotoxicity (any grade, 53 [41%] vs 38 [58%]; grade 1, 24 [19%] vs 20 [30%]; grade 2, 14 [11%] vs 10 [15%]; grade 3, 12 [9%] vs 6 [9%], and grade 4, 3 [2%] vs 2 [3%]; p=0·20) and cytokine release syndrome (any grade, 110 [85%] vs 53 [80%]; grade 1, 12 [9%] vs 2 [3%]; grade 2, 61 [47%] vs 38 [58%]; grade 3, 18 [14%] vs 7 [11%] and grade 4, 19 [15%] vs 6 [9%]; p=0·26) did not differ between the CNS-negative and the CNS-positive disease strata. INTERPRETATION Tisagenlecleucel and huCART19 are active at clearing CNS disease and maintaining durable remissions in children and young adults with CNS relapsed or refractory B-cell acute lymphocytic leukaemia or lymphocytic lymphoma, without increasing the risk of severe neurotoxicity; although care should be taken in the timing of therapy and disease control to mitigate this risk. These preliminary findings support the use of these CAR T-cell therapies for patients with CNS relapsed or refractory B-cell acute lymphocytic leukaemia. FUNDING Children's Hospital of Philadelphia Frontier Program.
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Affiliation(s)
- Allison Barz Leahy
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Haley Newman
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yimei Li
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hongyan Liu
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Regina Myers
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Amanda DiNofia
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Joseph G Dolan
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Colleen Callahan
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diane Baniewicz
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kaitlin Devine
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lisa Wray
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Richard Aplenc
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Carl H June
- Center for Cellular Immunotherapies, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; The Parker Institute for Cancer Immunotherapy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Stephan A Grupp
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Susan R Rheingold
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Shannon L Maude
- Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Cellular Immunotherapies, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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20
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Newman H, Smale H, Barrie A, Campbell A. P–223 The necrotic oocyte: does the uncontrolled release of cell contents affect adjacently, group cultured embryos? Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is embryo utilisation rate, embryo morphokinetics and the incidence of irregular divisions affected when embryos are group-cultured adjacent to a necrotic oocyte?
Summary answer
This study demonstrates that embryos cultured adjacent to necrotic oocytes appear to be unaffected both in terms of utilisation, morphokinetics and incidence of irregular divisions.
What is known already
Necrosis is a form of uncontrolled cell death, usually resulting from external injury, causing the cell’s contents to release into the surrounding environment1. A cell undergoing necrosis will first visibly swell before the collapse of the plasma membrane causes it to subsequently shrink and the cell to lyse2. An escalation of inflammation occurs due to the release of intracellular factors3. Neighbouring embryos are believed to be negatively affected by a necrotic oocyte with some laboratories choosing to remove necrotic oocytes from culture dishes, however, little is known regarding this impact.
Study design, size, duration
The project was a single site, retrospective cohort analysis using time-lapse data from August 2017 to December 2018. Only patients with at least one necrotic oocyte, a minimum of one adjacent embryo to the necrotic oocyte and those cultured in the EmbryoScope+® were included in the analysis.
Participants/materials, setting, methods
The study included 868 embryos from 89 patients. The embryos were categorised as adjacent to a necrotic oocyte (group 1, n = 208) and not adjacent to a necrotic oocyte (group 2, n = 660). The utilisation rate and irregular division rate were analysed using a Chi-squared test, the morphokinetic parameters was analysed using a t-test. Morphokinetic data included; tPB2, tPNa, tPNf, t2, t3, t4, t5, t6, t7, t8, t9, tSC, tM, tSB and tB.
Main results and the role of chance
Utilisation rate between the two groups was not significantly different (group 1; 40.9% versus group 2; 47.6%, p = 0.09). Incidence of irregular division was not significantly different between the two groups (group 1; 24.0% vs group 2; 21.7%, p = 0.51). No morphokinetic parameter was statistically significantly different when comparing group 1 to group 2, respectively: tPB2, 3.61 vs 3.73, p = 0.38; tPNa, 7.01 vs 6.91, p = 0.59; tPNf, 23.64 vs 23.66, p = 0.95; t2, 3.44 vs 2.98, p = 0.09; t3, 14.56 vs 14.41, p = 0.75; t4, 15.96 vs 15.8, p = 0.77; t5, 15.96 vs 15.8, p = 0.77; t6, 30.33 vs 30.46, p = 0.86; t7, 33.11 vs 33.16, p = 0.95; t8, 37.93 vs 36.92, p = 0.34; t9, 48.66 vs 48.97, p = 0.73; tSC, 58.04 vs 57.89, p = 0.88; tM, 74.02 vs 73.76, p = 0.8; tSB, 75.55 vs 75.42, p = 0.9; tB, 87.06 vs 87.2, p = 0.91.
Limitations, reasons for caution
The time at which the oocytes became necrotic was not analysed therefore the effect, if any, of exposure time could not be determined. Of the 169 necrotic oocytes, two were from IVF and 167 from ICSI; the increased exposure of the embryos derived from ICSI was not controlled for.
Wider implications of the findings: Necrotic oocytes are easily identified in standard culture observations and in time-lapse imaging, therefore, their removal may be an unnecessary practice. More harm could be caused by removing the dish from the incubator, as this would unnecessarily expose any viable embryos contained within the dish to a suboptimal environment.
Trial registration number
Not applicable
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Affiliation(s)
- H Newman
- CARE Fertility Chester, Embryology, Chester, United Kingdom
| | - H Smale
- CARE Fertility Chester, Embryology, Chester, United Kingdom
| | - A Barrie
- CARE Fertility Chester, Embryology, Chester, United Kingdom
| | - A Campbell
- CARE Fertility UK, Embryology, Nottingham, United Kingdom
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21
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Vitali J, Nix J, Newman H, Singh A, Colaneri M. Crystal structure of an archaeal dihydroorotase. Acta Crystallogr A Found Adv 2021. [DOI: 10.1107/s0108767321097038] [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: 11/10/2022] Open
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22
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Herrick HM, Weinberg DD, Cecarelli C, Fishman CE, Newman H, den Boer MC, Martherus T, Katz TA, Nadkarni V, te Pas AB, Foglia EE. Provider visual attention on a respiratory function monitor during neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed 2020; 105:666-668. [PMID: 32616559 PMCID: PMC7581552 DOI: 10.1136/archdischild-2020-319291] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/16/2020] [Accepted: 06/04/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND A respiratory function monitor (RFM) provides real-time positive pressure ventilation feedback. Whether providers use RFM during neonatal resuscitation is unknown. METHODS Ancillary study to the MONITOR(NCT03256578) randomised controlled trial. Neonatal resuscitation leaders at two centres wore eye-tracking glasses, and visual attention (VA) patterns were compared between RFM-visible and RFM-masked groups. RESULTS 14 resuscitations (6 RFM-visible, 8 RFM-masked) were analysed. The median total gaze duration on the RFM was significantly higher with a visible RFM (29% vs 1%, p<0.01), while median total gaze duration on other physical objects was significantly lower with a visible RFM (3% vs 8%, p=0.02). Median total gaze duration on the infant was lower with RFM visible, although not statistically significantly (29% vs 46%, p=0.05). CONCLUSION Providers' VA patterns differed during neonatal resuscitation when the RFM was visible, emphasising the importance of studying the impact of additional delivery room technology on providers' behaviour.
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Affiliation(s)
- Heidi M. Herrick
- The Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Neonatology, Philadelphia, PA, USA,Corresponding Author: Heidi Meredith Herrick, MD, Attending Physician, Department of Pediatrics/Division of Neonatology, The Children’s Hospital of Philadelphia, Division of Neonatology, 2nd Floor, Main Building, 3401 Civic Center Boulevard, Philadelphia, PA 19104, Tel: (267)408-6146, Fax: (215) 590-3051,
| | - Danielle D. Weinberg
- The Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Neonatology, Philadelphia, PA, USA
| | | | - Claire E. Fishman
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Haley Newman
- The Children’s Hospital of Philadelphia, Department of Pediatrics, Philadelphia, PA, USA
| | - Maria C. den Boer
- Leiden University Medical Center, Department of Neonatology, Leiden, Zuid-Holland, NL
| | - Tessa Martherus
- Leiden University Medical Center, Department of Neonatology, Leiden, Zuid-Holland, NL
| | - Trixie A. Katz
- Amsterdam University Medical Center, Emma Children’s Hospital, Department of Neonatology, Amsterdam, The Netherlands
| | - Vinay Nadkarni
- The Children’s Hospital of Philadelphia, Division of Anesthesiology and Critical Care Medicine, Philadelphia, PA, USA,The Children’s Hospital of Philadelphia, Center for Simulation, Advanced Education, and Innovation, Philadelphia, PA, USA
| | - Arjan B. te Pas
- Leiden University Medical Center, Department of Neonatology, Leiden, Zuid-Holland, NL
| | - Elizabeth E. Foglia
- The Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Neonatology, Philadelphia, PA, USA
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23
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Newman H, Barz Leahy AE, Li Y, Liu H, Myers RM, DiNofia AM, Dolan JG, Callahan C, Devine KJ, Wray L, June CH, Grupp SA, Rheingold SR, Maude SL. CD19-targeted chimeric antigen receptor (CAR) T cells in CNS relapsed acute lymphoblastic leukemia (ALL). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10511] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10511 Background: CNS relapse of B-ALL is difficult to treat after cranial radiation or multiple relapses. Durable remissions of relapsed/refractory (r/r) B-ALL have been seen with CD19 CAR T cells; however, most trials excluded patients with active CNS disease. As we observed CAR trafficking into the CSF, we hypothesized that CD19 CAR T cells could control CNS B-ALL. Methods: We identified children and young adults with r/r CNS B-ALL treated on 4 clinical trials of CD19 CAR T cells, CTL019 or CTL119. NCT01626495 and NCT02435849 excluded active CNS disease, while the former in an amendment as well as NCT02374333 and NCT02906371 permitted active CNS disease controlled on therapy. All trials permitted CNS disease that cleared and excluded bulky intracranial disease that did not improve. We analyzed outcomes (CR, RFS) and safety. Results: We identified 65 patients 1-29y (median 10y) with r/r CNS B-ALL (CNS+) of 182 treated with CTL019/CTL119. There were no differences in age, sex, history of SCT or neurologic comorbidities in the CNS+ and CNS- cohorts. CNS+ patients were more likely to be in ≥2nd relapse (74% vs 46%, p < 0.01), to have received cranial radiation (58% vs 11%, p < 0.01), to have detectable CNS disease (p = 0.02) and less bone marrow disease pre-infusion (p < 0.01). At 1 mo post infusion, 62 (95%) CNS+ and 110 (94%) CNS- patients were in CR; 1 in each cohort died of sequelae of CRS and was inevaluable for response. All patients with CNS disease detected pre-infusion cleared by mo 3, including 9 in the CNS+ cohort [5 CNS2 ( < 5 CSF WBC with blasts), 4 CNS3 ( > 5 CSF WBC with blasts or exam/imaging evidence)] and 8 in the CNS- cohort (isolated CNS2 status pre-infusion). There was no difference in RFS (p = 0.28) in the CNS+ and CNS- cohorts [24-mo RFS: 61% (95% CI 46-73%) and 60% (95% CI 48-70%)]. There were 4 CNS relapses in the CNS+ cohort, and 1 in the CNS- cohort. Encephalopathy rate and grade was similar in the CNS+ and CNS- cohorts (52% vs 40% any grade; 12% vs 11% grade 3/4; p = 0.41). There were no deaths due to neurotoxicity (NT) and no statistically significant differences in incidence or severity of any NT or CRS in the CNS+ and CNS- cohorts. Conclusions: The CD19 CAR T cell therapies CTL019/CTL119 are effective at clearing CNS disease and inducing durable remissions in children and young adults with r/r CNS B-ALL. CNS relapse rates are low ( < 3%). Most CD19 CAR T cell trials excluded patients with active CNS disease, primarily due to the risk of NT. We show that patients with r/r CNS B-ALL that is adequately controlled prior to infusion can be safely treated with CD19 CAR T cells, with no increased risk of NT. Clinical trial information: NCT01626495, NCT02435849, NCT02374333, NCT02906371.
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Affiliation(s)
- Haley Newman
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Yimei Li
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Hongyan Liu
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | - Colleen Callahan
- Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Lisa Wray
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Carl H. June
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Stephan A. Grupp
- Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Susan R. Rheingold
- Children's Hospital of Philadelphia/Perelman School of Medicine, Philadelphia, PA
| | - Shannon L. Maude
- Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, PA
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Affiliation(s)
- Haley Newman
- Children's Hospital of Philadelphia, Philadelphia, PA
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Weinberg DD, Newman H, Fishman CE, Katz TA, Nadkarni V, Herrick HM, Foglia EE. Visual attention patterns of team leaders during delivery room resuscitation. Resuscitation 2020; 147:21-25. [PMID: 31870924 PMCID: PMC6995430 DOI: 10.1016/j.resuscitation.2019.12.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/13/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022]
Abstract
AIM To assess visual attention of neonatal team leaders during delivery room resuscitation of preterm infants using eye tracking glasses. METHODS Prospective observational eye tracking study. Gaze fixations and sequences were captured, categorized, and mapped during the first 5 min of the resuscitations. Gaze fixation metrics of total gaze duration, visit count, and visit duration were summarized and compared based on interventions performed and provider training level. Fixation sequences were compared between attending neonatologists and fellows. RESULTS During 18 eye tracking recordings, practitioners focused most of their cumulative visual attention on the infant (median total gaze duration 57%, interquartile range [IQR] 38-61%), followed by monitors (24%, IQR 13-46%), clinical staff (5%, IQR 1-8%), other physical objects (4%, IQR 3-6%), T-piece resuscitator (2%, IQR 0-4%) and the Apgar timer (1%, IQR 0-2%). Visual attention parameters varied according to intervention, with higher visit counts on the infant during corrective ventilation steps than during Continuous Positive Airway Pressure (CPAP) or Positive Pressure Ventilation (PPV), and longer visit durations on monitors during PPV. Time and frequency-based measures of visual attention did not significantly differ by provider training level, but patterned fixation sequences were identified among attending neonatologists that were not observed in fellows. CONCLUSION Team leaders predominantly gazed upon the infant and monitors during resuscitation, and visual attention parameters varied depending on the respiratory interventions performed. Attending neonatologists exhibited patterned fixation sequences that were not observed in fellows. Study results may have implications for optimizing delivery room design and training novice providers.
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Affiliation(s)
- Danielle D Weinberg
- Children's Hospital of Philadelphia, 3501 Civic Center Blvd., Philadelphia, PA 19104, United States; The Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States
| | - Haley Newman
- Children's Hospital of Philadelphia, 3501 Civic Center Blvd., Philadelphia, PA 19104, United States
| | - Claire E Fishman
- The Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States
| | - Trixie A Katz
- Neonatology, Amsterdam UMC, University of Amsterdam, Meibergerdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Vinay Nadkarni
- Children's Hospital of Philadelphia, 3501 Civic Center Blvd., Philadelphia, PA 19104, United States; Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, 3501 Civic Center Blvd., Philadelphia, PA 19104, United States
| | - Heidi M Herrick
- Children's Hospital of Philadelphia, 3501 Civic Center Blvd., Philadelphia, PA 19104, United States; The Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States
| | - Elizabeth E Foglia
- Children's Hospital of Philadelphia, 3501 Civic Center Blvd., Philadelphia, PA 19104, United States; The Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States.
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Newman H, Hu J, Li X, He J, Bradford L, Shan S, Wu X, Zhu B, Yang W, Fu B, Zhu B, Gao G. Evaluation of portable colposcopy and human papillomavirus testing for screening of cervical cancer in rural China. Int J Gynecol Cancer 2020; 29:23-27. [PMID: 30640679 DOI: 10.1136/ijgc-2018-000006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/29/2018] [Accepted: 10/08/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the use of a portable, rechargeable colposcope combined with human papillomavirus (HPV) testing, as compared with HPV testing alone, for screening of cervical cancer and pre-cancerous lesions. METHODS This was a cross-sectional study among 488 women in Baoshan County, Yunnan. The women underwent HPV testing followed by Gynocular portable colposcopy with visual inspection with acetic acid. Obvious lesions were biopsied. If portable colposcopy testing was negative but HPV testing was positive, the women underwent follow-up testing with thin-prep cytology and traditional colposcopy. Cervical biopsies were performed for any abnormalities. Histopathology was followed up with diagnosis and treatment. RESULTS Among 488 women screened with portable colposcopy, 24 women underwent biopsy based on positive colposcopy screening. Of these 24 women, three were HPV positive and 21 were HPV negative. Five women had cervical intra-epithelial neoplasia (CIN) I and one had advanced cervical cancer. Forty-six women tested positive for HPV. Three of these women had screened positive on preliminary colposcopy, with one positive for CIN III/squamous cell carcinoma and one woman with CIN I. Forty-three women underwent follow-up testing with thin-prep cytology. Two women had atypical squamous cells of undetermined significance and five had low-grade squamous intra-epithelial lesions and were biopsied; three women had CIN I, one had CIN II and one had CIN III. HPV testing and portable colposcopy was more sensitive but slightly less specific than portable colposcopy or HPV testing alone. CONCLUSION While HPV testing has high sensitivity and specificity for the detection of pre-cancerous and cancerous lesions and portable colposcopy has lower specificity, both methods of detection have low positive predictive value and high negative predictive value. In tandem, HPV testing and portable colposcopy had higher sensitivity for detection among women who underwent biopsies. In clinical practice, portable colposcopy was an effective, easy and affordable tool to transport to villages where cytology is not currently feasible.
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Affiliation(s)
- Haley Newman
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jilin Hu
- Kunming University of Science and Technology, Kunming, China
| | - Xiao Li
- Department of Obstetrics and Gynecology, National Health Commission's Key Laboratory for Healthy Births in Western China, First People's Hospital of Yunnan Province, Yunnan, China
| | - Jing He
- Kunming University of Science and Technology, Kunming, China.,Department of Obstetrics and Gynecology, National Health Commission's Key Laboratory for Healthy Births in Western China, First People's Hospital of Yunnan Province, Yunnan, China
| | - Leslie Bradford
- Maine Medical Partners Women's Health Division of Gynecologic Oncology, Portland, Maine, USA
| | - Songmei Shan
- Department of Obstetrics and Gynecology, National Health Commission's Key Laboratory for Healthy Births in Western China, First People's Hospital of Yunnan Province, Yunnan, China
| | - Xiaomei Wu
- Kunming University of Science and Technology, Kunming, China.,Department of Obstetrics and Gynecology, National Health Commission's Key Laboratory for Healthy Births in Western China, First People's Hospital of Yunnan Province, Yunnan, China
| | - Bin Zhu
- Maternal and Child Health and Family Planning Service Center of Longyang District, Yunnan, China
| | - Wenyang Yang
- Maternal and Child Health and Family Planning Service Center of Longyang District, Yunnan, China
| | - Bingqin Fu
- Maternal and Child Health and Family Planning Service Center of Longyang District, Yunnan, China
| | - Baosheng Zhu
- Kunming University of Science and Technology, Kunming, China .,Department of Obstetrics and Gynecology, National Health Commission's Key Laboratory for Healthy Births in Western China, First People's Hospital of Yunnan Province, Yunnan, China
| | - Guangping Gao
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Newman H, Jilin H, Zhu B, Bradford L, Gao G. Evaluation of portable colposcopy and HPV testing for screening of cervical cancer in rural China. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.267] [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: 11/26/2022]
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Newman H, Angus-Leppan H. Dealer's Dytonia (Croupier's Cramp) - An Unusual Hazard Of Gambling. Acute Med 2019; 18:124-126. [PMID: 31127803] [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: 06/09/2023]
Abstract
Dystonia takes many forms and often presents acutely to emergency care. The diagnosis is often delayed because it mimics other more common conditions. This report describes a patient with a rare occupational dystonia, the typical clinical features of dystonia in general, and differentials to consider.
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Abstract
SummaryA segmental radial defect model was used to radiographically and histologically evaluate response to ratite cancellous xenograft in pigeons. The control group showed little evidence of callus production with all fractures proceeding to nonunion. Lymphocytic response to xenograft peaked at four weeks and diminished thereafter. Fractures treated with cancellous xenograft had significant increases in new bone production.
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Lehn A, Sowden D, Anstey C, Stephensen B, Newman H. Patients with Bacteraemia Discharged from the Department of Emergency Medicine: Distribution of Organisms and Associated Characteristics. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791201900506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Although blood cultures are commonly used to investigate febrile patients presenting to an emergency department, treatment decisions usually have to be made before the results are available. Methods We performed a retrospective analysis of consecutive patients presenting with community-acquired bacteraemia at the emergency department of Nambour Hospital, Queensland, Australia between 2000 and 2008. We determined their clinical characteristics, the distribution of organisms and also assessed patient characteristics associated with discharge from the emergency department. Results A total of 885 patients with 915 presentations of community-acquired bacteraemia were included. While having bacteraemia, 33 patients (3.6%) were discharged from the emergency department. Age, mode of presentation, altered mental state, presence of immunocompromise, presence of respiratory distress, C reactive protein, Charlson score, age score and estimated 10 years survival were significant factors discriminating the admitted from discharged patients. The most commonly found organism in blood cultures of discharged patients was Staphylococcus aureus (27.3%), whereas in admitted patients it was E. coli (27.7%). Methicillin-resistant Staphylococcus aureus accounted for 1.7% of cases of community-acquired bacteraemia. Conclusions Emergency physicians only rarely discharge patients with community-acquired bacteraemia using current assessment tools and decision-making rules. However, they tend to discharge younger self-presenting patients with good baseline function.
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Affiliation(s)
| | - D Sowden
- Nambour General Hospital, Department of Infectious Diseases, Hospital Road, Nambour QLD 4560, Australia; David Sowden, MBBS
| | - C Anstey
- Nambour General Hospital, Department of Intensive Care Medicine, Hospital Road, Nambour QLD 4560, Australia; Chris Anstey, MBBS, FANZCA, FCICM
| | - B Stephensen
- Nambour General Hospital, Department of Surgery, Hospital Road, Nambour QLD, 4560 Australia; Bree Stephensen, MBBS, BSc
| | - H Newman
- Nambour General Hospital, Department of Anaesthetics, Hospital Road, Nambour QLD 4560, Australia; Helen Newman, MBBS
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Soni A, Fahey N, Jaffe A, Raithatha S, Raithatha N, Prabhakaran A, Moore Simas TA, Byatt N, Vankar J, Chin M, Phatak AG, Srivastava S, McManus DD, O'Keefe E, Patel H, Patel N, Patel D, Tracey M, Khubchandani JA, Newman H, Earon A, Rosenfield H, Handorf A, Novak B, Bostrom J, Deb A, Desai S, Patel D, Nimbalkar A, Talati K, Rosal M, McQuilkin P, Pandya H, Santry HP, Thanvi S, Kharod U, Fischer M, Allison J, Nimbalkar SM. RAHI-SATHI Indo-U.S. Collaboration: The Evolution of a Trainee-Led Twinning Model in Global Health Into a Multidisciplinary Collaborative Program. Glob Health Sci Pract 2017; 5:152-163. [PMID: 28351882 PMCID: PMC5482068 DOI: 10.9745/ghsp-d-16-00190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 01/25/2017] [Indexed: 01/01/2023]
Abstract
RAHI–SATHI presents an innovative twinning model of global health academic partnership, resulting in a number of successful research activities, that features trainees or students as the driving force, complemented by strategic institutional support from both sides of the partnership. Others can promote similar student-led initiatives by: (1) accepting an expanded role for trainees in global health programs, (2) creating structured research and program opportunities for trainees, (3) developing a network of faculty and trainees interested in global health, (4) sharing extramural global health funding opportunities with faculty and trainees, and (5) offering seed funding. Background: In recent years there has been a surge in the number of global health programs operated by academic institutions. However, most of the existing programs describe partnerships that are primarily faculty-driven and supported by extramural funding. Program Description: Research and Advocacy for Health in India (RAHI, or “pathfinder” in Hindi) and Support and Action Towards Health-Equity in India (SATHI, or “partnership” in Hindi) are 2 interconnected, collaborative efforts between the University of Massachusetts Medical School (UMMS) and Charutar Arogya Mandal (CAM), a medical college and a tertiary care center in rural western India. The RAHI–SATHI program is the culmination of a series of student/trainee-led research and capacity strengthening initiatives that received institutional support in the form of faculty mentorship and seed funding. RAHI–SATHI's trainee-led twinning approach overcomes traditional barriers faced by global health programs. Trainees help mitigate geographical barriers by acting as a bridge between members from different institutions, garner cultural insight through their ability to immerse themselves in a community, and overcome expertise limitations through pre-planned structured mentorship from faculty of both institutions. Trainees play a central role in cultivating trust among the team members and, in the process, they acquire personal leadership skills that may benefit them in their future careers. Conclusion: This paradigm of trainee-led twinning partnership promotes sustainability in an uncertain funding climate and provides a roadmap for conducting foundational work that is essential for the development of a broad, university-wide global health program.
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Affiliation(s)
- Apurv Soni
- University of Massachusetts Medical School, Worcester, MA, USA.
| | - Nisha Fahey
- University of Massachusetts Medical School, Worcester, MA, USA.,Des Moines University, Des Moines, IA, USA
| | - Abraham Jaffe
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | | | | | - Nancy Byatt
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Michael Chin
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - David D McManus
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Niket Patel
- Pramukhswami Medical College, Karamsad, India
| | | | - Michaela Tracey
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Haley Newman
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Allison Earon
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Anna Handorf
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Brittany Novak
- University of Massachusetts Medical School, Worcester, MA, USA
| | - John Bostrom
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Anindita Deb
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Dipen Patel
- Pramukhswami Medical College, Karamsad, India
| | | | | | - Milagros Rosal
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Heena P Santry
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Melissa Fischer
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Jeroan Allison
- University of Massachusetts Medical School, Worcester, MA, USA
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Jain S, Edgar D, Bothe J, Harris J, Newman H, Wilson A, Bint B, Brown M, Alexander S. Reflection on observation: A qualitative study using practice development methods to explore the experience of being a hand hygiene auditor in Australia. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.620] [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: 11/28/2022] Open
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Sindone A, Erlich J, Lee C, Newman H, Suranyi M, Roger SD. Cardiovascular risk reduction in hypertension: angiotensin-converting enzyme inhibitors, angiotensin receptor blockers. Where are we up to? Intern Med J 2016; 46:364-72. [DOI: 10.1111/imj.12975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/05/2015] [Accepted: 11/16/2015] [Indexed: 11/26/2022]
Affiliation(s)
- A. Sindone
- Heart Failure Unit and Department of Cardiac Rehabilitation; Concord Repatriation General Hospital; Concord New South Wales Australia
| | - J. Erlich
- Faculty of Medicine; University of NSW; Sydney New South Wales Australia
- Department of Nephrology; Prince of Wales Hospital; Sydney New South Wales Australia
| | - C. Lee
- Department of Cardiology; Nepean Hospital; Sydney New South Wales Australia
| | - H. Newman
- Department of Cardiology; Liverpool Hospital; Sydney New South Wales Australia
| | - M. Suranyi
- Liverpool Renal Clinical Research Centre; Liverpool Hospital; Sydney New South Wales Australia
| | - S. D. Roger
- Department of Renal Medicine; Gosford Hospital; Gosford New South Wales Australia
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Duberstein K, Lalvani S, Cobb L, Newman H. 32 An assessment of gait symmetry at the trot in non-loaded horses compared with symmetrical and asymmetrical load distribution. J Equine Vet Sci 2015. [DOI: 10.1016/j.jevs.2015.03.040] [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: 11/28/2022]
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Newman H. Charles Christopher Hunter. Assoc Med J 2014. [DOI: 10.1136/bmj.g1876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hanson G, Leong J, Newman H, Law ME, Litke A, Madaras R, Wilson R, Hofmann A, Law L, Little R, Paterson JM, Pordes R, Strauch K, Tarnopolsky G. Experimental test of quantum electrodynamics for the reaction e+e−→γγ at 4 GeV center-of-mass energy. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/bf02727692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lo DS, Zeldin RA, Skrastins R, Fraser IM, Newman H, Monavvari A, Ung Y, Joseph H, Downton T, Meharchand J. Time to treat: A system redesign focusing on decreasing the time from suspicion of lung cancer to diagnosis in a community hospital. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.17005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17005 Background: Multiple physician visits, numerous investigations, and serial wait times often result in a lengthy process from the onset of lung cancer-related symptoms until diagnosis. An unpublished retrospective chart review from a Toronto community hospital indicated suboptimal delays for patients from onset of symptoms until the diagnosis of lung cancer. Methods: The Time to Treat Program (TTT), consisting of a streamlined referral system and a clerical facilitator to fast-track patients through a diagnostic pathway algorithm, was designed for patients with clinical or radiological suspicion of lung cancer. Data on patient visits and investigations were collected. Pre- and post-implementation data on median wait times were compared. Results: From April 2005 to December 2006 over 120 physicians referred 188 females and 226 males. For the majority of patients (95.2%), the reason for referral was chest x-ray findings suspicious for lung cancer. After TTT implementation, the median time from suspicion of lung cancer to referral for specialist consultation decreased from 19.9 days to 10 days, and the median time from such referral to the actual consultation date decreased from 16.8 days to 5.3 days. The median time from specialist consultation to CT scan decreased from 52.1 days to 4 days and the median time from CT to diagnosis decreased from 39 days to 12.4 days. Overall, the median time from suspicion of lung cancer to diagnosis decreased from 127.8 days to 30 days. For 25% of the patients in the TTT it took 13 or fewer days from suspicion of lung cancer to diagnosis, while for 5% of the patients it took 90 days or more. Half of the patients in the TTT had a diagnosis by 24 days from the time of suspicion. Of all patients in the TTT, 33% were eventually diagnosed with lung cancer. The time from suspicion to diagnosis took longer for patients who eventually had confirmed lung cancer than those who did not: 36.5 days vs. 28.7 days. Conclusions: By addressing process issues in the work-up of lung cancer, the TTT was effective in shortening the time from suspicion of lung cancer to diagnosis and reduced time intervals at each step in the process. Earlier diagnosis of lung cancer may allow increased treatment options for patients. No significant financial relationships to disclose.
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Affiliation(s)
- D. S. Lo
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - R. A. Zeldin
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - R. Skrastins
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - I. M. Fraser
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - H. Newman
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - A. Monavvari
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - Y. Ung
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - H. Joseph
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - T. Downton
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - J. Meharchand
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
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Newman H, Cavanaugh R, Bunn J, Legrand I, Low S, Nae D, Ravot S, Steenberg C, Xun Su, Thomas M, van Lingen F, Yang Xia, McKee S. The UltraLight Project: The Network as an Integrated and Managed Resource for Data-Intensive Science. Comput Sci Eng 2005. [DOI: 10.1109/mcse.2005.127] [Citation(s) in RCA: 4] [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: 11/08/2022]
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Madden IM, Newman H, Hall C, Brading MG, Ketkar V, Bidinger PD. Sustained oral health improvement and use of toothbrushes and dentifrice by previous users of traditional materials in a rural population in Andhra Pradesh, India. Int Dent J 2004; 54:315-20. [PMID: 15509083 DOI: 10.1111/j.1875-595x.2004.tb00005.x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIM To follow-up, one year later, a double-blind, randomised study, which investigated the effect of regular brushing with dentifrices on the oral health of an economically disadvantaged rural population in Andhra Pradesh, India who were primarily users of traditional materials. SUBJECTS 150 of the original study population. METHOD Examination to determine whether the improvements in oral health status and oral health behaviour (use of toothbrush and dentifrice), being unsupported, had been sustained since completion of the original study. RESULTS Data analysis showed sustained, statistically significant improvements in gingival health as measured by gingival bleeding and plaque indices (GBI and PI) comparing users and non-users of toothbrushes and dentifrice in the original study (PI: p = 0.04; GBI: p = 0.03) and sustained use of toothbrushes and dentifrice by 60% of the subjects at follow-up one year later. CONCLUSIONS This study shows a beneficial effect on oral hygiene indices following the introduction of toothbrushes and dentifrices to a community using traditional oral hygiene materials and sustainability of use of these materials with motivation and support. It may therefore be concluded that it is feasible to achieve significant use of conventional toothbrushes and toothpastes, with consequent major and sustained improvements in plaque control and gingival health in a disadvantaged population hitherto often considered as not amenable to conventional oral hygiene for cultural or economic reasons.
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Affiliation(s)
- I M Madden
- Eastman Dental Institute, University College London, UK.
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40
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Bromidge SM, Griffith K, Heightman TD, Jennings A, King FD, Moss SF, Newman H, Riley G, Routledge C, Serafinowska HT, Thomas DR. Novel (4-piperazin-1-ylquinolin-6-yl) arylsulfonamides with high affinity and selectivity for the 5-HT(6) receptor. Bioorg Med Chem Lett 2001; 11:2843-6. [PMID: 11597412 DOI: 10.1016/s0960-894x(01)00558-3] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The discovery of (4-piperazin-1-ylquinolin-6-yl) arylsulfonamides and their binding affinities for a selection of 5-HT and dopamine subreceptors is described. Many compounds show high affinity (pK(i)>8) for the 5-HT(6) receptor and >100-fold selectivity against a range of other receptors. Structure-activity relationships of these compounds are discussed.
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Affiliation(s)
- S M Bromidge
- Discovery Chemistry Europe, GlaxoSmithKline, Discovery Research, New Frontiers Science Park, Third Avenue, Harlow, CM19 5AW, Essex, UK
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Abstract
Particulate Bioglass is a bioactive material used in the repair of periodontal defects. This material undergoes a series of surface reactions in an aqueous environment which lead to osseointegration. The aim of this study was to determine whether these reactions exerted an antibacterial effect on a range of oral bacteria. Streptococcus sanguis, Streptococcus mutans and Actinomyces viscosus were suspended in nutrient broth (NB), artificial saliva (AS) or Dulbecco's modified eagle medium plus 10% foetal calf serum (DMEM + 10%FCS), with or without particulate Bioglass. All bacteria showed reduced viability following exposure to Bioglass in all the media after 1 h. This antibacterial effect increased after 3 h. Porphyromonas gingivalis, Fusobacterium nucleatum, Prevotella intermedia and Actinobacillus actinomycetemcomitans were suspended in either BM broth or 40% horse serum (HS) in RPMI. A considerable reduction in viability was observed with all bacteria tested, in both media, compared to inert glass controls. In further experiments it was found that the viability of S. sanguis was significantly reduced following exposure to NB pre-incubated with Bioglass. Additionally, it was found that neutralisation of this highly alkaline solution eliminated the antibacterial effect. Moreover, a solution of NB and NaOH (of equivalent pH) exerted an antibacterial effect of similar magnitude to that of the solution pre-incubated with Bioglass. Thus, particulate Bioglass exerts an antibacterial effect on certain oral bacteria, possibly by virtue of the alkaline nature of its surface reactions. This may reduce bacterial colonisation of its surface in vivo.
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Affiliation(s)
- I Allan
- Department of Microbiology, Eastman Dental Institute, University College London, UK.
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42
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Bromidge SM, Clarke SE, Gager T, Griffith K, Jeffrey P, Jennings AJ, Joiner GF, King FD, Lovell PJ, Moss SF, Newman H, Riley G, Rogers D, Routledge C, Serafinowska H, Smith DR. Phenyl benzenesulfonamides are novel and selective 5-HT6 antagonists: identification of N-(2,5-dibromo-3-fluorophenyl)-4-methoxy-3-piperazin-1-ylbenzenesulfonamide (SB-357134). Bioorg Med Chem Lett 2001; 11:55-8. [PMID: 11140733 DOI: 10.1016/s0960-894x(00)00597-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [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: 11/17/2022]
Abstract
Substituted N-phenyl-4-methoxy-3-piperazin-1-ylbenzenesulfonamides and conformationally restricted analogues have been identified as high affinity and selective 5-HT6 antagonists. Compounds from this series had a range of pharmacokinetic profiles in rat and in general there was a correlation between clearance and CNS penetration. Based on its overall biological profile 2 (SB-357134) was selected for further pre-clinical evaluation.
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Affiliation(s)
- S M Bromidge
- Discovery Chemistry Europe, SmithKline Beecham Pharmaceuticals, Discovery Research, Harlow, Essex, UK.
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43
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Hillary F, Schatz P, Newman H, Chute D. Vehicular factors affect injury location, severity and outcome. Arch Clin Neuropsychol 2000. [DOI: 10.1093/arclin/15.8.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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44
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Routledge C, Bromidge SM, Moss SF, Price GW, Hirst W, Newman H, Riley G, Gager T, Stean T, Upton N, Clarke SE, Brown AM, Middlemiss DN. Characterization of SB-271046: a potent, selective and orally active 5-HT(6) receptor antagonist. Br J Pharmacol 2000; 130:1606-12. [PMID: 10928964 PMCID: PMC1572216 DOI: 10.1038/sj.bjp.0703457] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.9] [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: 11/05/1999] [Revised: 03/30/2000] [Accepted: 05/04/2000] [Indexed: 11/09/2022] Open
Abstract
SB-271046, potently displaced [(3)H]-LSD and [(125)I]-SB-258585 from human 5-HT(6) receptors recombinantly expressed in HeLa cells in vitro (pK(i) 8.92 and 9.09 respectively). SB-271046 also displaced [(125)I]-SB-258585 from human caudate putamen and rat and pig striatum membranes (pK(i) 8.81, 9.02 and 8.55 respectively). SB-271046 was over 200 fold selective for the 5-HT(6) receptor vs. 55 other receptors, binding sites and ion channels. In functional studies on human 5-HT(6) receptors SB-271046 competitively antagonized 5-HT-induced stimulation of adenylyl cyclase activity with a pA(2) of 8.71. SB-271046 produced an increase in seizure threshold over a wide-dose range in the rat maximal electroshock seizure threshold (MEST) test, with a minimum effective dose of < or =0.1 mg kg(-1) p.o. and maximum effect at 4 h post-dose. The level of anticonvulsant activity achieved correlated well with the blood concentrations of SB-271046 (EC(50) of 0.16 microM) and brain concentrations of 0.01-0.04 microM at C(max). These data, together with the observed anticonvulsant activity of other selective 5-HT(6) receptor antagonists, SB-258510 (10 mg kg(-1), 2-6 h pre-test) and Ro 04-6790 (1-30 mg kg(-1), 1 h pre-test), in the rat MEST test, suggest that the anticonvulsant properties of SB-271046 are likely to be mediated by 5-HT(6) receptors. Overall, these studies demonstrate that SB-271046 is a potent and selective 5-HT(6) receptor antagonist and is orally active in the rat MEST test. SB-271046 represents a valuable tool for evaluating the in vivo central function of 5-HT(6) receptors.
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Affiliation(s)
- C Routledge
- Department of Neuroscience Research, SmithKline Beecham Pharmaceuticals, New Frontiers Science Park, Third Avenue, Harlow, Essex, CM19 5AW.
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Battino M, Bullon P, Wilson M, Newman H. Oxidative injury and inflammatory periodontal diseases: the challenge of anti-oxidants to free radicals and reactive oxygen species. Crit Rev Oral Biol Med 2000; 10:458-76. [PMID: 10634583 DOI: 10.1177/10454411990100040301] [Citation(s) in RCA: 210] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In recent years, there has been a tremendous expansion in medical and dental research concerned with free radicals, reactive oxygen species, and anti-oxidant defense mechanisms. This review is intended to provide a critical, up-to-date summary of the field, with particular emphasis on its implications for the application of "anti-oxidant therapy" in periodontal disease. We have reviewed the nomenclature, mechanisms of actions, features, and sources of most common free radicals and reactive oxygen species, as well as analyzed the typical biological targets for oxidative damage. Based on a review of direct and indirect anti-oxidant host defenses, particularly in relation to the key role of polymorphonuclear neutrophils in periodontitis, we review current evidence for oxidative damage in chronic inflammatory periodontal disease, and the possible therapeutic effects of anti-oxidants in treating and/or preventing such pathology, with special attention to vitamin E and Co-enzyme Q.
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Affiliation(s)
- M Battino
- Institute of Biochemistry, Faculty of Medicine, University of Ancona, Italy
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Gregor A, Lind M, Newman H, Grant R, Hadley DM, Barton T, Osborn C. Phase II studies of RMP-7 and carboplatin in the treatment of recurrent high grade glioma. RMP-7 European Study Group. J Neurooncol 1999; 44:137-45. [PMID: 10619497 DOI: 10.1023/a:1006379332212] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The selective bradykinin analogue, RMP-7, transiently increases the permeability of the blood brain barrier and the delivery of hydrophilic agents into brain tumours. In 87 recurrent glioma patients (WHO Grade III/IV, median age 46, Karnofsky 70%) clinical and Magnetic Resonance Imaging (MRI) responses to i.v. cycles (q 28 days) of RMP-7 (300 ng/kg given as a 10 min infusion) and carboplatin (AUC 4-9) were assessed. 45 of these patients were chemotherapy naive (CN-RMP) and 42 had received one prior course of chemotherapy (CP-RMP). Neurological impairment, performance status and steroid use were measured prior to dosing at each cycle and tumour volume by 3-D MRI at the end of cycles 2, 4, 6, 9 and 12. Clinical evaluation of response demonstrated that 61% of CN-RMP patients were either stable or improved whilst this was 39% for CP-RMP patients, of which 37% and 8% improved respectively. Radiological evaluation showed 79% of CN-RMP patients were either stable, partial or complete responses and 24% for CP-RMP patients, of which 32% and 5% were CR or PR respectively. The median duration of response was 30.3 weeks in CN-RMP patients and 19.6 weeks in the CP-RMP group. Lack of response was associated with substantial baseline tumour volume. Drug toxicity was as previously reported for carboplatin. 11 patients had treatment-associated transient focal seizures. These results indicate that RMP-7 and carboplatin have significant activity in recurrent malignant glioma following radiotherapy.
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Affiliation(s)
- A Gregor
- Department of Clinical Oncology, University of Edinburgh, Western General Hospital, UK
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Purinton SC, Newman H, Castro MI, Wood CE. Ontogeny of estrogen sulfatase activity in ovine fetal hypothalamus, hippocampus, and brain stem. Am J Physiol 1999; 276:R1647-52. [PMID: 10362743 DOI: 10.1152/ajpregu.1999.276.6.r1647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ovine parturition is initiated by increases in fetal hypothalamus-pituitary-adrenal (HPA) axis activity, which in turn increase placental estrogen biosynthesis and ultimately increase uterine contractility. In addition to the action in the uterus, estrogens augment fetal ACTH secretion. In late gestation, estrone sulfate is more abundant in fetal plasma than is unconjugated estrone. We studied hypothalamus, hippocampus, and brain stem tissue from fetal, neonatal, and adult sheep to test the hypothesis that the ovine brain contains estrogen sulfatase activity. We found that the activity in the hippocampus was significantly increased in late-gestation fetuses compared with both younger and older animals. No significant change in either hypothalamus or brain stem was revealed; however, the activity in all brain areas was high. Immunohistochemistry revealed the presence of estrogen sulfatase in the paraventricular nucleus of the hypothalamus, the nucleus of the solitary tract, and the rostral ventrolateral medulla. We conclude that ovine fetal hypothalamus, hippocampus, and brain stem contain estrogen sulfatase activity and that the activity in the hippocampus is developmentally regulated.
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Affiliation(s)
- S C Purinton
- Department of Physiology, College of Medicine, University of Florida, Gainesville, Florida 32610, USA
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48
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Bromidge SM, Brown AM, Clarke SE, Dodgson K, Gager T, Grassam HL, Jeffrey PM, Joiner GF, King FD, Middlemiss DN, Moss SF, Newman H, Riley G, Routledge C, Wyman P. 5-Chloro-N-(4-methoxy-3-piperazin-1-yl- phenyl)-3-methyl-2-benzothiophenesulfon- amide (SB-271046): a potent, selective, and orally bioavailable 5-HT6 receptor antagonist. J Med Chem 1999; 42:202-5. [PMID: 9925723 DOI: 10.1021/jm980532e] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S M Bromidge
- Departments of Medicinal Chemistry, SmithKline Beecham Pharmaceuticals, Discovery Research, New Frontiers Science Park, Third Avenue, Harlow, Essex CM19 5AW, England, UK
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49
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Abstract
Interleukin 6 (IL-6) is a multi-functional cytokine which has a major role in tissue damage. It is secreted by many types of cell, including oral fibroblasts, and has been implicated in the pathogenesis of periodontal diseases, particularly those associated with sex hormones. In the present study we investigated whether the androgen dihydrotestosterone (DHT) affects the expression and regulation of IL-6 in gingival fibroblasts. Using a 'capture' ELISA assay, it was found that increasing DHT concentrations progressively reduced IL-6 production by gingival cells from normal individuals and from patients with gingival inflammation and gingival hyperplasia. In contrast, cells from periodontal ligament tissue produced only barely detectable levels of IL-6. The anti-androgen cyproterone acetate acted as an androgen analogue in the gingival fibroblasts, potently inhibiting IL-6 production, and did not reverse the DHT-mediated downregulation of the cytokine. Flutamide also failed to abrogate DHT inhibition of IL-6 production, and it had no effect on IL-6 production in the absence of DHT. Moreover, semi-quantitative RT-PCR showed that DHT acted at the level of transcription of the IL-6 gene, causing a marked reduction in the relative level of IL-6 mRNA in the gingival cells.
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Affiliation(s)
- M Parkar
- Department of Periodontology, Eastman Dental Institute for Oral Health Care Sciences, University of London, UK
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50
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Newman H. Do not confuse the bone loss of periodontitis with root exposure due to supereruption. Factors affecting the lifespan of the human dentition in Britain prior to the seventeenth century. Br Dent J 1998; 184:229. [PMID: 9606077 DOI: 10.1038/sj.bdj.4809649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- H Newman
- Department of Periodontology, Eastman Dental Institute for Oral Health Care Sciences
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