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Yeoh S, Estrada-Rivadeneyra D, Jackson H, Keren I, Galassini R, Cooray S, Shah P, Agyeman P, Basmaci R, Carrol E, Emonts M, Fink C, Kuijpers T, Martinon-Torres F, Mommert-Tripon M, Paulus S, Pokorn M, Rojo P, Romani L, Schlapbach L, Schweintzger N, Shen CF, Tsolia M, Usuf E, van der Flier M, Vermont C, von Both U, Yeung S, Zavadska D, Coin L, Cunnington A, Herberg J, Levin M, Kaforou M, Hamilton S. Plasma Protein Biomarkers Distinguish Multisystem Inflammatory Syndrome in Children From Other Pediatric Infectious and Inflammatory Diseases. Pediatr Infect Dis J 2024; 43:444-453. [PMID: 38359342 PMCID: PMC11003410 DOI: 10.1097/inf.0000000000004267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious hyperinflammatory complication following infection with severe acute respiratory syndrome coronavirus 2. The mechanisms underpinning the pathophysiology of MIS-C are poorly understood. Moreover, clinically distinguishing MIS-C from other childhood infectious and inflammatory conditions, such as Kawasaki disease or severe bacterial and viral infections, is challenging due to overlapping clinical and laboratory features. We aimed to determine a set of plasma protein biomarkers that could discriminate MIS-C from those other diseases. METHODS Seven candidate protein biomarkers for MIS-C were selected based on literature and from whole blood RNA sequencing data from patients with MIS-C and other diseases. Plasma concentrations of ARG1, CCL20, CD163, CORIN, CXCL9, PCSK9 and ADAMTS2 were quantified in MIS-C (n = 22), Kawasaki disease (n = 23), definite bacterial (n = 28) and viral (n = 27) disease and healthy controls (n = 8). Logistic regression models were used to determine the discriminatory ability of individual proteins and protein combinations to identify MIS-C and association with severity of illness. RESULTS Plasma levels of CD163, CXCL9 and PCSK9 were significantly elevated in MIS-C with a combined area under the receiver operating characteristic curve of 85.7% (95% confidence interval: 76.6%-94.8%) for discriminating MIS-C from other childhood diseases. Lower ARG1 and CORIN plasma levels were significantly associated with severe MIS-C cases requiring inotropes, pediatric intensive care unit admission or with shock. CONCLUSION Our findings demonstrate the feasibility of a host protein biomarker signature for MIS-C and may provide new insight into its pathophysiology.
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Affiliation(s)
- Sophya Yeoh
- From the Department of Infectious Disease, Faculty of Medicine
| | - Diego Estrada-Rivadeneyra
- From the Department of Infectious Disease, Faculty of Medicine
- Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom
| | - Heather Jackson
- From the Department of Infectious Disease, Faculty of Medicine
- Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom
| | - Ilana Keren
- From the Department of Infectious Disease, Faculty of Medicine
| | | | - Samantha Cooray
- From the Department of Infectious Disease, Faculty of Medicine
- Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom
| | - Priyen Shah
- From the Department of Infectious Disease, Faculty of Medicine
- Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom
| | - Philipp Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Romain Basmaci
- Service de Pédiatrie-Urgences, AP-HP, Hôpital Louis-Mourier, Colombes, France
- Infection, Antimicrobials, Modelling, Evolution, Université Paris Cité, Inserm, IAME, Paris, France
| | - Enitan Carrol
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, United Kingdom
| | - Marieke Emonts
- Translational and Clinical Research Institute, Newcastle University
- Paediatric Infectious Diseases and Immunology Department, Newcastle upon Tyne Hospitals Foundation Trust, Great North Children’s Hospital
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Colin Fink
- Micropathology Ltd., University of Warwick, Warwick, United Kingdom
| | - Taco Kuijpers
- Department of Pediatric Immunology, Rheumatology, and Infectious Diseases, Emma Children’s Hospital, Amsterdam University Medical Centre
- Sanquin Research, Department of Blood Cell Research, Landsteiner Laboratory, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Federico Martinon-Torres
- Translational Paediatrics and Infectious Diseases, Hospital Clínico Universitario, Universidad de Santiago de Compostela
- Genetics, Vaccines and Paediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Universidade de Santiago de Compostela (USC), Galicia, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Stephane Paulus
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Marko Pokorn
- Division of Pediatrics, University Medical Centre Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Pablo Rojo
- Pediatric Infectious Diseases Unit, Pediatric Department, Hospital Doce de Octubre, Madrid, Spain
| | - Lorenza Romani
- Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Luregn Schlapbach
- Department of Intensive Care and Neonatology, Children’s Research Center, University Children`s Hospital, Zurich, Switzerland
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Nina Schweintzger
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Maria Tsolia
- Second Department of Paediatrics, National and Kapodistrian University of Athens (NKUA), School of Medicine, P. and A. Kyriakou Children’s Hospital, Athina, Athens, Greece
| | - Effua Usuf
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Michiel van der Flier
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Clementien Vermont
- Department of Paediatric Infectious Diseases and Immunology, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Ulrich von Both
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Dr von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Shunmay Yeung
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dace Zavadska
- Children’s Clinical University Hospital, Rīga, Latvia
| | - Lachlan Coin
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Aubrey Cunnington
- From the Department of Infectious Disease, Faculty of Medicine
- Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom
| | - Jethro Herberg
- From the Department of Infectious Disease, Faculty of Medicine
- Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom
| | - Michael Levin
- From the Department of Infectious Disease, Faculty of Medicine
- Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom
| | - Myrsini Kaforou
- From the Department of Infectious Disease, Faculty of Medicine
- Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom
| | - Shea Hamilton
- From the Department of Infectious Disease, Faculty of Medicine
- Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom
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Brett BA, Conroy M, Doshi H, Lowe MX, Kalcheff-Korn S, Jackson H. An observational time-series study on the behavioral effects of adjunctive artisanal cannabidiol use by adults with treatment resistant epilepsies. BMC Neurol 2024; 24:141. [PMID: 38671370 PMCID: PMC11046917 DOI: 10.1186/s12883-024-03646-8] [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: 07/28/2023] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND For approximately 30% of people with epilepsy, seizures are not well-controlled by anti-seizure medication (ASM). This condition, called treatment resistant epilepsy (TRE), is associated with increased morbidity and mortality, and substantially impacts the quality of life of both the individual and their family. Non-responsiveness to ASMs leads many people with TRE to seek alternative therapies, such as cannabinoid-based medication, particularly cannabidiol (CBD), with or without medical or professional advice. This is due in part to widespread reporting in the media about the benefits of CBD for seizures in some forms of epilepsy. METHODS Adults with TRE, opting to add CBD to their existing treatment regime, completed this prospective, observational, longitudinal, quasi-experimental, time-series study. We hypothesized that adjunctive CBD use would positively impact participants' quality of life and psychological well-being in comparison to a baseline period without CBD use. Participants were followed for a period of approximately six months - for approximately one month of baseline prior to the initiation of CBD use and approximately five months after the initiation of CBD use. Participants provided urine samples and completed behavioral questionnaires that assessed quality of life, anxiety/depression, and adverse events during baseline and at two times during CBD use. RESULTS Complete case analyses (n = 10) showed a statistically significant improvement in quality of life, a statistically significant decrease in anxiety symptoms, and a statistically significant decrease in the experience of adverse events over time (p < 0.05). Improvements noted in the experience of depression symptoms did not reach statistical significance. Urinalysis revealed the majority of participants had no CBD/metabolites in their system at the beginning of the study, and confirmed the presence of CBD/metabolites in participants' urine after CBD was added to their treatment regime. Analysis of missing data using multiple imputation supported the findings of the complete case analysis. INTERPRETATION For a small group of individuals with TRE of varying etiologies, adjunctive use of artisanal CBD was associated with improvements in the behavioral and psychological symptoms of TRE, as well as improved medication tolerability.
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Affiliation(s)
- Barbara A Brett
- Department of Psychology, Colorado State University-Pueblo, 2200 Bonforte Blvd., Pueblo, CO, 81001, USA.
| | - Matthieu Conroy
- US Army Medical Research Institute of Chemical Defense, Aberdeen, MD, USA
| | - Hardik Doshi
- Cape Fear Valley Medical Center, Fayetteville, NC, USA
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Lowe MX, Kettner H, Jolly DRP, Carhart-Harris RL, Jackson H. Long-term benefits to psychological health and well-being after ceremonial use of Ayahuasca in Middle Eastern and North African immigrants and refugees. Front Psychiatry 2024; 15:1279887. [PMID: 38666090 PMCID: PMC11044680 DOI: 10.3389/fpsyt.2024.1279887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
Background Refugees and immigrants can experience complex stressors from the process of immigration that can have lasting and severe long-term mental health consequences. Experiences after ayahuasca ingestion are shown to produce positive effects on psychological wellbeing and mental health, including anecdotal reports of improved symptoms of trauma and related disorders. However, data on the longitudinal health impact of naturalistic ayahuasca use in Middle Eastern and North African (MENA) immigrant and refugee populations is limited. Aims The current longitudinal online survey study was conducted to gather prospective data on ceremonial ayahuasca use in a group (N = 15) of primarily female MENA immigrants and refugees and to provide further insight into the patterns and outcomes surrounding that use. The study sought to assess self-reported changes in physical and mental health, well-being, and psychological functioning, examine relationships between aspects of individual mindset (e.g., psychedelic preparedness) prior to ayahuasca use and observed outcomes during (e.g., subjective drug effects) and afterwards (i.e., persisting effects), characterize risks and negative experiences, and describe trauma exposure and personal history. Results/Outcomes Our findings revealed ceremonial use of ayahuasca is associated with significant improvements in mental health, well-being, and psychological functioning, including reductions in depression, anxiety, and shame, and increases in cognitive reappraisal and self-compassion. Most participants reported no lasting adverse effects and experienced notable positive behavioral changes persisting months after ingestion. Conclusion/Interpretation While preliminary, results suggest naturalistic ayahuasca use might hold therapeutic potential for MENA populations exposed to trauma prior to and during the process of migration.
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Affiliation(s)
| | - Hannes Kettner
- Psychedelics Division, Neuroscape, University of California, San Francisco, San Francisco, CA, United States
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| | | | - Robin L. Carhart-Harris
- Psychedelics Division, Neuroscape, University of California, San Francisco, San Francisco, CA, United States
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
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Hande K, Jackson H. Navigating the pathway to advanced practice: A grounded theory of nurse practitioner role transition in a fellowship. J Am Assoc Nurse Pract 2024; 36:221-232. [PMID: 38320261 DOI: 10.1097/jxx.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Greater attention to the transitional period for advanced practice nurses has urged health care organizations and employers to implement fellowships. Currently, the theoretical process of nurse practitioner (NP) role transition from the essential perspectives of NP fellows does not exist. PURPOSE The purpose of this study was to construct a middle-range theory grounded in reality of an NP fellowship environment that explains how NPs transition to their new role. METHODOLOGY Following Charmaz's constructivist methodology, 11 NPs who transitioned to practice in a fellowship were interviewed. RESULTS "Navigating the Pathway to Advanced Practice: A Grounded Theory of Nurse Practitioner Role Transition in a Fellowship" emerged from the data and is composed of through five phases: (1) mapping a path, (2) stepping onto the trailhead, (3) navigating the trailway, (4) gaining traction, and (5) summiting. CONCLUSIONS The resulting middle-range theory is the first in the nursing literature that conceptualizes meaning about NP role transition in a fellowship. This process occurs in the contextual factor of a realm of support that includes growth, value, lifelong learning, and readiness. Throughout this process, NPs build competence and confidence that advances them to summit, or transition, to their NP role at the completion of an NP fellowship. IMPLICATIONS This discovery will fill the research gap pertaining to best practice interventions in support of NPs during role transition in fellowships. Understanding how NPs transition to their new advanced practice roles may inform organizations on how to structure fellowships that support learning, encourage confidence, and enhance competence.
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Affiliation(s)
- Karen Hande
- Vanderbilt School of Nursing, Nashville, Tennessee
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Heather Jackson
- Advanced Practice Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt University School of Nursing, Nashville, Tennessee
- Vanderbilt University School of Medicine, Nashville, Tennessee
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Jackson H, Bowen S, Jaki T. Using biomarkers to allocate patients in a response-adaptive clinical trial. COMMUN STAT-SIMUL C 2023; 52:5946-5965. [PMID: 38045870 PMCID: PMC7615340 DOI: 10.1080/03610918.2021.2004420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
Abstract
In this paper, we discuss a response adaptive randomization method, and why it should be used in clinical trials for rare diseases compared to a randomized controlled trial with equal fixed randomization. The developed method uses a patient's biomarkers to alter the allocation probability to each treatment, in order to emphasize the benefit to the trial population. The method starts with an initial burn-in period of a small number of patients, who with equal probability, are allocated to each treatment. We then use a regression method to predict the best outcome of the next patient, using their biomarkers and the information from the previous patients. This estimated best treatment is assigned to the next patient with high probability. A completed clinical trial for the effect of catumaxomab on the survival of cancer patients is used as an example to demonstrate the use of the method and the differences to a controlled trial with equal allocation. Different regression procedures are investigated and compared to a randomized controlled trial, using efficacy and ethical measures.
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Affiliation(s)
| | | | - T Jaki
- Lancaster University, Lancaster, UK
- University of Cambridge, Cambridge, UK
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6
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Nayak SM, Jackson H, Sepeda ND, Mathai DS, So S, Yaffe A, Zaki H, Brasher TJ, Lowe MX, Jolly DRP, Barrett FS, Griffiths RR, Strickland JC, Johnson MW, Jackson H, Garcia-Romeu A. Naturalistic psilocybin use is associated with persisting improvements in mental health and wellbeing: results from a prospective, longitudinal survey. Front Psychiatry 2023; 14:1199642. [PMID: 37795509 PMCID: PMC10545967 DOI: 10.3389/fpsyt.2023.1199642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/14/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction The classic psychedelic psilocybin, found in some mushroom species, has received renewed interest in clinical research, showing potential mental health benefits in preliminary trials. Naturalistic use of psilocybin outside of research settings has increased in recent years, though data on the public health impact of such use remain limited. Methods This prospective, longitudinal study comprised six sequential automated web-based surveys that collected data from adults planning to take psilocybin outside clinical research: at time of consent, 2 weeks before, the day before, 1-3 days after, 2-4 weeks after, and 2-3 months after psilocybin use. Results A sample of 2,833 respondents completed all baseline assessments approximately 2 weeks before psilocybin use, 1,182 completed the 2-4 week post-use survey, and 657 completed the final follow-up survey 2-3 months after psilocybin use. Participants were primarily college-educated White men residing in the United States with a prior history of psychedelic use; mean age = 40 years. Participants primarily used dried psilocybin mushrooms (mean dose = 3.1 grams) for "self-exploration" purposes. Prospective longitudinal data collected before and after a planned psilocybin experience on average showed persisting reductions in anxiety, depression, and alcohol misuse, increased cognitive flexibility, emotion regulation, spiritual wellbeing, and extraversion, and reduced neuroticism and burnout after psilocybin use. However, a minority of participants (11% at 2-4 weeks and 7% at 2-3 months) reported persisting negative effects after psilocybin use (e.g., mood fluctuations, depressive symptoms). Discussion Results from this study, the largest prospective survey of naturalistic psilocybin use to date, support the potential for psilocybin to produce lasting improvements in mental health symptoms and general wellbeing.
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Affiliation(s)
- Sandeep M. Nayak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hillary Jackson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nathan D. Sepeda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Psychedelic Drug Research and Education, The Ohio State University, Columbus, OH, United States
| | - David S. Mathai
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sara So
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Abigail Yaffe
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hadi Zaki
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | | | | | - Frederick S. Barrett
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, MD, United States
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Roland R. Griffiths
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Justin C. Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Matthew W. Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Tan CD, van den Broek B, Womersley RS, Kaforou M, Hagedoorn NN, van der Flier M, Jackson H, Moll HA, Snijder R, de Jonge MI, Vermont CL. A Novel Combination of Host Protein Biomarkers to Distinguish Bacterial From Viral Infections in Febrile Children in Emergency Care. Pediatr Infect Dis J 2023; Publish Ahead of Print:00006454-990000000-00447. [PMID: 37200500 DOI: 10.1097/inf.0000000000003952] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Distinguishing bacterial and viral infections based on clinical symptoms in febrile children attending the emergency department (ED) is challenging. The aim of this study is to determine a novel combination of host protein biomarkers and to assess its performance in distinguishing between bacterial and viral infection in febrile children attending EDs. METHODS A literature search was performed to identify blood protein biomarkers able to distinguish bacterial and viral infections (May 2015-May 2019). We selected 7 protein biomarkers: Procalcitonin, TNF-related apoptosis-inducing ligand (TRAIL), interleukin (IL)-4, IL-6, Interferon gamma-induced protein-10 (CXCL-10), interferon-gamma and lipocalin 2 (LCN2). These were measured in blood plasma using a bead-based immunoassay in children with a confirmed bacterial or viral infection attending EDs in the Netherlands. We used generalized linear modeling to classify bacterial and viral infections and applied a previously developed feature selection algorithm to select the optimal combination of proteins. We performed a subgroup analysis of this protein signature in patients with C-reactive protein <60 mg/L, representing a clinically challenging diagnostic group. RESULTS In total 102 children were included (N = 67 bacterial; N = 35 viral). Individual performance of the 7 biomarkers in classifying bacterial versus viral infections ranged from 60.8%-74.5% area under the receiver operator curve (AUC). TRAIL, LCN2 and IL-6 were identified as the best 3-protein signature with an AUC of 86% (95% CI: 71.3%-100%). In 57 patients with C-reactive protein levels <60 mg/L, the 3-protein signature had an AUC of 85.1% (95% CI: 75.3%-94.9%). CONCLUSION We demonstrate a promising novel combination of 3 host protein biomarkers; TRAIL, LCN2 and IL-6, which performs well in classifying bacterial and viral infections in febrile children in emergency care.
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Affiliation(s)
- Chantal D Tan
- From the Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Bryan van den Broek
- Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
| | - Rebecca S Womersley
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Myrsini Kaforou
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Nienke N Hagedoorn
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Michiel van der Flier
- Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
- Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Heather Jackson
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Henriette A Moll
- From the Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Rozemarijn Snijder
- Department of Paediatrics, Rotterdam, Franciscus Gasthuis en Vlietland, the Netherlands; and
| | - Marien I de Jonge
- Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
| | - Clementien L Vermont
- Department of Paediatric Infectious diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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Skotte E, Iams W, Maldonado F, Lentz R, Jackson H, Williams T. QIM23-128: Improving Multidisciplinary Thoracic Tumor Board With a Case Submission Tool. J Natl Compr Canc Netw 2023. [DOI: 10.6004/jnccn.2022.7116] [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: 04/03/2023]
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Jackson H, West O, Austin A, Peal K. Interventions to Improve Advanced Practitioner Work-Related Quality of Life and Patient Satisfaction. J Adv Pract Oncol 2023; 14:49-53. [PMID: 36741211 PMCID: PMC9894207 DOI: 10.6004/jadpro.2023.14.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Across the United States, an incremental need for cancer care continues to emerge. Specialty nurse practitioners and physician assistant teams have helped in meeting this demand. However, there is a need for evidence-based recommendations to inform appropriate provider-patient staffing ratios that encompass complex cancer treatments and ensure optimal care. Methods A literature review identified a gap in existing research with regard to recommended inpatient provider-patient ratios for hematology and oncology services. The conceptual framework of ICU nursing workload was utilized to ensure a comprehensive understanding of an inpatient specialty cancer provider's duties. Results Within the unit, job, patient, and situation workload levels, there were multiple interventions implemented to streamline systems and improve workplace conditions for providers, as measured by the work-related quality of life (WRQoL) scale. Patient satisfaction scores improved an average of 4% across multiple criteria and exceeded benchmark rankings by 10.7% surrounding communication with nurses and physicians (a 6.3% increase). Discharge efficiency improved, with 6.1% more discharges occurring by 11:00 am, and length of stay was noted to be 8.8 days fewer than teaching services treating the same cancer diagnosis. Finally, additional shift pay was greatly reduced and turnover decreased by 17%. Conclusion Application of the conceptual framework of ICU nursing workload provided a scientific assessment of specialty inpatient cancer services within one institution. Interventions resulted in improved working conditions, patient satisfaction, discharge efficiency, and reduced turnover, ultimately ensuring the provision of high-quality cancer care.
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Affiliation(s)
- Heather Jackson
- From Vanderbilt University Medical Center, Nashville, Tennessee
| | - Olivia West
- From Vanderbilt University Medical Center, Nashville, Tennessee
| | - Annie Austin
- From Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karline Peal
- From Vanderbilt University Medical Center, Nashville, Tennessee
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van der Velden FJS, de Vries G, Martin A, Lim E, von Both U, Kolberg L, Carrol ED, Khanijau A, Herberg JA, De T, Galassini R, Kuijpers TW, Martinón-Torres F, Rivero-Calle I, Vermont CL, Hagedoorn NN, Pokorn M, Pollard AJ, Schlapbach LJ, Tsolia M, Elefhteriou I, Yeung S, Zavadska D, Fink C, Voice M, Zenz W, Kohlmaier B, Agyeman PKA, Usuf E, Secka F, de Groot R, Levin M, van der Flier M, Emonts M, Cunnington A, De T, Herberg J, Kaforou M, Wright V, Baumard L, Bellos E, D’Souza G, Galassini R, Habgood-Coote D, Hamilton S, Hoggart C, Hourmat S, Jackson H, Maconochie I, Menikou S, Lin N, Nichols S, Nijman R, Powell O, Pena Paz I, Shah P, Shen CF, Vito O, Wilson C, Abdulla A, Ali L, Darnell S, Jorgensen R, Mustafa S, Persand S, Stevens MM, Kim N, Kim E, Fidler K, Dudley J, Richmond V, Tavliavini E, Shen CF, Liu CC, Wang SM, Martinón-Torres F, Salas A, González FÁ, Farto CB, Barral-Arca R, Castro MB, Bello X, García MB, Carnota S, Cebey-López M, Curras-Tuala MJ, Suárez CD, Vicente LG, Gómez-Carballa A, Rial JG, Iglesias PL, Martinón-Torres F, Martinón-Torres N, Sánchez JMM, Pérez BM, Pardo-Seco J, Rodríguez LP, Pischedda S, Vázquez SR, Calle IR, Rodríguez-Tenreiro C, Redondo-Collazo L, Ora MS, Salas A, Fernández SS, Trasorras CS, Iglesias MV, Zavadska D, Balode A, Bārzdiņa A, Deksne D, Gardovska D, Grāvele D, Grope I, Meiere A, Nokalna I, Pavāre J, Pučuka Z, Selecka K, Rudzāte A, Svile D, Urbāne UN, Usuf E, Bojang K, Zaman SMA, Secka F, Anderson S, Sarr AR, Saidykhan M, Darboe S, Ceesay S, D’alessandro U, Moll HA, Vermont CL, Borensztajn DM, Hagedoorn NN, Tan C, Zachariasse J, Dik W, Agyeman PKA, Berger C, Giannoni E, Stocker M, Posfay-Barbe KM, Heininger U, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert CR, Natalucci G, Relly C, Riedel T, Aebi C, Schlapbach LJ, Carrol ED, Cocklin E, Jennings R, Johnston J, Khanijau A, Leigh S, Lewis-Burke N, Newall K, Romaine S, Tsolia M, Eleftheriou I, Tambouratzi M, Marmarinos A, Xagorari M, Syggelou K, Fink C, Voice M, Calvo-Bado L, Zenz W, Kohlmaier B, Schweintzger NA, Sagmeister MG, Kohlfürst DS, Zurl C, Binder A, Hösele S, Leitner M, Pölz L, Rajic G, Bauchinger S, Baumgart H, Benesch M, Ceolotto A, Eber E, Gallistl S, Gores G, Haidl H, Hauer A, Hude C, Keldorfer M, Krenn L, Pilch H, Pfleger A, Pfurtscheller K, Nordberg G, Niedrist T, Rödl S, Skrabl-Baumgartner A, Sperl M, Stampfer L, Strenger V, Till H, Trobisch A, Löffler S, Yeung S, Dewez JE, Hibberd M, Bath D, Miners A, Nijman R, Fitchett E, de Groot R, van der Flier M, de Jonge MI, van Aerde K, Alkema W, van den Broek B, Gloerich J, van Gool AJ, Henriet S, Huijnen M, Philipsen R, Willems E, Gerrits G, van Leur M, Heidema J, de Haan L, Miedema C, Neeleman C, Obihara C, Tramper-Stranders G, Pollard AJ, Kandasamy R, Paulus S, Carter MJ, O’Connor D, Bibi S, Kelly DF, Gurung M, Thorson S, Ansari I, Murdoch DR, Shrestha S, Oliver Z, Emonts M, Lim E, Valentine L, Allen K, Bell K, Chan A, Crulley S, Devine K, Fabian D, King S, McAlinden P, McDonald S, McDonnell A, Pickering A, Thomson E, Wood A, Wallia D, Woodsford P, Baxter F, Bell A, Rhodes M, Agbeko R, Mackerness C, Baas B, Kloosterhuis L, Oosthoek W, Arif T, Bennet J, Collings K, van der Giessen I, Martin A, Rashid A, Rowlands E, de Vries G, van der Velden F, Soon J, Valentine L, Martin M, Mistry R, von Both U, Kolberg L, Zwerenz M, Buschbeck J, Bidlingmaier C, Binder V, Danhauser K, Haas N, Griese M, Feuchtinger T, Keil J, Kappler M, Lurz E, Muench G, Reiter K, Schoen C, Mallet F, Brengel-Pesce K, Pachot A, Mommert M, Pokorn M, Kolnik M, Vincek K, Srovin TP, Bahovec N, Prunk P, Osterman V, Avramoska T, Kuijpers T, Jongerius I, van den Berg JM, Schonenberg D, Barendregt AM, Pajkrt D, van der Kuip M, van Furth AM, Sprenkeler E, Zandstra J, van Mierlo G, Geissler J. Correction to: Febrile illness in high-risk children: a prospective, international observational study. Eur J Pediatr 2023; 182:555-556. [PMID: 36689005 PMCID: PMC9899168 DOI: 10.1007/s00431-022-04788-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Fabian J. S. van der Velden
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gabriella de Vries
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.416135.40000 0004 0649 0805Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Alexander Martin
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Lim
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ulrich von Both
- grid.5252.00000 0004 1936 973XDivision Paediatric Infectious Diseases, Dr. Von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Laura Kolberg
- grid.5252.00000 0004 1936 973XDivision Paediatric Infectious Diseases, Dr. Von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Enitan D. Carrol
- grid.10025.360000 0004 1936 8470Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK ,grid.417858.70000 0004 0421 1374Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Aakash Khanijau
- grid.10025.360000 0004 1936 8470Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK ,grid.417858.70000 0004 0421 1374Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Jethro A. Herberg
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Tisham De
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Rachel Galassini
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Taco W. Kuijpers
- grid.7177.60000000084992262Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Federico Martinón-Torres
- grid.411048.80000 0000 8816 6945Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain ,grid.11794.3a0000000109410645Grupo de Genetica, Vacunas, Infecciones y Pediatria, Instituto de Investigacion Sanitaria de Santiago, Universidad de Santiago, Santiago de Compostela, Spain ,grid.512891.6Consorcio Centro de Investigacion Biomedicaen Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Irene Rivero-Calle
- grid.411048.80000 0000 8816 6945Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Clementien L. Vermont
- grid.416135.40000 0004 0649 0805Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Nienke N. Hagedoorn
- grid.416135.40000 0004 0649 0805Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Marko Pokorn
- grid.29524.380000 0004 0571 7705University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrew J. Pollard
- grid.4991.50000 0004 1936 8948Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Luregn J. Schlapbach
- grid.412341.10000 0001 0726 4330Neonatal and Pediatric Intensive Care Unit, Children’s Research Center, University Children’s Hospital Zürich, University of Zürich, Zurich, Switzerland
| | - Maria Tsolia
- grid.5216.00000 0001 2155 08002nd Department of Pediatrics, National and Kapodistrian University of Athens, Children’s Hospital ‘P, and A. Kyriakou’, Athens, Greece
| | - Irini Elefhteriou
- grid.5216.00000 0001 2155 08002nd Department of Pediatrics, National and Kapodistrian University of Athens, Children’s Hospital ‘P, and A. Kyriakou’, Athens, Greece
| | - Shunmay Yeung
- grid.8991.90000 0004 0425 469XClinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Dace Zavadska
- grid.17330.360000 0001 2173 9398Department of Pediatrics, Rīgas Stradina Universitāte, Children’s Clinical University Hospital, Riga, Latvia
| | - Colin Fink
- grid.7372.10000 0000 8809 1613Micropathology Ltd, University of Warwick, Warwick, UK
| | - Marie Voice
- grid.7372.10000 0000 8809 1613Micropathology Ltd, University of Warwick, Warwick, UK
| | - Werner Zenz
- grid.11598.340000 0000 8988 2476Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Benno Kohlmaier
- grid.11598.340000 0000 8988 2476Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Philipp K. A. Agyeman
- grid.5734.50000 0001 0726 5157Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Effua Usuf
- grid.415063.50000 0004 0606 294XMedical Research Council Unit, Serrekunda, The Gambia
| | - Fatou Secka
- grid.415063.50000 0004 0606 294XMedical Research Council Unit, Serrekunda, The Gambia
| | - Ronald de Groot
- grid.461578.9Pediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michael Levin
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Michiel van der Flier
- grid.461578.9Pediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.7692.a0000000090126352Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. .,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK. .,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK.
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Jackson H, Rivero Calle I, Broderick C, Habgood-Coote D, D’Souza G, Nichols S, Vito O, Gómez-Rial J, Rivero-Velasco C, Rodríguez-Núñez N, Barbeito-Castiñeiras G, Pérez-Freixo H, Barreiro-de Acosta M, Cunnington AJ, Herberg JA, Wright VJ, Gómez-Carballa A, Salas A, Levin M, Martinon-Torres F, Kaforou M, Jackson H, Calle IR, Habgood-Coote D, D’Souza G, Nichols S, Gómez-Rial J, Cunnington AJ, Herberg JA, Wright VJ, Gómez-Carballa A, Salas A, Levin M, Martinon-Torres F, Kaforou M, Antonio AG, Julián ÁE, Antonio AL, Gema BC, Xabier BP, Miriam BG, María Victoria CG, Miriam CL, Amparo CN, Mónica CP, José Javier CA, María José CT, Ana Isabel DU, Blanca DE, María Jesús DS, Cristina FP, Juan FV, Cristóbal GR, José Luis GA, Luisa GV, Elena GV, Alberto GC, José GR, Francisco Javier GB, Beatriz GL, Pilar LI, Beatriz LM, Marta LF, Montserrat LF, Ana LL, Federico MT, De la Cruz Daniel N, Eloína NM, Juan Bautista OD, Jacobo PS, María PN, del Molino Bernal Marisa P, Hugo PF, Lidia PR, Sara P, Manuel PR, Antonio PR, Gloria María PH, Teresa QV, Lorenzo RC, Patricia RC, Susana RG, Sara RV, Vanessa RB, Irene RC, Carmen RV, Nuria RN, Carmen RTS, Eva SP, José Miguel SO, Carla SV, Sonia SF, Pablo SS, Manuel TM, Rocío TP, Mercedes TC, Luis VC, Pablo VG, Soledad VIM, Sandra VL, Rocio FI, Iria BR, Cristina CS. Characterisation of the blood RNA host response underpinning severity in COVID-19 patients. Sci Rep 2022; 12:12216. [PMID: 35844004 PMCID: PMC9288817 DOI: 10.1038/s41598-022-15547-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/24/2022] [Indexed: 01/08/2023] Open
Abstract
Infection with SARS-CoV-2 has highly variable clinical manifestations, ranging from asymptomatic infection through to life-threatening disease. Host whole blood transcriptomics can offer unique insights into the biological processes underpinning infection and disease, as well as severity. We performed whole blood RNA Sequencing of individuals with varying degrees of COVID-19 severity. We used differential expression analysis and pathway enrichment analysis to explore how the blood transcriptome differs between individuals with mild, moderate, and severe COVID-19, performing pairwise comparisons between groups. Increasing COVID-19 severity was characterised by an abundance of inflammatory immune response genes and pathways, including many related to neutrophils and macrophages, in addition to an upregulation of immunoglobulin genes. In this study, for the first time, we show how immunomodulatory treatments commonly administered to COVID-19 patients greatly alter the transcriptome. Our insights into COVID-19 severity reveal the role of immune dysregulation in the progression to severe disease and highlight the need for further research exploring the interplay between SARS-CoV-2 and the inflammatory immune response.
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Garcia-Romeu A, Elmore J, Mayhugh RE, Schlienz NJ, Martin EL, Strickland JC, Bonn-Miller M, Jackson H, Vandrey R. Online survey of medicinal cannabis users: Qualitative analysis of patient-level data. Front Pharmacol 2022; 13:965535. [PMID: 36147312 PMCID: PMC9485457 DOI: 10.3389/fphar.2022.965535] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Aim: To characterize perceived benefits and challenges experienced by medicinal cannabis users. Methods: An anonymous online survey collected demographics, health information, and open-ended responses from medicinal cannabis users regarding perceptions, motivations, and experience of treatment. Qualitative open-ended responses were thematically analyzed. Results: Respondents (N = 808) were predominantly White (79%), female (63%), with a mean (SD) age of 38 (20). Two hundred eighty-four (35%) respondents provided data on a dependent family member (e.g., child; 22% of total sample). Most used cannabidiol (CBD)-dominant products (58%), primarily for neurological disorders (38%) or pain (25%). Primary motivations for medicinal cannabis use were based on beliefs that traditional treatments were ineffective and/or had intolerable side effects (51%), positive scientific or media portrayals of the safety/efficacy of cannabis as a therapeutic (29%), or preference for “natural” treatments over pharmaceuticals (21%). A majority of respondents (77%) attributed positive effects to the medicinal use of cannabis/cannabinoids. These included physical symptom improvements such as reduced pain (28%), improved sleep (18%), and seizure reduction (18%), and mental health improvements including reduced anxiety (22%) and improved mood (11%). Additionally, respondents reported reduced use of other medications (e.g., opioids) (12%), and improved quality of life (14%). Problems associated with use were cited by 41% of respondents, and included unwanted side effects (16%), lack of information or medical support (16%), prohibitive costs (12%), and legal concerns (10%). Conclusion: Most participants reported benefits from cannabis use for a variety of conditions where traditional treatments were ineffective or unacceptable. Concerns regarding cannabis side effects, legality, lack of information, and cost were raised. Data indicate greater research and education on the safety and efficacy of medicinal cannabis/cannabinoid use is warranted.
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Affiliation(s)
- Albert Garcia-Romeu
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Albert Garcia-Romeu,
| | - Joshua Elmore
- University of Colorado Boulder, Boulder, CO, United States
| | | | | | - Erin L. Martin
- Medical University of South Carolina, Charleston, SC, United States
| | | | | | - Heather Jackson
- Realm of Caring Foundation, Colorado Springs, Colorado, CO, United States
| | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Harrell SL, Peal K, Freitas N, Jackson H. QIM22-193: Development and Implementation of a Scheduling Tool to Improve Patient Access to Outpatient Care in an Academic Cancer Center. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Shelton Lacy Harrell
- 1 Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Karline Peal
- 1 Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Nicole Freitas
- 1 Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Heather Jackson
- 1 Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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Mehta R, Chekmeneva E, Jackson H, Sands C, Mills E, Arancon D, Li HK, Arkell P, Rawson TM, Hammond R, Amran M, Haber A, Cooke GS, Noursadeghi M, Kaforou M, Lewis MR, Takats Z, Sriskandan S. Antiviral metabolite 3'-deoxy-3',4'-didehydro-cytidine is detectable in serum and identifies acute viral infections including COVID-19. Med 2022; 3:204-215.e6. [PMID: 35128501 PMCID: PMC8801973 DOI: 10.1016/j.medj.2022.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/14/2021] [Accepted: 01/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is a critical need for rapid viral infection diagnostics to enable prompt case identification in pandemic settings and support targeted antimicrobial prescribing. METHODS Using untargeted high-resolution liquid chromatography coupled with mass spectrometry, we compared the admission serum metabolome of emergency department patients with viral infections (including COVID-19), bacterial infections, inflammatory conditions, and healthy controls. Sera from an independent cohort of emergency department patients admitted with viral or bacterial infections underwent profiling to validate findings. Associations between whole-blood gene expression and the identified metabolite of interest were examined. FINDINGS 3'-Deoxy-3',4'-didehydro-cytidine (ddhC), a free base of the only known human antiviral small molecule ddhC-triphosphate (ddhCTP), was detected for the first time in serum. When comparing 60 viral with 101 non-viral cases in the discovery cohort, ddhC was the most significantly differentially abundant metabolite, generating an area under the receiver operating characteristic curve (AUC) of 0.954 (95% CI: 0.923-0.986). In the validation cohort, ddhC was again the most significantly differentially abundant metabolite when comparing 40 viral with 40 bacterial cases, generating an AUC of 0.81 (95% CI 0.708-0.915). Transcripts of viperin and CMPK2, enzymes responsible for ddhCTP synthesis, were among the five genes most highly correlated with ddhC abundance. CONCLUSIONS The antiviral precursor molecule ddhC is detectable in serum and an accurate marker for acute viral infection. Interferon-inducible genes viperin and CMPK2 are implicated in ddhC production in vivo. These findings highlight a future diagnostic role for ddhC in viral diagnosis, pandemic preparedness, and acute infection management. FUNDING NIHR Imperial BRC; UKRI.
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Affiliation(s)
- Ravi Mehta
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | - Elena Chekmeneva
- National Phenome Centre, Imperial College London, London SW7 2AZ, UK
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Heather Jackson
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | - Caroline Sands
- National Phenome Centre, Imperial College London, London SW7 2AZ, UK
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Ewurabena Mills
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | | | - Ho Kwong Li
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
- MRC Centre for Molecular Bacteriology & Infection, Imperial College London, London SW7 2AZ, UK
| | - Paul Arkell
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Timothy M. Rawson
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
- Division of Infection & Immunity, University College London, London WC1 E6BT, UK
| | - Robert Hammond
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Maisarah Amran
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Anna Haber
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Graham S. Cooke
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | - Mahdad Noursadeghi
- Division of Infection & Immunity, University College London, London WC1 E6BT, UK
| | - Myrsini Kaforou
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | - Matthew R. Lewis
- National Phenome Centre, Imperial College London, London SW7 2AZ, UK
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Zoltan Takats
- National Phenome Centre, Imperial College London, London SW7 2AZ, UK
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Shiranee Sriskandan
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
- MRC Centre for Molecular Bacteriology & Infection, Imperial College London, London SW7 2AZ, UK
- NIHR Health Protection Research Unit in Healthcare-associated Infection & Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
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Schlienz NJ, Scalsky R, Martin EL, Jackson H, Munson J, Strickland JC, Bonn-Miller MO, Loflin M, Vandrey R. A Cross-Sectional and Prospective Comparison of Medicinal Cannabis Users and Controls on Self-Reported Health. Cannabis Cannabinoid Res 2021; 6:548-558. [PMID: 33998852 PMCID: PMC8713273 DOI: 10.1089/can.2019.0096] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction: Despite widespread legalization, the impact of medicinal cannabis use on patient-level health and quality of life (QOL) has not been carefully evaluated. The objective of this study was to characterize self-reported demographics, health characteristics, QOL, and health care utilization of Cannabis Users compared with Controls. Methods: A longitudinal, cross-sectional web-based survey study was completed between April 2016 and February 2018. Study participants (n=1276) were a convenience sample of either patients with a diagnosed health condition or caregivers of a patient with a diagnosed health condition registered with the Realm of Caring Foundation (a nonprofit organization dedicated to therapeutic cannabis research and education). Participants were invited through e-mail to complete follow-up assessments every 3 months with 33% of participants completing one or more prospective follow-ups. Assessments included self-reported demographics, health care utilization, medication use, pain, anxiety, depression, sleep, and QOL. Cannabis Users (n=808) were compared with Controls (n=468) using negative binomial regression and linear mixed effects models testing the effect of initiation, cessation, and maintenance of medicinal cannabis use. Results: Cannabis Users self-reported significantly better QOL [t(1054)=-4.19, p<0.001], greater health satisfaction [t(1045)=-4.14, p<0.001], improved sleep [children: t(224)=2.90, p<0.01; adults: [t(758)=3.03, p<0.01], lower average pain severity [t(1150)=2.34, p<0.05], lower anxiety [t(1151)=4.38, p<0.001], and lower depression [t(1210)=5.77, p<0.001] compared with Controls. Cannabis Users reported using fewer prescription medications (rate ratio [RR]=0.86; 95% confidence interval [CI]: 0.77-0.96) and were less likely to have a past-month emergency department visit (RR=0.61; 95% CI: 0.44-0.84) or hospital admission (RR=0.54; 95% CI: 0.34-0.87). Controls who initiated cannabis use after baseline showed significant health improvements at follow-up, and the magnitude of improvement mirrored the between-group differences observed at baseline. Conclusions: Cannabis use was associated with improved health and QOL. Longitudinal testing suggests that group differences may be due to the medicinal use of cannabis. Although bias related to preexisting beliefs regarding the health benefits of cannabis in this sample should be considered, these findings indicate that clinical trials evaluating the efficacy of defined cannabinoid products for specific health conditions are warranted.
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Affiliation(s)
- Nicolas J. Schlienz
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York, USA
| | - Ryan Scalsky
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Erin L. Martin
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Joel Munson
- Realm of Caring Foundation, Colorado Springs, Colorado, USA
| | - Justin C. Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marcel O. Bonn-Miller
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mallory Loflin
- Center of Excellence for Stress and Mental Health, VA San Diego Health care System, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, School of Medicine, La Jolla, California, USA
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Jackson H, Harrell S, Collins AM, Lopez N, Skotte E, Hande K. Optimization of Patient Scheduling in a Hematology Outpatient Setting. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Montes de Oca R, Alavi AS, Vitali N, Bhattacharya S, Blackwell C, Patel K, Seestaller-Wehr L, Kaczynski H, Shi H, Dobrzynski E, Obert L, Tsvetkov L, Cooper DC, Jackson H, Bojczuk P, Forveille S, Kepp O, Sauvat A, Kroemer G, Creighton-Gutteridge M, Yang J, Hopson C, Yanamandra N, Shelton C, Mayes P, Opalinska J, Barnette M, Srinivasan R, Smothers J, Hoos A. Belantamab Mafodotin (GSK2857916) Drives Immunogenic Cell Death and Immune-mediated Antitumor Responses In Vivo. Mol Cancer Ther 2021; 20:1941-1955. [PMID: 34253590 PMCID: PMC9398105 DOI: 10.1158/1535-7163.mct-21-0035] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/10/2021] [Accepted: 06/29/2021] [Indexed: 01/07/2023]
Abstract
B-cell maturation antigen (BCMA) is an attractive therapeutic target highly expressed on differentiated plasma cells in multiple myeloma and other B-cell malignancies. GSK2857916 (belantamab mafodotin, BLENREP) is a BCMA-targeting antibody-drug conjugate approved for the treatment of relapsed/refractory multiple myeloma. We report that GSK2857916 induces immunogenic cell death in BCMA-expressing cancer cells and promotes dendritic cell activation in vitro and in vivo GSK2857916 treatment enhances intratumor immune cell infiltration and activation, delays tumor growth, and promotes durable complete regressions in immune-competent mice bearing EL4 lymphoma tumors expressing human BCMA (EL4-hBCMA). Responding mice are immune to rechallenge with EL4 parental and EL4-hBCMA cells, suggesting engagement of an adaptive immune response, immunologic memory, and tumor antigen spreading, which are abrogated upon depletion of endogenous CD8+ T cells. Combinations with OX40/OX86, an immune agonist antibody, significantly enhance antitumor activity and increase durable complete responses, providing a strong rationale for clinical evaluation of GSK2857916 combinations with immunotherapies targeting adaptive immune responses, including T-cell-directed checkpoint modulators.
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Affiliation(s)
- Rocio Montes de Oca
- Experimental Medicine Unit, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania.,Corresponding Author: Rocio Montes de Oca, Experimental Medicine Unit, Oncology R&D, GlaxoSmithKline (United States), 1250 S. Collegeville Road, Collegeville, PA 19426. Phone: 610-917-5746; E-mail:
| | - Alireza S. Alavi
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Nick Vitali
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Sabyasachi Bhattacharya
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Christina Blackwell
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Krupa Patel
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Laura Seestaller-Wehr
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Heather Kaczynski
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Hong Shi
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Eric Dobrzynski
- Bioanalysis, Immunogenicity and Biomarkers, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Leslie Obert
- Translational Medicine and Comparative Pathobiology, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Lyuben Tsvetkov
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - David C. Cooper
- Research Statistics, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Heather Jackson
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Paul Bojczuk
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Sabrina Forveille
- Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Center, Villejuif, France
| | - Oliver Kepp
- Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Center, Villejuif, France
| | - Allan Sauvat
- Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Center, Villejuif, France
| | - Guido Kroemer
- Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Center, Villejuif, France.,Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.,Suzhou Institute for Systems Medicine, Chinese Academy of Medical Sciences, Suzhou, P.R. China.,Karolinska Institute, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jingsong Yang
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Chris Hopson
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Niranjan Yanamandra
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Christopher Shelton
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Patrick Mayes
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | | | - Mary Barnette
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Roopa Srinivasan
- Experimental Medicine Unit, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - James Smothers
- Immuno-Oncology and Combinations RU, Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
| | - Axel Hoos
- Oncology R&D, GlaxoSmithKline, Collegeville, Pennsylvania
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Martin EL, Strickland JC, Schlienz NJ, Munson J, Jackson H, Bonn-Miller MO, Vandrey R. Antidepressant and Anxiolytic Effects of Medicinal Cannabis Use in an Observational Trial. Front Psychiatry 2021; 12:729800. [PMID: 34566726 PMCID: PMC8458732 DOI: 10.3389/fpsyt.2021.729800] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/16/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Anxiety and depressive disorders are highly prevalent. Patients are increasingly using medicinal cannabis products to treat these disorders, but little is known about the effects of medicinal cannabis use on symptoms of anxiety and depression. The aim of the present observational study was to assess general health in medicinal cannabis users and non-using controls with anxiety and/or depression. Methods: Participants (368 Cannabis Users; 170 Controls) completed an online survey assessing anxiety and depressive symptoms, cannabis product use, sleep, quality of life, and comorbid chronic pain. Participants that completed this baseline survey were then invited to complete additional follow-up surveys at 3-month intervals. Baseline differences between Cannabis Users and Controls were assessed using independent-samples t-tests and generalized linear mixed effects models were used to assess the impact of initiating cannabis product use, sustained use, or discontinuation of use on anxiety and depressive symptoms at follow-up. Results: Medicinal cannabis use was associated with lower self-reported depression, but not anxiety, at baseline. Medicinal cannabis users also reported superior sleep, quality of life, and less pain on average. Initiation of medicinal cannabis during the follow-up period was associated with significantly decreased anxiety and depressive symptoms, an effect that was not observed in Controls that never initiated cannabis use. Conclusions: Medicinal cannabis use may reduce anxiety and depressive symptoms in clinically anxious and depressed populations. Future placebo-controlled studies are necessary to replicate these findings and to determine the route of administration, dose, and product formulation characteristics to optimize clinical outcomes.
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Affiliation(s)
- Erin L. Martin
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, United States
| | - Justin C. Strickland
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nicolas J. Schlienz
- Department of Psychology, University at Buffalo, Buffalo, NY, United States
- Realm of Caring Foundation, Colorado Springs, CO, United States
| | - Joel Munson
- Realm of Caring Foundation, Colorado Springs, CO, United States
| | - Heather Jackson
- Realm of Caring Foundation, Colorado Springs, CO, United States
| | | | - Ryan Vandrey
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Strickland JC, Jackson H, Schlienz NJ, Salpekar JA, Martin EL, Munson J, Bonn-Miller MO, Vandrey R. Cross-sectional and longitudinal evaluation of cannabidiol (CBD) product use and health among people with epilepsy. Epilepsy Behav 2021; 122:108205. [PMID: 34311183 DOI: 10.1016/j.yebeh.2021.108205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/01/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 12/21/2022]
Abstract
Recent approval of Epidiolex® (pharmaceutical cannabidiol/CBD) for the treatment of Lennox Gastaut syndrome (LGS) and Dravet syndrome highlights a therapeutic efficacy of CBD in the treatment of epilepsy. However, a large number of patients with epilepsy elect to use alternative artisanal CBD products due to cost or access constraints. Despite widespread availability and variety of these artisanal CBD products, studies evaluating their safety or efficacy are rare, making conclusions about clinical utility uncertain. The purpose of the present study was to evaluate cross-sectional and longitudinal associations of artisanal CBD product use with quality of life, mental health, healthcare utilization, and epilepsy-specific outcomes within a large, observational cohort of people with epilepsy. Participants who reported using artisanal CBD products at baseline (Artisanal CBD Users; n = 280) and participants who used no cannabis-based products (Controls; n = 138) completed web-based assessments evaluating psychiatric symptoms, healthcare utilization, and epilepsy-specific factors. Follow-up surveys were collected in a subset of participants (n = 190) following baseline assessment for longitudinal comparison. Cross-sectionally, higher quality of life, lower psychiatric symptom severity, and improved sleep were observed among Artisanal CBD Users at baseline compared with Controls. Initiation of artisanal CBD product use was also related to improved health outcomes longitudinally. No group differences were observed for seizure control, but both groups included a high number of individuals with no past month seizures. Artisanal CBD Users reported significantly better epilepsy medication tolerability, use of fewer prescription medications overall, and reduced healthcare utilization compared with Controls. These findings are consistent with research indicating that practitioners recommending CBD in clinical care for epilepsy report integrating the use of CBD both as a means to improve patient quality of life as well as for seizure control.
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Affiliation(s)
- Justin C Strickland
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA.
| | - Heather Jackson
- Realm of Caring Foundation, PO Box 15224, Colorado Springs, CO, USA
| | | | - Jay A Salpekar
- Johns Hopkins University School of Medicine, Kennedy Krieger Institute, Departments of Psychiatry and Neurology, Baltimore, MD, USA
| | - Erin L Martin
- Medical University of South Carolina, Department of Neuroscience, Charleston, SC, USA
| | - Joel Munson
- Realm of Caring Foundation, PO Box 15224, Colorado Springs, CO, USA
| | | | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
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20
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Fenn N, Reyes C, Mushkat Z, Vinacco K, Jackson H, Al Sanea A, Robbins ML, Hulme J, Dupre AM. Empathy, better patient care, and how interprofessional education can help. J Interprof Care 2021; 36:660-669. [PMID: 34382506 DOI: 10.1080/13561820.2021.1951187] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Interprofessional education (IPE) has been promoted as one way to prepare healthcare students for interprofessional encounters they might experience in the workplace. However, the link between IPE, interprofessional care in the workforce, and better patient outcomes is tenuous, perhaps in part due to the inability of IPE programs to adequately address barriers associated with interprofessional care (e.g., power differentials, role disputes). Empathy, or understanding the experiences of others, has emerged as a critical tool to breaking down barriers inherent to working in teams. Given the evidence connecting empathy to stronger team collaboration and better patient care, researchers significantly revamped programming from a prior training called Interprofessional Education for Complex Neurological Cases (IPE Neuro) to enhance empathy, foster stronger team collaboration, and improve information integration among participants. In this improved three-session program, participants from seven different professions were grouped into teams, assessed a patient volunteer with neurological disorder, and created and presented an integrated, patient-centric treatment plan. Students (N = 31) were asked to report general empathy levels, as well as attitudes, team skills, and readiness toward interprofessional care, before and after the program. We conducted paired samples t-tests and thematic analysis to analyze the data. Results showed that participants reported higher empathy levels, more positive attitudes, and greater team skills pre- to posttest with moderate to large effects. Results bolster IPE Neuro programming as one approach to prepare students for interprofessional care while underscoring the potential implications of IPE to improve empathy levels of healthcare professionals.
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Affiliation(s)
- Natalie Fenn
- Department of Psychology, University of Rhode Island, Kingston, RI United States
| | - Cheyenne Reyes
- Department of Psychology, University of Rhode Island, Kingston, RI United States
| | - Zoe Mushkat
- Department of Psychology, University of Rhode Island, Kingston, RI United States
| | - Kenneth Vinacco
- Department of Physical Therapy, University of Rhode Island, Kingston, RI United States
| | - Heather Jackson
- Department of Physical Therapy, University of Rhode Island, Kingston, RI United States
| | - Alia Al Sanea
- Department of Psychology, University of Rhode Island, Kingston, RI United States
| | - Mark L Robbins
- Department of Psychology, University of Rhode Island, Kingston, RI United States
| | - Janice Hulme
- Department of Physical Therapy, University of Rhode Island, Kingston, RI United States
| | - Anne-Marie Dupre
- Department of Physical Therapy, University of Rhode Island, Kingston, RI United States
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21
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Gomez A, Capon-Saez A, Gomez-Mosquera A, Parada-DeFreitas Y, Arechaderra-Calderon JJ, Hoyos E, Jackson H, Ramon-Espinoza F, Vilches-Moraga A. 433 SAME SPECIALITY, DIFFERENT REALITY? Age Ageing 2021. [DOI: 10.1093/ageing/afab119.03] [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
Introduction
The United Kingdom and Spain run government-funded social and health care services, free for the user at the point of delivery. Acute Geriatric Units (AGU) carrying out Comprehensive Geriatric Assessments improve the clinical outcomes of older patients. Little is known about the similarities and differences between countries, and how these may impact on clinical outcomes.
Methods
Prospective observational study of consecutive patients admitted to AGU of 2 hospitals in the UK and 4 hospitals in Spain between the 1st to the 30th of October 2019 and from the 1st to the 29th of February 2020. We followed up the patients for a 90 day period.
Conclusions
Frailty, multimorbidity and polypharmacy were prevalent in both cohorts. English patients were younger, with shorter hospital stay, mortality and use of antipsychotic medication but higher readmission rates. Involvement from Allied health care professionals was higher in UK hospitals.
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Affiliation(s)
| | | | | | | | | | - E Hoyos
- Salford Royal NHS Foundation Trust
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22
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Behm C, Jackson H, Parnell S, Yu A. Proximal Tubule‐Specific Knockout of Claudin‐2 Causes Hypercalciuria in Mice. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.03110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Alan Yu
- University of Kansas Medical CenterKansas CityKS
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23
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Simanovskaia M, Droster A, Jackson H, Urdinaran I, van Bibber K. A symmetric multi-rod tunable microwave cavity for a microwave cavity dark matter axion search. Rev Sci Instrum 2021; 92:033305. [PMID: 33820018 DOI: 10.1063/5.0016125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/06/2021] [Indexed: 06/12/2023]
Abstract
The microwave cavity technique is currently the most sensitive way of looking for dark matter axions in the 0.1 GHz-10 GHz range, corresponding to masses of 0.41 µeV-41 µeV. A particular challenge for frequencies greater than 5 GHz is designing a cavity with a large volume that contains a resonant mode that shows high coupling to dark matter axions, a high quality factor, is broadly tunable, and is free from intruder modes. For the Haloscope at Yale Sensitive to Axion Cold dark matter, we have designed and constructed an optimized high frequency cavity with a tuning mechanism that preserves a high degree of rotational symmetry, critical to maximizing its figure of merit. This cavity covers an important frequency range according to recent theoretical estimates for the axion mass, 5.5 GHz-7.4 GHz, and the design appears extendable to higher frequencies as well. This paper will discuss key design and construction details of the cavity, present a summary of the design evolution, and alert practitioners of potentially unfruitful avenues for future work.
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Affiliation(s)
- Maria Simanovskaia
- Department of Nuclear Engineering, University of California Berkeley, Berkeley, California 94720, USA
| | - Alex Droster
- Department of Nuclear Engineering, University of California Berkeley, Berkeley, California 94720, USA
| | - Heather Jackson
- Department of Nuclear Engineering, University of California Berkeley, Berkeley, California 94720, USA
| | - Isabella Urdinaran
- Department of Nuclear Engineering, University of California Berkeley, Berkeley, California 94720, USA
| | - Karl van Bibber
- Department of Nuclear Engineering, University of California Berkeley, Berkeley, California 94720, USA
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Backes KM, Palken DA, Kenany SA, Brubaker BM, Cahn SB, Droster A, Hilton GC, Ghosh S, Jackson H, Lamoreaux SK, Leder AF, Lehnert KW, Lewis SM, Malnou M, Maruyama RH, Rapidis NM, Simanovskaia M, Singh S, Speller DH, Urdinaran I, Vale LR, van Assendelft EC, van Bibber K, Wang H. A quantum enhanced search for dark matter axions. Nature 2021; 590:238-242. [DOI: 10.1038/s41586-021-03226-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/08/2020] [Indexed: 11/09/2022]
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25
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Wittink MN, Cross W, Goodman J, Jackson H, Lee HB, Olivares T, Maeng DD, Caine ED. Taking the Long View in an Inpatient Medical Unit: A Person-Centered, Integrated Team Approach for Patients With Severe Mental Illnesses. Psychiatr Serv 2020; 71:885-892. [PMID: 32362225 DOI: 10.1176/appi.ps.201900385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patients with severe mental illnesses and related conditions, such as substance misuse and suicide attempts, are among the highest utilizers of acute inpatient medical services. The objective of this study was to assess the impact of a specialized medical unit that uses a comprehensive biopsychosocial model to care for patients with severe mental illnesses. METHODS The study used administrative data to compare patients with severe mental illnesses admitted to a specialized unit with patients admitted to medically similar acute (non-intensive care) medical units in a tertiary academic medical center. With controls for sociodemographic variables, illness severity, and medical complexity, multivariate regression analyses compared utilization outcomes for patients from the specialized unit with outcomes from comparison units. RESULTS Patients on the specialized unit (N=2,077) were younger, had more mental disorder diagnoses, and were more likely to have less severe general medical illness and less medical complexity than patients from comparison units (N=12,824). Analyses of a subsample of patients with complex behavioral health diagnoses indicated that those on the specialized unit had a shorter average stay, higher odds of discharge to home, and lower odds of 30-day readmission, compared with those on comparison units. CONCLUSIONS Specialized units targeted to the needs of patients with serious mental illnesses can provide a moment of engagement when vulnerable patients are likely to benefit from more coordinated care. Findings suggest that a specialized unit that capitalizes on this moment of engagement and uses a biopsychosocial model of care can improve utilization outcomes.
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Affiliation(s)
- Marsha N Wittink
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
| | - Wendi Cross
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
| | - Jacqueline Goodman
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
| | - Heather Jackson
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
| | - Hochang B Lee
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
| | - Telva Olivares
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
| | - Daniel D Maeng
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
| | - Eric D Caine
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
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Wang X, Nijman R, Camuzeaux S, Sands C, Jackson H, Kaforou M, Emonts M, Herberg JA, Maconochie I, Carrol ED, Paulus SC, Zenz W, Van der Flier M, de Groot R, Martinon-Torres F, Schlapbach LJ, Pollard AJ, Fink C, Kuijpers TT, Anderson S, Lewis MR, Levin M, McClure M. Plasma lipid profiles discriminate bacterial from viral infection in febrile children. Sci Rep 2019; 9:17714. [PMID: 31776453 PMCID: PMC6881435 DOI: 10.1038/s41598-019-53721-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/03/2019] [Indexed: 11/16/2022] Open
Abstract
Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and there is no definitive test for the accurate diagnosis of infection. The 'omics' approaches to identifying biomarkers from the host-response to bacterial infection are promising. In this study, lipidomic analysis was carried out with plasma samples obtained from febrile children with confirmed bacterial infection (n = 20) and confirmed viral infection (n = 20). We show for the first time that bacterial and viral infection produces distinct profile in the host lipidome. Some species of glycerophosphoinositol, sphingomyelin, lysophosphatidylcholine and cholesterol sulfate were higher in the confirmed virus infected group, while some species of fatty acids, glycerophosphocholine, glycerophosphoserine, lactosylceramide and bilirubin were lower in the confirmed virus infected group when compared with confirmed bacterial infected group. A combination of three lipids achieved an area under the receiver operating characteristic (ROC) curve of 0.911 (95% CI 0.81 to 0.98). This pilot study demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing bacterial from viral infection in febrile children, to facilitate effective clinical management and to the limit inappropriate use of antibiotics.
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Affiliation(s)
- Xinzhu Wang
- Department of Infectious Disease, Imperial College London, London, W2 1PG, United Kingdom
| | - Ruud Nijman
- Department of Infectious Disease, Imperial College London, London, W2 1PG, United Kingdom
| | - Stephane Camuzeaux
- National Phenome Centre and Imperial Clinical Phenotyping Centre, Department of Metabolism, Digestion and Reproduction, IRDB Building, Du Cane Road, Imperial College London, London, W12 0NN, United Kingdom
| | - Caroline Sands
- National Phenome Centre and Imperial Clinical Phenotyping Centre, Department of Metabolism, Digestion and Reproduction, IRDB Building, Du Cane Road, Imperial College London, London, W12 0NN, United Kingdom
| | - Heather Jackson
- Department of Infectious Disease, Imperial College London, London, W2 1PG, United Kingdom
| | - Myrsini Kaforou
- Department of Infectious Disease, Imperial College London, London, W2 1PG, United Kingdom
| | - Marieke Emonts
- Great North Children's Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
- NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, NE4 5PL, United Kingdom
| | - Jethro A Herberg
- Department of Infectious Disease, Imperial College London, London, W2 1PG, United Kingdom
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, W2 1NY, United Kingdom
| | - Enitan D Carrol
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, United Kingdom
- Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, United Kingdom
- Liverpool Health Partners, Liverpool, L3 5TF, United Kingdom
| | - Stephane C Paulus
- Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, United Kingdom
- Liverpool Health Partners, Liverpool, L3 5TF, United Kingdom
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - Michiel Van der Flier
- Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, 3508 AB, The Netherlands
- Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, and Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands
| | - Ronald de Groot
- Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, and Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands
| | - Federico Martinon-Torres
- Genetic, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago and Universidad de Santiago de Compostela (USC), Galicia, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Galicia, 15706, Spain
| | - Luregn J Schlapbach
- Paediatirc Criticial Care Research Group, Child Health Research Centre, The University of Queensland and Paediatric Intensive Care Research Group, Queensland Children's Hospital, Brisbane, Australia
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, OX3 9DU, United Kingdom
| | - Colin Fink
- Micropathology Ltd, University of Warwick, Warwick, CV4 7EZ, United Kingdom
| | - Taco T Kuijpers
- Division of Pediatric Hematology, Immunology and Infectious diseases, Emma Children's Hospital Academic Medical Center, Amsterdam, 1105 AZ, The Netherlands
| | - Suzanne Anderson
- Medical Research Council Unit at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Matthew R Lewis
- National Phenome Centre and Imperial Clinical Phenotyping Centre, Department of Metabolism, Digestion and Reproduction, IRDB Building, Du Cane Road, Imperial College London, London, W12 0NN, United Kingdom
| | - Michael Levin
- Department of Infectious Disease, Imperial College London, London, W2 1PG, United Kingdom
| | - Myra McClure
- Department of Infectious Disease, Imperial College London, London, W2 1PG, United Kingdom.
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Bird CB, Malone B, Rice LG, Ross PF, Eppley R, Abouzied MM, Ashman P, Carpenter N, Drouches M, Fairchild A, Hartman R, Herald S, Holloway S, Horrisberger G, Jackson H, Jones K, Landis K, Leichtweis H, Peden J. Determination of Total Fumonisins in Corn by Competitive Direct Enzyme-Linked Immunosorbent Assay: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/85.2.404] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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]
Abstract
Abstract
Fumonisins—mycotoxins produced by some Fusarium species—have been shown to be the causative agent of diseases in horses and other domesticated animals as well as possible carcinogens in humans. A collaborative study was conducted to evaluate the effectiveness of a competitive direct enzyme-linked immunosorbent assay (CD-ELISA) for the determination of total fumonisins (B1, B2, and B3) in corn. The test portion was extracted with methanol–water (7 + 3), filtered, diluted, and tested on the CD-ELISA. Naturally and artificially contaminated corn test portions were sent to 13 collaborators in the United States. Naturally contaminated field test portions were prepared at 3 different levels. Artificially contaminated test portions were spiked at 1.0, 3.0, and 5.0 mg/kg total fumonisins (B1, B2, and B3). Average recoveries of total fumonisins were 120, 100, and 90%, respectively. The relative standard deviations for repeatability ranged from 13.3 to 23.3% and the relative standard deviations for reproducibility ranged from 15.8 to 30.3% across all levels tested. HORRAT values, calculated for each individual sample, ranged from 1.24 to 1.94. This method demonstrated acceptable intra- and interlaboratory precision at the levels tested.
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Affiliation(s)
| | - Bruce Malone
- Trilogy Analytical Laboratory, Inc., 111 W. Fourth St, Washington, MO 63090
| | - Larry G Rice
- U.S. Department of Agriculture, Animal and Plant Health Inspection Service, National Veterinary Services Laboratory, 1800 Dayton Rd, Ames, IA 50010
| | - P Frank Ross
- U.S. Department of Agriculture, Animal and Plant Health Inspection Service, National Veterinary Services Laboratory, 1800 Dayton Rd, Ames, IA 50010
| | - Robert Eppley
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 200 C St, SW, Washington, DC 20204
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Kapu AN, Borg Card E, Jackson H, Kleinpell R, Kendall J, Lupear BK, LeBar K, Dietrich MS, Araya WA, Delle J, Payne K, Ford J, Dubree M. Assessing and addressing practitioner burnout: Results from an advanced practice registered nurse health and well-being study. J Am Assoc Nurse Pract 2019; 33:38-48. [PMID: 31702604 DOI: 10.1097/jxx.0000000000000324] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/08/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Numerous nursing and physician studies have reported the effects of workload, environment, and life circumstances contributing to burnout. Effects may include job dissatisfaction, poor quality of life, and associated negative patient outcomes. Although assessing clinician burnout to determine effective interventions has become a topic of great importance, there are minimal studies specific to advanced practice registered nurses (APRNs). PURPOSE This single-center study was conducted to assess the prevalence and impact of APRN burnout and to recommend targeted interventions toward improvement of overall health and well-being. METHODS A cross-sectional, mixed methods design was used. The voluntary, anonymous survey examined perceptions of wellness, inclusion, social support, personal coping mechanisms, and status of burnout. RESULTS The 78-question survey was sent to 1,014 APRNs (94%) and PAs (6%), with a 43.6% response rate (n = 433); 76.4% were nurse practitioners. Participants were identified as currently experiencing burnout, formerly burned out, or never having experienced burnout. Profiles were developed, and similarities and differences between each group were compared. Of 433 respondents, 40.4% (n = 175) reported having never experienced burnout, 33.3% (n = 144) reported they had formerly experienced burnout, and 26.3% (n = 114) reported they were currently experiencing burnout. IMPLICATIONS FOR PRACTICE The results of the study identified that some APRNs report experiencing burnout at different times in their careers. Recommendations by participants to mitigate burnout included self-care, organizational promotion of health and well-being, career development, and leadership support. This study is one of the first to report on burnout among APRNs and potential interventions to build resilience; however, additional research is warranted.
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Affiliation(s)
- April N Kapu
- Advanced Practice, Vanderbilt University Medical Center and Professor of Clinical Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee
| | | | - Heather Jackson
- Outpatient Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ruth Kleinpell
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Jim Kendall
- Work/Life Connections-EAP, Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Buffy Krauser Lupear
- Office of Advanced Practice, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kiersten LeBar
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary S Dietrich
- Vanderbilt University Schools of Medicine and Nursing, Nashville, Tennessee
| | - Wendy A Araya
- Neonatal Intensive Care Practitioners, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Janelle Delle
- Trauma Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kate Payne
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jaquelyn Ford
- Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marilyn Dubree
- Vanderbilt University Medical Center, Nashville, Tennessee
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Yao RJR, Andrade JG, Deyell MW, Jackson H, McAlister FA, Hawkins NM. Sensitivity, specificity, positive and negative predictive values of identifying atrial fibrillation using administrative data: a systematic review and meta-analysis. Clin Epidemiol 2019; 11:753-767. [PMID: 31933524 PMCID: PMC6712502 DOI: 10.2147/clep.s206267] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/29/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Atrial fibrillation (AF) is the commonest arrhythmia and a major cause of stroke and health care utilization. Researchers and administrators use electronic health data to assess disease burden, quality and variance in care, value of interventions and prognosis. We performed a systematic review and meta-analysis to assess the validity of AF case definitions in administrative databases. Methods Medline was searched from 2000 to 2018. Extracted information included sensitivity, specificity, positive and negative predictive values (PPV and NPV) for various AF case definitions. Estimates were pooled using random-effects models due to significant heterogeneity between studies. Results We identified 24 studies, including 21 from North America or Scandinavia. Hospital, ambulatory and mixed data sources were assessed in 10, 4 and 10 studies, respectively. Nine different AF case definitions were evaluated, most based on ICD-9 or 10 codes. Twenty-two studies assessed case definitions in patients diagnosed with AF and thus could generate PPV alone. Half the studies sampled unrestricted populations including a mix of those with and without AF to assess sensitivity. Only 13 studies included ECG confirmation as a gold standard. The pooled random effects estimates were: sensitivity 80% (95% CI 72-86%); specificity 98% (96-99%); PPV 88% (82-94%); NPV 97% (94-99%). Only 3 studies reported all accuracy parameters and included rhythm monitoring in the gold standard definition. Conclusion Relatively few studies examined sensitivity, and fewer still included rhythm monitoring in the gold standard comparison. Administrative data may fail to identify a significant proportion of patients with AF. This, in turn, may bias estimates of quality of care and prognosis.
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Affiliation(s)
- Ren Jie Robert Yao
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Jason G Andrade
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Marc W Deyell
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | | | - Finlay A McAlister
- Division of General Internal Medicine, University of Alberta, Edmonton, Canada
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Kalyana-Sundaram S, Traini C, Halsey W, Jackson H, Bhattacharya S, Yanamandra N, Sathe G, Livi G. Abstract 1208: Comparative analysis between DNA vs RNA-based T cell repertoire profiling for cancer immunotherapy. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-1208] [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: 11/16/2022]
Abstract
Abstract
The T cell receptor (TCR), a defining structure of T cells is responsible for the recognition of the antigen-major histocompatibility complex, leading to the initiation of an immune response. The extreme diversity of the TCR repertoire represents a major analytical challenge. Massively parallel high throughput sequencing is commonly deployed to characterize various key features of T cell receptors including their clonal expansion and repertoire diversity. Genomic DNA is the most widely employed starting material to characterize the TCR repertoire. DNA is highly stable and contains a fixed copy number per cell, which allows for better quantification of TCR clones. However, the inclusiveness is a major limitation of using genomic DNA along with the PCR amplification challenges and sequencing errors due to recombined gene segments within the context of ‘unused’ segments and introns. Here we deploy RNA-based TCR profiling as an alternate strategy to overcome the major limitations associated with the DNA-based approach. Employing RNA with a simplified PCR amplification strategy allows a more comprehensive identification of unique TCR variants with greater sensitivity. It also provides information about expression levels of TCR sequences, and more importantly, excludes the non-productive sequences that are functionally irrelevant. In addition, Unique Molecular Indexing (UMIs) enables the determination of the absolute count of RNA transcripts processed in a sample, allowing straightforward error corrections.
Citation Format: Shanker Kalyana-Sundaram, Christopher Traini, Wendy Halsey, Heather Jackson, Sabyasachi Bhattacharya, Niranjan Yanamandra, Ganesh Sathe, George Livi. Comparative analysis between DNA vs RNA-based T cell repertoire profiling for cancer immunotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1208.
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Steel JL, Miceli J, Hecht CL, Tsung A, Marsh W, Antoni M, Vodovotz Y, Peddada S, Spring M, Jackson H, Vanegas Y, Olejniczak D, Chen Q, Geller DA. Interim analyses of the efficacy of a collaborative care intervention for patients diagnosed with comorbid cancer and depression. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11599] [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
11599 Background: There is an urgent need for evidence-based and scalable interventions to reduce depression, pain, and fatigue and improve quality of life in patients diagnosed with cancer. The aims of this study were to share the interim analyses of testing the efficacy of a stepped collaborative care intervention for patients diagnosed with cancers affecting the hepatobiliary and pancreatic system. Methods: Patients were screened for clinical levels of depression, pain, or fatigue and were enrolled in the study if they screened positive for depression, pain, and/or fatigue. After completing a baseline battery of instruments, patients were randomized to the stepped collaborative care intervention or the screening and referral arm. Post-treatment data was collected at 6 months and 12 months to assess efficacy and maintenance of change in depressive symptoms. Results: A total of 100 patients have completed the post-treatment assessment. Interim data analyses revealed that the mean age of patients was 64.0 years (SD = 10.3) and the majority of patient were male (51%), Caucasian (89%), diagnosed with liver cancer (47%) and stage III and IV (60%). Patients randomized to the stepped collaborative care intervention reported significant reductions in depressive symptoms (F(1,92) = 6.22, p = 0.014) and improvements in quality of life (F(1,92) = 7.36, p = 0.008) with moderate effect sizes (Cohen’s d = 0.547 and 0.652, respectively) at 6-months. The mean change in depressive symptoms from randomization to 6-month post- treatment was -4.3 (SD = 9.7) for the patients randomized to the collaborative care intervention and +0.71 (SD = 9.4) for the patients randomized to the screening and referral arm of the study. The mean change in quality of life from randomization to 6-month post-treatment was +4.5 (SD = 16.2) for the patients randomized to the collaborative care intervention and -4.4 (SD = 15.2) for the patients randomized to the screening and referral arm of the study. Conclusions: This promising evidence-based, scalable intervention to treat comorbid cancer and depression was shown to be effective in reducing depressive symptoms and improving quality of life in patients with cancer. Clinical trial information: NCT02939755.
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Affiliation(s)
| | | | | | - Allan Tsung
- Comprehensive Liver Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Michael Antoni
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | | | | | | | | | | | | | - Qi Chen
- University of Pittsburgh, Pittsburgh, PA
| | - David A. Geller
- University of Pittsburgh Medical Center Liver Cancer Center, Pittsburgh, PA
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Bunn TL, Quesinberry D, Jennings T, Kizewski A, Jackson H, McKee S, Eustice S. Timely linkage of individuals to substance use disorder treatment: development, implementation, and evaluation of FindHelpNowKY.org. BMC Public Health 2019; 19:177. [PMID: 30744608 PMCID: PMC6371481 DOI: 10.1186/s12889-019-6499-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/30/2019] [Indexed: 11/20/2022] Open
Abstract
Background Substance use disorders (SUD) have steadily increased over the last two decades. Seeking SUD treatment involves searching SUD treatment facility types (inpatient, outpatient and intensive outpatient, residential and family residential, and detoxification facilities) that offer specialized SUD treatment depending on individual needs and preferences. Referrals to SUD treatment require innovative strategies that rapidly link individuals to SUD treatment when they are at the critical stage of readiness. The aim of this study was to develop, implement, and evaluate a user-friendly SUD treatment facility opening availability website called FindHelpNowKY.org. The objectives of the study were to 1) recruit SUD treatment facility and partner participation; 2) develop platform, content, and analytics for the FindHelpNowKY.org website intervention with an information repository; 3) assess barriers and facilitators to implementation; and 4) evaluate the development and implementation of FindHelpNowKY.org. Methods Website development stakeholders were identified and the website concept was developed. The logic model for FindHelpNowKY.org outlined resources, activities, and outputs as well as the associated short-term, medium-term, and long-term objectives, along with a website evaluation plan. Website usability and focus group testing was conducted. Information repository resource documents were compiled and categorized. An inventory of Kentucky-based SUD treatment facilities was compiled using various state and federal resources. Results Development/implementation barriers were addressed, facilitators were identified, and the website was implemented; 83% of SUD treatment facilities were indexed on the website, and average website user time was 7 min. From February to October 2018, there were 29,000 visitors, and 30,000 unique searches. The most common website query was a friend or family member seeking long-term residential or outpatient treatment facilities accepting Medicaid or Medicare. Conclusions FindHelpNowKY.org has the potential to fill a critical need for timely access to available SUD treatment in the state. The website may be a valuable resource for health professionals that can enhance clinical workflow and reduce staff time conducting phone and website searches for available SUD treatment. The website is a promising tool for assessing current SUD treatment capacity vs. SUD treatment need. The FindHelpNow model can be used by other states to increase timely access to SUD treatment.
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Affiliation(s)
- Terry Lee Bunn
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA. .,Department of Preventive Medicine and Environmental Health, University of Kentucky, College of Public Health, 111 Washington Ave, Lexington, KY, 40536, USA.
| | - Dana Quesinberry
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Tyler Jennings
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Amber Kizewski
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Heather Jackson
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Sarah McKee
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
| | - Sarah Eustice
- Kentucky Injury Prevention and Research Center, University of Kentucky, 333 Waller Ave., Suite 242, Lexington, KY, 40504, USA
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Rothwell L, Jackson H, Engel B. The effectiveness of hand grip dynamometry in assessing the nutritional status of renal inpatients. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2018.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jackson H, Bhattacharya S, Bojczuk P, Kilian D, Seestaller Wehr L, Hahn A, Shi H, Bi M, Adam M, Jing J, Morley P, Hopson C, Paul E, Hoos A, Smothers J, Srinivasan R, Yanamandra N. Evaluation of OX40 receptor density, influence of IgG Isotype and dosing paradigm in anti-OX40-mediated efficacy and biomarker responses with PD-1 blockade. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Brett S, Yadavilli S, Seestaller-Wehr L, Bhattacharya S, Jackson H, Bi M, Willoughby J, Zhang T, Liu YB, Katlinskaya Y, Shi H, Jing J, Hahn A, Speller S, David Figueroa D, Yu J, Olive D, Cragg M, Mayes P, Hoos A. Preclinical evaluation of a non-depleting, first-in-class humanized IgG4 agonist anti-ICOS antibody. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy303.010] [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: 11/12/2022] Open
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Peng W, Xu C, Melendez B, Jackson H, McKenzi JA, Williams LJ, Chen Y, Mbofung RM, Leahey SELE, Lizee G, Davies MA, Yanamandra N, Hwu P. Abstract 4938: OX40 agonist antibody-based combination therapy with PI3Kβ selective inhibitor enhances T cell immunity. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-4938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
OX40 (CD134), a tumor necrosis factor (TNF) receptor family member, plays a critical role in initiating signaling cascades required for full activation of tumor-reactive T cells. Due to its distinct mechanism of action, the use of OX40 agonist-based combinations is emerging as a novel avenue to improve the effectiveness of cancer treatments. Our recently published studies demonstrate that oncogenic activation of the PI3K pathway by loss of the expression of tumor suppressor PTEN, imposes an immunosuppressive microenvironment in favor of tumor immune evasion. These results highlight the therapeutic potential of combinational therapy using OX40 agonists and PI3K inhibitors in cancer patients. In this study, we sought to evaluate the antitumor efficacy of the combination of an OX40 agonist antibody and a PI3Kβ selective inhibitor, GSK2636771, in tumors with PTEN loss. By using a genetically engineered mouse (GEM) model of melanoma, which can spontaneously develop tumors with PTEN loss, we observed that combination therapy using anti-OX40 and GSK2636771 significantly delayed tumor growth and improved survival time of mice bearing PTEN loss tumors. This combinational treatment was also well tolerated in experimental mice. Unlike the combination of GSK2636771 and immune checkpoint blockers, this combinational treatment did not result in an increase in the number of CD8+ tumor-infiltrating T cells, but significantly enhanced the percentage of Ki67+ CD8+ T cells at the tumor site when compared to either treatment alone. These results suggest that GSK2636771 treatment can synergize with OX40 agonists to augment effector functions of tumor-reactive T cells. To further confirm this synergistic effect, we measured serum levels of 45 cytokines/chemokines in tumor-bearing mice receiving anti-OX40 alone or in combination with GSK2636771. Serum levels of CCL4, CXCL10 and IFN-γ, which are mainly produced by memory and/or effector T cells, were significantly increased in mice in the combination cohort in comparison to the monotherapy cohorts. More importantly, using a vaccine mouse model, we demonstrate that GSK2636771 in combination with anti-OX40 did not significantly impair the generation and maintenance of memory T cells. Taken together, our results suggest that the combinational approach of an OX40 agonist antibody and GSK2636771 may induce robust and durable antitumor T cell immunity. Our study also provides a rationale to explore the clinical activity of an OX40 agonist antibody in combination with GSK2636771 in cancer patients with PTEN loss tumors.
Citation Format: Weiyi Peng, Chunyu Xu, Brenda Melendez, Heather Jackson, Jodi A. McKenzi, Leila J. Williams, Yuan Chen, Rina M. Mbofung, Sara E. Leahey E. Leahey, Greg Lizee, Michael A. Davies, Niranjan Yanamandra, Patrick Hwu. OX40 agonist antibody-based combination therapy with PI3Kβ selective inhibitor enhances T cell immunity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4938.
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Affiliation(s)
- Weiyi Peng
- 1UT MD Anderson Cancer Ctr., Houston, TX
| | - Chunyu Xu
- 1UT MD Anderson Cancer Ctr., Houston, TX
| | | | | | | | | | - Yuan Chen
- 1UT MD Anderson Cancer Ctr., Houston, TX
| | | | | | - Greg Lizee
- 1UT MD Anderson Cancer Ctr., Houston, TX
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Byrne M, Symington M, Stainer B, Leighton J, Jackson H, Singhal N, Shiel-Rankin S, Mayes J, Mogg J, Bonham T, Smit A, Deutsch B, Wilson C. School Level Education to Increase Organ Donation and The Effect Of Deprivation. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.695] [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: 11/16/2022]
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Forman J, Baumbusch J, Jackson H, Lindenberg J, Shook A, Bashir J. Exploring the patients’ experiences of living with a subcutaneous implantable cardioverter defibrillator. Eur J Cardiovasc Nurs 2018; 17:698-706. [DOI: 10.1177/1474515118777419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The implantable cardioverter defibrillator provides effective treatment for the prevention of sudden cardiac arrest but significant risks associated with transvenous implantation persist. The subcutaneous implantable cardioverter defibrillator has proven to be an alternative and innovative treatment option for select patients to mitigate these risks. Obtaining the patients’ perspectives can provide clinicians with essential information to guide implant selection, procedural decision-making, and support patient management. Conventional implantable cardioverter defibrillator patients have reported shock-related anxiety, fear, insufficient education, and challenges adapting to physical and psychological changes. Little evidence exists to determine whether differences between the subcutaneous implantable cardioverter defibrillator and conventional implantable cardioverter defibrillator allow for the transferability of our current knowledge to the care and management of this population. Aims: The purpose of this study was to explore patients’ experiences of living with a subcutaneous implantable cardioverter defibrillator including the decision-making process, implant, and follow-up care processes. Methods: Using an exploratory qualitative approach, semi-structured interviews were conducted by telephone with 15 participants who underwent subcutaneous implantable cardioverter defibrillator implant. Results: Analysis revealed five main themes: (a) influences on decision-making; (b) unmet education needs; (c) physical impact; (d) psychological impact; and (e) recommendations. Conclusion: As a new technology, little knowledge of the subcutaneous implantable cardioverter defibrillator exists outside of the tertiary implanting sites, therefore developing new strategies to increase learning and dissemination is essential. Although similarities exist in our findings to those of conventional implantable cardioverter defibrillators, there are significant differences in the decision-making process and physical impact which require individualized care planning and development of strategies to provide a patient-centered approach to care.
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Byrne M, Jackson H, Sinha A, Tong G, Grafton-Clarke C, Rees S, Mathur A, Cross B, Christopher E, Isaacs L, Banh S, Sheng Z, Lundin R. The National Student Association of Medical Research (NSAMR) Publication Pathway. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pali‐Schöll I, De Lucia M, Jackson H, Janda J, Mueller RS, Jensen‐Jarolim E. Comparing immediate-type food allergy in humans and companion animals-revealing unmet needs. Allergy 2017; 72:1643-1656. [PMID: 28394404 DOI: 10.1111/all.13179] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 12/15/2022]
Abstract
Adverse food reactions occur in human as well as veterinary patients. Systematic comparison may lead to improved recommendations for prevention and treatment in both. In this position paper, we summarize the current knowledge on immediate-type food allergy vs other food adverse reactions in companion animals, and compare this to the human situation. While the prevalence of food allergy in humans has been well studied for some allergens, this remains to be investigated for animal patients, where owner-reported as well as veterinarian-diagnosed food adverse reactions are on the increase. The characteristics of the disease in humans vs dogs, cats, and horses are most often caused by similar, but sometimes species-dependent different pathophysiological mechanisms, prompting the specific clinical symptoms, diagnoses, and treatments. Furthermore, little is known about the allergen molecules causative for type I food allergy in animals, which, like in human patients, could represent predictive biomarkers for risk evaluation. The definite diagnosis of food allergy relies-as in humans-on elimination diet and provocation tests. Besides allergen avoidance in daily practice, novel treatment options and tolerization strategies are underway. Taken together, numerous knowledge gaps were identified in veterinary food allergy, which need to be filled by systematic comparative studies.
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Affiliation(s)
- I. Pali‐Schöll
- Comparative Medicine The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna Medical University of Vienna and University of Vienna Vienna Austria
| | - M. De Lucia
- Clinica Veterinaria Privata San Marco Padova Italy
| | - H. Jackson
- Dermatology Referral Services LTD Glasgow Scotland UK
| | - J. Janda
- Faculty of Science Charles University Prague Czech Republic
| | - R. S. Mueller
- Centre for Clinical Veterinary Medicine Ludwig Maximilian University Munich Munich Germany
| | - E. Jensen‐Jarolim
- Comparative Medicine The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna Medical University of Vienna and University of Vienna Vienna Austria
- Institute of Pathophysiology and Allergy Research Center of Pathophysiology Infectiology and Immunology Medical University of Vienna Vienna Austria
- Allergy Care Allergy Diagnosis and Study Center Vienna Austria
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Forman J, Jackson H, Walter C, Hawkins N, Krahn A, Bashir J. THE SUBCUTANEOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR EXPERIENCE IN BRITISH COLUMBIA – PROVINCIAL COORDINATION ENABLES DISTRIBUTED PATIENT ACCESS TO NEW TECHNOLOGY. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Davis ID, Quirk J, Morris L, Seddon L, Tai TY, Whitty G, Cavicchiolo T, Ebert L, Jackson H, Browning J, MacGregor D, Wittke F, Winkels G, Alex R, Miloradovic L, Maraskovsky E, Chen W, Cebon J. A pilot study of peripheral blood BDCA-1 (CD1c) positive dendritic cells pulsed with NY-ESO-1 ISCOMATRIX™ adjuvant. Immunotherapy 2017; 9:249-259. [PMID: 28183192 DOI: 10.2217/imt-2016-0132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIM Pilot clinical trial of NY-ESO-1 (ESO) protein in ISCOMATRIX™ adjuvant pulsed onto peripheral blood dendritic cells (PBDC), to ascertain feasibility, evaluate toxicity and assess induction of ESO-specific immune responses. PATIENTS & METHODS Eligible participants had resected cancers expressing ESO or LAGE-1 and were at high risk of relapse. PBDC were produced using CliniMACS®plus, with initial depletion of CD1c+ B cells followed by positive selection of CD1c+ PBDC. Patients received three intradermal vaccinations of ESO/IMX-pulsed PBDC at 4-week intervals. RESULTS The process was feasible and safe. No vaccine-induced immune responses were detected. Assays of immunomodulatory cells did not correlate with outcomes. One patient had a long lasting complete remission. CONCLUSION This method was feasible and safe but was minimally immunogenic.
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Affiliation(s)
- Ian D Davis
- Ludwig Institute for Cancer Research, Victoria, Australia.,Austin Health, Department of Medical Oncology, Victoria, Australia.,Monash University Eastern Health Clinical School, Level 2, 5 Arnold St, Box Hill, Victoria 3128, Australia.,Eastern Health, Victoria, Australia
| | - Juliet Quirk
- Ludwig Institute for Cancer Research, Victoria, Australia
| | - Leone Morris
- Ludwig Institute for Cancer Research, Victoria, Australia
| | - Lauren Seddon
- Ludwig Institute for Cancer Research, Victoria, Australia
| | - Tsin Yee Tai
- Ludwig Institute for Cancer Research, Victoria, Australia
| | | | | | - Lisa Ebert
- Ludwig Institute for Cancer Research, Victoria, Australia
| | | | - Judy Browning
- Austin Health, Department of Anatomical Pathology, Victoria, Australia
| | - Duncan MacGregor
- Austin Health, Department of Anatomical Pathology, Victoria, Australia
| | | | | | | | | | - Eugene Maraskovsky
- Ludwig Institute for Cancer Research, Victoria, Australia.,CSL Limited, Melbourne, Australia
| | - Weisan Chen
- Ludwig Institute for Cancer Research, Victoria, Australia.,School of Cancer Medicine, La Trobe University, Australia
| | - Jonathan Cebon
- Ludwig Institute for Cancer Research, Victoria, Australia.,Austin Health, Department of Medical Oncology, Victoria, Australia.,School of Cancer Medicine, La Trobe University, Australia.,Olivia Newton-John Cancer Research Institute, Victoria, Australia
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Gedye C, Cardwell T, Dimopoulos N, Tan BS, Jackson H, Svobodová S, Anaka M, Behren A, Maher C, Hofmann O, Hide W, Caballero O, Davis ID, Cebon J. Mycoplasma Infection Alters Cancer Stem Cell Properties in Vitro. Stem Cell Rev Rep 2016; 12:156-61. [PMID: 26514153 DOI: 10.1007/s12015-015-9630-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cancer cell lines can be useful to model cancer stem cells. Infection with Mycoplasma species is an insidious problem in mammalian cell culture. While investigating stem-like properties in early passage melanoma cell lines, we noted poorly reproducible results from an aliquot of a cell line that was later found to be infected with Mycoplasma hyorhinis. Deliberate infection of other early passage melanoma cell lines aliquots induced variable and unpredictable effects on expression of putative cancer stem cell markers, clonogenicity, proliferation and global gene expression. Cell lines established in stem cell media (SCM) were equally susceptible. Mycoplasma status is rarely reported in publications using cultured cells to study the cancer stem cell hypothesis. Our work highlights the importance of surveillance for Mycoplasma infection while using any cultured cells to interrogate tumor heterogeneity.
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Affiliation(s)
- Craig Gedye
- Ludwig Institute for Cancer Research, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia.,University of Newcastle, School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Tracy Cardwell
- Ludwig Institute for Cancer Research, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia.,School of Cancer Medicine, LaTrobe University, Olivia Newton-John Cancer Research Institute, Level 5, Olivia Newton-John Cancer & Wellness Centre, Austin Health, 145-163 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Nektaria Dimopoulos
- Ludwig Institute for Cancer Research, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia
| | - Bee Shin Tan
- Ludwig Institute for Cancer Research, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia
| | - Heather Jackson
- Ludwig Institute for Cancer Research, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia
| | - Suzanne Svobodová
- Ludwig Institute for Cancer Research, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia
| | - Matthew Anaka
- Ludwig Institute for Cancer Research, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia
| | - Andreas Behren
- Ludwig Institute for Cancer Research, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia.,School of Cancer Medicine, LaTrobe University, Olivia Newton-John Cancer Research Institute, Level 5, Olivia Newton-John Cancer & Wellness Centre, Austin Health, 145-163 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Christopher Maher
- South African National Bioinformatics Institute, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa.,Washington University Genome Institute, St. Louis, MO, 63110, USA
| | - Oliver Hofmann
- South African National Bioinformatics Institute, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa.,Department of Biostatistics, Harvard School of Public Health, 655 Huntington Avenue, SPH2, 4th Floor, Boston, MA, 02115, USA
| | - Winston Hide
- South African National Bioinformatics Institute, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa.,Department of Biostatistics, Harvard School of Public Health, 655 Huntington Avenue, SPH2, 4th Floor, Boston, MA, 02115, USA
| | - Otavia Caballero
- Ludwig Institute for Cancer Research, New York Branch at Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA
| | - Ian D Davis
- Ludwig Institute for Cancer Research, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia.,Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, and Eastern Health, Box Hill Hospital, 5 Arnold St, Box Hill, VIC, 3128, Australia
| | - Jonathan Cebon
- Ludwig Institute for Cancer Research, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia. .,School of Cancer Medicine, LaTrobe University, Olivia Newton-John Cancer Research Institute, Level 5, Olivia Newton-John Cancer & Wellness Centre, Austin Health, 145-163 Studley Road, Heidelberg, VIC, 3084, Australia.
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Jackson H, MacLeod AK. Well-being in Chronic Fatigue Syndrome: Relationship to Symptoms and Psychological Distress. Clin Psychol Psychother 2016; 24:859-869. [DOI: 10.1002/cpp.2051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 09/23/2016] [Accepted: 09/27/2016] [Indexed: 01/30/2023]
Affiliation(s)
- H. Jackson
- Royal Holloway; University of London; London UK
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Milders M, Bell S, Lorimer A, Jackson H, McNamee P. Improving access to a multi-component intervention for caregivers and people with dementia. Dementia (London) 2016; 18:347-359. [PMID: 27758958 DOI: 10.1177/1471301216672745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Due to the increasing social and economic costs of dementia, there are urgent calls to develop accessible and sustainable care for people with dementia and their caregivers. Multi-component non-pharmacological interventions (NPIs) appear effective in improving or maintaining daily functioning and well-being, but are typically labour-intensive for health care professionals, thus hindering access. The current study aimed to explore the feasibility and acceptability of a novel approach to widen access to NPI by involving caregivers to present part of the intervention and with staff from local support organizations instructed to train the caregivers. Trainers and caregivers were shown to comply with training instructions and the direct intervention costs were low. Feedback from trainers and caregivers was positive and well-being ratings from people with dementia and caregivers remained stable over time and caregivers' sense of competence improved. The findings suggest that involving caregivers and trained non-professionals to provide the intervention is feasible and acceptable and could be a cost-effective solution to improve access to care.
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Lim WS, Sikandar M, Jackson H. Air entry into the anterior chamber post intravitreal injection of Eylea. BMJ Case Rep 2016; 2016:bcr-2016-216247. [PMID: 27440854 DOI: 10.1136/bcr-2016-216247] [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: 11/04/2022] Open
Abstract
An 84-year-old man had air entry into the anterior chamber following intravitreal injection. The air bubble was reabsorbed over time without any complications. No further problems occurred with subsequent intravitreal injections.
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Affiliation(s)
- Wei Sing Lim
- Department of Ophthalmology, Princess Royal University Hospital, Greater London, UK
| | - Munir Sikandar
- Department of Ophthalmology, Princess Royal University Hospital, Greater London, UK
| | - Heather Jackson
- Department of Ophthalmology, Princess Royal University Hospital, Greater London, UK
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Toniatti C, Yanamandra N, Voo K, Al-Shami A, Bover L, Morley P, Brett S, Lofton T, Greer J, Feng N, Wistuba II, Bhattacharya S, Hopson C, Kilian D, Jackson H, Bojczuk P, Mandal M, Jing J, French K, Srinivasan R, Hoos A. Abstract 4864: Engaging the immune system with GSK3174998, a potent anti-OX40 agonist antibody. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-4864] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: GSK3174998, a humanized IgG1 agonistic anti-OX40 monoclonal antibody (mAb) identified in collaboration between GSK and MDACC is currently in Phase I clinical development. Critical for the development of more effective cancer immunotherapy are agents that stimulate effector T cells (Teff) and inhibit the immunosuppressive function of regulatory T cells (Treg) that typically infiltrate tumors. OX40 is a tumor necrosis factor receptor superfamily member expressed on the surface of activated CD4+ and CD8+ T cells. OX40 agonism stimulates both immune effector and memory functions and attenuation of Tregs. Therefore, OX40 agonistic mAbs are ideal candidates to potentially increase the efficacy of immune-checkpoint blocking antibodies, like anti-PD1 (aPD1).
Methods: GSK3174998 has suitable cross-reactivity to cynomolgus monkey OX40 to inform directly on toxicology, pharmacokinetic and pharmacodynamic (PD) preclinical endpoints. However, to understand the antitumor efficacy of OX40 agonism in vivo, studies were performed using a surrogate mAb to murine OX40 (OX86) alone or in combination with a surrogate aPD1 antibody in A20 lymphoma and CT26 colon carcinoma syngeneic tumor models. Intratumoral (i.e. tumor infiltrating T cells) and peripheral (blood) PD biomarkers, including T cell intracellular and surface protein expression, cytokine production and gene regulation were analyzed.
Results: GSK3174998 was well tolerated in monkeys up to 100 mg/kg. In vitro T-cell activation of OX40 with GSK3174998 resulted in enhanced CD4+ and CD8+ effector T-cell proliferation, both in plate-bound as well as soluble PBMC assays. Suppression of Treg differentiation was observed with GSK3174998 as compared with an Fc-disabled mAb, which did not demonstrate these effects. In vitro GSK3174998 induced Th1 cytokine production (IFN and TNFá) and this was further enhanced by the addition of pembrolizumab. In vitro OX86 demonstrated similar characteristics to GSK3174998. In vivo OX86 induced a significant dose-dependent, durable anti-tumor response as monotherapy, which was significantly enhanced when combined with an aPD1 checkpoint inhibitor. Preclinical efficacy correlated with PD changes in several immunological markers including T-cell proliferation and activation. In silico and IHC analysis of expression of OX40 and PDL1 in human tumors was utilized to prioritize cancers most likely to respond to monotherapy and combination therapy for the first-time-in-human (FTIH) clinical study.
Conclusions: GSK3174998 is a potent anti-OX40 agonist that engages the immune system via several T-cell-mediated pathways and may further enhance the antitumor activity observed with PD1 inhibition. Preclinical studies provide a strong rationale to support the ongoing FTIH Phase I study of GSK3174998 administered alone and in combination with pembrolizumab to patients with selected advanced solid tumors.
Citation Format: Carlo Toniatti, Niranjan Yanamandra, Kui Voo, Amin Al-Shami, Laura Bover, Peter Morley, Sara Brett, Tim Lofton, Jennifer Greer, Ningping Feng, Ignacio Ivan Wistuba, Sabyasachi Bhattacharya, Christopher Hopson, David Kilian, Heather Jackson, Paul Bojczuk, Mili Mandal, Junping Jing, Kevin French, Roopa Srinivasan, Axel Hoos. Engaging the immune system with GSK3174998, a potent anti-OX40 agonist antibody. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4864.
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Affiliation(s)
| | | | - Kui Voo
- 1MD Anderson Cancer Center, Houston, TX
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Jackson H, Granger D, Jones G, Anderson L, Friel S, Rycroft D, Fieles W, Tunstead J, Steward M, Wattam T, Walker A, Griggs J, Al-Hajj M, Shelton C. Novel Bispecific Domain Antibody to LRP6 Inhibits Wnt and R-spondin Ligand-Induced Wnt Signaling and Tumor Growth. Mol Cancer Res 2016; 14:859-68. [DOI: 10.1158/1541-7786.mcr-16-0088] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/22/2016] [Indexed: 11/16/2022]
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van de Crommenacker J, Bourgeois YXC, Warren BH, Jackson H, Fleischer-Dogley F, Groombridge J, Bunbury N. Using molecular tools to guide management of invasive alien species: assessing the genetic impact of a recently introduced island bird population. DIVERS DISTRIB 2015. [DOI: 10.1111/ddi.12364] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- J. van de Crommenacker
- Seychelles Islands Foundation; La Ciotat Building, Mont Fleuri, Mahé Victoria Seychelles
- Durrell Institute of Conservation and Ecology (DICE); School of Anthropology and Conservation; University of Kent; Marlowe Building Canterbury Kent UK
| | - Y. X. C. Bourgeois
- Zoologisches Institut, Evolutionsbiologie; University of Basel; Vesalgasse 1 4051 Basel Switzerland
| | - B. H. Warren
- Institute of Systematic Botany; University of Zurich; Zollikerstrasse 107 8008 Zurich Switzerland
| | - H. Jackson
- Durrell Institute of Conservation and Ecology (DICE); School of Anthropology and Conservation; University of Kent; Marlowe Building Canterbury Kent UK
| | - F. Fleischer-Dogley
- Seychelles Islands Foundation; La Ciotat Building, Mont Fleuri, Mahé Victoria Seychelles
| | - J. Groombridge
- Durrell Institute of Conservation and Ecology (DICE); School of Anthropology and Conservation; University of Kent; Marlowe Building Canterbury Kent UK
| | - N. Bunbury
- Seychelles Islands Foundation; La Ciotat Building, Mont Fleuri, Mahé Victoria Seychelles
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Klein O, Davis ID, McArthur GA, Chen L, Haydon A, Parente P, Dimopoulos N, Jackson H, Xiao K, Maraskovsky E, Hopkins W, Stan R, Chen W, Cebon J. Low-dose cyclophosphamide enhances antigen-specific CD4(+) T cell responses to NY-ESO-1/ISCOMATRIX™ vaccine in patients with advanced melanoma. Cancer Immunol Immunother 2015; 64:507-18. [PMID: 25662405 PMCID: PMC11029160 DOI: 10.1007/s00262-015-1656-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 01/30/2014] [Accepted: 01/10/2015] [Indexed: 12/13/2022]
Abstract
Clinical outcomes from cancer vaccine trials in patients with advanced melanoma have so far been disappointing. This appears at least partially due to a state of immunosuppression in these patients induced by an expansion of regulatory cell populations including regulatory T cells (Tregs). We have previously demonstrated potent immunogenicity of the NY-ESO-1/ISCOMATRIX™ vaccine in patients with resected melanoma (study LUD99-08); however, the same vaccine induced only a few vaccine antigen-specific immune responses in patients with advanced disease (study LUD2002-013). Pre-clinical models suggest that the alkylating agent cyclophosphamide can enhance immune responses by depleting Tregs. Therefore, we have enrolled a second cohort of patients with advanced melanoma in the clinical trial LUD2002-013 to investigate whether pre-treatment with cyclophosphamide could improve the immunogenicity of the NY-ESO-1/ISCOMATRIX™ vaccine. The combination treatment led to a significant increase in vaccine-induced NY-ESO-1-specific CD4(+) T cell responses compared with the first trial cohort treated with vaccine alone. We could not detect a significant decline in regulatory T cells in peripheral blood of patients 14 days after cyclophosphamide administration, although a decline at an earlier time point cannot be excluded. Our observations support the inclusion of cyclophosphamide in combination trials with vaccines and other immune-modulatory agents.
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Affiliation(s)
- Oliver Klein
- Ludwig Institute for Cancer Research (Melbourne-Austin Branch), 147-163 Studley Road, Heidelberg, VIC, 3084, Australia,
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