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Wylezinski LS, Sesler CL, Shaginurova GI, Grigorenko EV, Wohlgemuth JG, Cockerill FR, Racke MK, Spurlock CF. Machine Learning Analysis Using RNA Sequencing to Distinguish Neuromyelitis Optica from Multiple Sclerosis and Identify Therapeutic Candidates. J Mol Diagn 2024; 26:520-529. [PMID: 38522839 DOI: 10.1016/j.jmoldx.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/19/2024] [Accepted: 03/01/2024] [Indexed: 03/26/2024] Open
Abstract
This study aims to identify RNA biomarkers distinguishing neuromyelitis optica (NMO) from relapsing-remitting multiple sclerosis (RRMS) and explore potential therapeutic applications leveraging machine learning (ML). An ensemble approach was developed using differential gene expression analysis and competitive ML methods, interrogating total RNA-sequencing data sets from peripheral whole blood of treatment-naïve patients with RRMS and NMO and healthy individuals. Pathway analysis of candidate biomarkers informed the biological context of disease, transcription factor activity, and small-molecule therapeutic potential. ML models differentiated between patients with NMO and RRMS, with the performance of certain models exceeding 90% accuracy. RNA biomarkers driving model performance were associated with ribosomal dysfunction and viral infection. Regulatory networks of kinases and transcription factors identified biological associations and identified potential therapeutic targets. Small-molecule candidates capable of reversing perturbed gene expression were uncovered. Mitoxantrone and vorinostat-two identified small molecules with previously reported use in patients with NMO and experimental autoimmune encephalomyelitis-reinforced discovered expression signatures and highlighted the potential to identify new therapeutic candidates. Putative RNA biomarkers were identified that accurately distinguish NMO from RRMS and healthy individuals. The application of multivariate approaches in analysis of RNA-sequencing data further enhances the discovery of unique RNA biomarkers, accelerating the development of new methods for disease detection, monitoring, and therapeutics. Integrating biological understanding further enhances detection of disease-specific signatures and possible therapeutic targets.
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Affiliation(s)
- Lukasz S Wylezinski
- Decode Health, Inc., Nashville, Tennessee; Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | - Jay G Wohlgemuth
- Quest Diagnostics, Secaucus, New Jersey; Trusted Health Advisors, San Juan Capistrano, California
| | - Franklin R Cockerill
- Decode Health, Inc., Nashville, Tennessee; Trusted Health Advisors, San Juan Capistrano, California; Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | | | - Charles F Spurlock
- Decode Health, Inc., Nashville, Tennessee; Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Wagner School of Public Service, New York University, New York, New York.
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2
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Kaufman HW, Meyer WA, Clarke NJ, Radcliff J, Rank CM, Freeman J, Eisenberg M, Gillim L, Morice WG, Briscoe DM, Perlin DS, Wohlgemuth JG. Assessing Vulnerability to COVID-19 in High-Risk Populations: The Role of SARS-CoV-2 Spike-Targeted Serology. Popul Health Manag 2023; 26:29-36. [PMID: 36799932 DOI: 10.1089/pop.2022.0241] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Individuals at increased risk for severe coronavirus disease-2019 (COVID-19) outcomes, due to compromised immunity or other risk factors, would benefit from objective measures of vulnerability to infection based on vaccination or prior infection. The authors reviewed published data to identify a specific role and interpretation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spike-targeted serology testing. Specific recommendations are provided for an evidence-based and clinically-useful interpretation of SARS-CoV-2 spike-targeted serology to identify vulnerability to infection and potential subsequent adverse outcomes. Decreased vaccine effectiveness among immunocompromised individuals is linked to correspondingly high rates of breakthrough infections. Negative results on SARS-CoV-2 antibody tests are associated with increased risk for subsequent infection. "Low-positive" results on semiquantitative SARS-CoV-2 spike-targeted antibody tests may help identify persons at increased risk as well. Standardized SARS-CoV-2 spike-targeted antibody tests may provide objective information on the risk of SARS-CoV-2 infection and associated adverse outcomes. This holds especially for high-risk populations that demonstrate a relatively high rate of seronegativity. The widespread availability of such tests presents an opportunity to refine risk assessment for individuals with suboptimal SARS-CoV-2 antibody levels and to promote effective interventions. Interim federal guidance would support physicians and patients while additional investigations are pursued.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - David S Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
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3
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Romero JR, Inostroza‐Nieves Y, Pulido‐Perez P, Lopez P, Wohlgemuth JG, Dlott JS, Snyder LM, Alper SL, Rivera A. Magnesium homeostasis in deoxygenated sickle erythrocytes is modulated by endothelin-1 via Na + /Mg 2+ exchange. FASEB J 2022; 36:e22638. [PMID: 36331552 PMCID: PMC9703344 DOI: 10.1096/fj.202201339r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Painful crises in sickle cell disease (SCD) are associated with increased plasma cytokines levels, including endothelin-1 (ET-1). Reduced red cell magnesium content, mediated in part by increased Na+ /Mg2+ exchanger (NME) activity, contributes to erythrocyte K+ loss, dehydration and sickling in SCD. However, the relationship between ET-1 and the NME in SCD has remained unexamined. We observed increased NME activity in sickle red cells incubated in the presence of 500 nM ET-1. Deoxygenation of sickle red cells, in contrast, led to decreased red cell NME activity and cellular dehydration that was reversed by the NME inhibitor, imipramine. Increased NME activity in sickle red cells was significantly blocked by pre-incubation with 100 nM BQ788, a selective blocker of ET-1 type B receptors. These results suggest an important role for ET-1 and for cellular magnesium homeostasis in SCD. Consistent with these results, we observed increased NME activity in sickle red cells of three mouse models of sickle cell disease greater than that in red cells of C57BL/J6 mice. In vivo treatment of BERK sickle transgenic mice with ET-1 receptor antagonists reduced red cell NME activity. Our results suggest that ET-1 receptor blockade may be a promising therapeutic approach to control erythrocyte volume and magnesium homeostasis in SCD and may thus attenuate or retard the associated chronic inflammatory and vascular complications of SCD.
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Affiliation(s)
- José R. Romero
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, and Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Yaritza Inostroza‐Nieves
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, and Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA,Department of Biochemistry and PharmacologySan Juan Bautista School of MedicineCaguasPuerto RicoUSA
| | - Patricia Pulido‐Perez
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, and Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Pablo Lopez
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, and Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | | | | | | | - Seth L. Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, and Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Alicia Rivera
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, and Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA,Division of Laboratory Medicine, Boston Children's Hospital, and Department of PathologyHarvard Medical SchoolBostonMassachusettsUSA
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4
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Rivera A, Nasburg JA, Shim H, Shmukler BE, Kitten J, Wohlgemuth JG, Dlott JS, Snyder LM, Brugnara C, Wulff H, Alper SL. The erythroid K-Cl cotransport inhibitor [(dihydroindenyl)oxy]acetic acid blocks erythroid Ca 2+-activated K + channel KCNN4. Am J Physiol Cell Physiol 2022; 323:C694-C705. [PMID: 35848620 PMCID: PMC9448282 DOI: 10.1152/ajpcell.00240.2022] [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: 06/08/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/22/2022]
Abstract
Red cell volume is a major determinant of HbS concentration in sickle cell disease. Cellular deoxy-HbS concentration determines the delay time, the interval between HbS deoxygenation and deoxy-HbS polymerization. Major membrane transporter protein determinants of sickle red cell volume include the SLC12/KCC K-Cl cotransporters KCC3/SLC12A6 and KCC1/SLC12A4, and the KCNN4/KCa3.1 Ca2+-activated K+ channel (Gardos channel). Among standard inhibitors of KCC-mediated K-Cl cotransport, only [(dihydroindenyl)oxy]acetic acid (DIOA) has been reported to lack inhibitory activity against the related bumetanide-sensitive erythroid Na-K-2Cl cotransporter NKCC1/SLC12A2. DIOA has been often used to inhibit K-Cl cotransport when studying the expression and regulation of other K+ transporters and K+ channels. We report here that DIOA at concentrations routinely used to inhibit K-Cl cotransport can also abrogate activity of the KCNN4/KCa3.1 Gardos channel in human and mouse red cells and in human sickle red cells. DIOA inhibition of A23187-stimulated erythroid K+ uptake (Gardos channel activity) was chloride-independent and persisted in mouse red cells genetically devoid of the principal K-Cl cotransporters KCC3 and KCC1. DIOA also inhibited YODA1-stimulated, chloride-independent erythroid K+ uptake. In contrast, DIOA exhibited no inhibitory effect on K+ influx into A23187-treated red cells of Kcnn4-/- mice. DIOA inhibition of human KCa3.1 was validated (IC50 42 µM) by whole cell patch clamp in HEK-293 cells. RosettaLigand docking experiments identified a potential binding site for DIOA in the fenestration region of human KCa3.1. We conclude that DIOA at concentrations routinely used to inhibit K-Cl cotransport can also block the KCNN4/KCa3.1 Gardos channel in normal and sickle red cells.
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Affiliation(s)
- Alicia Rivera
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Joshua A Nasburg
- Department of Pharmacology, School of Medicine, University of California, Davis, California
| | - Heesung Shim
- Department of Pharmacology, School of Medicine, University of California, Davis, California
| | - Boris E Shmukler
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Heike Wulff
- Department of Pharmacology, School of Medicine, University of California, Davis, California
| | - Seth L Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
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5
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Heneghan JF, Majmundar AJ, Rivera A, Wohlgemuth JG, Dlott JS, Snyder LM, Hildebrandt F, Alper SL. Activation of 2-oxoglutarate receptor 1 (OXGR1) by α-ketoglutarate (αKG) does not detectably stimulate Pendrin-mediated anion exchange in Xenopus oocytes. Physiol Rep 2022; 10:e15362. [PMID: 35851763 PMCID: PMC9294391 DOI: 10.14814/phy2.15362] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023] Open
Abstract
SLC26A4/Pendrin is the major electroneutral Cl- /HCO3- exchanger of the apical membrane of the Type B intercalated cell (IC) of the connecting segment (CNT) and cortical collecting duct (CCD). Pendrin mediates both base secretion in response to systemic base load and Cl- reabsorption in response to systemic volume depletion, manifested as decreased nephron salt and water delivery to the distal nephron. Pendrin-mediated Cl- /HCO3- exchange in the apical membrane is upregulated through stimulation of the β-IC apical membrane G protein-coupled receptor, 2-oxoglutarate receptor 1 (OXGR1/GPR99), by its ligand α-ketoglutarate (αKG). αKG is both filtered by the glomerulus and lumenally secreted by proximal tubule apical membrane organic anion transporters (OATs). OXGR1-mediated regulation of Pendrin by αKG has been documented in transgenic mice and in isolated perfused CCD. However, aspects of the OXGR1 signaling pathway have remained little investigated since its original discovery in lymphocytes. Moreover, no ex vivo cellular system has been reported in which to study the OXGR1 signaling pathway of Type B-IC, a cell type refractory to survival in culture in its differentiated state. As Xenopus oocytes express robust heterologous Pendrin activity, we investigated OXGR1 regulation of Pendrin in oocytes. Despite functional expression of OXGR1 in oocytes, co-expression of Pendrin and OXGR1 failed to exhibit αKG-sensitive stimulation of Pendrin-mediated Cl- /anion exchange under a wide range of conditions. We conclude that Xenopus oocytes lack one or more essential molecular components or physical conditions required for OXGR1 to regulate Pendrin activity.
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Affiliation(s)
- John F. Heneghan
- Division of NephrologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Amar J. Majmundar
- Division of NephrologyBoston Children's HospitalBostonMassachusettsUSA
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
| | - Alicia Rivera
- Division of NephrologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | | | | | | | - Friedhelm Hildebrandt
- Division of NephrologyBoston Children's HospitalBostonMassachusettsUSA
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
- Department of GeneticsHarvard Medical SchoolBostonMassachusettsUSA
| | - Seth L. Alper
- Division of NephrologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
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6
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Ferreira A, Rivera A, Wohlgemuth JG, Dlott JS, Snyder LM, Alper SL, Romero JR. Dysregulated Erythroid Mg2+ Efflux in Type 2 Diabetes. Front Cell Dev Biol 2022; 10:861644. [PMID: 35445032 PMCID: PMC9013827 DOI: 10.3389/fcell.2022.861644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/09/2022] [Indexed: 12/23/2022] Open
Abstract
Hyperglycemia is associated with decreased Mg2+ content in red blood cells (RBC), but mechanisms remain unclear. We characterized the regulation of Mg2+ efflux by glucose in ex vivo human RBC. We observed that hemoglobin A1C (HbA1C) values correlated with Na+-dependent Mg2+ efflux (Na+/Mg2+ exchange) and inversely correlated with cellular Mg content. Treatment of cells with 50 mM D-glucose, but not with sorbitol, lowered total cellular Mg (2.2 ± 0.1 to 2.0 ± 0.1 mM, p < 0.01) and enhanced Na+/Mg2+ exchange activity [0.60 ± 0.09 to 1.12 ± 0.09 mmol/1013 cell × h (flux units, FU), p < 0.05]. In contrast, incubation with selective Src family kinase inhibitors PP2 or SU6656 reduced glucose-stimulated exchange activation (p < 0.01). Na+/Mg2+ exchange activity was also higher in RBC from individuals with type 2 diabetes (T2D, 1.19 ± 0.13 FU) than from non-diabetic individuals (0.58 ± 0.05 FU, p < 0.01). Increased Na+/Mg2+ exchange activity in RBC from T2D subjects was associated with lower intracellular Mg content. Similarly increased exchange activity was evident in RBC from the diabetic db/db mouse model as compared to its non-diabetic control (p < 0.03). Extracellular exposure of intact RBC from T2D subjects to recombinant peptidyl-N-glycosidase F (PNGase F) reduced Na+/Mg2+ exchange activity from 0.98 ± 0.14 to 0.59 ± 0.13 FU (p < 0.05) and increased baseline intracellular Mg content (1.8 ± 0.1 mM) to normal values (2.1 ± 0.1 mM, p < 0.05). These data suggest that the reduced RBC Mg content of T2D RBC reflects enhanced RBC Na+/Mg2+ exchange subject to regulation by Src family kinases and by the N-glycosylation state of one or more membrane proteins. The data extend our understanding of dysregulated RBC Mg2+ homeostasis in T2D.
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Affiliation(s)
- Ana Ferreira
- Interdisciplinary Centre of Social Sciences (CICS.NOVA), Faculty of Social Sciences and Humanities (NOVA FCSH), Lisbon, Portugal
| | - Alicia Rivera
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
- *Correspondence: Alicia Rivera,
| | | | | | | | - Seth L. Alper
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Jose R. Romero
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
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7
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Shmukler BE, Rivera A, Nishimura K, Hsu A, Wohlgemuth JG, Dlott JS, Michael Snyder L, Brugnara C, Alper SL. Erythroid-specific inactivation of Slc12a6/Kcc3 by EpoR promoter-driven Cre expression reduces K-Cl cotransport activity in mouse erythrocytes. Physiol Rep 2022; 10:e15186. [PMID: 35274823 PMCID: PMC8915159 DOI: 10.14814/phy2.15186] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Abstract
Investigation of erythrocytes from spontaneous or engineered germ‐line mutant mice has been instrumental in characterizing the physiological functions of components of the red cell cytoskeleton and membrane. However, the red blood cell expresses some proteins whose germline loss‐of‐function is embryonic‐lethal, perinatal‐lethal, or confers reduced post‐weaning viability. Promoter regions of erythroid‐specific genes have been used to engineer erythroid‐specific expression of Cre recombinase. Through breeding with mice carrying appropriately spaced insertions of loxP sequences, generation of erythroid‐specific knockouts has been carried out for signaling enzymes, transcription factors, peptide hormones, and single transmembrane span signaling receptors. We report here the use of Cre recombinase expression driven by the erythropoietin receptor (EpoR) promoter to generate EpoR‐Cre;Kcc3f/f mice, designed to express erythroid‐specific knockout of the KCC3 K‐Cl cotransporter encoded by Kcc3/Slc12A6. We confirm KCC3 as the predominant K‐Cl cotransporter of adult mouse red cells in mice with better viability than previously exhibited by Kcc3−/− germline knockouts. We demonstrate roughly proportionate preservation of K‐Cl stimulation by hypotonicity, staurosporine, and urea in the context of reduced, but not abrogated, K‐Cl function in EpoR‐Cre;Kcc3f/f mice. We also report functional evidence suggesting incomplete recombinase‐mediated excision of the Kcc3 gene in adult erythroid tissues.
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Affiliation(s)
- Boris E Shmukler
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alicia Rivera
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Katherine Nishimura
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ann Hsu
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | | | | | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Seth L Alper
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Vandorpe DH, Shmukler BE, Ilboudo Y, Bhasin S, Thomas B, Rivera A, Wohlgemuth JG, Dlott JS, Snyder LM, Sieff C, Bhasin M, Lettre G, Brugnara C, Alper SL. A Grammastola spatulata mechanotoxin-4 (GsMTx4)-sensitive cation channel mediates increased cation permeability in human hereditary spherocytosis of multiple genetic etiologies. Haematologica 2021; 106:2759-2762. [PMID: 34109777 PMCID: PMC8485688 DOI: 10.3324/haematol.2021.278770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- David H Vandorpe
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215
| | - Boris E Shmukler
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215
| | - Yann Ilboudo
- Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada, H1T 1C8
| | - Swati Bhasin
- Division of Integrative Medicine and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215
| | - Beena Thomas
- Division of Integrative Medicine and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215
| | - Alicia Rivera
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215
| | | | | | | | - Colin Sieff
- Cancer and Blood Disorders Center, Dana-Farber Cancer Center and Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA 02115
| | - Manoj Bhasin
- Division of Integrative Medicine and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215
| | - Guillaume Lettre
- Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada, H1T 1C8
| | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital and Department of Pathology, Harvard Medical School, Boston, MA 02115
| | - Seth L Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA 02215.
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Cockerill FR, Wohlgemuth JG, Radcliff J, Sabol CE, Kapoor H, Dlott JS, Marlowe EM, Clarke NJ. Evolution of Specimen Self-Collection in the COVID-19 Era: Implications for Population Health Management of Infectious Disease. Popul Health Manag 2021; 24:S26-S34. [PMID: 33544647 PMCID: PMC7875129 DOI: 10.1089/pop.2020.0296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Indexed: 01/19/2023] Open
Abstract
Laboratory testing is an important component in the diagnosis of respiratory tract infections such as with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, specimen collection not only risks exposure of health care workers and other patients to infection, but also necessitates use of personal protective equipment that may be in short supply during periods of heightened disease activity. Self-collection of nasal or oropharyngeal swabs offers an alternative to address these drawbacks. Although studies in the past decade have demonstrated the utility of this approach for respiratory infections, it has not been widely adopted in routine clinical practice. The rapid spread of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has focused attention on the need for safe, convenient, timely, and scalable methods for collecting upper respiratory specimens for testing. The goals of this article are to highlight the literature regarding self-collected nasal or oropharyngeal specimens for respiratory pathogen testing; discuss the role of self-collection in helping prevent the spread of the COVID-19 disease from infected patients and facilitating a shift toward “virtual” medicine or telemedicine; and describe the current and future state of self-collection for infectious agents, and the impacts these approaches can have on population health management and disease diagnosis and prevention.
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Affiliation(s)
| | | | | | | | - Hema Kapoor
- Quest Diagnostics, Secaucus, New Jersey, USA
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10
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Kaufman HW, Chen Z, Meyer WA, Wohlgemuth JG. Insights from Patterns of SARS-CoV-2 Immunoglobulin G Serology Test Results from a National Clinical Laboratory, United States, March-July 2020. Popul Health Manag 2020; 24:S35-S42. [PMID: 33216694 PMCID: PMC7875137 DOI: 10.1089/pop.2020.0256] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Serologic tests for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) provide information on past infection and immune response. To better understand the persistence of immune response and the proportion of the population who can develop one, the authors assessed patterns of immunoglobulin G (IgG) positivity over time in individuals tested for SARS-CoV-2 RNA or IgG at a large national reference laboratory. More than 2.4 million SARS-CoV-2 IgG serology (initiated April 21, 2020) and 6.6 million nucleic acid amplification testing (NAAT) (initiated March 9, 2020) results on persons from across the United States as of July 10, 2020 were analyzed. Additional IgG serology results through August 11, 2020 were used for one household analysis. SARS-CoV-2 IgG positivity was observed in 91% (19,434/21,452) of individuals tested after a positive NAAT result and in 10% (7,831/80,968) after a negative NAAT result. Factors associated with seropositivity include age, region of patient residence, and interval between NAAT and IgG serology. The probability of persistent IgG seropositivity declined from 98.6% after 1 week to 74.3% after 2 months, less so in individuals ages ≥55 years than in younger groups. Specimens within 2 days from pairs of same-household members showed 92% IgG antibody concordance. Household adults were more frequently IgG positive prior to household children testing positive (36% versus 8%). IgG serology testing can identify an immune response to SARS-CoV-2 that varies based on age, sex, and duration since exposure. Loss of detectable IgG seropositivity occurs, in some patients, over weeks or months. Adults may be infecting household children.
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Affiliation(s)
| | - Zhen Chen
- Quest Diagnostics, Secaucus, New Jersey, USA
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11
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Demler OV, Liu Y, Luttmann-Gibson H, Watrous JD, Lagerborg KA, Dashti H, Giulianini F, Heath M, Camargo CA, Harris WS, Wohlgemuth JG, Andres AM, Tivari S, Long T, Najhawan M, Dao K, Prentice JG, Larsen JA, Okereke OI, Costenbader KH, Buring JE, Manson JE, Cheng S, Jain M, Mora S. One-Year Effects of Omega-3 Treatment on Fatty Acids, Oxylipins, and Related Bioactive Lipids and Their Associations with Clinical Lipid and Inflammatory Biomarkers: Findings from a Substudy of the Vitamin D and Omega-3 Trial (VITAL). Metabolites 2020; 10:metabo10110431. [PMID: 33120862 PMCID: PMC7693376 DOI: 10.3390/metabo10110431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
Omega-3 (n-3) treatment may lower cardiovascular risk, yet its effects on the circulating lipidome and relation to cardiovascular risk biomarkers are unclear. We hypothesized that n-3 treatment is associated with favorable changes in downstream fatty acids (FAs), oxylipins, bioactive lipids, clinical lipid and inflammatory biomarkers. We examined these VITAL200, a nested substudy of 200 subjects balanced on demographics and treatment and randomly selected from the Vitamin D and Omega-3 Trial (VITAL). VITAL is a randomized double-blind trial of 840 mg/d eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) vs. placebo among 25,871 individuals. Small polar bioactive lipid features, oxylipins and FAs from plasma and red blood cells were measured using three independent assaying techniques at baseline and one year. The Women's Health Study (WHS) was used for replication with dietary n-3 intake. Randomized n-3 treatment led to changes in 143 FAs, oxylipins and bioactive lipids (False Discovery Rate (FDR) < 0.05 in VITAL200, validated (p-values < 0.05)) in WHS with increases in 95 including EPA, DHA, n-3 docosapentaenoic acid (DPA-n3), and decreases in 48 including DPA-n6, dihomo gamma linolenic (DGLA), adrenic and arachidonic acids. N-3 related changes in the bioactive lipidome were heterogeneously associated with changes in clinical lipid and inflammatory biomarkers. N-3 treatment significantly modulates the bioactive lipidome, which may contribute to its clinical benefits.
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Affiliation(s)
- Olga V. Demler
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
- Correspondence:
| | - Yanyan Liu
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
| | - Heike Luttmann-Gibson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (C.A.C.J.); (O.I.O.)
| | - Jeramie D. Watrous
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - Kim A. Lagerborg
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - Hesam Dashti
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
| | - Franco Giulianini
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
| | - Mallory Heath
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Carlos A. Camargo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (C.A.C.J.); (O.I.O.)
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Jay G. Wohlgemuth
- Quest Diagnostics, San Juan Capistrano, CA 92673, USA; (J.G.W.); (J.G.P.); (J.A.L.)
| | - Allen M. Andres
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - Saumya Tivari
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - Tao Long
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - Mahan Najhawan
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - Khoi Dao
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - James G. Prentice
- Quest Diagnostics, San Juan Capistrano, CA 92673, USA; (J.G.W.); (J.G.P.); (J.A.L.)
| | - Julia A. Larsen
- Quest Diagnostics, San Juan Capistrano, CA 92673, USA; (J.G.W.); (J.G.P.); (J.A.L.)
| | - Olivia I. Okereke
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (C.A.C.J.); (O.I.O.)
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Karen H. Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Julie E. Buring
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (C.A.C.J.); (O.I.O.)
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (C.A.C.J.); (O.I.O.)
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Ctr, Los Angeles, CA 90048, USA;
| | - Mohit Jain
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - Samia Mora
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
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12
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Shrank WH, Caveney B, Miller S, Medows RM, Arroliga A, Doga B, Ban K, Muldoon S, Seiden JM, Tong I, Chaguturu S, Wohlgemuth JG. A Simple Algorithm for Return to Workplace Employer Antibody Testing. Popul Health Manag 2020; 23:346-349. [PMID: 32857015 DOI: 10.1089/pop.2020.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- William H Shrank
- Office of Health Affairs and Advocacy, Humana, Inc., Louisville, Kentucky, USA
| | | | | | | | | | | | - Kevin Ban
- Walgreens Boots Alliance, Inc., Deerfield, Illinois, USA
| | - Sean Muldoon
- Kindred Healthcare, Inc., Louisville, Kentucky, USA
| | | | - Ian Tong
- Doctor on Demand, San Francisco, California, USA
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13
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Shmukler BE, Rivera A, Bhargava P, Nishimura K, Kim EH, Hsu A, Wohlgemuth JG, Morton J, Snyder LM, De Franceschi L, Rust MB, Hubner CA, Brugnara C, Alper SL. Genetic disruption of KCC cotransporters in a mouse model of thalassemia intermedia. Blood Cells Mol Dis 2020; 81:102389. [PMID: 31835175 PMCID: PMC7002294 DOI: 10.1016/j.bcmd.2019.102389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023]
Abstract
β-thalassemia (β-Thal) is caused by defective β-globin production leading to globin chain imbalance, aggregation of free alpha chain in developing erythroblasts, reticulocytes, and mature circulating red blood cells. The hypochromic thalassemic red cells exhibit increased cell dehydration in association with elevated K+ leak and increased K-Cl cotransport activity, each of which has been linked to globin chain imbalance and related oxidative stress. We therefore tested the effect of genetic inactivation of K-Cl cotransporters KCC1 and KCC3 in a mouse model of β-thalassemia intermedia. In the absence of these transporters, the anemia of β-Thal mice was ameliorated, in association with increased MCV and reductions in CHCM and hyperdense cells, as well as in spleen size. The resting K+ content of β-Thal red cells was greatly increased, and Thal-associated splenomegaly slightly decreased. Lack of KCC1 and KCC3 activity in Thal red cells reduced red cell density and improved β-Thal-associated osmotic fragility. We conclude that genetic inactivation of K-Cl cotransport can reverse red cell dehydration and partially attenuate the hematologic phenotype in a mouse model of β-thalassemia.
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Affiliation(s)
- Boris E Shmukler
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America; Department of Medicine, Harvard Medical School, Boston, MA 02215, United States of America
| | - Alicia Rivera
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA 02115, United States of America; Department of Pathology, Harvard Medical School, Boston, MA 02115, United States of America
| | - Parul Bhargava
- Department of Laboratory Medicine, UCSF, San Francisco, CA, United States of America
| | - Katherine Nishimura
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Edward H Kim
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Ann Hsu
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Jay G Wohlgemuth
- Quest Diagnostics, San Juan Capistrano, CA, United States of America
| | - James Morton
- Quest Diagnostics, San Juan Capistrano, CA, United States of America
| | | | - Lucia De Franceschi
- Dept. of Medicine, Universita Verona and Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona, Italy
| | - Marco B Rust
- Institute of Physiological Chemistry, Philipps-Universität Marburg, Marburg, Germany
| | | | - Carlo Brugnara
- Department of Medicine, Harvard Medical School, Boston, MA 02215, United States of America; Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA 02115, United States of America
| | - Seth L Alper
- Renal Division and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America; Department of Pathology, Harvard Medical School, Boston, MA 02115, United States of America.
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14
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Rivera A, Vandorpe DH, Shmukler BE, Andolfo I, Iolascon A, Archer NM, Shabani E, Auerbach M, Hamerschlak N, Morton J, Wohlgemuth JG, Brugnara C, Snyder LM, Alper SL. Erythrocyte ion content and dehydration modulate maximal Gardos channel activity in KCNN4 V282M/+ hereditary xerocytosis red cells. Am J Physiol Cell Physiol 2019; 317:C287-C302. [PMID: 31091145 DOI: 10.1152/ajpcell.00074.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hereditary xerocytosis (HX) is caused by missense mutations in either the mechanosensitive cation channel PIEZO1 or the Ca2+-activated K+ channel KCNN4. All HX-associated KCNN4 mutants studied to date have revealed increased current magnitude and red cell dehydration. Baseline KCNN4 activity was increased in HX red cells heterozygous for KCNN4 mutant V282M. However, HX red cells maximally stimulated by Ca2+ ionophore A23187 or by PMCA Ca2+-ATPase inhibitor orthovanadate displayed paradoxically reduced KCNN4 activity. This reduced Ca2+-stimulated mutant KCNN4 activity in HX red cells was associated with unchanged sensitivity to KCNN4 inhibitor senicapoc and KCNN4 activator Ca2+, with slightly elevated Ca2+ uptake and reduced PMCA activity, and with decreased KCNN4 activation by calpain inhibitor PD150606. The altered intracellular monovalent cation content of HX red cells prompted experimental nystatin manipulation of red cell Na and K contents. Nystatin-mediated reduction of intracellular K+ with corresponding increase in intracellular Na+ in wild-type cells to mimic conditions of HX greatly suppressed vanadate-stimulated and A23187-stimulated KCNN4 activity in those wild-type cells. However, conferral of wild-type cation contents on HX red cells failed to restore wild-type-stimulated KCNN4 activity to those HX cells. The phenotype of reduced, maximally stimulated KCNN4 activity was shared by HX erythrocytes expressing heterozygous PIEZO1 mutants R2488Q and V598M, but not by HX erythrocytes expressing heterozygous KCNN4 mutant R352H or PIEZO1 mutant R2456H. Our data suggest that chronic KCNN4-driven red cell dehydration and intracellular cation imbalance can lead to reduced KCNN4 activity in HX and wild-type red cells.
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Affiliation(s)
- Alicia Rivera
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - David H Vandorpe
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Boris E Shmukler
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Immacolata Andolfo
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Achille Iolascon
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Natasha M Archer
- Division of Hematology and Oncology, Boston Children's Hospital, Dana-Farber Cancer Center, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Estela Shabani
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Nelson Hamerschlak
- Department of Hematology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - James Morton
- Quest Diagnostics, San Juan Capistrano, California
| | | | - Carlo Brugnara
- Department of Laboratory Medicine, Boston Children's Hospital and Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - L Michael Snyder
- Quest Diagnostics, Marlborough, Massachusetts.,Departments of Medicine and Laboratory Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Seth L Alper
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.,Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts
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15
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Goldberg SE, Fragala MS, Wohlgemuth JG. Self-Insured Employer Health Benefits Strategy Established a Negative Cost Trend While Improving Performance. Popul Health Manag 2019; 22:547-554. [PMID: 30907688 PMCID: PMC6885757 DOI: 10.1089/pop.2018.0184] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This case study describes the collaboration between a self-insured employee benefits team and a national health insurance provider to control costs while maintaining program quality and promoting population health. In 2015, Quest Diagnostics well exceeded the full-year expense target for their ∼60,000-life Group Health Insurance (GHI) program. Through proactive changes, physician executive leadership, health plan collaboration, disease-specific population health initiatives, and plan design, Quest GHI annual employer health care cost trend subsequently improved from a year-over-year trend of 5.7% for 2014 to 2015, to 4.6% for 2015 to 2016, to −1.0% for 2016 to 2017, and most recently, 0.3% for 2017 to 2018. The actuarial value of the GHI plan did not decline, and employee cost share also remained unchanged in 2017 and 2018 versus 2016 for the high-performance network option. There was a 3% premium increase for the Preferred Provider Organization option in 2018. A third-party analysis for full year 2017 showed Quest GHI to be 11% more efficient than the mean GHI for programs with a comparable benefit and employee contribution. Early results in 2018 show improvements in the health status of the health plan membership. This article describes an approach for self-insured employers to proactively collaborate with a health plan and pharmacy benefits manager to practice the Triple Aim of improving the patient health care experience and population health while reducing per capita health care spending.
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16
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Muse ED, Wineinger NE, Spencer EG, Peters M, Henderson R, Zhang Y, Barrett PM, Rivera SP, Wohlgemuth JG, Devlin JJ, Shiffman D, Topol EJ. Validation of a genetic risk score for atrial fibrillation: A prospective multicenter cohort study. PLoS Med 2018; 15:e1002525. [PMID: 29534064 PMCID: PMC5849279 DOI: 10.1371/journal.pmed.1002525] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/06/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most commonly encountered arrhythmia and is associated with an elevated risk of stroke. Improving the identification of patients with the highest risk for AF to enable appropriate surveillance and treatment, if necessary, is critical to reducing AF-associated morbidity and mortality. Multiple common single nucleotide polymorphisms (SNPs) are unequivocally associated with the lifetime risk of AF. In the current study we aimed to prospectively validate an AF genetic risk score (GRS) in previously undiagnosed patients at risk for AF. METHODS AND FINDINGS Individuals 40 years of age or older with 1 clinical risk factor for AF, presenting with symptoms of AF, or with a first diagnosis of AF, were enrolled for genetic testing and ambulatory cardiac rhythm monitoring with an adhesive patch monitor or a long-term Holter monitor (mean wear time 10 days 21 hours and 13 days 18 hours, respectively). An AF event was the first diagnosis of AF by ECG, patch monitor, or long-term Holter monitor. The AF GRS was determined for each participant based on the weighted contribution of 12 genetic risk loci. Of 904 participants, 85 manifested AF. Their mean age was 66.2 (SD 11.8) years; 38% of participants were male. Participants in the highest quintile of AF GRS were more likely (odds ratio 3.11; 95% CI 1.27-7.58; p = 0.01) to have had an AF event than participants in the lowest quintile after adjusting for age, sex, smoking status, BMI, hypertension, diabetes mellitus, heart failure, and prior myocardial infarction. Study limitations included an ethnically homogenous population, a restricted rhythm monitoring period, and the evolving discovery of SNPs associated with AF. CONCLUSIONS Prospective assessment of a GRS for AF identified participants with elevated risk of AF beyond established clinical criteria. Accordingly, a GRS for AF could be incorporated into overall risk assessment to better identify patients at the highest risk of developing AF, although further testing in larger populations is needed to confirm these findings. TRIAL REGISTRATION ClinicalTrials.gov NCT01970969.
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Affiliation(s)
- Evan D. Muse
- Scripps Translational Science Institute, The Scripps Research Institute, La Jolla, California, United States of America
- Division of Cardiovascular Disease, Scripps Clinic–Scripps Health, La Jolla, California, United States of America
| | - Nathan E. Wineinger
- Scripps Translational Science Institute, The Scripps Research Institute, La Jolla, California, United States of America
| | - Emily G. Spencer
- Scripps Translational Science Institute, The Scripps Research Institute, La Jolla, California, United States of America
| | - Melissa Peters
- Scripps Translational Science Institute, The Scripps Research Institute, La Jolla, California, United States of America
| | - Riley Henderson
- Scripps Translational Science Institute, The Scripps Research Institute, La Jolla, California, United States of America
| | - Yunyue Zhang
- Scripps Translational Science Institute, The Scripps Research Institute, La Jolla, California, United States of America
| | - Paddy M. Barrett
- Scripps Translational Science Institute, The Scripps Research Institute, La Jolla, California, United States of America
| | - Steven P. Rivera
- Quest Diagnostics, San Juan Capistrano, California, United States of America
| | - Jay G. Wohlgemuth
- Quest Diagnostics, San Juan Capistrano, California, United States of America
| | - James J. Devlin
- Quest Diagnostics, San Juan Capistrano, California, United States of America
| | - Dov Shiffman
- Quest Diagnostics, San Juan Capistrano, California, United States of America
| | - Eric J. Topol
- Scripps Translational Science Institute, The Scripps Research Institute, La Jolla, California, United States of America
- Division of Cardiovascular Disease, Scripps Clinic–Scripps Health, La Jolla, California, United States of America
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17
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Musunuru K, Roden DM, Boineau R, Bristow MR, McCaffrey TA, Newton-Cheh C, Paltoo DN, Rosenberg Y, Wohlgemuth JG, Zineh I, Hasan AAK. Cardiovascular pharmacogenomics: current status and future directions-report of a national heart, lung, and blood institute working group. J Am Heart Assoc 2012; 1:e000554. [PMID: 23130127 PMCID: PMC3487365 DOI: 10.1161/jaha.111.000554] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Kiran Musunuru
- Brigham and Women's Hospital, Boston and Harvard University, Cambridge, MA (K.M.)
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18
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Donahue AC, Abdool AK, Gaur R, Wohlgemuth JG, Yeh CH. Multiplex ligation-dependent probe amplification for detection of chromosomal abnormalities in myelodysplastic syndrome and acute myeloid leukemia. Leuk Res 2011; 35:1477-83. [PMID: 21764131 DOI: 10.1016/j.leukres.2011.06.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 06/10/2011] [Accepted: 06/15/2011] [Indexed: 11/16/2022]
Abstract
Current strategies for detecting chromosome abnormalities in MDS/AML include FISH or traditional cytogenetics. MLPA detects abnormalities in multiple loci simultaneously, with higher resolution and throughput. Peripheral blood from 50 healthy subjects was used to establish probe-specific reference ranges, increasing MLPA sensitivity and specificity. MLPA was then performed on 110 FISH-tested blood or bone marrow samples from suspected leukemia patients. Our novel MLPA analysis system combined maximum stringency with sensitive detection of low-frequency abnormalities. Accuracy/specificity of MLPA were excellent compared to FISH. Our MLPA analysis/interpretation method provides a clinically robust, high-throughput, high-resolution option for detection of abnormalities associated with MDS/AML.
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Affiliation(s)
- Amber C Donahue
- Department of Hematopathology, Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
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19
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Wohlgemuth JG. Charting a path for Plavix response testing. MLO Med Lab Obs 2011; 43:40-41. [PMID: 21520728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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20
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Abdool A, Donahue AC, Wohlgemuth JG, Yeh CH. Detection, analysis and clinical validation of chromosomal aberrations by multiplex ligation-dependent probe amplification in chronic leukemia. PLoS One 2010; 5:e15407. [PMID: 21049055 PMCID: PMC2963645 DOI: 10.1371/journal.pone.0015407] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 09/16/2010] [Indexed: 11/21/2022] Open
Abstract
Current diagnostic screening strategies based on karyotyping or fluorescent in situ hybridization (FISH) for detection of chromosomal abnormalities in chronic lymphocytic leukemia (CLL) are laborious, time-consuming, costly, and have limitations in resolution. Multiplex ligation-dependent probe amplification (MLPA) can simultaneously detect copy number changes of multiple loci in one simple PCR reaction, making it an attractive alternative to FISH. To enhance the clinical robustness and further harness MLPA technology for routine laboratory operations, we have developed and validated a protocol for comprehensive, automatic data analysis and interpretation. A training set of 50 normal samples was used to establish reference ranges for each individual probe, for the calling of statistically significant copy number changes. The maximum normal ranges of 2 and 3 standard deviations (SD) are distributed between 0.82 and 1.18 (Mean ± 2SD, 95% CI, P = 0.05), and between 0.73 and 1.27 (Mean ± 3SD, 99% CI, P = 0.01), respectively. We found an excellent correlation between MLPA and FISH with 93.6% concordance (P<0.0001) from a testing cohort of 100 clinically suspected CLL cases. MLPA analyses done on 94/100 patients showed sensitivity and specificity of 94.2% and 92.9%, respectively. MLPA detected additional copy number gains on 18q21.1 and chromosome 19, and novel micro-deletions at 19q13.43 and 19p13.2 loci in six samples. Three FISH-failed samples were tested positive by MLPA, while three 13q- cases with a low percentage of leukemia cells (7%, 12% and 19%) were not detected by MLPA. The improved CLL MLPA represents a high-throughput, accurate, cost-effective and user-friendly platform that can be used as a first-line screening test in a clinical laboratory.
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Affiliation(s)
- Adam Abdool
- Department of Hematology and Oncology, Quest Diagnostics Nichols Institute, San Juan Capistrano, California, United States of America
| | - Amber C. Donahue
- Department of Hematology and Oncology, Quest Diagnostics Nichols Institute, San Juan Capistrano, California, United States of America
| | - Jay G. Wohlgemuth
- Department of Hematology and Oncology, Quest Diagnostics Nichols Institute, San Juan Capistrano, California, United States of America
| | - Chen-Hsiung Yeh
- Department of Hematology and Oncology, Quest Diagnostics Nichols Institute, San Juan Capistrano, California, United States of America
- * E-mail:
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21
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Bernstein D, Williams GE, Eisen H, Mital S, Wohlgemuth JG, Klingler TM, Fang KC, Deng MC, Kobashigawa J. Gene Expression Profiling Distinguishes a Molecular Signature for Grade 1B Mild Acute Cellular Rejection in Cardiac Allograft Recipients. J Heart Lung Transplant 2007; 26:1270-80. [DOI: 10.1016/j.healun.2007.09.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 09/17/2007] [Accepted: 09/20/2007] [Indexed: 10/22/2022] Open
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22
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Mehra MR, Uber PA, Walther D, Vesely M, Wohlgemuth JG, Prentice J, Tayama D, Billingham M. Gene Expression Profiles and B-Type Natriuretic Peptide Elevation in Heart Transplantation. Circulation 2006; 114:I21-6. [PMID: 16820574 DOI: 10.1161/circulationaha.105.000513] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
B-type natriuretic peptide (BNP) is chronically elevated in heart transplantation and reflects diastolic dysfunction, cardiac allograft vasculopathy, and poor late outcome. This investigation studied peripheral gene expression signatures of elevated BNP concentrations in clinically quiescent heart transplant recipients in an effort to elucidate molecular correlates beyond hemodynamic perturbations.
Methods and Results—
We performed gene microarray analysis in peripheral blood mononuclear cells of 28 heart transplant recipients with clinical quiescence (absence of dyspnea or fatigue; normal left ventricular ejection fraction [EF >55%]; ISHLT biopsy score 0 or 1A; and normal hemodynamics [RAP <7 mm Hg, PCWP ≤15 mm Hg, and CI ≥2.5 L/min per m
2
]). BNP levels were performed using the Triage B-type Natriuretic Peptide test (Biosite Diagnostics Inc, San Diego, Calif) and median BNP concentration was 165 pg/mL. Seventy-eight probes (of 7370) mapped to 54 unique genes were significantly correlated with BNP concentrations (
P
<0.001). Of these, the strongest correlated genes (
P
<0.0001) were in the domains of gelsolin (actin cytoskeleton), matrix metallopeptidases (collagen degradation), platelet function, and immune activity (human leukocyte antigen system, heat shock protein, mast cell, and B-cell lineage).
Conclusions—
In the clinically quiescent heart transplant recipient, an elevated BNP concentration is associated with molecular patterns that point to ongoing active cardiac structural remodeling, vascular injury, inflammation, and alloimmune processes. Thus, these findings allude to the notion that BNP elevation is not merely a hemodynamic marker but should be considered reflective of integrated processes that determine the balance between active cardiac allograft injury and repair.
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Affiliation(s)
- Mandeep R Mehra
- University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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23
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Deng MC, Eisen HJ, Mehra MR, Billingham M, Marboe CC, Berry G, Kobashigawa J, Johnson FL, Starling RC, Murali S, Pauly DF, Baron H, Wohlgemuth JG, Woodward RN, Klingler TM, Walther D, Lal PG, Rosenberg S, Hunt S. Noninvasive discrimination of rejection in cardiac allograft recipients using gene expression profiling. Am J Transplant 2006; 6:150-60. [PMID: 16433769 DOI: 10.1111/j.1600-6143.2005.01175.x] [Citation(s) in RCA: 376] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Rejection diagnosis by endomyocardial biopsy (EMB) is invasive, expensive and variable. We investigated gene expression profiling of peripheral blood mononuclear cells (PBMC) to discriminate ISHLT grade 0 rejection (quiescence) from moderate/severe rejection (ISHLT > or = 3A). Patients were followed prospectively with blood sampling at post-transplant visits. Biopsies were graded by ISHLT criteria locally and by three independent pathologists blinded to clinical data. Known alloimmune pathways and leukocyte microarrays identified 252 candidate genes for which real-time PCR assays were developed. An 11 gene real-time PCR test was derived from a training set (n = 145 samples, 107 patients) using linear discriminant analysis (LDA), converted into a score (0-40), and validated prospectively in an independent set (n = 63 samples, 63 patients). The test distinguished biopsy-defined moderate/severe rejection from quiescence (p = 0.0018) in the validation set, and had agreement of 84% (95% CI 66% C94%) with grade ISHLT > or = 3A rejection. Patients >1 year post-transplant with scores below 30 (approximately 68% of the study population) are very unlikely to have grade > or = 3A rejection (NPV = 99.6%). Gene expression testing can detect absence of moderate/severe rejection, thus avoiding biopsy in certain clinical settings. Additional clinical experience is needed to establish the role of molecular testing for clinical event prediction and immunosuppression management.
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Affiliation(s)
- M C Deng
- Columbia University, New York, NY, USA.
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24
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Kirou KA, Lee C, George S, Louca K, Papagiannis IG, Peterson MGE, Ly N, Woodward RN, Fry KE, Lau AYH, Prentice JG, Wohlgemuth JG, Crow MK. Coordinate overexpression of interferon-alpha-induced genes in systemic lupus erythematosus. ACTA ACUST UNITED AC 2005; 50:3958-67. [PMID: 15593221 DOI: 10.1002/art.20798] [Citation(s) in RCA: 312] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To study the contribution of interferon-alpha (IFNalpha) and IFNgamma to the IFN gene expression signature that has been observed in microarray screens of peripheral blood mononuclear cells (PBMCs) from patients with systemic lupus erythematosus (SLE). METHODS Quantitative real-time polymerase chain reaction analysis of healthy control PBMCs was used to determine the relative induction of a panel of IFN-inducible genes (IFIGs) by IFNalpha and IFNgamma. PBMCs from 77 SLE patients were compared with those from 22 disease controls and 28 healthy donors for expression of IFIGs. RESULTS Expression of IFNalpha-inducible genes was significantly higher in SLE PBMCs than in those from disease controls or healthy donors. The level of expression of all IFIGs in PBMCs from SLE patients with IFNalpha pathway activation correlated highly with the inherent responsiveness of those genes to IFNalpha, suggesting coordinate activation of that cytokine pathway. Expression of genes preferentially induced by IFNgamma was not significantly increased in SLE PBMCs compared with control PBMCs. IFNalpha-regulated gene-inducing activity was detected in some SLE plasma samples. CONCLUSION The coordinate activation of IFNalpha-induced genes is a characteristic of PBMCs from many SLE patients, supporting the hypothesis that IFNalpha is the predominant stimulus for IFIG expression in lupus.
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Affiliation(s)
- Kyriakos A Kirou
- Hospital for Special Surgery, and Weill Medical College of Cornell University, New York, New York 10021, USA
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25
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Mehra MR, Uber PA, Park MH, Scott R, Ventura HO, Wohlgemuth JG, Prentice JG. 1051-127 Molecular pathways of cardiac allograft dysfunction independent of acute cellular rejection. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90743-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Wohlgemuth JG, Kang SH, Bulboaca GH, Nawotka KA, Calos MP. Long-term gene expression from autonomously replicating vectors in mammalian cells. Gene Ther 1996; 3:503-12. [PMID: 8789800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We tested the longevity of gene expression provided by autonomously replicating vectors. The vectors contain segments of human genomic DNA that provide efficient replication initiation and sequences derived from Epstein-Barr virus that provide nuclear retention. In order to monitor gene expression, the vectors also carry an expression cassette containing the chloramphenicol acetyl transferase gene. Replicating and control vectors were transfected into rapidly dividing human 293 cells, and gene expression and DNA retention were monitored. Gene expression decreased rapidly from a control vector lacking replication and retention functions, reaching near background levels by 10 days. Vectors having both replication and retention showed greatly prolonged gene expression, with vector DNA still detectable after 2 months. Autonomously replicating vectors also prolonged gene expression in rodent cells, in human lung epithelial cells, and in slowly dividing cell cultures. These results demonstrate the utility of this autonomous replication system for long-term retention and expression of introduced genes in mammalian cells. Such vectors could be useful for gene therapy, in combination with any of several methods for introduction of DNA.
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Affiliation(s)
- J G Wohlgemuth
- Department of Genetics, Stanford University School of Medicine, CA 94305, USA
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27
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Abstract
The centromeric DNAs of Schizosaccharomyces pombe chromosomes resemble those of higher eukaryotes in being large and composed predominantly of repeated sequences. To begin a detailed analysis of the mode of replication of a complex centromere, we examined whether any sequences within S. pombe centromere II (cen2) have the ability to mediate autonomous replication. We found a high density of segments with such activity, including at least eight different regions comprising most of the repeated and unique centromeric DNA elements. A physical mapping analysis using two-dimensional gels showed that autonomous replication initiated within the S. pombe sequences in each plasmid. A two-dimensional gel analysis of replication on the chromosomes revealed that the K and L repeat elements, which occur in multiple copies at all three centromeres and comprise approximately 70% of total centromeric DNA mass in S. pombe, are both sites of replication initiation. In contrast, the unique cen2 central core, which contains multiple segments that can support autonomous replication, appears to be repressed for initiation on the chromosome. We discuss the implications of these findings for our understanding of DNA replication and centromere function.
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Affiliation(s)
- J G Smith
- Department of Genetics, Stanford University School of Medicine, California 94305, USA
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28
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Wohlgemuth JG, Bulboaca GH, Moghadam M, Caddle MS, Calos MP. Physical mapping of origins of replication in the fission yeast Schizosaccharomyces pombe. Mol Biol Cell 1994; 5:839-49. [PMID: 7803852 PMCID: PMC301105 DOI: 10.1091/mbc.5.8.839] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We isolated four fragments from the Schizosaccharomyces pombe genome that mediate autonomous replication. A two-dimensional gel analysis revealed that in each case initiation could be mapped to within the S. pombe sequences. In three of the fragments, initiation could be mapped to one discrete location. In the fourth fragment, subcloning and two-dimensional gel analysis suggested that two discrete origins of replication were located within 3 kb of each other. When in proximity, usually only one of these origins fired, suggesting origin interference. Two-dimensional gel analysis of the four origin fragments at their genomic locations demonstrated that each is used in the chromosomes, but in only a subset of cells or cell divisions. The S. pombe genome appears to contain many discrete origins, not all of which fire in any given cell and some of which are closely spaced. Not I/Sfi I mapping of the five origins from this and a previous study indicates that they are randomly distributed throughout the genome and appear to be representative of chromosomal origins of replication in this organism. We compare the features of S. pombe replication origins with those of S. cerevisiae and animal cells.
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Affiliation(s)
- J G Wohlgemuth
- Department of Genetics, Stanford University School of Medicine, California 94305
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