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Abstract
Serious early complications of catheter insertion and catheter outcomes are compared in patients with or without a history of major abdominal surgery or peritonitis. Previous major surgery and peritonitis are important risk factors for early serious complications of catheter placement. Despite the higher risk of early complications, subsequent attempts at catheter placement were successful in all but one of the high risk patients.Patients with previous major abdominal surgery or peritonitis generally are considered to be at high risk for complications of permanent peritoneal catheter placement. However, few physicians would refuse to attempt catheter insertion in patients highly motivated to undergo peritoneal dialysis. In this setting, the patient and the physician must decide whether the motivation and potential benefit justify the risk. Unfortunately, extensive quantitative data on the success rate and the likelihood of complications in the high-risk patient are not available. In order to determine the success rate and relative risk, we reviewed the outcome of catheter placement for continuous ambulatory peritoneal dialysis (CAPD) in our patients. In this report, we identify the serious early complications of catheter insertion and compare the outcomes in patients with and without a history of major abdominal surgery or peritonitis.
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Affiliation(s)
- A.S. Levey
- New England Medical Center, Departments of Nursing, Surgery, and Medicine, Division of Nephrology, Boston, Massachusetts
| | - G.M. Simon
- New England Medical Center, Departments of Nursing, Surgery, and Medicine, Division of Nephrology, Boston, Massachusetts
| | - J. McCauley
- New England Medical Center, Departments of Nursing, Surgery, and Medicine, Division of Nephrology, Boston, Massachusetts
| | - T.J. Smith
- New England Medical Center, Departments of Nursing, Surgery, and Medicine, Division of Nephrology, Boston, Massachusetts
| | - S. I. Cho
- New England Medical Center, Departments of Nursing, Surgery, and Medicine, Division of Nephrology, Boston, Massachusetts
| | - J. T. Harrington
- New England Medical Center, Departments of Nursing, Surgery, and Medicine, Division of Nephrology, Boston, Massachusetts
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2
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Bale SD, Goetz K, Harvey PR, Turin P, Bonnell JW, de Wit TD, Ergun RE, MacDowall RJ, Pulupa M, Andre M, Bolton M, Bougeret JL, Bowen TA, Burgess D, Cattell CA, Chandran BDG, Chaston CC, Chen CHK, Choi MK, Connerney JE, Cranmer S, Diaz-Aguado M, Donakowski W, Drake JF, Farrell WM, Fergeau P, Fermin J, Fischer J, Fox N, Glaser D, Goldstein M, Gordon D, Hanson E, Harris SE, Hayes LM, Hinze JJ, Hollweg JV, Horbury TS, Howard RA, Hoxie V, Jannet G, Karlsson M, Kasper JC, Kellogg PJ, Kien M, Klimchuk JA, Krasnoselskikh VV, Krucker S, Lynch JJ, Maksimovic M, Malaspina DM, Marker S, Martin P, Martinez-Oliveros J, McCauley J, McComas DJ, McDonald T, Meyer-Vernet N, Moncuquet M, Monson SJ, Mozer FS, Murphy SD, Odom J, Oliverson R, Olson J, Parker EN, Pankow D, Phan T, Quataert E, Quinn T, Ruplin SW, Salem C, Seitz D, Sheppard DA, Siy A, Stevens K, Summers D, Szabo A, Timofeeva M, Vaivads A, Velli M, Yehle A, Werthimer D, Wygant JR. The FIELDS Instrument Suite for Solar Probe Plus: Measuring the Coronal Plasma and Magnetic Field, Plasma Waves and Turbulence, and Radio Signatures of Solar Transients. Space Sci Rev 2016; 204:49-82. [PMID: 29755144 PMCID: PMC5942226 DOI: 10.1007/s11214-016-0244-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
NASA's Solar Probe Plus (SPP) mission will make the first in situ measurements of the solar corona and the birthplace of the solar wind. The FIELDS instrument suite on SPP will make direct measurements of electric and magnetic fields, the properties of in situ plasma waves, electron density and temperature profiles, and interplanetary radio emissions, amongst other things. Here, we describe the scientific objectives targeted by the SPP/FIELDS instrument, the instrument design itself, and the instrument concept of operations and planned data products.
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Affiliation(s)
- S D Bale
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
- Physics Department, University of California, Berkeley, CA, USA
| | - K Goetz
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - P R Harvey
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - P Turin
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J W Bonnell
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - T Dudok de Wit
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | - R E Ergun
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - R J MacDowall
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - M Pulupa
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - M Andre
- Swedish Institute of Space Physics (IRF), Uppsala, Sweden
| | - M Bolton
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | | | - T A Bowen
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
- Physics Department, University of California, Berkeley, CA, USA
| | - D Burgess
- Astronomy Unit, Queen Mary, University of London, London, UK
| | - C A Cattell
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - B D G Chandran
- Department of Physics, University of New Hampshire, Durham, NH, USA
| | - C C Chaston
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - C H K Chen
- Department of Physics, Imperial College, London, UK
| | - M K Choi
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J E Connerney
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - S Cranmer
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - M Diaz-Aguado
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - W Donakowski
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J F Drake
- Department of Physics, University of Maryland, College Park, MD, USA
| | - W M Farrell
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - P Fergeau
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | - J Fermin
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J Fischer
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - N Fox
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - D Glaser
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - M Goldstein
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - D Gordon
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - E Hanson
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
- Physics Department, University of California, Berkeley, CA, USA
| | - S E Harris
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - L M Hayes
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J J Hinze
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - J V Hollweg
- Department of Physics, University of New Hampshire, Durham, NH, USA
| | - T S Horbury
- Department of Physics, Imperial College, London, UK
| | - R A Howard
- Space Science Division, Naval Research Laboratory, Washington, DC, USA
| | - V Hoxie
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - G Jannet
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | - M Karlsson
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - J C Kasper
- University of Michigan, Ann Arbor, MI, USA
| | - P J Kellogg
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - M Kien
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - J A Klimchuk
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | | | - S Krucker
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J J Lynch
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | | | - D M Malaspina
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - S Marker
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - P Martin
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | | | - J McCauley
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - D J McComas
- Southwest Research Institute, San Antonio, TX, USA
| | - T McDonald
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | | | - M Moncuquet
- LESIA, Observatoire de Paris, Meudon, France
| | - S J Monson
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - F S Mozer
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - S D Murphy
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J Odom
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - R Oliverson
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J Olson
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - E N Parker
- Department of Astronomy and Astrophysics, University of Chicago, Chicago, IL, USA
| | - D Pankow
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - T Phan
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - E Quataert
- Astronomy Department, University of California, Berkeley, CA, USA
| | - T Quinn
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | | | - C Salem
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - D Seitz
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - D A Sheppard
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - A Siy
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - K Stevens
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - D Summers
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - A Szabo
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - M Timofeeva
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | - A Vaivads
- Swedish Institute of Space Physics (IRF), Uppsala, Sweden
| | - M Velli
- Earth, Planetary, and Space Sciences, UCLA, Los Angelos, CA, USA
| | - A Yehle
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - D Werthimer
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J R Wygant
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
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3
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Asghar H, Browne HM, McCauley J, Malik M, Khan W. Contribution of laboratories in the WHO Eastern Mediterranean Region to the selection of candidate seasonal influenza vaccine, 2010-2015. East Mediterr Health J 2016; 22:445-452. [PMID: 27714738 DOI: 10.26719/2016.22.7.445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/23/2016] [Indexed: 11/09/2022]
Abstract
The World Health Organization (WHO) formulates recommendations for viruses to be included in vaccines for the influenza seasons in the northern and southern hemispheres on the basis of analyses by its collaborating centres (CCs). This report describes the contribution of influenza laboratories and national influenza centres in countries in the WHO Region for the Eastern Mediterranean to the selection process of seasonal and pre-pandemic influenza virus subtypes. Data submitted by 22 countries to FluNet and FluID between September 2010 and June 2015 were analysed. National Influenza Centres (NICs) in 12 countries (55%) reported data, 5 (23%) to both FluNet and FluID and 7 (32%) only to FluNet. The WHO CC in London characterized 78% of the samples, and the CC in Atlanta, characterized 21%. The contribution of influenza laboratories and NICs from this Region to global influenza surveillance is appreciable. However, enhancing the contribution through initiatives such as the Pandemic Influenza Preparedness Framework is still needed.
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Affiliation(s)
- H Asghar
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - H M Browne
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, United Kingdom
| | - J McCauley
- Crick Worldwide Centre, The Francis Crick Institute, Mill Hill Laboratory, The Ridgeway Mill Hill, London, United Kingdom
| | - M Malik
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - W Khan
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Mosher PJ, Murphy AA, Anderson JM, Coyle M, McCauley J, Boyle K, Yaeger K, Iverson N, Halamek LP. 141 DEATH, DYING AND DELIVERING BAD NEWS: SIMULATION-BASED TRAINING, A NEW EDUCATIONAL PARADIGM FOR MEDICAL STUDENTS. J Investig Med 2015. [DOI: 10.1136/jim-52-suppl1-141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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5
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Brown JR, Tang JW, Pankhurst L, Klein N, Gant V, Lai KM, McCauley J, Breuer J. Influenza virus survival in aerosols and estimates of viable virus loss resulting from aerosolization and air-sampling. J Hosp Infect 2015; 91:278-81. [PMID: 26412395 DOI: 10.1016/j.jhin.2015.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/04/2015] [Indexed: 12/17/2022]
Abstract
Using a Collison nebulizer, aerosols of influenza (A/Udorn/307/72 H3N2) were generated within a controlled experimental chamber, from known starting virus concentrations. Air samples collected after variable suspension times were tested quantitatively using both plaque and polymerase chain reaction assays, to compare the proportion of viable virus against the amount of detectable viral RNA. These experiments showed that whereas influenza RNA copies were well preserved, the number of viable viruses decreased by a factor of 10(4)-10(5). This suggests that air-sampling studies for assessing infection control risks that detect only influenza RNA may greatly overestimate the amount of viable virus available to cause infection.
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Affiliation(s)
- J R Brown
- Great Ormond Street Hospital, London, UK
| | - J W Tang
- University Hospitals Leicester, Leicester, UK.
| | - L Pankhurst
- University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - N Klein
- University College London, London, UK
| | - V Gant
- University College London Hospitals, London, UK
| | - K M Lai
- Hong Kong Baptist University, Hong Kong, China
| | - J McCauley
- The Francis Crick Institute, Mill Hill Laboratory, London, UK
| | - J Breuer
- University College London, London, UK
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6
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Goddard N, Rebelo-de-Andrade H, Meijer A, McCauley J, Daniels R, Zambon M. Future directions for the European influenza reference laboratory network in influenza surveillance. ACTA ACUST UNITED AC 2015; 20. [PMID: 26250071 DOI: 10.2807/1560-7917.es2015.20.30.21195] [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]
Abstract
By defining strategic objectives for the network of influenza laboratories that have national influenza centre status or national function within European Union Member States, Iceland and Norway, it is possible to align their priorities in undertaking virological surveillance of influenza. This will help maintain and develop the network to meet and adapt to new challenges over the next 3-5 years and underpin a longer-term strategy over 5-10 years. We analysed the key activities undertaken by influenza reference laboratories in Europe and categorised them into a framework of four key strategic objectives areas: enhancing laboratory capability, ensuring laboratory capacity, providing emergency response and translating laboratory data into information for public health action. We make recommendations on the priority areas for future development.
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Affiliation(s)
- N Goddard
- Public Health England (PHE), London, United Kingdom
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7
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Abstract
Although the ESwab kit (Copan, Brescia, Italy) is intended for sampling bacteria for culture, this kit is increasingly also used for virus sampling. The effect of ESwab medium on influenza virus detection by real-time reverse transcription-polymerase chain reaction (RT-PCR) or virus propagation in Madin-Darby canine kidney (MDCK) cell culture was investigated. The ESwab medium was suitable for viral RNA detection but not for viral propagation due to cytotoxicity. Sampling influenza viruses with ESwab challenges influenza surveillance by strongly limiting the possibility of antigenic characterisation.
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Affiliation(s)
- R Trebbien
- National Influenza Center Denmark, Statens Serum Institut, Copenhagen, Denmark
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8
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Broberg E, Pereyaslov D, Struelens M, Palm D, Meijer A, Ellis J, Zambon M, McCauley J, Daniels R. Laboratory preparedness in EU/EEA countries for detection of novel avian influenza A(H7N9) virus, May 2013. ACTA ACUST UNITED AC 2014; 19. [PMID: 24507469 DOI: 10.2807/1560-7917.es2014.19.4.20682] [Citation(s) in RCA: 3] [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: 11/20/2022]
Abstract
Following human infections with novel avian influenza A(H7N9) viruses in China, the European Centre for Disease Prevention and Control, the World Health Organization (WHO) Regional Office for Europe and the European Reference Laboratory Network for Human Influenza (ERLI-Net) rapidly posted relevant information, including real-time RT-PCR protocols. An influenza RNA sequence-based computational assessment of detection capabilities for this virus was conducted in 32 national influenza reference laboratories in 29 countries, mostly WHO National Influenza Centres participating in the WHO Global Influenza Surveillance and Response System (GISRS). Twenty-seven countries considered their generic influenza A virus detection assay to be appropriate for the novel A(H7N9) viruses. Twenty-two countries reported having containment facilities suitable for its isolation and propagation. Laboratories in 27 countries had applied specific H7 real-time RT-PCR assays and 20 countries had N9 assays in place. Positive control virus RNA was provided by the WHO Collaborating Centre in London to 34 laboratories in 22 countries to allow evaluation of their assays. Performance of the generic influenza A virus detection and H7 and N9 subtyping assays was good in 24 laboratories in 19 countries. The survey showed that ERLI-Net laboratories had rapidly developed and verified good capability to detect the novel A(H7N9) influenza viruses.
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Affiliation(s)
- E Broberg
- Surveillance and Response Support, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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9
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Li S, Jia Y, Jacobson B, McCauley J, Kratzke R, Bitterman PB, Wagner CR. Treatment of breast and lung cancer cells with a N-7 benzyl guanosine monophosphate tryptamine phosphoramidate pronucleotide (4Ei-1) results in chemosensitization to gemcitabine and induced eIF4E proteasomal degradation. Mol Pharm 2013; 10:523-31. [PMID: 23289910 DOI: 10.1021/mp300699d] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The development of cancer and fibrotic diseases has been shown to be highly dependent on disregulation of cap-dependent translation. Binding protein eIF4E to N(7)-methylated guanosine capped mRNA has been found to be the rate-limiting step governing translation initiation, and therefore represents an attractive target for drug discovery. Our group has found that 7-benzyl guanosine monophosphate (7Bn-GMP) is a potent antagonist of eIF4E cap binding (K(d) = 0.8 μM). Recent X-ray crystallographic studies have revealed that the cap-dependent pocket undergoes a unique structural change in order to accommodate the benzyl group. Unfortunately, 7Bn-GMP is not cell permeable. Recently, we have prepared a tryptamine phosphoramidate prodrug of 7Bn-GMP, 4Ei-1, and shown that it is a substrate for human histidine triad nucleotide binding protein (hHINT1) and inhibits eIF4E initiated epithelial-mesenchymal transition (EMT) by Zebra fish embryo cells. To assess the intracellular uptake of 4Ei-1 and conversion to 7Bn-GMP by cancer cells, we developed a sensitive assay using LC-ESI-MS/MS for the intracellular quantitation of 4Ei-1 and 7Bn-GMP. When incubated with the breast cancer cell line MDA-231 or lung cancer cell lines H460, H383 and H2009, 4Ei-1 was found to be rapidly internalized and converted to 7Bn-GMP. Since oncogenic mRNAs are predicted to have the highest eIF4E requirement for translation, we carried out chemosensitization studies with 4Ei-1. The prodrug was found to chemosensitize both breast and lung cancer cells to nontoxic levels of gemcitabine. Further mechanistic studies revealed that the expressed levels of eIF4E were substantially reduced in cells treated with 4Ei-1 in a dose-dependent manner. The levels of eI4E could be restored by treatment with the proteasome inhibitor MG-132. Taken together, our results demonstrate that 4Ei-1 is likely to inhibit translation initiation by eIF4E cap binding by both antagonizing eIF4E cap binding and initiating eIF4E proteasomal degradation.
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Affiliation(s)
- Shui Li
- Department of Medicinal Chemistry and Department of Medicine, University of Minnesota , Minneapolis, Minnesota 55455, United States
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10
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Puttarajappa C, Yabes J, Bei L, Shah N, Bernardo J, McCauley J, Basu A, Tan H, Shapiro R, Unruh M, Wu C. Cancer risk with alemtuzumab following kidney transplantation. Clin Transplant 2013; 27:E264-71. [PMID: 23480032 DOI: 10.1111/ctr.12094] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2012] [Indexed: 12/16/2022]
Abstract
Alemtuzumab has been employed for induction therapy in kidney transplantation with low rates of acute rejection and excellent graft and patient survival. Antibody induction therapy has been linked to increased vulnerability to cancer. Data regarding malignancy rates with alemtuzumab are limited. We studied 1350 kidney transplant recipients (between 2001 and 2009) at the University of Pittsburgh Starzl Transplant Institute, for post-transplant de novo and recurrent malignancy, excluding non-melanoma skin cancer, among patients receiving alemtuzumab, thymoglobulin, and no induction therapies. Of the 1350 patients, 1002 (74.2%) received alemtuzumab, 205 (15.2%) received thymoglobulin, and 122 (9%) received no induction therapy. After excluding cancers occurring within 60 d post-transplantation, 43 (3.25%) malignancies were observed during a median follow-up time of 4.0 yr. The incidence of malignancy was 5.4% (1.09 per 100 patient-years [PY]) with thymoglobulin, 2.8% (0.74 per 100 PY) with alemtuzumab, and 3.3% (0.66 per 100 PY) with no induction (across all groups; p = 0.2342, thymoglobulin vs. alemtuzumab; p = 0.008). Thus, with the exception of non-melanoma skin cancer which we did not evaluate, alemtuzumab induction was not associated with increased cancer incidence post-kidney transplantation when compared to no induction therapy and was associated with lower cancer incidence when compared to thymoglobulin.
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Affiliation(s)
- C Puttarajappa
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
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11
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Shapiro R, Park SC, Vekasy M, Good D, Tan HP, Wijkstrom M, Sturdevant M, Lopez R, McCauley J, Wu C, Shah N, Humar A. The Living Donor Evaluation as a Life-Saving Event. Transplantation 2012. [DOI: 10.1097/00007890-201211271-02179] [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: 11/25/2022]
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12
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McCauley J, D'Cunha J. Translational research: not just bench to bedside. Semin Thorac Cardiovasc Surg 2011; 22:197-9. [PMID: 21167453 DOI: 10.1053/j.semtcvs.2010.10.008] [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] [Accepted: 10/15/2010] [Indexed: 11/11/2022]
Abstract
The translation of proteins within the cell has been increasingly implicated in multiple malignancies as an important regulatory checkpoint. Although evidence continues to mount regarding the role of translation in cancer, questions persist as to how translation is activated and the overall significance in thoracic malignancies. Two recent articles are reviewed here that explore the role of enhanced translation in tumorigenesis and prognosis.
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Affiliation(s)
- Joel McCauley
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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13
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D'Cunha J, Antonoff M, Evenson K, McCauley J, Vickers S, Saluja A, Maddaus M. Triptolide Therapy Inhibits Non-Small Cell Lung Cancer In Vitro and In Vivo. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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McConville JF, Fernandes DJ, Churchill J, Dewundara S, Kogut P, Shah S, Fuchs G, Kedainis D, Bellam SK, Patel NM, McCauley J, Dulin NO, Gupta MP, Adam S, Yoneda Y, Camoretti-Mercado B, Solway J. Nuclear import of serum response factor in airway smooth muscle. Am J Respir Cell Mol Biol 2010; 45:453-8. [PMID: 21131446 DOI: 10.1165/rcmb.2008-0393oc] [Citation(s) in RCA: 2] [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: 11/24/2022] Open
Abstract
We have previously shown that the transcription-promoting activity of serum response factor (SRF) is partially regulated by its extranuclear redistribution. In this study, we examined the cellular mechanisms that facilitate SRF nuclear entry in canine tracheal smooth muscle cells. We used in vitro pull-down assays to determine which karyopherin proteins bound SRF and found that SRF binds KPNA1 and KPNB1 through its nuclear localization sequence. Immunoprecipitation studies also demonstrated direct SRF-KPNA1 interaction in HEK293 cells. Import assays demonstrated that KPNA1 and KPNB1 together were sufficient to mediate rapid nuclear import of SRF-GFP. Our studies also suggest that SRF is able to gain nuclear entry through an auxiliary, nuclear localization sequence-independent mechanism.
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Affiliation(s)
- John F McConville
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC6026, Chicago, IL 60637, USA
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15
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Abstract
Focal dermal hypoplasia (FDH) is an X-linked dominant disorder featuring developmental abnormalities of ectodermal and mesodermal tissues. Pathogenic mutations in the PORCN gene (locus Xp11.23) were identified in 2007 and thus far 27 different mutations have been reported. PORCN encodes a putative O-acyltransferase which facilitates secretion of Wnt proteins required for ectomesodermal tissue development. We investigated PORCN gene pathology and pattern of X-chromosome inactivation analysis in two unrelated Caucasian female patients who presented with multiple developmental abnormalities consistent with FDH. We also reviewed the clinical and molecular data for all reported PORCN mutations and assessed genotype-phenotype correlation for sporadic and familial cases of FDH. DNA sequencing revealed two new PORCN gene mutations: p.W282X and c.74delG (p.G25fsX51). X-chromosome inactivation analysis revealed a random pattern in one case but was uninformative in the other. Collectively, point/small mutations account for 24 out of the 29 PORCN mutations and are typically seen in sporadic cases; larger deletions are more common in familial cases. Identification of two new PORCN gene mutations confirms the importance of PORCN-associated Wnt signalling in embryogenesis. Both new cases showed Blaschko-linear dermal hypoplasia and extensive ectomesodermal abnormalities, including severe limb developmental anomalies and a giant cell tumour of bone in one patient. Clinical variability can be attributed to the degree of lyonization and postzygotic genomic mosaicism, which are important mechanisms in determining the clinical presentation.
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Affiliation(s)
- S E Clements
- Genetic Skin Disease Group, St John's Institute of Dermatology, King's College London, Guy's Campus, London, UK
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16
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Tan HP, Donaldson J, Basu A, Unruh M, Randhawa P, Sharma V, Morgan C, McCauley J, Wu C, Shah N, Zeevi A, Shapiro R. Two hundred living donor kidney transplantations under alemtuzumab induction and tacrolimus monotherapy: 3-year follow-up. Am J Transplant 2009; 9:355-66. [PMID: 19120078 DOI: 10.1111/j.1600-6143.2008.02492.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Alemtuzumab has been used in off-label studies of solid organ transplantation. We extend our report of the first 200 consecutive living donor solitary kidney transplantations under alemtuzumab pretreatment with tacrolimus monotherapy and subsequent spaced weaning to 3 years of follow-up. We focused especially on the causes of recipient death and graft loss, and the characteristics of rejection. The actuarial 1-, 2- and 3-year patient and graft survivals were 99.0% and 98.0%, 96.4% and 90.8% and 93.3% and 86.3%, respectively. The cumulative incidence of acute cellular rejection (ACR) at the following months was 2%</=6, 9.0%</=12, 16.5%</=18, 19.5%</=24, 23.5%</=30, 24.0%</=36 and 25%</=42. The mean serum creatinine (mg/dL) and glomerular filtration rate (mL/min/1.73 m(2)) at 1 and 3 years were 1.4 +/- 0.6 and 58.7 +/- 21.6 and 1.5 +/- 0.7 and 54.9 +/- 20.9, respectively. Fifty (25%) recipients had a total of 89 episodes of ACR. About 88.7% of ACR episodes were Banff 1, and of those, 82% were steroid-sensitive. Nine (4.5%) recipients had antibody-mediated rejection (AMR). About 76.5% were weaned but only 46% are currently on spaced dose (qod or less) tacrolimus monotherapy, and 94.4% remained steroid-free from the time of transplantation. Infectious complications were uncommon. This experience suggests the 3-year efficacy of this approach.
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Affiliation(s)
- H P Tan
- The Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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17
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Tan H, Donaldson J, Basu A, Unruh M, Randhawa P, Sharma V, Morgan C, McCauley J, Wu C, Shapiro R. 200 LIVING DONOR KIDNEY TRANSPLANTATIONS UNDER ALEMTUZUMAB PRETREATMENT AND WEANING OF TACROLIMUS MONOTHERAPY: 3 YEAR FOLLOW UP. Transplantation 2008. [DOI: 10.1097/01.tp.0000332018.69787.7d] [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: 11/25/2022]
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18
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Tan H, Donaldson J, Basu A, Unruh M, Randhawa P, McCauley J, Morgan C, Wu C, Shah N, Shapiro R. 411 LIVING DONOR KIDNEY TRANSPLANTS USING ALEMTUZUMAB PRE-CONDITIONING AND TACROLIMUS MONOTHERAPY: 5 YEAR EXPERIENCE. Transplantation 2008. [DOI: 10.1097/01.tp.0000331776.58663.24] [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: 11/25/2022]
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19
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Kayler LK, Lakkis FG, Morgan C, Basu A, Blisard D, Tan HP, McCauley J, Wu C, Shapiro R, Randhawa PS. Acute cellular rejection with CD20-positive lymphoid clusters in kidney transplant patients following lymphocyte depletion. Am J Transplant 2007; 7:949-54. [PMID: 17331114 DOI: 10.1111/j.1600-6143.2007.01737.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Lymphoid clusters (LC) containing CD20-positive B cells in kidney allografts undergoing acute cellular rejection (ACR) have been identified in small studies as a prognostic factor for glucocorticoid resistance and graft loss. Allograft biopsies obtained during the first episode of ACR in 120 recipients were evaluated for LC, immunostained with CD20 antibody, and correlated with conventional histopathologic criteria, response to treatment and outcome. LC were found in 71 (59%) of the 120 biopsies. All contained CD20 positive B cells that accounted for 5-90% of the LC leukocyte content. The incidence of LC was highest in the patients who had no lymphoid depletion or had been treated with Thymoglobulin preconditioning (79% vs. 75%, respectively) compared to 37% in patients pretreated with Campath (p = 0.0001). Banff 1a/1b ACR were more frequent in the LC-positive than the LC-negative group (96% vs. 80%, respectively; p = 0.0051). With a posttransplant follow-up of 953 +/- 430 days, no significant differences were detected between LC-postitive and LC-negative groups in time to ACR, steroid resistance, serum creatinine and graft loss. CD20+LC did not portend glucocorticoid resistance or worse short to medium term outcomes. CD20+LC may represent a heterogenous collection in which there may be a small still to be fully defined unfavorable subgroup.
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Affiliation(s)
- L K Kayler
- The Thomas E. Starzl Transplantation Institute, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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20
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Tan HP, Kaczorowski DJ, Basu A, Unruh M, McCauley J, Wu C, Donaldson J, Dvorchik I, Kayler L, Marcos A, Randhawa P, Smetanka C, Starzl TE, Shapiro R. Living donor renal transplantation using alemtuzumab induction and tacrolimus monotherapy. Am J Transplant 2006; 6:2409-17. [PMID: 16889606 PMCID: PMC3154761 DOI: 10.1111/j.1600-6143.2006.01495.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [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] [Indexed: 01/25/2023]
Abstract
Alemtuzumab was used as an induction agent in 205 renal transplant recipients undergoing 207 living donor renal transplants. All donor kidneys were recovered laparoscopically. Postoperatively, patients were treated with tacrolimus monotherapy, and immunosuppression was weaned when possible. Forty-seven recipients of living donor renal transplants prior to the induction era who received conventional triple drug immunosuppression without antibody induction served as historic controls. The mean follow-up was 493 days in the alemtuzumab group and 2101 days in the historic control group. Actuarial 1-year patient and graft survival were 98.6% and 98.1% in the alemtuzumab group, compared to 93.6% and 91.5% in the control group, respectively. The incidence of acute cellular rejection (ACR) at 1 year was 6.8% in the alemtuzumab group and 17.0% (p < 0.05) in the historic control group. Most (81.3%) episodes of ACR in the alemtuzumab group were Banff 1 (a or b) and were sensitive to steroid pulses for the treatment of rejection. There was no cytomegalovirus disease or infection. The incidence of delayed graft function was 0%, and the incidence of posttransplant insulin-dependent diabetes mellitus was 0.5%. This study represents the largest series to date of live donor renal transplant recipients undergoing alemtuzumab induction, and confirms the short-term safety and efficacy of this approach.
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Affiliation(s)
- H P Tan
- The Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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21
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Tan HP, Kaczorowski D, Basu A, McCauley J, Marcos A, Donaldson J, Unruh M, Randhawa P, Zeevi A, Shapiro R. Steroid-free tacrolimus monotherapy after pretransplantation thymoglobulin or Campath and laparoscopy in living donor renal transplantation. Transplant Proc 2006; 37:4235-40. [PMID: 16387087 DOI: 10.1016/j.transproceed.2005.10.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Indexed: 01/31/2023]
Abstract
Living donor renal transplantation was performed under a regimen of recipient pretreatment and low-dose postoperative immunosuppression with subsequent weaning. From October 9, 2002, to December 31, 2004, 196 consecutive, unselected laparoscopic live donor nephrectomies resulting in 196 living donor renal transplantations were performed. Recipients were pretreated with rabbit antithymocyte globulin (thymoglobulin; 24 patients or [12%]) or Campath 1H (alemtuzumab; 166 patients [85%]), or were not in protocol (6 patients [3%]), and were given postoperative steroid-free low-dose tacrolimus immunosuppressive monotherapy with subsequent weaning. There was no donor mortality. Major and minor donor morbidities were 2.6% and 4.2%, respectively. Laparoscopic live donor nephrectomy recipient outcomes with a mean follow-up of 401 days included (1) recipient and graft survival of 99.0% and 97.4%, respectively; (2) no ureteral stenosis; (3) 0.5% delayed graft function, from recurrent focal segmental glomerulosclinosis; and (4) no vascular thrombosis. The incidence of acute rejection at 30, 90, and 401 days was 1.5%, 3.8%, and 11.2% (all 196 recipients), 0%, 25%, and 29.2% (thymoglobulin recipients), and 1.8%, 3.9%, and 8.4% (Campath 1H recipients), respectively. Sixty-six patients (33.7%) are receiving spaced-dose immunosuppressive monotherapy. The mean creatinine concentration in all recipients was 1.5 +/- 1.1 mg/dL. There were no instances of cytomegalovirus tissue invasive disease or posttransplantation lymphoproliferative disease. The incidence of new-onset posttransplantation insulin-dependent diabetes was 0.5%. At current follow-up, the use of Campath 1H rather than thymoglobulin for pretreatment seems to have significantly improved the efficacy of our regimen.
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Affiliation(s)
- H P Tan
- Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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22
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Hayman A, Comely S, Lackenby A, Murphy S, McCauley J, Goodbourn S, Barclay W. Variation in the ability of human influenza A viruses to induce and inhibit the IFN-β pathway. Virology 2006; 347:52-64. [PMID: 16378631 DOI: 10.1016/j.virol.2005.11.024] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Revised: 11/10/2005] [Accepted: 11/11/2005] [Indexed: 12/01/2022]
Abstract
We investigated the ability of a selection of human influenza A viruses, including recent clinical isolates, to induce IFN-beta production in cultured cell lines. In contrast to the well-characterized laboratory strain A/PR/8/34, several, but not all, recent isolates of H3N2 viruses resulted in moderate IFN-beta stimulation. Through the generation of recombinant viruses, we were able to show that this is not due to a loss of the ability of the NS1 genes to suppress IFN-beta induction; indeed, the NS1 genes behaved similarly with respect to their abilities to block dsRNA signaling. Interestingly, replication of A/Sydney/5/97 virus was less susceptible to pre-treatment with IFN-alpha than the other viruses. In contrast to the universal effect on dsRNA signaling, we noted differences in the effect of NS1 proteins on expression of interferon stimulated genes and also genes induced by a distinct pathway. The majority of NS1 proteins blocked expression from both IFN-dependent and TNF-dependent promoters by an apparent post-transcriptional mechanism. The NS1 gene of A/PR/8/34 NS1 did not confer these blocks. We noted striking differences in the cellular localization of different influenza A virus NS1 proteins during infection, which might explain differences in biological activity.
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MESH Headings
- Animals
- Base Sequence
- Cell Line
- Chlorocebus aethiops
- DNA, Viral/genetics
- Genes, Reporter
- Genes, Viral
- Humans
- Immunity, Innate
- Influenza A Virus, H3N2 Subtype/genetics
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/pathogenicity
- Influenza A virus/genetics
- Influenza A virus/immunology
- Influenza A virus/pathogenicity
- Interferon-beta/biosynthesis
- Interferon-beta/genetics
- Promoter Regions, Genetic
- RNA, Double-Stranded/genetics
- Recombination, Genetic
- Signal Transduction
- Vero Cells
- Viral Nonstructural Proteins/genetics
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Affiliation(s)
- A Hayman
- School of Biological Sciences, University of Reading, Whiteknights, Reading RG6 6AJ, UK
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23
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McNutt LA, McCauley J, Campbell J, Abushomar H, Ford D. 246: Validity of Touch Screen Computers for Preventive Services Screening in Primary Care: Assessment of Screening for Intimate Partner Violence. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s62a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | | | | | - D Ford
- U Albany, SUNY, Rensselaer, NY 12144
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24
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Basu A, Ramkumar M, Tan HP, Khan A, McCauley J, Marcos A, Fung JJ, Starzl TE, Shapiro R. Reversal of Acute Cellular Rejection After Renal Transplantation With Campath-1H. Transplant Proc 2005; 37:923-6. [PMID: 15848576 DOI: 10.1016/j.transproceed.2004.12.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Between September 2002 and February 2004, 40 kidney transplant (27 from deceased and 13 from living donors) recipients (25 male and 15 female, aged 50.3 +/- 15.1 years) were treated with Campath 1H (C 1H; 30 mg/dose IV) for biopsy-proven steroid-resistant rejection (SRR) or rejections equal to or worse than Banff 1B. All transplantations occurred between August 2001 and May 2003. All patients had received antibody preconditioning (RATG 5 mg/kg, n = 34; C 1H 60 mg, n = 4; C 1H 30 mg, n = 2) preoperatively and were treated with Tacrolimus monotherapy (target level 10 ng/ml) postoperatively and subsequent spaced weaning. Elevated creatinine levels at follow-up were evaluated by renal transplant biopsy. Rejection was treated with steroids, reversal of weaning, addition of sirolimus, and/or antibody treatment, depending on grade of rejection. The mean duration of follow-up was 453 +/- 163 days after C 1H administration. Twenty-nine patients received C 1H for SRR and 11 patients for Banff 1B or worse rejections; 26 patients received more than 1 dose of C 1H. Graft survival was 62.5% (25 patients); 6 of the 15 allografts (40%) that failed had presented with rejections because of noncompliance. Graft survival in compliant patients with SRR or rejections equal to or worse than Banff 1B was 73.5% (25 of 34). Fourteen patients (35%) had infectious complications, of whom 2 patients (5%) died. C 1H is an effective agent for SRR and Banff 1B or worse rejections, with 95% patient survival and 73.5% graft survival (in compliant patients). The number of doses of 30 mg C 1H should be restricted to two, as there is a high incidence of potentially fatal infectious complications.
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Affiliation(s)
- A Basu
- University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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25
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Mosher PJ, Murphy AA, Anderson JM, Coyle M, McCauley J, Boyle K, Halamek LP. 140 DEATH, DYING AND DELIVERING BAD NEWS: CURRENT CURRICULAR OFFERINGS AND STUDENT ATTITUDES AT STANFORD UNIVERSITY SCHOOL OF MEDICINE. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Solway J, Bellam S, Dowell M, Camoretti-Mercado B, Dulin N, Fernandes D, Halayko A, Kocieniewski P, Kogut P, Lakser O, Liu HW, McCauley J, McConville J, Mitchell R. Actin dynamics: a potential integrator of smooth muscle (Dys-)function and contractile apparatus gene expression in asthma. Parker B. Francis lecture. Chest 2003; 123:392S-8S. [PMID: 12629000 DOI: 10.1378/chest.123.3_suppl.392s] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Julian Solway
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
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27
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McCauley J. 77. Bovine viral diarrhoea virus evasion of the innate immune responses of the host. Res Vet Sci 2003. [DOI: 10.1016/s0034-5288(03)90076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Shapiro R, Scantlebury VP, Jordan ML, Vivas CA, Jain A, Hakala TR, McCauley J, Johnston J, Randhawa P, Fedorek S, Gray E, Chesky A, Dvorchik I, Donaldson J, Fung JJ, Starzl TE. A pilot trial of tacrolimus, sirolimus, and steroids in renal transplant recipients. Transplant Proc 2002; 34:1651-2. [PMID: 12176521 PMCID: PMC2948865 DOI: 10.1016/s0041-1345(02)02966-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R Shapiro
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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29
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Marburg S, Jorn D, Tolman RL, Arison B, McCauley J, Kniskern PJ, Hagopian A, Vella PP. Bimolecular chemistry of macromolecules: synthesis of bacterial polysaccharide conjugates with Neisseria meningitidis membrane protein. J Am Chem Soc 2002. [DOI: 10.1021/ja00277a037] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [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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30
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Shapiro R, Randhawa P, Jordan ML, Scantlebury VP, Vivas C, Jain A, Corry RJ, McCauley J, Johnston J, Donaldson J, Gray EA, Dvorchik I, Hakala TR, Fung JJ, Starzl TE. An analysis of early renal transplant protocol biopsies--the high incidence of subclinical tubulitis. Am J Transplant 2001; 1:47-50. [PMID: 12095037 PMCID: PMC2955896 DOI: 10.1034/j.1600-6143.2001.010109.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [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] [Indexed: 01/25/2023]
Abstract
To investigate the possibility that we have been underestimating the true incidence of acute rejection, we began to perform protocol biopsies after kidney transplantation. This analysis looks at the one-week biopsies. Between March 1 and October 1, 1999, 100 adult patients undergoing cadaveric kidney or kidney/pancreas transplantation, or living donor kidney transplantation, underwent 277 biopsies. We focused on the subset of biopsies in patients without delayed graft function (DGF) and with stable or improving renal function, who underwent a biopsy 8.2+/-2.6 d (range 3-18 d) after transplantation (n = 28). Six (21%) patients with no DGF and with stable or improving renal function had borderline histopathology, and 7 (25%) had acute tubulitis on the one-week biopsy. Of the 277 kidney biopsies, there was one (0.4%) serious hemorrhagic complication, in a patient receiving low molecular weight heparin; she ultimately recovered and has normal renal function. Her biopsy showed Banff 1B tubulitis. In patients with stable or improving renal allograft function early after transplantation, subclinical tubulitis may be present in a substantial number of patients. This suggests that the true incidence of rejection may be higher than is clinically appreciated.
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Affiliation(s)
- R Shapiro
- University of Pittsburgh, Thomas E. Starzl Transplantation Institute, PA 15213, USA.
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31
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Shapiro R, Jordan ML, Scantlebury VP, Vivas CA, Jain A, Chakrabarti P, McCauley J, Johnston J, Randhawa P, Rao A, Fung JJ, Corry RJ. Simultaneous pancreas-kidney transplantation at the University of Pittsburgh. Clin Transpl 2001:217-21. [PMID: 11038640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Analysis of the SPK program at the University of Pittsburgh has led to a number of observations: 1. Under tacrolimus-based immunosuppression, without antibody induction, it has been possible to achieve (a) One- and 3-year actuarial patient survival rates of 98% and 95% (b) One- and 3-year actuarial kidney survival rates of 95% and 87% (c) One- and 3-year actuarial pancreas survival rates of 86% and 80% 2. Steroid withdrawal has been achieved in over half of the successfully transplanted recipients, with excellent outcomes and a low rate (4.7%) of subsequent rejection. 3. Bone marrow augmentation has been associated with (a) less rejection (b) less pancreatic graft loss to rejection (c) an increased ability to withdraw steroids 4. Rejection has been associated with a rising serum lipase. 5. Renal allograft rejection in SPK patients with elevated serum lipase levels has been seen in the setting of normal renal function. 6. Enteric drainage has been associated with a reasonably low complication rate. 7. SPK transplantation is a successful therapeutic option in selected type I diabetics with end-stage renal disease.
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Affiliation(s)
- R Shapiro
- University of Pittsburgh, Thomas E. Starzl Transplantation Institute, Pennsylvania, USA
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32
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McCauley J, Shapiro R, Jordan ML, Scantlebury VP, Vivas C, Jain A, Good D, Woods H, Johnston J, Corry RJ. Long-term lipid metabolism in combined kidney-pancreas transplant recipients under tacrolimus immunosuppression. Transplant Proc 2001; 33:1698-9. [PMID: 11267475 DOI: 10.1016/s0041-1345(00)02647-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J McCauley
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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33
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Chakrabarti P, Wong HY, Toyofuku A, Scantlebury VP, Jordan ML, Vivas C, Jain AB, McCauley J, Johnston J, Randhawa PS, Hakala TR, Simmons RL, Fung JJ, Starzl TE, Shapiro R. Outcome after steroid withdrawal in adult renal transplant patients receiving tacrolimus-based immunosuppression. Transplant Proc 2001; 33:1235-6. [PMID: 11267274 PMCID: PMC2972654 DOI: 10.1016/s0041-1345(00)02402-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- P Chakrabarti
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, 15213, Pittsburgh, PA, USA
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34
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35
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36
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Elton D, Simpson-Holley M, Archer K, Medcalf L, Hallam R, McCauley J, Digard P. Interaction of the influenza virus nucleoprotein with the cellular CRM1-mediated nuclear export pathway. J Virol 2001; 75:408-19. [PMID: 11119609 PMCID: PMC113933 DOI: 10.1128/jvi.75.1.408-419.2001] [Citation(s) in RCA: 221] [Impact Index Per Article: 9.6] [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: 07/10/2000] [Accepted: 10/10/2000] [Indexed: 11/20/2022] Open
Abstract
Influenza virus transcription occurs in the nuclei of infected cells, where the viral genomic RNAs are complexed with a nucleoprotein (NP) to form ribonucleoprotein (RNP) structures. Prior to assembly into progeny virions, these RNPs exit the nucleus and accumulate in the cytoplasm. The mechanisms responsible for RNP export are only partially understood but have been proposed to involve the viral M1 and NS2 polypeptides. We found that the drug leptomycin B (LMB), which specifically inactivates the cellular CRM1 polypeptide, caused nuclear retention of NP in virus-infected cells, indicating a role for the CRM1 nuclear export pathway in RNP egress. However, no alteration was seen in the cellular distribution of M1 or NS2, even in the case of a mutant virus which synthesizes greatly reduced amounts of NS2. Furthermore, NP was distributed throughout the nuclei of infected cells at early times postinfection but, when retained in the nucleus at late times by LMB treatment, was redistributed to the periphery of the nucleoplasm. No such change was seen in the nuclear distribution of M1 or NS2 after drug treatment. Similar to the behavior of NP, M1 and NS2 in infected cells, LMB treatment of cells expressing each polypeptide in isolation caused nuclear retention of NP but not M1 or NS2. Conversely, overexpression of CRM1 caused increased cytoplasmic accumulation of NP but had little effect on M1 or NS2 distribution. Consistent with this, NP bound CRM1 in vitro. Overall, these data raise the possibility that RNP export is mediated by a direct interaction between NP and the cellular CRM1 export pathway.
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Affiliation(s)
- D Elton
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge CB2 1QP, United Kingdom
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Shapiro R, Rao AS, Corry RJ, Valenti M, Zeevi A, Jordan ML, Scantlebury VP, Vivas CA, Jain A, McCauley J, Randhawa P, Gray EA, Dvorchik I, McMichael J, Fung JJ, Starzl TE. Kidney transplantation with bone marrow augmentation: five-year outcomes. Transplant Proc 2001; 33:1134-5. [PMID: 11267224 PMCID: PMC2978658 DOI: 10.1016/s0041-1345(00)02461-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- R Shapiro
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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38
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Soran A, Basar H, Shapiro R, Vivas C, Scantlebury VP, Jordan ML, Gritsch HA, McCauley J, Randhawa P, Hakala TR, Fung JJ. Renal retransplantation in elderly recipients under tacrolimus-based immunosuppression. Transplant Proc 2000; 32:663-4. [PMID: 10812157 DOI: 10.1016/s0041-1345(00)00935-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A Soran
- University of Pittsburgh, PA 15213, USA
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39
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Shapiro R, Jordan ML, Scantlebury VP, Vivas CA, Jain A, McCauley J, Egidi MF, Randhawa P, Chakrabarti P, Corry RJ. Renal allograft rejection with normal renal function in simultaneous kidney/pancreas recipients: does dissynchronous rejection really exist? Transplantation 2000; 69:440-1. [PMID: 10706058 DOI: 10.1097/00007890-200002150-00024] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Between July 1, 1994 and December 1, 1998, 147 simultaneous kidney/pancreas transplantations were performed at our center. Of 95 patients who experienced at least one acute renal allograft rejection episode after transplantation, 7 (7.4%) developed rejection in the presence of stable and normal or near-normal renal function. METHODS The indication for renal allograft biopsy was a rising serum lipase, i.e., suspected pancreatic rejection. All seven patients were treated with steroids and augmentation of the tacrolimus dose, with a fall in the serum lipase and no change in the serum creatinine. RESULTS The serum creatinine levels just before, at the time of, 1 week after the biopsy, and at most recent follow-up were 1.4+/-0.4, 1.3+/-0.3, 1.2+/-0.2, and 1.2+/-0.2 mg/dl. The serum lipase levels just before, at the time of, 1 week after the biopsy, and at most recent follow-up were 1022+/-1157 mg/dl, 874+/-996 mg/dl, 243+/-260 mg/dl, and 94+/-75 mg/dl. The tacrolimus dosages and levels at the time of the biopsy and 1 week later were 14.9+/-5.0 mg/day and 15.0+/-4.0 ng/ml, and 16.4+/-6.3 mg/day and 15.1+/-6.8 ng/ml. CONCLUSIONS These findings suggest that, in patients undergoing simultaneous kidney/pancreas transplantation, the entity of dissynchronous pancreatic allograft rejection without renal allograft rejection may not really exist. These data also make an additional fundamental point that acute rejection may occur in patients with normal and stable renal function.
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Affiliation(s)
- R Shapiro
- Thomas E. Starzl Transplantation Institute, Division of Urologic Surgery, University of Pittsburgh, Pennsylvania 15213, USA
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40
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Shapiro R, Nalesnik M, McCauley J, Fedorek S, Jordan ML, Scantlebury VP, Jain A, Vivas C, Ellis D, Lombardozzi-Lane S, Randhawa P, Johnston J, Hakala TR, Simmons RL, Fung JJ, Starzl TE. Posttransplant lymphoproliferative disorders in adult and pediatric renal transplant patients receiving tacrolimus-based immunosuppression. Transplantation 1999; 68:1851-4. [PMID: 10628763 PMCID: PMC3086425 DOI: 10.1097/00007890-199912270-00006] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.3] [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: 01/20/2023]
Abstract
Between March 27, 1989 and December 31, 1997, 1316 kidney transplantations alone were performed under tacrolimus-based immunosuppression at our center. Posttransplant lymphoproliferative disorders (PTLD) developed in 25 (1.9%) cases; the incidence in adults was 1.2% (15/1217), whereas in pediatric patients it was 10.1% (10/99; P<.0001). PTLD was diagnosed 21.0+/-22.5 months after transplantation, 25.0+/-24.7 months in adults and 14.4+/-18.2 months in pediatric patients. Of the 4 adult cases in whom both the donor and recipient Epstein Barr virus (EBV) serologies were known, 2 (50%) were seropositive donor --> seronegative recipient. Of 7 pediatric cases in whom both the donor and recipient EBV serologies were known, 6 (86%) were EBV seropositive donor --> seronegative recipient. Acute rejection was observed before the diagnosis of PTLD in 8 (53%) of 15 adults and 3 (30%) of 10 pediatric patients. Initial treatment of PTLD included a marked decrease or cessation of immunosuppression with concomitant ganciclovir therapy; two adults and two pediatric patients required chemotherapy. With a mean follow-up of 24.9+/-30.1 months after transplantation, the 1- and 5-year actuarial patient and graft survival rates in adults were 93% and 86%, and 80% and 60%, respectively. Two adults died, 3.7 and 46.2 months after transplantation, of complications related to PTLD, and 10 (including the 2 deaths) lost their allograft 3.7-84.7 months after transplantation. In children, the 1- and 5-year actuarial patient and graft survival rates were 100% and 100%, and 100% and 89%, respectively. No child died; one child lost his allograft 41.3 months after transplantation. One child had presumed recurrent PTLD that responded to discontinuation of tacrolimus and reinitiation of antiviral therapy. The mean serum creatinine level in adults was 2.5+/-1.2 mg/dl, and in children, it was 1.3+/-0.6 mg/ dl. Under tacrolimus-based immunosuppression, PTLD is less common after renal transplantation in adults than in children, but PTLD in children is associated with more favorable outcomes than in adults.
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Affiliation(s)
- R Shapiro
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pennsylvania 15213, USA
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41
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Affiliation(s)
- J McCauley
- Institute for Animal Health, Compton, Newbury, Berkshire, RG20 7NN, UK
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42
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Jordan ML, Shapiro R, Vivas C, Scantlebury V, McCauley J, McMichael J, Randhawa P, Demetris A, Fung J, Starzl TE. Outcome of tacrolimus conversion therapy for renal allograft rejection: 5-year follow-up. Transplant Proc 1999; 31:81S-83S. [PMID: 10576052 PMCID: PMC2972742 DOI: 10.1016/s0041-1345(99)00802-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- M L Jordan
- Division of Urologic Surgery/Transplantation, University of Pittsburgh Medical Center, PA 15213, USA
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43
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Zitzmann N, Mehta AS, Carrouée S, Butters TD, Platt FM, McCauley J, Blumberg BS, Dwek RA, Block TM. Imino sugars inhibit the formation and secretion of bovine viral diarrhea virus, a pestivirus model of hepatitis C virus: implications for the development of broad spectrum anti-hepatitis virus agents. Proc Natl Acad Sci U S A 1999; 96:11878-82. [PMID: 10518544 PMCID: PMC18380 DOI: 10.1073/pnas.96.21.11878] [Citation(s) in RCA: 266] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
One function of N-linked glycans is to assist in the folding of glycoproteins by mediating interactions of the lectin-like chaperone proteins calnexin and calreticulin with nascent glycoproteins. These interactions can be prevented by inhibitors of the alpha-glucosidases, such as N-butyl-deoxynojirimycin (NB-DNJ) and N-nonyl-DNJ (NN-DNJ), and this causes some proteins to be misfolded and retained within the endoplasmic reticulum (ER). We have shown previously that the NN-DNJ-induced misfolding of one of the hepatitis B virus (HBV) envelope glycoproteins prevents the formation and secretion of virus in vitro and that this inhibitor alters glycosylation and reduces the viral levels in an animal model of chronic HBV infection. This led us to investigate the effect of glucosidase inhibitors on another ER-budding virus, bovine viral diarrhea virus, a tissue culture surrogate of human hepatitis C virus (HCV). Here we show that in MDBK cells alpha-glucosidase inhibitors prevented the formation and secretion of infectious bovine viral diarrhea virus. Data also are presented showing that NN-DNJ, compared with NB-DNJ, exhibits a prolonged retention in liver in vivo. Because viral secretion is selectively hypersensitive to glucosidase inhibition relative to the secretion of cellular proteins, the possibility that glucosidase inhibitors could be used as broad-based antiviral hepatitis agents is discussed. A single drug against HBV, HCV, and, possibly, HDV, which together chronically infect more than 400 million people worldwide, would be of great therapeutic value.
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Affiliation(s)
- N Zitzmann
- The Glycobiology Institute, Department of Biochemistry, Oxford University, Oxford, OX1 3QU, United Kingdom
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44
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Soran A, Shapiro R, Basar H, Vivas C, Scantlebury VP, Jordan ML, Gritsch HA, McCauley J, Randhawa P, Hakala TR, Fung JJ. Outcome of kidney transplantation under tacrolimus-based immunosuppression in elderly patients. J Transpl Coord 1999; 9:101-3. [PMID: 10703390 DOI: 10.7182/prtr.1.9.2.2034366167382573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Kidney transplantation has become a reasonable treatment option for selected patients aged 60 years or older, and a number of different immunosuppressive drug protocols have been described. This article concerns 230 recipients who were aged 60 years or older and who were undergoing kidney-only transplantation at the University of Pittsburgh between January 1990 and April 1997. All recipients were treated with a tacrolimus-based immunosuppression regimen. The median follow-up was 31.5 months (range, 1-86). The 1-, 3-, and 5-year actuarial patient survival rates were 90%, 83%, and 76%, respectively. There were 42 (19%) deaths, cardiovascular disease (50%) and infection (38%) being the main causes. Death with a functioning kidney occurred in 28 (67%) patients. The 1-, 3-, and 5-year actuarial graft survival rates were 84%, 74%, and 64%, respectively. The delayed graft function rate was 33%. Rejection was seen in 57 (25%) elderly patients. The mean serum creatinine was 2.6 +/- 2.7 mg/dL and the serum urea nitrogen was 35 +/- 22 mg/dL. The mean tacrolimus level was 8.5 +/- 3.8 ng/mL. These results suggest that renal transplantation in older recipients under tacrolimus-based immunosuppression is associated with reasonable outcomes, and can be offered to appropriately selected patients.
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Affiliation(s)
- A Soran
- Department of Critical Care Medicine, University of Pittsburgh, Pa., USA
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45
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Abstract
Vitamin K deficiency is a common occurrence in the surgical and intensive care unit population, but its incidence in kidney and combined kidney-pancreas allograft recipients has not been described. We report four patients who received cadaveric kidney or combined kidney-pancreas allografts and subsequently developed significant bleeding associated with deficiency of vitamin K. Their coagulopathy promptly resolved with the parenteral administration of vitamin K. Treatment with vitamin K should be considered in kidney or combined kidney-pancreas allograft recipients with a prolonged prothrombin or partial thromboplastin time during the first postoperative week to avoid hemorrhagic complications.
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Affiliation(s)
- G V Prasad
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
Autoantibodies to intracellular antigens are a hallmark of autoimmune diseases, although their role in disease pathogenesis is unclear. Centrosomes are organelles involved in the organization of the mitotic spindle and they are targets of autoantibodies in systemic sclerosis (SSc). We used recombinant centrosome autoantigens, centrosome-specific antibodies, and immunoassays to demonstrate that a significant proportion of SSc patients exhibited centrosome reactivity. Two centrosome proteins cloned in our laboratory were used to screen 129 SSc sera by Western blotting. The same sera were screened by immunofluorescence using centrosome-specific antibodies to distinguish centrosomes from nuclear speckles commonly stained by SSc sera. Using these criteria, 42.6% of SSc patients were autoreactive to centrosomes, a larger percentage than reacted with all other known SSc autoantigens. Most centrosome-positive sera reacted with both centrosome proteins and half were negative for other routinely assayed SSc autoantibodies. By these criteria, we have identified a novel class of SSc autoreactivity. Only a small percentage of normal individuals and patients with other connective tissue diseases had centrosome reactivity. These results demonstrate that centrosome autoantibodies are a major component of autoreactivity in SSc and thus have potential in disease diagnosis. Centrosome autoantigens may be useful in studying the development of autoantibodies and chronic inflammation in SSc and perhaps other autoimmune diseases.
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Affiliation(s)
- I Gavanescu
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester 10605, USA
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47
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Basar H, Soran A, Shapiro R, Vivas C, Scantlebury VP, Jordan ML, Gritsch HA, McCauley J, Randhawa P, Irish W, Hakala TR, Fung JJ. Renal transplantation in recipients over the age of 60: the impact of donor age. Transplantation 1999; 67:1191-3. [PMID: 10232574 DOI: 10.1097/00007890-199904270-00019] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Kidneys from older donors exhibit a series of changes characterized by glomerular, vascular, and tubular senescence. These changes may be aggravated by atherosclerosis, hypertension, or diabetes, which are highly prevalent in older individuals. METHODS We analyzed the outcome after transplantation in 230 recipients over the age of 60, who received transplants between February 1990 and December 1996. We assessed the 1- and 5-year patient and graft survival, the quality of renal function, tacrolimus levels, the incidence of rejection, and the incidence of delayed graft function, and compared the outcomes in recipients of kidneys from donors over the age of 60 (group 1, n = 40) with those in recipients of kidneys from donors under the age of 60 (group 2, n = 190). There were no differences between the two groups in terms of recipient sex, race, age, and cold ischemia time. Immunosuppression was with tacrolimus and steroids in 61% of cases; in the remainder of the patients, a third agent, either azathioprine, cyclophosphamide (for 1 week), or mycophenolate mofetil was administered as well. The median follow-up was 31.5 months (range: 1-86). RESULTS In recipients over the age of 60 receiving tacrolimus-based immunosuppression, overall patient survival at 1 and 5 years was 90% and 76%, and was not significantly compromised in recipients receiving a kidney from a donor over the age of 60. The overall 1-and 5-year actuarial graft survival was 84% and 64%; in recipients from donors over the age of 60, it was 73% and 52%, whereas in recipients of kidneys from donors under the age of 60, it was 87% and 66% (P<0.05). Most of the effect on graft survival was seen by 1 year. The mean serum creatinine was 2.6+/-2.7 mg/dl, without any difference between the two groups. Although the incidence of delayed graft function was higher in recipients of kidneys from donors over the age of 60, this difference did not reach statistical significance. CONCLUSIONS Although the overall outcomes of transplantation in older recipients remain reasonable, the inferior outcomes with older donor kidneys call into question proposals to utilize older donor kidneys preferentially in older recipients.
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Affiliation(s)
- H Basar
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pennsylvania 15213, USA
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48
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Shapiro R, Jordan ML, Scantlebury VP, Vivas C, Marsh JW, McCauley J, Johnston J, Randhawa P, Irish W, Gritsch HA, Naraghi R, Hakala TR, Fung JJ, Starzl TE. A prospective, randomized trial of tacrolimus/prednisone versus tacrolimus/prednisone/mycophenolate mofetil in renal transplant recipients. Transplantation 1999; 67:411-5. [PMID: 10030287 PMCID: PMC2952470 DOI: 10.1097/00007890-199902150-00012] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Between September 20, 1995 and September 20, 1997, 208 adult patients undergoing renal transplantation were randomized to receive tacrolimus/prednisone (n=106) or tacrolimus/prednisone/mycophenolate mofetil (n=102), with the goal of reducing the incidence of rejection. METHODS The mean recipient age was 50.7+/-13.7 years. Sixty-three (30.3%) patients were 60 years of age or older at the time of transplantation. The mean donor age was 34.5+/-21.7 years. The mean cold ischemia time was 30.5+/-9.2 hr. The mean follow-up is 15+/-7 months. RESULTS The overall 1-year actuarial patient survival was 94%; the overall 1-year actuarial graft survival was 87%. When the patient and graft survival data were stratified to recipients under the age of 60 who did not have delayed graft function, the overall 1-year actuarial patient survival was 97%, and the corresponding 1-year actuarial graft survival was 93%. There were no differences between the two groups. The overall incidence of rejection was 36%; in the double-therapy group, it was 44%, whereas in the triple therapy group, it was 27% (P=0.014). The mean serum creatinine was 1.6+/-0.8 mg/dl. A total of 36% of the successfully transplanted patients were taken off prednisone; 32% of the patients were taken off antihypertensive medications. The incidence of delayed graft function was 21%, the incidence of cytomegalovirus was 12.5%, and the initial and final incidences of posttransplant insulin-dependent diabetes mellitus were 7.0% and 2.9%; again, there was no difference between the two groups. CONCLUSIONS This trial suggests that the combination of tacrolimus, steroids, and mycophenolate mofetil is associated with excellent patient and graft survival and a lower incidence of rejection than the combination of tacrolimus and steroids.
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Affiliation(s)
- R Shapiro
- University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pennsylvania 15213, USA
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Shapiro R, Scantlebury VP, Jordan ML, Vivas C, Ellis D, Lombardozzi-Lane S, Gilboa N, Gritsch HA, Irish W, McCauley J, Fung JJ, Hakala TR, Simmons RL, Starzl TE. Pediatric renal transplantation under tacrolimus-based immunosuppression. Transplantation 1999; 67:299-303. [PMID: 10075598 PMCID: PMC2975962 DOI: 10.1097/00007890-199901270-00020] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tacrolimus has been used as a primary immunosuppressive agent in adult and pediatric renal transplant recipients, with reasonable outcomes. Methods. Between December 14, 1989 and December 31, 1996, 82 pediatric renal transplantations alone were performed under tacrolimus-based immunosuppression without induction anti-lymphocyte antibody therapy. Patients undergoing concomitant or prior liver and/or intestinal transplantation were not included in the analysis. The mean recipient age was 10.6+/-5.2 years (range: 0.7-17.9). Eighteen (22%) cases were repeat transplantations, and 6 (7%) were in patients with panel-reactive antibody levels over 40%. Thirty-four (41%) cases were with living donors, and 48 (59%) were with cadaveric donors. The mean donor age was 27.3+/-14.6 years (range: 0.7-50), and the mean cold ischemia time in the cadaveric cases was 26.5+/-8.8 hr. The mean number of HLA matches and mismatches was 2.8+/-1.2 and 2.9+/-1.3; there were five (6%) O-Ag mismatches. The mean follow-up was 4.0+/-0.2 years. RESULTS The 1- and 4-year actuarial patient survival was 99% and 94%. The 1- and 4-year actuarial graft survival was 98% and 84%. The mean serum creatinine was 1.1+/-0.5 mg/dl, and the corresponding calculated creatinine clearance was 88+/-25 ml/min/1.73 m2. A total of 66% of successfully transplanted patients were withdrawn from prednisone. In children who were withdrawn from steroids, the mean standard deviation height scores (Z-score) at the time of transplantation and at 1 and 4 years were -2.3+/-2.0, -1.7+/-1.0, and +0.36+/-1.5. Eighty-six percent of successfully transplanted patients were not taking anti-hypertensive medications. The incidence of acute rejection was 44%; between December 1989 and December 1993, it was 63%, and between January 1994 and December 1996, it was 23% (P=0.0003). The incidence of steroid-resistant rejection was 5%. The incidence of delayed graft function was 5%, and 2% of patients required dialysis within 1 week of transplantation. The incidence of cytomegalovirus was 13%; between December 1989 and December 1992, it was 17%, and between January 1993 and December 1996, it was 12%. The incidence of early Epstein-Barr virus-related posttransplant lymphoproliferative disorder (PTLD) was 9%; between December 1989 and December 1992, it was 17%, and between January 1993 and December 1996, it was 4%. All of the early PTLD cases were treated successfully with temporary cessation of immunosuppression and institution of antiviral therapy, without patient or graft loss. CONCLUSIONS These data demonstrate the short- and medium-term efficacy of tacrolimus-based immunosuppression in pediatric renal transplant recipients, with reasonable patient and graft survival, routine achievement of steroid and anti-hypertensive medication withdrawal, gratifying increases in growth, and, with further experience, a decreasing incidence of both rejection and PTLD.
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Affiliation(s)
- R Shapiro
- Thomas E. Starzl Transplantation Institute, Division of Urologic Surgery, University of Pittsburgh, Pennsylvania 15213, USA
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50
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Shapiro R, Jordan ML, Scantlebury VP, Vivas C, Marsh JW, McCauley J, Johnston J, Randhawa P, Irish W, Gritsch HA, Naraghi R, Hakala TR, Fung JJ, Starzl TE. A prospective, randomized trial of tacrolimus/prednisone vs tacrolimus/prednisone/mycophenolate mofetil in renal transplantation: 1-year actuarial follow-up. Transplant Proc 1999; 31:1134. [PMID: 10083507 PMCID: PMC2958559 DOI: 10.1016/s0041-1345(98)01935-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- R Shapiro
- University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, USA
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