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Kim IK, Diamond M, Yuan S, Kemp S, Li Q, Lin J, Li J, Norgard R, Thomas S, Merolle M, Katsuda T, Tobias J, Politi K, Vonderheide R, Stanger B. Plasticity-induced repression of Irf6 underlies acquired resistance to cancer immunotherapy. Res Sq 2023:rs.3.rs-2960521. [PMID: 37398248 PMCID: PMC10312946 DOI: 10.21203/rs.3.rs-2960521/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Acquired resistance to immune checkpoint immunotherapy remains a critical yet incompletely understood biological mechanism. Here, using a mouse model of pancreatic ductal adenocarcinoma (PDAC) to study tumor relapse following immunotherapy-induced responses, we found that tumors underwent an epithelial-to-mesenchymal transition (EMT) that resulted in reduced sensitivity to T cell-mediated killing. EMT-transcription factors (EMT-TFs) ZEB1 and SNAIL function as master genetic and epigenetic regulators of this tumor-intrinsic effect. Acquired resistance was not due to immunosuppression in the tumor immune microenvironment, disruptions in the antigen presentation machinery, or altered expression of immune checkpoints. Rather, EMT was associated with epigenetic and transcriptional silencing of interferon regulatory factor 6 (Irf6), which renders tumor cells less sensitive to the pro-apoptotic effects of TNF-α. These findings show how resistance to immunotherapy in PDAC can be acquired through plasticity programs that render tumor cells impervious to T cell killing.
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Woodward E, Schlingmann K, Tobias J, Turner R. Characterisation of the testicular transcriptome in stallions with age-related testicular degeneration. Equine Vet J 2023; 55:239-252. [PMID: 35569039 DOI: 10.1111/evj.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 04/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Age-related testicular degeneration can be defined as the progressive deterioration of the testis that typically occurs in middle-aged or older males and that leads to diminished testicular function and subfertility. In the equine breeding industry, genetically valuable males maintain their value as breeding animals well into old age. Because testicular degeneration is common in middle-aged and older stallions, the disease often has a significant negative impact on a stallion's breeding career and leads to economic losses in the horse breeding industry. OBJECTIVE Because testicular degeneration is a tissue autologous disease in the horse, the objective of this study was to use whole-transcriptome sequencing to compare the testicular transcriptomes of normal, fertile stallions to those of stallions affected by age-related testicular degeneration in order to better understand the pathophysiology of the disease. STUDY DESIGN Cross sectional. METHODS Testicular tissue samples from clinical castrations or euthanasia were collected from normal healthy (n = 3) or older subfertile (n = 4) stallions. Samples were processed and sequenced on an Illumina HiSeq™ 2000 Sequencing System. Bioinformatic analysis of the data was performed in R/RStudio, and the transcriptomes were compared between the two groups. Genes were considered to be differentially expressed between healthy and diseased tissue if they demonstrated at least a ±1.5× fold change difference and had a false discovery rate-adjusted P value <0.05. Gene ontology analysis was performed using Ingenuity® IPA. RESULTS Analyses of differential expression of individual genes, as well as computer-based gene ontology analysis, identified upregulation of cytokine-mediated inflammatory pathways in testes from stallions affected with testicular degeneration. This upregulation of inflammation was associated with upregulation of cell survival pathways, inhibition of apoptotic pathways and increases in collagen formation. MAIN LIMITATIONS There are unavoidable confounding factors (e.g. differences in breed, management, environment, age) that could create non disease-related genetic variation between our normal and affected samples. In addition, there are practical limitations to applying computer-based gene ontology analysis to equine samples. Gene ontology software relies on published information (mostly non-equine), and some biological processes (e.g. apoptosis and inflammation) are more commonly studied than others and so are over-represented in the literature and therefore more likely to be identified by computer algorithms. Caution should be taken when interpreting the data, as alterations in gene expression can be the cause of disease processes or can be the result of disease processes. CONCLUSIONS These results suggest that chronic, low-grade inflammation may be involved in the pathophysiology of age-related testicular degeneration in stallions.
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Affiliation(s)
- Elizabeth Woodward
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen Schlingmann
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - John Tobias
- Penn Genome Analysis Core, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Regina Turner
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
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Kemp SB, Georgescu A, Pitarresi J, Katsuda T, Kim IK, Racca D, Tobias J, Huh D, Stanger B. Abstract C069: Using a cancer-on-a-chip approach to study the pancreatic cancer tumor microenvironment. Cancer Res 2022. [DOI: 10.1158/1538-7445.panca22-c069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy that is overwhelmingly resistant to therapy. PDAC tumors are characterized by an immunosuppressive fibroinflammatory stroma and can be broadly classified into those with an abundance of T cells or a paucity of T cells. Our lab has previously identified several tumor cell intrinsic factors that regulate the degree of T cell infiltration and response to immunotherapy, but it remains unknown how these factors influence T cell trafficking through the vasculature to the tumor. We used in vivo models and a cancer-on-a-chip platform to examine immune-vascular crosstalk in the pancreatic tumor microenvironment (TME). We first sought to characterize the vascular landscape in PDAC. Following up from previous work in the lab, we used bulk RNA sequencing appraoches to identify a subset of hyper-vascular murine PDAC lines. Using an in vivo dextran assay, we determined that endothelial-high tumors have increased vascular perfusion. We next utilized an in vitro tube formation assay to assess if the defects seen in tumor vasculature are from tumor-cell derived factors. Endothelial cells cultured in conditioned media from endothelial-low tumors had defects in tubule formation. We further identified endothelial-low tumors have a defect in pericyte coverage of the vessel. We next utilized organ-on-a-chip devices to assess angiogenesis in PDAC. Endothelial cells and fibroblasts self-assemble into a 3D vascular network when incorporated into the microdevices. In the absence of tumor cells, mature vascular networks formed on day 4 of culture. Interestingly, vascular networks formed faster in the presence of PDAC tumor cells, suggesting a tumor derived factor enhanced angiogenesis. The cancer-on-a-chip devices are perfusable and allow for the incorporation of other TME components. Future directions, include incorporation of myeloid cells and perfusing fluorescently labeled T cells into the vascular networks and using live imaging to monitor T cell trafficking in different PDAC TME settings. Further, we will use immune checkpoint blockade and CAR T cells to identify methods to enhance tumoral T cell infiltration.
Citation Format: Samantha B. Kemp, Andrei Georgescu, Jason Pitarresi, Takeshi Katsuda, Il-Kyu Kim, Dora Racca, John Tobias, Dan Huh, Ben Stanger. Using a cancer-on-a-chip approach to study the pancreatic cancer tumor microenvironment [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr C069.
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Affiliation(s)
| | | | | | | | - Il-Kyu Kim
- 1University of Pennsylvania, Philadelphia, PA
| | - Dora Racca
- 1University of Pennsylvania, Philadelphia, PA
| | - John Tobias
- 1University of Pennsylvania, Philadelphia, PA
| | - Dan Huh
- 1University of Pennsylvania, Philadelphia, PA
| | - Ben Stanger
- 1University of Pennsylvania, Philadelphia, PA
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Jiang Y, Han X, Wang M, Ng R, Burgess-Jones P, Tobias J, Coffey N, Hu A, Keith B, Simon C. Abstract B010: Investigating endoplasmic reticulum stress responses in pancreatic ductal adenocarcinoma under lipid imbalance. Cancer Res 2022. [DOI: 10.1158/1538-7445.panca22-b010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the 4th leading cause of cancer-related death with a five-year survival rate of 10%. The complex genetic makeup and heterogeneity of its microenvironment make PDAC difficult to treat. Desmoplasia, a major feature of PDAC’s TME, are dense fibrotic and inflammatory stromal regions. Desmoplastic reaction results in poor intratumoral perfusion and elevated interstitial fluid pressure, creating regions with severe oxygen and nutrient deprivation. One result is a deficiency in unsaturated fatty acids (uFAs) because the de novo synthesis of uFAs requires oxygen. Our results indicate that PDAC cells experience endoplasmic reticulum (ER) stress and trigger subsequent ER stress responses under uFA limited conditions in vitro. The ER stress responses are governed by three major stress sensors: Inositol-requiring enzyme 1𝛼 (IRE1𝛼), PKR-like ER kinase (PERK) and activating transcription factor 6𝛼 (ATF6𝛼). We hypothesize that ER stress responses are tumor promoting in PDAC and used as a survival strategy under uFA deprivation. In addition, previous studies showed that MYC-driven cancer cells are highly reliant on the ER stress response pathways. Therefore, we hypothesize that the two major PDAC transcriptional subtypes “Classical” and “Basal-like” have distinct dependencies on ER stress response pathways, with the basal-like subtype being more dependent due to an enrichment of MYC gene signatures. Our results suggest that opposite to cancer cell promoting, ER stress responses mediated by IRE1𝛼, PERK and ATF6𝛼 are cytotoxic in vitro under uFA deprived conditions. By analyzing the published bulk RNA-seq from patient samples, we found that the basal-like PDAC subtype is enriched with an ER stress gene signature. To avoid contamination from other cell populations, we are currently analyzing a published scRNA-seq dataset from 15 independent patient samples. We will investigate whether the ER stress signature is also enhanced in basal-like cells. Basal-like PDAC cells are usually more mesenchymal; we therefore created isogenic “epithelial” and “mesenchymal” lines to mimic PDAC subtypes. However, we did not see signaling preferences between the lines. One caveat is that the basal-like subtype have many more features than being mesenchymal, and our isogenic system might not be a faithful modeling of the subtypes. We are studying whether hypoxic PDAC cells experience ER stress in vivo due to a deprivation in uFAs using multiplex fluorescent imaging, stimulated Raman microscopy and/or mass spectrometry. We are evaluating the role of ER stress responses in vivo and see whether inhibiting ER stress response alone or in combination with other reagents gives rise to potential therapeutic opportunities. This project will provide a better understanding of the role ER stress responses play under uFA deprivation and will also enable us to further understand PDAC subtypes in terms of how they utilize ER stress responses.
Citation Format: Yanqing (Christine) Jiang, Xu Han, Mai Wang, Raymond Ng, Pamela Burgess-Jones, John Tobias, Nathan Coffey, Andrew Hu, Brian Keith, Celeste Simon. Investigating endoplasmic reticulum stress responses in pancreatic ductal adenocarcinoma under lipid imbalance [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr B010.
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Affiliation(s)
| | - Xu Han
- 1University of Pennsylvania, Philadelphia, PA,
| | - Mai Wang
- 1University of Pennsylvania, Philadelphia, PA,
| | - Raymond Ng
- 1University of Pennsylvania, Philadelphia, PA,
| | | | - John Tobias
- 1University of Pennsylvania, Philadelphia, PA,
| | | | - Andrew Hu
- 2Houston Methodist Cancer Center, Houston, TX
| | - Brian Keith
- 1University of Pennsylvania, Philadelphia, PA,
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Tobias J, Garner-Spitzer E, Drinić M, Wiedermann U. Vaccination against Her-2/neu, with focus on peptide-based vaccines. ESMO Open 2022; 7:100361. [PMID: 35026721 PMCID: PMC8760406 DOI: 10.1016/j.esmoop.2021.100361] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 11/03/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022] Open
Abstract
Immunotherapy has been a milestone in combatting cancer, by complementing or even replacing classic treatments like surgery, chemotherapy, radiation, and anti-hormonal therapy. In 15%-30% of breast cancers, overexpression of the human epidermal growth factor receptor 2 (Her-2/neu) is associated with more aggressive tumor development. Passive immunization/immunotherapy with the recombinantly produced Her-2/neu-targeting monoclonal antibodies (mAbs) pertuzumab and trastuzumab has been shown to effectively treat breast cancer and lead to a significantly better prognosis. However, allergic and hypersensitivity reactions, cardiotoxicity, development of resistance, lack of immunological memory which results in continuous application over a long period, and cost-intensiveness are among the drawbacks associated with this treatment. Furthermore, intrinsic or acquired resistance is associated with the application of therapeutic mAbs, leading to the disease recurrence. Conversely, these drawbacks could be potentially overcome by vaccination, i.e. an active immunization/immunotherapy approach by activating the patient’s own immune system to target cancer, along with inducing immunological memory. This review aims to summarize the main approaches investigated and undertaken for the production of Her-2/neu vaccine candidates, with the main focus on peptide-based vaccines and their evaluation in clinical settings. Her-2/neu is overexpressed in 10%-30% of breast and gastric cancer patients and this correlates with poor clinical outcomes. Passive application of trastuzumab and pertuzumab has outstandingly improved the Her-2/neu-related clinical outcomes. Treatment with mAbs is associated with frequent administration, cost-intensiveness, and resistance. Vaccination against Her-2/neu with e.g. mimotope- or peptide-based vaccines can alternatively overcome the mAbs’ drawbacks. Such alternatives may pave the way to therapeutics which could be used as monotherapy or in combination therapies with mAbs.
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Affiliation(s)
- J Tobias
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
| | - E Garner-Spitzer
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - M Drinić
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - U Wiedermann
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
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Heydinger G, Tobias J, Veneziano G. Fundamentals and innovations in regional anaesthesia for infants and children. Anaesthesia 2021; 76 Suppl 1:74-88. [PMID: 33426659 DOI: 10.1111/anae.15283] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/18/2022]
Abstract
Regional anaesthesia in children has evolved rapidly in the last decade. Although it previously consisted of primarily neuraxial techniques, the practice now incorporates advanced peripheral nerve blocks, which were only recently described in adults. These novel blocks provide new avenues for providing opioid-sparing analgesia while minimising invasiveness, and perhaps risk, associated with older techniques. At the same time, established methods, such as infant spinal anaesthesia, under-utilised in the last 20 years, are experiencing a revival. The impetus has been the concern regarding the potential long-term neurocognitive effects of general anaesthesia in the young child. These techniques have expanded from single shot spinal anaesthesia to combined spinal/epidural techniques, which can now effectively provide surgical anaesthesia for procedures below the umbilicus for a prolonged period of time, thereby avoiding the need for general anaesthesia. Continuous 2-chloroprocaine infusions, previously only described for intra-operative regional anaesthesia, have gained popularity as a means of providing prolonged postoperative analgesia in epidural and continuous nerve block techniques. The rapid, liver-independent metabolism of 2-chloroprocaine makes it ideal for prolonged local anaesthetic infusions in neonates and small infants, obviating the increased risk of local anaesthetic systemic toxicity that occurs with amide local anaesthetics. Debate continues over certain practices in paediatric regional anaesthesia. While the rarity of complications makes comparative analyses difficult, data from large prospective registries indicate that providing regional anaesthesia to children while under general anaesthesia appears to be at least as safe as in the sedated or awake patient. In addition, the estimated frequency of serious adverse events demonstrates that regional blocks in children under general anaesthesia are no less safe than in awake adults. In infants, the techniques of direct thoracic epidural placement or caudal placement with cephalad threading each have distinct advantages and disadvantages. As the data cannot support the safety of one technique over the other, the site of epidural insertion remains largely a matter of anaesthetist discretion.
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Affiliation(s)
- G Heydinger
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - J Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - G Veneziano
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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7
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Singh S, Kumar S, Srivastava RK, Nandi A, Thacker G, Murali H, Kim S, Baldeon M, Tobias J, Blanco MA, Saffie R, Zaidi MR, Sinha S, Busino L, Fuchs SY, Chakrabarti R. Loss of ELF5-FBXW7 stabilizes IFNGR1 to promote the growth and metastasis of triple-negative breast cancer through interferon-γ signalling. Nat Cell Biol 2020; 22:591-602. [PMID: 32284542 PMCID: PMC8237104 DOI: 10.1038/s41556-020-0495-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [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] [Received: 03/04/2019] [Accepted: 02/28/2020] [Indexed: 12/11/2022]
Abstract
Triple-negative breast cancer (TNBC) is characterized by a high degree of immune infiltrate in the tumour microenvironment, which may influence the fate of TNBC cells. We reveal that loss of the tumour suppressive transcription factor Elf5 in TNBC cells activates intrinsic interferon-γ (IFN-γ) signalling, promoting tumour progression and metastasis. Mechanistically, we find that loss of the Elf5-regulated ubiquitin ligase FBXW7 ensures stabilization of its putative protein substrate IFN-γ receptor 1 (IFNGR1) at the protein level in TNBC. Elf5low tumours show enhanced IFN-γ signalling accompanied by an increase of immunosuppressive neutrophils within the tumour microenvironment and increased programmed death ligand 1 expression. Inactivation of either programmed death ligand 1 or IFNGR1 elicited a robust anti-tumour and/or anti-metastatic effect. A positive correlation between ELF5 and FBXW7 expression and a negative correlation between ELF5, FBXW7 and IFNGR1 expression in the tumours of patients with TNBC strongly suggest that this signalling axis could be exploited for patient stratification and immunotherapeutic treatment strategies for Elf5low patients with TNBC.
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Affiliation(s)
- Snahlata Singh
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sushil Kumar
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ratnesh Kumar Srivastava
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ajeya Nandi
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gatha Thacker
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hemma Murali
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sabrina Kim
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary Baldeon
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John Tobias
- Department of Cancer Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mario Andres Blanco
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rizwan Saffie
- Department of Cancer Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M Raza Zaidi
- Fels Institute for Cancer Research and Molecular Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Satrajit Sinha
- Department of Biochemistry, State University of New York at Buffalo, Buffalo, NY, USA
| | - Luca Busino
- Department of Cancer Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Serge Y Fuchs
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rumela Chakrabarti
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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8
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Markosyan N, Li J, Sun Y, Richman L, Lin J, Yan F, Quinones L, Sela Y, Yamazoe T, Gordon N, Tobias J, Byrne K, Rech A, FitzGerald G, Stanger B, Vonderheide R. Abstract B33: Tumor cell-intrinsic EPHA2 suppresses antitumor immunity by regulating PTGS2 (COX-2) in pancreatic adenocarcinoma. Cancer Res 2019. [DOI: 10.1158/1538-7445.panca19-b33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Pancreatic adenocarcinoma (PDA) is highly refractory to immunotherapy, a consequence of T-cell exclusion from the tumor microenvironment (TME). Based on a pathway analysis of human PDAs, we hypothesized that the receptor tyrosine kinase ephrin A2 (EPHA2) drives this immunosuppressive TME, as its expression negatively correlated with CD8A, CD3, PRF1, GZMB, and patient survival (EPHA2low/EPHA2high log rank hazard ratio 0.115, 95% CI of ratio 0.0315-0.416, TCGA dataset). Deletion of Epha2 in tumor cells increased T-cell influx, decreased the number of infiltrating myeloid suppressor cells, and sensitized tumors to therapy. Treatment of Epha2-deficient tumors with combination of chemo and immunotherapy resulted in suppressed tumor growth or tumor regression in up to 85% of cases. Examination of Epha2-dependent gene expression nominated Ptgs2 as a downstream mediator of T-cell exclusion. Like EPHA2, PTGS2 exhibited a negative correlation with intratumoral T cells, cytolytic activity, and patient survival (PTGS2low/PTGS2high log rank hazard ratio 0.152, 95% CI of ratio 0.054-0.430, TCGA dataset). KPCY mice (mutant KrasG12D (K), dominant negative p53R172H (P), Cre recombinase (C), YFP protein (Y)) deficient in pancreatic ductal cell Ptgs2 had significantly increased overall survival compared to Ptgs2 sufficient KPCY mice (Ptgs2def/Ptgs2suff log rank hazard ratio 0.5001, 95% CI of ratio 0.294-0.851). Ptgs2 deletion promoted T-cell influx in both autochthonous and implanted tumors. Inversely, overexpression of Ptgs2 decreased the number of tumor-infiltrating T cells, increased the proportion of suppressor myeloid cells, and conferred resistance to the combination therapy. Remarkably, pharmacologic inhibition of PTGS2 sensitized the tumors to immunotherapy, suppressing the growth of implanted tumors and increasing the survival of treated KPCY mice (median survival of untreated and treated mice 151 and 199 days, respectively; survival curve log rank p-value= 0.017). These studies suggest that a tumor cell-intrinsic EPHA2-PTGS2 signaling axis regulates the immune TME in PDA and suggests that a two-step approach targeting T-cell exclusion and exhaustion holds promise for this treatment-refractory disease.
Citation Format: Nune Markosyan, Jinyang Li, Yu Sun, Lee Richman, Jeffrey Lin, Fangxue Yan, Liz Quinones, Yogev Sela, Taiji Yamazoe, Naomi Gordon, John Tobias, Katelyn Byrne, Andrew Rech, Garret FitzGerald, Ben Stanger, Robert Vonderheide. Tumor cell-intrinsic EPHA2 suppresses antitumor immunity by regulating PTGS2 (COX-2) in pancreatic adenocarcinoma [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer: Advances in Science and Clinical Care; 2019 Sept 6-9; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2019;79(24 Suppl):Abstract nr B33.
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Affiliation(s)
| | - Jinyang Li
- University of Pennsylvania, Philadelphia, PA
| | - Yu Sun
- University of Pennsylvania, Philadelphia, PA
| | - Lee Richman
- University of Pennsylvania, Philadelphia, PA
| | - Jeffrey Lin
- University of Pennsylvania, Philadelphia, PA
| | - Fangxue Yan
- University of Pennsylvania, Philadelphia, PA
| | | | - Yogev Sela
- University of Pennsylvania, Philadelphia, PA
| | | | | | - John Tobias
- University of Pennsylvania, Philadelphia, PA
| | | | - Andrew Rech
- University of Pennsylvania, Philadelphia, PA
| | | | - Ben Stanger
- University of Pennsylvania, Philadelphia, PA
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9
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Tobias J, Battin C, De Linhares AS, Lebens M, Baier K, Ambroz K, Högler S, Inic-Kanada A, Garner-Spitzer E, Preusser M, Kenner L, Kundi M, Zielinski C, Steinberger P, Wiedermann U. Active immunization with immune checkpoint inhibitors-mimotope elicits strong anti-tumour effect against HER-2/neu-expressing tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.006] [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: 11/12/2022] Open
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10
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Zakeri K, Rotolo F, Lacas B, Vitzthum L, Le QT, Gregoire V, Overgaard J, Tobias J, Zackrisson B, Parmar M, Burtness B, Ghi M, Sanguineti G, O'Sullivan B, Fortpied C, Bourhis J, Shen H, Harris J, Pignon JP, Mell L. Predictor of effectiveness of treatment intensification on overall survival in head and neck cancer (HNC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy287.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Hebb JH, Ashley JW, McDaniel L, Lopas LA, Tobias J, Hankenson KD, Ahn J. Bone healing in an aged murine fracture model is characterized by sustained callus inflammation and decreased cell proliferation. J Orthop Res 2018; 36:149-158. [PMID: 28708309 PMCID: PMC6385606 DOI: 10.1002/jor.23652] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 07/11/2017] [Indexed: 02/04/2023]
Abstract
UNLABELLED Geriatric fractures take longer to heal and heal with more complications than those of younger patients; however, the mechanistic basis for this difference in healing is not well understood. To improve this understanding, we investigated cell and molecular differences in fracture healing between 5-month-old (young adult) and 25-month-old (geriatric) mice healing utilizing high-throughput analysis of gene expression. Mice underwent bilateral tibial fractures and fracture calluses were harvested at 5, 10, and 20 days post-fracture (DPF) for analysis. Global gene expression analysis was performed using Affymetrix MoGene 1.0 ST microarrays. After normalization, data were compared using ANOVA and evaluated using Principal Component Analysis (PCA), CTen, heatmap, and Incromaps analysis. PCA and cross-sectional heatmap analysis demonstrated that DPF followed by age had pronounced effects on changes in gene expression. Both un-fractured and 20 DPF aged mice showed increased expression of immune-associated genes (CXCL8, CCL8, and CCL5) and at 10 DPF, aged mice showed increased expression of matrix-associated genes, (Matn1, Ucma, Scube1, Col9a1, and Col9a3). Cten analysis suggested an enrichment of CD8+ cells and macrophages in old mice relative to young adult mice and, conversely, a greater prevalence of mast cells in young adult mice relative to old. Finally, consistent with the PCA data, the classic bone healing pathways of BMP, Indian Hedgehog, Notch and Wnt clustered according to the time post-fracture first and age second. CLINICAL SIGNIFICANCE Greater understanding of age-dependent molecular changes with healing will help form a mechanistic basis for therapies to improve patient outcomes. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:149-158, 2018.
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Affiliation(s)
- John H Hebb
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jason W Ashley
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Biology, College of Science, Technology, Engineering, and Mathematics, Eastern Washington University, Cheney, WA
| | - Lee McDaniel
- Georgetown University School of Medicine, Washington D.C
| | - Luke A Lopas
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John Tobias
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kurt D Hankenson
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Orthopaedic Surgery, School of Medicine, University of Michigan, Ann Arbor, MI,Co-corresponding Authors: , Department of Orthopaedic Surgery, 2019 BSRB, 109 Zina Pitcher 48109, Phone: 734-395-7838, Jaimo Ahn, , Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market St, Suite 6121, Philadelphia, PA 19104, Phone: (215) 294-9141
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Co-corresponding Authors: , Department of Orthopaedic Surgery, 2019 BSRB, 109 Zina Pitcher 48109, Phone: 734-395-7838, Jaimo Ahn, , Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market St, Suite 6121, Philadelphia, PA 19104, Phone: (215) 294-9141
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Morrison A, Tumin D, Hayes D, Phelps C, Tobias J, Gajarski R, Nandi D. Pediatric Marginal Donor Hearts: National Use and Center-Specific Variability. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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13
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Schaufler C, Lasky J, Lim B, Suzuki Y, Mallem D, Oyster M, Lederer D, Meyer K, Bermudez C, Tobias J, Van Deerlin V, Olthoff K, Shaked A, Diamond J, Cantu E, Christie J. Gene Set Enrichment Analysis Identifies a Potential Link Between Smoking and Upregulation of Olfactory Receptor and Cytokine Enrichment Pathways. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1194] [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: 10/19/2022] Open
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Petit C, Pignon J, Landais C, Trotti A, Gregoire V, Overgaard J, Tobias J, Zackrisson B, Parmar M, Lee J, Ghi M, Corvo R, Janot F, O'Sullivan B, Horiuchi M, Zhang Q, Fortpied C, Grau C, Bourhis J, Blanchard P. What is the most effective treatment for head and neck squamous cell carcinoma? An individual patient data network meta-analysis from the MACH-NC and MARCH collaborative groups. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30415-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Blanchard P, Landais C, Petit C, Zhang Q, Grégoire V, Tobias J, Burtness B, Ghi M, Janot F, Overgaard J, Wolf G, Lewin F, Hitt R, Corvo R, Budach V, Trotti A, Fortpied C, Hackshaw A, Bourhis J, Pignon JP. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 100 randomized trials and 19,248 patients, on behalf of MACH-NC group. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw376.02] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Al-Sari UA, Tobias J, Clark E. Health-related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis. Osteoporos Int 2016; 27:2891-900. [PMID: 27262840 DOI: 10.1007/s00198-016-3648-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/20/2016] [Indexed: 11/30/2022]
Abstract
Health-related quality of life in osteoporotic patients with vertebral fracture is of increasing interest, but relevant studies have yielded debatable results. This systematic review and meta-analysis of 16 observational studies demonstrate a clear association between physical health status and presence of vertebral fracture after accounting for age. This meta-analysis was conducted to identify if there are any differences between physical and/or mental health-related quality of life (HRQoL) in older people with osteoporosis based on conventional T-score definitions and the presence or absence of vertebral fracture. A comprehensive search was undertaken using the databases of PubMed, Embase, Medline, Web of Science, and the "grey" literature from 1950 to the end of April 2015. Search terms for vertebral fracture (VF) included VF, osteoporotic fracture, fragility fracture, and spinal fracture. Quality of life was searched using the following terms: quality of life, health-related quality of life, HRQoL, and QoL. Strict inclusion and exclusion criteria were used. The standardized mean difference (SMD) was calculated for each HRQoL domain by the difference in means between case and control groups divided by the pooled SD of participants. Sixteen eligible studies were identified involving 3131 men and women. There was evidence of publication bias and heterogeneity. The meta-analysis showed worse physical (SMD = 0.53, 95 % confidence interval (CI) 0.38 to 0.68; P < 0.001) and mental (SMD = 0.19, 95 % CI 0.05 to 0.33; P = 0.009) HRQoL in osteoporotic older people with vertebral fracture compared to those without fracture. Similar differences were observed for physical HRQoL in further analyses accounting for possible confounding effects of age. Sub-analysis to assess associations between number/severity of fractures and time since fracture was not possible due to small numbers of studies that accounted for age. Osteoporotic older people with vertebral fracture have worse physical HRQoL than osteoporotic older people without vertebral fracture, even after accounting for age differences.
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Affiliation(s)
- U A Al-Sari
- Academic Rheumatology, Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - J Tobias
- Academic Rheumatology, Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - E Clark
- Academic Rheumatology, Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK.
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17
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Li N, Nakauka-Ddamba A, Tobias J, Jensen ST, Lengner CJ. Mouse Label-Retaining Cells Are Molecularly and Functionally Distinct From Reserve Intestinal Stem Cells. Gastroenterology 2016; 151:298-310.e7. [PMID: 27237597 PMCID: PMC4961601 DOI: 10.1053/j.gastro.2016.04.049] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 04/07/2016] [Accepted: 04/29/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS Intestinal homeostasis and regeneration after injury are controlled by 2 different types of cells: slow cycling, injury-resistant reserve intestinal stem cells (ISCs) and actively proliferative ISCs. Putative reserve ISCs have been identified using a variety of methods, including CreER insertions at Hopx or Bmi1 loci in mice and DNA label retention. Label-retaining cells (LRCs) include dormant stem cells in several tissues; in the intestine, LRCs appear to share some properties with reserve ISCs, which can be marked by reporter alleles. We investigated the relationships between these populations. METHODS Studies were performed in Lgr5-EGFP-IRESCreERT2, Bmi1-CreERT2, Hopx-CreERT2, and TRE-H2BGFP::Hopx-CreERT2::lox-stop-lox-tdTomato mice. Intestinal epithelial cell populations were purified; we compared reporter allele-marked reserve ISCs and several LRC populations (marked by H2B-GFP retention) using histologic flow cytometry and functional and single-cell gene expression assays. RESULTS LRCs were dynamic and their cellular composition changed with time. Short-term LRCs had properties of secretory progenitor cells undergoing commitment to the Paneth or enteroendocrine lineages, while retaining some stem cell activity. Long-term LRCs lost stem cell activity and were a homogenous population of terminally differentiated Paneth cells. Reserve ISCs marked with HopxCreER were primarily quiescent (in G0), with inactive Wnt signaling and robust stem cell activity. In contrast, most LRCs were in G1 arrest and expressed genes that are regulated by the Wnt pathway or are in the secretory lineage. CONCLUSIONS LRCs are molecularly and functionally distinct from reporter-marked reserve ISCs. This information provides an important basis for future studies of relationships among ISC populations.
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Affiliation(s)
- Ning Li
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, 3800 Spruce Street, Philadelphia PA 19104
| | - Angela Nakauka-Ddamba
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, 3800 Spruce Street, Philadelphia PA 19104
| | - John Tobias
- Penn Genomic Analysis Core, University of Pennsylvania, 3800 Spruce Street, Philadelphia PA 19104
| | - Shane T. Jensen
- Department of Statistics, The Wharton School, University of Pennsylvania, 3800 Spruce Street, Philadelphia PA 19104
| | - Christopher J. Lengner
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, 3800 Spruce Street, Philadelphia PA 19104, Department of Cell and Developmental Biology, School of Medicine, and Institute for Regenerative Medicine, University of Pennsylvania, 3800 Spruce Street, Philadelphia PA 19104, To whom correspondence should be addressed ()
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18
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Li N, Yousefi M, Nakauka-Ddamba A, Li F, Vandivier L, Parada K, Woo DH, Wang S, Naqvi AS, Rao S, Tobias J, Cedeno RJ, Minuesa G, Y K, Barlowe TS, Valvezan A, Shankar S, Deering RP, Klein PS, Jensen ST, Kharas MG, Gregory BD, Yu Z, Lengner CJ. The Msi Family of RNA-Binding Proteins Function Redundantly as Intestinal Oncoproteins. Cell Rep 2015; 13:2440-2455. [PMID: 26673327 DOI: 10.1016/j.celrep.2015.11.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 09/08/2015] [Accepted: 11/04/2015] [Indexed: 12/19/2022] Open
Abstract
Members of the Msi family of RNA-binding proteins have recently emerged as potent oncoproteins in a range of malignancies. MSI2 is highly expressed in hematopoietic cancers, where it is required for disease maintenance. In contrast to the hematopoietic system, colorectal cancers can express both Msi family members, MSI1 and MSI2. Here, we demonstrate that, in the intestinal epithelium, Msi1 and Msi2 have analogous oncogenic effects. Further, comparison of Msi1/2-induced gene expression programs and transcriptome-wide analyses of Msi1/2-RNA-binding targets reveal significant functional overlap, including induction of the PDK-Akt-mTORC1 axis. Ultimately, we demonstrate that concomitant loss of function of both MSI family members is sufficient to abrogate the growth of human colorectal cancer cells, and Msi gene deletion inhibits tumorigenesis in several mouse models of intestinal cancer. Our findings demonstrate that MSI1 and MSI2 act as functionally redundant oncoproteins required for the ontogeny of intestinal cancers.
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Affiliation(s)
- Ning Li
- State Key Laboratories for Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing 100194, China; Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Maryam Yousefi
- Cell and Molecular Biology Graduate Program, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Angela Nakauka-Ddamba
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Fan Li
- Department of Biology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA; Genomics and Computational Biology Graduate Program, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Lee Vandivier
- Department of Biology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA; Cell and Molecular Biology Graduate Program, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kimberly Parada
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dong-Hun Woo
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shan Wang
- State Key Laboratories for Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing 100194, China; Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ammar S Naqvi
- Department of Biology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shilpa Rao
- PENN Molecular Profiling Facility, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - John Tobias
- PENN Molecular Profiling Facility, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ryan J Cedeno
- Cell and Molecular Biology Graduate Program, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Gerard Minuesa
- Molecular Pharmacology and Chemistry Program, Experimental Therapeutics Center and Center for Stem Cell Biology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Katz Y
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Trevor S Barlowe
- Molecular Pharmacology and Chemistry Program, Experimental Therapeutics Center and Center for Stem Cell Biology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Alexander Valvezan
- Cell and Molecular Biology Graduate Program, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sheila Shankar
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Peter S Klein
- Cell and Molecular Biology Graduate Program, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Institute for Regenerative Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shane T Jensen
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michael G Kharas
- Molecular Pharmacology and Chemistry Program, Experimental Therapeutics Center and Center for Stem Cell Biology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Brian D Gregory
- Department of Biology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA; Genomics and Computational Biology Graduate Program, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Zhengquan Yu
- State Key Laboratories for Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing 100194, China.
| | - Christopher J Lengner
- Center for Molecular Studies in Digestive and Liver Diseases, University of Pennsylvania, Philadelphia, PA 19104, USA; Cell and Molecular Biology Graduate Program, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Cell and Developmental Biology, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Institute for Regenerative Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Diamond J, Cantu E, Lederer D, Tobias J, Arcasoy S, Olthoff K, Chang B, Feng R, Meyer K, Emond J, Shaked A, Christie J. PGD Is Associated With Persistent Differential Gene Expression After Lung Transplantation. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Pitman JP, Wilkinson R, Basavaraju SV, von Finckenstein B, Sibinga CS, Marfin AA, Postma MJ, Mataranyika M, Tobias J, Lowrance DW. Investments in blood safety improve the availability of blood to underserved areas in a sub-Saharan African country. ACTA ACUST UNITED AC 2014; 9:325-333. [PMID: 26478742 DOI: 10.1111/voxs.12107] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Since 2004, several African countries, including Namibia, have received assistance from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Gains have been documented in the safety and number of collected units in these countries, but the distribution of blood has not been described. MATERIALS AND METHODS Nine years of data on blood requests and issues from Namibia were stratified by region to describe temporal and spatial changes in the number and type of blood components issued to Namibian healthcare facilities nationally. RESULTS Between 2004 and 2007 (early years of PEPFAR support) and 2008-2011 (peak years of PEPFAR support), the average number of red cell units issued annually increased by 23.5% in seven densely populated but less-developed regions in northern Namibia; by 30% in two regions with urban centres; and by 35.1% in four sparsely populated rural regions. CONCLUSION Investments in blood safety and a policy decision to emphasize distribution of blood to underserved regions improved blood availability in remote rural areas and increased the proportion of units distributed as components. However, disparities persist in the distribution of blood between Namibia's urban and rural regions.
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Affiliation(s)
- J P Pitman
- Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - R Wilkinson
- The Blood Transfusion Service of Namibia, Windhoek, Namibia
| | - S V Basavaraju
- Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - A A Marfin
- Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - M J Postma
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands ; Institute of Science in Healthy Aging & health caRE (SHARE), University Medical Center Groningen (UMCG), Groningen, Netherlands
| | - M Mataranyika
- Directorate for Clinical Support Services, Ministry of Health and Social Services, Windhoek, Namibia
| | - J Tobias
- Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - D W Lowrance
- Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Tobias J. I47. Paget’s Disease and Other Metabolic Bone Disorders. Rheumatology (Oxford) 2014. [DOI: 10.1093/rheumatology/keu058.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Vaidya J, Wenz F, Bulsara M, Massarut S, Tobias J, Williams N, Joseph D, Baum M. Omitting Whole Breast Radiation Therapy did not Increase Axillary Recurrence in the TARGIT-A Trial. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vaidya J, Bulsara M, Wenz F, Massarut S, Joseph D, Tobias J, Williams N, Baum M. The Lower Non-Breast Cancer Mortality With TARGIT in the TARGIT-A Trial Could Be a Systemic Effect of TARGIT on Tumor Microenvironment. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.623] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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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Cornell P, Trehane A, Thompson P, Rahmeh F, Greenwood M, Baqai TJ, Cambridge S, Shaikh M, Rooney M, Donnelly S, Tahir H, Ryan S, Kamath S, Hassell A, McCuish WJ, Bearne L, Mackenzie-Green B, Price E, Williamson L, Collins D, Tang E, Hayes J, McLoughlin YM, Chamberlain V, Campbell S, Shah P, McKenna F, Cornell P, Westlake S, Thompson P, Richards S, Homer D, Gould E, Empson B, Kemp P, Richards AG, Walker J, Taylor S, Bari SF, Alachkar M, Rajak R, Lawson T, O'Sullivan M, Samant S, Butt S, Gadsby K, Flurey CA, Morris M, Hughes R, Pollock J, Richards P, Hewlett S, Edwards KR, Rowe I, Sanders T, Dunn K, Konstantinou K, Hay E, Jones LE, Adams J, White P, Donovan-Hall M, Hislop K, Barbosa Boucas S, Nichols VP, Williamson EM, Toye F, Lamb SE, Rodham K, Gavin J, Watts L, Coulson N, Diver C, Avis M, Gupta A, Ryan SJ, Stangroom S, Pearce JM, Byrne J, Manning VL, Hurley M, Scott DL, Choy E, Bearne L, Taylor J, Morris M, Dures E, Hewlett S, Wilson A, Adams J, Larkin L, Kennedy N, Gallagher S, Fraser AD, Shrestha P, Batley M, Koduri G, Scott DL, Flurey CA, Morris M, Hughes R, Pollock J, Richards P, Hewlett S, Kumar K, Raza K, Nightingale P, Horne R, Chapman S, Greenfield S, Gill P, Ferguson AM, Ibrahim F, Scott DL, Lempp H, Tierney M, Fraser A, Kennedy N, Barbosa Boucas S, Hislop K, Dziedzic K, Arden N, Burridge J, Hammond A, Stokes M, Lewis M, Gooberman-Hill R, Coales K, Adams J, Nutland H, Dean A, Laxminarayan R, Gates L, Bowen C, Arden N, Hermsen L, Terwee CB, Leone SS, vd Zwaard B, Smalbrugge M, Dekker J, vd Horst H, Wilkie R, Ferguson AM, Nicky Thomas V, Lempp H, Cope A, Scott DL, Simpson C, Weinman J, Agarwal S, Kirkham B, Patel A, Ibrahim F, Barn R, Brandon M, Rafferty D, Sturrock R, Turner D, Woodburn J, Rafferty D, Paul L, Marshall R, Gill J, McInnes I, Roderick Porter D, Woodburn J, Hennessy K, Woodburn J, Steultjens M, Siddle HJ, Hodgson RJ, Hensor EM, Grainger AJ, Redmond A, Wakefield RJ, Helliwell PS, Hammond A, Rayner J, Law RJ, Breslin A, Kraus A, Maddison P, Thom JM, Newcombe LW, Woodburn J, Porter D, Saunders S, McCarey D, Gupta M, Turner D, McGavin L, Freeburn R, Crilly A, Lockhart JC, Ferrell WR, Goodyear C, Ledingham J, Waterman T, Berkin L, Nicolaou M, Watson P, Lillicrap M, Birrell F, Mooney J, Merkel PA, Poland F, Spalding N, Grayson P, Leduc R, Shereff D, Richesson R, Watts RA, Roussou E, Thapper M, Bateman J, Allen M, Kidd J, Parsons N, Davies D, Watt KA, Scally MD, Bosworth A, Wilkinson K, Collins S, Jacklin CB, Ball SK, Grosart R, Marks J, Litwic AE, Sriranganathan MK, Mukherjee S, Khurshid MA, Matthews SM, Hall A, Sheeran T, Baskar S, Muether M, Mackenzie-Green B, Hetherington A, Wickrematilake G, Williamson L, Daniels LE, Gwynne CE, Khan A, Lawson T, Clunie G, Stephenson S, Gaffney K, Belsey J, Harvey NC, Clarke-Harris R, Murray R, Costello P, Garrett E, Holbrook J, Teh AL, Wong J, Dogra S, Barton S, Davies L, Inskip H, Hanson M, Gluckman P, Cooper C, Godfrey K, Lillycrop K, Anderton T, Clarke S, Rao Chaganti S, Viner N, Seymour R, Edwards MH, Parsons C, Ward K, Thompson J, Prentice A, Dennison E, Cooper C, Clark E, Cumming M, Morrison L, Gould VC, Tobias J, Holroyd CR, Winder N, Osmond C, Fall C, Barker D, Ring S, Lawlor D, Tobias J, Davey Smith G, Cooper C, Harvey NC, Toms TE, Afreedi S, Salt K, Roskell S, Passey K, Price T, Venkatachalam S, Sheeran T, Davies R, Southwood TR, Kearsley-Fleet L, Hyrich KL, Kingsbury D, Quartier P, Patel G, Arora V, Kupper H, Mozaffarian N, Kearsley-Fleet L, Baildam E, Beresford MW, Davies R, Foster HE, Mowbray K, Southwood TR, Thomson W, Hyrich KL, Saunders E, Baildam E, Chieng A, Davidson J, Foster H, Gardner-Medwin J, Wedderburn L, Thomson W, Hyrich K, McErlane F, Beresford M, Baildam E, Chieng SE, Davidson J, Foster HE, Gardner-Medwin J, Lunt M, Wedderburn L, Thomson W, Hyrich K, Rooney M, Finnegan S, Gibson DS, Borg FA, Bale PJ, Armon K, Cavelle A, Foster HE, McDonagh J, Bale PJ, Armon K, Wu Q, Pesenacker AM, Stansfield A, King D, Barge D, Abinun M, Foster HE, Wedderburn L, Stanley K, Morrissey D, Parsons S, Kuttikat A, Shenker N, Garrood T, Medley S, Ferguson AM, Keeling D, Duffort P, Irving K, Goulston L, Culliford D, Coakley P, Taylor P, Hart D, Spector T, Hakim A, Arden N, Mian A, Garrood T, Magan T, Chaudhary M, Lazic S, Sofat N, Thomas MJ, Moore A, Roddy E, Peat G, Rees F, Lanyon P, Jordan N, Chaib A, Sangle S, Tungekar F, Sabharwal T, Abbs I, Khamashta M, D'Cruz D, Dzifa Dey I, Isenberg DA, Chin CW, Cheung C, Ng M, Gao F, Qiong Huang F, Thao Le T, Yong Fong K, San Tan R, Yin Wong T, Julian T, Parker B, Al-Husain A, Yvonne Alexander M, Bruce I, Jordan N, Abbs I, D'cruz D, McDonald G, Miguel L, Hall C, Isenberg DA, Magee A, Butters T, Jury E, Yee CS, Toescu V, Hickman R, Leung MH, Situnayake D, Bowman S, Gordon C, Yee CS, Toescu V, Hickman R, Leung MH, Situnayake D, Bowman S, Gordon C, Lazarus MN, Isenberg DA, Ehrenstein M, Carter LM, Isenberg DA, Ehrenstein MR, Chanchlani N, Gayed M, Yee CS, Gordon C, Ball E, Rooney M, Bell A, Reynolds JA, Ray DW, O'Neill T, Alexander Y, Bruce I, Sutton EJ, Watson KD, Isenberg D, Rahman A, Gordon C, Yee CS, Lanyon P, Jayne D, Akil M, D'Cruz D, Khamashta M, Lutalo P, Erb N, Prabu A, Edwards CJ, Youssef H, McHugh N, Vital E, Amft N, Griffiths B, Teh LS, Zoma A, Bruce I, Durrani M, Jordan N, Sangle S, D'Cruz D, Pericleous C, Ruiz-Limon P, Romay-Penabad Z, Carrera-Marin A, Garza-Garcia A, Murfitt L, Driscoll PC, Giles IP, Ioannou Y, Rahman A, Pierangeli SS, Ripoll VM, Lambrianides A, Heywood WE, Ioannou J, Giles IP, Rahman A, Stevens C, Dures E, Morris M, Knowles S, Hewlett S, Marshall R, Reddy V, Croca S, Gerona D, De La Torre Ortega I, Isenberg DA, Leandro M, Cambridge G, Reddy V, Cambridge G, Isenberg DA, Glennie M, Cragg M, Leandro M, Croca SC, Isenberg DA, Giles I, Ioannou Y, Rahman A, Croca SC, Isenberg DA, Giles I, Ioannou Y, Rahman A, Artim Esen B, Pericleous C, MacKie I, Ioannou Y, Rahman A, Isenberg DA, Giles I, Skeoch S, Haque S, Pemberton P, Bruce I. BHPR: Audit and Clinical Evaluation * 103. Dental Health in Children and Young Adults with Inflammatory Arthritis: Access to Dental Care. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket196] [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: 11/12/2022] Open
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Karrar S, Shiwen X, Nikotorowicz-Buniak J, Abraham DJ, Denton C, Stratton R, Bayley R, Kite KA, Clay E, Smith JP, Kitas GD, Buckley C, Young SP, Ye L, Zhang L, Goodall J, Gaston H, Xu H, Lutalo PM, Zhao Y, Meng Choong L, Sangle S, Spencer J, D'Cruz D, Rysnik OJ, McHugh K, Bowness P, Rump-Goodrich L, Mattey D, Kehoe O, Middleton J, Cartwright A, Schmutz C, Askari A, Middleton J, Gardner DH, Jeffery LE, Raza K, Sansom DM, Clay E, Bayley R, Fitzpatrick M, Wallace G, Young S, Shaw J, Hatano H, Cauli A, Giles JL, McHugh K, Mathieu A, Bowness P, Kollnberger S, Webster S, Ellis L, O'Brien LM, Fitzmaurice TJ, Gaston H, Goodall J, Nazeer Moideen A, Evans L, Osgood L, Williams A, Jones S, Thomas C, O'Donnell V, Nowell M, Ouboussad L, Savic S, Dickie LJ, Hintze J, Wong CH, Cook GP, Buch M, Emery P, McDermott MF, Hardcastle SA, Gregson CL, Deere K, Davey Smith G, Dieppe P, Tobias JH, Dennison E, Edwards M, Bennett J, Coggon D, Palmer K, Cooper C, McWilliams D, Young A, Kiely PD, Walsh D, Taylor HJ, Harding I, Hutchinson J, Nelson I, Blom A, Tobias J, Clark E, Parker J, Bukhari M, McWilliams D, Jayakumar K, Young A, Kiely P, Walsh D, Diffin J, Lunt M, Marshall T, Chipping J, Symmons D, Verstappen S, Taylor HJ, Harding I, Hutchinson J, Nelson I, Tobias J, Clark E, Bluett J, Bowes J, Ho P, McHugh N, Buden D, Fitzgerald O, Barton A, Glossop JR, Nixon NB, Emes RD, Dawes PT, Farrell WE, Mattey DL, Scott IC, Steer S, Seegobin S, Hinks AM, Eyre S, Morgan A, Wilson AG, Hocking L, Wordsworth P, Barton A, Worthington J, Cope A, Lewis CM, Guerra S, Ahmed BA, Denton C, Abraham D, Fonseca C, Robinson J, Taylor J, Haroon Rashid L, Flynn E, Eyre S, Worthington J, Barton A, Isaacs J, Bowes J, Wilson AG, Barrett JH, Morgan A, Kingston B, Ahmed M, Kirwan JR, Marshall R, Chapman K, Pearson R, Heycock C, Kelly C, Rynne M, Saravanan V, Hamilton J, Saeed A, Coughlan R, Carey JJ, Farah Z, Matthews W, Bell C, Petford S, Tibbetts LM, Douglas KMJ, Holden W, Ledingham J, Fletcher M, Winfield R, Price Z, Mackay K, Dixon C, Oppong R, Jowett S, Nicholls E, Whitehurst D, Hill S, Hammond A, Hay E, Dziedzic K, Righetti C, Lebmeier M, Manning VL, Hurley M, Scott DL, Choy E, Bearne L, Nikiphorou E, Morris S, James D, Kiely P, Walsh D, Young A, Wong EC, Long J, Fletcher A, Fletcher M, Holmes S, Hockey P, Abbas M, Chattopadhyay C, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, Robson J, Kiran A, Maskell J, Arden N, Hutchings A, Emin A, Culliford D, Dasgupta B, Hamilton W, Luqmani R, Jethwa H, Rowczenio D, Trojer H, Russell T, Loeffler J, Hawkins P, Lachmann H, Verma I, Syngle A, Krishan P, Garg N, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, McGowan SP, Gerrard DT, Chinoy H, Ollier WE, Cooper RG, Lamb JA, Taborda L, Correia Azevedo P, Isenberg D, Leyland KM, Kiran A, Judge A, Hunter D, Hart D, Javaid MK, Arden N, Cooper C, Edwards MH, Litwic AE, Jameson KA, Deeg D, Cooper C, Dennison E, Edwards MH, Jameson KA, Cushnaghan J, Aihie Sayer A, Deeg D, Cooper C, Dennison E, Jagannath D, Parsons C, Cushnaghan J, Cooper C, Edwards MH, Dennison E, Stoppiello L, Mapp P, Ashraf S, Wilson D, Hill R, Scammell B, Walsh D, Wenham C, Shore P, Hodgson R, Grainger A, Aaron J, Hordon L, Conaghan P, Bar-Ziv Y, Beer Y, Ran Y, Benedict S, Halperin N, Drexler M, Mor A, Segal G, Lahad A, Haim A, Rath U, Morgensteren DM, Salai M, Elbaz A, Vasishta VG, Derrett-Smith E, Hoyles R, Khan K, Abraham DJ, Denton C, Ezeonyeji A, Takhar G, Denton C, Ong V, Loughrey L, Bissell LA, Hensor E, Abignano G, Redmond A, Buch M, Del Galdo F, Hall FC, Malaviya A, Nisar M, Baker S, Furlong A, Mitchell A, Godfrey AL, Ruddlesden M, Hadjinicolaou A, Hughes M, Moore T, O'Leary N, Tracey A, Ennis H, Dinsdale G, Roberts C, Herrick A, Denton CP, Guillevin L, Hunsche E, Rosenberg D, Schwierin B, Scott M, Krieg T, Anderson M, Hall FC, Herrick A, McHugh N, Matucci-Cerinic M, Alade R, Khan K, Xu S, Denton C, Ong V, Nihtyanova S, Ong V, Denton CP, Clark KE, Tam FWK, Unwin R, Khan K, Abraham DJ, Denton C, Stratton RJ, Nihtyanova S, Schreiber B, Ong V, Denton CP, Seng Edwin Lim C, Dasgupta B, Corsiero E, Sutcliffe N, Wardemann H, Pitzalis C, Bombardieri M, Tahir H, Donnelly S, Greenwood M, Smith TO, Easton V, Bacon H, Jerman E, Armon K, Poland F, Macgregor A, van der Heijde D, Sieper J, Elewaut D, Pangan AL, Nguyen D, Badenhorst C, Kirby S, White D, Harrison A, Garcia JA, Stebbings S, MacKay JW, Aboelmagd S, Gaffney K, van der Heijde D, Deodhar A, Braun J, Mack M, Hsu B, Gathany T, Han C, Inman RD, Cooper-Moss N, Packham J, Strauss V, Freeston JE, Coates L, Nam J, Moverley AR, Helliwell P, Hensor E, Wakefield R, Emery P, Conaghan P, Mease P, Fleischmann R, Wollenhaupt J, Deodhar A, Kielar D, Woltering F, Stach C, Hoepken B, Arledge T, van der Heijde D, Gladman D, Fleischmann R, Coteur G, Woltering F, Mease P, Kavanaugh A, Gladman D, van der Heijde D, Purcaru O, Mease P, McInnes I, Kavanaugh A, Gottlieb AB, Puig L, Rahman P, Ritchlin C, Li S, Wang Y, Mendelsohn A, Doyle M, Tillett W, Jadon D, Shaddick G, Cavill C, Robinson G, Sengupta R, Korendowych E, de Vries C, McHugh N, Thomas RC, Shuto T, Busquets-Perez N, Marzo-Ortega H, McGonagle D, Tillett W, Richards G, Cavill C, Sengupta R, Shuto T, Marzo-Ortega H, Thomas RC, Bingham S, Coates L, Emery P, John Hamlin P, Adshead R, Cambridge S, Donnelly S, Tahir H, Suppiah P, Cullinan M, Nolan A, Thompson WM, Stebbings S, Mathieson HR, Mackie SL, Bryer D, Buch M, Emery P, Marzo-Ortega H, Krutikov M, Gray L, Bruce E, Ho P, Marzo-Ortega H, Busquets-Perez N, Thomas RC, Gaffney K, Keat A, Innes W, Pandit R, Kay L, Lapshina S, Myasoutova L, Erdes S, Wallis D, Waldron N, McHugh N, Korendowych E, Thorne I, Harris C, Keat A, Garg N, Syngle A, Vohra K, Khinchi D, Verma I, Kaur L, Jones A, Harrison N, Harris D, Jones T, Rees J, Bennett A, Fazal S, Tugnet N, Barkham N, Basu N, McClean A, Harper L, Amft EN, Dhaun N, Luqmani RA, Little MA, Jayne DR, Flossmann O, McLaren J, Kumar V, Reid DM, Macfarlane GJ, Jones G, Yates M, Watts RA, Igali L, Mukhtyar C, Macgregor A, Robson J, Doll H, Yew S, Flossmann O, Suppiah R, Harper L, Hoglund P, Jayne D, Mukhtyar C, Westman K, Luqmani R, Win Maw W, Patil P, Williams M, Adizie T, Christidis D, Borg F, Dasgupta B, Robertson A, Croft AP, Smith S, Carr S, Youssouf S, Salama A, Pusey C, Harper L, Morgan M. Basic Science * 208. Stem Cell Factor Expression is Increased in the Skin of Patients with Systemic Sclerosis and Promotes Proliferation and Migration of Fibroblasts in vitro. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Tobias J, Deere K, Palmer S, Clark E, Clinch J, Fikree A, Aktar R, Wellstead G, Knowles C, Grahame R, Aziz Q, Amaral B, Murphy G, Ioannou Y, Isenberg DA, Tansley SL, Betteridge ZE, Gunawardena H, Shaddick G, Varsani H, Wedderburn L, McHugh N, De Benedetti F, Ruperto N, Espada G, Gerloni V, Flato B, Horneff G, Myones BL, Onel K, Frane J, Kenwright A, Lipman TH, Bharucha KN, Martini A, Lovell DJ, Baildam E, Ruperto N, Brunner H, Zuber Z, Keane C, Harari O, Kenwright A, Cuttica RJ, Keltsev V, Xavier R, Penades IC, Nikishina I, Rubio-Perez N, Alekseeva E, Chasnyk V, Chavez J, Horneff G, Opoka-Winiarska V, Quartier P, Silva CA, Silverman ED, Spindler A, Lovell DJ, Martini A, De Benedetti F, Hendry GJ, Watt GF, Brandon M, Friel L, Turner D, Lorgelly PK, Gardner-Medwin J, Sturrock RD, Woodburn J, Firth J, Waxman R, Law G, Siddle H, Nelson AE, Helliwell P, Otter S, Butters V, Loughrey L, Alcacer-Pitarch B, Tranter J, Davies S, Hryniw R, Lewis S, Baker L, Dures E, Hewlett S, Ambler N, Clarke J, Gooberman-Hill R, Jenkins R, Wilkie R, Bucknall M, Jordan K, McBeth J, Norton S, Walsh D, Kiely P, Williams R, Young A, Harkess JE, McAlarey K, Chesterton L, van der Windt DA, Sim J, Lewis M, Mallen CD, Mason E, Hay E, Clarson LE, Hider SL, Belcher J, Heneghan C, Roddy E, Mallen CD, Gibson J, Whiteford S, Williamson E, Beatty S, Hamilton-Dyer N, Healey EL, Ryan S, McHugh GA, Main CJ, Porcheret M, Nio Ong B, Pushpa-Rajah A, Dziedzic KS, MacRae CS, Shortland A, Lewis J, Morrissey M, Critchley D, Muller S, Mallen CD, Belcher J, Helliwell T, Hider SL, Cole Z, Parsons C, Crozier S, Robinson S, Taylor P, Inskip H, Godfrey K, Dennison E, Harvey NC, Cooper C, Prieto Alhambra D, Lalmohamed A, Abrahamsen B, Arden N, de Boer A, Vestergaard P, de Vries F, Kendal A, Carr A, Prieto-Alhambra D, Judge A, Cooper C, Chapurlat R, Bellamy N, Czerwinski E, Pierre Devogelaer J, March L, Pavelka K, Reginster JY, Kiran A, Judge A, Javaid MK, Arden N, Cooper C, Sundy JS, Baraf HS, Becker M, Treadwell EL, Yood R, Ottery FD. Oral Abstracts 3: Adolescent and Young Adult * O13. Hypermobility is a Risk Factor for Musculoskeletal Pain in Adolescence: Findings From a Prospective Cohort Study. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket200] [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: 11/13/2022] Open
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Tobias J, Vaidya J. OC-0236: The TARGIT-A trial of intra-operative radiotherapy for breast cancer: Updated recurrence and survival. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32542-1] [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: 10/23/2022]
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Lundgren A, Leach S, Tobias J, Carlin N, Gustafsson B, Jertborn M, Bourgeois L, Walker R, Holmgren J, Svennerholm AM. Clinical trial to evaluate safety and immunogenicity of an oral inactivated enterotoxigenic Escherichia coli prototype vaccine containing CFA/I overexpressing bacteria and recombinantly produced LTB/CTB hybrid protein. Vaccine 2013; 31:1163-70. [DOI: 10.1016/j.vaccine.2012.12.063] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 12/18/2012] [Accepted: 12/26/2012] [Indexed: 11/30/2022]
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Yehya N, Yerrapureddy A, Tobias J, Margulies SS. MicroRNA modulate alveolar epithelial response to cyclic stretch. BMC Genomics 2012; 13:154. [PMID: 22537220 PMCID: PMC3425319 DOI: 10.1186/1471-2164-13-154] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [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: 05/07/2011] [Accepted: 04/26/2012] [Indexed: 12/14/2022] Open
Abstract
Background MicroRNAs (miRNAs) are post-transcriptional regulators of gene expression implicated in multiple cellular processes. Cyclic stretch of alveoli is characteristic of mechanical ventilation, and is postulated to be partly responsible for the lung injury and inflammation in ventilator-induced lung injury. We propose that miRNAs may regulate some of the stretch response, and therefore hypothesized that miRNAs would be differentially expressed between cyclically stretched and unstretched rat alveolar epithelial cells (RAECs). Results RAECs were isolated and cultured to express type I epithelial characteristics. They were then equibiaxially stretched to 25% change in surface area at 15 cycles/minute for 1 hour or 6 hours, or served as unstretched controls, and miRNAs were extracted. Expression profiling of the miRNAs with at least 1.5-fold change over controls revealed 42 miRNAs were regulated (34 up and 8 down) with stretch. We validated 6 of the miRNAs using real-time PCR. Using a parallel mRNA array under identical conditions and publicly available databases, target genes for these 42 differentially regulated miRNAs were identified. Many of these genes had significant up- or down-regulation under the same stretch conditions. There were 362 down-regulated genes associated with up-regulated miRNAs, and 101 up-regulated genes associated with down-regulated miRNAs. Specific inhibition of two selected miRNAs demonstrated a reduction of the increased epithelial permeability seen with cyclic stretch. Conclusions We conclude that miRNA expression is differentially expressed between cyclically stretched and unstretched alveolar epithelial cells, and may offer opportunities for therapeutic intervention to ameliorate stretch-associated alveolar epithelial cell dysfunction.
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Affiliation(s)
- Nadir Yehya
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA 19104-6321, USA
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Aad G, Abbott B, Abdallah J, Abdelalim AA, Abdesselam A, Abdinov O, Abi B, Abolins M, Abramowicz H, Abreu H, Acerbi E, Acharya BS, Adams DL, Addy TN, Adelman J, Aderholz M, Adomeit S, Adragna P, Adye T, Aefsky S, Aguilar-Saavedra JA, Aharrouche M, Ahlen SP, Ahles F, Ahmad A, Ahsan M, Aielli G, Akdogan T, Akesson TPA, Akimoto G, Akimov AV, Akiyama A, Alam MS, Alam MA, Albert J, Albrand S, Aleksa M, Aleksandrov IN, Alessandria F, Alexa C, Alexander G, Alexandre G, Alexopoulos T, Alhroob M, Aliev M, Alimonti G, Alison J, Aliyev M, Allport PP, Allwood-Spiers SE, Almond J, Aloisio A, Alon R, Alonso A, Alvarez Gonzalez B, Alviggi MG, Amako K, Amaral P, Amelung C, Ammosov VV, Amorim A, Amorós G, Amram N, Anastopoulos C, Ancu LS, Andari N, Andeen T, Anders CF, Anders G, Anderson KJ, Andreazza A, Andrei V, Andrieux ML, Anduaga XS, Angerami A, Anghinolfi F, Anjos N, Annovi A, Antonaki A, Antonelli M, Antonov A, Antos J, Anulli F, Aoun S, Aperio Bella L, Apolle R, Arabidze G, Aracena I, Arai Y, 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Zhong J, Zhou B, Zhou N, Zhou Y, Zhu CG, Zhu H, Zhu J, Zhu Y, Zhuang X, Zhuravlov V, Zieminska D, Zimmermann R, Zimmermann S, Zimmermann S, Ziolkowski M, Zitoun R, Zivković L, Zmouchko VV, Zobernig G, Zoccoli A, Zolnierowski Y, Zsenei A, Zur Nedden M, Zutshi V, Zwalinski L. Measurement of the ZZ production cross section and limits on anomalous neutral triple gauge couplings in proton-proton collisions at sqrt[s] = 7 TeV with the ATLAS detector. Phys Rev Lett 2012; 108:041804. [PMID: 22400826 DOI: 10.1103/physrevlett.108.041804] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Indexed: 05/31/2023]
Abstract
A measurement of the ZZ production cross section in proton-proton collisions at sqrt[s] = 7 TeV using data corresponding to an integrated luminosity of 1.02 fb(-1) recorded by the ATLAS experiment at the LHC is presented. Twelve events containing two Z boson candidates decaying to electrons and/or muons are observed, with an expected background of 0.3 ± 0.3(stat)(-0.3)(+0.4)(syst) events. The cross section measured in a phase-space region with good detector acceptance and for dilepton masses within the range 66 to 116 GeV is σ(ZZ → ℓ+ ℓ- ℓ+ ℓ-)(fid) = 19.4(-5.2)(+6.3)(stat)(-0.7)(+0.9)(syst) ± 0.7(lumi) fb. The resulting total cross section for on-shell ZZ production, σ(ZZ)(tot) = 8.5(-2.3)(+2.7)(stat)(-0.3)(+0.4)(syst) ± 0.3(lumi) pb, is consistent with the standard model expectation of 6.5(-0.2)(+0.3) pb calculated at the next-to-leading order in QCD. Limits on anomalous neutral triple gauge boson couplings are derived.
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Affiliation(s)
- G Aad
- Fakultät für Mathematik und Physik, Albert-Ludwigs-Universität, Freiburg i.Br., Germany
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Vaidya JS, Baum M, Wenz F, Bulsara M, Tobias J, Alvarodo M, Saunders C, Williams N, Joseph D. P3-13-07: The TARGIT-A Trial Update Confirms No Increase in Local Recurrence. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-13-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: In June 2010, we published the results of the TARGIT-A trial (1) that compared “one-size fits” all radiotherapy (whole breast radiotherapy-EBRT group) with risk -adjusted radiotherapy (TARGIT- group: single dose TARGeted Intraoperative radioTherapy with additional whole breast radiotherapy if adverse prognostic factors were found). These results showed that the risk of local recurrence in the TARGIT group was non-inferior to that of the EBRT group (the difference between the two arms was 0.25% at 4 years). We now report the results analyzed after further follow up of the total trial cohort without unblinding.
Method: As often repeated, unplanned analysis comparing two groups in a randomized trial can result in an increased alpha-spent as well as carry the risk of a false positive result, we have remained blinded to the further recurrences in the trial according to allocated treatment, since the original publication in the Lancet. Instead we proposed and performed a blinded analysis of the local recurrence rate for the whole cohort. We plotted the Kaplan Meier plots and compared the estimated 4-year recurrences.
Results: Amongst the 2232 patients randomized, there were 13 recurrences at the time of Lancet publication and since then, we have had 8 additional recurrences. The number of patients who have completed at least 4 years of follow up has increased from 420 to 717. We found that the 4-year Kaplan Meier estimate of local recurrence was 1.08% (95% CI 0.59 −1.96) at the time of the Lancet publication and it is 1.09% (95% CI 0.65 - 1.85) now.
Conclusion: We found that the overall 4-year recurrence rates of the TARGIT-A trial have remained stable with a longer follow up and therefore; it is statistically implausible, that one particular arm has a significantly higher local recurrence.
References
1. Vaidya JS, Joseph DJ, Tobias JS, Bulsara M, Wenz F, Saunders C, Alvarado M, Flyger HL, Massarut S, Eiermann W, Keshtgar M, Dewar J, Kraus-Tiefenbacher U, Sutterlin M, Esserman L, Holtveg HM, Roncadin M, Pigorsch S, Metaxas M, Falzon M, Matthews A, Corica T, Williams NR, Baum M. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 2010;376(9735):91–102.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-13-07.
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Affiliation(s)
- JS Vaidya
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - M Baum
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - F Wenz
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - M Bulsara
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - J Tobias
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - M Alvarodo
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - C Saunders
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - N Williams
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - D Joseph
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
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Erdogan B, Facey C, Qualtieri J, Tedesco J, Rinker E, Isett RB, Tobias J, Baldwin DA, Thompson JE, Carroll M, Kim AS. Diagnostic microRNAs in myelodysplastic syndrome. Exp Hematol 2011; 39:915-926.e2. [DOI: 10.1016/j.exphem.2011.06.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 05/07/2011] [Accepted: 06/02/2011] [Indexed: 02/06/2023]
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Vagadia V, Bartholomew P, Kelly M, Handley G, Kelly C, Bridges M, Ruddick S, Malik R, Gilleece Y, Fisher M, Walker-Bone K, Selvan S, Collins DA, Meryon I, Pattle J, Scurr C, Davies G, Callan M, Mercieca C, Down M, Webb J, Shipley J, Bhalla AK, Poole KE, Treece GM, Ridgway GR, Mayhew PM, Borggrefe J, Gee AH, Mehta P, Nelson M, Boag F, Oldroyd AG, Halsey J, Goodson NJ, Greenbank C, Evans B, Bukhari M, Azagra R, Roca G, Encabo G, Aguye A, Zwart M, Casado E, Iglesias M, Puchol N, Sola S, Guell S, Harvey NC, Garrett E, Sheppard A, McLean C, Lillycrop K, Burdge G, Slater-Jefferies J, Rodford J, Crozier S, Inskip H, Starling Emerald B, Gale C, Hanson M, Gluckman P, Godfrey K, Cooper C, Edwards MH, Jameson K, Denison H, Aihie Sayer A, Cooper C, Dennison E, Cole Z, Harvey NC, Kim M, Robinson S, Inskip H, Godfrey KM, Cooper C, Dennison E, Clark EM, Morrison L, Gould V, Cuming M, Tobias J. Osteoporosis and metabolic bone disease: 73. Do Low Vitamin D Levels Predict Osteoporosis? Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Clark E, Tobias J, Fraser B. What's new in metabolic bone disease?: IP73. Is Frax Useful for Identifying People with Vertebral Fracture? Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Clark E, Tobias J. Educational achievement and fracture risk. Osteoporos Int 2010; 21:1625; author reply 1623. [PMID: 20012019 DOI: 10.1007/s00198-009-1115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 09/29/2009] [Indexed: 11/30/2022]
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Gillmore R, Laurence V, Raouf S, Tobias J, Blackman G, Meyer T, Goodchild K, Collis C, Bridgewater J. Chemoradiotherapy with or without induction chemotherapy for locally advanced pancreatic cancer: a UK multi-institutional experience. Clin Oncol (R Coll Radiol) 2010; 22:564-9. [PMID: 20605709 DOI: 10.1016/j.clon.2010.05.007] [Citation(s) in RCA: 13] [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: 10/19/2009] [Revised: 03/16/2010] [Accepted: 05/05/2010] [Indexed: 01/19/2023]
Abstract
AIMS The optimal management for patients with unresectable locally advanced adenocarcinoma of the pancreas (LAPC) is unclear. The aim of this study was to determine the outcome of patients treated with chemoradiotherapy (CRT) with or without induction chemotherapy. MATERIALS AND METHODS We conducted a multi-centre retrospective analysis of 48 patients with biopsy-proven LAPC treated with CRT in four regional oncology centres in the UK between March 2000 and October 2007. The prescribed radiotherapy dose was 4500-5040 cGy in 25-28 fractions and was given concurrent with gemcitabine (n=37), gemcitabine/cisplatin (n=9), 5-fluorouracil (n=1) or capecitabine (n=1). RESULTS Four patients (8.3%) did not complete the intended treatment due to CRT-related toxicities. The disease control rate (Objective response rate (ORR) and stable disease (SD)) was 81.3%. The median overall survival was 17 months (range 5-66 months). In subgroup analysis, a trend towards improved survival was seen in patients who completed the intended treatment (17.1 months vs 11.0 months, P=0.06) and in patients undergoing surgery (27 months vs 16 months, P=0.023). CONCLUSIONS This is the largest reported series from the UK focussing on patients who received CRT for pancreas cancer. It shows that it is possible to deliver pancreatic CRT with acceptable toxicity. Induction chemotherapy followed by gemcitabine-based CRT shows promising activity and should be evaluated in phase III studies.
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Affiliation(s)
- R Gillmore
- University College Hospital, University College London Cancer Institute, London, UK
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Yerrapureddy A, Tobias J, Margulies SS. Cyclic stretch magnitude and duration affect rat alveolar epithelial gene expression. Cell Physiol Biochem 2009; 25:113-22. [PMID: 20054150 DOI: 10.1159/000272056] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2009] [Indexed: 12/31/2022] Open
Abstract
Mechanical ventilation with large tidal volumes can increase lung alveolar permeability and initiate inflammatory responses; but the mechanisms that regulate ventilator-associated lung injury and inflammation remain unclear. Analysis of the genomic response of the lung has been performed in intact lungs ventilated at large tidal volumes. This study is the first to study the genomic response of cultured primary alveolar epithelial cells undergoing large and moderate physiologic cyclic stretch. Responses were dependent on stretch magnitude and duration. Genomic expression was validated for 5 genes of interest: Amphiregulin, Glutamate-Cysteine Ligase Catalytic subunit, Matrix Metalloproteinase 7, Protein Phosphatase 1 regulatory inhibitor subunit 10, and Serpine-1, and protein expression mirrored genomic responses. Differences between results reported from homogenized intact lungs and monolayers of alveolar epithelial cells with type-I like phenotype provide provocative evidence that the whole lung preparation may mask the response of individual cell types.
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Affiliation(s)
- Adi Yerrapureddy
- Department of Bioengineering University of Pennsylvania, Philadelphia, USA
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Keshtgar M, Vaidya J, Stacey C, Tobias J, Williams N, Baum M. Single dose radiotherapy during surgery for breast cancer patients where external beam radiation was not feasible - results after 3 years of follow-up. Eur J Surg Oncol 2009. [DOI: 10.1016/j.ejso.2009.07.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Baum M, Williams N, Vaidya J, Keshtgar M, Tobias J. TARGIT: an international trial of intraoperative versus external beam radiotherapy. Breast Cancer Res 2008. [PMCID: PMC3300776 DOI: 10.1186/bcr1957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ebinuma H, Nakamoto N, Li Y, Price DA, Gostick E, Levine BL, Tobias J, Kwok WW, Chang KM. Identification and in vitro expansion of functional antigen-specific CD25+ FoxP3+ regulatory T cells in hepatitis C virus infection. J Virol 2008; 82:5043-53. [PMID: 18337568 PMCID: PMC2346728 DOI: 10.1128/jvi.01548-07] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [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: 07/16/2007] [Accepted: 03/04/2008] [Indexed: 01/14/2023] Open
Abstract
CD4(+)CD25(+) regulatory T cells (CD25(+) Tregs) play a key role in immune regulation. Since hepatitis C virus (HCV) persists with increased circulating CD4(+)CD25(+) T cells and virus-specific effector T-cell dysfunction, we asked if CD4(+)CD25(+) T cells in HCV-infected individuals are similar to natural Tregs in uninfected individuals and if they include HCV-specific Tregs using the specific Treg marker FoxP3 at the single-cell level. We report that HCV-infected patients display increased circulating FoxP3(+) Tregs that are phenotypically and functionally indistinguishable from FoxP3(+) Tregs in uninfected subjects. Furthermore, HCV-specific FoxP3(+) Tregs were detected in HCV-seropositive persons with antigen-specific expansion, major histocompatibility complex class II/peptide tetramer binding affinity, and preferential suppression of HCV-specific CD8 T cells. Transforming growth factor beta contributed to antigen-specific Treg expansion in vitro, suggesting that it may contribute to antigen-specific Treg expansion in vivo. Interestingly, FoxP3 expression was also detected in influenza virus-specific CD4 T cells. In conclusion, functionally active and virus-specific FoxP3(+) Tregs are induced in HCV infection, thus providing targeted immune regulation in vivo. Detection of FoxP3 expression in non-HCV-specific CD4 T cells suggests that immune regulation through antigen-specific Treg induction extends beyond HCV.
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Affiliation(s)
- Hirotoshi Ebinuma
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA 19104, USA
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Yang S, Farias M, Kapfhamer D, Tobias J, Grant G, Abel T, Bućan M. Biochemical, molecular and behavioral phenotypes of Rab3A mutations in the mouse. Genes Brain Behav 2007; 6:77-96. [PMID: 16734774 PMCID: PMC2914309 DOI: 10.1111/j.1601-183x.2006.00235.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ras-associated binding (Rab) protein 3A is a neuronal guanosine triphosphate (GTP)-binding protein that binds synaptic vesicles and regulates synaptic transmission. A mouse mutant, earlybird (Ebd), with a point mutation in the GTP-binding domain of Rab3A (D77G), exhibits anomalies in circadian behavior and homeostatic response to sleep loss. Here, we show that the D77G substitution in the Ebd allele causes reduced GTP and GDP binding, whereas GTPase activity remains intact, leading to reduced protein levels of both Rab3A and rabphilin3A. Expression profiling of the cortex and hippocampus of Ebd and Rab3a-deficient mice revealed subtle differences between wild-type and mutant mice. Although mice were backcrossed for three generations to a C57BL/6J background, the most robust changes at the transcriptional level between Rab3a(-/-) and Rab3a(+/+) mice were represented by genes from the 129/Sv-derived chromosomal region surrounding the Rab3a gene. These results showed that differences in genetic background have a stronger effect on gene expression than the mutations in the Rab3a gene. In behavioral tests, the Ebd/Ebd mice showed a more pronounced mutant phenotype than the null mice; Ebd/Ebd have reduced anxiety-like behavior in the elevated zero-maze test, reduced response to stress in the forced swim test and a deficit in cued fear conditioning (FC), whereas Rab3a(-/-) showed only a deficit in cued FC. Our data implicate Rab3A in learning and memory as well as in the regulation of emotion. A combination of forward and reverse genetics has provided multiple alleles of the Rab3a gene; our studies illustrate the power and complexities of the parallel analysis of these alleles at the biochemical, molecular and behavioral levels.
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Affiliation(s)
- S. Yang
- Department of Genetics, University of Pennsylvania, Philadelphia, PA
| | - M. Farias
- Department of Genetics, University of Pennsylvania, Philadelphia, PA
| | - D. Kapfhamer
- Department of Genetics, University of Pennsylvania, Philadelphia, PA
| | - J. Tobias
- Penn Center for Bioinformatics, University of Pennsylvania, Philadelphia, PA, USA
| | - G. Grant
- Department of Genetics, University of Pennsylvania, Philadelphia, PA
- Penn Center for Bioinformatics, University of Pennsylvania, Philadelphia, PA, USA
| | - T. Abel
- Department of Biology, University of Pennsylvania, Philadelphia, PA, USA
| | - M. Bućan
- Department of Genetics, University of Pennsylvania, Philadelphia, PA
- Penn Center for Bioinformatics, University of Pennsylvania, Philadelphia, PA, USA
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Keshtgar M, Tobias J, Vaidya J, Murphy O, Stacey C, Metaxas M, Douek M, Sainsbury R, Houghton J, Baum M. 286 POSTER Use of intra-operative radiotherapy [IORT] alone in breast cancer patients when conventional external beam radiation therapy [EBRT] was not possible. Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70721-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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43
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Weng AP, Millholland JM, Yashiro-Ohtani Y, Arcangeli ML, Lau A, Wai C, Del Bianco C, Rodriguez CG, Sai H, Tobias J, Li Y, Wolfe MS, Shachaf C, Felsher D, Blacklow SC, Pear WS, Aster JC. c-Myc is an important direct target of Notch1 in T-cell acute lymphoblastic leukemia/lymphoma. Genes Dev 2006; 20:2096-109. [PMID: 16847353 PMCID: PMC1536060 DOI: 10.1101/gad.1450406] [Citation(s) in RCA: 660] [Impact Index Per Article: 36.7] [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: 02/17/2006] [Accepted: 06/06/2006] [Indexed: 02/06/2023]
Abstract
Human acute T-cell lymphoblastic leukemias and lymphomas (T-ALL) are commonly associated with gain-of-function mutations in Notch1 that contribute to T-ALL induction and maintenance. Starting from an expression-profiling screen, we identified c-myc as a direct target of Notch1 in Notch-dependent T-ALL cell lines, in which Notch accounts for the majority of c-myc expression. In functional assays, inhibitors of c-myc interfere with the progrowth effects of activated Notch1, and enforced expression of c-myc rescues multiple Notch1-dependent T-ALL cell lines from Notch withdrawal. The existence of a Notch1-c-myc signaling axis was bolstered further by experiments using c-myc-dependent murine T-ALL cells, which are rescued from withdrawal of c-myc by retroviral transduction of activated Notch1. This Notch1-mediated rescue is associated with the up-regulation of endogenous murine c-myc and its downstream transcriptional targets, and the acquisition of sensitivity to Notch pathway inhibitors. Additionally, we show that primary murine thymocytes at the DN3 stage of development depend on ligand-induced Notch signaling to maintain c-myc expression. Together, these data implicate c-myc as a developmentally regulated direct downstream target of Notch1 that contributes to the growth of T-ALL cells.
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Affiliation(s)
- Andrew P Weng
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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Bourhis J, Le Maı̂tre A, Pignon J, Ang K, Bernier J, Overgaard J, Tobias J, Saunders M, Adelstein D, O’Sullivan B. Impact of age on treatment effect in locally advanced head and neck cancer (HNC): Two individual patient data meta-analyses. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5501] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5501 Background: The Meta-Analysis of Radiotherapy in Carcinomas of Head & Neck (MARCH; Bourhis J, ASTRO 2002) showed that altered fractionation radiotherapy (Alt-RT) could improve survival as compared to standard RT in patients with locally advanced HNC (pooled hazard ratio - HR -: 0.92, 95% confidence interval: 0.86–0.97). The Meta-Analysis of Chemotherapy in Head and Neck Cancer (MACH-NC; Bourhis J, ASCO 2004) demonstrated that concomitant chemotherapy (CT), added to RT, improved survival (HR: 0.82, 95% CI: 0.78–0.86). This study considers age as a potential modifier of the treatment effect. Methods: 15 randomized trials with 6,515 patients were included in MARCH (median follow up: 6.0 years), and 50 with 9,471 patients in concomitant part of MACH-NC (median follow up: 5.6 years). The interaction between age and treatment effect, using HR of death, was tested with heterogeneity test. Effect of prognostic factors on the interaction was analysed using Cox model. Results: The effect of Alt-RT in MARCH and of concomitant CT in MACH-NC on overall survival decreased with increased age ( table ). Patients aged 71+ had a lower performance status, less advanced stage, and more often laryngeal cancer than the younger patients; there were more women in the oldest patients group. However, adjusting on covariates did not modify the results. Causes of death was available in MARCH and in recent (1994–2000) trials of MACH-NC. The proportion of deaths not due to HNC increased with age, from 18% at age 50 to 41% at age 71+ in MARCH, and from 15% to 39% in MACH-NC. Conclusions: Treatment benefit decreases with increasing age. Patients aged 71+ did not benefit from Alt- RT nor from concomitant CT. The increasing risk of death from other causes with age may explain part of these observations. Supported by PHRC, ARC, LNCC [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- J. Bourhis
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - A. Le Maı̂tre
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - J. Pignon
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - K. Ang
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - J. Bernier
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - J. Overgaard
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - J. Tobias
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - M. Saunders
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - D. Adelstein
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - B. O’Sullivan
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
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De León DD, Farzad C, Crutchlow MF, Brestelli J, Tobias J, Kaestner KH, Stoffers DA. Identification of transcriptional targets during pancreatic growth after partial pancreatectomy and exendin-4 treatment. Physiol Genomics 2006; 24:133-43. [PMID: 16410542 DOI: 10.1152/physiolgenomics.00156.2005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [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: 01/29/2023] Open
Abstract
After partial pancreatectomy (Ppx), substantial regeneration of the endocrine and exocrine pancreatic compartments has been shown in adult rodents. Exendin-4 (Ex-4) is a glucagon-like peptide-1 receptor agonist that augments endocrine β-cell mass by stimulating neogenesis, proliferation, and cell survival. After Ppx, treatment with Ex-4 ameliorates hyperglycemia by stimulating β-cell mass recovery. We utilized a cDNA microarray approach to identify genes differentially regulated during pancreatic regeneration after Ppx and/or Ex-4 administration. The pancreatic remnant after Ppx showed a large number of differentially regulated genes. In contrast, Ex-4 treatment resulted in a smaller number of differentially regulated genes. Of note, a common subset of genes regulated by Ex-4 and after Ppx was identified, including three members of the mitogenic Reg gene family, Reg2, -3γ, and -3β, as well as fragilis, a gene that maintains pluripotency during germ cell specification, and Serpin b1a, a member of an intracellular protease inhibitor family involved in cell survival. These observations were confirmed by real-time PCR. We determined that Reg3β protein is also induced in the acinar pancreas after Ppx, suggesting a novel role for this factor in pancreatic growth or response to injury. Finally, comparison of transcription factor-binding sites present in the proximal promoters of these genes identified potential common transcription factors that may regulate these genes. Chromatin immunoprecipitation analyses confirmed Reg3γ as a novel transcriptional target of Foxa2 (HNF3β). Our data suggest molecular pathways that may regulate pancreatic growth and offer a unique set of candidate genes to target in the development of therapies aimed at improving pancreatic growth and function.
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Affiliation(s)
- Diva D De León
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Institute for Diabetes, Obesity and Metabolism, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Kirwan JR, Averns H, Creamer P, Davies M, Hickling P, Hutton C, Jacoby R, Kyle V, Laversuch C, Palferman T, Tobias J, Viner N, Woolf A, Yates D. Changes in rheumatology out-patient workload over 12 years in the South West of England. Rheumatology (Oxford) 2003; 42:175-9. [PMID: 12509633 DOI: 10.1093/rheumatology/keg056] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J R Kirwan
- Academic Rheumatology, University Department of Medicine, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
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Abstract
STUDY DESIGN A prospective review of patients undergoing epidural catheter placement after anterior spinal fusion and instrumentation for adolescent scoliosis was performed. Data were collected using visual analog pain scores reflecting the patients' perception of their pain control. OBJECTIVES To present the authors' technique for epidural catheter placement and dosing protocol, and to demonstrate the results from postoperative pain control after anterior spinal instrumented fusion for 10 consecutive patients. SUMMARY OF BACKGROUND DATA The literature regarding the benefits of epidural catheters after spinal surgery is contradictory, even with controlled studies comparing epidural catheters with intravenous morphine patient-controlled anesthesia. The authors believe that this lack of consensus stems from varied epidural dosing protocols and techniques in catheter placement, which they have witnessed anecdotally at their own institution. This prompted the authors to develop and refine a standardized dosing and catheter placement protocol for pain control after spinal surgery. METHODS Epidural catheters were placed intraoperatively before wound closure, then removed on postoperative Day 5. Dosing consisted of fentanyl (1 microg/kg) and hydromorphone (5 microg/kg) diluted in preservative-free saline (0.2 mL/kg). After surgery, dosing consisted of 0.1% ropivacaine and hydromorphone (10 microg/ml) continuously infused at 0.2 mL/kg/hour. Postoperative pain control was assessed on each postoperative day using a visual analog pain scale with choices ranging from 0 to 10. RESULTS The arithmetic mean of the median pain scores after surgery was 2.1. The mean of the maximum pain scores for the 5 days was 4.1. Three patients required an epidural bolus and a 20% increase in the epidural infusion rate. One patient was judged to be excessively sleepy, so the epidural infusion rate was decreased by 20%. Pruritus requiring diphenhydramine developed in three patients. No other adverse effects related to epidural analgesia were noted. No catheters were accidentally pulled out or disconnected. CONCLUSION By following the dosing protocol described, epidural catheters can be used safely and effectively to control postoperative pain after anterior instrumentation and spinal fusion for adolescent scoliosis.
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Affiliation(s)
- K J Lowry
- Department of Orthopaedics Surgery, University of Missouri, Columbia, USA
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Tobias J. The ATAC (Arimidex, Tamoxifen, alone or in combination) trial in post-menopausal patients with operable breast cancer. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81116-3] [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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49
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Herod J, Burton A, Buxton J, Tobias J, Luesley D, Jordan S, Dunn J, Poole CJ. A randomised, prospective, phase III clinical trial of primary bleomycin, ifosfamide and cisplatin (BIP) chemotherapy followed by radiotherapy versus radiotherapy alone in inoperable cancer of the cervix. Ann Oncol 2000; 11:1175-81. [PMID: 11061615 DOI: 10.1023/a:1008346901733] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Phase II studies have shown primary (neo-adjuvant) chemotherapy with bleomycin, ifosfamide and cisplatin (BIP) is active against inoperable cervical cancer. We present here results of a randomised phase III multicentre trial comparing radical radiotherapy with neo-adjuvant BIP chemotherapy followed by radical radiotherapy in patients with inoperable cervical cancer, designed to discover whether this combination might improve survival. PATIENTS AND METHODS Patients with inoperable cervical carcinoma were randomised to pelvic radiotherapy alone [RT] or two to three cycles of bleomycin 30 units/24-hour infusion, ifosfamide 5 g/m2/24 hours, and cisplatin 50 mg/m2) chemotherapy followed by pelvic radiotherapy (BIP + RT). Randomisation was stratified by stage and radiotherapy centre. RESULTS One hundred seventy-two eligible women were randomised into this trial; eighty-six to RT and eighty-six to BIP + RT. A total of 190 cycles of chemotherapy were given. Median follow-up for the 47 patients still alive is 9 years with a minimum follow-up of 3 years. Complete or partial response occurred in 51 of 86 (59%) of those randomised to RT and 60 of 86 (69%) of those randomised to BIP + RT. The difference between response rates does not reach statistical significance (chi2 = 2.06, P = 0.15). Median survival is two years with an actuarial survival at five years of 32% (95% confidence interval (95% CI): 25%-39%). There is no significant difference between the treatment groups (chi2log-rank = 0.11, P = 0.74). CONCLUSIONS This study does not show any survival benefit from the use of neo-adjuvant BIP chemotherapy in advanced cervical cancer.
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Affiliation(s)
- J Herod
- CRC Trials Unit, Institute for Cancer Studies, University of Birmingham, Edgbaston, UK
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Abstract
To investigate the relative importance of paternity defences in the European robin we used behavioural observations, simulated intrusions and temporary male removal experiments. Given that paired males did not increase their mate attendance, copulation rate or territory size during the female's fertile period, the most frequently quoted paternity assurance strategies in birds were absent. However, males with fertile females sang and patrolled their territories more regularly, suggesting that territorial motivation and vigilance were elevated when the risk of cuckoldry was greatest. In addition, there was a significant effect of breeding period on response to simulated intrusions: residents approached and attacked freeze-dried mounts more readily in the fertile period. During 90-min removals of the pair male in the fertile period, neighbours trespassed more frequently relative to prefertile and fertile period controls and appeared to seek copulations with unattended females. When replaced on their territories, males immediately increased both song rate and patrolling rate in comparison with controls. We propose that male robins sing to signal their presence, and increase their territorial vigilance and aggression in the fertile period to protect paternity. Copyright 2000 The Association for the Study of Animal Behaviour.
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Affiliation(s)
- J Tobias
- Department of Zoology, University of Cambridge
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