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Patel K, Irizarry-Caro JA, Khan A, Holder T, Salako D, Goyal P, Kwak MJ. Definition of Polypharmacy in Heart Failure: A Scoping Review of the Literature. Cardiol Res 2024; 15:75-85. [PMID: 38645827 PMCID: PMC11027783 DOI: 10.14740/cr1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/23/2024] Open
Abstract
Patients with heart failure (HF) have a high prevalence of polypharmacy, which can lead to drug interactions, cognitive impairment, and medication non-compliance. However, the definition of polypharmacy in these patients is still inconsistent. The aim of this scoping review was to find the most common definition of polypharmacy in HF patients. We conducted a scoping review searching Medline, Embase, CINAHL, and Cochrane using terms including polypharmacy, HF and deprescribing, which resulted in 7,949 articles. Articles without a definition of polypharmacy in HF patients and articles which included patients < 18 years of age were excluded; only 59 articles were included. Of the 59 articles, 49% (n = 29) were retrospective, 20% (n = 12) were prospective, 10% (n = 6) were cross-sectional, and 27% (n = 16) were review articles. Twenty percent (n = 12) of the articles focused on HF with reduced ejection fraction, 10% (n = 6) focused on HF with preserved ejection fraction and 69% (n = 41) articles either focused on both diagnoses or did not clarify the specific type of HF. The most common cutoff for polypharmacy in HF was five medications (59%, n = 35). There was no consensus regarding the inclusion or exclusion of over-the-counter medications, supplements, or vitamins. Some newer studies used a cutoff of 10 medications (14%, n = 8), and this may be a more practical and meaningful definition for HF patients.
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Affiliation(s)
- Keshav Patel
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Jorge A. Irizarry-Caro
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Adil Khan
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Travis Holder
- Houston Academy of Medicine, The Texas Medical Center Library, Houston, TX, USA
| | | | - Parag Goyal
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Min Ji Kwak
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Irizarry-Caro JA, Song J, Miller C, Desai S, Going J, Fossas-Espinosa J, Fatakdawala MM, Ali A, Iliescu C, Palaskas N, Deswal A, Koutroumpakis E. Evaluation of Midodrine Utilization in Patients with Cancer and Heart Failure. Cardiovasc Drugs Ther 2024:10.1007/s10557-024-07546-4. [PMID: 38224416 DOI: 10.1007/s10557-024-07546-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE The purpose of this study was to evaluate safety and cardiovascular outcomes as well as overall survival of cancer patients with concomitant heart failure (HF) treated with midodrine for hypotension. METHODS Adult patients diagnosed with cancer and HF who were treated with midodrine at a tertiary cancer center from 03/2013 to 08/2021 were identified. Demographic and clinical parameters were collected retrospectively. RESULTS A total of 85 patients were included with a median age of 68 years (IQR: 60, 74; 33% female and 85% White). Of those, 31% had HFpEF (EF ≥ 50%), 42% HF with mildly reduced EF (HFmrEF; EF 41-49%), and 27% HFrEF (EF ≤ 40%). The most common indication for midodrine use was orthostatic hypotension (49%). Midodrine was continued for at least one month in 57% of the patients. Supine hypertension was the only side effect reported in 6% of patients. No statistically significant changes in NYHA class, guideline-directed medical therapy, cardiac biomarkers (NT-proBNP or troponin T), echocardiographic findings or cardiovascular hospitalizations were observed between patients who continued treatment with midodrine compared to those who stopped using midodrine over a median follow-up of 38 months. In the multivariable cox regression analysis, continuation of midodrine, compared to discontinuation, and use of midodrine for orthostatic hypotension, as opposed to other causes of hypotension, were not associated with an increased risk of mortality (HR 0.41, 95% CI 0.24-0.69, p < .0001; HR 0.34, 95% CI 0.18-0.64, p < .001, respectively). In contrast, elevated creatinine (> 1.3 for males and > 1.1 for females) was associated with an increased risk of mortality (HR 1.83, 95% CI 1.07-3.14). LVEF was not significantly associated with lower or higher risk of mortality. CONCLUSIONS In our study, midodrine use in patients with cancer and HF was not associated with significant adverse effects, worse cardiovascular outcomes, or increased risk of mortality. Larger, prospective studies are needed to confirm these findings.
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Affiliation(s)
- Jorge A Irizarry-Caro
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chase Miller
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shyam Desai
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - James Going
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jose Fossas-Espinosa
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Advanced Heart Failure and Transplant Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mariya M Fatakdawala
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1451, Houston, TX, 77030, USA
| | - Abdelrahman Ali
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1451, Houston, TX, 77030, USA
| | - Cezar Iliescu
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1451, Houston, TX, 77030, USA
| | - Nicolas Palaskas
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1451, Houston, TX, 77030, USA
| | - Anita Deswal
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1451, Houston, TX, 77030, USA
| | - Efstratios Koutroumpakis
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1451, Houston, TX, 77030, USA.
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Yarrabothula AR, Alsheikh-Kassim M, Amatullah A, Fossas J, Salman J, Seal Z, Lin H, Irizarry-Caro JA, Wanna C, Miller C, Fatakdawala M, Palaskas NL, Deswal A, Koutroumpakis E. TOLERABILITY OF SACUBITRIL-VALSARTAN IN PATIENTS WITH CANCER AND HEART FAILURE WITH REDUCED EJECTION FRACTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02769-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Amatullah A, Irizarry-Caro JA, Hoang K, Ma J, Yarrabothula AR, Haque K, Salman J, Goenka KV, Lobo N, Dhoble A, Charitakis K, Owen B. E. COLI BACTERIAL PERICARDITIS ASSOCIATED WITH SPONTANEOUS BACTERIAL PERITONITIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03923-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Koutroumpakis E, Xu T, Lopez-Mattei J, Pan T, Lu Y, Irizarry-Caro JA, Mohan R, Zhang X, Meng QH, Lin R, Xu T, Deswal A, Liao Z. Coronary artery calcium score on standard of care oncologic CT scans for the prediction of adverse cardiovascular events in patients with non-small cell lung cancer treated with concurrent chemoradiotherapy. Front Cardiovasc Med 2022; 9:1071701. [DOI: 10.3389/fcvm.2022.1071701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
IntroductionChemoradiotherapy (CRT) has been associated with increased incidence of cardiovascular (CV) adverse events (CVAE). Coronary artery calcium scoring (CAC) has shown to predict coronary events beyond the traditional CV risk factors. This study examines whether CAC, measured on standard of care, non-contrast chest CT (NCCT) imaging, predicts the development of CVAE in patients with non-small cell lung cancer (NSCLC) treated with CRT.MethodsPatients with NSCLC treated with CRT at MD Anderson Cancer Center from 7/2009 until 4/2014 and who had at least one NCCT scan within 6 months from their first CRT were identified. CAC scoring was performed on NCCT scans by an expert cardiologist and a cardiac radiologist following the 2016 SCCT/STR guidelines. CVAE were graded based on the most recent Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. CVAE were also grouped into (i) coronary/vascular events, (ii) arrhythmias, or (iii) heart failure. All CVAE were adjudicated by a board-certified cardiologist.ResultsOut of a total of 193 patients, 45% were female and 91% Caucasian. Mean age was 64 ± 9 years and mean BMI 28 ± 6 kg/m2. Of 193 patients, 74% had CAC >0 Agatston units (AU), 49% CAC ≥100 AU and 36% CAC ≥300 AU. Twenty-nine patients (15%) developed a grade ≥2 CVAE during a median follow-up of 24.3 months (IQR: 10.9–51.7). Of those, 11 (38%) were coronary/vascular events. In the multivariate cox regression analysis, controlling for mean heart dose and pre-existing CV disease, higher CAC score was independently associated with development of a grade ≥2 CVAE [HR: 1.04 (per 100 AU), 95% CI: 1.01–1.08, p = 0.022] and with worse overall survival (OS; CAC ≥100 vs. <100 AU, HR: 1.64, 95% CI: 1.11–2.44, p = 0.013). In a sub-analysis evaluating the type of the CVAE, it was the coronary/vascular events that were significantly associated with higher baseline CAC (median: 676 AU vs. 73 AU, p = 0.035).DiscussionCardiovascular adverse events are frequent in patients with NSCLC treated with CRT. CAC calculated on “standard of care” NCCT can predict the development of CVAEs and specifically coronary/vascular events, as well as OS, independently from other traditional risk factors and radiation mean heart dose.Clinical trial registration[https://clinicaltrials.gov/ct2/show/NCT00915005], identifier [NCT00915005].
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Ploch M, Ahmed T, Reyes S, Irizarry-Caro JA, Fossas-Espinosa JE, Shoar S, Amatullah A, Jogimahanti A, Antonioli M, Iliescu CA, Balan P, Naeini PS, Madjid M. Determinants of change in code status among patients with cardiopulmonary arrest admitted to the intensive care unit. Resuscitation 2022; 181:190-196. [PMID: 36174763 DOI: 10.1016/j.resuscitation.2022.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with cardiopulmonary arrest often have a poor prognosis, prompting discussion with families about code status. The impact of socioeconomic factors, demographics, medical comorbidities and medical interventions on code status changes is not well understood. METHODS This retrospective study included adult patients presenting with cardiac arrest to the intensive care unit of a hospital group between 5/1/2010-5/1/2020. We extracted chart data on socioeconomic factors, demographics, and medical comorbidities. RESULTS We identified 1,254 patients, of which 57.5% were males. Age was different across the groups with (61.2 ± 15.5 years) and without (61.2 ± 15.5 years) code status change (p= <0.0001). Code status was changed in 583 patients (46.5%). Among patients with code status change, the highest prevalence was White patients (34.8%), followed by African Americans (30.9%), and Hispanics (25.4%). Compared to patients who did not have a code status change, those with a change in code status were older (66.7 ± 14.8 years vs 61.2 ± 15.5 years). They were also more likely to receive vasopressor/inotropic support (74.6% vs 58.5%), and broad-spectrum antibiotics (70.3% vs 57.7%). Insurance status, ethnicity, religion, education, and salary did not lead to statistically significant changes in code status. CONCLUSIONS In patients with cardiopulmonary arrest, code status change was more likely to be influenced by the presence of medical comorbidities and medical interventions during hospitalization rather than by socioeconomic factors.
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Affiliation(s)
- Michelle Ploch
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Talha Ahmed
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States; Heart and Vascular Institute, Memorial Hermann Hospital, Houston, TX, United States
| | - Stephan Reyes
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jorge A Irizarry-Caro
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jose E Fossas-Espinosa
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Saeed Shoar
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States; Heart and Vascular Institute, Memorial Hermann Hospital, Houston, TX, United States
| | - Atia Amatullah
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Arjun Jogimahanti
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Matthew Antonioli
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cesar A Iliescu
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Prakash Balan
- Department of Cardiology, Banner University Medical Center, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Payam Safavi Naeini
- Center for Cardiac Arrhythmias and Electrophysiology, Texas Heart Institute, Houston, TX, United States
| | - Mohammad Madjid
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States; Heart and Vascular Institute, Memorial Hermann Hospital, Houston, TX, United States; Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States.
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Ahmed T, Marmagkiolis K, Ploch M, Irizarry-Caro JA, Amatullah A, Desai S, Aziz MK, Yarrabothula A, Fossas-Espinosa J, Koutroumpakis E, Hassan S, Karimzad K, Kim P, Cilingiroglu M, Iliescu C. The year in Cardio-oncology 2022. Curr Probl Cardiol 2022; 48:101435. [DOI: 10.1016/j.cpcardiol.2022.101435] [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] [Received: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 10/14/2022]
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Ploch M, Ahmed T, Reyes S, Irizarry-Caro JA, Fossas-Espinosa JE, Shoar S, Amatullah A, Safavi-Naeini P, Jogimahanti A, Antonioli M, Iliescu CA, Balan P, Madjid M. Abstract 157: Clinical And Social Determinants Of Change In Code Status Among Patients Hospitalized With Covid-19. Circ Cardiovasc Qual Outcomes 2022. [DOI: 10.1161/circoutcomes.15.suppl_1.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Patients hospitalized with COVID-19 who develop cardiopulmonary arrest often have poor prognosis, prompting discussions with families about goals of care. The relationship between clinical and social determinants of code status change is poorly understood.
Methods:
This retrospective study included adult COVID-19 positive patients admitted to the intensive care unit with cardiac arrest in a multihospital center over the first 9 months of the pandemic (3/1/2020 - 12/1/2020). Data on medical and social factors was collected and adjudicated.
Results:
We identified 208 patients over the study timeline. The mean age was 63.7 ± 14.5 years and 54.3% (n=113) were male. The majority of patients with cardiopulmonary arrest had pulseless electrical activity (PEA) as their initial rhythm (91.3%, n=190). Code status was changed in 56.3% (n=117) of patients. The majority of COVID-19 patients with cardiac arrest were Hispanic (53.4%, n=111), followed by African American (27.9%, n=58), and White patients (13.5%, n=28). Race/ethnicity did not affect the rate of code status change. COVID-19 patients who had a code status change were statistically more likely to have a lower salary ($54,838 vs $62,374), have a history of stroke/transient ischemic attack (15.4 vs 4.4%, 18:4), or heart failure (28.2 vs 15.6%, 33:14), all with P<0.05. Patients with code status change had shorter courses of cardiopulmonary resuscitation (11.9 vs 16.9 minutes, P<0.05). Both groups had similar levels of aggressive care received including continuous renal replacement therapy, vasopressor and broad-spectrum antibiotics requirements. Insurance status, ethnicity, religion, and education did not lead to statistically significant changes in code status in COVID patients.
Conclusion:
Patients hospitalized with cardiopulmonary arrest and positive for COVID-19 are more likely to have a change in code status. This code status change is affected by cardiovascular comorbidities such as stroke and heart failure, along with lower income but not by insurance status, ethnicity, religion, and educational level.
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Affiliation(s)
- Michelle Ploch
- Dept of Medicine, Univ of Texas Health Science Cntr at Houston, Houston, TX
| | - Talha Ahmed
- Div of Cardiology, Dept of Medicine, Univ of Texas Health Science Cntr at Houston, Houston, TX
| | - Stephan Reyes
- Dept of Medicine, Univ of Texas Health Science Cntr at Houston, Houston, TX
| | | | | | - Saeed Shoar
- Div of Cardiology, Dept of Medicine, Univ of Texas Health Science Cntr at Houston, Houston, TX
| | - Atia Amatullah
- Dept of Medicine, Univ of Texas Health Science Cntr at Houston, Houston, TX
| | | | - Arjun Jogimahanti
- Dept of Medicine, Univ of Texas Health Science Cntr at Houston, Houston, TX
| | - Matthew Antonioli
- Dept of Medicine, Univ of Texas Health Science Cntr at Houston, Houston, TX
| | - Cesar A Iliescu
- Dept of Cardiology, Div of Internal Medicine, The Univ of Texas MD Anderson Cancer Cntr, Houston, TX
| | - Prakash Balan
- Dept of Cardiology, Univ of Arizona College of Medicine, Phoenix, AZ
| | - Mohammad Madjid
- Div of Cardiology, Dept of Medicine, David Geffen Sch of Medicine, Univ of California, Los Angeles (UCLA), Los Angeles, CA
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Shekhar S, Irizarry-Caro JA, Sinaii N, Gahl W, Estrada-Veras JI, Dave R, Papadakis GZ, Patronas N, Stratakis CA, O’Brien K, Hannah-Shmouni F. Abnormal Pituitary Imaging and Associated Endocrine Dysfunctions in Erdheim-Chester Disease. J Endocr Soc 2021. [PMCID: PMC8090311 DOI: 10.1210/jendso/bvab048.1268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: Erdheim Chester disease (ECD) is a rare histiocytic neoplasm associated with hypothalamic and pituitary infiltration and dysfunction. We determined the abnormal pituitary imaging (API) phenotypes in subjects with ECD and analyzed their associated endocrine dysfunctions. Methods: This was a cross-sectional examination of a natural history cohort study of 61 subjects with ECD performed at a tertiary care clinical research center. The diagnosis of ECD was based on clinical, molecular, and histopathological features. Enrolled subjects underwent baseline endocrine tests of anterior and posterior pituitary function in addition to pituitary imaging. The following variables were analyzed- age, sex, body mass index (BMI), BRAF V600E, hsCRP, ESR, pituitary hormone deficit number, diabetes insipidus (DI), and panhypopituitarism. Fisher’s exact test or t-test/Wilcoxon tests compared patients with and without API. Results: Sixty-one subjects with ECD (age ±SD: 54.3 ±10.9, 46 (75.4%) males) were studied. The prevalence of API was 32.8% (n=20), who were younger than those with normal imaging (50.3 ±10.5 vs 56.3 ±10.7 yrs, p=0.042). The most common pituitary imaging abnormalities included thickened pituitary stalk (18.03%, n=11/61), followed by pituitary encasement, small pituitary and abnormal morphology (6.55%, n= 4/61 for each). A higher prevalence of DI (45.0% vs 9.8%, p=0.003) and panhypopituitarism (45.0% vs 4.9%, p<0.001), and a higher number of pituitary deficits (median (IQR): 2.0 (0-2.5) vs 0 (0-1.0), p=0.007) were noted in patients with API compared to those with normal imaging. Other biochemical markers were similar between both groups. Conclusion: Abnormal pituitary imaging was commonly seen in ECD and was also associated with a younger age and hormone deficits suggesting associations with pituitary structure-function.
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Affiliation(s)
- Skand Shekhar
- NICHD and NIEHS, National Institutes of Health, Bethesda, MD, USA
| | | | - Ninet Sinaii
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - William Gahl
- NHGRI, National Institutes of Health, Bethesda, MD, USA
| | | | - Rahul Dave
- NHGRI, National Institutes of Health and Inova Fairfax VCU College of Medicine, Fairfax, VA, USA
| | | | - Nicholas Patronas
- Foundation for Research and Technology Hellas (FORTH), Computational Biomedicine Laboratory (CBML), Heraklion, Greece
- Department of Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Kevin O’Brien
- NHGRI, National Institutes of Health, Bethesda, MD, USA
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Kim PY, Irizarry-Caro JA, Ramesh T, Iliescu C, Lopez-Mattei JC. How to Diagnose and Manage QT Prolongation in Cancer Patients. JACC CardioOncol 2021; 3:145-149. [PMID: 34396315 PMCID: PMC8352274 DOI: 10.1016/j.jaccao.2021.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 10/25/2022] Open
Affiliation(s)
- Peter Y. Kim
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jorge A. Irizarry-Caro
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Tushar Ramesh
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Cezar Iliescu
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan C. Lopez-Mattei
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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11
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Shekhar S, Sinaii N, Irizarry-Caro JA, Gahl WA, Estrada-Veras JI, Dave R, Papadakis GZ, Tirosh A, Abel BS, Klubo-Gwiezdzinska J, Skarulis MC, Gochuico BR, O’Brien K, Hannah-Shmouni F. Prevalence of Hypothyroidism in Patients With Erdheim-Chester Disease. JAMA Netw Open 2020; 3:e2019169. [PMID: 33119105 PMCID: PMC7596581 DOI: 10.1001/jamanetworkopen.2020.19169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis affecting multiple organs and commonly caused by somatic pathogenic variants in BRAF V600E and mitogen-activated protein kinase genes. Clinical features of ECD result from histiocytic involvement of various tissues; while endocrine involvement in ECD occurs frequently, the prevalence of central or primary hypothyroidism has not been thoroughly investigated. OBJECTIVE To assess hypothalamus-pituitary-thyroid (HPT) dysfunction in patients with ECD. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 61 patients with ECD who were enrolled in a natural history study at a tertiary care center between January 2011 and December 2018. ECD was diagnosed on the basis of clinical, genetic, and histopathological features. Data were analyzed in March 2020. EXPOSURE Diagnosis of ECD. MAIN OUTCOMES AND MEASURES Main outcome was the prevalence of thyroid dysfunction in adults with ECD compared with community estimates. Patients underwent baseline evaluation with a thyroid function test, including thyrotropin, free thyroxine (fT4), and total thyroxine (T4), and sellar imaging with magnetic resonance imaging or computed tomography scan. The association of HPT dysfunction was assessed for differences in age, sex, body mass index, BRAF V600E status, high sensitivity C-reactive protein level, sellar imaging, and pituitary hormonal dysfunction. RESULTS A total of 61 patients with ECD (46 [75%] men; mean [SD] age, 54.3 [10.9] years) were evaluated. Seventeen patients (28%) had hypothyroidism requiring levothyroxine therapy. The prevalence of both central and primary hypothyroidism were higher than community estimates (central hypothyroidism: 9.8% vs 0.1%; odds ratio, 109.0; 95% CI, 37.4-260.6; P < .001; primary hypothyroidism: 18.0% vs 4.7%; OR, 4.4; 95% CI, 2.1-8.7; P < .001). Patients with hypothyroidism (both primary and central), compared with patients with euthyroidism, had higher body mass index (median [interquartile range] 31.4 [28.3-38.3] vs 26.7 [24.4-31.9]; P = .004) and a higher prevalence of panhypopituitarism (7 [47%] vs 3 [7%]; P < .001). Among patients with hypothyroidism, those with central hypothyroidism, compared with patients with primary hypothyroidism, had a lower mean (SD) body mass index (28.3 [2.6] vs 36.3 [5.9]; P = .007) and higher frequencies of abnormal sellar imaging (5 [83%] vs 3 [27%]; P = .050) and panhypopituitarism (5 [83%] vs 3 [27%]; P = .050). CONCLUSIONS AND RELEVANCE In this cohort study, a higher prevalence of central and primary hypothyroidism was identified in patients with ECD compared with the community. There should be a low threshold for testing for hypothyroidism in patients with ECD, and treatment should follow standard guidelines.
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Affiliation(s)
- Skand Shekhar
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Ninet Sinaii
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Jorge A. Irizarry-Caro
- Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - William A Gahl
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Rahul Dave
- Inova Fairfax-Virginia Commonwealth University College of Medicine, Falls Church
| | - Georgios Z. Papadakis
- Department of Radiology, Medical School, University of Crete, Heraklion, Greece
- Foundation for Research and Technology Hellas, Computational Biomedicine Laboratory, Heraklion, Greece
| | - Amit Tirosh
- Neuroendocrine Tumor Service, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brent S. Abel
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Joanna Klubo-Gwiezdzinska
- Thyroid Tumors and Functional Thyroid Disorders Section, Metabolic Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Monica C. Skarulis
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Bernadette R. Gochuico
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Kevin O’Brien
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Fady Hannah-Shmouni
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Carmona-Rivera C, Khaznadar SS, Shwin KW, Irizarry-Caro JA, O'Neil LJ, Liu Y, Jacobson KA, Ombrello AK, Stone DL, Tsai WL, Kastner DL, Aksentijevich I, Kaplan MJ, Grayson PC. Deficiency of adenosine deaminase 2 triggers adenosine-mediated NETosis and TNF production in patients with DADA2. Blood 2019; 134:395-406. [PMID: 31015188 PMCID: PMC6659253 DOI: 10.1182/blood.2018892752] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/08/2019] [Indexed: 12/30/2022] Open
Abstract
Reduction of adenosine deaminase 2 (ADA2) activity due to autosomal-recessive loss-of-function mutations in the ADA2 gene (previously known as CECR1) results in a systemic vasculitis known as deficiency of ADA2 (DADA2). Neutrophils and a subset of neutrophils known as low-density granulocytes (LDGs) have been implicated in the pathogenesis of vasculitis, at least in part, through the formation of neutrophil extracellular traps (NETs). The study objective was to determine whether neutrophils and NETs play a pathogenic role in DADA2. In vivo evidence demonstrated NETs and macrophages in affected gastrointestinal tissue from patients with DADA2. An abundance of circulating LDGs prone to spontaneous NET formation was observed during active disease in DADA2 and were significantly reduced after remission induction by anti-tumor necrosis factor (TNF) therapy. Increased circulating LDGs were identified in unaffected family members with monoallelic ADA2 mutations. Adenosine triggered NET formation, particularly in neutrophils from female patients, by engaging A1 and A3 adenosine receptors (ARs) and through reactive oxygen species- and peptidylarginine deiminase-dependent pathways. Adenosine-induced NET formation was inhibited by recombinant ADA2, A1/A3 AR antagonists, or by an A2A agonist. M1 macrophages incubated with NETs derived from patients with DADA2 released significantly greater amounts of TNF-α. Treatment with an A2AAR agonist decreased nuclear translocation of NF-κB and subsequent production of inflammatory cytokines in DADA2 monocyte-derived macrophages. These results suggest that neutrophils may play a pathogenic role in DADA2. Modulation of adenosine-mediated NET formation may contribute a novel and directed therapeutic approach in the treatment of DADA2 and potentially other inflammatory diseases.
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Affiliation(s)
- Carmelo Carmona-Rivera
- Systemic Autoimmunity Branch, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Sami S Khaznadar
- Molecular Recognition Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Kyawt W Shwin
- Division of Rheumatic Diseases, Dallas VA Medical Center, UT Southwestern Medical Center, Dallas, TX
| | - Jorge A Irizarry-Caro
- Systemic Autoimmunity Branch, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Liam J O'Neil
- Systemic Autoimmunity Branch, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Yudong Liu
- Systemic Autoimmunity Branch, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Kenneth A Jacobson
- Molecular Recognition Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Amanda K Ombrello
- Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD; and
| | - Deborah L Stone
- Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD; and
| | - Wanxia L Tsai
- Translational Immunology Section, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Daniel L Kastner
- Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD; and
| | - Ivona Aksentijevich
- Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD; and
| | - Mariana J Kaplan
- Systemic Autoimmunity Branch, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Peter C Grayson
- Systemic Autoimmunity Branch, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
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13
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Irizarry-Caro JA, Carmona-Rivera C, Schwartz DM, Khaznadar SS, Kaplan MJ, Grayson PC. Brief Report: Drugs Implicated in Systemic Autoimmunity Modulate Neutrophil Extracellular Trap Formation. Arthritis Rheumatol 2018; 70:468-474. [PMID: 29121457 DOI: 10.1002/art.40372] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 11/02/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Aberrant neutrophil extracellular trap (NET) formation has been implicated as a mechanism to induce autoreactivity in individuals at risk of autoimmune diseases. The objective of this study was to assess whether medications implicated in cases of drug-induced autoimmunity (hydralazine and procainamide) and medications less commonly associated with drug-induced autoimmunity (minocycline and clozapine) induce NET formation and/or prevent NET degradation. METHODS Human neutrophils were incubated with the drugs of interest and resultant NET formation was quantified by fluorescent microscopy. The ability of these drugs to interfere with NET degradation by serum nuclei was assessed. Pathways of drug-induced NET formation were studied with pharmacologic inhibitors of reactive oxygen species (ROS), peptidylarginine deiminases (PADs), and muscarinic receptors, and by assessment of intracellular calcium levels by flow cytometry. To determine if NET protein cargo varies by drug stimulus and/or neutrophil source, proteomic analysis of NET lysates induced by specific medications was compared using neutrophils from healthy donors and from patients with autoimmune diseases. RESULTS Hydralazine and procainamide significantly induced NET formation while minocycline and clozapine did not. None of the medications significantly impaired NET degradation. NETosis induced by these drugs required NADPH oxidase and PAD4 activation. Procainamide triggered NETs via muscarinic receptor engagement on neutrophils, while hydralazine modulated calcium release from intracellular stores. Differences in protein cargo, particularly histone content, were observed in NETs induced by hydralazine and procainamide. CONCLUSION Medications commonly implicated in drug-induced autoimmunity trigger NET formation displaying distinct protein cargo, via common and specific pathways. NETosis may play a role in the pathogenesis of drug-induced autoimmunity.
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Affiliation(s)
- Jorge A Irizarry-Caro
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Carmelo Carmona-Rivera
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Daniella M Schwartz
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Sami S Khaznadar
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Mariana J Kaplan
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
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14
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Irizarry-Caro JA, Ernst M, Court C, Rattray A, Bubunenko M, Jin D, Court D, Strathern J. Abstract 2219: Development of an assay to detect transcription misincorporation errors in Escherichia coli. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-2219] [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
In contrast to errors in DNA replication which can product heritable mutations, errors in transcription cause only transient alterations. The temporary nature of these transcription mistakes has made them difficult to detect and genetic screens to identify mutations that lower the fidelity of transcription have been problematic. We addressed this problem by developing methods to turn transient transcription errors into permanent genetic changes. The principle is based on suppression of a mutation in the active site of the cre recombinase. This assay is based on two parts: a source of Cre, which is actually the transcription misincorporation substrate, and a genetic reporter with a phenotypic change created by Cre-mediated recombination between lox sites. To develop a substrate for E. coli we chose the galactokinase gene (galK) as our reporter. From an alignment of the galK protein from E.coli, H. sapiens and L. lactis we identified sites that might be able to accept a 12aa insertion encoded by the LoxP sequence without disrupting its function. We selected four different sites that were away from the GalK active site and on the surface of the protein. We started our project using the strain MG1655, which is galK (+), able to grow in galactose as a carbon source and red on a MacConkey galactose plate (MAcGal). Using oligo recombineering, we first inserted a 7 base sequence, which caused a frame-shift mutation, the cells became galK (-) and, therefore white on MacGal. To put it back in frame, we next replaced the 7 bases with a 36 base loxP site, which, if it does not disrupt the function of galK will make the cells galK (+) again. To our surprise, the insertion of this LoxP site was completely successful, putting the gene back in frame and making the cells galK (+) and, therefore, red at each of the four sites we chose. A derivative of this reporter was made with the a portion of the galK gene inverted at one of the loxP sites. Active Cre recombinase can be detected by flipping the inversion to restore galK function. The active site mutant cre-Y324C exhibits a very low inversion rate. Mutations that reduce the accuracy of transcription, such as cells defective in greA, exhibit an elevated frequency of galK (+) inversions. This system will be used to identify additional mutations that reduce the fidelity of transcription in E. coli.
Citation Format: Jorge A. Irizarry-Caro, Mary Ernst, Carolyn Court, Alison Rattray, Mikhail Bubunenko, Ding Jin, Donald Court, Jeffrey Strathern. Development of an assay to detect transcription misincorporation errors in Escherichia coli. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2219. doi:10.1158/1538-7445.AM2015-2219
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Affiliation(s)
| | - Mary Ernst
- 2National Cancer Institute, Frederick, MD
| | | | | | | | - Ding Jin
- 2National Cancer Institute, Frederick, MD
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