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Ruthirakuhan M, Swardfager W, Xiong L, MacIntosh BJ, Rabin JS, Lanctôt KL, Ottoy J, Ramirez J, Keith J, Black SE. Investigating the impact of hypertension with and without diabetes on Alzheimer's disease risk: A clinico-pathological study. Alzheimers Dement 2024; 20:2766-2778. [PMID: 38425134 PMCID: PMC11032528 DOI: 10.1002/alz.13717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Hypertension and diabetes are common cardiovascular risk factors that increase Alzheimer's disease (AD) risk. However, it is unclear whether AD risk differs in hypertensive individuals with and without diabetes. METHODS Cognitively normal individuals (N = 11,074) from the National Alzheimer's Coordinating Center (NACC) were categorized as having (1) hypertension with diabetes (HTN+/DM+), (2) hypertension without diabetes (HTN+/DM-), or (3) neither (HTN-/DM-). AD risk in HTN+/DM+ and HTN+/DM- was compared to HTN-/DM-. This risk was then investigated in those with AD neuropathology (ADNP), cerebral amyloid angiopathy (CAA), cerebrovascular neuropathology (CVNP), arteriolosclerosis, and atherosclerosis. Finally, AD risk in HTN-/DM+ was compared to HTN-/DM-. RESULTS Seven percent (N = 830) of individuals developed AD. HTN+/DM+ (hazard ratio [HR] = 1.31 [1.19-1.44]) and HTN+/DM- (HR = 1.24 [1.17-1.32]) increased AD risk compared to HTN-/DM-. AD risk was greater in HTN+/DM+ with ADNP (HR = 2.10 [1.16-3.79]) and CAA (HR = 1.52 [1.09-2.12]), and in HTN+/DM- with CVNP (HR = 1.54 [1.17-2.03]). HTN-/DM+ also increased AD risk (HR = 1.88 [1.30-2.72]) compared to HTN-/DM-. DISCUSSION HTN+/DM+ and HTN+/DM- increased AD risk compared to HTN-/DM-, but pathological differences between groups suggest targeted therapies may be warranted based on cardiovascular risk profiles. HIGHLIGHTS AD risk was studied in hypertensive (HTN+) individuals with/without diabetes (DM+/-). HTN+/DM+ and HTN+/DM- both had an increased risk of AD compared to HTN-/DM-. Post mortem analysis identified neuropathological differences between HTN+/DM+ and HTN+/DM-. In HTN+/DM+, AD risk was greater in those with AD neuropathology and CAA. In HTN+/DM-, AD risk was greater in those with cerebrovascular neuropathology.
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Affiliation(s)
- Myuri Ruthirakuhan
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Walter Swardfager
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
| | - Lisa Xiong
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
| | - Bradley J. MacIntosh
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
| | - Jennifer S. Rabin
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of NeurologyDepartment of MedicineSunnybrook Health Sciences CentreTorontoOntarioCanada
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
| | - Krista L. Lanctôt
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
- Department of PsychiatrySunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Julie Ottoy
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Joel Ramirez
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Julia Keith
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of Anatomic PathologySunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Sandra E. Black
- Dr. Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of NeurologyDepartment of MedicineSunnybrook Health Sciences CentreTorontoOntarioCanada
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Zeng KL, Soliman H, Myrehaug S, Tseng CL, Detsky J, Chen H, Lim-Fat MJ, Ruschin M, Atenafu EG, Keith J, Lipsman N, Heyn C, Maralani P, Das S, Pirouzmand F, Sahgal A. Dose-Escalated Radiation Therapy Is Associated With Improved Outcomes for High-Grade Meningioma. Int J Radiat Oncol Biol Phys 2024; 118:662-671. [PMID: 37793575 DOI: 10.1016/j.ijrobp.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE The optimal modern radiation therapy (RT) approach after surgery for atypical and malignant meningioma is unclear. We present results of dose escalation in a single-institution cohort spanning 2000 to 2021. METHODS AND MATERIALS Consecutive patients with histopathologic grade 2 or 3 meningioma treated with RT were reviewed. A dose-escalation cohort (≥66 Gy equivalent dose in 2-Gy fractions using an α/β = 10) was compared with a standard-dose cohort (<66 Gy). Outcomes were progression-free survival (PFS), cause-specific survival, overall survival (OS), local failure (LF), and radiation necrosis. RESULTS One hundred eighteen patients (111 grade 2, 94.1%) were identified; 54 (45.8%) received dose escalation and 64 (54.2%) standard dose. Median follow-up was 45.4 months (IQR, 24.0-80.0 months) and median OS was 9.7 years (Q1: 4.6 years, Q3: not reached). All dose-escalated patients had residual disease versus 65.6% in the standard-dose cohort (P < .001). PFS at 3, 4, and 5 years in the dose-escalated versus standard-dose cohort was 78.9%, 72.2%, and 64.6% versus 57.2%, 49.1%, and 40.8%, respectively, (P = .030). On multivariable analysis, dose escalation (hazard ratio [HR], 0.544; P = .042) was associated with improved PFS, whereas ≥2 surgeries (HR, 1.989; P = .035) and older age (HR, 1.035; P < .001) were associated with worse PFS. The cumulative risk of LF was reduced with dose escalation (P = .016). Multivariable analysis confirmed that dose escalation was protective for LF (HR, 0.483; P = .019), whereas ≥2 surgeries before RT predicted for LF (HR, 2.145; P = .008). A trend was observed for improved cause-specific survival and OS in the dose-escalation cohort (P < .1). Seven patients (5.9%) developed symptomatic radiation necrosis with no significant difference between the 2 cohorts. CONCLUSIONS Dose-escalated RT with ≥66 Gy for high-grade meningioma is associated with improved local control and PFS with an acceptable risk of radiation necrosis.
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Affiliation(s)
- K Liang Zeng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mary-Jane Lim-Fat
- Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
| | - Julia Keith
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Chris Heyn
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Pejman Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sunit Das
- Division of Neurosurgery, Unity Health Toronto, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Farhad Pirouzmand
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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McKeever PM, Sababi AM, Sharma R, Khuu N, Xu Z, Shen SY, Xiao S, McGoldrick P, Orouji E, Ketela T, Sato C, Moreno D, Visanji N, Kovacs GG, Keith J, Zinman L, Rogaeva E, Goodarzi H, Bader GD, Robertson J. Single-nucleus multiomic atlas of frontal cortex in amyotrophic lateral sclerosis with a deep learning-based decoding of alternative polyadenylation mechanisms. bioRxiv 2023:2023.12.22.573083. [PMID: 38187588 PMCID: PMC10769403 DOI: 10.1101/2023.12.22.573083] [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] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
The understanding of how different cell types contribute to amyotrophic lateral sclerosis (ALS) pathogenesis is limited. Here we generated a single-nucleus transcriptomic and epigenomic atlas of the frontal cortex of ALS cases with C9orf72 (C9) hexanucleotide repeat expansions and sporadic ALS (sALS). Our findings reveal shared pathways in C9-ALS and sALS, characterized by synaptic dysfunction in excitatory neurons and a disease-associated state in microglia. The disease subtypes diverge with loss of astrocyte homeostasis in C9-ALS, and a more substantial disturbance of inhibitory neurons in sALS. Leveraging high depth 3'-end sequencing, we found a widespread switch towards distal polyadenylation (PA) site usage across ALS subtypes relative to controls. To explore this differential alternative PA (APA), we developed APA-Net, a deep neural network model that uses transcript sequence and expression levels of RNA-binding proteins (RBPs) to predict cell-type specific APA usage and RBP interactions likely to regulate APA across disease subtypes.
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Zeng KL, Soliman H, Myrehaug SD, Tseng CL, Detsky J, Chen H, Lim-Fat MJ, Ruschin ME, Atenafu E, Keith J, Lipsman N, Heyn C, Maralani P, Das S, Pirouzmand F, Sahgal A. Outcomes Following Dose Escalated Radiotherapy for High Grade Meningioma. Int J Radiat Oncol Biol Phys 2023; 117:e161. [PMID: 37784757 DOI: 10.1016/j.ijrobp.2023.06.991] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Conventionally fractionated radiotherapy (RT) is a defined treatment following surgery for atypical and malignant meningioma. However, the optimal radiotherapeutic approach is not well defined. We present the results of our dose-escalation strategy. MATERIALS/METHODS Consecutive patients with a histopathologic grade 2 or 3 meningioma treated with RT were retrospectively reviewed. The primary outcome was progression-free survival (PFS), and secondary outcomes included cause-specific survival (CSS), overall survival (OS), local failure and incidence of radiation necrosis. We specifically compared the dose-escalation cohort, defined as those treated with ≥66 Gy EQD2 (equivalent dose in 2 Gy fractions, a/b = 10), to the standard dose cohort receiving <66 Gy EQD2. We defined adjuvant as RT delivered within 6 months of surgery otherwise the treatment was salvage. RESULTS A total of 118 patients with Grade 2 (111/118) or 3 (7/118) meningioma were identified. 54/118 (45.8%) received dose-escalation and 64/118 (54.2%) standard dosing. 34/54 (63.0%) dose-escalated and 45/64 (70.3%) standardly dosed were treated adjuvantly. The median follow-up was 45.4 months (IQR: 24.0-80.0 months) and median OS was 9.7 years. Post-operative residual disease was present in all dose-escalated patients, as compared to 65.6% in the standard dose cohort. PFS at 3-, 4- and 5-years in the dose-escalated vs. standard dose cohort were 78.9%, 72.2% and 64.6% vs. 57.2%, 49.1% and 40.8%, respectively, (p = 0.030). On multivariable (MVA) analysis, dose-escalation (HR: 0.544, 95% CI: 0.303-0.977, p = 0.042) was associated with improved PFS, whereas ≥2 surgeries (HR: 1.989, 95% CI: 1.049-3.773, p = 0.035) and older age (HR: 1.035, 95% CI:1.015-1.056, p<0.001) associated with worse PFS. The cumulative risk of local failure at 3-, 4- and 5-years in the dose-escalated vs. standard dose cohort were 16.9%, 23.8% and 31.8% vs. 39.6%, 45.6% and 53.9%, respectively, favoring dose-escalation (p = 0.016). MVA confirmed dose-escalation as predictive of a lower risk of LF (HR: 0.483, 95% CI: 0.263-0.887, p = 0.019), while ≥2 surgeries prior to RT predicted for greater LF rates (HR:2.145, 95% CI:1.220-3.771, p = 0.008). A trend was observed for prolonged CSS and OS in the dose escalation cohort (p = <0.1). Seven patients (5.9%) developed symptomatic radiation necrosis (RN) with no significant difference between the two cohorts. CONCLUSION Dose-escalated radiotherapy for high grade meningioma to at least 66 Gy is associated with significantly improved rates of local control and PFS with an acceptable risk of RN.
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Affiliation(s)
- K L Zeng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - M J Lim-Fat
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - M E Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - J Keith
- Department of Neuropathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - N Lipsman
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - C Heyn
- Department of Neuroradiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S Das
- Division of Neurosurgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - F Pirouzmand
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Keith J, Shannon P. Brain pathology of lissencephaly type 2 with an ISPD pathogenic variant. Neuropathol Appl Neurobiol 2023; 49:e12939. [PMID: 37766395 DOI: 10.1111/nan.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Julia Keith
- Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Shannon
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Keith J, Christakopoulos GE, Fernandez AG, Yao Y, Zhang J, Mayberry K, Telange R, Sweileh RBA, Dudley M, Westbrook C, Sheppard H, Weiss MJ, Lechauve C. Loss of miR-144/451 alleviates β-thalassemia by stimulating ULK1-mediated autophagy of free α-globin. Blood 2023; 142:918-932. [PMID: 37339583 PMCID: PMC10517214 DOI: 10.1182/blood.2022017265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 05/08/2023] [Accepted: 05/29/2023] [Indexed: 06/22/2023] Open
Abstract
Most cells can eliminate unstable or misfolded proteins through quality control mechanisms. In the inherited red blood cell disorder β-thalassemia, mutations in the β-globin gene (HBB) lead to a reduction in the corresponding protein and the accumulation of cytotoxic free α-globin, which causes maturation arrest and apoptosis of erythroid precursors and reductions in the lifespan of circulating red blood cells. We showed previously that excess α-globin is eliminated by Unc-51-like autophagy activating kinase 1 (ULK1)-dependent autophagy and that stimulating this pathway by systemic mammalian target of rapamycin complex 1 (mTORC1) inhibition alleviates β-thalassemia pathologies. We show here that disrupting the bicistronic microRNA gene miR-144/451 alleviates β-thalassemia by reducing mTORC1 activity and stimulating ULK1-mediated autophagy of free α-globin through 2 mechanisms. Loss of miR-451 upregulated its target messenger RNA, Cab39, which encodes a cofactor for LKB1, a serine-threonine kinase that phosphorylates and activates the central metabolic sensor adenosine monophosphate-activated protein kinase (AMPK). The resultant enhancement of LKB1 activity stimulated AMPK and its downstream effects, including repression of mTORC1 and direct activation of ULK1. In addition, loss of miR-144/451 inhibited the expression of erythroblast transferrin receptor 1, causing intracellular iron restriction, which has been shown to inhibit mTORC1, reduce free α-globin precipitates, and improve hematological indices in β-thalassemia. The beneficial effects of miR-144/451 loss in β-thalassemia were inhibited by the disruption of Cab39 or Ulk1 genes. Together, our findings link the severity of β-thalassemia to a highly expressed erythroid microRNA locus and a fundamental, metabolically regulated protein quality control pathway that is amenable to therapeutic manipulation.
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Affiliation(s)
- Julia Keith
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | | | - Yu Yao
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jingjing Zhang
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kalin Mayberry
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Rahul Telange
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Razan B. A. Sweileh
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Michael Dudley
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Camilla Westbrook
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Heather Sheppard
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Cell and Molecular Biology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Mitchell J. Weiss
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Christophe Lechauve
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
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Moore-Palhares D, Chen H, Keith J, Wang M, Myrehaug S, Tseng CL, Detsky J, Perry J, Lim-Fat MJ, Heyn C, Maralani P, Lipsman N, Das S, Sahgal A, Soliman H. Correction to: Re-irradiation for recurrent high-grade glioma: an analysis of prognostic factors for survival and predictors of radiation necrosis. J Neurooncol 2023; 163:553. [PMID: 37378836 DOI: 10.1007/s11060-023-04364-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Affiliation(s)
- Daniel Moore-Palhares
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Julia Keith
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Michael Wang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - James Perry
- Division of Neurology, Department of Medicine Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Mary Jane Lim-Fat
- Division of Neurology, Department of Medicine Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Chris Heyn
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Pejman Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sunit Das
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
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Moore-Palhares D, Chen H, Keith J, Wang M, Myrehaug S, Tseng CL, Detsky J, Perry J, Lim-Fat MJ, Heyn C, Maralani P, Lipsman N, Das S, Sahgal A, Soliman H. Re-irradiation for recurrent high-grade glioma: an analysis of prognostic factors for survival and predictors of radiation necrosis. J Neurooncol 2023; 163:541-551. [PMID: 37256526 DOI: 10.1007/s11060-023-04340-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/11/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Recurrent high-grade glioma (rHGG) is a heterogeneous population, and the ideal patient selection for re-irradiation (re-RT) has yet to be established. This study aims to identify prognostic factors for rHGG patients treated with re-RT. METHODS We retrospectively reviewed consecutive adults with rHGG who underwent re-RT from 2009 to 2020 from our institutional database. The primary objective was overall survival (OS). Secondary endpoints included prognostic factors for early death (< 6 months after re-RT) and predictors of radiation necrosis (RN). RESULTS For the 79 patients identified, the median OS after re-RT was 9.9 months (95% CI 8.3-11.6). On multivariate analyses, re-resection at progression (HR 0.56, p = 0.027), interval from primary treatment to first progression ≥ 16.3 months (HR 0.61, p = 0.034), interval from primary treatment to re-RT ≥ 23.9 months (HR 0.35, p < 0.001), and re-RT PTV volume < 112 cc (HR 0.27, p < 0.001) were prognostic for improved OS. Patients who had unmethylated-MGMT tumours (OR 12.4, p = 0.034), ≥ 3 prior systemic treatment lines (OR 29.1, p = 0.022), interval to re-RT < 23.9 months (OR 9.0, p = 0.039), and re-RT PTV volume ≥ 112 cc (OR 17.8, p = 0.003) were more likely to die within 6 months of re-RT. The cumulative incidence of RN was 11.4% (95% CI 4.3-18.5) at 12 months. Concurrent bevacizumab use (HR < 0.001, p < 0.001) and cumulative equivalent dose in 2 Gy fractions (EQD2, α/β = 2) < 99 Gy2 (HR < 0.001, p < 0.001) were independent protective factors against RN. Re-RT allowed for less corticosteroid dependency. Sixty-six percent of failures after re-RT were in-field. CONCLUSION We observe favorable OS rates following re-RT and identified prognostic factors, including methylation status, that can assist in patient selection and clinical trial design. Concurrent use of bevacizumab mitigated the risk of RN.
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Affiliation(s)
- Daniel Moore-Palhares
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Julia Keith
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Michael Wang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - James Perry
- Division of Neurology, Department of Medicine Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Mary Jane Lim-Fat
- Division of Neurology, Department of Medicine Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Chris Heyn
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Pejman Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sunit Das
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
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9
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Kaivola K, Chia R, Ding J, Rasheed M, Fujita M, Menon V, Walton RL, Collins RL, Billingsley K, Brand H, Talkowski M, Zhao X, Dewan R, Stark A, Ray A, Solaiman S, Alvarez Jerez P, Malik L, Dawson TM, Rosenthal LS, Albert MS, Pletnikova O, Troncoso JC, Masellis M, Keith J, Black SE, Ferrucci L, Resnick SM, Tanaka T, Topol E, Torkamani A, Tienari P, Foroud TM, Ghetti B, Landers JE, Ryten M, Morris HR, Hardy JA, Mazzini L, D'Alfonso S, Moglia C, Calvo A, Serrano GE, Beach TG, Ferman T, Graff-Radford NR, Boeve BF, Wszolek ZK, Dickson DW, Chiò A, Bennett DA, De Jager PL, Ross OA, Dalgard CL, Gibbs JR, Traynor BJ, Scholz SW. Genome-wide structural variant analysis identifies risk loci for non-Alzheimer's dementias. Cell Genom 2023; 3:100316. [PMID: 37388914 PMCID: PMC10300553 DOI: 10.1016/j.xgen.2023.100316] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/21/2023] [Accepted: 04/06/2023] [Indexed: 07/01/2023]
Abstract
We characterized the role of structural variants, a largely unexplored type of genetic variation, in two non-Alzheimer's dementias, namely Lewy body dementia (LBD) and frontotemporal dementia (FTD)/amyotrophic lateral sclerosis (ALS). To do this, we applied an advanced structural variant calling pipeline (GATK-SV) to short-read whole-genome sequence data from 5,213 European-ancestry cases and 4,132 controls. We discovered, replicated, and validated a deletion in TPCN1 as a novel risk locus for LBD and detected the known structural variants at the C9orf72 and MAPT loci as associated with FTD/ALS. We also identified rare pathogenic structural variants in both LBD and FTD/ALS. Finally, we assembled a catalog of structural variants that can be mined for new insights into the pathogenesis of these understudied forms of dementia.
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Affiliation(s)
- Karri Kaivola
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Ruth Chia
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Jinhui Ding
- Computational Biology Group, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Memoona Rasheed
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Masashi Fujita
- Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center and the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, New York, NY, USA
| | - Vilas Menon
- Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center and the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, New York, NY, USA
| | - Ronald L. Walton
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, USA
| | - Ryan L. Collins
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology (M.I.T.), Cambridge, MA, USA
- Division of Medical Sciences and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Kimberley Billingsley
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
- Centre for Alzheimer’s and Related Dementias, National Institute on Aging, Bethesda, MD, USA
| | - Harrison Brand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology (M.I.T.), Cambridge, MA, USA
- Division of Medical Sciences and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Michael Talkowski
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology (M.I.T.), Cambridge, MA, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Xuefang Zhao
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology (M.I.T.), Cambridge, MA, USA
| | - Ramita Dewan
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Ali Stark
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Anindita Ray
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Sultana Solaiman
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Pilar Alvarez Jerez
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
- Centre for Alzheimer’s and Related Dementias, National Institute on Aging, Bethesda, MD, USA
| | - Laksh Malik
- Centre for Alzheimer’s and Related Dementias, National Institute on Aging, Bethesda, MD, USA
| | - Ted M. Dawson
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
- Neuroregeneration and Stem Cell Programs, Institute of Cell Engineering, Johns Hopkins University Medical Center, Baltimore, MD, USA
- Department of Pharmacology and Molecular Science, Johns Hopkins University Medical Center, Baltimore, MD, USA
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Liana S. Rosenthal
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Marilyn S. Albert
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Olga Pletnikova
- Department of Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
- Department of Pathology (Neuropathology), Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Juan C. Troncoso
- Department of Pathology (Neuropathology), Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Mario Masellis
- Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, University of Toronto, 1 King’s College Circle, Room 2374, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Toronto, ON, Canada
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Toronto, ON, Canada
| | - Julia Keith
- Department of Anatomical Pathology, Sunnybrook Health Sciences Centre, University of Toronto, 1 King’s College Circle, Room 2374, Toronto, ON, Canada
| | - Sandra E. Black
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Toronto, ON, Canada
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Toronto, ON, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, 1 King’s College Circle, Room 2374, Toronto, ON, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, University of Toronto, 1 King’s College Circle, Room 2374, Toronto, ON, Canada
| | - Luigi Ferrucci
- Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA
| | - Susan M. Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Toshiko Tanaka
- Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA
| | - PROSPECT Consortium
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
- Computational Biology Group, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
- Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center and the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, New York, NY, USA
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology (M.I.T.), Cambridge, MA, USA
- Division of Medical Sciences and Department of Medicine, Harvard Medical School, Boston, MA, USA
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
- Centre for Alzheimer’s and Related Dementias, National Institute on Aging, Bethesda, MD, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
- Neuroregeneration and Stem Cell Programs, Institute of Cell Engineering, Johns Hopkins University Medical Center, Baltimore, MD, USA
- Department of Pharmacology and Molecular Science, Johns Hopkins University Medical Center, Baltimore, MD, USA
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University Medical Center, Baltimore, MD, USA
- Department of Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
- Department of Pathology (Neuropathology), Johns Hopkins University Medical Center, Baltimore, MD, USA
- Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, University of Toronto, 1 King’s College Circle, Room 2374, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Toronto, ON, Canada
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Toronto, ON, Canada
- Department of Anatomical Pathology, Sunnybrook Health Sciences Centre, University of Toronto, 1 King’s College Circle, Room 2374, Toronto, ON, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, 1 King’s College Circle, Room 2374, Toronto, ON, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, University of Toronto, 1 King’s College Circle, Room 2374, Toronto, ON, Canada
- Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA
- Translational Immunology, Research Programs Unit, University of Helsinki, Helsinki, Finland
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Genetics and Genomic Medicine Research & Teaching, UCL GOS Institute of Child Health, University College London, London, UK
- Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
- UCL Movement Disorders Centre, University College London, London, UK
- UK Dementia Research Institute, Department of Neurogenerative Disease and Reta Lila Weston Institute, London, UK
- Institute of Advanced Study, The Hong Kong University of Science and Technology, Hong Kong SAR, China
- Maggiore della Carita University Hospital, Novara, Italy
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero Universitaria Città, della Salute e della Scienza, Corso Bramante, 88, Turin, Italy
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ, USA
- Department of Psychiatry and Psychology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, USA
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, USA
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
- Institute of Cognitive Sciences and Technologies, C.N.R., Via S. Martino della Battaglia, 44, Rome, Italy
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The American Genome Center, Collaborative Health Initiative Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- RNA Therapeutics Laboratory, Therapeutics Development Branch, National Center for Advancing Translational Sciences, Rockville, MD, USA
| | - Eric Topol
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA
| | - Ali Torkamani
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA
| | - Pentti Tienari
- Translational Immunology, Research Programs Unit, University of Helsinki, Helsinki, Finland
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Tatiana M. Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bernardino Ghetti
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John E. Landers
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Mina Ryten
- Department of Genetics and Genomic Medicine Research & Teaching, UCL GOS Institute of Child Health, University College London, London, UK
- Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
| | - Huw R. Morris
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
- UCL Movement Disorders Centre, University College London, London, UK
| | - John A. Hardy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
- UCL Movement Disorders Centre, University College London, London, UK
- UK Dementia Research Institute, Department of Neurogenerative Disease and Reta Lila Weston Institute, London, UK
- Institute of Advanced Study, The Hong Kong University of Science and Technology, Hong Kong SAR, China
| | | | - Sandra D'Alfonso
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Cristina Moglia
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero Universitaria Città, della Salute e della Scienza, Corso Bramante, 88, Turin, Italy
| | - Andrea Calvo
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero Universitaria Città, della Salute e della Scienza, Corso Bramante, 88, Turin, Italy
| | - Geidy E. Serrano
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ, USA
| | - Thomas G. Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ, USA
| | - Tanis Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, USA
| | | | | | - Zbigniew K. Wszolek
- Institute of Cognitive Sciences and Technologies, C.N.R., Via S. Martino della Battaglia, 44, Rome, Italy
| | - Dennis W. Dickson
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, USA
| | - Adriano Chiò
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero Universitaria Città, della Salute e della Scienza, Corso Bramante, 88, Turin, Italy
- Institute of Cognitive Sciences and Technologies, C.N.R., Via S. Martino della Battaglia, 44, Rome, Italy
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Philip L. De Jager
- Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center and the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, New York, NY, USA
| | - Owen A. Ross
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, USA
| | - Clifton L. Dalgard
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The American Genome Center, Collaborative Health Initiative Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - J. Raphael Gibbs
- Computational Biology Group, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Bryan J. Traynor
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
- RNA Therapeutics Laboratory, Therapeutics Development Branch, National Center for Advancing Translational Sciences, Rockville, MD, USA
| | - Sonja W. Scholz
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
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10
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Lai C, Bajin D, Chen JM, Dickson BC, Keith J, Pirouzmand F. Malignant Cerebellopontine Angle Peripheral Nerve Sheath Tumor with Divergent Mesenchymal (Cartilaginous) Differentiation Presenting with Catastrophic Hemorrhage: Case Report and Review. J Int Adv Otol 2023; 19:155-158. [PMID: 36975088 PMCID: PMC10152102 DOI: 10.5152/iao.2023.22799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Malignant peripheral nerve sheath tumors of the cerebellopontine angle are rare, especially even outside of the context of neurofibromatosis or malignant transformation of previously radiated vestibular schwannomas. This case report describes a case of a presumed vestibular schwannoma without previous radiation or history of neurofibromatosis presenting with progressive hearing loss, facial weakness, growth, and ultimately catastrophic hemorrhage requiring urgent surgery. Histopathology revealed an exceptionally rare malignant peripheral nerve sheath tumor with divergent mesenchymal (chondrosarcomatous) differentiation with few rigorously interrogated cases in the literature. In retrospect, facial weakness, growth, and early intratumoral hemorrhage were harbingers of atypical malignant pathology. We advocate for a heightened index of suspicion, shorter interval follow-up, and consideration of early surgery in such cases in hopes of preventing potentially catastrophic outcomes.
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Affiliation(s)
- Carolyn Lai
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Demir Bajin
- Department of Otolaryngology-Head - Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Joseph M Chen
- Department of Otolaryngology-Head - Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Julia Keith
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Farhad Pirouzmand
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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11
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Ruthirakuhan M, Cogo‐Moreira H, Swardfager W, Herrmann N, Lanctôt KL, Keith J, Black SE. Differences in Alzheimer’s disease and cerebrovascular disease neuropathology between latent class groups of cardiovascular risk factors. Alzheimers Dement 2022. [DOI: 10.1002/alz.067295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Myuri Ruthirakuhan
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute Toronto ON Canada
| | | | - Walter Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute Toronto ON Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute Toronto ON Canada
| | - Krista L. Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute Toronto ON Canada
| | - Julia Keith
- Sunnybrook Health Sciences Centre, University of Toronto ON Toronto Canada
| | - Sandra E. Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute Toronto ON Canada
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12
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Lahna D, Schwartz DL, Woltjer R, Black SE, Roese N, Dodge H, Boespflug EL, Keith J, Gao F, Ramirez J, Silbert LC. Venous Collagenosis as Pathogenesis of White Matter Hyperintensity. Ann Neurol 2022; 92:992-1000. [PMID: 36054513 PMCID: PMC9671829 DOI: 10.1002/ana.26487] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/05/2022] [Accepted: 08/13/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Periventricular white matter hyperintensities (pvWMHs) are commonly observed on MRI in older individuals and are associated with cognitive and motor decline. The etiology of pvWMH remains unknown. Venous collagenosis has been implicated, which may also interfere with perivascular fluid flow leading to dilation of perivascular spaces (PVS). Here, we examine relationships between in vivo pvWMH volume and ex vivo morphological quantification of collagenosis and the PVS in veins and arteries. METHODS Brain tissue from 25 Oregon Alzheimer's Disease Research Center subjects was selected to cover the full range of WMH burden. Tissue from white matter abutting the ventricle was stained with Masson's trichrome and smooth muscle actin. An automated hue based algorithm identified and segmented vessel into collagenized vessel walls, lumen, and PVS. Multiple linear regressions with pvWMH volume as the dependent variable and either collagen thickness or PVS width were performed with covariates of vessel diameter, age at death, sex, and interval between MRI and death. RESULTS PVS width and collagen thickness were significantly correlated in both arteries (r = 0.21, p = 0.001) and veins (r = 0.23, p = 0.001). Increased venous collagen (p = 0.017) was a significant predictor of higher pvWMH burden while arterial collagen was not (p = 0.128). Neither PVS width in arteries (p = 0.937) nor veins (p = 0.133) predicted pvWMH burden. INTERPRETATION These findings are consistent with a model in which venous collagenosis mediates the relationship between vascular risk factors and pvWMH. This study confirms the importance of changes to the venous system in contributing to MRI white matter lesions commonly observed with advanced age. ANN NEUROL 2022;92:992-1000.
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Affiliation(s)
- David Lahna
- NIA‐Layton Aging and Alzheimer's Disease Research Center, OHSUPortlandOregon
| | - Daniel L Schwartz
- NIA‐Layton Aging and Alzheimer's Disease Research Center, OHSUPortlandOregon,Advanced Imaging Research Center, OHSUPortlandOregon
| | | | - Sandra E Black
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, LC Campbell Cognitive NeurologySunnybrook Research Institute, University of TorontoTorontoOntario (ON)Canada,Heart & Stroke FoundationCanadian Partnership for Stroke RecoveryTorontoOntarioCanada,Department of Medicine (Neurology)Sunnybrook Health Sciences Centre and University of TorontoOntarioCanada
| | - Natalie Roese
- NIA‐Layton Aging and Alzheimer's Disease Research Center, OHSUPortlandOregon
| | - Hiroko Dodge
- NIA‐Layton Aging and Alzheimer's Disease Research Center, OHSUPortlandOregon
| | - Erin L Boespflug
- NIA‐Layton Aging and Alzheimer's Disease Research Center, OHSUPortlandOregon
| | - Julia Keith
- Department of Anatomic Pathology, Sunnybrook Health Sciences CenterUniversity of TorontoTorontoOntarioCanada
| | - Fuqiang Gao
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, LC Campbell Cognitive NeurologySunnybrook Research Institute, University of TorontoTorontoOntario (ON)Canada,Heart & Stroke FoundationCanadian Partnership for Stroke RecoveryTorontoOntarioCanada
| | - Joel Ramirez
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, LC Campbell Cognitive NeurologySunnybrook Research Institute, University of TorontoTorontoOntario (ON)Canada,Heart & Stroke FoundationCanadian Partnership for Stroke RecoveryTorontoOntarioCanada
| | - Lisa C Silbert
- NIA‐Layton Aging and Alzheimer's Disease Research Center, OHSUPortlandOregon
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13
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Negm L, Nobre L, Bennett J, Chung J, Fernandez N, Johnson M, Aronson M, Zhang C, Komosa M, Bianchi V, Stengs L, Lim-Fat MJ, Keith J, Tsang D, Gao A, Munoz D, Nguyen L, Das S, Levine A, Das A, Hawkins C, Tabori U. DNAR-09. THE IMPACT OF MISMATCH REPAIR DEFICIENCY ON HIGH GRADE GLIOMAS IN CHILDREN, ADOLESCENTS AND YOUNG ADULTS; A REPORT FROM THE IRRDC AND THE GLIOMA TASKFORCE. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.341] [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] Open
Abstract
Abstract
Mismatch repair deficiency (MMRD) is a pan-cancer mechanism resulting in universal hypermutation and aggressive cancers that are resistant to chemoradiation yet sensitive to immunotherapy. MMRD mutations can occur somatically or be inherited as a part of Lynch Syndrome or Constitutional Mismatch Repair Deficiency (CMMRD). Although MMRD affects children, adolescents and young adults (CAYA, ages 0-40) with gliomas, its prevalence and impact of germline inheritance is unknown. Given that high microsatellite instability (MSI) is a key characteristic of MMRD, we previously developed a robust low-coverage whole genome-based tool to quantify MSI, which allows for accurate MMRD detection. We are therefore performing a large-scale MMRD screen of CAYA high grade gliomas (HGGs) and utilizing data from the International Replication Repair Deficiency Consortium (IRRDC) to determine the impact of germline mutations in MMRD gliomas. Ongoing data on 346 HGGs from CAYA patients reveals that MMRD is identified in 6% of HGGs and is not present in tumors with pediatric type alterations. Moreover, of MMRD tumors with IDH1 mutations, none harbor 1p/19q co-deletions. Of patients with available information, all are diagnosed with Lynch Syndrome (69%) or CMMRD (31%), with all Lynch Syndrome diagnoses occurring in patients above 18 years of age. Complementary data from the IRRDC on 113 MMRD patients with gliomas reveal that the median age of glioma is 9.7 and 17.5 years in CMMRD and Lynch Syndrome, respectively (p < 0.001). Strikingly, CMMRD gliomas are enriched for secondary polymerase mutations (60%, p < 0.001) and exhibit ultra-hypermutation, while MMRD gliomas with Lynch Syndrome are enriched for IDH1 mutations (32%, p < 0.025) and harbor a lower mutational burden. Our data reveal a high prevalence of MMRD in CAYA HGGs with alarming impact of germline predisposition. These data can support universal screening for MMRD in high grade glioma diagnostics and identify patients for precision therapeutics.
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Affiliation(s)
- Logine Negm
- Hospital for Sick Children, Toronto , Ontario , Canada
| | - Liana Nobre
- Hospital for Sick Children, Toronto , Ontario , Canada
| | - Julie Bennett
- Hospital for Sick Children, Toronto , Ontario , Canada
| | - Jiil Chung
- Hospital for Sick Children, Toronto , Ontario , Canada
| | | | | | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto , Ontario , Canada
| | - Cindy Zhang
- Hospital for Sick Children, Toronto , Ontario , Canada
| | - Martin Komosa
- Hospital for Sick Children, Toronto , Ontario , Canada
| | | | - Lucie Stengs
- Hospital for Sick Children, Toronto , Ontario , Canada
| | - Mary Jane Lim-Fat
- Sunnybrook Health Sciences Centre, University of Toronto , Toronto , Canada
| | - Julia Keith
- Department of Anatomical Pathology, Sunnybrook Health Sciences Centre, Toronto , Ontario , Canada
| | - Derek Tsang
- Department of Radiation Oncology, University of Toronto, Toronto , Ontario , Canada
| | | | | | - Lananh Nguyen
- Department of Lab Medicine and Pathology, Unity Health Toronto, Toronto , Ontario , Canada
| | - Sunit Das
- Unity Health Toronto, Toronto , Ontario , Canada
| | | | - Anirban Das
- Hospital for Sick Children , Toronto , Canada
| | - Cynthia Hawkins
- Hospital for Sick Children, University of Toronto , Toronto , USA
| | - Uri Tabori
- Hospital for Sick Children , Toronto , Canada
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14
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Bennett J, Nobre L, Sheth J, Ryall S, Fang K, Johnson M, Negm L, Chung J, Komosa M, Nunes N, Lim-Fat MJ, Perry J, Sahgal A, Detsky J, Bouffet E, Hazrati LN, Dirks P, Ertl-Wagner B, Kongkham P, Zadeh G, Mason W, Cusimano M, Das S, Gao A, Tsang D, Nguyen L, Laperriere N, Keith J, Munoz D, Tabori U, Hawkins C. EPID-25. THE CLINICAL AND MOLECULAR LANDSCAPE OF GLIOMAS IN ADOLESCENTS AND YOUNG ADULTS. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.435] [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] Open
Abstract
Abstract
OBJECTIVE
Gliomas in adolescents and young adults (AYA) are commonly treated with a standard chemo-radiation approach. Molecular alterations have not been comprehensively described to date.
METHODS
We compiled a multi-institutional cohort of patients diagnosed with glioma between 15-39.9 years over 20 years. Molecular analysis, therapeutic data and outcome was collected. For specific alterations, analysis included patients aged 0-39.9 years.
RESULTS
A total of 1900 patients with 876 AYA gliomas were included. Ongoing analysis reveals genetic alterations in 95% of available tumours. IDH p.R132H was found in 49% of tumours, while non-canonical IDH mutations were found in 7%. Paediatric-type mutations were found in 33% of AYA tumours with IDH-WT GBM accounting for the remaining 11%. The most common paediatric alterations in AYAs included BRAF p.V600E (11%) and FGFR alterations (7%) while BRAF fusions, H3 p.K27M and H3.3 p.G34R were rarely observed (4%, 4% and 1% respectively). BRAF fused tumours with non-canonical binding partners were enriched in AYAs. Analysis of BRAF-V600E gliomas between ages 0-40 revealed increased tendency for malignant tumours in patients > 20 years suggesting malignant transformation possibly due to higher rate of secondary hits. This resulted in worse overall-survival for AYA patients with BRAF-V600E glioma when compared to children under 20 years (p=0.0032). Ten-year OS of 100%, 90% and 95% was seen for BRAF fused, BRAF-V600E and FGFR-altered AYA low grade glioma respectively, compared to 14% and 25% for BRAF-V600E and FGFR-altered high grade glioma. In contrast, continuous decline was observed in the IDH-mutant gliomas with 10-year OS of 50% which declined to 29% at 15 years.
CONCLUSIONS
Gliomas in AYA often have non-canonical alterations that may evade standard molecular analysis. They are enriched for paediatric-type alterations with distinct molecularly-based outcomes. These tumours may respond to targeted inhibitors and would benefit from comprehensive diagnostic and therapeutic approaches.
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Affiliation(s)
- Julie Bennett
- Hospital for Sick Children, Toronto , Ontario , Canada
| | - Liana Nobre
- Hospital for Sick Children, Toronto , Ontario , Canada
| | - Javal Sheth
- Hospital for Sick Children, University of Toronto , Toronto , Canada
| | - Scott Ryall
- Hospital for Sick Children , Toronto , Canada
| | - Karen Fang
- The Hospital for Sick Children , Toronto , USA
| | | | - Logine Negm
- Hospital for Sick Children, Toronto , Ontario , Canada
| | - Jiil Chung
- Hospital for Sick Children, Toronto , Ontario , Canada
| | | | - Nuno Nunes
- The Hospital for Sick Children , Toronto , Canada
| | - Mary Jane Lim-Fat
- Sunnybrook Health Sciences Centre, University of Toronto , Toronto , Canada
| | | | - Arjun Sahgal
- Sunnybrook Health Sciences Centre , Toronto , Canada
| | - Jay Detsky
- Sunnybrook Health Sciences Centre , Toronto , Canada
| | - Eric Bouffet
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada , Toronto , Canada
| | | | - Peter Dirks
- Department of Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, ON, Canada, Toronto , Ontario , Canada
| | | | | | - Gelareh Zadeh
- Princess Margaret Cancer Center and MacFeeters-Hamilton Center for Neuro-Oncology Research, University Health Network, Wilkins Family Chair in Brain Tumor Research , Toronto , Canada
| | - Warren Mason
- The Princess Margaret Cancer Center , Toronto , Canada
| | | | - Sunit Das
- Unity Health Toronto, Toronto , Ontario , Canada
| | | | - Derek Tsang
- Department of Radiation Oncology, University of Toronto, Toronto , Ontario , Canada
| | - Lananh Nguyen
- Department of Lab Medicine and Pathology, Unity Health Toronto, Toronto , Ontario , Canada
| | | | - Julia Keith
- Department of Anatomical Pathology, Sunnybrook Health Sciences Centre, Toronto , Ontario , Canada
| | | | - Uri Tabori
- Hospital for Sick Children , Toronto , Canada
| | - Cynthia Hawkins
- Hospital for Sick Children, University of Toronto , Toronto , USA
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15
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Palhares D, Chen H, Wang M, Myrehaug S, Detsky J, Tseng C, Husain Z, Perry J, Lim-Fat M, Lipsman N, Das S, Keith J, Sahgal A, Soliman H. Predictive Factors for Survival and Radiation Necrosis in Patients with Recurrent High-Grade Glioma Treated with Re-Irradiation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.843] [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: 11/24/2022]
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16
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Ryan SA, Masellis M, Bilbao J, Keith J, Rogaeva E, Black SE, Lang AE, Kleiner G. Reply: Is Pathology Always the Diagnostic Gold Standard in Neurodegeneration? Mov Disord Clin Pract 2022; 9:1154-1155. [PMID: 36339302 PMCID: PMC9631844 DOI: 10.1002/mdc3.13571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Stephen A. Ryan
- L.C. Campbell Cognitive Neurology Research UnitSunnybrook Health Sciences CentreTorontoOntarioCanada
- Division of Neurology, Department of MedicineQueens UniversityKingstonOntarioCanada
| | - Mario Masellis
- L.C. Campbell Cognitive Neurology Research UnitSunnybrook Health Sciences CentreTorontoOntarioCanada
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Juan Bilbao
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
| | - Julia Keith
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
| | - Sandra E. Black
- L.C. Campbell Cognitive Neurology Research UnitSunnybrook Health Sciences CentreTorontoOntarioCanada
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Hurvitz Brain Sciences Program, Sunnybrook Research InstituteTorontoOntarioCanada
| | - Anthony E. Lang
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Galit Kleiner
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Baycrest Centre for Geriatric CareTorontoOntarioCanada
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17
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Terry M, Keith J, Oden A, Birket S. 387 Preinfection knockdown of Muc5b reduces severity of chronic Pseudomonas aeruginosa infection in the cystic fibrosis transmembrane conductance regulator knockout rat. J Cyst Fibros 2022. [PMCID: PMC9527891 DOI: 10.1016/s1569-1993(22)01077-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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18
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Lim-Fat MJ, Macdonald M, Lapointe S, Climans SA, Cacciotti C, Chahal M, Perreault S, Tsang DS, Gao A, Yip S, Keith J, Bennett J, Ramaswamy V, Detsky J, Tabori U, Das S, Hawkins C. Molecular testing for adolescent and young adult central nervous system tumors: A Canadian guideline. Front Oncol 2022; 12:960509. [PMID: 36249063 PMCID: PMC9559579 DOI: 10.3389/fonc.2022.960509] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022] Open
Abstract
The 2021 World Health Organization (WHO) classification of CNS tumors incorporates molecular signatures with histology and has highlighted differences across pediatric vs adult-type CNS tumors. However, adolescent and young adults (AYA; aged 15–39), can suffer from tumors across this spectrum and is a recognized orphan population that requires multidisciplinary, specialized care, and often through a transition phase. To advocate for a uniform testing strategy in AYAs, pediatric and adult specialists from neuro-oncology, radiation oncology, neuropathology, and neurosurgery helped develop this review and testing framework through the Canadian AYA Neuro-Oncology Consortium. We propose a comprehensive approach to molecular testing in this unique population, based on the recent tumor classification and within the clinical framework of the provincial health care systems in Canada.
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Affiliation(s)
- Mary Jane Lim-Fat
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- *Correspondence: Mary Jane Lim-Fat,
| | - Maria Macdonald
- Department of Oncology, London Health Sciences Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Sarah Lapointe
- Division of Neurology, Department of Medicine, Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Seth Andrew Climans
- Department of Oncology, London Health Sciences Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Chantel Cacciotti
- Department of Paediatrics, Division of Pediatric Hematology/Oncology, London Health Sciences Centre, London, ON, Canada
| | - Manik Chahal
- Department of Medical Oncology, BC Cancer Vancouver Centre, Vancouver, BC, Canada
| | - Sebastien Perreault
- Department of Pediatrics, Division of Child Neurology, CHU Sainte-Justine, Montreal, QC, Canada
| | - Derek S. Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Andrew Gao
- Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Stephen Yip
- Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, BC, Canada
| | - Julia Keith
- Department of Laboratory Medicine and Pathobiology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Julie Bennett
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto ON, Canada
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto ON, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Uri Tabori
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto ON, Canada
| | - Sunit Das
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Cynthia Hawkins
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto ON, Canada
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19
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Palhares D, Chen H, Wang M, Myrehaug S, Detsky J, Tseng CLE, Husain Z, Lim-fat MJ, Lipsman N, Das S, Keith J, Sahgal A, Soliman H. 43: Predictive Factors for Survival and Radiation Necrosis in Patients with Recurrent High-Grade Glioma Treated with Re-Irradiation. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04322-5] [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: 11/15/2022]
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20
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Herzl E, Schmitt E, Shearrer G, Keith J. The Transgenerational Effects of a Western vs. High Fiber Traditional Diet on Health Outcomes in Mice Offspring. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.06.216] [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: 11/27/2022]
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21
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Abstract
CONTEXT.— Burnout affects 44% of physicians, negatively impacts physicians and the patient care that they provide, and can be assessed by the Maslach Burnout Inventory. Forces contributing to physician burnout have been identified and grouped into 7 dimensions. Burnout within pathology has not been well studied. OBJECTIVE.— To identify the prevalence of burnout within Canadian pathology, drivers of burnout important in pathology, and pathologist burnout mitigation strategies at an individual and departmental level. DESIGN.— An electronic survey was disseminated by participating departmental chiefs and the Canadian Association of Pathologists. Survey content included the Maslach Burnout Inventory and 3 free-text questions, including: "What do you find most stressful about your work?" and "What is working for you, at an individual or departmental level, to mitigate against burnout?" Comparative statistics were performed by using Pearson χ2. Significant relationships were sought between pathologist burnout and potential drivers, using Mann-Whitney and Kruskal-Wallis tests. Responses to the qualitative questions were themed and mapped onto the 7 dimensions of burnout. RESULTS.— Four hundred twenty-seven pathologists participated in the survey from all 10 Canadian provinces. The prevalence of burnout in Canadian pathology was 58% (246 respondents), and there were significant differences by gender and years in practice. Drivers of pathologist burnout included workload and chronic work-related pain. The most frequently reported effective departmental strategy to mitigate against burnout mapped to "organizational culture," and the approach that most individual pathologists have taken to mitigate against burnout involves work-life integration. CONCLUSIONS.— Burnout within Canadian laboratory medicine is prevalent, and workload is a major driver.
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Affiliation(s)
- Julia Keith
- From the Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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22
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Bennett J, Nobre L, Sheth J, Ryall S, Fang K, Johnson M, Negm L, Chung J, Komosa M, Nunes NM, Fat MJL, Perry J, Sahgal A, Detsky J, Bouffet E, Naz-Hazrati L, Dirks P, Ertl-Wagner B, Kongkham P, Zadeh G, Mason W, Climans S, Cusimano M, Das S, Gao A, Tsang D, Nguyen L, Laperriere N, Keith J, Munoz D, Tabori U, Hawkins C. LGG-41. The clinical and molecular landscape of gliomas in adolescents and young adults. Neuro Oncol 2022. [PMCID: PMC9165411 DOI: 10.1093/neuonc/noac079.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVE: Gliomas in adolescents and young adults (AYA) are commonly treated with a standard chemo-radiation approach based on data from adults. The clinical impact of paediatric-type alterations in these tumours is unknown. METHODS: We compiled a multi-institutional cohort of patients diagnosed with glioma between 15-39.9 years over 20 years. Complete molecular analysis, therapeutic data and outcome was collected. For specific alterations, analysis included patients aged 0-39.9 years. RESULTS: A total of 1900 patients with 876 AYA gliomas were included. Ongoing analysis reveals genetic alterations in 95% of available tumours. IDH-mutant tumours account for only 53%, while paediatric-type mutations were found in 35% of AYA tumours with IDH-WT GBM accounting for the remaining 12%. The most common paediatric alterations in AYAs included BRAF p.V600E (11%) and FGFR alterations (6%) while BRAF fusions, H3 p.K27M and H3.3 p.G34R were rarely observed (4%, 4% and 1% respectively). BRAF fused tumours with non-canonical binding partners were enriched in AYAs. Analysis of BRAF-V600E gliomas between ages 0-40 revealed increased tendency for malignant tumours in patients >20 years suggesting malignant transformation possibly due to higher rate of secondary hits including TP53, CDKN2A and ATRX mutations. This resulted in worse overall-survival for AYA patients with BRAF-V600E glioma when compared to children under 20 years (p=0.0032). Ten-year OS of 100%, 90% and 95% was seen for BRAF fused, BRAF-V600E and FGFR-altered AYA low grade glioma respectively, compared to 14% and 25% for BRAF-V600E and FGFR-altered high grade glioma. In contrast, continuous decline was observed in the IDH-mutant gliomas with 10-year OS of 50% which declined to 29% at 15 years. CONCLUSIONS: Gliomas in AYA are enriched for paediatric-type alterations with distinct molecularly-based outcomes. As these tumours carry different outcomes than childhood glioma and may respond to targeted inhibitors, AYA gliomas would benefit from comprehensive diagnostic and therapeutic approaches.
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Affiliation(s)
- Julie Bennett
- The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Liana Nobre
- The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Javal Sheth
- The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Scott Ryall
- The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Karen Fang
- The Hospital for Sick Children , Toronto, Ontario , Canada
| | | | - Logine Negm
- The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Jiil Chung
- The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Martin Komosa
- The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Nuno M Nunes
- The Hospital for Sick Children , Toronto, Ontario , Canada
| | | | - James Perry
- Sunnybrook Health Sciences Center , Toronto, Ontario , Canada
| | - Arjun Sahgal
- Sunnybrook Health Sciences Center , Toronto, Ontario , Canada
| | - Jay Detsky
- Sunnybrook Health Sciences Center , Toronto, Ontario , Canada
| | - Eric Bouffet
- The Hospital for Sick Children , Toronto, Ontario , Canada
| | | | - Peter Dirks
- The Hospital for Sick Children , Toronto, Ontario , Canada
| | | | - Paul Kongkham
- University Health Network , Toronto, Ontario , Canada
| | - Gelareh Zadeh
- University Health Network , Toronto, Ontario , Canada
| | - Warren Mason
- University Health Network , Toronto, Ontario , Canada
| | - Seth Climans
- London Health Sciences Center , London, Ontario , Canada
| | | | - Sunit Das
- Unity Health , Toronto, Ontario , Canada
| | - Andrew Gao
- University Health Network , Toronto, Ontario , Canada
| | - Derek Tsang
- University Health Network , Toronto, Ontario , Canada
| | | | | | - Julia Keith
- Sunnybrook Health Sciences Center , Toronto, Ontario , Canada
| | | | - Uri Tabori
- The Hospital for Sick Children , Toronto, Ontario , Canada
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23
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Kleiner G, Ryan SA, Bilbao J, Keith J, Rogaeva E, Black SE, Lang AE, Masellis M. Case of a Man with Hemichorea and Behavioral Changes: "A Red Herring". Mov Disord Clin Pract 2022; 9:501-507. [PMID: 35586540 PMCID: PMC9092749 DOI: 10.1002/mdc3.13433] [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: 11/17/2021] [Revised: 01/23/2022] [Accepted: 02/20/2022] [Indexed: 11/05/2022] Open
Abstract
Background Progressive supranuclear palsy (PSP)-pallido-nigro-luysian atrophy (PNLA) is a neuropathological entity thought to be a variant of classic PSP. Clinical features and pathologic hallmarks are the same in both conditions; however, age and order of symptom onset, disease duration and prognosis, and distribution and density of pathology differentiate the 2 entities. Objectives This study presents a PSP-PNLA case confirmed pathologically with a clinical presentation of hemichorea/ballism, spasticity, progressive hemiparesis, and a frontal behavioral syndrome with relative cognitive sparing early in the disease course. Methods We describe the clinical progression in this unique case supplemented with video and imaging findings in the form of magnetic resonance imaging and brain single photon emission computed tomography. Final diagnosis is via pathological analysis at autopsy. Results We present an elderly gentleman who manifested a clinical syndrome consisting of subacute onset of chorea that at presentation was distinctly unilateral and a frontal behavioral syndrome in the setting of mild thrombocytopenia and elevated anticardiolipin antibodies. Positive antiphospholipid antibodies resulted in an initial antemortem diagnosis of primary antiphospholipid syndrome as a cause of his chorea. Longitudinal follow-up over 5 years demonstrated a progression of clinical features with hemi-motor impersistence/chorea, disinhibition and impulsivity, and eventually corticospinal distribution weakness on the initially affected side. He required nursing home care and falls necessitated wheelchair use. Postmortem neuropathological study revealed a diagnosis of frontotemporal lobar degeneration-tau, PSP-PNLA. Conclusions This case broadens the phenotype of PSP-PNLA and to our knowledge is the only case presenting with unilateral chorea.
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Affiliation(s)
- Galit Kleiner
- Jeff and Diane Ross Movement Disorders ClinicBaycrest Centre for Geriatric CareTorontoOntarioCanada
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Stephen A. Ryan
- L.C. Campbell Cognitive Neurology Research UnitSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Juan Bilbao
- Department of Laboratory Medicine and Molecular DiagnosticsSunnybrook Health Sciences Centre, Laboratory Medicine and Pathobiology, University of TorontoTorontoOntarioCanada
| | - Julia Keith
- Department of Laboratory Medicine and Molecular DiagnosticsSunnybrook Health Sciences Centre, Laboratory Medicine and Pathobiology, University of TorontoTorontoOntarioCanada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative DiseaseUniversity of TorontoTorontoOntarioCanada
| | - Sandra E. Black
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
- L.C. Campbell Cognitive Neurology Research UnitSunnybrook Health Sciences CentreTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Anthony E. Lang
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders ClinicToronto Western Hospital, University Health NetworkTorontoOntarioCanada
| | - Mario Masellis
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
- L.C. Campbell Cognitive Neurology Research UnitSunnybrook Health Sciences CentreTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Cognitive and Movement Disorders ClinicSunnybrook Health Sciences CentreTorontoOntarioCanada
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24
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Kiger L, Keith J, Freiwan A, Fernandez AG, Tillman H, Isakson BE, Weiss MJ, Lechauve C. Redox-Regulation of α-Globin in Vascular Physiology. Antioxidants (Basel) 2022; 11:antiox11010159. [PMID: 35052663 PMCID: PMC8773178 DOI: 10.3390/antiox11010159] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/22/2022] Open
Abstract
Interest in the structure, function, and evolutionary relations of circulating and intracellular globins dates back more than 60 years to the first determination of the three-dimensional structure of these proteins. Non-erythrocytic globins have been implicated in circulatory control through reactions that couple nitric oxide (NO) signaling with cellular oxygen availability and redox status. Small artery endothelial cells (ECs) express free α-globin, which causes vasoconstriction by degrading NO. This reaction converts reduced (Fe2+) α-globin to the oxidized (Fe3+) form, which is unstable, cytotoxic, and unable to degrade NO. Therefore, (Fe3+) α-globin must be stabilized and recycled to (Fe2+) α-globin to reinitiate the catalytic cycle. The molecular chaperone α-hemoglobin-stabilizing protein (AHSP) binds (Fe3+) α-globin to inhibit its degradation and facilitate its reduction. The mechanisms that reduce (Fe3+) α-globin in ECs are unknown, although endothelial nitric oxide synthase (eNOS) and cytochrome b5 reductase (CyB5R3) with cytochrome b5 type A (CyB5a) can reduce (Fe3+) α-globin in solution. Here, we examine the expression and cellular localization of eNOS, CyB5a, and CyB5R3 in mouse arterial ECs and show that α-globin can be reduced by either of two independent redox systems, CyB5R3/CyB5a and eNOS. Together, our findings provide new insights into the regulation of blood vessel contractility.
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Affiliation(s)
- Laurent Kiger
- Inserm U955, Institut Mondor de Recherche Biomédicale, University Paris Est Creteil, 94017 Créteil, France;
| | - Julia Keith
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.K.); (A.G.F.); (M.J.W.)
| | - Abdullah Freiwan
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - Alfonso G. Fernandez
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.K.); (A.G.F.); (M.J.W.)
| | - Heather Tillman
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - Brant E. Isakson
- Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA 22908, USA;
| | - Mitchell J. Weiss
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.K.); (A.G.F.); (M.J.W.)
| | - Christophe Lechauve
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.K.); (A.G.F.); (M.J.W.)
- Correspondence: ; Tel.: +1-(901)-595-8344; Fax: +1-(901)-595-4723
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25
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Brown MJ, Patel P, Nash E, Dikid T, Blanton C, Forsyth JE, Fontaine R, Sharma P, Keith J, Babu B, Vaisakh TP, Azarudeen MJ, Riram B, Shrivastava A. Prevalence of elevated blood lead levels and risk factors among children living in Patna, Bihar, India 2020. PLOS Glob Public Health 2022; 2:e0000743. [PMID: 36962532 PMCID: PMC10021519 DOI: 10.1371/journal.pgph.0000743] [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] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/15/2022] [Indexed: 03/26/2023]
Abstract
Childhood lead exposure remains a key health concern for officials worldwide, contributing some 600,000 new cases of intellectually disabled children annually. Most children affected by high exposure to lead live in low- and middle-income countries. The leaded gasoline phase out in India was completed in 2000. Yet, in 2020, an estimated 275 million children aged 0 to 9 years had blood lead levels (BLLs) ≥ 5 μg/dL known to adversely affect intelligence and behavior. Lead sources reported in India include spices, cookware, paint, traditional medicines and cosmetics, and lead-acid battery recycling and repair. However, their relative contribution has not been characterized. More than 200 lead pollution sites related to battery recycling and repair activities were identified in Bihar and Jharkhand, India. Ninety percent of the recycling sites had soil lead concentrations exceeding the US Environmental Protection Agency's standards. We compared blood and environmental lead levels in two groups of children in Patna, Bihar. Households in proximity to battery recycling operations (Proximal n = 67) versus households distal to these operations (Distal n = 68). The average age of children was 40 months; 46% were female. Overall, the geometric mean (GM) BLL was 11.6 μg/dL. GM BLLs of children in Proximal and Distal households were not significantly different (10.2 μg/dL vs. 13.1 μg/dL respectively; p≤0.07). About 87% children, 56 Proximal and 62 Distal had BLLs ≥5 μg/dl. Lead concentrations in environmental samples were significantly higher in Proximal households (soil mean 9.8 vs. 1.6 μg/ft2; dust mean 52.9 vs. 29.9 μg/ft2 p<0.001; Proximal vs. Distal respectively) whereas concentrations in all spices were higher in Distal households (mean 46.8 vs 134.5 ppm p<0.001; Proximal vs. Distal respectively), and turmeric (mean 59.4 vs. 216.9 ppm Proximal vs. Distal respectively). In multivariate analyses for all children lead in spices and turmeric and number of rooms in the house were significant while for the Proximal group only lead in spices remained in the model. The predictive value of these models was poor. For the Distal group, a model with lead concentration in spices, turmeric and soil and number of rooms in the house was a much better fit. Of the 34 water samples collected, 7 were above the Indian standard of 10 ppb for lead in drinking water (2 in the Proximal area, 5 in the Distal area). Children in Patna, Bihar, India are exposed to multiple sources of lead, with lead levels in house dust and loose, locally sourced spices the most likely to increase blood lead levels. A holistic approach to blood lead testing and source identification and remediation are necessary to prevent lead exposure.
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Affiliation(s)
- M J Brown
- Department of Social and Behavioral Sciences, Harvard Chan School of Public Health, Boston, Massachusetts, United States of America
| | - P Patel
- National Center for Disease Control India, New Delhi, India
| | - E Nash
- Pure Earth, New York, New York, United States of America
| | - T Dikid
- National Center for Disease Control India, New Delhi, India
| | - C Blanton
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - J E Forsyth
- Stanford Woods Institute for the Environment, Stanford University, Stanford, California, United States of America
| | - R Fontaine
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - P Sharma
- Pure Earth, New York, New York, United States of America
| | - J Keith
- Pure Earth, New York, New York, United States of America
| | - B Babu
- National Center for Disease Control India, New Delhi, India
| | - T P Vaisakh
- National Center for Disease Control India, New Delhi, India
| | - M J Azarudeen
- National Center for Disease Control India, New Delhi, India
| | - B Riram
- National Center for Disease Control India, New Delhi, India
| | - A Shrivastava
- National Center for Disease Control India, New Delhi, India
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Stewart J, Sahgal A, Chan AKM, Soliman H, Tseng CL, Detsky J, Myrehaug S, Atenafu EG, Helmi A, Perry J, Keith J, Jane Lim-Fat M, Munoz DG, Zadeh G, Shultz DB, Das S, Coolens C, Alcaide-Leon P, Maralani PJ. Pattern of Recurrence of Glioblastoma Versus Grade 4 IDH-Mutant Astrocytoma Following Chemoradiation: A Retrospective Matched-Cohort Analysis. Technol Cancer Res Treat 2022; 21:15330338221109650. [PMID: 35762826 PMCID: PMC9247382 DOI: 10.1177/15330338221109650] [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] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose: To quantitatively compare the recurrence
patterns of glioblastoma (isocitrate dehydrogenase-wild type) versus grade 4
isocitrate dehydrogenase-mutant astrocytoma (wild type isocitrate dehydrogenase
and mutant isocitrate dehydrogenase, respectively) following primary
chemoradiation. Materials and Methods: A retrospective matched
cohort of 22 wild type isocitrate dehydrogenase and 22 mutant isocitrate
dehydrogenase patients were matched by sex, extent of resection, and corpus
callosum involvement. The recurrent gross tumor volume was compared to the
original gross tumor volume and clinical target volume contours from
radiotherapy planning. Failure patterns were quantified by the incidence and
volume of the recurrent gross tumor volume outside the gross tumor volume and
clinical target volume, and positional differences of the recurrent gross tumor
volume centroid from the gross tumor volume and clinical target volume.
Results: The gross tumor volume was smaller for wild type
isocitrate dehydrogenase patients compared to the mutant isocitrate
dehydrogenase cohort (mean ± SD: 46.5 ± 26.0 cm3 vs
72.2 ± 45.4 cm3, P = .026). The recurrent gross
tumor volume was 10.7 ± 26.9 cm3 and 46.9 ± 55.0 cm3
smaller than the gross tumor volume for the same groups
(P = .018). The recurrent gross tumor volume extended outside
the gross tumor volume in 22 (100%) and 15 (68%) (P= .009) of
wild type isocitrate dehydrogenase and mutant isocitrate dehydrogenase patients,
respectively; however, the volume of recurrent gross tumor volume outside the
gross tumor volume was not significantly different (12.4 ± 16.1 cm3
vs 8.4 ± 14.2 cm3, P = .443). The recurrent gross
tumor volume centroid was within 5.7 mm of the closest gross tumor volume edge
for 21 (95%) and 22 (100%) of wild type isocitrate dehydrogenase and mutant
isocitrate dehydrogenase patients, respectively. Conclusion: The
recurrent gross tumor volume extended beyond the gross tumor volume less often
in mutant isocitrate dehydrogenase patients possibly implying a differential
response to chemoradiotherapy and suggesting isocitrate dehydrogenase status
might be used to personalize radiotherapy. The results require validation in
prospective randomized trials.
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Affiliation(s)
- James Stewart
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Aimee K M Chan
- Department of Medical Imaging, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook 151192Odette Cancer Centre, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, 7938University of Toronto, 7989University Health Network, Toronto, Ontario, Canada
| | - Ali Helmi
- Department of Medical Imaging, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - James Perry
- Division of Neurology, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julia Keith
- Department of Laboratory Medicine & Pathobiology, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mary Jane Lim-Fat
- Division of Neurology, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David G Munoz
- Department of Pathology, 7938University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, 7938University of Toronto, 7989University Health Network, Toronto, Ontario, Canada
| | - David B Shultz
- Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7989University Health Network, Toronto, Ontario, Canada
| | - Sunit Das
- Division of Neurosurgery, Department of Surgery, 7938University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine Coolens
- Department of Radiation Oncology, 7938University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, 7989University Health Network, Toronto, Ontario, Canada
| | - Paula Alcaide-Leon
- Department of Medical Imaging, 7938University of Toronto, 7989University Health Network, Toronto, Ontario, Canada
| | - Pejman Jabehdar Maralani
- Department of Medical Imaging, 7938University of Toronto, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Bollar G, Keith J, Oden A, Kiedrowski M, Birket S. 507: Establishing a mutant for modeling Staphylococcus aureus small colony–variant airway infection in cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01931-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Terry M, Keith J, Oden A, Birket S. 401: Muc5b knockdown alters chronic infection outcomes in CFTR-KO rats. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01825-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Meng Y, Pople CB, Suppiah S, Llinas M, Huang Y, Sahgal A, Perry J, Keith J, Davidson B, Hamani C, Amemiya Y, Seth A, Leong H, Heyn CC, Aubert I, Hynynen K, Lipsman N. MR-guided focused ultrasound liquid biopsy enriches circulating biomarkers in patients with brain tumors. Neuro Oncol 2021; 23:1789-1797. [PMID: 33693781 PMCID: PMC8485448 DOI: 10.1093/neuonc/noab057] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Liquid biopsy is promising for early detection, monitoring of response, and recurrence of cancer. The blood-brain barrier (BBB) limits the shedding of biomarker, such as cell-free DNA (cfDNA), into the blood from brain tumors, and their detection by conventional assays. Transcranial MR-guided focused ultrasound (MRgFUS) can safely and transiently open the BBB, providing an opportunity for less-invasive access to brain pathology. We hypothesized that MRgFUS can enrich the signal of circulating brain-derived biomarkers to aid in liquid biopsy. METHODS Nine patients were treated in a prospective single-arm, open-label trial to investigate serial MRgFUS and adjuvant temozolomide combination in patients with glioblastoma (NCT03616860). Blood samples were collected as an exploratory measure within the hours before and after sonication, with control samples from non-brain tumor patients undergoing BBB opening (BBBO) alone (NCT03739905). RESULTS Brain regions averaging 7.8 ± 6.0 cm3 (range 0.8-23.1 cm3) were successfully treated within 111 ± 39 minutes without any serious adverse events. We found MRgFUS acutely enhanced plasma cfDNA (2.6 ± 1.2-fold, P < .01, Wilcoxon signed-rank test), neuron-derived extracellular vesicles (3.2 ± 1.9-fold, P < .01), and brain-specific protein S100b (1.4 ± 0.2-fold, P < .01). Further comparison of the cfDNA methylation profiles suggests a signature that is disease- and post-BBBO-specific, in keeping with our hypothesis. We also found cfDNA-mutant copies of isocitrate dehydrogenase 1 (IDH1) increased, although this was in only one patient known to harbor the tumor mutation. CONCLUSIONS This first-in-human proof-of-concept study shows MRgFUS enriches the signal of circulating brain-derived biomarkers, demonstrating the potential of the technology to support liquid biopsy for the brain.
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Affiliation(s)
- Ying Meng
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Suganth Suppiah
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Yuexi Huang
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James Perry
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Julia Keith
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Davidson
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Clement Hamani
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Arun Seth
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Hon Leong
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Chinthaka C Heyn
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Isabelle Aubert
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Kullervo Hynynen
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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30
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Myrehaug S, Hudson J, Soliman H, Ruschin M, Tseng CL, Detsky J, Husain Z, Keith J, Atenafu EG, Maralani P, Heyn C, Das S, Lipsman N, Sahgal A. Hypofractionated Stereotactic Radiation Therapy for Intact Brain Metastases in 5 Daily Fractions: Effect of Dose on Treatment Response. Int J Radiat Oncol Biol Phys 2021; 112:342-350. [PMID: 34537313 DOI: 10.1016/j.ijrobp.2021.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/13/2021] [Accepted: 09/01/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE Multileaf collimator (MLC) linear accelerator (Linac)-based hypofractionated stereotactic radiation therapy (HSRT) is increasingly used not only for large brain metastases or those adjacent to critical structures but also for those metastases that would otherwise be considered for single-fraction radiosurgery (SRS). However, data on outcomes in general are limited, and there is a lack of understanding regarding optimal dosing. Our aim was to report mature image-based outcomes for MLC-Linac HSRT with a focus on clinical and dosimetric factors associated with local failure (LF). METHODS AND MATERIALS A total of 220 patients with 334 brain metastases treated with HSRT were identified. All patients were treated using a 5-fraction daily regimen and were followed with clinical evaluation and volumetric magnetic resonance imaging every 2 to 3 months. Overall survival and progression-free survival were calculated using the Kaplan-Meier method, with LF determined using Fine and Gray's competing risk method. Predictive factors were identified using Cox regression multivariate analysis. RESULTS Median follow-up was 10.8 months. Median size of treated metastasis was 1.9 cm; 60% of metastases were <2 cm in size. The median total dose was 30 Gy in 5 fractions; 36% of the cohort received <30 Gy. The median time to LF and 12-month cumulative incidence of LF was 8.5 months and 23.8%, respectively. Median time to death and 12-month overall survival rates were 11.8 months and 48.2%, respectively. Fifty-two metastases (15.6%) had an adverse radiation effect, of which 32 (9.5%) were symptomatic necrosis. Multivariable analysis identified worse LF in patients who received a total dose of <30 Gy (hazard ratio, 1.62; P = .03), with LF at 6 and 12 months of 13% and 33% for patients treated with <30 Gy versus 5% and 19% for patients treated with >30 Gy. Exploratory analysis demonstrated a dose-response effect observed in all histologic types, including among breast cancer subtypes. CONCLUSION Optimal local control is achieved with HSRT of ≥30 Gy in 5 daily fractions, independent of tumor volume and histology, with an acceptable risk of radiation necrosis.
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Affiliation(s)
- Sten Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada.
| | - John Hudson
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Mark Ruschin
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Julia Keith
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, Ontario, Canada
| | - Pejman Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Chris Heyn
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Sunit Das
- Department of Neurosurgery, St. Michaels Hospital, Ontario, Canada
| | - Nir Lipsman
- Department of Neurosurgery, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
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Schinkel K, Dai B, Porter C, Budowle R, Keith J. Food Security Among Military-connected Students: The Relationship between Service and Sacrifice. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Han R, Keith J, Slodkowska E, Nofech-Mozes S, Djordjevic B, Parra-Herran C, Shachar S, Mirkovic J, Sherman C, Hsieh E, Ismiil N, Lu FI. Hot Seat Diagnosis: Competency-Based Tool Is Superior to Time-Based Tool for the Formative In-Service Assessment of Pathology Trainees. Arch Pathol Lab Med 2021; 146:123-131. [PMID: 34133708 DOI: 10.5858/arpa.2020-0702-ep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 01/09/2023]
Abstract
CONTEXT.— Competency-based medical education relies on frequent formative in-service assessments to ascertain trainee progression. Currently at our institution, trainees receive a summative end-of-rotation In-Training Evaluation Report based on feedback collected from staff pathologists. There is no method of simulating report sign-out. OBJECTIVE.— To develop a formative in-service assessment tool that is able to simulate report sign-out and provide case-by-case feedback to trainees. Further, to compare time- versus competency-based assessment models. DESIGN.— Twenty-one pathology trainees were assessed for 20 months. Hot Seat Diagnosis by trainees and trainee assessment by pathologists were recorded in the Laboratory Information System. In the first iteration, trainees were assessed by using a time-based assessment scale on their ability to diagnose, report, use ancillary testings, comment on clinical implications, provide intraoperative consultation and/or gross cases. The second iteration used a competency-based assessment scale. Trainees and pathologists completed surveys on the effectiveness of the In-Training Evaluation Report versus the Hot Seat Diagnosis tool. RESULTS.— Scores from both iterations correlated significantly with other assessment tools including the Resident In-Service Examination (r = 0.93, P = .04 and r = 0.87, P = .03). The competency-based model was better able to demonstrate improvement over time and stratify junior versus senior trainees than the time-based model. Trainees and pathologists rated Hot Seat Diagnosis as significantly more objective, detailed, and timely than the In-Training Evaluation Report, and effective at simulating report sign-out. CONCLUSIONS.— Hot Seat Diagnosis is an effective tool for the formative in-service assessment of pathology trainees and simulation of report sign-out, with the competency-based model outperforming the time-based model.
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Affiliation(s)
- Rachel Han
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Julia Keith
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Elzbieta Slodkowska
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Sharon Nofech-Mozes
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Bojana Djordjevic
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Carlos Parra-Herran
- The Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Parra-Herran)
| | - Sade Shachar
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Jelena Mirkovic
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Christopher Sherman
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Eugene Hsieh
- The Department of Pathology, Dynacare, Brampton, Ontario, Canada (Hsieh)
| | - Nadia Ismiil
- The Department of Pathology, Lakeridge Health Ajax Pickering Hospital, Ajax, Ontario, Canada (Ismiil)
| | - Fang-I Lu
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
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Chia R, Sabir MS, Bandres-Ciga S, Saez-Atienzar S, Reynolds RH, Gustavsson E, Walton RL, Ahmed S, Viollet C, Ding J, Makarious MB, Diez-Fairen M, Portley MK, Shah Z, Abramzon Y, Hernandez DG, Blauwendraat C, Stone DJ, Eicher J, Parkkinen L, Ansorge O, Clark L, Honig LS, Marder K, Lemstra A, St George-Hyslop P, Londos E, Morgan K, Lashley T, Warner TT, Jaunmuktane Z, Galasko D, Santana I, Tienari PJ, Myllykangas L, Oinas M, Cairns NJ, Morris JC, Halliday GM, Van Deerlin VM, Trojanowski JQ, Grassano M, Calvo A, Mora G, Canosa A, Floris G, Bohannan RC, Brett F, Gan-Or Z, Geiger JT, Moore A, May P, Krüger R, Goldstein DS, Lopez G, Tayebi N, Sidransky E, Norcliffe-Kaufmann L, Palma JA, Kaufmann H, Shakkottai VG, Perkins M, Newell KL, Gasser T, Schulte C, Landi F, Salvi E, Cusi D, Masliah E, Kim RC, Caraway CA, Monuki ES, Brunetti M, Dawson TM, Rosenthal LS, Albert MS, Pletnikova O, Troncoso JC, Flanagan ME, Mao Q, Bigio EH, Rodríguez-Rodríguez E, Infante J, Lage C, González-Aramburu I, Sanchez-Juan P, Ghetti B, Keith J, Black SE, Masellis M, Rogaeva E, Duyckaerts C, Brice A, Lesage S, Xiromerisiou G, Barrett MJ, Tilley BS, Gentleman S, Logroscino G, Serrano GE, Beach TG, McKeith IG, Thomas AJ, Attems J, Morris CM, Palmer L, Love S, Troakes C, Al-Sarraj S, Hodges AK, Aarsland D, Klein G, Kaiser SM, Woltjer R, Pastor P, Bekris LM, Leverenz JB, Besser LM, Kuzma A, Renton AE, Goate A, Bennett DA, Scherzer CR, Morris HR, Ferrari R, Albani D, Pickering-Brown S, Faber K, Kukull WA, Morenas-Rodriguez E, Lleó A, Fortea J, Alcolea D, Clarimon J, Nalls MA, Ferrucci L, Resnick SM, Tanaka T, Foroud TM, Graff-Radford NR, Wszolek ZK, Ferman T, Boeve BF, Hardy JA, Topol EJ, Torkamani A, Singleton AB, Ryten M, Dickson DW, Chiò A, Ross OA, Gibbs JR, Dalgard CL, Traynor BJ, Scholz SW. Genome sequencing analysis identifies new loci associated with Lewy body dementia and provides insights into its genetic architecture. Nat Genet 2021; 53:294-303. [PMID: 33589841 PMCID: PMC7946812 DOI: 10.1038/s41588-021-00785-3] [Citation(s) in RCA: 165] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/12/2021] [Indexed: 01/30/2023]
Abstract
The genetic basis of Lewy body dementia (LBD) is not well understood. Here, we performed whole-genome sequencing in large cohorts of LBD cases and neurologically healthy controls to study the genetic architecture of this understudied form of dementia, and to generate a resource for the scientific community. Genome-wide association analysis identified five independent risk loci, whereas genome-wide gene-aggregation tests implicated mutations in the gene GBA. Genetic risk scores demonstrate that LBD shares risk profiles and pathways with Alzheimer's disease and Parkinson's disease, providing a deeper molecular understanding of the complex genetic architecture of this age-related neurodegenerative condition.
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Affiliation(s)
- Ruth Chia
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Marya S Sabir
- Neurodegenerative Diseases Research Unit, Laboratory of Neurogenetics, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Sara Bandres-Ciga
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Sara Saez-Atienzar
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Regina H Reynolds
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
- Great Ormond Street Institute of Child Health, Genetics and Genomic Medicine, University College London, London, UK
| | - Emil Gustavsson
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
- Great Ormond Street Institute of Child Health, Genetics and Genomic Medicine, University College London, London, UK
| | - Ronald L Walton
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Sarah Ahmed
- Neurodegenerative Diseases Research Unit, Laboratory of Neurogenetics, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Coralie Viollet
- Collaborative Health Initiative Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Jinhui Ding
- Computational Biology Group, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Mary B Makarious
- Neurodegenerative Diseases Research Unit, Laboratory of Neurogenetics, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Monica Diez-Fairen
- Memory and Movement Disorders Units, Department of Neurology, University Hospital Mutua de Terrassa, Barcelona, Spain
| | - Makayla K Portley
- Neurodegenerative Diseases Research Unit, Laboratory of Neurogenetics, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Zalak Shah
- Neurodegenerative Diseases Research Unit, Laboratory of Neurogenetics, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Yevgeniya Abramzon
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Dena G Hernandez
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Cornelis Blauwendraat
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | | | - John Eicher
- Genetics and Pharmacogenomics, Merck & Co., Inc., West Point, PA, USA
| | - Laura Parkkinen
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
| | - Olaf Ansorge
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
| | - Lorraine Clark
- Taub Institute for Alzheimer Disease and the Aging Brain, and Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Lawrence S Honig
- Taub Institute for Alzheimer Disease and the Aging Brain, G. H. Sergievsky Center and Department of Neurology, Columbia University, New York, NY, USA
| | - Karen Marder
- Taub Institute for Alzheimer Disease and the Aging Brain, G. H. Sergievsky Center and Department of Neurology, Columbia University, New York, NY, USA
| | - Afina Lemstra
- Department of Neurology and Alzheimer Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Peter St George-Hyslop
- Department of Clinical Neurosciences, Cambridge Institute of Medical Research, University of Cambridge, Cambridge, UK
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elisabet Londos
- Clinical Memory Research Unit, Institution of Clinical Sciences Malmo, Lund University, Lund, Sweden
| | - Kevin Morgan
- Human Genetics, School of Life Sciences, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Tammaryn Lashley
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Queen Square Brain Bank for Neurological Disorders, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Thomas T Warner
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, University College London, London, UK
- Queen Square Brain Bank for Neurological Disorders, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Zane Jaunmuktane
- Queen Square Brain Bank for Neurological Disorders, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Isabel Santana
- Neurology Service, University of Coimbra Hospital, Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Pentti J Tienari
- Translational Immunology, Research Programs Unit, University of Helsinki, Helsinki, Finland
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Liisa Myllykangas
- Department of Pathology, Medicum, University of Helsinki, Helsinki, Finland
- HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| | - Minna Oinas
- Department of Clinical Medicine, Faculty of Health, UiT The Arctic University of Norway, Tromsø, Norway
| | - Nigel J Cairns
- Knight Alzheimer's Disease Research Center, Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - John C Morris
- Knight Alzheimer's Disease Research Center, Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Glenda M Halliday
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maurizio Grassano
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
| | - Andrea Calvo
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Gabriele Mora
- Istituti Clinici Scientifici Maugeri, IRCCS, Milan, Italy
| | - Antonio Canosa
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Gianluca Floris
- Department of Neurology, University Hospital of Cagliari, Cagliari, Italy
| | - Ryan C Bohannan
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, USA
| | - Francesca Brett
- Dublin Brain Bank, Neuropathology Department, Beaumont Hospital, Dublin, Ireland
| | - Ziv Gan-Or
- Montreal Neurological Institute and Hospital, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Joshua T Geiger
- Neurodegenerative Diseases Research Unit, Laboratory of Neurogenetics, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Anni Moore
- Computational Biology Group, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Patrick May
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Rejko Krüger
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Transversal Translational Medicine, Luxembourg Institute of Health, Strassen, Luxembourg
- Parkinson Research Clinic, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - David S Goldstein
- Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Grisel Lopez
- Medical Genetics Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Nahid Tayebi
- Medical Genetics Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Ellen Sidransky
- Medical Genetics Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | | | - Jose-Alberto Palma
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Horacio Kaufmann
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Vikram G Shakkottai
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Matthew Perkins
- Michigan Brain Bank, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kathy L Newell
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas Gasser
- Department of Neurodegenerative Diseases, Center of Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen and German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Claudia Schulte
- Department of Neurodegenerative Diseases, Center of Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen and German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Francesco Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - Erika Salvi
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Daniele Cusi
- Bio4Dreams-Business Nursery for Life, Milan, Italy
| | - Eliezer Masliah
- Molecular Neuropathology Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Ronald C Kim
- Department of Neuropathology, School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Chad A Caraway
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, CA, USA
| | - Edwin S Monuki
- Department of Pathology & Laboratory Medicine, School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Maura Brunetti
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
| | - Ted M Dawson
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
- Neuroregeneration and Stem Cell Programs, Institute of Cell Engineering, Johns Hopkins University Medical Center, Baltimore, MD, USA
- Department of Pharmacology and Molecular Science, Johns Hopkins University Medical Center, Baltimore, MD, USA
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Marilyn S Albert
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Olga Pletnikova
- Department of Pathology (Neuropathology), Johns Hopkins University Medical Center, Baltimore, MD, USA
- Department of Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Juan C Troncoso
- Department of Pathology (Neuropathology), Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Margaret E Flanagan
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Qinwen Mao
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Eileen H Bigio
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Eloy Rodríguez-Rodríguez
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL-UC-CIBERNED, Santander, Spain
| | - Jon Infante
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL-UC-CIBERNED, Santander, Spain
| | - Carmen Lage
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL-UC-CIBERNED, Santander, Spain
| | - Isabel González-Aramburu
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL-UC-CIBERNED, Santander, Spain
| | - Pascual Sanchez-Juan
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL-UC-CIBERNED, Santander, Spain
| | - Bernardino Ghetti
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Julia Keith
- Department of Anatomical Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
- Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Charles Duyckaerts
- Department of Neuropathology Escourolle, Paris Brain Institute, Sorbonne Universités, Paris, France
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Pitié-Salpêtrière, DMU Neuroscience 6, Paris, France
| | - Alexis Brice
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Pitié-Salpêtrière, DMU Neuroscience 6, Paris, France
| | - Suzanne Lesage
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Pitié-Salpêtrière, DMU Neuroscience 6, Paris, France
| | - Georgia Xiromerisiou
- Department of Neurology, University Hospital of Larissa, University of Thessalia, Larissa, Greece
| | - Matthew J Barrett
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Bension S Tilley
- Neuropathology Unit, Department of Brain Sciences, Imperial College London, London, UK
| | - Steve Gentleman
- Neuropathology Unit, Department of Brain Sciences, Imperial College London, London, UK
| | - Giancarlo Logroscino
- Department of Basic Medicine Neurosciences and Sense Organs, University Aldo Moro, Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain - Department of Clinical Research in Neurology of the University of Bari at 'Pia Fondazione Card G. Panico' Hospital Tricase (Le), Bari, Italy
| | - Geidy E Serrano
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ, USA
| | - Thomas G Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ, USA
| | - Ian G McKeith
- Newcastle Brain Tissue Resource, Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Newcastle Brain Tissue Resource, Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, UK
| | - Johannes Attems
- Newcastle Brain Tissue Resource, Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher M Morris
- Newcastle Brain Tissue Resource, Translational and Clinical Research Institute, Biomedical Research Building, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Palmer
- South West Dementia Brain Bank, Bristol Medical School, University of Bristol, Bristol, UK
| | - Seth Love
- Dementia Research Group, Bristol Medical School, University of Bristol, Bristol, UK
| | - Claire Troakes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Safa Al-Sarraj
- Department of Clinical Neuropathology and London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, King's College Hospital and King's College London, London, UK
| | - Angela K Hodges
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Gregory Klein
- Rush Alzheimer's Disease Center, Rush University, Chicago, IL, USA
| | - Scott M Kaiser
- Department of Neuropathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Randy Woltjer
- Department of Neurology, Oregon Health & Sciences University, Portland, OR, USA
| | - Pau Pastor
- Memory and Movement Disorders Units, Department of Neurology, University Hospital Mutua de Terrassa, Barcelona, Spain
| | - Lynn M Bekris
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James B Leverenz
- Cleveland Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lilah M Besser
- Institute for Human Health and Disease Intervention, Florida Atlantic University, Boca Raton, FL, USA
| | - Amanda Kuzma
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alan E Renton
- Ronald M. Loeb Center for Alzheimer's Disease, Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alison Goate
- Ronald M. Loeb Center for Alzheimer's Disease, Nash Family Department of Neuroscience, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University, Chicago, IL, USA
| | - Clemens R Scherzer
- Precision Neurology Program, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Huw R Morris
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Raffaele Ferrari
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Diego Albani
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Stuart Pickering-Brown
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Kelley Faber
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Walter A Kukull
- National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Estrella Morenas-Rodriguez
- Biomedizinisches Centrum, Biochemie, Ludwig-Maximilians-Universität München & Deutsches Zentrum für Neurodegenerative Erkrankungen, Munich, Germany
- Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- The Network Center for Biomedical Research in Neurodegenerative Diseases, Madrid, Spain
| | - Alberto Lleó
- Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- The Network Center for Biomedical Research in Neurodegenerative Diseases, Madrid, Spain
| | - Juan Fortea
- Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- The Network Center for Biomedical Research in Neurodegenerative Diseases, Madrid, Spain
| | - Daniel Alcolea
- Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- The Network Center for Biomedical Research in Neurodegenerative Diseases, Madrid, Spain
| | - Jordi Clarimon
- Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- The Network Center for Biomedical Research in Neurodegenerative Diseases, Madrid, Spain
| | - Mike A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
- Data Tecnica International, Glen Echo, MD, USA
- Center for Alzheimer's and Related Dementias, National Institute on Aging, Bethesda, MD, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Toshiko Tanaka
- Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA
| | - Tatiana M Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Tanis Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | | | - John A Hardy
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, University College London, London, UK
- UK Dementia Research Institute of UCL, UCL Institute of Neurology, University College London, London, UK
- UCL Movement Disorders Centre, University College London, London, UK
- Institute for Advanced Study, The Hong Kong University of Science and Technology, Hong Kong SAR, China
| | - Eric J Topol
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA
| | - Ali Torkamani
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA
| | - Andrew B Singleton
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
- Center for Alzheimer's and Related Dementias, National Institute on Aging, Bethesda, MD, USA
| | - Mina Ryten
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
- Great Ormond Street Institute of Child Health, Genetics and Genomic Medicine, University College London, London, UK
| | | | - Adriano Chiò
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
- Institute of Cognitive Sciences and Technologies, C.N.R., Rome, Italy
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, USA
| | - J Raphael Gibbs
- Computational Biology Group, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Clifton L Dalgard
- Department of Anatomy, Physiology & Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The American Genome Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Bryan J Traynor
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Sonja W Scholz
- Neurodegenerative Diseases Research Unit, Laboratory of Neurogenetics, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
- Department of Neurology, Johns Hopkins University Medical Center, Baltimore, MD, USA.
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Jabehdar Maralani P, Myrehaug S, Mehrabian H, Chan AKM, Wintermark M, Heyn C, Conklin J, Ellingson BM, Rahimi S, Lau AZ, Tseng CL, Soliman H, Detsky J, Daghighi S, Keith J, Munoz DG, Das S, Atenafu EG, Lipsman N, Perry J, Stanisz G, Sahgal A. Intravoxel incoherent motion (IVIM) modeling of diffusion MRI during chemoradiation predicts therapeutic response in IDH wildtype glioblastoma. Radiother Oncol 2021; 156:258-265. [PMID: 33418005 PMCID: PMC8186561 DOI: 10.1016/j.radonc.2020.12.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022]
Abstract
Background: Prediction of early progression in glioblastoma may provide an opportunity to personalize treatment. Simplified intravoxel incoherent motion (IVIM) MRI offers quantitative estimates of diffusion and perfusion metrics. We investigated whether these metrics, during chemoradiation, could predict treatment outcome. Methods: 38 patients with newly diagnosed IDH-wildtype glioblastoma undergoing 6-week/30-fraction chemoradiation had standardized post-operative MRIs at baseline (radiation planning), and at the 10th and 20th fractions. Non-overlapping T1-enhancing (T1C) and non-enhancing T2-FLAIR hyperintense regions were independently segmented. Apparent diffusion coefficient (ADCT1C, ADCT2-FLAIR) and perfusion fraction (fT1C, fT2-FLAIR) maps were generated with simplified IVIM modelling. Parameters associated with progression before or after 6.9 months (early vs late progression, respectively), overall survival (OS) and progression-free survival (PFS) were investigated. Results: Higher ADCT2-FLAIR at baseline [Odds Ratio (OR) = 1.06, 95% CI 1.01–1.15, p = 0.025], lower fT2-FLAIR at fraction 10 (OR = 2.11, 95% CI 1.04–4.27, p = 0.018), and lack of increase in ADCT2-FLAIR at fraction 20 compared to baseline (OR = 1.12, 95% CI 1.02–1.22, p = 0.02) were associated with early progression. Combining ADCT2-FLAIR at baseline, fT2-FLAIR at fraction 10, ECOG and MGMT promoter methylation status significantly improved AUC to 90.3% compared to a model with only ECOG and MGMT promoter methylation status (p = 0.001). Using multivariable analysis, neither IVIM metrics were associated with OS but higher fT2-FLAIR at fraction 10 (HR = 0.72, 95% CI 0.56–0.95, p = 0.018) was associated with longer PFS. Conclusion: ADCT2-FLAIR at baseline, its lack of increase from baseline to fraction 20, or fT2-FLAIR at fraction 10 significantly predicted early progression. fT2-FLAIR at fraction 10 was associated with PFS.
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Affiliation(s)
- Pejman Jabehdar Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Canada.
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Hatef Mehrabian
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Aimee K M Chan
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Max Wintermark
- Department of Radiology, Stanford University, United States
| | - Chris Heyn
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, United States
| | - Benjamin M Ellingson
- Department of Radiological Sciences and Psychiatry, University of California Los Angeles, United States
| | - Saba Rahimi
- Department of Biomedical Engineering, University of Toronto, Canada
| | - Angus Z Lau
- Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Shadi Daghighi
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Julia Keith
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada
| | - David G Munoz
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada
| | - Sunit Das
- Department of Surgery, Division of Neurosurgery, University of Toronto, Canada
| | | | - Nir Lipsman
- Department of Surgery, Division of Neurosurgery, University of Toronto, Canada
| | - James Perry
- Department of Medicine, Division of Neurology, University of Toronto, Canada
| | - Greg Stanisz
- Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
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Bennett J, Fang K, Sheth J, Ryall S, Martin K, Nunes N, Nobre L, Perry J, Sahgal A, Mason W, Das S, Gao A, Tsang D, Nguyen L, Laperriere N, Keith J, Munoz D, Tabori U, Hawkins C. LGG-13. THE CLINICAL AND MOLECULAR LANDSCAPE OF GLIOMAS IN ADOLESCENTS AND YOUNG ADULTS. Neuro Oncol 2020. [PMCID: PMC7715841 DOI: 10.1093/neuonc/noaa222.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Pediatric low grade gliomas are typically driven by MAPK upregulation with excellent long-term survival. In contrast, adult lower grade gliomas commonly harbor IDH-1 mutations and undergo malignant transformation. Gliomas in adolescents and young adults (AYA) are an orphan group of tumors that have been poorly described. We aim to determine the clinical and molecular landscape of AYA gliomas. METHODS A multi-institutional population based cohort of 839 patients diagnosed with glioma between 15–40 years has been identified. Complete molecular analysis, long term outcome and therapeutic data are being collected. RESULTS Of 364 AYA gliomas analyzed, the prevalence of WHO grade I tumors was highest in those <21 years (54%), while the prevalence of higher grade tumors increased with age. Interestingly, only 38% harbor IDH-1 mutations while 23% harbor pediatric mutations, including 8% with BRAF p.V600E, and 4% with KIAA1549:BRAF fusion. The median age for IDH-1 mutation is 32 years, with highest frequency in WHO grade II and III tumors. In contrast, BRAF alterations were most frequently observed in WHO grade I and II tumors and enriched in those less than 20 years. Five-year progression-free survival for BRAF fusion, p.V600E and IDH-1 p.R132H were 81%, 78% and 26% respectively. No survivors were observed in H3 p.K27M and p.G34R gliomas (p<0.0001). CONCLUSIONS Gliomas in AYA overlap pediatric and adult classification and exhibit enrichment for pediatric alterations. As the latter are associated with improved PFS and are amenable to targeted therapies, this should be considered in the work up of these tumors.
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Affiliation(s)
| | - Karen Fang
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Javal Sheth
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Scott Ryall
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Nuno Nunes
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Liana Nobre
- The Hospital for Sick Children, Toronto, ON, Canada
| | - James Perry
- Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Arjun Sahgal
- Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | | | - Sunit Das
- St. Michael’s Hospital, Toronto, ON, Canada
| | - Andrew Gao
- University Health Network, Toronto, ON, Canada
| | - Derek Tsang
- University Health Network, Toronto, ON, Canada
| | | | | | - Julia Keith
- Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | | | - Uri Tabori
- The Hospital for Sick Children, Toronto, ON, Canada
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36
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Lahna D, Schwartz DL, Woltjer R, Black SE, Roese NE, Dodge HH, Boespflug EL, Keith J, Gao F, Ramirez J, Silbert LC. Perivascular space dilation in white matter mediates a significant relationship between white matter hyperintensity burden and venous collagenosis. Alzheimers Dement 2020. [DOI: 10.1002/alz.045432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- David Lahna
- Oregon Health & Science University Portland OR USA
| | | | - Randy Woltjer
- NIA‐Layton Aging & Alzheimer's Disease Center Portland OR USA
| | - Sandra E. Black
- L.C.Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre Toronto ON Canada
| | | | | | | | - Julia Keith
- Sunnybrook Health Sciences Centre University of Toronto Toronto ON Canada
| | - Fuqiang Gao
- Sunnybrook Research Institute Toronto ON Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology Research Unit Toronto ON Canada
| | - Lisa C. Silbert
- Oregon Center for Aging & Technology (ORCATECH) Portland OR USA
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Pasarikovski CR, Ku JC, Keith J, Ramjist J, Dobashi Y, Priola SM, da Costa L, Yang VXD. Endovascular Cerebral Venous Sinus Imaging with Optical Coherence Tomography. AJNR Am J Neuroradiol 2020; 41:2292-2297. [PMID: 33214185 DOI: 10.3174/ajnr.a6909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/28/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Imaging of the cerebral venous sinuses has evolved Substantially during the past 2 decades, and most recently intravascular sinus imaging with sonography has shed light on the pathophysiology of sinus thrombosis and intracranial hypertension. Optical coherence tomography is the highest resolution intravascular imaging technique available but has not been previously used in cerebral sinus imaging. The purpose of this study was to develop a preclinical animal model of endovascular optical coherence tomography cerebral venous sinus imaging and compare optical coherence tomography findings with histology. MATERIALS AND METHODS Four consecutive Yorkshire swine were selected. The superior sagittal sinus was first catheterized with a microwire, and the optical coherence tomography catheter was delivered via a monorail technique into the sinus. Luminal blood was cleared with a single arterial injection. After structural and Doppler optical coherence tomography imaging, a craniotomy was performed and the sinus and adjacent dura/veins were resected. Bland-Altman analysis was performed to compare optical coherence tomography and histology. RESULTS Technically successful optical coherence tomography images were obtained in 3 of 4 swine. The luminal environment and visualization of dural arteries and draining cortical veins were characterized. The average maximum diameters of the sinus, dural arteries, and cortical veins were 3.14 mm, 135 µm, and 260 µm, respectively. Bland-Altman analysis demonstrated good agreement between histology and optical coherence tomography images. CONCLUSIONS Endovascular optical coherence tomography imaging was feasible in this preclinical animal study. Adoption of this imaging technique in the human cerebral venous sinus could aid in the diagnosis, treatment, and understanding of the pathophysiology of various diseases of the sinus. Human safety and feasibility studies are needed.
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Affiliation(s)
- C R Pasarikovski
- From the Division of Neurosurgery (C.R.P., J.C.K.), Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - J C Ku
- From the Division of Neurosurgery (C.R.P., J.C.K.), Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - J Keith
- Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - J Ramjist
- Division of Neurosurgery (J.R., Y.D., L.d.C., V.X.D.Y.), Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Y Dobashi
- Division of Neurosurgery (J.R., Y.D., L.d.C., V.X.D.Y.), Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
| | - S M Priola
- Division of Neurosurgery (S.M.P.), Department of Surgery, Health Sciences North, Sudbury, Ontario, Canada
| | - L da Costa
- Division of Neurosurgery (J.R., Y.D., L.d.C., V.X.D.Y.), Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
| | - V X D Yang
- Division of Neurosurgery (J.R., Y.D., L.d.C., V.X.D.Y.), Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program (V.X.D.Y.), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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38
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Pasarikovski CR, Ku JC, Keith J, Ramjist J, Dobashi Y, Priola SM, da Costa L, Kumar A, Yang VXD. Mechanical thrombectomy and intravascular imaging for cerebral venous sinus thrombosis: a preclinical model. J Neurosurg 2020:1-6. [PMID: 33126210 DOI: 10.3171/2020.6.jns201795] [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: 05/13/2020] [Accepted: 06/12/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although the majority of patients with cerebral venous sinus thrombosis (CVST) will improve with anticoagulation therapy, a portion of patients will either present in a comatose state or continue to deteriorate clinically despite early anticoagulation. In these cases, along with treating the underlying thrombophilia, timely thrombolysis may be beneficial. Repurposed arterial thrombectomy devices may not perform as expected in the cerebral venous sinus, and there are currently no preclinical endovascular thrombectomy (EVT) models for CVST. Contrary to arterial stroke research, preclinical models utilized to test various endovascular techniques and devices are lacking. The purpose of this research was to develop a reliable preclinical animal model for the testing of endovascular strategies to treat CVST. METHODS Five consecutive male Yorkshire swine weighing 45 kg were utilized. Thrombosis of the superior sagittal sinus was induced with a bovine thrombin injection via a microcatheter under distal balloon occlusion for 15 minutes. Combined arterial injections and superselective sinus injections confirmed the extent of thrombosis. EVT was subsequently performed using a second-generation stent retriever, followed by intravascular optical coherence tomography (OCT) imaging to assess the luminal environment after thrombectomy. RESULTS Thrombosis of the superior sagittal sinus, EVT, and subsequent OCT imaging were technically successful in 4 of the 5 swine. Recanalization of the sinus with a second-generation stent retriever was successful after one attempt in 3 of 4 swine (75%), and 1 swine required two attempts. OCT imaging after thrombectomy revealed regions of residual sinus luminal thrombus despite complete angiographic recanalization. Thrombosed bridging cortical veins were also observed before draining into the sinus, along with patent cortical veins. CONCLUSIONS The authors describe a preclinical model to assess endovascular techniques and devices for the treatment of CVST. Repurposed devices from arterial stroke may not perform as expected, given the unique features of venous sinus thrombosis. Residual bridging cortical vein thrombus and residual sinus thrombus, visualized on intravascular OCT, may be present despite complete sinus recanalization on angiography, and this may be the etiology of the poor clinical outcome despite technical success. In the setting of bridging cortical vein thrombus after successful sinus thrombectomy, direct chemical thrombolysis may be warranted to dissolve the remaining clot. This model may be helpful in developing and testing a new generation of devices designed specifically for CVST treatment.
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Affiliation(s)
| | - Jerry C Ku
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
| | - Julia Keith
- 2Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto
| | - Joel Ramjist
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
| | - Yuta Dobashi
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
| | - Stefano M Priola
- 4Division of Neurosurgery, Department of Surgery, Health Sciences North, Sudbury; and
| | - Leodante da Costa
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
| | - Ashish Kumar
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
| | - Victor X D Yang
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
- 5Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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39
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Lechauve C, Keith J, Khandros E, Fowler S, Mayberry K, Freiwan A, Thom CS, Delbini P, Romero EB, Zhang J, Motta I, Tillman H, Cappellini MD, Kundu M, Weiss MJ. The autophagy-activating kinase ULK1 mediates clearance of free α-globin in β-thalassemia. Sci Transl Med 2020; 11:11/506/eaav4881. [PMID: 31434755 DOI: 10.1126/scitranslmed.aav4881] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/26/2019] [Accepted: 07/18/2019] [Indexed: 12/15/2022]
Abstract
In β-thalassemia, accumulated free α-globin forms intracellular precipitates that impair erythroid cell maturation and viability. Protein quality control systems mitigate β-thalassemia pathophysiology by degrading toxic free α-globin, although the associated mechanisms are poorly understood. We show that loss of the autophagy-activating Unc-51-like kinase 1 (Ulk1) gene in β-thalassemic mice reduces autophagic clearance of α-globin in red blood cell precursors and exacerbates disease phenotypes, whereas inactivation of the canonical autophagy-related 5 (Atg5) gene has relatively minor effects. Systemic treatment with the mTORC1 inhibitor rapamycin reduces α-globin precipitates and lessens pathologies in β-thalassemic mice via an ULK1-dependent pathway. Similarly, rapamycin reduces free α-globin accumulation in erythroblasts derived from CD34+ cells of β-thalassemic individuals. Our findings define a drug-regulatable pathway for ameliorating β-thalassemia.
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Affiliation(s)
- Christophe Lechauve
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Julia Keith
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Eugene Khandros
- Department of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Stephanie Fowler
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Kalin Mayberry
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Abdullah Freiwan
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Christopher S Thom
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Paola Delbini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Emilio Boada Romero
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jingjing Zhang
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Irene Motta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Heather Tillman
- Departments of Pathology and Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - M Domenica Cappellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Mondira Kundu
- Departments of Pathology and Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
| | - Mitchell J Weiss
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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40
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Shellikeri S, Keith J, Black SE, Zinman L, Yunusova Y. Neuropathology of Speech Network Distinguishes Bulbar From Nonbulbar Amyotrophic Lateral Sclerosis. J Neuropathol Exp Neurol 2020; 79:284-295. [PMID: 31951003 DOI: 10.1093/jnen/nlz130] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/26/2019] [Indexed: 12/14/2022] Open
Abstract
Bulbar amyotrophic lateral sclerosis (ALS) is a debilitating neurodegenerative subtype affecting speech and swallowing motor functions as well as associated with the burden of cognitive deficits. The neuroanatomical underpinnings of bulbar ALS are not well understood. The aim of this study was to compare neuropathology of the speech network (SpN) between 3 cases of bulbar-onset ALS (bALS), 3 cases of spinal-onset ALS (sALS) with antemortem bulbar ALS (sALSwB) against 3 sALS without antemortem bulbar ALS (sALSnoB) and 3 controls. Regional distribution and severity of neuronal loss, TDP-43 (transactive response DNA-binding protein of 43 kDa), and tau proteinopathy were examined. All 3 bALS cases showed marked neuronal loss and severe proteinopathy across most SpN regions; sALSwB cases showed no neuronal loss but mild and variable TDP-43 pathology in focal regions; sALSnoB cases demonstrated an absence of pathology. Two bALS cases had coexisting tauopathy in SpN regions, which was not noted in any sALS cases. The findings suggested that bALS may have a distinct neuropathological signature characterized by marked neuronal loss and polypathology in the SpN. Milder TDP-43 pathology in the SpN for sALSwB cases suggested a link between severity of bulbar ALS and SpN damage. Findings support a clinicopathologic link between bulbar symptoms and pathology in the SpN.
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Affiliation(s)
- Sanjana Shellikeri
- Department of Speech-Language Pathology & Rehabilitation Sciences Institute, University of Toronto.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute
| | - Julia Keith
- Laboratory Medicine and Molecular Diagnostics, Anatomic Pathology, Sunnybrook Health Sciences Centre, and Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto
| | - Sandra E Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre.,L.C. Campbell Cognitive Neurology Research Unit, Cognitive Neurology, Sunnybrook Research Institute, University of Toronto.,Rotman Research Institute, Baycrest
| | - Lorne Zinman
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre.,L.C. Campbell Cognitive Neurology Research Unit, Cognitive Neurology, Sunnybrook Research Institute, University of Toronto
| | - Yana Yunusova
- Department of Speech-Language Pathology & Rehabilitation Sciences Institute, University of Toronto.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute.,University Health Network - Toronto Rehabilitation Institute (YY), Toronto, Ontario, Canada
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41
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Kotecha R, Mehta MP, Chang EL, Brown PD, Suh JH, Lo SS, Das S, Samawi HH, Keith J, Perry J, Sahgal A. Updates in the management of intradural spinal cord tumors: a radiation oncology focus. Neuro Oncol 2020; 21:707-718. [PMID: 30977511 DOI: 10.1093/neuonc/noz014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Primary spinal cord tumors represent a hetereogeneous group of central nervous system malignancies whose management is complex given the relatively uncommon nature of the disease and variety of tumor subtypes, functional neurologic deficits from the tumor, and potential morbidities associated with definitive treatment. Advances in neuroimaging; integration of diagnostic, prognostic, and predictive molecular testing into tumor classification; and developments in neurosurgical techniques have refined the current role of radiotherapy in the multimodal management of patients with primary spinal cord tumors, and corroborated the need for prospective, multidisciplinary discussion and treatment decision making. Radiotherapeutic technological advances have dramatically improved the entire continuum from treatment planning to treatment delivery, and the development of stereotactic radiosurgery and proton radiotherapy provides new radiotherapy options for patients treated in the definitive, adjuvant, or salvage setting. The objective of this comprehensive review is to provide a contemporary overview of the management of primary intradural spinal cord tumors, with a focus on radiotherapy.
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Affiliation(s)
- Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Eric L Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - John H Suh
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Sunit Das
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Haider H Samawi
- Division of Hematology/Oncology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Julia Keith
- Department of Anatomical Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James Perry
- Department of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Shivji S, Wong W, Fischer CE, Fornazzari LR, Masellis M, Keith J. Parkinsonism in C9orf72 expansion without co-existing Lewy body pathology; a case report and review of the literature. Neuropathol Appl Neurobiol 2020; 46:786-789. [PMID: 32339329 DOI: 10.1111/nan.12623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/03/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022]
Affiliation(s)
- S Shivji
- Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - W Wong
- Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - C E Fischer
- Keenan Research Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - L R Fornazzari
- Department of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - M Masellis
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - J Keith
- Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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43
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Fukuoka K, Mamatjan Y, Ryall S, Komosa M, Bennett J, Zapotocky M, Keith J, Myrehaug S, Hazrati L, Aldape K, Laperriere N, Bouffet E, Tabori U, Hawkins C. BRAF V600E mutant oligodendroglioma-like tumors with chromosomal instability in adolescents and young adults. Brain Pathol 2020; 30:515-523. [PMID: 31630459 PMCID: PMC8018140 DOI: 10.1111/bpa.12799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/11/2019] [Indexed: 12/28/2022] Open
Abstract
We performed genome-wide methylation analysis on 136 pediatric low-grade gliomas, identifying a unique cluster consisting of three tumors with oligodendroglioma-like histology, BRAF p.V600E mutations and recurrent whole chromosome gains of 7 and loss of 10. Morphologically, all showed similar features, including a diffusely infiltrative glioma composed of round nuclei with perinuclear halos, a chicken-wire pattern of branching capillaries and microcalcification. None showed astrocytic features or characteristics suggestive of high-grade tumors including necrosis or mitotic figures. All tumors harbored multiple chromosomal copy number abnormalities (>10 chromosomes altered), but none showed 1p/19q co-deletion or IDH1 p.R132H mutation. Hierarchical clustering and t-stochastic neighbor embedding analyses from DNA methylation data cluster them more closely to previously described pediatric-type low-grade gliomas and separate from adult gliomas. These tumors exhibit distinct clinical features; they are temporal lobe lesions occurring in adolescents and young adults with a prolonged history of seizures and all are alive with no recurrence (follow-up 3.2 to 13.2 years). We encountered another young adult case with quite similar pathological appearance and molecular status except for TERT promoter mutation. Although the series is small, these may represent a new category of IDH wild-type low-grade gliomas which may be confused with "molecular GBM." Further, they highlight the heterogeneity of IDH wild-type gliomas and the relatively indolent behavior of "pediatric-type" gliomas.
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Affiliation(s)
- Kohei Fukuoka
- Division of Haematology/OncologyDepartment of PaediatricsThe Hospital for Sick ChildrenTorontoONCanada
| | - Yasin Mamatjan
- Princess Margaret Cancer Centre and MacFeetersHamilton Centre for Neuro‐Oncology ResearchTorontoONCanada
| | - Scott Ryall
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoONCanada
| | - Martin Komosa
- Program in Genetics and Genome BiologyThe Arthur and Sonia Labatt Brain Tumour Research CentreThe Hospital for Sick ChildrenTorontoONCanada
| | - Julie Bennett
- Division of Haematology/OncologyDepartment of PaediatricsThe Hospital for Sick ChildrenTorontoONCanada
| | - Michal Zapotocky
- Division of Haematology/OncologyDepartment of PaediatricsThe Hospital for Sick ChildrenTorontoONCanada
| | - Julia Keith
- Department of PathologySunnybrook Health Sciences CentreTorontoONCanada
| | - Sten Myrehaug
- Department of Radiation OncologySunnybrook Health Sciences CentreTorontoONCanada
| | - Lili‐Naz Hazrati
- Division of PathologyThe Hospital for Sick ChildrenTorontoONCanada
| | - Kenneth Aldape
- Princess Margaret Cancer Centre and MacFeetersHamilton Centre for Neuro‐Oncology ResearchTorontoONCanada
| | - Norm Laperriere
- Department of Radiation OncologyPrincess Margaret HospitalTorontoONCanada
| | - Eric Bouffet
- Division of Haematology/OncologyDepartment of PaediatricsThe Hospital for Sick ChildrenTorontoONCanada
| | - Uri Tabori
- Division of Haematology/OncologyDepartment of PaediatricsThe Hospital for Sick ChildrenTorontoONCanada
| | - Cynthia Hawkins
- Division of PathologyThe Hospital for Sick ChildrenTorontoONCanada
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Zhang M, McKeever PM, Xi Z, Moreno D, Sato C, Bergsma T, McGoldrick P, Keith J, Robertson J, Zinman L, Rogaeva E. DNA methylation age acceleration is associated with ALS age of onset and survival. Acta Neuropathol 2020; 139:943-946. [PMID: 32146547 PMCID: PMC7181538 DOI: 10.1007/s00401-020-02131-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Ming Zhang
- Shanghai First Rehabilitation Hospital, School of Medicine, Tongji University, Shanghai, 200090, China.
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Ave., Toronto, ON, M5T 2S8, Canada.
- Clinical Center for Brain and Spinal Cord Research, Tongji University, Shanghai, 200092, China.
- Institute for Advanced Study, Tongji University, Shanghai, China.
| | - Paul M McKeever
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Ave., Toronto, ON, M5T 2S8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - Zhengrui Xi
- Clinical Center for Brain and Spinal Cord Research, Tongji University, Shanghai, 200092, China
- Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
| | - Danielle Moreno
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Ave., Toronto, ON, M5T 2S8, Canada
| | - Christine Sato
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Ave., Toronto, ON, M5T 2S8, Canada
| | - Tessa Bergsma
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Ave., Toronto, ON, M5T 2S8, Canada
| | - Philip McGoldrick
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Ave., Toronto, ON, M5T 2S8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - Julia Keith
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Janice Robertson
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Ave., Toronto, ON, M5T 2S8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - Lorne Zinman
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Ave., Toronto, ON, M5T 2S8, Canada.
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.
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Van Ommeren R, Izenberg A, Shadowitz S, Aviv R, Keith J. Clinical Reasoning: An 81-year-old woman with decreased consciousness and fluctuating right facial droop. Neurology 2020; 94:843-848. [PMID: 32317353 DOI: 10.1212/wnl.0000000000009410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Randy Van Ommeren
- From the Department of Laboratory Medicine and Pathobiology (R.V.O., J.K.) and Department of Medicine (S.S.), Division of Neurology (A.I.), Department of Radiology (R.A.), and Department of Laboratory Medicine and Molecular Diagnostics (J.K.), Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Aaron Izenberg
- From the Department of Laboratory Medicine and Pathobiology (R.V.O., J.K.) and Department of Medicine (S.S.), Division of Neurology (A.I.), Department of Radiology (R.A.), and Department of Laboratory Medicine and Molecular Diagnostics (J.K.), Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Steven Shadowitz
- From the Department of Laboratory Medicine and Pathobiology (R.V.O., J.K.) and Department of Medicine (S.S.), Division of Neurology (A.I.), Department of Radiology (R.A.), and Department of Laboratory Medicine and Molecular Diagnostics (J.K.), Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Richard Aviv
- From the Department of Laboratory Medicine and Pathobiology (R.V.O., J.K.) and Department of Medicine (S.S.), Division of Neurology (A.I.), Department of Radiology (R.A.), and Department of Laboratory Medicine and Molecular Diagnostics (J.K.), Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Julia Keith
- From the Department of Laboratory Medicine and Pathobiology (R.V.O., J.K.) and Department of Medicine (S.S.), Division of Neurology (A.I.), Department of Radiology (R.A.), and Department of Laboratory Medicine and Molecular Diagnostics (J.K.), Sunnybrook Health Sciences Centre, University of Toronto, Canada.
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Dmytriw AA, Alrashed A, Keith J, Yang VXD. Endovascular Retrieval of Ruptured Carotid Plaque Embolus. Ann Neurol 2020; 87:807-808. [PMID: 32277500 DOI: 10.1002/ana.25745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Adam A Dmytriw
- Departments of Neurosurgery and Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Abdullah Alrashed
- Departments of Neurosurgery and Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Julia Keith
- Departments of Laboratory Medicine and Molecular Diagnostics, Laboratory Medicine and Pathobiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Victor X D Yang
- Departments of Neurosurgery and Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Khademullah CS, Aqrabawi AJ, Place KM, Dargaei Z, Liang X, Pressey JC, Bedard S, Yang JW, Garand D, Keramidis I, Gasecka A, Côté D, De Koninck Y, Keith J, Zinman L, Robertson J, Kim JC, Woodin MA. Cortical interneuron-mediated inhibition delays the onset of amyotrophic lateral sclerosis. Brain 2020; 143:800-810. [DOI: 10.1093/brain/awaa034] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/08/2020] [Indexed: 12/13/2022] Open
Abstract
Abstract
Amyotrophic lateral sclerosis is a fatal disease resulting from motor neuron degeneration in the cortex and spinal cord. Cortical hyperexcitability is a hallmark feature of amyotrophic lateral sclerosis and is accompanied by decreased intracortical inhibition. Using electrophysiological patch-clamp recordings, we revealed parvalbumin interneurons to be hypoactive in the late pre-symptomatic SOD1*G93A mouse model of amyotrophic lateral sclerosis. We discovered that using adeno-associated virus-mediated delivery of chemogenetic technology targeted to increase the activity of the interneurons within layer 5 of the primary motor cortex, we were able to rescue intracortical inhibition and reduce pyramidal neuron hyperexcitability. Increasing the activity of interneurons in the layer 5 of the primary motor cortex was effective in delaying the onset of amyotrophic lateral sclerosis-associated motor deficits, slowing symptom progression, preserving neuronal populations, and increasing the lifespan of SOD1*G93A mice. Taken together, this study provides novel insights into the pathogenesis and treatment of amyotrophic lateral sclerosis.
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Affiliation(s)
- C Sahara Khademullah
- Department of Cell and Systems Biology, University of Toronto, 25 Harbord Street, Toronto, Ontario, M5S 3G5, Canada
| | - Afif J Aqrabawi
- Department of Psychology, University of Toronto, 100 St George Street, Toronto, Ontario, M5S 3G3, Canada
| | - Kara M Place
- Department of Cell and Systems Biology, University of Toronto, 25 Harbord Street, Toronto, Ontario, M5S 3G5, Canada
| | - Zahra Dargaei
- Department of Cell and Systems Biology, University of Toronto, 25 Harbord Street, Toronto, Ontario, M5S 3G5, Canada
| | - Xinyi Liang
- Department of Cell and Systems Biology, University of Toronto, 25 Harbord Street, Toronto, Ontario, M5S 3G5, Canada
| | - Jessica C Pressey
- Department of Cell and Systems Biology, University of Toronto, 25 Harbord Street, Toronto, Ontario, M5S 3G5, Canada
| | - Simon Bedard
- Department of Cell and Systems Biology, University of Toronto, 25 Harbord Street, Toronto, Ontario, M5S 3G5, Canada
| | - Jy Wei Yang
- Department of Cell and Systems Biology, University of Toronto, 25 Harbord Street, Toronto, Ontario, M5S 3G5, Canada
| | - Danielle Garand
- Department of Cell and Systems Biology, University of Toronto, 25 Harbord Street, Toronto, Ontario, M5S 3G5, Canada
| | - Iason Keramidis
- CERVO Brain Research Institute, Laval University, 2601 Chemin de la Canardière, Québec, Québec, G1J 2G3, Canada
| | - Alicja Gasecka
- CERVO Brain Research Institute, Laval University, 2601 Chemin de la Canardière, Québec, Québec, G1J 2G3, Canada
| | - Daniel Côté
- CERVO Brain Research Institute, Laval University, 2601 Chemin de la Canardière, Québec, Québec, G1J 2G3, Canada
| | - Yves De Koninck
- CERVO Brain Research Institute, Laval University, 2601 Chemin de la Canardière, Québec, Québec, G1J 2G3, Canada
| | - Julia Keith
- Sunnybrook Health Science Centre, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada
| | - Lorne Zinman
- Sunnybrook Health Science Centre, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada
| | - Janice Robertson
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research into Neurodegenerative Diseases, Toronto, Ontario, M5T 2S8, Canada
| | - Jun Chul Kim
- Department of Psychology, University of Toronto, 100 St George Street, Toronto, Ontario, M5S 3G3, Canada
| | - Melanie A Woodin
- Department of Cell and Systems Biology, University of Toronto, 25 Harbord Street, Toronto, Ontario, M5S 3G5, Canada
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Pasarikovski CR, Keith J, da Costa L, Ramjist J, Dobashi Y, Black SE, Yang VXD. Optical coherence tomography imaging after endovascular thrombectomy: a novel method for evaluating vascular injury in a swine model. J Neurosurg 2020; 134:870-877. [PMID: 32059182 DOI: 10.3171/2019.12.jns192881] [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: 10/22/2019] [Accepted: 12/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although studies have shown that some degree of iatrogenic endothelial injury occurs during endovascular thrombectomy (EVT), the clinical significance of such injury is uncertain. Furthermore, it is likely that iatrogenic effects such as endothelial denudation, intimal dissection, and tunica media edema will have varying clinical implications. The purpose of this study was to assess the feasibility of endovascular optical coherence tomography (OCT) in quantifying vessel injury in real time after EVT, correlate vessel injury with histological findings, and perform imaging at varying time intervals after EVT to assess the impact of prolonged direct exposure of the vessel to the thrombus. METHODS Yorkshire swine weighing 35-40 kg were selected for use as the animal model, with a total of 9 vessels from 3 swine examined. Thrombectomy was performed using a second-generation stent retriever 1, 3, and 6 hours after thrombus deposition. The presence and degree of denudation of the endothelium, detachment and separation of the layers of the tunic media, hemorrhage within the media, dissection of the vessels, and thrombus within the lumina were assessed using OCT images acquired immediately after EVT. Bland-Altman analysis indicated that these OCT findings were correlated with postmortem histological findings. RESULTS OCT image acquisition was technically successful in all cases. Endothelial denudation was present in 65% ± 16%, 87% ± 8%, and 93% ± 7% of the vessel surface 1, 3, and 6 hours, respectively, after thrombus deposition and subsequent EVT. Residual intraluminal thrombus was present in vessels at all time intervals despite complete angiographic revascularization. Bland-Altman plots showed good agreement between OCT and histological analysis with respect to the degree of endothelial denudation and elevation, separation of the tunica media, and hemorrhage within the media. OCT appears to be more specific than histological analysis in detecting endothelial elevation. CONCLUSIONS OCT is a feasible method that can be used to assess vascular injury after EVT with histological accuracy. Varying degrees of vessel injury occur after EVT, and residual luminal thrombus can be present despite complete angiographic revascularization.
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Affiliation(s)
| | - Julia Keith
- 2Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Leodante da Costa
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
| | - Joel Ramjist
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
| | - Yuta Dobashi
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
| | - Sandra E Black
- 4Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto; and.,5Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Victor X D Yang
- 1Division of Neurosurgery, Department of Surgery, University of Toronto.,3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto.,4Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto; and
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49
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Pasarikovski C, Keith J, daCosta L, Ramjist J, Dobashi Y, Black SE, Yang V. Abstract 1: Optical Coherence Tomography Imaging in Acute Ischemic Stroke: Preliminary Animal and Human Results. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.1] [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
Background:
Studies evaluating endothelial injury after EVT have been done by means of retrieved human thrombus, MR vessel-wall imaging, and animal histopathologic studies. These techniques have limitations, as MR imaging has insufficient spatial resolution to directly visualize endothelium, and histopathologic examinations are ex-vivo and unable to provide real-time patterns of injury.
Objective:
Endovascular imaging after EVT using optical coherence tomography (OCT) to examine for vessel injury in real-time.
Methodology:
Three swine weighing 35-40kg were selected for the animal model. Autologous venous whole-blood was used to create thrombus. A second-generation stent retriever was used for EVT. Next, three consecutive patients with basilar artery occlusion underwent EVT and endovascular OCT imaging.
Results:
In the animal model, revascularization and OCT imaging was successful for all 9 vessels. Endothelial injury was observed in 4/9 (44%) of vessels, and residual thrombus was observed in 4/9 (44%) of vessels despite complete angiographic revascularization. All vessels undergoing EVT after 6 hours had evidence of endothelial injury, and 2/3 (66%) had residual thrombus. Two basilar stroke patients (2/3) 66% had significant residual thrombus despite complete angiographic revascularization. The residual thrombus was also not visible on CT angiography or MR imaging done within 24 hours of EVT.
Conclusions:
Endothelial injury and residual thrombus despite complete revascularization is present after EVT and can be observed in real-time using OCT. It is possible that the longer occlusive thrombus is present, the more endothelial injury will occur during EVT.
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Affiliation(s)
| | - Julia Keith
- Pathology, Sunnybrook Health Sciences Cntr, Toronto, Canada
| | | | - Joel Ramjist
- Sunnybrook Health Sciences Cntr, Toronto, Canada
| | | | - Sandra E Black
- Neurology, Sunnybrook Health Sciences Cntr, Toronto, Canada
| | - Victor Yang
- Neurosurgery, Sunnybrook Health Sciences Cntr, Toronto, Canada
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50
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Mirza SS, Saeed U, Knight J, Ramirez J, Stuss DT, Keith J, Nestor SM, Yu D, Swardfager W, Rogaeva E, St George Hyslop P, Black SE, Masellis M. APOE ε4, white matter hyperintensities, and cognition in Alzheimer and Lewy body dementia. Neurology 2019; 93:e1807-e1819. [PMID: 31575706 PMCID: PMC6946485 DOI: 10.1212/wnl.0000000000008377] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 06/13/2019] [Indexed: 01/07/2023] Open
Abstract
Objective To determine if APOE ε4 influences the association between white matter hyperintensities (WMH) and cognitive impairment in Alzheimer disease (AD) and dementia with Lewy bodies (DLB). Methods A total of 289 patients (AD = 239; DLB = 50) underwent volumetric MRI, neuropsychological testing, and APOE ε4 genotyping. Total WMH volumes were quantified. Neuropsychological test scores were included in a confirmatory factor analysis to identify cognitive domains encompassing attention/executive functions, learning/memory, and language, and factor scores for each domain were calculated per participant. After testing interactions between WMH and APOE ε4 in the full sample, we tested associations of WMH with factor scores using linear regression models in APOE ε4 carriers (n = 167) and noncarriers (n = 122). We hypothesized that greater WMH volume would relate to worse cognition more strongly in APOE ε4 carriers. Findings were replicated in 198 patients with AD from the Alzheimer's Disease Neuroimaging Initiative (ADNI-I), and estimates from both samples were meta-analyzed. Results A significant interaction was observed between WMH and APOE ε4 for language, but not for memory or executive functions. Separate analyses in APOE ε4 carriers and noncarriers showed that greater WMH volume was associated with worse attention/executive functions, learning/memory, and language in APOE ε4 carriers only. In ADNI-I, greater WMH burden was associated with worse attention/executive functions and language in APOE ε4 carriers only. No significant associations were observed in noncarriers. Meta-analyses showed that greater WMH volume was associated with worse performance on all cognitive domains in APOE ε4 carriers only. Conclusion APOE ε4 may influence the association between WMH and cognitive performance in AD and DLB.
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Affiliation(s)
- Saira Saeed Mirza
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK.
| | - Usman Saeed
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Jo Knight
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Joel Ramirez
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Donald T Stuss
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Julia Keith
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Sean M Nestor
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Di Yu
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Walter Swardfager
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Ekaterina Rogaeva
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Peter St George Hyslop
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Sandra E Black
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
| | - Mario Masellis
- From the Division of Neurology, Department of Medicine (S.S.M., D.T.S., S.E.B., M.M.), Hurvitz Brain Sciences Research Program (S.S.M., J.R., D.T.S., D.Y., W.S., S.E.B., M.M.) and LC Campbell Cognitive Neurology Research Unit (U.S., J.R., S.M.N., D.Y., W.S., S.E.B., M.M.), Sunnybrook Research Institute, Institute of Medical Science (U.S., S.E.B., M.M.), Rehabilitation Sciences Institute (D.T.S., S.E.B.), and Department of Psychiatry (S.M.N.), Faculty of Medicine, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (J.R., D.Y., W.S., S.E.B.) and Department of Anatomic Pathology (J.K.), Sunnybrook Health Sciences Centre, Department of Psychology, Faculty of Arts and Science (D.T.S.), Department of Pharmacology & Toxicity (D.Y., W.S.), Tanz Centre for Research in Neurodegenerative Diseases (E.R., P.S.G.H.), and Institute of Biomaterials and Biomedical Engineering (S.E.B.), University of Toronto, Canada; Data Science Institute and Medical School (J.K.), Lancaster University, Lancaster; and Cambridge Institute for Medical Research (P.S.G.H.), Department of Clinical Neuroscience, University of Cambridge, UK
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