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Büttner P, Böttner J, Krohn K, Baber R, Platzbecker U, Cross M, Thiele H, Branzan D. Clonal hematopoiesis of indeterminate potential in peripheral artery disease. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Jaumann R, Schmitz N, Ho TM, Schröder SE, Otto KA, Stephan K, Elgner S, Krohn K, Preusker F, Scholten F, Biele J, Ulamec S, Krause C, Sugita S, Matz KD, Roatsch T, Parekh R, Mottola S, Grott M, Michel P, Trauthan F, Koncz A, Michaelis H, Lange C, Grundmann JT, Maibaum M, Sasaki K, Wolff F, Reill J, Moussi-Soffys A, Lorda L, Neumann W, Vincent JB, Wagner R, Bibring JP, Kameda S, Yano H, Watanabe S, Yoshikawa M, Tsuda Y, Okada T, Yoshimitsu T, Mimasu Y, Saiki T, Yabuta H, Rauer H, Honda R, Morota T, Yokota Y, Kouyama T. Images from the surface of asteroid Ryugu show rocks similar to carbonaceous chondrite meteorites. Science 2020; 365:817-820. [PMID: 31439797 DOI: 10.1126/science.aaw8627] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/23/2019] [Indexed: 11/02/2022]
Abstract
The near-Earth asteroid (162173) Ryugu is a 900-m-diameter dark object expected to contain primordial material from the solar nebula. The Mobile Asteroid Surface Scout (MASCOT) landed on Ryugu's surface on 3 October 2018. We present images from the MASCOT camera (MASCam) taken during the descent and while on the surface. The surface is covered by decimeter- to meter-sized rocks, with no deposits of fine-grained material. Rocks appear either bright, with smooth faces and sharp edges, or dark, with a cauliflower-like, crumbly surface. Close-up images of a rock of the latter type reveal a dark matrix with small, bright, spectrally different inclusions, implying that it did not experience extensive aqueous alteration. The inclusions appear similar to those in carbonaceous chondrite meteorites.
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Affiliation(s)
- R Jaumann
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany. .,Free University of Berlin, Institute of Geosciences, Berlin, Germany
| | - N Schmitz
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - T-M Ho
- DLR, Institute of Space Systems, Bremen, Germany
| | - S E Schröder
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - K A Otto
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - K Stephan
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - S Elgner
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - K Krohn
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - F Preusker
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - F Scholten
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - J Biele
- DLR, Microgravity User Support Center, Linder Höhe, Cologne, Germany
| | - S Ulamec
- DLR, Microgravity User Support Center, Linder Höhe, Cologne, Germany
| | - C Krause
- DLR, Microgravity User Support Center, Linder Höhe, Cologne, Germany
| | - S Sugita
- Department of Earth and Planetary Science, School of Science, University of Tokyo, Tokyo 113-0033, Japan
| | - K-D Matz
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - T Roatsch
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - R Parekh
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany.,Free University of Berlin, Institute of Geosciences, Berlin, Germany
| | - S Mottola
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - M Grott
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - P Michel
- Université Côte d'Azur, Observatoire de la Côte d'Azur, Centre National de la Recherche Scientifique, Laboratoire Lagrange, Nice, France
| | - F Trauthan
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - A Koncz
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - H Michaelis
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - C Lange
- DLR, Institute of Space Systems, Bremen, Germany
| | | | - M Maibaum
- DLR, Microgravity User Support Center, Linder Höhe, Cologne, Germany
| | - K Sasaki
- DLR, Institute of Space Systems, Bremen, Germany
| | - F Wolff
- DLR, Institute of System Dynamics and Control, Oberpfaffenhofen, Germany
| | - J Reill
- DLR, Institute of Robotics and Mechatronics, Oberpfaffenhofen, Germany
| | - A Moussi-Soffys
- Centre National d'Études Spatiales, 18 Avenue E. Belin, Toulouse 31401, France
| | - L Lorda
- Centre National d'Études Spatiales, 18 Avenue E. Belin, Toulouse 31401, France
| | - W Neumann
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - J-B Vincent
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - R Wagner
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - J-P Bibring
- L'Université de Paris Sud-Orsay, Institut d'Astrophysique Spatiale, Orsay, France
| | - S Kameda
- Department of Physics, Rikkyo University, 3-34-1 Nishi-Ikebukuro, Toshima, Tokyo 171-8501, Japan
| | - H Yano
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara, Japan
| | - S Watanabe
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara, Japan.,Department of Earth and Planetary Sciences, Nagoya University Furo-cho Chikusa-ku, Nagoya, Japan
| | - M Yoshikawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara, Japan
| | - Y Tsuda
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara, Japan
| | - T Okada
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara, Japan
| | - T Yoshimitsu
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara, Japan
| | - Y Mimasu
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara, Japan
| | - T Saiki
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara, Japan
| | - H Yabuta
- Department of Earth and Planetary Systems Science, Hiroshima University, Hiroshima, Japan
| | - H Rauer
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany.,Free University of Berlin, Institute of Geosciences, Berlin, Germany
| | - R Honda
- Kochi University, Department of Information Science, Akebono, Kochi, Japan
| | - T Morota
- University of Tokyo, Department of Earth and Planetary Science, Hongo, Bunkyo, Tokyo, Japan
| | - Y Yokota
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Sagamihara, Japan
| | - T Kouyama
- National Institute of Advanced Industrial Science and Technology, Aomi, Koto, Tokyo, Japan
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Rothman MS, Olenginski TP, Stanciu I, Krohn K, Lewiecki EM. Lessons learned with Bone Health TeleECHO: making treatment decisions when guidelines conflict. Osteoporos Int 2019; 30:2401-2406. [PMID: 31471665 DOI: 10.1007/s00198-019-05147-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/23/2019] [Indexed: 12/24/2022]
Abstract
Clinical practice guidelines provide helpful information for managing patients with metabolic bone disease. Good guidelines are based on the best available medical evidence; however, guidelines from different societies can conflict. Additionally, it is not possible for a guideline to anticipate the vast variability of circumstances, comorbidities, previous medical experiences, cultural differences, and preferences in real-world patients. Bone Health TeleECHO is a strategy for sharing knowledge on the care of patients with skeletal diseases through ongoing interactive videoconferences. We report three cases based on those presented at Bone Health TeleECHO, where, through discussion, treatment outside of commonly used guidelines was ultimately recommended. Guidelines developed by different organizations may provide "evidence-based" or "informed" recommendations which do not account for the variability of clinical circumstances encountered in the care of individual patients. This highlights the importance of Bone Health TeleECHO, where healthcare professionals can share knowledge, individualize treatment decisions, and improve patient care.Learning objectives At the end of this activity participants should be able to:• Distinguish between the onset and off of bisphosphonates versus other medications used in the prevention and treatment of osteoporosis and how this affects choice of a "drug holiday."• Understand the limitations of clinical practices guidelines in the care of an individual patient and how interactive video conferencing can assist with decision making.• Recognize that patients treated with glucocorticoids at high risk for fracture can benefit from more aggressive interventions for osteoporosis.
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Affiliation(s)
- M S Rothman
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Colorado School of Medicine, Aurora, CO, USA.
| | - T P Olenginski
- Department of Rheumatology, Geisinger Medical Center, Danville, PA, USA
| | - I Stanciu
- Colorado Center for Bone Research at Panorama Orthopedics and Spine Center, Golden, CO, USA
| | - K Krohn
- The CORE Institute Phoenix, Phoenix, AZ, USA
| | - E M Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
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Manohar PM, Peterson LM, Wu V, Jenkins IC, Novakova-Jiresova A, Specht JM, Link JM, Krohn KA, Kinahan PE, Mankoff DA, Linden HM. Abstract PD4-10: 18F-fluoroestradiol (FES) and 18F-fluorodeoxyglucose (FDG) PET imaging in staging extent of disease in metastatic lobular breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd4-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The histology and pattern of spread in lobular breast cancer has presented challenges in estimating extent of disease and identifying treatment options. 18F-FES is an estrogen analogue PET imaging tracer which measures tumor ER expression at multiple tumor sites simultaneously and predicts response to endocrine therapy. We analyzed FES-PET and FDG-PET SUV uptake in patients with metastatic lobular and ductal carcinoma to identify sites of tumor and responsiveness to therapy.
Methods: We retrospectively reviewed FES and FDG SUV uptake between ER+ lobular (n = 36) and ductal (n= 173, including 6 men) metastatic breast cancer patients enrolled in various institutional studies. Up to 3 lesions in each patient were evaluated by FES SUVmax and/or FDG SUVmax for a total of 475 lesions in FES images and 462 lesions in FDG images. Classification into three categories (low FDG, high FDG/high FES, and high FDG/low FES) was generated using recursive portioning with 5-fold internal cross validation. Using a Pearson Chi-squared test, we compared degree of uptake in FES and FDG between lobular and ductal carcinomas. We used linear mixed effects model to assess association of FES SULmean3 (Lean body mass adjusted SUV) and FDG SULmean3 with histology. Overall survival (OS), from time of FES-PET scan to death, and progression free survival (PFS) was evaluated between classification groups in both histologies using Kaplan-Meier curves and Cox model.
Results: In patients with metastatic breast cancer, 72 patients had low FDG, 96 had high FES/high FDG, and 41 with high FES/low FDG. Lobular lesions tended to have a higher proportion of patients in the risk group with lower FDG (42% vs 33%) and a lower proportion in the risk group with high FDG/low FES (11% vs 21%) but the difference was not statistically significant (p = 0.32). Mean (range) FES SULmean3 and FDG SULmax3 respectively for ductal was 1.38 (0.10, 6.7) and 3.17 (0.88, 12.26) and for lobular was 1.42 (0.34, 3.43) and 3.13 (1.04, 13.87). There was no significant difference between in FES SULmean3 and FDG SULmax3 between histologies. Following FES-PET imaging, patients with lobular carcinomas and low FDG demonstrated a higher median survival time (7.7 years) compared to high FDG/low FES (4.3 years) and high FDG/high FES (2.6 years). Similarly, patients with ductal carcinomas and low FDG had an improved median survival time (5.6 years) compared to both high FDG/high FES (2.9 years) and high FDG/low FES (2.5 years). However, the interaction between histology and the FDG/FES classifications was not significant (p = 0.86). Across a variety of tumor sites, lobular histology can be detected by both FES and FDG with no difference between the imaging modalities.
Conclusions: In the metastatic setting, quantitative FES and FDG can be used to discriminate indolent and aggressive phenotypes in both lobular and ductal breast cancer. A greater proportion of lobular carcinoma lesions had higher FES/lower FDG and would be anticipated to be more sensitive to endocrine therapy. Further prospective trials are needed to confirm the utility of FES to stage extent of disease in metastatic breast cancer.
Citation Format: Manohar PM, Peterson LM, Wu V, Jenkins IC, Novakova-Jiresova A, Specht JM, Link JM, Krohn KA, Kinahan PE, Mankoff DA, Linden HM. 18F-fluoroestradiol (FES) and 18F-fluorodeoxyglucose (FDG) PET imaging in staging extent of disease in metastatic lobular breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD4-10.
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Affiliation(s)
- PM Manohar
- University of Washington/Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Institute, Seattle, WA; Oregon Health Sciences University, Portland, OR; University of Pennsylvania, Philadelphia, PA
| | - LM Peterson
- University of Washington/Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Institute, Seattle, WA; Oregon Health Sciences University, Portland, OR; University of Pennsylvania, Philadelphia, PA
| | - V Wu
- University of Washington/Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Institute, Seattle, WA; Oregon Health Sciences University, Portland, OR; University of Pennsylvania, Philadelphia, PA
| | - IC Jenkins
- University of Washington/Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Institute, Seattle, WA; Oregon Health Sciences University, Portland, OR; University of Pennsylvania, Philadelphia, PA
| | - A Novakova-Jiresova
- University of Washington/Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Institute, Seattle, WA; Oregon Health Sciences University, Portland, OR; University of Pennsylvania, Philadelphia, PA
| | - JM Specht
- University of Washington/Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Institute, Seattle, WA; Oregon Health Sciences University, Portland, OR; University of Pennsylvania, Philadelphia, PA
| | - JM Link
- University of Washington/Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Institute, Seattle, WA; Oregon Health Sciences University, Portland, OR; University of Pennsylvania, Philadelphia, PA
| | - KA Krohn
- University of Washington/Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Institute, Seattle, WA; Oregon Health Sciences University, Portland, OR; University of Pennsylvania, Philadelphia, PA
| | - PE Kinahan
- University of Washington/Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Institute, Seattle, WA; Oregon Health Sciences University, Portland, OR; University of Pennsylvania, Philadelphia, PA
| | - DA Mankoff
- University of Washington/Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Institute, Seattle, WA; Oregon Health Sciences University, Portland, OR; University of Pennsylvania, Philadelphia, PA
| | - HM Linden
- University of Washington/Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Institute, Seattle, WA; Oregon Health Sciences University, Portland, OR; University of Pennsylvania, Philadelphia, PA
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Keshishian A, Boytsov N, Burge R, Krohn K, Lombard L, Zhang X, Xie L, Baser O. Examining the treatment gap and risk of subsequent fractures among females with a fragility fracture in the US Medicare population. Osteoporos Int 2017; 28:2485-2494. [PMID: 28536737 PMCID: PMC5524851 DOI: 10.1007/s00198-017-4072-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/28/2017] [Indexed: 01/18/2023]
Abstract
UNLABELLED Our aim was to evaluate the gap in osteoporosis treatment and the impact of osteoporosis treatment on subsequent fragility fractures. We found osteoporosis medication use lowered risk of subsequent fractures by 21% and that black race, higher CCI scores, dementia, and kidney diseases reduced the likelihood of osteoporosis medication use. INTRODUCTION The goal of this study was to evaluate the predictors of osteoporosis medication use and compare the risk of fragility fractures within 1 year of a fragility fracture between osteoporosis treated and untreated women. METHODS We conducted a retrospective, observational cohort study using the national Medicare database. Elderly women (≥65 years) who were hospitalized or had an outpatient/ER service for fragility fracture between January 1, 2011 and December 31, 2011 were included. The outcomes of interest were the correlates of and time-to-osteoporosis medication use and risk of a subsequent fracture within 12 months for treated and untreated women. Cox regression was used to evaluate the predictors of treatment use and the risk of fracture based on treatment status. RESULTS Women (28,722) (27.7%) were treated with osteoporosis medication within 12 months of index fracture, and 74,979 (72.2%) were untreated. A number of patient characteristics were associated with a reduced likelihood of osteoporosis medication use, including black race, higher Charlson comorbidity index scores, presence of dementia, and kidney diseases in the baseline. The predictor most strongly and positively associated with osteoporosis medication use after fracture was osteoporosis medication use before fragility fracture (HR = 7.87; 95% CI 7.67-8.07). After adjusting for baseline characteristics, osteoporosis medication use lowered the risk of subsequent fractures by 21% (HR = 0.79, 95% CI 0.75-0.83) over 12 months compared to women without treatment. CONCLUSIONS Demographics and clinical characteristics were strong predictors of osteoporosis medication use. In the US Medicare population, osteoporosis treatment significantly reduced the risk of fragility fractures.
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Affiliation(s)
| | - N Boytsov
- Eli Lilly and Company, Indianapolis, IN, USA
| | - R Burge
- Eli Lilly and Company, Indianapolis, IN, USA
- Winkle College of Pharmacy, Pharmacy Practice and Administrative Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - K Krohn
- Eli Lilly and Company, Indianapolis, IN, USA
| | - L Lombard
- Eli Lilly and Company, Indianapolis, IN, USA
| | - X Zhang
- Eli Lilly and Company, Indianapolis, IN, USA
| | - L Xie
- STATinMED Research, Ann Arbor, MI, USA
| | - O Baser
- Center for Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, NY, USA
- STATinMED Research, New York, NY, USA
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Beall D, Krohn K. Osteoanabolic therapy for reduction of refracture risk after vertebral augmentation procedures? Response to Massarotti et al. Osteoporos Int 2016; 27:3389. [PMID: 27283404 DOI: 10.1007/s00198-016-3657-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
- D Beall
- Clinical Radiology of Oklahoma, Oklahoma, OK, USA
| | - K Krohn
- Lilly USA, LLC, Indianapolis, IN, USA.
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Beall DP, Feldman RG, Gordon ML, Gruber BL, Lane JM, Valenzuela G, Yim D, Alam J, Krege JH, Krohn K. Patients with prior vertebral or hip fractures treated with teriparatide in the Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) observational study. Osteoporos Int 2016; 27:1191-1198. [PMID: 26556737 DOI: 10.1007/s00198-015-3353-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/29/2015] [Indexed: 12/31/2022]
Abstract
SUMMARY In patients in the Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) observational study with and without a prior vertebral or hip fracture, the incidence of nonvertebral fractures was lower with >6 months of teriparatide treatment than during the first 6 months. INTRODUCTION Clinical evidence on the effect of teriparatide in patients with prior fracture is limited. In the DANCE observational study, the incidence of nonvertebral fragility fractures (NVFX) decreased significantly in patients receiving teriparatide for >6 months (6-24 months) versus >0 to ≤6 months (reference period). METHODS We performed a post hoc analysis to assess the effect of teriparatide 20 μg/day in patients who entered DANCE with prior vertebral or hip fractures. The incidence of patients experiencing a NVFX for four 6-month intervals during and after treatment was compared with the reference period. RESULTS Overall, 4085 patients received ≥1 dose of teriparatide. Of 3720 with sufficient data for efficacy analysis, 692 had prior vertebral fracture, including 179 with previous kyphoplasty/vertebroplasty; 290 had prior hip fracture. These patients were older, and those with prior vertebral fractures had more comorbid conditions at baseline than those without prior vertebral fractures. The incidence of patients experiencing NVFX declined over time in all patient groups. The fracture incidence rate declined 49 and 46%, respectively, in patients with and without prior vertebral fracture and was 63 and 46% lower in patients with previous kyphoplasty/vertebroplasty and without prior vertebral fracture. NVFX declined 43 and 48% in patients with and without prior hip fracture. The reduced incidence over time was consistent in the subgroups (all interaction p values >0.05). Patients with prior fracture were more likely to experience serious adverse events. CONCLUSION The incidence of NVFX decreased over time in patients receiving teriparatide in DANCE regardless of prior fracture status.
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Affiliation(s)
- D P Beall
- Clinical Radiology of Oklahoma, 1800 S. Renaissance Blvd, Edmond, OK, 73013, USA
| | - R G Feldman
- Senior Clinical Trials, Inc., 23961 Calle de la Magdalena Suite 429, Laguna Hills, CA, 92653, USA
| | - M L Gordon
- Newport Orthopedic Institute, Newport Beach 22 Corporate Plaza Drive, Newport Beach, CA, 92660, USA
| | - B L Gruber
- Long Island Regional Arthritis and Osteoporosis Care, PC, 500 West Main Street, Suite 110, Babylon, NY, 11702, USA
| | - J M Lane
- Hospital for Special Surgery, Weill Cornell Medical College, Ground Floor 523 East 72nd Street, New York, NY, 10021, USA
| | - G Valenzuela
- Integral Rheumatology & Immunology Specialists, 140 SW 84th Avenue, Fort Lauderdale, FL, 33324, USA
| | - D Yim
- UC Irvine Medical Center, 101 The City Drive South, Route 140, Orange, CA, 92868, USA
| | - J Alam
- Lilly USA, LLC, Indianapolis, IN, 46285, USA
| | - J H Krege
- Lilly USA, LLC, Indianapolis, IN, 46285, USA
| | - K Krohn
- Lilly USA, LLC, Indianapolis, IN, 46285, USA.
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Peck M, Pollack HA, Friesen A, Muzi M, Shoner SC, Shankland EG, Fink JR, Armstrong JO, Link JM, Krohn KA. Applications of PET imaging with the proliferation marker [18F]-FLT. Q J Nucl Med Mol Imaging 2015; 59:95-104. [PMID: 25737423 PMCID: PMC4415691] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
[18F]-3'-fluoro-3'-deoxythymidine (FLT) is a nucleoside-analog imaging agent for quantifying cellular proliferation that was first reported in 1998. It accumulates during the S-phase of the cell cycle through the action of cytosolic thymidine kinase, TK1. Since TK1 is primarily expressed in dividing cells, FLT uptake is essentially limited to dividing cells. Thus FLT is an effective measure of cell proliferation. FLT uptake has been shown to correlate with the more classic proliferation marker, the monoclonal antibody to Ki-67. Increased cellular proliferation is known to correlate with worse outcome in many cancers. However, the Ki-67 binding assay is performed on a sampled preparation, ex vivo, whereas FLT can be quantitatively measured in vivo using positron emission tomography (PET). FLT is an effective and quantitative marker of cell proliferation, and therefore a useful prognostic predictor in the setting of neoplastic disease. This review summarizes clinical studies from 2011 forward that used FLT-PET to assess tumor response to therapy. The paper focuses on our recommendations for a standardized clinical trial protocol and components of a report so multi center studies can be effectively conducted, and different studies can be compared. For example, since FLT is glucuronidated by the liver, and the metabolite is not transported into the cell, the plasma fraction of FLT can be significantly changed by treatment with particular drugs that deplete this enzyme, including some chemotherapy agents and pain medications. Therefore, the plasma level of metabolites should be measured to assure FLT uptake kinetics can be accurately calculated. This is important because the flux constant (KFLT) is a more accurate measure of proliferation and, by inference, a better discriminator of tumor recurrence than standardized uptake value (SUVFLT). This will allow FLT imaging to be a specific and clinically relevant prognostic predictor in the treatment of neoplastic disease.
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Affiliation(s)
- M Peck
- Stanford University, Stanford, CA, USA -
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Jochum F, Krohn K, Kohl M, Loui A, Nomayo A, Koletzko B. Parenterale Ernährung von Kindern und Jugendlichen: Empfehlungen und Experten-Statements. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-014-3278-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Murphy S, Hawe D, Hernandez F, Wolsztynski E, Huang J, O'Sullivan J, Muzi M, Eary J, Krohn K, O'Sullivan F. 235 Kinetic analysis of dynamic 11C thymidine PET imaging studies: Compartmental and nonparametric approaches. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70361-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hernandez F, Hawe D, Murphy S, O'Sullivan J, Wolsztynski E, Huang J, Muzi M, Eary J, Krohn K, O'Sullivan F. 234 Kinetic analysis of dynamic 11C-verapamil PET study: Compartmental v adaptive mixture models comparison. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70360-0] [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: 10/24/2022]
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Krohn K, Müller F, Ruprecht K, Ulrich U. Fulminante demyelinisierende Enzephalitis vier Wochen nach Entfernung eines ovariellen maturen Teratoms. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388307] [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: 10/24/2022] Open
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Jochum F, Krohn K, Kohl M, Loui A, Nomayo A, Koletzko B. S3-Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der Gesellschaft für klinische Ernährung der Schweiz (GESKES), der Österreichischen Arbeitsgemeinschaft für klinische Ernährung (AKE), die Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ) und die Gesellschaft für Neonatologie und pädiatrische Intensivmedizin (GNPI). Aktuel Ernahrungsmed 2014. [DOI: 10.1055/s-0034-1370222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- F. Jochum
- Evangelisches Waldkrankenhaus Spandau, Klinik für Kinder- und Jugendmedizin, Berlin, Deutschland
| | - K. Krohn
- iSPZ im Dr. von Haunerschen Kinderspital der LMU München – Kindergastroenterologie
| | - M. Kohl
- Universitätsklinikum Schleswig-Holstein, Klinik für Allgemeine Pädiatrie, Kiel/Lübeck, Deutschland
| | - A. Loui
- Charité, Campus Virchow Klinikum, Klinik für Neonatologie, Berlin, Deutschland
| | - A. Nomayo
- Evangelisches Waldkrankenhaus Spandau, Klinik für Kinder- und Jugendmedizin, Berlin, Deutschland
| | - B. Koletzko
- Dr. von Haunersches Kinderspital Kinderklinik und Kinderpoliklinik der Ludwig-Maximilians-Universität München, Abteilung für Stoffwechsel und Ernährung, München, Deutschland
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Krohn K, Valenzuela G, Lane J, Gruber B, Alam J, Chiang A, Krege J. Effect of Prior Hip Fracture Status in Patients With Osteoporosis Receiving Teriparatide. J Clin Densitom 2014. [DOI: 10.1016/j.jocd.2014.04.099] [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: 10/25/2022]
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Krohn K, Kellier N, Masica D, Midkiff K, Harris D, Andrews E. Post-Marketing Case Series Study of Adult Osteosarcoma and For(s)teo: Study Findings From the First 9 Years. J Clin Densitom 2014. [DOI: 10.1016/j.jocd.2014.04.106] [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: 11/16/2022]
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Linden HM, Kurland BF, Link JM, Novakova A, Chai X, Specht JM, Gadi VK, Gralow JR, Schubert EK, Peterson LM, Eary J, Shields A, Mankoff DA, Krohn KA. Abstract P4-01-03: HDACi (vorinostat) in metastatic breast cancer to restore sensitivity to ER-directed (AI) therapy: A phase II clinical trial with FES imaging correlates. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-01-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Histone deacetylase inhibitors (HDACi) have shown pre-clinical promise in estrogen receptor(ER)-modulation and restoring sensitivity to endocrine manipulation, suggesting potential clinical benefit (Sabnis 2011) (Huang 2000) in ER+ breast cancer. Vorinostat is an FDA-approved HDACi for CTCL, and could have a beneficial role in restoring ER-signaling in endocrine-resistant tumors (Munster 2011) (Yardley 2011). [F-18]fluoroestradiol (FES) PET imaging may be used to monitor regional tumor ER expression in patients with breast cancer (Linden 2011).
Methods: Patients with metastatic breast cancer with prior clinical benefit from endocrine manipulation who progressed on an AI therapy are eligible for this ongoing trial. In part A, patients were given vorinostat for 2 weeks, then resumed AI for 6 W. In part B (reflecting results of prior HDACi trials) patients are given vorinostat 400mg po daily 5/7 days 3/4 weeks while AI is given continuously. Paired FES and FDG PET are performed at baseline, week 2 and 8; clinical/radiologic assessment of disease is also performed at week 8. Patients with clinical benefit (response or stable disease) may continue on treatment until progressive disease or study withdrawal. Lesion-level analysis of the association between baseline FES uptake (logged) and FES/FDG ratio used generalized estimating equations (GEE) with small-sample adjustments to standard errors.
Results: 12/ 20 planned patients have accrued, and the treatment is well tolerated. Enrolled women were postmenopausal, the majority with primary infiltrating ductal tumors, bone/soft tissue dominant with longstanding metastatic disease, exposed to multiple endocrine and chemotherapy regimens. Five patients have had clinical benefit (2/4 on part B with greater HDACi exposure). One patient withdrew from the study due to toxicity. FES and FDG uptake was analyzed in 42 lesions in 11 patients. Average FES uptake was 2.0 (SULmean) for patients with clinical benefit, and 1.2 in patients with progressive disease by 8 weeks (p = 0.09). FES/FDG ratio at baseline was also associated with response (p = 0.04).
Conclusions: HDACi therapy is promising in relapsed ER+ breast cancer. Imaging of metabolic pathways in parallel with clinical trials may accelerate understanding of the underlying tumor biology and refine treatment selection.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-01-03.
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Affiliation(s)
- HM Linden
- University of Washington, Seattle, WA; Fred Hutchison Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - BF Kurland
- University of Washington, Seattle, WA; Fred Hutchison Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - JM Link
- University of Washington, Seattle, WA; Fred Hutchison Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - A Novakova
- University of Washington, Seattle, WA; Fred Hutchison Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - X Chai
- University of Washington, Seattle, WA; Fred Hutchison Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - JM Specht
- University of Washington, Seattle, WA; Fred Hutchison Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - VK Gadi
- University of Washington, Seattle, WA; Fred Hutchison Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - JR Gralow
- University of Washington, Seattle, WA; Fred Hutchison Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - EK Schubert
- University of Washington, Seattle, WA; Fred Hutchison Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - LM Peterson
- University of Washington, Seattle, WA; Fred Hutchison Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - J Eary
- University of Washington, Seattle, WA; Fred Hutchison Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - A Shields
- University of Washington, Seattle, WA; Fred Hutchison Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - DA Mankoff
- University of Washington, Seattle, WA; Fred Hutchison Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - KA Krohn
- University of Washington, Seattle, WA; Fred Hutchison Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
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Linden HM, Kurland BF, Link JM, Novakova A, Chai X, Gadi VK, Specht JM, Hills D, Gralow JR, Schubert EK, Korde L, Peterson LM, Doot R, Eary J, Shields A, Krohn KA, Mankoff DA. Abstract P4-01-02: The role of FLT PET early assessment of response to endocrine therapy for early stage breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-01-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In estrogen receptor positive (ER+) tumors, a low proliferative index (Ki-67) two weeks into endocrine therapy predicts response. FLT PET non-invasively measures tumor proliferation in vivo. The pre-operative window is an opportunity to assess impact of systemic therapies. We tested associations between FLT PET qualitative and quantitative measures and Ki-67 following two weeks of aromatase inhibitor (AI) therapy.
Methods: Women with clinical stage I-II ER+ HER2– breast cancer underwent “run-in” of AI monotherapy prior to definitive surgery. Premenopausal women were given GNRH agonist treatment 2 W prior to AI therapy. FLT PET was performed before AI therapy, and 1-7 days before surgery. Ki-67 was measured in baseline core biopsy and surgical specimens.
Results: Fourteen patients (8 postmenopausal, 6 premenopausal) have been enrolled. All have undergone baseline FLT PET imaging; 11 have completed imaging and surgery, including one premenopausal patient with no residual invasive carcinoma following 26 days of AI therapy. The majority harbored ductal carcinomas (n = 9, 5 with lobular histology) with the majority histologic grade ≥ 2 (n = 11). The median number of days exposed to AI was 19 (range, 9-42). Baseline SUVmax ranged from 1.2 to 3.9 (median 2.2), and post run-in SUV (6-64 days later) ranged from 1.2 to 2.8 (median 1.8). Baseline Ki-67 ranged from 6-26.2, median 11.6; surgical Ki-67 post AI therapy ranged from 0- 20.3 median 3.7, with seven below 5%. SUV and flux declined in most patients, as did Ki-67.
Quantitative FLT flux correlated with tumor response assessed by proliferative index (Ki-67) before the “run-in” period, with a stronger correlation at surgery, Pearson correlation coefficients = 0.41 and 0.82, respectively. FLT SUV and qualitative changes were not strongly associated with Ki-67.
Conclusions: Both pre and postmenopausal women with early stage breast cancer showed imaging and tissue response to endocrine therapy. Quantitative, but not qualitative FLT is a promising tool to assess tumor proliferation and response to therapy. Accrual is ongoing and updated results will be reported.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-01-02.
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Affiliation(s)
- HM Linden
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - BF Kurland
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - JM Link
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - A Novakova
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - X Chai
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - VK Gadi
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - JM Specht
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - D Hills
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - JR Gralow
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - EK Schubert
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - L Korde
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - LM Peterson
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - R Doot
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - J Eary
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - A Shields
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - KA Krohn
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
| | - DA Mankoff
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; University of Pennsylvania, Philadelphia, PA; University of Pittsburgh, Pittsburgh, PA
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Gao W, Nyflot M, Rajendran J, Hendrickson K, Krohn K. Local Recurrence and Progression Is Spatially Correlated With Focal Pretreatment FMISO PET Uptake in Head and Neck SCC. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zhao Y, Johnston SS, Smith DM, McMorrow D, Krohn K, Krege J. Association between teriparatide adherence and healthcare utilization and costs in real-world US kyphoplasty/vertebroplasty patients. Osteoporos Int 2013; 24:2525-33. [PMID: 23529293 DOI: 10.1007/s00198-013-2324-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/12/2013] [Indexed: 11/26/2022]
Abstract
UNLABELLED The objective of this study was to examine the association between teriparatide adherence and healthcare utilization and costs in real-world US kyphoplasty/vertebroplasty (KV) patients. Among KV patients newly initiating teriparatide, significantly increased pharmacy costs associated with high teriparatide adherence were offset by significantly lower inpatient utilization and medical costs. INTRODUCTION This study seeks to examine the association between teriparatide adherence and healthcare utilization/costs in real-world US KV patients. METHODS Identified patients from a large US administrative claims database were aged 50+ with KV from 1/1/2002-12/31/2010 (first observed KV = index). Included individuals had 6+ months of pre-index continuous enrollment and no pre-index teriparatide, cancer, or Paget's disease. Follow-up period for patients initiating teriparatide was ≤36 months post-index. Three teriparatide adherence cohorts were constructed using the proportion of days covered (PDC) during the follow-up period: low (PDC ≤ 0.5), medium (PDC >0.5-≤ 0.8), and high (PDC >0.8). Repeated KV admissions, any inpatient admission, number of inpatient admissions, and per-patient-per-month (PPPM) inpatient, outpatient, pharmacy, and total costs were compared between cohorts. The associations between teriparatide adherence and healthcare utilization/costs were examined using multivariable regression models, adjusting for patient demographics and clinical characteristics. RESULTS Included were 1,568 patients (mean age, 75 years; 82% female): 403 (26%) had low adherence, 382 (24%) medium, and 783 (50%) high. After multivariable adjustment, high adherence was significantly associated with the lowest PPPM inpatient (low = $1,287; medium = $1,005; high = $678) and outpatient (low = $1,464; medium = $1,244; high = $1,077) medical costs, but with increased pharmacy costs (low = $752; medium = $1,159; high = $1,616; all P < 0.05), leading to similar total costs (low = $3,344; medium = $3,376; high = $3,351) between cohorts; high adherence was also significantly associated with the lowest odds of repeated KV admission, any inpatient admission, and number of inpatient admissions (all P < 0.05). CONCLUSIONS Among KV patients initiating teriparatide, significantly increased pharmacy costs associated with high teriparatide adherence were offset by significantly lower inpatient utilization and medical costs.
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Affiliation(s)
- Y Zhao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
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Silverman S, Miller P, Sebba A, Weitz M, Wan X, Alam J, Masica D, Taylor KA, Ruff VA, Krohn K. The Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) study: 2-year nonvertebral fragility fracture results. Osteoporos Int 2013; 24:2309-17. [PMID: 23404615 PMCID: PMC3706736 DOI: 10.1007/s00198-013-2284-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 01/03/2013] [Indexed: 11/04/2022]
Abstract
UNLABELLED This observational study evaluated the occurrence of nonvertebral fragility fractures (NVFX) in over 4,000 men and women with osteoporosis treated with teriparatide (TPTD). The incidence of new NVFX decreased for patients receiving TPTD treatment for greater than 6 months. No new significant safety findings were observed in this large trial. INTRODUCTION The Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) study evaluated the occurrence of NVFX in patients receiving TPTD for osteoporosis in a real-world setting. METHODS DANCE is a multicenter, prospective, observational trial that examined the long-term effectiveness of TPTD in men and women with osteoporosis whom study physicians judged to be suitable for TPTD therapy. Patients received 20 μg TPTD per day by subcutaneous injection for up to 24 months and were followed for 24 months after treatment cessation. The incidence of patients experiencing a new NVFX, defined as a fracture associated with low trauma, was evaluated during four 6-month periods in both the treatment and cessation phases with >0 to ≤6 months serving as the reference. We also observed the spectrum and occurrence of serious adverse events. RESULTS Of the 4,167 patients enrolled, 4,085 took one or more doses of TPTD (safety population); 3,720 were included in the efficacy analysis. The incidence of patients experiencing a NVFX was 1.42, 0.91, 0.70, and 0.81 % for the four treatment periods, respectively, and 0.80, 0.68, 0.33, and 0.33 % for the four periods after treatment cessation. Differences for each period were statistically significant compared with the reference period (first 6-month interval, each p < 0.05). No new significant safety findings were observed. CONCLUSIONS In this study, the incidence of NVFX decreased for patients receiving TPTD for all three treatment periods >6 months compared to 0 to ≤6 months, and this trend persisted throughout the cessation phase. TPTD was generally well tolerated.
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Affiliation(s)
- S Silverman
- Cedars-Sinai/UCLA Medical Center and OMC Clinical Research Center, 8641 Wilshire Blvd, Suite 301, Beverly Hills, CA 90211, USA.
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Eszlinger M, Niedziela M, Typlt E, Jaeschke H, Huth S, Krohn K, Paschke R. Somatic mutations in 29 hot nodules in children. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Linden HM, Kurland BF, Specht JM, Vijayakrishn GK, Gralow JR, Peterson LM, Schubert EK, Link JM, David MA, Eary JF, Krohn KA. Abstract P6-04-03: Changes in breast tumor metabolism and estradiol binding as measured by FES PET in patients treated with the histone deacetylace inhibitor vorinostat and aromatase inhibitor therapy. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-04-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Some estrogen receptor-positive (ER+) metastatic breast cancers are bone and soft tissue dominant, indolent, and controlled by endocrine therapy. However, these tumors eventually become refractory to endocrine therapy and need a mechanism to reset the “estrogen-dependence” to allow continued benefit upon progression. Histone deacetylase inhibitors (HDACi) act as modulators of gene expression that are promising therapeutic agents for this group of tumors (Huang 2000, Sabnis 2011). Preclinical and clinical data demonstrate in ER-poor tumors and cell lines ER up-regulation and consequently enhanced lethality to endocrine agents. The optimal dose and schedule are not known, but two promising phase II studies show benefit in a continuous schedule (Yardley 2011, Munster 2011). FES PET is a promising imaging agent used as a biomarker to determine which patients will benefit from endocrine therapy, and to monitor estradiol binding during therapy (Mortimer 2001, Linden 2011).
Methods: Patients with ER+ HER2− metastatic breast cancer with prior aromatase inhibitor (AI) exposure and clinical benefit of endocrine therapy were eligible for a phase II study of HDACi therapy to restore sensitivity to AI therapy. Following baseline FDG PET, FES PET and standard imaging (CT, MRI, ultrasound and/or bone scan as indicated by tumor location), patients received 2 weeks of vorinostat therapy (400 mg po daily). FES PET was performed at 2 weeks while on HDACi therapy. Patients then received 6 weeks of AI monotherapy. FDG PET, FES PET and response assessment were performed at 8 weeks. Patients with clinical benefit (stable disease or response) continued on the regimen, 2 weeks of vorinostat followed by 6 weeks of AI.
Results: To date, 8 patients have been enrolled of whom 6 have completed the first 8 weeks of treatment and all correlative imaging studies. FES biomarker imaging results are mixed, with some patients showing an increase in tumor estradiol concentrating ability by FES PET on HDACi therapy, and decline in metabolic activity by FDG. Two patients continue on treatment with clinical benefit. Results will be updated as accrual continues.
Conclusions: Changes in estradiol binding are measured by serial FES PET in patients on HDACi therapy support preclinical concept of HDACi modulation of ER expression in metastatic breast cancer. Molecular imaging is a promising tool to monitor Estradiol binding pharmacodynamics, and Vorinostat HDACi therapy is a promising novel approach to allow patients to avoid toxicities of traditional chemotherapy once their tumor has progressed on endocrine therapy.
Funding: P01, MKA, Merck
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-04-03.
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Affiliation(s)
- HM Linden
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA
| | - BF Kurland
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA
| | - JM Specht
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA
| | - GK Vijayakrishn
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA
| | - JR Gralow
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA
| | - LM Peterson
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA
| | - EK Schubert
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA
| | - JM Link
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA
| | - MA David
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA
| | - JF Eary
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA
| | - KA Krohn
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pennsylvania, Philadelphia, PA
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Sun P, Lu S, V. Ree T, Krohn K, Li L, Zhang W. Nonanolides of natural origin: structure, synthesis, and biological activity. Curr Med Chem 2012; 19:3417-55. [PMID: 22612710 DOI: 10.2174/092986712801215874] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 04/04/2012] [Accepted: 04/04/2012] [Indexed: 11/22/2022]
Abstract
Naturally occurring nonanolides (synonym decanolides) are a large family of secondary metabolites with an interesting 10- membered macrolide subunit. Metabolites of the nonanolide family have been found to have various biological activities, including cytotoxic, phytotoxic, antimalarial, antifungal, antibacterial, and antimicrofilament activities. An early review of the chemistry and bioactivity of nonanolides was presented in 1996, covering the literature published between 1975 and 1995. During the past decades, the broad spectrum of bioactivity and the intriguing structure of the medium-sized ring in nonanolide analogues have continuously drawn the attention of biologists and natural product and synthetic chemists, resulting in a great number of publications. This review summarizes in whole the recent progress in the field of the nonanolides of natural origin, aiming to give the readers a brief view of the compounds, concerning their natural occurrence, structural elucidation, biological activities, total synthesis, and structure-activity relationships. The article covers the literature published in the period from the beginning of 1996 to July 2011.
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Choi YJ, Gabikian P, Zhu F, Appelbaum DE, Wollmann RL, Lukas RV, Xu LW, Thomas RP, Lober RM, Nagpal S, Li G, Megyesi JF, Macdonald D, Chaudhary N, Berghoff AS, Spanberger T, Magerle M, Dinhof C, Woehrer A, Hackl M, Birner P, Widhalm G, Marosi C, Prayer D, Preusser M, Kamson DO, Juhasz C, Buth A, Kupsky WJ, Muzik O, Robinette NL, Barger GR, Mittal S, Kinoshita M, Hirayama R, Chiba Y, Kagawa N, Nonaka M, Kanemura Y, Kishima H, Nakajima S, Hatazawa J, Hashimoto N, Yoshimine T, Kim EH, Kim SH, Nowosielski M, Hutterer M, Putzer D, Iglseder S, Seiz M, Jacobs AH, Gobel G, Stockhammer G, Hutterer M, Nowosielski M, Putzer D, Iglseder S, Seiz M, Jacobs AH, Gobel G, Stockhammer G, Juhasz C, Buth A, Kamson DO, Kupsky WJ, Barger GR, Mittal S, Zach L, Guez D, Last D, Daniels D, Grober Y, Nissim O, Hoffman C, Nass D, Spiegelmann R, Cohen ZR, Mardor Y, Mittal S, Buth A, Kupsky WJ, Kamson DO, Barger GR, Juhasz C, Perreault S, Lober RM, Zhang GH, Hershon L, Decarie JC, Yeom K, Vogel H, Partap S, Carret AS, Fisher PG, Colen RR, Changlai T, Sathyan P, Gutman D, Zinn P, Colen RR, Kovacs A, Zinn P, Jolesz F, Colen RR, Zinn P, Asthagiri A, Vasquez R, Butman J, Wu T, Morgan K, Brewer C, King K, Zalewski C, Jeffrey Kim H, Lonser R, Akbari H, Da X, Macyszyn L, Verma R, Wolf RL, Bilello M, Melhem ER, O'Rourke DM, Davatzikos C, Liu X, Madhankumar AB, Miller PA, Duck KA, Hafenstein S, Rizk E, Sheehan JM, Connor JR, Yang QX, Fouke SJ, Weinberger K, Kelsey M, Cholleti S, Politte D, Marcus D, Boyd A, Keogh B, Benzinger T, Milchenko M, Kim L, Prior F, Kim LM, Commean P, Boyd A, Milchenko M, Politte D, Chicoine M, Rich K, Benzinger T, Marcus D, Jost S, Fatterpekar G, Raz E, Knopp E, Gruber M, Parker E, Golfinos J, Zagzag D, Parker E, Fatterpekar G, Raz E, Narayana A, Johnson G, Placantonakis D, Zagzag D, Wen Q, Essock-Burns E, Li Y, Chang S, Nelson SJ, Li Y, Larson P, Chen A, Lupo JM, Kelley D, Chang S, Nelson SJ, Li Y, Lupo JM, Parvataneni R, Lamborn K, Cha S, Chang S, Nelson SJ, Jalbert LE, Elkhaled A, Phillips JJ, Williams C, Cha S, Berger MS, Chang SM, Nelson SJ, Damek DM, Ney DE, Borges MT, Colantoni W, Bert R, Huang R, Chen C, Mukundan S, Wen P, Norden A, Andre JB, Schmiedeskamp H, Thomas RP, Feroze A, Nagpal S, Zaharchuk G, Straka M, Recht L, Bammer R, Rockhill J, Mrugala M, Fink J, Rostomily R, Link J, Muzi M, Eary J, Krohn K, Perreault S, Lober RM, Partap S, Carret AS, Fisher FG, Ellingson BM, Pope WB, Boxerman JL, Harris RJ, Lai A, Nghiemphu PL, Jeyapalan S, Safran H, Kruse CA, Liau LM, Cloughesy TF, Harris RJ, Cloughesy TF, Lai A, Nghiemphu PL, Pope WB, Ellingson BM, Elkhaled A, Phillips J, Chang SM, Cha S, Nelson SJ. CLIN-RADIOLOGY. Neuro Oncol 2012; 14:vi120-vi128. [PMCID: PMC3488790 DOI: 10.1093/neuonc/nos236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
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Jaumann R, Williams DA, Buczkowski DL, Yingst RA, Preusker F, Hiesinger H, Schmedemann N, Kneissl T, Vincent JB, Blewett DT, Buratti BJ, Carsenty U, Denevi BW, De Sanctis MC, Garry WB, Keller HU, Kersten E, Krohn K, Li JY, Marchi S, Matz KD, McCord TB, McSween HY, Mest SC, Mittlefehldt DW, Mottola S, Nathues A, Neukum G, O’Brien DP, Pieters CM, Prettyman TH, Raymond CA, Roatsch T, Russell CT, Schenk P, Schmidt BE, Scholten F, Stephan K, Sykes MV, Tricarico P, Wagner R, Zuber MT, Sierks H. Vesta’s Shape and Morphology. Science 2012; 336:687-90. [PMID: 22582254 DOI: 10.1126/science.1219122] [Citation(s) in RCA: 195] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- R. Jaumann
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
- Freie Universität Berlin, Planetary Sciences, Germany
| | | | - D. L. Buczkowski
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - R. A. Yingst
- Planetary Science Institute, Tucson, AZ 85719, USA
| | - F. Preusker
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - H. Hiesinger
- Westfälische Wilhelms-Universität Münster, Germany
| | | | - T. Kneissl
- Freie Universität Berlin, Planetary Sciences, Germany
| | - J. B. Vincent
- Max Planck Institute for Solar System Research (MPS), Katlenburg-Lindau, Germany
| | - D. T. Blewett
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - B. J. Buratti
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - U. Carsenty
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - B. W. Denevi
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. C. De Sanctis
- Istituto di Astrofisica e Planetologia Spaziali, Istituto Nazionale di Astrofisica (INAF), Roma, Italy
| | - W. B. Garry
- Planetary Science Institute, Tucson, AZ 85719, USA
| | | | - E. Kersten
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - K. Krohn
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - J.-Y. Li
- University of Maryland, College Park, MD 20742, USA
| | - S. Marchi
- National Aeronautics and Space Administration (NASA) Lunar Science Institute, Boulder, CO 80309, USA
| | - K. D. Matz
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | | | - H. Y. McSween
- Department of Earth and Planetary Sciences, University of Tennessee, Knoxville, TN 37996, USA
| | - S. C. Mest
- Planetary Science Institute, Tucson, AZ 85719, USA
| | - D. W. Mittlefehldt
- Astromaterials Research Office, NASA Johnson Space Center, Houston, TX 77058, USA
| | - S. Mottola
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - A. Nathues
- Max Planck Institute for Solar System Research (MPS), Katlenburg-Lindau, Germany
| | - G. Neukum
- Freie Universität Berlin, Planetary Sciences, Germany
| | | | - C. M. Pieters
- Brown University, Planetary Geosciences Department, Providence, RI 02912, USA
| | | | - C. A. Raymond
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - T. Roatsch
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - C. T. Russell
- Institute of Geophysics and Planetary Physics, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - P. Schenk
- Lunar and Planetary Institute, Houston, TX 77058, USA
| | - B. E. Schmidt
- Institute for Geophysics, University of Texas, Austin, TX 78712, USA
| | - F. Scholten
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - K. Stephan
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - M. V. Sykes
- Planetary Science Institute, Tucson, AZ 85719, USA
| | - P. Tricarico
- Planetary Science Institute, Tucson, AZ 85719, USA
| | - R. Wagner
- German Aerospace Center (DLR), Institute of Planetary Research, Berlin, Germany
| | - M. T. Zuber
- Massachusetts Institute of Technology, Cambridge, MA 02139,USA
| | - H. Sierks
- Max Planck Institute for Solar System Research (MPS), Katlenburg-Lindau, Germany
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Wong M, Wan X, Ruff V, Krohn K, Taylor K. Gender differences for initiating teriparatide therapy: baseline data from the Direct Assessment of Nonvertebral Fracture in the Community Experience (DANCE) study. Osteoporos Int 2012; 23:1445-52. [PMID: 21769662 DOI: 10.1007/s00198-011-1725-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 04/26/2011] [Indexed: 01/30/2023]
Abstract
UNLABELLED The prospective, observational Direct Assessment of Nonvertebral Fracture in the Community Experience (DANCE) study shows that, among patients with risk factors for osteoporosis, women are more likely to be screened and to receive appropriate treatment than men. There needs to be greater awareness that osteoporosis affects both men and women. INTRODUCTION The prospective, observational DANCE study evaluated teriparatide use in the mainland USA and Puerto Rico in patients with osteoporosis in a community setting. This analysis compares baseline characteristics of women and men that may contribute to differences in initiation of teriparatide therapy. METHODS Investigators prescribed teriparatide 20 μg/day subcutaneous injection for ≤24 months to 3,698 patients (3,342 women, 356 men) whom they considered appropriate candidates for therapy. Study entry was guided by product labeling. Specific timing and frequency of office visits were not mandated. Treatment decisions were based on the clinical judgment of study investigators and local standards of care. RESULTS At baseline, similar proportions of women and men had prior fragility fractures (57% and 59%, respectively) and comorbid conditions that increase fracture risk (83% and 84%, respectively). Women were older than men (mean age 68 vs. 65 year; P < 0.0001) and more likely to have received prior osteoporosis therapy (88% vs. 62%; P < 0.0001). Investigators prescribed teriparatide more often for women than men based on general frailty (21% vs. 16%; P = 0.0151), low body mass index (17% vs. 10%; P = 0.0005), and an inadequate response (58% vs. 36%; P < 0.0001) or intolerance to previous therapy (23% vs. 12%; P < 0.0001). Chronic glucocorticoid therapy was the reason investigators cited most frequently for initiating therapy more often in men than in women (17% vs. 10%; P < 0.0001) CONCLUSIONS These results suggest that patients' gender may influence the reasons physicians initiate teriparatide therapy in a community setting.
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Affiliation(s)
- M Wong
- Eli Lilly and Company, Lilly Corporate Center, Drop Code 2234, Indianapolis, IN 42225, USA.
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Langdahl BL, Marin F, Shane E, Dobnig H, Zanchetta JR, Maricic M, Krohn K, See K, Warner MR. Teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: an analysis by gender and menopausal status. Osteoporos Int 2009; 20:2095-104. [PMID: 19350340 DOI: 10.1007/s00198-009-0917-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 03/04/2009] [Indexed: 12/17/2022]
Abstract
SUMMARY The effects of teriparatide versus alendronate were compared by gender and menopausal status in patients with glucocorticoid-induced osteoporosis. At 18 months, increases in lumbar spine BMD were significantly greater in the teriparatide versus alendronate group in postmenopausal women (7.8% versus 3.7%, p < 0.001), premenopausal women (7.0% versus 0.7%, p < 0.001), and men (7.3% versus 3.7%, p = 0.03). INTRODUCTION In patients with glucocorticoid-induced osteoporosis (GIO), teriparatide significantly increased bone mineral density (BMD) and decreased vertebral fractures compared with alendronate. We examined effects of teriparatide versus alendronate by gender and menopausal status. METHODS This was a multicenter, randomized, double-blind study of teriparatide 20 microg/day versus alendronate 10 mg/day in patients with GIO (277 postmenopausal women, 67 premenopausal women, 83 men). Primary outcome was change in lumbar spine BMD. Secondary outcomes included change in hip BMD, change in bone biomarkers, fracture incidence, and safety. RESULTS At 18 months, mean percent increases from baseline in lumbar spine BMD were significantly greater in the teriparatide versus alendronate group in postmenopausal women (7.8% versus 3.7%, p < 0.001), premenopausal women (7.0% versus 0.7%, p < 0.001), and men (7.3% versus 3.7%, p = 0.03). Radiographic vertebral fractures occurred in one teriparatide (one postmenopausal) and ten alendronate patients (six postmenopausal, four men), and nonvertebral fractures occurred in 12 teriparatide (nine postmenopausal, two premenopausal, one man) and eight alendronate patients (six postmenopausal, two men). The proportion of patients reporting adverse events in teriparatide versus alendronate groups was consistent across subgroups. CONCLUSION Among men and pre- and postmenopausal women with GIO, lumbar spine BMD increased more in patients receiving teriparatide compared with alendronate.
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Affiliation(s)
- B L Langdahl
- Aarhus University Hospital, Aarhus Sygehus, Tage Hansens Gade 2, 8000 Aarhus, Denmark.
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Koletzko B, Jauch KW, Verwied-Jorky S, Krohn K, Mittal R. Guidelines on Parenteral Nutrition from the German Society for Nutritional Medicine (DGEM) - overview. Ger Med Sci 2009; 7:Doc27. [PMID: 20049076 PMCID: PMC2795376 DOI: 10.3205/000086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Indexed: 11/30/2022]
Affiliation(s)
- B Koletzko
- Dept. Metabolic Diseases & Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich, 80337 Muenchen, Germany.
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Fusch C, Bauer K, Böhles HJ, Jochum F, Koletzko B, Krawinkel M, Krohn K, Mühlebach S. Neonatology/Paediatrics - Guidelines on Parenteral Nutrition, Chapter 13. Ger Med Sci 2009; 7:Doc15. [PMID: 20049070 PMCID: PMC2795370 DOI: 10.3205/000074] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Indexed: 12/30/2022]
Abstract
There are special challenges in implementing parenteral nutrition (PN) in paediatric patients, which arises from the wide range of patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. Age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN-practice in adult patients, e.g. the fluid, nutrient and energy needs of premature infants and newborns per kg body weight are markedly higher than of older paediatric and adult patients. Premature infants <35 weeks of pregnancy and most sick term infants usually require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated). Enteral nutrition should be gradually introduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. If energy and nutrient demands in children and adolescents cannot be met through enteral nutrition, partial or total PN should be considered within 7 days or less depending on the nutritional state and clinical conditions.
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Affiliation(s)
- C Fusch
- Dept. of Pediatrics, McMaster University, Hamilton, Canada
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Adolph M, Heller AR, Koch T, Koletzko B, Kreymann KG, Krohn K, Pscheidl E, Senkal M. Lipid emulsions - Guidelines on Parenteral Nutrition, Chapter 6. Ger Med Sci 2009; 7:Doc22. [PMID: 20049078 PMCID: PMC2795378 DOI: 10.3205/000081] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Indexed: 01/07/2023]
Abstract
The infusion of lipid emulsions allows a high energy supply, facilitates the prevention of high glucose infusion rates and is indispensable for the supply with essential fatty acids. The administration of lipid emulsions is recommended within ≤7 days after starting PN (parenteral nutrition) to avoid deficiency of essential fatty acids. Low-fat PN with a high glucose intake increases the risk of hyperglycaemia. In parenterally fed patients with a tendency to hyperglycaemia, an increase in the lipid-glucose ratio should be considered. In critically ill patients the glucose infusion should not exceed 50% of energy intake. The use of lipid emulsions with a low phospholipid/triglyceride ratio is recommended and should be provided with the usual PN to prevent depletion of essential fatty acids, lower the risk of hyperglycaemia, and prevent hepatic steatosis. Biologically active vitamin E (α-tocopherol) should continuously be administered along with lipid emulsions to reduce lipid peroxidation. Parenteral lipids should provide about 25–40% of the parenteral non-protein energy supply. In certain situations (i.e. critically ill, respiratory insufficiency) a lipid intake of up to 50 or 60% of non-protein energy may be reasonable. The recommended daily dose for parenteral lipids in adults is 0.7–1.3 g triglycerides/kg body weight. Serum triglyceride concentrations should be monitored regularly with dosage reduction at levels >400 mg/dl (>4.6 mmol/l) and interruption of lipid infusion at levels >1000 mg/dl (>11.4 mmol/l). There is little evidence at this time that the choice of different available lipid emulsions affects clinical endpoints.
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Affiliation(s)
- M Adolph
- Dept. of Anaesthesiology and Intensive Medicine, Eberhard-Karl University, Tuebingen, Germany
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Abstract
Cellular immune reactivity was studied in 78 patients with various forms of renal disease by skin testing with four recall antigens and a lymphocyte transformation test with tuberculin PPD and leucoagglutinin. Patients with S-creatine greater than or equal to 230 micromol/l as well as those with chronic pyelonephritis who had S-creatinine values below 230 micromol/l had significantly lower skin reactions than the controls to streptokinase-streptodornase, parotitis and PPD. Glomerulonephritic patients with S-creatinine values below 230 micromol/l had normal skin reactivity. Lymphocyte transformation tests showed decreased reactivity only in patients with S-creatinine level greater than or equal to 230 micromol/l. The results suggest an association of chronic pyelonephritis with a defective efferent, nonspecific arm of cellular immunity.
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Tönjes A, Dünnebeil J, Schleinitz D, Koriath M, Rayner NW, Dietrich K, Enigk B, Böttcher Y, Krohn K, Kovacs P, Stumvoll M. Genome wide association study for lipid traits in the self-contained population of sorbs in Germany. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1222055] [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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Dietrich K, Schröck K, Enigk B, Schleinitz D, Müller I, Krohn K, Stumvoll M, Kovacs P, Schöneberg T, Tönjes A. Selektion des FTO-Gens in menschlichen Populationen. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221806] [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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Frey H, Syrjälä P, Antonen J, Salmi J, Krohn K. REGULATION OF THE IMMUNOLOGICAL SYSTEM BY CNS. EXPERIMENTAL STUDIES IN HUMANS. Acta Neurol Scand 2009. [DOI: 10.1111/j.1600-0404.1984.tb02521.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Carlsson E, Ovaska K, Sipilä L, Helle M, Abdel-Rahman W, Karenko L, Peltomäki P, Hautaniemi S, Krohn K, Ranki A. 366 POSTER NAV3 gene aberrations in colorectal cancer target signalling pathways associated with inflammation and the progression of cancer. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72300-0] [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: 10/21/2022] Open
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Koletzko B, Jauch KW, Verwied-Jorky S, Krohn K, Mittal R. WITHDRAWN: National Guidelines. Guidelines on Parenteral Nutrition from the German Society for Nutritional Medicine (DGEM) - Part 1. Clin Nutr 2008:S0261-5614(08)00108-8. [PMID: 18775588 DOI: 10.1016/j.clnu.2008.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 04/20/2008] [Accepted: 05/30/2008] [Indexed: 10/21/2022]
Abstract
This article has been withdrawn at the request of the authors and Editor. The publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Tönjes A, Zeggini E, Kovacs P, Böttcher Y, Schleinitz D, Morris AP, Enigk B, Rayner NW, Hoffmann K, Teupser D, Thiery J, Krohn K, McCarthy MI, Stumvoll M. Association of FTO variants with BMI, fat mass and waist in the isolated population of Sorbs in Germany. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076215] [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: 10/21/2022]
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Reimand K, Perheentupa J, Link M, Krohn K, Peterson P, Uibo R. Testis-expressed protein TSGA10 - an auto-antigen in autoimmune polyendocrine syndrome type I. Int Immunol 2007; 20:39-44. [DOI: 10.1093/intimm/dxm118] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nurani R, Rajendran J, Austin-Seymour M, Scharnhorst J, Krohn K, Laramore G. The Predictive Utility of PET-Misonidazole in Locally Advanced Head and Neck Cancer Treated with Radiotherapy. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- F. Ameer
- a Department of Chemistry , University of the Western Cape , Bellville, South Africa
| | - Ivan R. Green
- a Department of Chemistry , University of the Western Cape , Bellville, South Africa
| | - K. Krohn
- b Department of Chemistry , University of Paderborn , Paderborn, Germany
| | - M. Sitoza
- a Department of Chemistry , University of the Western Cape , Bellville, South Africa
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Kuete V, Eyong KO, Folefoc GN, Beng VP, Hussain H, Krohn K, Nkengfack AE. Antimicrobial activity of the methanolic extract and of the chemical constituents isolated from Newbouldia laevis. Pharmazie 2007; 62:552-6. [PMID: 17718200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The methanolic extract (NLB) and ten compounds isolated from the root bark of Newbouldia laevis Seem, namely chrysoeriol (1), newbouldiaquinone (2), 2-acetylfuro-1,4-naphthoquinone (3), 2-hydroxy-3-methoxy-9,10-dioxo-9,10-dihydroanthracene-1-carbaldehyde (4), lapachol (5), beta-sitosterol-3-O-beta-D-glucopyranoside (6), oleanolic acid (7), canthic acid (8) newbouldiamide (9) and 2-(4-hydroxyphenyl)-ethyltrioctanoate (10), were tested for in vitro antimicrobial activity. Twenty one microorganisms belonging to six Gram-positive and twelve Gram-negative bacterial species as well as three yeasts from Candida species were tested for their susceptibility to NLB and the pure isolated compounds based on the Agar Hole Diffusion test and the Liquid Dilution method. The Hole Diffusion assay indicated that NLB and compound 7 were active against all tested pathogens while other compounds showed selective activity with the antimicrobial spectra varying from 76% (compound 10) to 95 % (compound 6). Minimal inhibitory concentrations (MIC) also illustrated the important antimicrobial activity of NLB and of the isolated compounds. MIC values obtained varied from 9.76 to 312.50 microg/ml for NLB, and 0.038 to 9.76 microg/ml for pure compounds against most of the tested microorganisms. The antimicrobial activities of compounds 2, 4 and 9 are described here extensively for the first time. The results indicate a promising basis for the use of Newbouldia laevis and some of its active principles in the treatment of infectious diseases.
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Affiliation(s)
- V Kuete
- Department of Biochemistry, Yaounde University I, Yaounde, Cameroon.
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Maier J, van Steeg H, van Oostrom C, Paschke R, Weiss RE, Krohn K. Iodine deficiency activates antioxidant genes and causes DNA damage in the thyroid gland of rats and mice. Biochimica et Biophysica Acta (BBA) - Molecular Cell Research 2007; 1773:990-9. [PMID: 17467074 DOI: 10.1016/j.bbamcr.2007.03.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 03/16/2007] [Accepted: 03/19/2007] [Indexed: 01/17/2023]
Abstract
Because thyroid nodules are frequent in areas with iodine deficiency the aim of this study was to characterise molecular events during iodine deficiency that could explain mutagenesis and nodule formation. We therefore studied gene expression of catalytic enzymes prominent for H(2)O(2) detoxification and antioxidative defence, quantified DNA oxidation and damage as well as spontaneous mutation rates (SMR) in mice and rats fed an iodine controlled diet. Antioxidative enzymes such as superoxide dismutase 3, glutathione peroxidase 4 and the peroxiredoxins 3 and 5 showed increased mRNA expression, which indicates increased radical burden that could be the cause of additional oxidized base adducts found in thyroidal genomic DNA in our experiments of iodine deficiency. Furthermore, the uracil content of thyroid DNA was significantly higher in the iodine-deficient compared to the control group. While SMR is very high in the normal thyroid gland it is not changed in experimental iodine deficiency. Our data suggest that iodine restriction causes oxidative stress and DNA modifications. A higher uracil content of the thyroid DNA could be a precondition for C-->T transitions often detected as somatic mutations in nodular thyroid tissue. However, the absence of increased SMR would argue for more efficient DNA repair in response to iodine restriction.
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Affiliation(s)
- J Maier
- III Medical Department, Interdisciplinary Centre for Clinical Research, University of Leipzig, Leipzig, Germany
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44
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Fusch C, Bauer K, Böhles HJ, Jochum F, Koletzko B, Krawinkel M, Krohn K, Mühlebach S. 13 Neonatologie/Pädiatrie. Akt Ernähr Med 2007. [DOI: 10.1055/s-2006-951889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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45
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Koletzko B, Jauch K, Krohn K, Verwied-Jorky S. Leitlinie Parenterale Ernährung der Deutschen Gesellschaft für Ernährungsmedizin e. V. (DGEM)*. Akt Ernähr Med 2007. [DOI: 10.1055/s-2006-951869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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46
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47
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Ströbel P, Murumägi A, Klein R, Luster M, Lahti M, Krohn K, Schalke B, Nix W, Gold R, Rieckmann P, Toyka K, Burek C, Rosenwald A, Müller-Hermelink HK, Pujoll-Borrell R, Meager A, Willcox N, Peterson P, Marx A. Deficiency of the autoimmune regulator AIRE in thymomas is insufficient to elicit autoimmune polyendocrinopathy syndrome type 1 (APS-1). J Pathol 2007; 211:563-571. [PMID: 17334980 DOI: 10.1002/path.2141] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Accepted: 12/21/2006] [Indexed: 01/12/2023]
Abstract
Thymomas are thymic epithelial neoplasms, associated with a variety of autoimmune disorders (especially myasthenia gravis), that apparently result from aberrant intra-tumourous thymopoiesis and export of inefficiently tolerized T-cells to the periphery. The autoimmune regulator (AIRE) drives the expression of self-antigens in the thymic medulla and plays an essential role in 'central' tolerance in both humans and mice. However, while inactivating AIRE mutations result in the 'autoimmune polyendocrinopathy syndrome type 1' (APS-1), its major features are not well reproduced in AIRE-knock-out mice. Therefore, alternative human disease scenarios with concomitant AIRE deficiency may be valuable tools to test conclusions drawn from mouse models. Here we show, in a large series, that approximately 95% of thymoma patients are 'chimeric'; expression of AIRE and major AIRE-related autoantigens (eg insulin) were undetectable in their tumours but maintained in their remnant thymic tissue and lymph nodes. Notably, despite the AIRE-deficient thymopoiesis in thymomas, disorders and autoantibodies typical of APS-1 were distinctly uncommon in these patients. The one striking similarity was in the recently observed neutralizing anti-type I interferon (IFN) antibodies, which are found at diagnosis in 100% of patients with APS-1 and in approximately 60% of patients with thymomas, as we show here. We conclude that APS-1 type autoantigens must be protected from autoimmunity by mechanisms that do not extend to the muscle autoantigens so frequently targeted in thymoma patients but so rarely recognized in APS-1. Thus our findings argue strongly for a tolerogenic function of AIRE beyond its role in negative T-cell selection in human thymopoiesis, and/or for specific autoimmunization against muscle in thymomas.
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Affiliation(s)
- P Ströbel
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Germany
| | - A Murumägi
- Institute of Medical Technology, Tampere, Finland
| | - R Klein
- Department of Internal Medicine II, University of Tübingen, Germany
| | - M Luster
- Department of Nuclear Medicine, University of Würzburg, Germany
| | - M Lahti
- Institute of Medical Technology, Tampere, Finland
| | - K Krohn
- Institute of Medical Technology, Tampere, Finland
| | - B Schalke
- Department of Neurology, University of Regensburg, Germany
| | - W Nix
- Department of Neurology, University of Mainz, Germany
| | - R Gold
- Department of Neurology, University of Göttingen, Germany
| | - P Rieckmann
- Department of Neurology, University of Würzburg, Germany
| | - K Toyka
- Department of Neurology, University of Würzburg, Germany
| | - C Burek
- Institute of Pathology, University of Würzburg, Germany
| | - A Rosenwald
- Institute of Pathology, University of Würzburg, Germany
| | | | | | - A Meager
- Biotherapeutics, National Institute for Biological Standards and Control, South Mimms, UK
| | - N Willcox
- Neurosciences Group, Weatherall Institute of Molecular Medicine, University of Oxford, UK
| | - P Peterson
- Molecular Pathology, University of Tartu, Estonia
| | - A Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Germany
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48
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Stephens PJ, Pan JJ, Devlin FJ, Krohn K, Kurtán T. Determination of the Absolute Configurations of Natural Products via Density Functional Theory Calculations of Vibrational Circular Dichroism, Electronic Circular Dichroism, and Optical Rotation: The Iridoids Plumericin and Isoplumericin. J Org Chem 2007; 72:3521-36. [PMID: 17388636 DOI: 10.1021/jo070155q] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The absolute configurations (ACs) of the iridoid natural products, plumericin (1) and isoplumericin (2), have been re-investigated using vibrational circular dichroism (VCD) spectroscopy, electronic circular dichroism (ECD) spectroscopy, and optical rotatory dispersion (ORD). Comparison of DFT calculations of the VCD spectra of 1 and 2 to the experimental VCD spectra of the natural products, (+)-1 and (+)-2, leads unambiguously to the AC (1R,5S,8S,9S,10S)-(+) for both 1 and 2. In contrast, comparison of time-dependent DFT (TDDFT) calculations of the ECD spectra of 1 and 2 to the experimental spectra of (+)-1 and (+)-2 does not permit definitive assignment of their ACs. On the other hand, TDDFT calculations of the ORD of (1R,5S,8S,9S,10S)-1 and -2 over the range of 365-589 nm are in excellent agreement with the experimental data of (+)-1 and (+)-2, confirming the ACs derived from the VCD spectra. Thus, the ACs initially proposed by Albers-Schönberg and Schmid are shown to be correct, and the opposite ACs recently derived from the ECD spectra of 1 and 2 by Elsässer et al. are shown to be incorrect. As a result, the ACs of other iridoid natural products obtained by chemical correlation with 1 and 2 are not in need of revision.
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Affiliation(s)
- P J Stephens
- Department of Chemistry, University of Southern California, Los Angeles, California 90089-0482, USA.
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Lorenz S, Eszlinger M, Führer D, Krohn K. Altered expression of Ca2+ binding proteins in FRTL-5 clones expressing mutant TSH receptors. Exp Clin Endocrinol Diabetes 2007. [DOI: 10.1055/s-2007-972277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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50
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Eszlinger M, Krohn K, Tönjes A, Paschke R. Variability of gene expression of „normal“ thyroid tissue. Exp Clin Endocrinol Diabetes 2007. [DOI: 10.1055/s-2007-972231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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