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Fernandes S, Williams E, Finlayson N, Stewart H, Dhaliwal C, Dorward DA, Wallace WA, Akram AR, Stone J, Dhaliwal K, Williams GOS. Fibre-based fluorescence-lifetime imaging microscopy: a real-time biopsy guidance tool for suspected lung cancer. Transl Lung Cancer Res 2024; 13:355-361. [PMID: 38496695 PMCID: PMC10938104 DOI: 10.21037/tlcr-23-638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/23/2024] [Indexed: 03/19/2024]
Abstract
Lung cancer is the most common cause of cancer-related deaths worldwide. Early detection improves outcomes, however, existing sampling techniques are associated with suboptimal diagnostic yield and procedure-related complications. Autofluorescence-based fluorescence-lifetime imaging microscopy (FLIM), a technique which measures endogenous fluorophore decay rates, may aid identification of optimal biopsy sites in suspected lung cancer. Our fibre-based fluorescence-lifetime imaging system, utilising 488 nm excitation, which is deliverable via existing diagnostic platforms, enables real-time visualisation and lifetime analysis of distal alveolar lung structure. We evaluated the diagnostic accuracy of the fibre-based fluorescence-lifetime imaging system to detect changes in fluorescence lifetime in freshly resected ex vivo lung cancer and adjacent healthy tissue as a first step towards future translation. The study compares paired non-small cell lung cancer (NSCLC) and non-cancerous tissues with gold standard diagnostic pathology to assess the performance of the technique. Paired NSCLC and non-cancerous lung tissues were obtained from thoracic resection patients (N=21). A clinically compatible 488 nm fluorescence-lifetime endomicroscopy platform was used to acquire simultaneous fluorescence intensity and lifetime images. Fluorescence lifetimes were calculated using a computationally-lightweight, rapid lifetime determination method. Fluorescence lifetime was significantly reduced in ex vivo lung cancer, compared with non-cancerous lung tissue [mean ± standard deviation (SD), 1.79±0.40 vs. 2.15±0.26 ns, P<0.0001], and fluorescence intensity images demonstrated distortion of alveolar elastin autofluorescence structure. Fibre-based fluorescence-lifetime imaging demonstrated good performance characteristics for distinguishing lung cancer, from adjacent non-cancerous tissue, with 81.0% sensitivity and 71.4% specificity. Our novel fibre-based fluorescence-lifetime imaging system, which enables label-free imaging and quantitative lifetime analysis, discriminates ex vivo lung cancer from adjacent healthy tissue. This minimally invasive technique has potential to be translated as a real-time biopsy guidance tool, capable of optimising diagnostic accuracy in lung cancer.
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Affiliation(s)
- Susan Fernandes
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- Department of Respiratory Medicine, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Elvira Williams
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
| | - Neil Finlayson
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- Institute for Integrated Micro and Nano Systems, School of Engineering, The University of Edinburgh, Edinburgh, UK
| | - Hazel Stewart
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
| | - Catharine Dhaliwal
- Department of Pathology, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - David A. Dorward
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- Department of Pathology, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William A. Wallace
- Department of Pathology, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ahsan R. Akram
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- Department of Respiratory Medicine, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - James Stone
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- Centre for Photonics and Photonic Materials, Department of Physics, The University of Bath, Bath, UK
| | - Kevin Dhaliwal
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- Department of Respiratory Medicine, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Gareth O. S. Williams
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
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Demirel M, Mills B, Gaughan E, Dhaliwal K, Hopgood JR. Bayesian Statistical Analysis for Bacterial Detection in Pulmonary Endomicroscopic Fluorescence Lifetime Imaging. IEEE Trans Image Process 2024; 33:1241-1256. [PMID: 38324436 DOI: 10.1109/tip.2024.3361217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Pneumonia, a respiratory disease often caused by bacterial infection in the distal lung, requires rapid and accurate identification, especially in settings such as critical care. Initiating or de-escalating antimicrobials should ideally be guided by the quantification of pathogenic bacteria for effective treatment. Optical endomicroscopy is an emerging technology with the potential to expedite bacterial detection in the distal lung by enabling in vivo and in situ optical tissue characterisation. With advancements in detector technology, optical endomicroscopy can utilize fluorescence lifetime imaging (FLIM) to help detect events that were previously challenging or impossible to identify using fluorescence intensity imaging. In this paper, we propose an iterative Bayesian approach for bacterial detection in FLIM. We model the FLIM image as a linear combination of background intensity, Gaussian noise, and additive outliers (labelled bacteria). While previous bacteria detection methods model anomalous pixels as bacteria, here the FLIM outliers are modelled as circularly symmetric Gaussian-shaped objects, based on their discrete shape observed through visual analysis and the physical nature of the imaging modality. A Hierarchical Bayesian model is used to solve the bacterial detection problem where prior distributions are assigned to unknown parameters. A Metropolis-Hastings within Gibbs sampler draws samples from the posterior distribution. The proposed method's detection performance is initially measured using synthetic images, and shows significant improvement over existing approaches. Further analysis is conducted on real optical endomicroscopy FLIM images annotated by trained personnel. The experiments show the proposed approach outperforms existing methods by a margin of +16.85% ( F1 ) for detection accuracy.
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Taimori A, Mills B, Gaughan E, Ali A, Dhaliwal K, Williams G, Finlayson N, Hopgood JR. A Novel Fit-Flexible Fluorescence Soft Imager: Tri-Sensing of Intensity, Fall-Time, and Life Profile. IEEE Trans Biomed Eng 2024; PP:1-14. [PMID: 38300773 DOI: 10.1109/tbme.2024.3354856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Time-resolved fluorescence imaging techniques, like confocal fluorescence lifetime imaging microscopy, are powerful photonic instrumentation tools of modern science with diverse applications, including: biology, medicine, and chemistry. However, complexities of the systems, both at specimen and device levels, cause difficulties in quantifying soft biomarkers. To address the problems, we first aim to understand and model the underlying photophysics of fluorescence decay curves. For this purpose, we provide a set of mathematical functions, called "life models", fittable with the real temporal recordings of histogram of photon counts. For each model, an equivalent electrical circuit, called a "life circuit", is derived for explaining the whole process. In confocal endomicroscopy, the components of excitation laser, specimen, and fluorescence-emission signal as the histogram of photon counts are modelled by a power source, network of resistor-inductor-capacitor circuitry, and multimetre, respectively. We then design a novel pixel-level temporal classification algorithm, called a "fit-flexible approach", where qualities of "intensity", "fall-time", and "life profile" are identified for each point. A model selection mechanism is used at each pixel to flexibly choose the best representative life model based on a proposed Misfit-percent metric. A two-dimensional arrangement of the quantified information detects some kind of structural information. This approach showed a potential of separating microbeads from lung tissue, distinguishing the tri-sensing from conventional methods. We alleviated by 7% the error of the Misfit-percent for recovering the histograms on real samples than the best state-of-the-art competitor. Codes are available online.
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Adams AC, Kufcsák A, Lochenie C, Khadem M, Akram AR, Dhaliwal K, Seth S. Fibre-optic based exploration of lung cancer autofluorescence using spectral fluorescence lifetime. Biomed Opt Express 2024; 15:1132-1147. [PMID: 38404342 PMCID: PMC10890895 DOI: 10.1364/boe.515609] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/05/2024] [Indexed: 02/27/2024]
Abstract
Fibre-optic based time-resolved fluorescence spectroscopy (TRFS) is an advanced spectroscopy technique that generates sample-specific spectral-temporal signature, characterising variations in fluorescence in real-time. As such, it can be used to interrogate tissue autofluorescence. Recent advancements in TRFS technology, including the development of devices that simultaneously measure high-resolution spectral and temporal fluorescence, paired with novel analysis methods extracting information from these multidimensional measurements effectively, provide additional insight into the underlying autofluorescence features of a sample. This study demonstrates, using both simulated data and endogenous fluorophores measured bench-side, that the shape of the spectral fluorescence lifetime, or fluorescence lifetimes estimated over high-resolution spectral channels across a broad range, is influenced by the relative abundance of underlying fluorophores in mixed systems and their respective environment. This study, furthermore, explores the properties of the spectral fluorescence lifetime in paired lung tissue deemed either abnormal or normal by pathologists. We observe that, on average, the shape of the spectral fluorescence lifetime at multiple locations sampled on 14 abnormal lung tissue, compared to multiple locations sampled on the respective paired normal lung tissue, shows more variability; and, while not statistically significant, the average spectral fluorescence lifetime in abnormal tissue is consistently lower over every wavelength than the normal tissue.
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Affiliation(s)
- Alexandra C. Adams
- Translational Healthcare Technology Group, Institute for Regeneration and Repair, 5 Little France Dr, Edinburgh EH16 4UU, UK
| | - András Kufcsák
- Institute of Photonics and Quantum Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK
| | - Charles Lochenie
- Translational Healthcare Technology Group, Institute for Regeneration and Repair, 5 Little France Dr, Edinburgh EH16 4UU, UK
| | - Mohsen Khadem
- Translational Healthcare Technology Group, Institute for Regeneration and Repair, 5 Little France Dr, Edinburgh EH16 4UU, UK
- School of Informatics, University of Edinburgh, Edinburgh EH8 9AB, UK
| | - Ahsan R. Akram
- Translational Healthcare Technology Group, Institute for Regeneration and Repair, 5 Little France Dr, Edinburgh EH16 4UU, UK
| | - Kevin Dhaliwal
- Translational Healthcare Technology Group, Institute for Regeneration and Repair, 5 Little France Dr, Edinburgh EH16 4UU, UK
| | - Sohan Seth
- Translational Healthcare Technology Group, Institute for Regeneration and Repair, 5 Little France Dr, Edinburgh EH16 4UU, UK
- School of Informatics, University of Edinburgh, Edinburgh EH8 9AB, UK
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Gunasekaran R, Chandrasekaran A, Rajarathinam K, Duncan S, Dhaliwal K, Lalitha P, Prajna NV, Mills B. Rapid Point-of-Care Identification of Aspergillus Species in Microbial Keratitis. JAMA Ophthalmol 2023; 141:966-973. [PMID: 37768674 PMCID: PMC10540059 DOI: 10.1001/jamaophthalmol.2023.4214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/30/2023] [Indexed: 09/29/2023]
Abstract
Importance Microbial keratitis (MK) is a common cause of unilateral visual impairment, blindness, and eye loss in low-income and middle-income countries. There is an urgent need to develop and implement rapid and simple point-of-care diagnostics for MK to increase the likelihood of good outcomes. Objective To evaluate the diagnostic performance of the Aspergillus-specific lateral-flow device (AspLFD) to identify Aspergillus species causing MK in corneal scrape and corneal swab samples of patients presenting with microbial keratitis. Design, Setting, and Participants This diagnostic study was conducted between May 2022 and January 2023 at the corneal clinic of Aravind Eye Hospital in Madurai, Tamil Nadu, India. All study participants were recruited during their first presentation to the clinic. Patients aged 15 years or older met the eligibility criteria if they were attending their first appointment, had a corneal ulcer that was suggestive of a bacterial or fungal infection, and were about to undergo diagnostic scrape and culture. Main Outcomes and Measures Sensitivity and specificity of the AspLFD with corneal samples collected from patients with MK. During routine diagnostic scraping, a minimally invasive corneal swab and an additional corneal scrape were collected and transferred to aliquots of sample buffer and analyzed by lateral-flow device (LFD) if the patient met the inclusion criteria. Photographs of devices were taken with a smartphone and analyzed using a ratiometric approach, which was developed for this study. The AspLFD results were compared with culture reports. Results The 198 participants who met the inclusion criteria had a mean (range) age of 51 (15-85) years and included 126 males (63.6%). Overall, 35 of 198 participants with corneal scrape (17.7%) and 17 of 40 participants with swab samples (42.5%) had positive culture results for Aspergillus species. Ratiometric analysis results for the scrape samples found that the AspLFD achieved high sensitivity (0.89; 95% CI, 0.74-0.95), high negative predictive value (0.97; 95% CI, 0.94-0.99), low negative likelihood ratio (0.12; 95% CI, 0.05-0.30), and an accuracy of 0.94 (95% CI, 0.90-0.97). Ratiometric analysis results for the swab samples showed that the AspLFD had high sensitivity (0.94; 95% CI, 0.73-1.00), high negative predictive value (0.95; 95% CI, 0.76-1.00), low negative likelihood ratio (0.07; 95% CI, 0.01-0.48), and an accuracy of 0.88 (95% CI, 0.73-0.96). Conclusions and Relevance Results of this diagnostic study suggest that AspLFD along with the ratiometric analysis of LFDs developed for this study has high diagnostic accuracy in identifying Aspergillus species from corneal scrapes and swabs. This technology is an important step toward the provision of point-of-care diagnostics for MK and could inform the clinical management strategy.
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Affiliation(s)
- Rameshkumar Gunasekaran
- Department of Ocular Microbiology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Abinaya Chandrasekaran
- Department of Cornea and Refractive Surgery Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Karpagam Rajarathinam
- Department of Ocular Microbiology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Sheelagh Duncan
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, United Kingdom
| | - Kevin Dhaliwal
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, United Kingdom
| | - Prajna Lalitha
- Department of Ocular Microbiology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - N. Venkatesh Prajna
- Department of Cornea and Refractive Surgery Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Bethany Mills
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, United Kingdom
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Megia-Fernandez A, Marshall A, Akram AR, Mills B, Chankeshwara SV, Scholefield E, Miele A, McGorum BC, Michaels C, Knighton N, Vercauteren T, Lacombe F, Dentan V, Bruce AM, Mair J, Hitchcock R, Hirani N, Haslett C, Bradley M, Dhaliwal K. Erratum to "Optical Detection of Distal Lung Enzyme Activity in Human Inflammatory Lung Disease". BME Front 2023; 4:0029. [PMID: 37849676 PMCID: PMC10521641 DOI: 10.34133/bmef.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 10/19/2023] Open
Abstract
[This corrects the article DOI: 10.34133/2021/9834163.].
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Affiliation(s)
- Alicia Megia-Fernandez
- EaStCHEM, The University of Edinburgh School of Chemistry, Joseph Black Building, West Mains Road, Edinburgh EH9 3FJ, UK
| | - Adam Marshall
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Ahsan R. Akram
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Bethany Mills
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Sunay V. Chankeshwara
- EaStCHEM, The University of Edinburgh School of Chemistry, Joseph Black Building, West Mains Road, Edinburgh EH9 3FJ, UK
| | - Emma Scholefield
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Amy Miele
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Bruce C. McGorum
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian EH25 9RG, UK
| | - Chesney Michaels
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Nathan Knighton
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Dr, Salt Lake City, UT 84112, USA
| | - Tom Vercauteren
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EH, UK
| | | | | | - Annya M. Bruce
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Joanne Mair
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Robert Hitchcock
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Dr, Salt Lake City, UT 84112, USA
| | - Nik Hirani
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Chris Haslett
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Mark Bradley
- EaStCHEM, The University of Edinburgh School of Chemistry, Joseph Black Building, West Mains Road, Edinburgh EH9 3FJ, UK
| | - Kevin Dhaliwal
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
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Neary M, Sharp J, Gallardo-Toledo E, Herriott J, Kijak E, Bramwell C, Cox H, Tatham L, Box H, Curley P, Arshad U, Rajoli RKR, Pertinez H, Valentijn A, Dhaliwal K, Mc Caughan F, Hobson J, Rannard S, Kipar A, Stewart JP, Owen A. Evaluation of Nafamostat as Chemoprophylaxis for SARS-CoV-2 Infection in Hamsters. Viruses 2023; 15:1744. [PMID: 37632086 PMCID: PMC10458615 DOI: 10.3390/v15081744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/04/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
The successful development of a chemoprophylaxis against SARS-CoV-2 could provide a tool for infection prevention that is implementable alongside vaccination programmes. Nafamostat is a serine protease inhibitor that inhibits SARS-CoV-2 entry in vitro, but it has not been characterised for chemoprophylaxis in animal models. Clinically, nafamostat is limited to intravenous delivery and has an extremely short plasma half-life. This study sought to determine whether intranasal dosing of nafamostat at 5 mg/kg twice daily was able to prevent the airborne transmission of SARS-CoV-2 from infected to uninfected Syrian Golden hamsters. SARS-CoV-2 RNA was detectable in the throat swabs of the water-treated control group 4 days after cohabitation with a SARS-CoV-2 inoculated hamster. However, throat swabs from the intranasal nafamostat-treated hamsters remained SARS-CoV-2 RNA negative for the full 4 days of cohabitation. Significantly lower SARS-CoV-2 RNA concentrations were seen in the nasal turbinates of the nafamostat-treated group compared to the control (p = 0.001). A plaque assay quantified a significantly lower concentration of infectious SARS-CoV-2 in the lungs of the nafamostat-treated group compared to the control (p = 0.035). When taken collectively with the pathological changes observed in the lungs and nasal mucosa, these data are strongly supportive of the utility of intranasally delivered nafamostat for the prevention of SARS-CoV-2 infection.
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Affiliation(s)
- Megan Neary
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Joanne Sharp
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Eduardo Gallardo-Toledo
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Joanne Herriott
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Edyta Kijak
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Chloe Bramwell
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Helen Cox
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Lee Tatham
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Helen Box
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Paul Curley
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Usman Arshad
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Rajith K. R. Rajoli
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Henry Pertinez
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Anthony Valentijn
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Kevin Dhaliwal
- Translational Healthcare Technologies Group, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH10 5HF, UK
| | - Frank Mc Caughan
- Victor Phillip Dahdaleh Heart and Lung Research Institute, Department of Medicine, University of Cambridge, Cambridge Biomedical Campus, Papworth Road, Cambridge CB2 1BN, UK
| | - James Hobson
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Steve Rannard
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
| | - Anja Kipar
- Department of Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L3 5TR, UK; (A.K.)
- Laboratory for Animal Model Pathology, Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - James P. Stewart
- Department of Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L3 5TR, UK; (A.K.)
| | - Andrew Owen
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 5TR, UK (J.S.); (E.G.-T.); (E.K.)
- Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool L3 5TR, UK
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Mohanan SMPC, Russell K, Duncan S, Kiang A, Lochenie C, Duffy E, Kennedy S, Prajna NV, Williams RL, Dhaliwal K, Williams GOS, Mills B. FluoroPi Device With SmartProbes: A Frugal Point-of-Care System for Fluorescent Detection of Bacteria From a Pre-Clinical Model of Microbial Keratitis. Transl Vis Sci Technol 2023; 12:1. [PMID: 37395707 DOI: 10.1167/tvst.12.7.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Purpose Rapid and accurate diagnosis of microbial keratitis (MK) could greatly improve patient outcomes. Here, we present the development of a rapid, accessible multicolour fluorescence imaging device (FluoroPi) and evaluate its performance in combination with fluorescent optical reporters (SmartProbes) to distinguish bacterial Gram status. Furthermore, we show feasibility by imaging samples obtained by corneal scrape and minimally invasive corneal impression membrane (CIM) from ex vivo porcine corneal MK models. Methods FluoroPi was built using a Raspberry Pi single-board computer and camera, light-emitting-diodes (LEDs), and filters for white-light and fluorescent imaging, with excitation and detection of bacterial optical SmartProbes: Gram-negative, NBD-PMX (exmax 488 nm); Gram positive, Merocy-Van (exmax 590 nm). We evaluated FluoroPi with bacteria (Pseudomonas aeruginosa and Staphylococcus aureus) isolated from ex vivo porcine corneal models of MK by scrape (needle) and CIM with the SmartProbes. Results FluoroPi provides <1 µm resolution and was able to readily distinguish bacteria isolated from ex vivo models of MK from tissue debris when combined with SmartProbes, retrieved by both scrape and CIM. Single bacteria could be resolved within the field of view, with limits of detection demonstrated as 103 to 104 CFU/mL. Sample preparation prior to imaging was minimal (wash-free), and imaging and postprocessing with FluoroPi were straightforward, confirming ease of use. Conclusions FluoroPi coupled with SmartProbes provides effective, low-cost bacterial imaging, delineating Gram-negative and Gram-positive bacteria directly sampled from a preclinical model of MK. Translational Relevance This study provides a crucial stepping stone toward clinical translation of a rapid, minimally invasive diagnostic approach for MK.
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Affiliation(s)
- Syam Mohan P C Mohanan
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Kay Russell
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Sheelagh Duncan
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Alex Kiang
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Charles Lochenie
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Emma Duffy
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Stephnie Kennedy
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - N Venkatesh Prajna
- Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, India
| | - Rachel L Williams
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Kevin Dhaliwal
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Gareth O S Williams
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Bethany Mills
- Translational Healthcare Technologies Group, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
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Benson S, Kiang A, Lochenie C, Lal N, Mohanan SMPC, Williams GOS, Dhaliwal K, Mills B, Vendrell M. Environmentally sensitive photosensitizers enable targeted photodynamic ablation of Gram-positive antibiotic resistant bacteria. Theranostics 2023; 13:3814-3825. [PMID: 37441588 PMCID: PMC10334829 DOI: 10.7150/thno.84187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/09/2023] [Indexed: 07/15/2023] Open
Abstract
Bacterial infections remain among the biggest challenges to human health, leading to high antibiotic usage, morbidity, hospitalizations, and accounting for approximately 8 million deaths worldwide every year. The overuse of antibiotics and paucity of antimicrobial innovation has led to antimicrobial resistant pathogens that threaten to reverse key advances of modern medicine. Photodynamic therapeutics can kill bacteria but there are few agents that can ablate pathogens with minimal off-target effects. Methods: We describe nitrobenzoselenadiazoles as some of the first environmentally sensitive organic photosensitizers, and their adaptation to produce theranostics with optical detection and light-controlled antimicrobial activity. We combined nitrobenzoselenadiazoles with bacteria-targeting moieties (i.e., glucose-6-phosphate, amoxicillin, vancomycin) producing environmentally sensitive photodynamic agents. Results: The labelled vancomycin conjugate was able to both visualize and eradicate multidrug resistant Gram-positive ESKAPE pathogens at nanomolar concentrations, including clinical isolates and those that form biofilms. Conclusion: Nitrobenzoselenadiazole conjugates are easily synthesized and display strong environment dependent ROS production. Due to their small size and non-invasive character, they unobtrusively label antimicrobial targeting moieties. We envisage that the simplicity and modularity of this chemical strategy will accelerate the rational design of new antimicrobial therapies for refractory bacterial infections.
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Affiliation(s)
- Sam Benson
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh EH16 4TJ, UK
- IRR Chemistry Hub, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh EH16 4UU, UK
| | - Alex Kiang
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Charles Lochenie
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh EH16 4TJ, UK
- IRR Chemistry Hub, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh EH16 4UU, UK
| | - Navita Lal
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh EH16 4TJ, UK
| | | | - Gareth O. S. Williams
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Kevin Dhaliwal
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Bethany Mills
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Marc Vendrell
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh EH16 4TJ, UK
- IRR Chemistry Hub, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh EH16 4UU, UK
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Titmarsh HF, von Kriegsheim A, Wills JC, O’Connor RA, Dhaliwal K, Frame MC, Pattle SB, Dorward DA, Byron A, Akram AR. Quantitative proteomics identifies tumour matrisome signatures in patients with non-small cell lung cancer. Front Oncol 2023; 13:1194515. [PMID: 37397358 PMCID: PMC10313119 DOI: 10.3389/fonc.2023.1194515] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction The composition and remodelling of the extracellular matrix (ECM) are important factors in the development and progression of cancers, and the ECM is implicated in promoting tumour growth and restricting anti-tumour therapies through multiple mechanisms. The characterisation of differences in ECM composition between normal and diseased tissues may aid in identifying novel diagnostic markers, prognostic indicators and therapeutic targets for drug development. Methods Using tissue from non-small cell lung cancer (NSCLC) patients undergoing curative intent surgery, we characterised quantitative tumour-specific ECM proteome signatures by mass spectrometry. Results We identified 161 matrisome proteins differentially regulated between tumour tissue and nearby non-malignant lung tissue, and we defined a collagen hydroxylation functional protein network that is enriched in the lung tumour microenvironment. We validated two novel putative extracellular markers of NSCLC, the collagen cross-linking enzyme peroxidasin and a disintegrin and metalloproteinase with thrombospondin motifs 16 (ADAMTS16), for discrimination of malignant and non-malignant lung tissue. These proteins were up-regulated in lung tumour samples, and high PXDN and ADAMTS16 gene expression was associated with shorter survival of lung adenocarcinoma and squamous cell carcinoma patients, respectively. Discussion These data chart extensive remodelling of the lung extracellular niche and reveal tumour matrisome signatures in human NSCLC.
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Affiliation(s)
- Helen F. Titmarsh
- The EPSRC and MRC Centre for Doctoral Training in Optical Medical Imaging, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh Bioquarter, Edinburgh, United Kingdom
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh Bioquarter, Edinburgh, United Kingdom
| | - Alex von Kriegsheim
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
| | - Jimi C. Wills
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
| | - Richard A. O’Connor
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh Bioquarter, Edinburgh, United Kingdom
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh Bioquarter, Edinburgh, United Kingdom
| | - Margaret C. Frame
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
| | - Samuel B. Pattle
- Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - David A. Dorward
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh Bioquarter, Edinburgh, United Kingdom
- Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Adam Byron
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
- Division of Molecular and Cellular Function, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Ahsan R. Akram
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh Bioquarter, Edinburgh, United Kingdom
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
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11
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Wadhwa B, Malhotra V, Kerai S, Husain F, Pandey NB, Saxena KN, Singh V, Quinn TM, Li F, Gaughan E, Shankar-Hari M, Mills B, Antonelli J, Bruce A, Finlayson K, Moore A, Dhaliwal K, Edwards C. Phase 2 randomised placebo-controlled trial of spironolactone and dexamethasone versus dexamethasone in COVID-19 hospitalised patients in Delhi. BMC Infect Dis 2023; 23:326. [PMID: 37189034 PMCID: PMC10184093 DOI: 10.1186/s12879-023-08286-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 04/27/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND In this phase 2 randomised placebo-controlled clinical trial in patients with COVID-19, we hypothesised that blocking mineralocorticoid receptors using a combination of dexamethasone to suppress cortisol secretion and spironolactone is safe and may reduce illness severity. METHODS Hospitalised patients with confirmed COVID-19 were randomly allocated to low dose oral spironolactone (50 mg day 1, then 25 mg once daily for 21 days) or standard of care in a 2:1 ratio. Both groups received dexamethasone 6 mg daily for 10 days. Group allocation was blinded to the patient and research team. Primary outcomes were time to recovery, defined as the number of days until patients achieved WHO Ordinal Scale (OS) category ≤ 3, and the effect of spironolactone on aldosterone, D-dimer, angiotensin II and Von Willebrand Factor (VWF). RESULTS One hundred twenty patients with PCR confirmed COVID were recruited in Delhi from 01 February to 30 April 2021. 74 were randomly assigned to spironolactone and dexamethasone (SpiroDex), and 46 to dexamethasone alone (Dex). There was no significant difference in the time to recovery between SpiroDex and Dex groups (SpiroDex median 4.5 days, Dex median 5.5 days, p = 0.055). SpiroDex patients had significantly lower D-dimer levels on days 4 and 7 (day 7 mean D-dimer: SpiroDex 1.15 µg/mL, Dex 3.15 µg/mL, p = 0.0004) and aldosterone at day 7 (SpiroDex 6.8 ng/dL, Dex 14.52 ng/dL, p = 0.0075). There was no difference in VWF or angiotensin II levels between groups. For secondary outcomes, SpiroDex patients had a significantly greater number of oxygen free days and reached oxygen freedom sooner than the Dex group. Cough scores were no different during the acute illness, however the SpiroDex group had lower scores at day 28. There was no difference in corticosteroid levels between groups. There was no increase in adverse events in patients receiving SpiroDex. CONCLUSION Low dose oral spironolactone in addition to dexamethasone was safe and reduced D-dimer and aldosterone. Time to recovery was not significantly reduced. Phase 3 randomised controlled trials with spironolactone and dexamethasone should be considered. TRIAL REGISTRATION The trial was registered on the Clinical Trials Registry of India TRI: CTRI/2021/03/031721, reference: REF/2021/03/041472. Registered on 04/03/2021.
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Affiliation(s)
- Bharti Wadhwa
- Department of Anaesthesia, Maulana Azad Medical College, New Delhi, India.
| | - Vikas Malhotra
- Department of ENT & Head and Neck Surgery, Maulana Azad Medical College & Associated Hospitals, New Delhi, India
| | - Sukhyanti Kerai
- Department of Anaesthesia, Maulana Azad Medical College, New Delhi, India
| | - Farah Husain
- Department of Anaesthesia, Maulana Azad Medical College, New Delhi, India
| | - Nalini Bala Pandey
- Department of Anaesthesia, Maulana Azad Medical College, New Delhi, India
| | - Kirti N Saxena
- Department of Anaesthesia, Maulana Azad Medical College, New Delhi, India
| | - Vinay Singh
- Department of Anaesthesia, Maulana Azad Medical College, New Delhi, India
| | - Tom M Quinn
- Centre for Inflammation Research, The Queen's Medical Research Institute, BioQuarter, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
- Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh, EH16 4SA, UK
| | - Feng Li
- Centre for Inflammation Research, The Queen's Medical Research Institute, BioQuarter, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Erin Gaughan
- Centre for Inflammation Research, The Queen's Medical Research Institute, BioQuarter, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
- Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh, EH16 4SA, UK
| | - Manu Shankar-Hari
- Centre for Inflammation Research, The Queen's Medical Research Institute, BioQuarter, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
- Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh, EH16 4SA, UK
| | - Bethany Mills
- Centre for Inflammation Research, The Queen's Medical Research Institute, BioQuarter, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Jean Antonelli
- Centre for Inflammation Research, The Queen's Medical Research Institute, BioQuarter, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Annya Bruce
- Centre for Inflammation Research, The Queen's Medical Research Institute, BioQuarter, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Keith Finlayson
- Centre for Inflammation Research, The Queen's Medical Research Institute, BioQuarter, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Anne Moore
- Centre for Inflammation Research, The Queen's Medical Research Institute, BioQuarter, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Kevin Dhaliwal
- Centre for Inflammation Research, The Queen's Medical Research Institute, BioQuarter, The University of Edinburgh, Edinburgh, EH16 4TJ, UK.
- Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh, EH16 4SA, UK.
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12
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Humphries DC, O’Connor RA, Stewart HL, Quinn TM, Gaughan EE, Mills B, Williams GO, Stone JM, Finlayson K, Chabaud-Riou M, Boudet F, Dhaliwal K, Pavot V. Specific in situ immuno-imaging of pulmonary-resident memory lymphocytes in human lungs. Front Immunol 2023; 14:1100161. [PMID: 36845117 PMCID: PMC9951616 DOI: 10.3389/fimmu.2023.1100161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
Introduction Pulmonary-resident memory T cells (TRM) and B cells (BRM) orchestrate protective immunity to reinfection with respiratory pathogens. Developing methods for the in situ detection of these populations would benefit both research and clinical settings. Methods To address this need, we developed a novel in situ immunolabelling approach combined with clinic-ready fibre-based optical endomicroscopy (OEM) to detect canonical markers of lymphocyte tissue residency in situ in human lungs undergoing ex vivo lung ventilation (EVLV). Results Initially, cells from human lung digests (confirmed to contain TRM/BRM populations using flow cytometry) were stained with CD69 and CD103/CD20 fluorescent antibodies and imaged in vitro using KronoScan, demonstrating it's ability to detect antibody labelled cells. We next instilled these pre-labelled cells into human lungs undergoing EVLV and confirmed they could still be visualised using both fluorescence intensity and lifetime imaging against background lung architecture. Finally, we instilled fluorescent CD69 and CD103/CD20 antibodies directly into the lung and were able to detect TRM/BRM following in situ labelling within seconds of direct intra-alveolar delivery of microdoses of fluorescently labelled antibodies. Discussion In situ, no wash, immunolabelling with intra-alveolar OEM imaging is a novel methodology with the potential to expand the experimental utility of EVLV and pre-clinical models.
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Affiliation(s)
- Duncan C. Humphries
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom,Research & Development, Sanofi, Marcy L’Etoile, France
| | - Richard A. O’Connor
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Hazel L. Stewart
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Tom M. Quinn
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Erin E. Gaughan
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Beth Mills
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Gareth O.S. Williams
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - James M. Stone
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom,Centre for Photonic and Physics, Bath University, Bath, United Kingdom
| | - Keith Finlayson
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Kevin Dhaliwal
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom,*Correspondence: Kevin Dhaliwal, ; Vincent Pavot,
| | - Vincent Pavot
- Research & Development, Sanofi, Marcy L’Etoile, France,*Correspondence: Kevin Dhaliwal, ; Vincent Pavot,
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13
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Wood HAC, Ehrlich K, Yerolatsitis S, Kufcsák A, Quinn TM, Fernandes S, Norberg D, Jenkins NC, Young V, Young I, Hamilton K, Seth S, Akram A, Thomson RR, Finlayson K, Dhaliwal K, Stone JM. Tri-mode optical biopsy probe with fluorescence endomicroscopy, Raman spectroscopy, and time-resolved fluorescence spectroscopy. J Biophotonics 2023; 16:e202200141. [PMID: 36062395 DOI: 10.1002/jbio.202200141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/30/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
We present an endoscopic probe that combines three distinct optical fibre technologies including: A high-resolution imaging fibre for optical endomicroscopy, a multimode fibre for time-resolved fluorescence spectroscopy, and a hollow-core fibre with multimode signal collection cores for Raman spectroscopy. The three fibers are all enclosed within a 1.2 mm diameter clinical grade catheter with a 1.4 mm end cap. To demonstrate the probe's flexibility we provide data acquired with it in loops of radii down to 2 cm. We then use the probe in an anatomically accurate model of adult human airways, showing that it can be navigated to any part of the distal lung using a commercial bronchoscope. Finally, we present data acquired from fresh ex vivo human lung tissue. Our experiments show that this minimally invasive probe can deliver real-time optical biopsies from within the distal lung - simultaneously acquiring co-located high-resolution endomicroscopy and biochemical spectra.
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Affiliation(s)
- Harry Alexander Charles Wood
- Centre for Photonics and Photonic Materials, University of Bath, Bath, UK
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Katjana Ehrlich
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Scottish Universities Physics Alliance (SUPA), Institute of Photonics and Quantum Science, Heriot-Watt University, Edinburgh, UK
| | - Stephanos Yerolatsitis
- Centre for Photonics and Photonic Materials, University of Bath, Bath, UK
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- The College of Optics and Photonics (CREOL), University of Central Florida, Orlando, Florida, USA
| | - András Kufcsák
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Tom Michael Quinn
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Susan Fernandes
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Dominic Norberg
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Nia Caitlin Jenkins
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Vikki Young
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Irene Young
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Katie Hamilton
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sohan Seth
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Ahsan Akram
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Robert Rodrick Thomson
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Scottish Universities Physics Alliance (SUPA), Institute of Photonics and Quantum Science, Heriot-Watt University, Edinburgh, UK
| | - Keith Finlayson
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Kevin Dhaliwal
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - James Morgan Stone
- Centre for Photonics and Photonic Materials, University of Bath, Bath, UK
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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14
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Thamo B, Hanley D, Dhaliwal K, Khadem M. Data-Driven Steering of Concentric Tube Robots in Unknown Environments via Dynamic Mode Decomposition. IEEE Robot Autom Lett 2023. [DOI: 10.1109/lra.2022.3231490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Balint Thamo
- School of Informatics, University of Edinburgh, Edinburgh, U.K
| | - David Hanley
- School of Informatics, University of Edinburgh, Edinburgh, U.K
| | - Kevin Dhaliwal
- The Translational Healthcare Technologies Group in Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, U.K
| | - Mohsen Khadem
- School of Informatics, University of Edinburgh, Edinburgh, U.K
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15
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Gaughan EE, Quinn TM, Mills A, Bruce AM, Antonelli J, MacKinnon AC, Aslanis V, Li F, O’Connor R, Boz C, Mills R, Emanuel P, Burgess M, Rinaldi G, Valanciute A, Mills B, Scholefield E, Hardisty G, Findlay EG, Parker RA, Norrie J, Dear JW, Akram AR, Koch O, Templeton K, Dockrell DH, Walsh TS, Partridge S, Humphries D, Wang-Jairaj J, Slack RJ, Schambye H, Phung D, Gravelle L, Lindmark B, Shankar-Hari M, Hirani N, Sethi T, Dhaliwal K. An Inhaled Galectin-3 Inhibitor in COVID-19 Pneumonitis: A Phase Ib/IIa Randomized Controlled Clinical Trial (DEFINE). Am J Respir Crit Care Med 2023; 207:138-149. [PMID: 35972987 PMCID: PMC9893334 DOI: 10.1164/rccm.202203-0477oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/16/2022] [Indexed: 02/02/2023] Open
Abstract
Rationale: High circulating galectin-3 is associated with poor outcomes in patients with coronavirus disease (COVID-19). We hypothesized that GB0139, a potent inhaled thiodigalactoside galectin-3 inhibitor with antiinflammatory and antifibrotic actions, would be safely and effectively delivered in COVID-19 pneumonitis. Objectives: Primary outcomes were safety and tolerability of inhaled GB0139 as an add-on therapy for patients hospitalized with COVID-19 pneumonitis. Methods: We present the findings of two arms of a phase Ib/IIa randomized controlled platform trial in hospitalized patients with confirmed COVID-19 pneumonitis. Patients received standard of care (SoC) or SoC plus 10 mg inhaled GB0139 twice daily for 48 hours, then once daily for up to 14 days or discharge. Measurements and Main Results: Data are reported from 41 patients, 20 of which were assigned randomly to receive GB0139. Primary outcomes: the GB0139 group experienced no treatment-related serious adverse events. Incidences of adverse events were similar between treatment arms (40 with GB0139 + SoC vs. 35 with SoC). Secondary outcomes: plasma GB0139 was measurable in all patients after inhaled exposure and demonstrated target engagement with decreased circulating galectin (overall treatment effect post-hoc analysis of covariance [ANCOVA] over days 2-7; P = 0.0099 vs. SoC). Plasma biomarkers associated with inflammation, fibrosis, coagulopathy, and major organ function were evaluated. Conclusions: In COVID-19 pneumonitis, inhaled GB0139 was well-tolerated and achieved clinically relevant plasma concentrations with target engagement. The data support larger clinical trials to determine clinical efficacy. Clinical trial registered with ClinicalTrials.gov (NCT04473053) and EudraCT (2020-002230-32).
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Affiliation(s)
- Erin E. Gaughan
- Centre for Inflammation Research, Edinburgh BioQuarter
- Department of Respiratory Medicine
| | - Tom M. Quinn
- Centre for Inflammation Research, Edinburgh BioQuarter
- Department of Respiratory Medicine
| | | | | | | | | | | | - Feng Li
- Centre for Inflammation Research, Edinburgh BioQuarter
| | | | - Cecilia Boz
- Centre for Inflammation Research, Edinburgh BioQuarter
| | - Ross Mills
- Centre for Inflammation Research, Edinburgh BioQuarter
| | | | | | | | | | - Bethany Mills
- Centre for Inflammation Research, Edinburgh BioQuarter
| | | | | | | | | | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, and
| | - James W. Dear
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Ahsan R. Akram
- Centre for Inflammation Research, Edinburgh BioQuarter
- Department of Respiratory Medicine
| | - Oliver Koch
- Centre for Inflammation Research, Edinburgh BioQuarter
- Infectious Diseases Department, Western General Hospital, Edinburgh, United Kingdom
| | | | - David H. Dockrell
- Centre for Inflammation Research, Edinburgh BioQuarter
- Infectious Diseases Department, Western General Hospital, Edinburgh, United Kingdom
| | - Timothy S. Walsh
- Centre for Inflammation Research, Edinburgh BioQuarter
- Department of Critical Care, New Royal Infirmary of Edinburgh, Edinburgh BioQuarter, Edinburgh, United Kingdom
| | | | | | | | | | | | - De Phung
- Galecto Inc., Copenhagen, Denmark; and
| | | | | | - Manu Shankar-Hari
- Centre for Inflammation Research, Edinburgh BioQuarter
- Department of Critical Care, New Royal Infirmary of Edinburgh, Edinburgh BioQuarter, Edinburgh, United Kingdom
| | - Nikhil Hirani
- Centre for Inflammation Research, Edinburgh BioQuarter
- Department of Respiratory Medicine
| | | | - Kevin Dhaliwal
- Centre for Inflammation Research, Edinburgh BioQuarter
- Department of Respiratory Medicine
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16
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Adams AC, Kufcsak A, Ehrlich K, Dhaliwal K, Seth S. Simultaneous Spectral Temporal Modelling for a Time-Resolved Fluorescence Emission Spectrum. IEEE Trans Biomed Eng 2023; PP. [PMID: 37028307 DOI: 10.1109/tbme.2023.3244664] [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: 03/18/2023]
Abstract
Innovations in complementary metal-oxide semiconductor (CMOS) single-photon avalanche diode (SPAD) technology has featured in the development of next-generation instruments for point-based time-resolved fluorescence spectroscopy (TRFS). These instruments provide hundreds of spectral channels, allowing the collection of fluorescence intensity and fluorescence lifetime information over a broad spectral range at a high spectral and temporal resolution. We present Multichannel Fluorescence Lifetime Estimation, MuFLE, an efficient computational approach to exploit the unique multi-channel spectroscopy data with an emphasis on simultaneous estimation of the emission spectra, and the respective spectral fluorescence lifetimes. In addition, we show that this approach can estimate the individual spectral characteristics of fluorophores from a mixed sample.
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Affiliation(s)
- Alexandra C. Adams
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK
| | - Andras Kufcsak
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK
| | - Katjana Ehrlich
- Scottish Universities Physics Alliance (SUPA), Institute of Photonics and Quantum Science, Heriot-Watt University, Edinburgh, UK
| | - Kevin Dhaliwal
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK
| | - Sohan Seth
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK
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17
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Jenkins NC, Ehrlich K, Kufcsak A, Yerolatsitis S, Fernandes S, Young I, Hamilton K, Wood HAC, Quinn T, Young V, Akram AR, Stone JM, Thomson RR, Finlayson K, Dhaliwal K, Seth S. Computational Fluorescence Suppression in Shifted Excitation Raman Spectroscopy. IEEE Trans Biomed Eng 2023; PP. [PMID: 37022914 DOI: 10.1109/tbme.2023.3243866] [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: 02/12/2023]
Abstract
Fiber-based Raman spectroscopy in the context of in vivo biomedical application suffers from the presence of background fluorescence from the surrounding tissue that might mask the crucial but inherently weak Raman signatures. One method that has shown potential for suppressing the background to reveal the Raman spectra is shifted excitation Raman spectroscopy (SER). SER collects multiple emission spectra by shifting the excitation by small amounts and uses these spectra to computationally suppress the fluorescence background based on the principle that Raman spectrum shifts with excitation while fluorescence spectrum does not. We introduce a method that utilizes the spectral characteristics of the Raman and fluorescence spectra to estimate them more effectively, and compare this approach against existing methods on real world datasets.
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Affiliation(s)
- Nia C. Jenkins
- School of Informatics, University of Edinburgh, 10 Crichton Street, Edinburgh, U.K
| | - Katjana Ehrlich
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, U.K
| | - Andras Kufcsak
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, U.K
| | - Stephanos Yerolatsitis
- Centre for Photonics and Photonic Materials, University of Bath, Claverton Down, Bath, U.K
| | - Susan Fernandes
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, U.K
| | - Irene Young
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, U.K
| | - Katie Hamilton
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, U.K
| | - Harry A. C. Wood
- Centre for Photonics and Photonic Materials, University of Bath, Claverton Down, Bath, U.K
| | - Tom Quinn
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, U.K
| | - Vikki Young
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, U.K
| | - Ahsan R. Akram
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, U.K
| | - James M. Stone
- Centre for Photonics and Photonic Materials, University of Bath, Claverton Down, Bath, U.K
| | - Robert R. Thomson
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, U.K
| | - Keith Finlayson
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, U.K
| | - Kevin Dhaliwal
- Translational Healthcare Technology Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, U.K
| | - Sohan Seth
- School of Informatics, University of Edinburgh, 10 Crichton Street, Edinburgh, U.K
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18
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Wang Q, Fernandes S, Williams GOS, Finlayson N, Akram AR, Dhaliwal K, Hopgood JR, Vallejo M. Deep learning-assisted co-registration of full-spectral autofluorescence lifetime microscopic images with H&E-stained histology images. Commun Biol 2022; 5:1119. [PMID: 36271298 PMCID: PMC9586936 DOI: 10.1038/s42003-022-04090-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/10/2022] [Indexed: 11/28/2022] Open
Abstract
Autofluorescence lifetime images reveal unique characteristics of endogenous fluorescence in biological samples. Comprehensive understanding and clinical diagnosis rely on co-registration with the gold standard, histology images, which is extremely challenging due to the difference of both images. Here, we show an unsupervised image-to-image translation network that significantly improves the success of the co-registration using a conventional optimisation-based regression network, applicable to autofluorescence lifetime images at different emission wavelengths. A preliminary blind comparison by experienced researchers shows the superiority of our method on co-registration. The results also indicate that the approach is applicable to various image formats, like fluorescence in-tensity images. With the registration, stitching outcomes illustrate the distinct differences of the spectral lifetime across an unstained tissue, enabling macro-level rapid visual identification of lung cancer and cellular-level characterisation of cell variants and common types. The approach could be effortlessly extended to lifetime images beyond this range and other staining technologies.
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Affiliation(s)
- Qiang Wang
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
| | - Susan Fernandes
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Gareth O S Williams
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Neil Finlayson
- Institute for Integrated Micro and Nano Systems, School of Engineering, University of Edinburgh, Edinburgh, UK
| | - Ahsan R Akram
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - James R Hopgood
- Institute for Digital Communications, School of Engineering, University of Edinburgh, Edinburgh, UK
| | - Marta Vallejo
- School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
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19
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Valančiūtė A, Mathieson L, O’Connor RA, Scott JI, Vendrell M, Dorward DA, Akram AR, Dhaliwal K. Phototherapeutic Induction of Immunogenic Cell Death and CD8+ T Cell-Granzyme B Mediated Cytolysis in Human Lung Cancer Cells and Organoids. Cancers (Basel) 2022; 14:4119. [PMID: 36077656 PMCID: PMC9454585 DOI: 10.3390/cancers14174119] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Augmenting T cell mediated tumor killing via immunogenic cancer cell death (ICD) is the cornerstone of emerging immunotherapeutic approaches. We investigated the potential of methylene blue photodynamic therapy (MB-PDT) to induce ICD in human lung cancer. Non-Small Cell Lung Cancer (NSCLC) cell lines and primary human lung cancer organoids were evaluated in co-culture killing assays with MB-PDT and light emitting diodes (LEDs). ICD was characterised using immunoblotting, immunofluorescence, flow cytometry and confocal microscopy. Phototherapy with MB treatment and low energy LEDs decreased the proliferation of NSCLC cell lines inducing early necrosis associated with reduced expression of the anti-apoptotic protein, Bcl2 and increased expression of ICD markers, calreticulin (CRT), intercellular cell-adhesion molecule-1 (ICAM-1) and major histocompatibility complex I (MHC-I) in NSCLC cells. MB-PDT also potentiated CD8+ T cell-mediated cytolysis of lung cancer via granzyme B in lung cancer cells and primary human lung cancer organoids.
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Affiliation(s)
- Asta Valančiūtė
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Layla Mathieson
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Richard A. O’Connor
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Jamie I. Scott
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Marc Vendrell
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - David A. Dorward
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
- Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Ahsan R. Akram
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Kevin Dhaliwal
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
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20
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McShane EP, Chandrasekharan HK, Kufcsák A, Finlayson N, Erdogan AT, Henderson RK, Dhaliwal K, Thomson RR, Tanner MG. High resolution TCSPC imaging of diffuse light with a one-dimensional SPAD array scanning system. Opt Express 2022; 30:27926-27937. [PMID: 36236951 DOI: 10.1364/oe.461334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/22/2022] [Indexed: 06/16/2023]
Abstract
We report a time-correlated single-photon counting (TCSPC) imaging system based on a line-scanning architecture. The system benefits from the high fill-factor, active area, and large dimension of an advanced CMOS single-photon avalanche diode (SPAD) array line-sensor. A two-dimensional image is constructed using a moving mirror to scan the line-sensor field-of-view (FOV) across the target, to enable the efficient acquisition of a two-dimensional 0.26 Mpixel TCSPC image. We demonstrate the capabilities of the system for TCSPC imaging and locating objects obscured in scattering media - specifically to locate a series of discrete point sources of light along an optical fibre submerged in a highly scattering solution. We demonstrate that by selectively imaging using early arriving photons which have undergone less scattering than later arriving photons, our TCSPC imaging system is able to locate the position of discrete point sources of light than a non-time-resolved imaging system.
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21
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Taimori A, Humphries D, Williams G, Dhaliwal K, Finlayson N, Hopgood J. Fast and robust single-exponential decay recovery from noisy fluorescence lifetime imaging. IEEE Trans Biomed Eng 2022; 69:3703-3716. [PMID: 35609109 DOI: 10.1109/tbme.2022.3176224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fluorescence lifetime imaging is a valuable technique for probing characteristics of wide ranging samples and sensing of the molecular environment. However, the desire to measure faster and reduce effects such as photo bleaching in optical photon-count measurements for lifetime estimation lead to inevitable effects of convolution with the instrument response functions and noise, causing a degradation of the lifetime accuracy and precision. To tackle the problem, this paper presents a robust and computationally efficient framework for recovering fluorophore sample decay from the histogram of photon-count arrivals modelled as a decaying single-exponential function. In the proposed approach, the temporal histogram data is first decomposed into multiple bins via an adaptive multi-bin signal representation. Then, at each level of the multi-resolution temporal space, decay information including both the amplitude and the lifetime of a single-exponential function is rapidly decoded based on a novel statistical estimator. Ultimately, a game-theoretic model consisting of two players in an "amplitude-lifetime" game is constructed to be able to robustly recover optimal fluorescence decay signal from a set of fused multi-bin estimates. In addition to theoretical demonstrations, the efficiency of the proposed framework is experimentally shown on both synthesised and real data in different imaging circumstances. On a challenging low photon-count regime, our approach achieves about 28% improvement in bias than the best competing method. On real images, the proposed method processes data on average around 63 times faster than the gold standard least squares fit. Implementation codes are available to researchers.
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22
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Halford S, Wan S, Dragoni I, Silvester J, Nazarov B, Anthony D, Anthony S, Ladds E, Norrie J, Dhaliwal K. Correction to: SPIKE-1: A Randomised Phase II/III trial in a community setting, assessing use of camostat in reducing the clinical progression of COVID-19 by blocking SARS-CoV-2 Spike protein-initiated membrane fusion. Trials 2022; 23:336. [PMID: 35449061 PMCID: PMC9022056 DOI: 10.1186/s13063-022-06266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sarah Halford
- Cancer Research UK Centre for Drug Development, London, UK.
| | - Susan Wan
- Cancer Research UK Centre for Drug Development, London, UK
| | - Ilaria Dragoni
- Cancer Research UK Centre for Drug Development, London, UK
| | | | | | | | - Suzie Anthony
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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23
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Mathieson L, O'Connor RA, Stewart H, Shaw P, Dhaliwal K, Williams GOS, Megia-Fernandez A, Akram AR. Fibroblast Activation Protein Specific Optical Imaging in Non-Small Cell Lung Cancer. Front Oncol 2022; 12:834350. [PMID: 35359378 PMCID: PMC8961646 DOI: 10.3389/fonc.2022.834350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
Fibroblast activation protein (FAP) is a cell surface propyl-specific serine protease involved in the regulation of extracellular matrix. Whilst expressed at low levels in healthy tissue, upregulation of FAP on fibroblasts can be found in several solid organ malignancies, including non-small cell lung cancer, and chronic inflammatory conditions such as pulmonary fibrosis and rheumatoid arthritis. Their full role remains unclear, but FAP expressing cancer associated fibroblasts (CAFs) have been found to relate to a poor prognosis with worse survival rates in breast, colorectal, pancreatic, and non-small cell lung cancer (NSCLC). Optical imaging using a FAP specific chemical probe, when combined with clinically compatible imaging systems, can provide a readout of FAP activity which could allow disease monitoring, prognostication and potentially stratify therapy. However, to derive a specific signal for FAP any sequence must retain specificity over closely related endopeptidases, such as prolyl endopeptidase (PREP), and be resistant to degradation in areas of active inflammation. We describe the iterative development of a FAP optical reporter sequence which retains FAP specificity, confers resistance to degradation in the presence of activated neutrophil proteases and demonstrates clinical tractability ex vivo in NSCLC samples with an imaging platform.
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Affiliation(s)
- Layla Mathieson
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.,Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Richard A O'Connor
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.,Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Hazel Stewart
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Paige Shaw
- EaStCHEM, The University of Edinburgh School of Chemistry, Edinburgh, United Kingdom
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.,Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Gareth O S Williams
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Ahsan R Akram
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.,Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.,Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, United Kingdom
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24
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Jones WS, Suklan J, Winter A, Green K, Craven T, Bruce A, Mair J, Dhaliwal K, Walsh T, Simpson AJ, Graziadio S, Allen AJ. Diagnosing ventilator-associated pneumonia (VAP) in UK NHS ICUs: the perceived value and role of a novel optical technology. Diagn Progn Res 2022; 6:5. [PMID: 35144691 PMCID: PMC8830125 DOI: 10.1186/s41512-022-00117-x] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnosing ventilator-associated pneumonia (VAP) in an intensive care unit (ICU) is a complex process. Our aim was to collect, evaluate and represent the information relating to current clinical practice for the diagnosis of VAP in UK NHS ICUs, and to explore the potential value and role of a novel diagnostic for VAP, which uses optical molecular alveoscopy to visualise the alveolar space. METHODS Qualitative study performing semi-structured interviews with clinical experts. Interviews were recorded, transcribed, and thematically analysed. A flow diagram of the VAP patient pathway was elicited and validated with the expert interviewees. Fourteen clinicians were interviewed from a range of UK NHS hospitals: 12 ICU consultants, 1 professor of respiratory medicine and 1 professor of critical care. RESULTS Five themes were identified, relating to [1] current practice for the diagnosis of VAP, [2] current clinical need in VAP diagnostics, [3] the potential value and role of the technology, [4] the barriers to adoption and [5] the evidence requirements for the technology, to help facilitate a successful adoption. These themes indicated that diagnosis of VAP is extremely difficult, as is the decision to stop antibiotic treatment. The analysis revealed that there is a clinical need for a diagnostic that provides an accurate and timely diagnosis of the causative pathogen, without the long delays associated with return of culture results, and which is not dangerous to the patient. It was determined that the technology would satisfy important aspects of this clinical need for diagnosing VAP (and pneumonia, more generally), but would require further evidence on safety and efficacy in the patient population to facilitate adoption. CONCLUSIONS Care pathway analysis performed in this study was deemed accurate and representative of current practice for diagnosing VAP in a UK ICU as determined by relevant clinical experts, and explored the value and role of a novel diagnostic, which uses optical technology, and could streamline the diagnostic pathway for VAP and other pneumonias.
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Affiliation(s)
- W S Jones
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK.
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
| | - J Suklan
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - A Winter
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - K Green
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - T Craven
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
- Edinburgh Critical Care Research Group, University of Edinburgh, Edinburgh, UK
| | - A Bruce
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - J Mair
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - K Dhaliwal
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - T Walsh
- Edinburgh Critical Care Research Group, University of Edinburgh, Edinburgh, UK
| | - A J Simpson
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - S Graziadio
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - A J Allen
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
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25
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Russell CD, Valanciute A, Gachanja NN, Stephen J, Penrice-Randal R, Armstrong SD, Clohisey S, Wang B, Al Qsous W, Wallace WA, Oniscu GC, Stevens J, Harrison DJ, Dhaliwal K, Hiscox JA, Baillie JK, Akram AR, Dorward DA, Lucas CD. Tissue Proteomic Analysis Identifies Mechanisms and Stages of Immunopathology in Fatal COVID-19. Am J Respir Cell Mol Biol 2022; 66:196-205. [PMID: 34710339 PMCID: PMC8845132 DOI: 10.1165/rcmb.2021-0358oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/26/2021] [Indexed: 12/15/2022] Open
Abstract
Immunopathology occurs in the lung and spleen in fatal coronavirus disease (COVID-19), involving monocytes/macrophages and plasma cells. Antiinflammatory therapy reduces mortality, but additional therapeutic targets are required. We aimed to gain mechanistic insight into COVID-19 immunopathology by targeted proteomic analysis of pulmonary and splenic tissues. Lung parenchymal and splenic tissue was obtained from 13 postmortem examinations of patients with fatal COVID-19. Control tissue was obtained from cancer resection samples (lung) and deceased organ donors (spleen). Protein was extracted from tissue by phenol extraction. Olink multiplex immunoassay panels were used for protein detection and quantification. Proteins with increased abundance in the lung included MCP-3, antiviral TRIM21, and prothrombotic TYMP. OSM and EN-RAGE/S100A12 abundance was correlated and associated with inflammation severity. Unsupervised clustering identified "early viral" and "late inflammatory" clusters with distinct protein abundance profiles, and differences in illness duration before death and presence of viral RNA. In the spleen, lymphocyte chemotactic factors and CD8A were decreased in abundance, and proapoptotic factors were increased. B-cell receptor signaling pathway components and macrophage colony stimulating factor (CSF-1) were also increased. Additional evidence for a subset of host factors (including DDX58, OSM, TYMP, IL-18, MCP-3, and CSF-1) was provided by overlap between 1) differential abundance in spleen and lung tissue; 2) meta-analysis of existing datasets; and 3) plasma proteomic data. This proteomic analysis of lung parenchymal and splenic tissue from fatal COVID-19 provides mechanistic insight into tissue antiviral responses, inflammation and disease stages, macrophage involvement, pulmonary thrombosis, splenic B-cell activation, and lymphocyte depletion.
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Affiliation(s)
- Clark D. Russell
- University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh, United Kingdom
- Roslin Institute, University of Edinburgh, Easter Bush Campus, Midlothian, United Kingdom
| | - Asta Valanciute
- University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh, United Kingdom
| | - Naomi N. Gachanja
- University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh, United Kingdom
| | - Jillian Stephen
- University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh, United Kingdom
| | - Rebekah Penrice-Randal
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Stuart D. Armstrong
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sara Clohisey
- Roslin Institute, University of Edinburgh, Easter Bush Campus, Midlothian, United Kingdom
| | - Bo Wang
- Roslin Institute, University of Edinburgh, Easter Bush Campus, Midlothian, United Kingdom
| | - Wael Al Qsous
- Department of Pathology, Western General Hospital, Edinburgh, United Kingdom
| | | | | | - Jo Stevens
- Roslin Institute, University of Edinburgh, Easter Bush Campus, Midlothian, United Kingdom
| | - David J. Harrison
- School of Medicine, University of St. Andrews, North Haugh, St. Andrews, United Kingdom
| | - Kevin Dhaliwal
- University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh, United Kingdom
- Department of Respiratory Medicine, and
| | - Julian A. Hiscox
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
- Infectious Diseases Horizontal Technology Centre, Agency for Science, Technology, and Research, Singapore; and
| | - J. Kenneth Baillie
- Roslin Institute, University of Edinburgh, Easter Bush Campus, Midlothian, United Kingdom
- Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Ahsan R. Akram
- University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh, United Kingdom
- Department of Respiratory Medicine, and
| | - David A. Dorward
- University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh, United Kingdom
- Department of Pathology
| | - Christopher D. Lucas
- University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, Edinburgh BioQuarter, Edinburgh, United Kingdom
- Department of Respiratory Medicine, and
- Institute for Regeneration and Repair, University of Edinburgh, Edinburgh BioQuarter, Edinburgh, United Kingdom
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Quinn TM, Gaughan EE, Bruce A, Antonelli J, O'Connor R, Li F, McNamara S, Koch O, MacKintosh C, Dockrell D, Walsh T, Blyth KG, Church C, Schwarze J, Boz C, Valanciute A, Burgess M, Emanuel P, Mills B, Rinaldi G, Hardisty G, Mills R, Findlay EG, Jabbal S, Duncan A, Plant S, Marshall ADL, Young I, Russell K, Scholefield E, Nimmo AF, Nazarov IB, Churchill GC, McCullagh JSO, Ebrahimi KH, Ferrett C, Templeton K, Rannard S, Owen A, Moore A, Finlayson K, Shankar-Hari M, Norrie J, Parker RA, Akram AR, Anthony DC, Dear JW, Hirani N, Dhaliwal K. Randomised controlled trial of intravenous nafamostat mesylate in COVID pneumonitis: Phase 1b/2a experimental study to investigate safety, Pharmacokinetics and Pharmacodynamics. EBioMedicine 2022; 76:103856. [PMID: 35152152 PMCID: PMC8831100 DOI: 10.1016/j.ebiom.2022.103856] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Many repurposed drugs have progressed rapidly to Phase 2 and 3 trials in COVID19 without characterisation of Pharmacokinetics /Pharmacodynamics including safety data. One such drug is nafamostat mesylate. METHODS We present the findings of a phase Ib/IIa open label, platform randomised controlled trial of intravenous nafamostat in hospitalised patients with confirmed COVID-19 pneumonitis. Patients were assigned randomly to standard of care (SoC), nafamostat or an alternative therapy. Nafamostat was administered as an intravenous infusion at a dose of 0.2 mg/kg/h for a maximum of seven days. The analysis population included those who received any dose of the trial drug and all patients randomised to SoC. The primary outcomes of our trial were the safety and tolerability of intravenous nafamostat as an add on therapy for patients hospitalised with COVID-19 pneumonitis. FINDINGS Data is reported from 42 patients, 21 of which were randomly assigned to receive intravenous nafamostat. 86% of nafamostat-treated patients experienced at least one AE compared to 57% of the SoC group. The nafamostat group were significantly more likely to experience at least one AE (posterior mean odds ratio 5.17, 95% credible interval (CI) 1.10 - 26.05) and developed significantly higher plasma creatinine levels (posterior mean difference 10.57 micromol/L, 95% CI 2.43-18.92). An average longer hospital stay was observed in nafamostat patients, alongside a lower rate of oxygen free days (rate ratio 0.55-95% CI 0.31-0.99, respectively). There were no other statistically significant differences in endpoints between nafamostat and SoC. PK data demonstrated that intravenous nafamostat was rapidly broken down to inactive metabolites. We observed no significant anticoagulant effects in thromboelastometry. INTERPRETATION In hospitalised patients with COVID-19, we did not observe evidence of anti-inflammatory, anticoagulant or antiviral activity with intravenous nafamostat, and there were additional adverse events. FUNDING DEFINE was funded by LifeArc (an independent medical research charity) under the STOPCOVID award to the University of Edinburgh. We also thank the Oxford University COVID-19 Research Response Fund (BRD00230).
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Affiliation(s)
- Tom M Quinn
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | - Erin E Gaughan
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | - Annya Bruce
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Jean Antonelli
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Richard O'Connor
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Feng Li
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Sarah McNamara
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Oliver Koch
- Regional Infectious Disease Unit, NHS Lothian, UK
| | | | - David Dockrell
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Regional Infectious Disease Unit, NHS Lothian, UK
| | - Timothy Walsh
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | - Kevin G Blyth
- Institute of Cancer Sciences, University of Glasgow, UK
| | - Colin Church
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Jürgen Schwarze
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Cecilia Boz
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Asta Valanciute
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Matthew Burgess
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Philip Emanuel
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Bethany Mills
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Giulia Rinaldi
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Gareth Hardisty
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Ross Mills
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Emily Gwyer Findlay
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Sunny Jabbal
- Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | | | - Sinéad Plant
- Regional Infectious Disease Unit, NHS Lothian, UK
| | - Adam D L Marshall
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | - Irene Young
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Kay Russell
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Emma Scholefield
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Alastair F Nimmo
- Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | - Islom B Nazarov
- Latus Therapeutics, Oxford, UK; Department of Pharmacology, University of Oxford, Oxford, UK
| | | | | | | | - Colin Ferrett
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kate Templeton
- Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | - Steve Rannard
- Centre of Excellence for Long-acting Therapeutics, Materials Innovation Factory and Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Andrew Owen
- Centre of Excellence for Long-acting Therapeutics, Materials Innovation Factory and Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Anne Moore
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Keith Finlayson
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Manu Shankar-Hari
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - John Norrie
- Centre for Cardiovascular Science, Queen's Medical Research Institute, Bioquarter, University of Edinburgh, Edinburgh, UK
| | - Richard A Parker
- Edinburgh Clinical Trials Unit (ECTU), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ahsan R Akram
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | | | - James W Dear
- Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh,; Centre for Cardiovascular Science, Queen's Medical Research Institute, Bioquarter, University of Edinburgh, Edinburgh, UK
| | - Nik Hirani
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh,.
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Gaughan E, Quinn T, Bruce A, Antonelli J, Young V, Mair J, Akram A, Hirani N, Koch O, Mackintosh C, Norrie J, Dear JW, Dhaliwal K. Evaluation of new or repurposed treatments for COVID-19: protocol for the phase Ib/IIa DEFINE trial platform. BMJ Open 2021; 11:e054442. [PMID: 34911721 PMCID: PMC8678561 DOI: 10.1136/bmjopen-2021-054442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/04/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION COVID-19 is a new viral-induced pneumonia caused by infection with a novel coronavirus, SARS-CoV-2. At present, there are few proven effective treatments. This early-phase experimental medicine protocol describes an overarching and adaptive trial designed to provide safety data in patients with COVID-19, pharmacokinetic (PK)/pharmacodynamic (PD) information and exploratory biological surrogates of efficacy, which may support further development and deployment of candidate therapies in larger scale trials of patients positive for COVID-19. METHODS AND ANALYSIS Define is an ongoing exploratory multicentre-platform, open-label, randomised study. Patients positive for COVID-19 will be recruited from the following cohorts: (a) community cases; (b) hospitalised patients with evidence of COVID-19 pneumonitis; and (c) hospitalised patients requiring assisted ventilation. The cohort recruited from will be dependent on the experimental therapy, its route of administration and mechanism of action. Randomisation will be computer generated in a 1:1:n ratio. Twenty patients will be recruited per arm for the initial two arms. This is permitted to change as per the experimental therapy. The primary statistical analyses are concerned with the safety of candidate agents as add-on therapy to standard of care in patients with COVID-19. Secondary analysis will assess the following variables during treatment period: (1) the response of key exploratory biomarkers; (2) change in WHO ordinal scale and National Early Warning Score 2 (NEWS2) score; (3) oxygen requirements; (4) viral load; (5) duration of hospital stay; (6) PK/PD; and (7) changes in key coagulation pathways. ETHICS AND DISSEMINATION The Define trial platform and its initial two treatment and standard of care arms have received a favourable ethical opinion from Scotland A Research Ethics Committee (REC) (20/SS/0066), notice of acceptance from The Medicines and Healthcare Products Regulatory Agency (MHRA) (EudraCT 2020-002230-32) and approval from the relevant National Health Service (NHS) Research and Development (R&D) departments (NHS Lothian and NHS Greater Glasgow and Clyde). Appropriate processes are in place in order to be able to consent adults with and without capacity while following the necessary COVID-19 safe procedures. Patients without capacity could be recruited via a legal representative. Witnessed electronic consent of participants or their legal representatives following consent discussions was established. The results of each study arm will be submitted for publication in a peer-reviewed journal as soon as the treatment arm has finished recruitment, data input is complete and any outstanding patient safety follow-ups have been completed. Depending on the results of these or future arms, data will be shared with larger clinical trial networks, including the Randomised Evaluation of COVID-19 Therapy trial (RECOVERY), and to other partners for rapid roll-out in larger patient cohorts. TRIAL REGISTRATION NUMBER ISRCTN14212905, NCT04473053.
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Affiliation(s)
- Erin Gaughan
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Tom Quinn
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Annya Bruce
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Jean Antonelli
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Vikki Young
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Joanne Mair
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Ahsan Akram
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Nik Hirani
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Oliver Koch
- Regional Infectious Diseases Unit, NHS Lothian, Edinburgh, UK
| | | | - John Norrie
- Edinburgh Clinical Trials Unit, The University of Edinburgh, Edinburgh, UK
| | - James W Dear
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
- Centre for Cardiovascular Science, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
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28
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Bing R, Andrews JPM, Williams MC, van Beek EJR, Lucatelli C, MacNaught G, Clark T, Koglin N, Stephens AW, MacAskill MG, Tavares AAS, Dhaliwal K, Dorward DA, Lucas CD, Dweck MR, Newby DE. In Vivo Thrombosis Imaging in Patients Recovering from COVID-19 and Pulmonary Embolism. Am J Respir Crit Care Med 2021; 204:855-856. [PMID: 34375153 PMCID: PMC8528526 DOI: 10.1164/rccm.202011-4182im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rong Bing
- British Heart Foundation Centre for Cardiovascular Science
| | | | - Michelle C. Williams
- British Heart Foundation Centre for Cardiovascular Science,,Edinburgh Imaging, and
| | | | | | | | | | | | | | | | | | - Kevin Dhaliwal
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom; and
| | - David A. Dorward
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom; and
| | - Christopher D. Lucas
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom; and
| | - Marc R. Dweck
- British Heart Foundation Centre for Cardiovascular Science
| | - David E. Newby
- British Heart Foundation Centre for Cardiovascular Science,,Edinburgh Imaging, and
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Yerolatsitis S, Kufcsák A, Ehrlich K, Wood HAC, Fernandes S, Quinn T, Young V, Young I, Hamilton K, Akram AR, Thomson RR, Finlayson K, Dhaliwal K, Stone JM. Sub millimetre flexible fibre probe for background and fluorescence free Raman spectroscopy. J Biophotonics 2021; 14:e202000488. [PMID: 33855811 DOI: 10.1002/jbio.202000488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/26/2021] [Accepted: 04/11/2021] [Indexed: 06/12/2023]
Abstract
Using the shifted-excitation Raman difference spectroscopy technique and an optical fibre featuring a negative curvature excitation core and a coaxial ring of high numerical aperture collection cores, we have developed a portable, background and fluorescence free, endoscopic Raman probe. The probe consists of a single fibre with a diameter of less than 0.25 mm packaged in a sub-millimetre tubing, making it compatible with standard bronchoscopes. The Raman excitation light in the fibre is guided in air and therefore interacts little with silica, enabling an almost background free transmission of the excitation light. In addition, we used the shifted-excitation Raman difference spectroscopy technique and a tunable 785 nm laser to separate the fluorescence and the Raman spectrum from highly fluorescent samples, demonstrating the suitability of the probe for biomedical applications. Using this probe we also acquired fluorescence free human lung tissue data.
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Affiliation(s)
| | - András Kufcsák
- Translational Healthcare Technologies Team, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Katjana Ehrlich
- Translational Healthcare Technologies Team, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Scottish Universities Physics Alliance (SUPA), Institute of Photonics and Quantum Sciences, Heriot-Watt University, Edinburgh, UK
| | | | - Susan Fernandes
- Translational Healthcare Technologies Team, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Tom Quinn
- Translational Healthcare Technologies Team, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Vikki Young
- Translational Healthcare Technologies Team, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Irene Young
- Translational Healthcare Technologies Team, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Katie Hamilton
- Translational Healthcare Technologies Team, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Ahsan R Akram
- Translational Healthcare Technologies Team, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Robert R Thomson
- Scottish Universities Physics Alliance (SUPA), Institute of Photonics and Quantum Sciences, Heriot-Watt University, Edinburgh, UK
| | - Keith Finlayson
- Translational Healthcare Technologies Team, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Kevin Dhaliwal
- Translational Healthcare Technologies Team, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Humphries DC, O’Connor RA, Larocque D, Chabaud-Riou M, Dhaliwal K, Pavot V. Pulmonary-Resident Memory Lymphocytes: Pivotal Orchestrators of Local Immunity Against Respiratory Infections. Front Immunol 2021; 12:738955. [PMID: 34603321 PMCID: PMC8485048 DOI: 10.3389/fimmu.2021.738955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/01/2021] [Indexed: 12/12/2022] Open
Abstract
There is increasing evidence that lung-resident memory T and B cells play a critical role in protecting against respiratory reinfection. With a unique transcriptional and phenotypic profile, resident memory lymphocytes are maintained in a quiescent state, constantly surveying the lung for microbial intruders. Upon reactivation with cognate antigen, these cells provide rapid effector function to enhance immunity and prevent infection. Immunization strategies designed to induce their formation, alongside novel techniques enabling their detection, have the potential to accelerate and transform vaccine development. Despite most data originating from murine studies, this review will discuss recent insights into the generation, maintenance and characterisation of pulmonary resident memory lymphocytes in the context of respiratory infection and vaccination using recent findings from human and non-human primate studies.
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Affiliation(s)
- Duncan C. Humphries
- Centre for Inflammation Research, Queen’s Medical Research Institute, Edinburgh BioQuarter, The University of Edinburgh, Edinburgh, United Kingdom
- Sanofi Pasteur, R&D, Marcy l’Etoile, Lyon, France
| | - Richard A. O’Connor
- Centre for Inflammation Research, Queen’s Medical Research Institute, Edinburgh BioQuarter, The University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen’s Medical Research Institute, Edinburgh BioQuarter, The University of Edinburgh, Edinburgh, United Kingdom
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Halford S, Wan S, Dragoni I, Silvester J, Nazarov B, Anthony D, Anthony S, Ladds E, Norrie J, Dhaliwal K. SPIKE-1: A Randomised Phase II/III trial in a community setting, assessing use of camostat in reducing the clinical progression of COVID-19 by blocking SARS-CoV-2 Spike protein-initiated membrane fusion. Trials 2021; 22:550. [PMID: 34412682 PMCID: PMC8375281 DOI: 10.1186/s13063-021-05461-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/15/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The primary objective is to evaluate the efficacy of camostat to prevent respiratory deterioration in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Secondary objectives include assessment of the ability of camostat to reduce the requirement for Coronavirus disease 2019 (COVID-19) related hospital admission and to reduce the requirement for supplementary oxygen and ventilation as treatment for SARS-CoV-2 infection, to evaluate overall mortality related to COVID-19 and to evaluate the efficacy of camostat by effect on clinical improvement. Research objectives include to assess change in COVID-19 symptom severity, to evaluate the ability of camostat to reduce viral load throughout duration of illness as well as translational research on host and viral genomics, serum antibody production, COVID-19 diagnostics, and validation of laboratory testing methods and biomarkers. TRIAL DESIGN SPIKE-1 is a randomised, multicentre, prospective, open label, community-based clinical trial. Eligible patients will be randomised 1:1 to the camostat treatment arm and control arm (best supportive care). The trial is designed to include a pilot phase recruiting up to 50 patients in each arm. An initial review at the end of the pilot phase will allow assessment of available data and inform the requirement for any protocol adaptations to include refinement of eligibility criteria to enrich the patient population and sample size calculations. Up to 289 additional patients will be randomised in the continuation phase of the trial. A formal interim analysis will be performed once 50% of the maximum sample size has been recruited PARTICIPANTS: The trial will recruit adults (≥ 18 years) who score moderate to very high risk according to COVID-age risk calculation, with typical symptoms of COVID-19 infection as per Public Health England guidance or equivalent organisations in the UK, Health Protection Scotland, Public Health Wales, Public Health Agency (Northern Ireland) and with evidence of current COVID-19 infection from a validated assay. The trial is being conducted in the UK and patients are recruited through primary care and hospital settings. INTERVENTION AND COMPARATOR Eligible patients with be randomised to receive either camostat tablets, 200 mg four times daily (qds) for 14 days (treatment arm) or best supportive care (control arm). MAIN OUTCOMES Primary outcome measure: the rate of hospital admissions requiring supplemental oxygen. Secondary outcome measures include: the rate of COVID-19 related hospital admission in patients with SARS-CoV-2 infection; the number of supplementary oxygen-free days and ventilator-free days measured at 28 days from randomisation; the rate of mortality related to COVID-19 one year from randomisation; the time to worst point on the nine-point category ordinal scale (recommended by the World Health Organization: Coronavirus disease (COVID-2019)) or deterioration of two points or more, within 28 days from randomisation. Research outcomes include the assessment of change in COVID-19 symptom severity on days 1-14 as measured by (1) time to apyrexia (maintained for 48 hrs) by daily self-assessment of temperature, time to improvement (by two points) in peripheral oxygenation saturation defined by daily self-assessment of fingertip peripheral oxygenation saturation levels, (3) assessment of COVID-19 symptoms using the Flu-iiQ questionnaire (determined by app recording and/or daily video call (or phone) consultation and (4) assessment of functional score (where possible) at screening, day 7 and 14. The ability of camostat to reduce viral load throughout duration of illness will be assessed by (1) change in respiratory (oropharyngeal/nasopharyngeal swab RT-PCR) log10 viral load from baseline to Days 7 and 14, (2) change in respiratory (saliva RT-PCR) log10 viral load from baseline to Days 1-14 and (3) change in upper respiratory viral shedding at Day 1 -14 measured as time to clearance of nasal SARS-CoV-2, defined as 2 consecutive negative swabs by qPCR. Additional translational research outcomes include assessment of host and viral genomics, serum antibody production and COVID-19 diagnostics at baseline and on Days 7 and 14. RANDOMISATION Eligible patients will be randomised using an interactive web response system (IWRS) in a 1:1 ratio to one of two arms: (1) treatment arm or (2) control arm. BLINDING (MASKING) The trial is open-label. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) The trial is designed to include a pilot and a continuation phase. Up to 100 patients (randomised 1:1 treatment and control arm) will be recruited in the pilot phase and a maximum of 289 patients (randomised 1:1 treatment and control) will be recruited as part of the continuation phase. The total number of patients recruited will not exceed 389. TRIAL STATUS Protocol version number v3 25 September 2020. Trial opened to recruitment on 04 August 2020. The authors anticipate recruitment to be completed by October 2021. TRIAL REGISTRATION EudraCT 2020-002110-41; 18 June 2020 ClinicalTrials.gov NCT04455815 ; 02 July 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). Unpublished PK data provided under confidentiality agreement to the trial Sponsor has been removed from the background section of the protocol to allow for publication of the trial protocol. In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
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Affiliation(s)
- Sarah Halford
- Cancer Research UK Centre for Drug Development, London, UK
| | - Susan Wan
- Cancer Research UK Centre for Drug Development, London, UK
| | - Ilaria Dragoni
- Cancer Research UK Centre for Drug Development, London, UK
| | | | | | | | - Suzie Anthony
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Neary M, Box H, Sharp J, Tatham L, Curley P, Herriott J, Kijak E, Arshad U, Hobson JJ, Rajoli R, Pertinez H, Valentijn A, Dhaliwal K, McCaughan F, Rannard SP, Kipar A, Stewart JP, Owen A. Evaluation of intranasal nafamostat or camostat for SARS-CoV-2 chemoprophylaxis in Syrian golden hamsters. bioRxiv 2021:2021.07.08.451654. [PMID: 34268511 PMCID: PMC8282100 DOI: 10.1101/2021.07.08.451654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Successful development of a chemoprophylaxis against SARS-CoV-2 could provide a tool for infection prevention implementable alongside vaccination programmes. Camostat and nafamostat are serine protease inhibitors that inhibit SARS-CoV-2 viral entry in vitro but have not been characterised for chemoprophylaxis in animal models. Clinically, nafamostat is limited to intravenous delivery and while camostat is orally available, both drugs have extremely short plasma half-lives. This study sought to determine whether intranasal dosing at 5 mg/kg twice daily was able to prevent airborne transmission of SARS-CoV-2 from infected to uninfected Syrian golden hamsters. SARS-CoV-2 viral RNA was above the limits of quantification in both saline- and camostat-treated hamsters 5 days after cohabitation with a SARS-CoV-2 inoculated hamster. However, intranasal nafamostat-treated hamsters remained RNA negative for the full 7 days of cohabitation. Changes in body weight over the course of the experiment were supportive of a lack of clinical symptomology in nafamostat-treated but not saline- or camostat-treated animals. These data are strongly supportive of the utility of intranasally delivered nafamostat for prevention of SARS-CoV-2 infection and further studies are underway to confirm absence of pulmonary infection and pathological changes.
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O’Connor RA, Chauhan V, Mathieson L, Titmarsh H, Koppensteiner L, Young I, Tagliavini G, Dorward DA, Prost S, Dhaliwal K, Wallace WA, Akram AR. T cells drive negative feedback mechanisms in cancer associated fibroblasts, promoting expression of co-inhibitory ligands, CD73 and IL-27 in non-small cell lung cancer. Oncoimmunology 2021; 10:1940675. [PMID: 34290905 PMCID: PMC8274440 DOI: 10.1080/2162402x.2021.1940675] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
The success of immune checkpoint therapy shows tumor-reactive T cells can eliminate cancer cells but are restrained by immunosuppression within the tumor micro-environment (TME). Cancer associated fibroblasts (CAFs) are the dominant stromal cell in the TME and co-localize with T cells in non-small cell lung cancer. We demonstrate the bidirectional nature of CAF/T cell interactions; T cells promote expression of co-inhibitory ligands, MHC molecules and CD73 on CAFs, increasing their production of IL-6 and eliciting production of IL-27. In turn CAFs upregulate co-inhibitory receptors on T cells including the ectonucleotidase CD39 promoting development of an exhausted but highly cytotoxic phenotype. Our results highlight the bidirectional interaction between T cells and CAFs in promoting components of the immunosuppressive CD39, CD73 adenosine pathway and demonstrate IL-27 production can be induced in CAF by activated T cells.
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Affiliation(s)
- Richard A O’Connor
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Vishwani Chauhan
- Edinburgh Medical School, The Chancellor’s Building, University of Edinburgh, Edinburgh, UK
| | - Layla Mathieson
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Helen Titmarsh
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Lilian Koppensteiner
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Irene Young
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Guilia Tagliavini
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - David A Dorward
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Sandrine Prost
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Department of Pathology, The Chancellor’s Building, University of Edinburgh, Edinburgh, UK
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - William A Wallace
- Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of Pathology, The Chancellor’s Building, University of Edinburgh, Edinburgh, UK
| | - Ahsan R Akram
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
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Chandrasekharan HK, McShane EP, Dhaliwal K, Thomson RR, Tanner MG. Ultrafast laser ablation of a multicore polymer optical fiber for multipoint light emission. Opt Express 2021; 29:20765-20775. [PMID: 34266158 DOI: 10.1364/oe.424494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
We demonstrate the use of ultrafast laser pulses to precisely ablate the side of polymer multicore optical fibres (MCF) in such a way that light is efficiently coupled out of a set of MCF cores to free space. By individually exciting sets of MCF cores, this flexible "micro-window" technology allows the controllable generation of light sources at multiple independently selectable locations along the MCF. We found that the maximum fraction of light that could be side coupled from the MCF varied between 55% and 73%.
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35
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Al-Omari B, McMeekin P, Allen AJ, Akram AR, Graziadio S, Suklan J, Jones WS, Lendrem BC, Winter A, Cullinan M, Gray J, Dhaliwal K, Walsh TS, Craven TH. Systematic review of studies investigating ventilator associated pneumonia diagnostics in intensive care. BMC Pulm Med 2021; 21:196. [PMID: 34107929 PMCID: PMC8189711 DOI: 10.1186/s12890-021-01560-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Background Ventilator-associated pneumonia (VAP) is an important diagnosis in critical care. VAP research is complicated by the lack of agreed diagnostic criteria and reference standard test criteria. Our aim was to review which reference standard tests are used to evaluate novel index tests for suspected VAP. Methods We conducted a comprehensive search using electronic databases and hand reference checks. The Cochrane Library, MEDLINE, CINHAL, EMBASE, and web of science were searched from 2008 until November 2018. All terms related to VAP diagnostics in the intensive treatment unit were used to conduct the search. We adopted a checklist from the critical appraisal skills programme checklist for diagnostic studies to assess the quality of the included studies. Results We identified 2441 records, of which 178 were selected for full-text review. Following methodological examination and quality assessment, 44 studies were included in narrative data synthesis. Thirty-two (72.7%) studies utilised a sole microbiological reference standard; the remaining 12 studies utilised a composite reference standard, nine of which included a mandatory microbiological criterion. Histopathological criteria were optional in four studies but mandatory in none. Conclusions Nearly all reference standards for VAP used in diagnostic test research required some microbiological confirmation of infection, with BAL culture being the most common reference standard used. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01560-0.
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Affiliation(s)
- Basem Al-Omari
- College of Medicine and Health Sciences, Khalifa University, PO Box 127788, Abu Dhabi, UAE. .,Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
| | - Peter McMeekin
- School of Health and Life Science, University of Northumbria, Newcastle upon Tyne, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ahsan R Akram
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sara Graziadio
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, UK
| | - Jana Suklan
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - William S Jones
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - B Clare Lendrem
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Amanda Winter
- NIHR Newcastle In Vitro Diagnostics Co-operative, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Milo Cullinan
- Laboratory Medicine, Newcastle-Upon-Tyne Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Joanne Gray
- School of Health and Life Science, University of Northumbria, Newcastle upon Tyne, UK
| | - Kevin Dhaliwal
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Timothy S Walsh
- Edinburgh Critical Care Research Group, University of Edinburgh, Edinburgh, UK
| | - Thomas H Craven
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.,Edinburgh Critical Care Research Group, University of Edinburgh, Edinburgh, UK
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36
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Marwick JA, Elliott RJR, Longden J, Makda A, Hirani N, Dhaliwal K, Dawson JC, Carragher NO. Application of a High-Content Screening Assay Utilizing Primary Human Lung Fibroblasts to Identify Antifibrotic Drugs for Rapid Repurposing in COVID-19 Patients. SLAS Discov 2021; 26:1091-1106. [PMID: 34078171 PMCID: PMC8458684 DOI: 10.1177/24725552211019405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung imaging and autopsy reports among COVID-19 patients show elevated lung scarring (fibrosis). Early data from COVID-19 patients as well as previous studies from severe acute respiratory syndrome, Middle East respiratory syndrome, and other respiratory disorders show that the extent of lung fibrosis is associated with a higher mortality, prolonged ventilator dependence, and poorer long-term health prognosis. Current treatments to halt or reverse lung fibrosis are limited; thus, the rapid development of effective antifibrotic therapies is a major global medical need that will continue far beyond the current COVID-19 pandemic. Reproducible fibrosis screening assays with high signal-to-noise ratios and disease-relevant readouts such as extracellular matrix (ECM) deposition (the hallmark of fibrosis) are integral to any antifibrotic therapeutic development. Therefore, we have established an automated high-throughput and high-content primary screening assay measuring transforming growth factor-β (TGFβ)-induced ECM deposition from primary human lung fibroblasts in a 384-well format. This assay combines longitudinal live cell imaging with multiparametric high-content analysis of ECM deposition. Using this assay, we have screened a library of 2743 small molecules representing approved drugs and late-stage clinical candidates. Confirmed hits were subsequently profiled through a suite of secondary lung fibroblast phenotypic screening assays quantifying cell differentiation, proliferation, migration, and apoptosis. In silico target prediction and pathway network analysis were applied to the confirmed hits. We anticipate this suite of assays and data analysis tools will aid the identification of new treatments to mitigate against lung fibrosis associated with COVID-19 and other fibrotic diseases.
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Affiliation(s)
- John A Marwick
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.,Centre for Inflammation Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Richard J R Elliott
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - James Longden
- Center for Clinical Brain Sciences, Chancellors Building, University of Edinburgh, Edinburgh, UK
| | - Ashraff Makda
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Nik Hirani
- Centre for Inflammation Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - John C Dawson
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Neil O Carragher
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
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37
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Reyes L, A. Sanchez-Garcia M, Morrison T, Howden AJM, Watts ER, Arienti S, Sadiku P, Coelho P, Mirchandani AS, Zhang A, Hope D, Clark SK, Singleton J, Johnston S, Grecian R, Poon A, McNamara S, Harper I, Fourman MH, Brenes AJ, Pathak S, Lloyd A, Blanco GR, von Kriegsheim A, Ghesquiere B, Vermaelen W, Cologna CT, Dhaliwal K, Hirani N, Dockrell DH, Whyte MKB, Griffith D, Cantrell DA, Walmsley SR. -------A type I IFN, prothrombotic hyperinflammatory neutrophil signature is distinct for COVID-19 ARDS--. Wellcome Open Res 2021; 6:38. [PMID: 33997298 PMCID: PMC8112464 DOI: 10.12688/wellcomeopenres.16584.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Acute respiratory distress syndrome (ARDS) is a severe critical condition with a high mortality that is currently in focus given that it is associated with mortality caused by coronavirus disease 2019 (COVID-19). Neutrophils play a key role in the lung injury characteristic of non-COVID-19 ARDS and there is also accumulating evidence of neutrophil mediated lung injury in patients who succumb to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: We undertook a functional proteomic and metabolomic survey of circulating neutrophil populations, comparing patients with COVID-19 ARDS and non-COVID-19 ARDS to understand the molecular basis of neutrophil dysregulation. Results: Expansion of the circulating neutrophil compartment and the presence of activated low and normal density mature and immature neutrophil populations occurs in ARDS, irrespective of cause. Release of neutrophil granule proteins, neutrophil activation of the clotting cascade and upregulation of the Mac-1 platelet binding complex with formation of neutrophil platelet aggregates is exaggerated in COVID-19 ARDS. Importantly, activation of components of the neutrophil type I interferon responses is seen in ARDS following infection with SARS-CoV-2, with associated rewiring of neutrophil metabolism, and the upregulation of antigen processing and presentation. Whilst dexamethasone treatment constricts the immature low density neutrophil population, it does not impact upon prothrombotic hyperinflammatory neutrophil signatures. Conclusions: Given the crucial role of neutrophils in ARDS and the evidence of a disordered myeloid response observed in COVID-19 patients, this work maps the molecular basis for neutrophil reprogramming in the distinct clinical entities of COVID-19 and non-COVID-19 ARDS.
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Affiliation(s)
- Leila Reyes
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Manuel A. Sanchez-Garcia
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Tyler Morrison
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Andy J. M. Howden
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Emily R. Watts
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Simone Arienti
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Pranvera Sadiku
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Patricia Coelho
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Ananda S. Mirchandani
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Ailiang Zhang
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - David Hope
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Sarah K. Clark
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Jo Singleton
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Shonna Johnston
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Robert Grecian
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Azin Poon
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Sarah McNamara
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Isla Harper
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Max Head Fourman
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Alejandro J. Brenes
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK,Centre for Gene Regulation and Expression, University of Dundee, Dundee, DD1 5EH, UK
| | - Shalini Pathak
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Amy Lloyd
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Giovanny Rodriguez Blanco
- The University of Edinburgh MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Alex von Kriegsheim
- The University of Edinburgh MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Bart Ghesquiere
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Wesley Vermaelen
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Camila T. Cologna
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Nik Hirani
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK,NHS Lothian, Respiratory Medicine, Edinburgh Lung Fibrosis Clinic, Royal Infirmary, Edinburgh, EH16 4SA, UK
| | - David H. Dockrell
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Moira K. B. Whyte
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - David Griffith
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Doreen A. Cantrell
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Sarah R. Walmsley
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK,
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38
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Reyes L, A. Sanchez-Garcia M, Morrison T, Howden AJM, Watts ER, Arienti S, Sadiku P, Coelho P, Mirchandani AS, Zhang A, Hope D, Clark SK, Singleton J, Johnston S, Grecian R, Poon A, McNamara S, Harper I, Fourman MH, Brenes AJ, Pathak S, Lloyd A, Blanco GR, von Kriegsheim A, Ghesquiere B, Vermaelen W, Cologna CT, Dhaliwal K, Hirani N, Dockrell DH, Whyte MKB, Griffith D, Cantrell DA, Walmsley SR. -------A type I IFN, prothrombotic hyperinflammatory neutrophil signature is distinct for COVID-19 ARDS--. Wellcome Open Res 2021; 6:38. [PMID: 33997298 PMCID: PMC8112464 DOI: 10.12688/wellcomeopenres.16584.2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Acute respiratory distress syndrome (ARDS) is a severe critical condition with a high mortality that is currently in focus given that it is associated with mortality caused by coronavirus disease 2019 (COVID-19). Neutrophils play a key role in the lung injury characteristic of non-COVID-19 ARDS and there is also accumulating evidence of neutrophil mediated lung injury in patients who succumb to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: We undertook a functional proteomic and metabolomic survey of circulating neutrophil populations, comparing patients with COVID-19 ARDS and non-COVID-19 ARDS to understand the molecular basis of neutrophil dysregulation. Results: Expansion of the circulating neutrophil compartment and the presence of activated low and normal density mature and immature neutrophil populations occurs in ARDS, irrespective of cause. Release of neutrophil granule proteins, neutrophil activation of the clotting cascade and upregulation of the Mac-1 platelet binding complex with formation of neutrophil platelet aggregates is exaggerated in COVID-19 ARDS. Importantly, activation of components of the neutrophil type I interferon responses is seen in ARDS following infection with SARS-CoV-2, with associated rewiring of neutrophil metabolism, and the upregulation of antigen processing and presentation. Whilst dexamethasone treatment constricts the immature low density neutrophil population, it does not impact upon prothrombotic hyperinflammatory neutrophil signatures. Conclusions: Given the crucial role of neutrophils in ARDS and the evidence of a disordered myeloid response observed in COVID-19 patients, this work maps the molecular basis for neutrophil reprogramming in the distinct clinical entities of COVID-19 and non-COVID-19 ARDS.
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Affiliation(s)
- Leila Reyes
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Manuel A. Sanchez-Garcia
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Tyler Morrison
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Andy J. M. Howden
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Emily R. Watts
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Simone Arienti
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Pranvera Sadiku
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Patricia Coelho
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Ananda S. Mirchandani
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Ailiang Zhang
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - David Hope
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Sarah K. Clark
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Jo Singleton
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Shonna Johnston
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Robert Grecian
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Azin Poon
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Sarah McNamara
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Isla Harper
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Max Head Fourman
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Alejandro J. Brenes
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK,Centre for Gene Regulation and Expression, University of Dundee, Dundee, DD1 5EH, UK
| | - Shalini Pathak
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Amy Lloyd
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Giovanny Rodriguez Blanco
- The University of Edinburgh MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Alex von Kriegsheim
- The University of Edinburgh MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Bart Ghesquiere
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Wesley Vermaelen
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Camila T. Cologna
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, Leuven, Belgium
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Nik Hirani
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK,NHS Lothian, Respiratory Medicine, Edinburgh Lung Fibrosis Clinic, Royal Infirmary, Edinburgh, EH16 4SA, UK
| | - David H. Dockrell
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Moira K. B. Whyte
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - David Griffith
- Anaesthesia, Critical Care and Pain, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Doreen A. Cantrell
- Division of Cell Signalling and Immunology, University of Dundee, Dundee, DD1 5EH, UK
| | - Sarah R. Walmsley
- Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK,
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Tan P, Dhaliwal K, Khanna A. 59 Should The ‘Normal’ And ‘Ideal’ Nipple Position in A Male Influence the Surgeon When Planning Severe Gynaecomastia Correction? Br J Surg 2021. [DOI: 10.1093/bjs/znab134.220] [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: 11/13/2022]
Abstract
Abstract
Background
The ideal nipple position of the male chest following gynecomastia surgery is well documented however with increased development of the chest muscles, the NAC placement can change, leading to the medial displacement of the nipple giving a poor aesthetic outcome. Therefore, we feel these measurements need to be applied to the patients build and take into consideration the patient's future fitness goals.
Method
We have analysed photographs of 3 groups of men: super- athletes, athletes and severe gynaecomastia. We assessed the proportions of the chest in relation to the NAC and the degree of ptosis.
Results
There is wide variation in the position of the nipple to the chest wall between each group with minor variation within each group. Based on this research we believe that surgeons should be circumspect when considering breast reduction with a Wise pattern in patients with severe gynaecomastia.
In patient with increased development of the pectoralis major muscles, the NAC placement can change, leading to medial displacement of the nipple and ptosis and poor aesthetic result.
Conclusions
We suggest a two-stage procedure, carried out on two separate occasions wound be more ideal than a single stage as this allows better long-term better positioning of the nipple.
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Affiliation(s)
- P Tan
- Sandwell General Hospital, West Bromwich, Birmingham, UK, BIRMINGHAM, United Kingdom
| | - K Dhaliwal
- Sandwell General Hospital, West Bromwich, Birmingham, UK, BIRMINGHAM, United Kingdom
| | - A Khanna
- Sandwell General Hospital, West Bromwich, Birmingham, UK, BIRMINGHAM, United Kingdom
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40
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Mitros Z, Thamo B, Bergeles C, da Cruz L, Dhaliwal K, Khadem M. Design and Modelling of a Continuum Robot for Distal Lung Sampling in Mechanically Ventilated Patients in Critical Care. Front Robot AI 2021; 8:611866. [PMID: 34012980 PMCID: PMC8126695 DOI: 10.3389/frobt.2021.611866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/24/2021] [Indexed: 12/02/2022] Open
Abstract
In this paper, we design and develop a novel robotic bronchoscope for sampling of the distal lung in mechanically-ventilated (MV) patients in critical care units. Despite the high cost and attributable morbidity and mortality of MV patients with pneumonia which approaches 40%, sampling of the distal lung in MV patients suffering from range of lung diseases such as Covid-19 is not standardised, lacks reproducibility and requires expert operators. We propose a robotic bronchoscope that enables repeatable sampling and guidance to distal lung pathologies by overcoming significant challenges that are encountered whilst performing bronchoscopy in MV patients, namely, limited dexterity, large size of the bronchoscope obstructing ventilation, and poor anatomical registration. We have developed a robotic bronchoscope with 7 Degrees of Freedom (DoFs), an outer diameter of 4.5 mm and inner working channel of 2 mm. The prototype is a push/pull actuated continuum robot capable of dexterous manipulation inside the lung and visualisation/sampling of the distal airways. A prototype of the robot is engineered and a mechanics-based model of the robotic bronchoscope is developed. Furthermore, we develop a novel numerical solver that improves the computational efficiency of the model and facilitates the deployment of the robot. Experiments are performed to verify the design and evaluate accuracy and computational cost of the model. Results demonstrate that the model can predict the shape of the robot in <0.011s with a mean error of 1.76 cm, enabling the future deployment of a robotic bronchoscope in MV patients.
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Affiliation(s)
- Zisos Mitros
- Robotics and Vision in Medicine (RViM) Lab, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Balint Thamo
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Christos Bergeles
- Robotics and Vision in Medicine (RViM) Lab, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Lyndon da Cruz
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Kevin Dhaliwal
- Translational Healthcare Technologies Group in the Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Mohsen Khadem
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Translational Healthcare Technologies Group in the Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh, United Kingdom
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Humphries DC, O‘Connor R, Chabaud-Riou M, Boudet F, Finlayson K, Dhaliwal K, Pavot V. Detection and characterisation of lung-resident memory T cells in human and non-human primates. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.26.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
Rationale: Lung-resident memory T cells (TRM) play a critical role in protecting against respiratory infection. Maintained in a quiescent state, TRM are poised for rapid effector function upon reactivation with cognate antigen. Kronoscan is a clinic-ready, fibre-based, optical imaging system developed by the University of Edinburgh, capable of measuring both fluorescence intensity and lifetime. The aim of this study is to develop a staining protocol to enable the detection of human and non-human primate (NHP) pulmonary TRM populations in situ.
Methods:
Human lungs (deemed non-suitable for transplantation) following ex vivo lung perfusion (EVLP) and NHP lungs (cynomolgus macaque obtained from Charles River Laboratories) were enzymatically digested to achieve a single cell suspension. Cells were stained with cross-reactive antibodies prior to flow cytometric analysis. Fluorescence intensity and lifetime imaging was also performed using Kronoscan on MACs-enriched, antibody-stained, pulmonary T cells.
Results:
Human and NHP TRM were primarily identified using CD69 and CD103 and co-expressed a number of chemokine receptors (CXCR3, CCR10), adhesion molecules (CD49a, CD49d) and the immune checkpoint inhibitor PD-1. Differences in phenotype were observed between CD4+ and CD8+ TRM. TRM could be identified via fluorescence intensity and lifetime imaging using Kronoscan.
Conclusions:
A cross-reactive antibody panel capable of detecting human and NHP pulmonary TRM was successfully developed. Fibre-based fluorescence lifetime imaging may provide a valuable tool for assessing pulmonary TRM populations in situ, reflecting the level of immunity following infection and vaccination.
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Megia-Fernandez A, Marshall A, Akram AR, Mills B, Chankeshwara SV, Scholefield E, Miele A, McGorum BC, Michaels C, Knighton N, Vercauteren T, Lacombe F, Dentan V, Bruce AM, Mair J, Hitchcock R, Hirani N, Haslett C, Bradley M, Dhaliwal K. Optical Detection of Distal Lung Enzyme Activity in Human Inflammatory Lung Disease. BME Front 2021; 2021:9834163. [PMID: 37851586 PMCID: PMC10530652 DOI: 10.34133/2021/9834163] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/10/2021] [Indexed: 10/19/2023] Open
Abstract
Objective and Impact Statement. There is a need to develop platforms delineating inflammatory biology of the distal human lung. We describe a platform technology approach to detect in situ enzyme activity and observe drug inhibition in the distal human lung using a combination of matrix metalloproteinase (MMP) optical reporters, fibered confocal fluorescence microscopy (FCFM), and a bespoke delivery device. Introduction. The development of new therapeutic agents is hindered by the lack of in vivo in situ experimental methodologies that can rapidly evaluate the biological activity or drug-target engagement in patients. Methods. We optimised a novel highly quenched optical molecular reporter of enzyme activity (FIB One) and developed a translational pathway for in-human assessment. Results. We demonstrate the specificity for matrix metalloproteases (MMPs) 2, 9, and 13 and probe dequenching within physiological levels of MMPs and feasibility of imaging within whole lung models in preclinical settings. Subsequently, in a first-in-human exploratory experimental medicine study of patients with fibroproliferative lung disease, we demonstrate, through FCFM, the MMP activity in the alveolar space measured through FIB One fluorescence increase (with pharmacological inhibition). Conclusion. This translational in situ approach enables a new methodology to demonstrate active drug target effects of the distal lung and consequently may inform therapeutic drug development pathways.
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Affiliation(s)
- Alicia Megia-Fernandez
- EaStCHEM, The University of Edinburgh School of Chemistry, Joseph Black Building, West Mains Road, Edinburgh, UK, EH9 3FJ
| | - Adam Marshall
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh, UK, EH16 4TJ
| | - Ahsan R. Akram
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh, UK, EH16 4TJ
| | - Bethany Mills
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh, UK, EH16 4TJ
| | - Sunay V. Chankeshwara
- EaStCHEM, The University of Edinburgh School of Chemistry, Joseph Black Building, West Mains Road, Edinburgh, UK, EH9 3FJ
| | - Emma Scholefield
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh, UK, EH16 4TJ
| | - Amy Miele
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh, UK, EH16 4TJ
| | - Bruce C. McGorum
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, UK, EH25 9RG
| | - Chesney Michaels
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh, UK, EH16 4TJ
| | - Nathan Knighton
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Dr, Salt Lake City, UT 84112, USA
| | - Tom Vercauteren
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK, SE1 7EH
| | | | | | - Annya M. Bruce
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh, UK, EH16 4TJ
| | - Joanne Mair
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh, UK, EH16 4TJ
| | - Robert Hitchcock
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Dr, Salt Lake City, UT 84112, USA
| | - Nik Hirani
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh, UK, EH16 4TJ
| | - Chris Haslett
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh, UK, EH16 4TJ
| | - Mark Bradley
- EaStCHEM, The University of Edinburgh School of Chemistry, Joseph Black Building, West Mains Road, Edinburgh, UK, EH9 3FJ
| | - Kevin Dhaliwal
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh BioQuarter, Edinburgh, UK, EH16 4TJ
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Wu H, Zhang H, Karwath A, Ibrahim Z, Shi T, Zhang X, Wang K, Sun J, Dhaliwal K, Bean D, Cardoso VR, Li K, Teo JT, Banerjee A, Gao-Smith F, Whitehouse T, Veenith T, Gkoutos GV, Wu X, Dobson R, Guthrie B. Ensemble learning for poor prognosis predictions: A case study on SARS-CoV-2. J Am Med Inform Assoc 2021; 28:791-800. [PMID: 33185672 PMCID: PMC7717299 DOI: 10.1093/jamia/ocaa295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/11/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Risk prediction models are widely used to inform evidence-based clinical decision making. However, few models developed from single cohorts can perform consistently well at population level where diverse prognoses exist (such as the SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2] pandemic). This study aims at tackling this challenge by synergizing prediction models from the literature using ensemble learning. MATERIALS AND METHODS In this study, we selected and reimplemented 7 prediction models for COVID-19 (coronavirus disease 2019) that were derived from diverse cohorts and used different implementation techniques. A novel ensemble learning framework was proposed to synergize them for realizing personalized predictions for individual patients. Four diverse international cohorts (2 from the United Kingdom and 2 from China; N = 5394) were used to validate all 8 models on discrimination, calibration, and clinical usefulness. RESULTS Results showed that individual prediction models could perform well on some cohorts while poorly on others. Conversely, the ensemble model achieved the best performances consistently on all metrics quantifying discrimination, calibration, and clinical usefulness. Performance disparities were observed in cohorts from the 2 countries: all models achieved better performances on the China cohorts. DISCUSSION When individual models were learned from complementary cohorts, the synergized model had the potential to achieve better performances than any individual model. Results indicate that blood parameters and physiological measurements might have better predictive powers when collected early, which remains to be confirmed by further studies. CONCLUSIONS Combining a diverse set of individual prediction models, the ensemble method can synergize a robust and well-performing model by choosing the most competent ones for individual patients.
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Affiliation(s)
- Honghan Wu
- Institute of Health Informatics, University College London,
London, United Kingdom
- Health Data Research UK, University College London, London,
United Kingdom
| | - Huayu Zhang
- Centre for Medical Informatics, Usher Institute, University of
Edinburgh, Edinburgh, United Kingdom
| | - Andreas Karwath
- Institute of Cancer and Genomic Sciences, University of
Birmingham, Birmingham, United Kingdom
- Health Data Research UK, University of Birmingham, Birmingham,
United Kingdom
| | - Zina Ibrahim
- Health Data Research UK, University College London, London,
United Kingdom
- Department of Biostatistics and Health Informatics, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ting Shi
- Centre for Global Health, Usher Institute, University of
Edinburgh, Edinburgh, United Kingdom
| | - Xin Zhang
- Department of Pulmonary and Critical Care Medicine, People’s Liberation Army
Joint Logistic Support Force 920th Hospital, Kunming, China
| | - Kun Wang
- Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital,
Tongji University, Shanghai, China
| | - Jiaxing Sun
- Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital,
Tongji University, Shanghai, China
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queens Medical Research Institute, University
of Edinburgh, Edinburgh, United
Kingdom
| | - Daniel Bean
- Department of Biostatistics and Health Informatics, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Victor Roth Cardoso
- Institute of Cancer and Genomic Sciences, University of
Birmingham, Birmingham, United Kingdom
- Health Data Research UK, University of Birmingham, Birmingham,
United Kingdom
| | - Kezhi Li
- Institute of Health Informatics, University College London,
London, United Kingdom
| | - James T Teo
- Department of Stroke and Neurology, King’s College Hospital NHS Foundation
Trust, London, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London,
London, United Kingdom
| | - Fang Gao-Smith
- Department of Intensive Care Medicine, Queen Elizabeth Hospital
Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research, University of Birmingham,
Birmingham, United Kingdom
| | - Tony Whitehouse
- Department of Intensive Care Medicine, Queen Elizabeth Hospital
Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research, University of Birmingham,
Birmingham, United Kingdom
| | - Tonny Veenith
- Department of Intensive Care Medicine, Queen Elizabeth Hospital
Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research, University of Birmingham,
Birmingham, United Kingdom
| | - Georgios V Gkoutos
- Institute of Cancer and Genomic Sciences, University of
Birmingham, Birmingham, United Kingdom
- Health Data Research UK, University of Birmingham, Birmingham,
United Kingdom
- Institute of Translational Medicine, University Hospitals Birmingham NHS
Foundation Trust, Birmingham, United
Kingdom
| | - Xiaodong Wu
- Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital,
Tongji University, Shanghai, China
- Department of Pulmonary and Critical Care Medicine, Taikang Tongji
Hospital, Wuhan, China
| | - Richard Dobson
- Institute of Health Informatics, University College London,
London, United Kingdom
- Health Data Research UK, University College London, London,
United Kingdom
- Department of Biostatistics and Health Informatics, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Bruce Guthrie
- Centre for Population Health Sciences, Usher Institute, University of
Edinburgh, Edinburgh, United Kingdom
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Fernandes S, Williams G, Williams E, Ehrlich K, Stone J, Finlayson N, Bradley M, Thomson RR, Akram AR, Dhaliwal K. Solitary pulmonary nodule imaging approaches and the role of optical fibre-based technologies. Eur Respir J 2021; 57:2002537. [PMID: 33060152 PMCID: PMC8174723 DOI: 10.1183/13993003.02537-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 09/29/2020] [Indexed: 12/18/2022]
Abstract
Solitary pulmonary nodules (SPNs) are a clinical challenge, given there is no single clinical sign or radiological feature that definitively identifies a benign from a malignant SPN. The early detection of lung cancer has a huge impact on survival outcome. Consequently, there is great interest in the prompt diagnosis, and treatment of malignant SPNs. Current diagnostic pathways involve endobronchial/transthoracic tissue biopsies or radiological surveillance, which can be associated with suboptimal diagnostic yield, healthcare costs and patient anxiety. Cutting-edge technologies are needed to disrupt and improve, existing care pathways. Optical fibre-based techniques, which can be delivered via the working channel of a bronchoscope or via transthoracic needle, may deliver advanced diagnostic capabilities in patients with SPNs. Optical endomicroscopy, an autofluorescence-based imaging technique, demonstrates abnormal alveolar structure in SPNs in vivo Alternative optical fingerprinting approaches, such as time-resolved fluorescence spectroscopy and fluorescence-lifetime imaging microscopy, have shown promise in discriminating lung cancer from surrounding healthy tissue. Whilst fibre-based Raman spectroscopy has enabled real-time characterisation of SPNs in vivo Fibre-based technologies have the potential to enable in situ characterisation and real-time microscopic imaging of SPNs, which could aid immediate treatment decisions in patients with SPNs. This review discusses advances in current imaging modalities for evaluating SPNs, including computed tomography (CT) and positron emission tomography-CT. It explores the emergence of optical fibre-based technologies, and discusses their potential role in patients with SPNs and suspected lung cancer.
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Affiliation(s)
- Susan Fernandes
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Gareth Williams
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Elvira Williams
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Katjana Ehrlich
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - James Stone
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Centre for Photonics and Photonic Materials, Dept of Physics, The University of Bath, Bath, UK
| | - Neil Finlayson
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Institute for Integrated Micro and Nano Systems, School of Engineering, The University of Edinburgh, Edinburgh, UK
| | - Mark Bradley
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- EaStCHEM, School of Chemistry, The University of Edinburgh, Edinburgh, UK
| | - Robert R. Thomson
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Institute of Photonics and Quantum Sciences, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Ahsan R. Akram
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
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Dorward DA, Russell CD, Um IH, Elshani M, Armstrong SD, Penrice-Randal R, Millar T, Lerpiniere CEB, Tagliavini G, Hartley CS, Randle NP, Gachanja NN, Potey PMD, Dong X, Anderson AM, Campbell VL, Duguid AJ, Al Qsous W, BouHaidar R, Baillie JK, Dhaliwal K, Wallace WA, Bellamy COC, Prost S, Smith C, Hiscox JA, Harrison DJ, Lucas CD. Tissue-Specific Immunopathology in Fatal COVID-19. Am J Respir Crit Care Med 2021; 203:192-201. [PMID: 33217246 PMCID: PMC7874430 DOI: 10.1164/rccm.202008-3265oc] [Citation(s) in RCA: 196] [Impact Index Per Article: 65.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: In life-threatening coronavirus disease (COVID-19), corticosteroids reduce mortality, suggesting that immune responses have a causal role in death. Whether this deleterious inflammation is primarily a direct reaction to the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or an independent immunopathologic process is unknown. Objectives: To determine SARS-CoV-2 organotropism and organ-specific inflammatory responses and the relationships among viral presence, inflammation, and organ injury. Methods: Tissue was acquired from 11 detailed postmortem examinations. SARS-CoV-2 organotropism was mapped by using multiplex PCR and sequencing, with cellular resolution achieved by in situ viral S (spike) protein detection. Histologic evidence of inflammation was quantified from 37 anatomic sites, and the pulmonary immune response was characterized by using multiplex immunofluorescence. Measurements and Main Results: Multiple aberrant immune responses in fatal COVID-19 were found, principally involving the lung and reticuloendothelial system, and these were not clearly topologically associated with the virus. Inflammation and organ dysfunction did not map to the tissue and cellular distribution of SARS-CoV-2 RNA and protein between or within tissues. An arteritis was identified in the lung, which was further characterized as a monocyte/myeloid-rich vasculitis, and occurred together with an influx of macrophage/monocyte-lineage cells into the pulmonary parenchyma. In addition, stereotyped abnormal reticuloendothelial responses, including excessive reactive plasmacytosis and iron-laden macrophages, were present and dissociated from viral presence in lymphoid tissues. Conclusions: Tissue-specific immunopathology occurs in COVID-19, implicating a significant component of the immune-mediated, virus-independent immunopathologic process as a primary mechanism in severe disease. Our data highlight novel immunopathologic mechanisms and validate ongoing and future efforts to therapeutically target aberrant macrophage and plasma-cell responses as well as promote pathogen tolerance in COVID-19.
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Affiliation(s)
- David A Dorward
- Centre for Inflammation Research, Queen's Medical Research Institute, and.,Department of Pathology
| | - Clark D Russell
- Centre for Inflammation Research, Queen's Medical Research Institute, and.,Regional Infectious Diseases Unit
| | - In Hwa Um
- School of Medicine, University of St. Andrews, St. Andrews, United Kingdom
| | - Mustafa Elshani
- School of Medicine, University of St. Andrews, St. Andrews, United Kingdom
| | - Stuart D Armstrong
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Rebekah Penrice-Randal
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Tracey Millar
- Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh BioQuarter, Edinburgh, United Kingdom
| | - Chris E B Lerpiniere
- Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh BioQuarter, Edinburgh, United Kingdom
| | - Giulia Tagliavini
- Centre for Inflammation Research, Queen's Medical Research Institute, and
| | - Catherine S Hartley
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Nadine P Randle
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Naomi N Gachanja
- Centre for Inflammation Research, Queen's Medical Research Institute, and
| | - Philippe M D Potey
- Centre for Inflammation Research, Queen's Medical Research Institute, and
| | - Xiaofeng Dong
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | - Wael Al Qsous
- Department of Pathology, Western General Hospital, Edinburgh, United Kingdom
| | | | - J Kenneth Baillie
- Intensive Care Unit, and.,Roslin Institute, Easter Bush Campus, University of Edinburgh, Midlothian, United Kingdom
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen's Medical Research Institute, and.,Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | | | - Christopher O C Bellamy
- Centre for Inflammation Research, Queen's Medical Research Institute, and.,Department of Pathology
| | - Sandrine Prost
- Centre for Inflammation Research, Queen's Medical Research Institute, and
| | - Colin Smith
- Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh BioQuarter, Edinburgh, United Kingdom.,Department of Pathology
| | - Julian A Hiscox
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore; and.,Health Protection Research Unit in Emerging and Zoonotic Infections, National Institute for Health Research, United Kingdom
| | - David J Harrison
- Department of Pathology.,School of Medicine, University of St. Andrews, St. Andrews, United Kingdom
| | - Christopher D Lucas
- Centre for Inflammation Research, Queen's Medical Research Institute, and.,Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Rupprechter SAE, Sloan DJ, Oosthuyzen W, Bachmann TT, Hill AT, Dhaliwal K, Templeton K, Matovu J, Sekaggya-Wiltshire C, Dear JW. MicroRNA-122 and cytokeratin-18 have potential as a biomarkers of drug-induced liver injury in European and African patients on treatment for mycobacterial infection. Br J Clin Pharmacol 2021; 87:3206-3217. [PMID: 33432705 PMCID: PMC8629110 DOI: 10.1111/bcp.14736] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 01/04/2023] Open
Abstract
Aims Patients on antituberculosis (anti‐TB) therapy are at risk of drug‐induced liver injury (DILI). MicroRNA‐122 (miR‐122) and cytokeratin‐18 (K18) are DILI biomarkers. To explore their utility in this global context, circulating miR‐122 and K18 were measured in UK and Ugandan populations on anti‐TB therapy for mycobacterial infection. Methods Healthy subjects and patients receiving anti‐TB therapy were recruited at the Royal Infirmary of Edinburgh, UK (ALISTER—ClinicalTrials.gov Identifier: NCT03211208). African patients with human immunodeficiency virus–TB coinfection were recruited at the Infectious Diseases Institute, Kampala, Uganda (SAEFRIF—NCT03982277). Serial blood samples, demographic and clinical data were collected. In ALISTER samples, MiR‐122 was quantified using polymerase chain reaction. In ALISTER and SAEFRIF samples, K18 was quantified by enzyme‐linked immunosorbent assay. Results The study had 235 participants (healthy volunteers [n = 28]; ALISTER: active TB [n = 30], latent TB [n = 88], nontuberculous mycobacterial infection [n = 25]; SAEFRIF: human immunodeficiency virus‐TB coinfection [n = 64]). In the absence of DILI, there was no difference in miR‐122 and K18 across the groups. Both miR‐122 and K18 correlated with alanine transaminase (ALT) activity (miR‐122: R = .52, 95%CI = 0.42–0.61, P < .0001. K18: R =0.42, 95%CI = 0.34–0.49, P < .0001). miR‐122 distinguished those patients with ALT>50 U/L with higher sensitivity/specificity than K18. There were 2 DILI cases: baseline ALT, 18 and 28 IU/L, peak ALT 431 and 194 IU/L; baseline K18, 58 and 219 U/L, peak K18 1247 and 3490 U/L; baseline miR‐122 4 and 17 fM, peak miR‐122 60 and 336 fM, respectively. Conclusion In patients treated with anti‐TB therapy, miR‐122 and K18 correlated with ALT and increased with DILI. Further work should determine their diagnostic and prognostic utility in this global context‐of‐use.
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Affiliation(s)
- Sarah A E Rupprechter
- Pharmacology, Therapeutics and Toxicology, Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - Derek J Sloan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Wilna Oosthuyzen
- Pharmacology, Therapeutics and Toxicology, Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - Till T Bachmann
- Chancellor's Building, Edinburgh University/Infection Medicine, Edinburgh, UK
| | - Adam T Hill
- The Queen's Medical Research Institute, Edinburgh University/Centre for Inflammation Research, Edinburgh, UK
| | - Kevin Dhaliwal
- The Queen's Medical Research Institute, Edinburgh University/Centre for Inflammation Research, Edinburgh, UK
| | - Kate Templeton
- Chancellor's Building, Edinburgh University/Infection Medicine, Edinburgh, UK
| | - Joshua Matovu
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - James W Dear
- Pharmacology, Therapeutics and Toxicology, Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
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Craven TH, Walton T, Akram AR, Scholefield E, McDonald N, Marshall ADL, Humphries DC, Mills B, Campbell TA, Bruce A, Mair J, Dear JW, Newby DE, Hill AT, Walsh TS, Haslett C, Dhaliwal K. Activated neutrophil fluorescent imaging technique for human lungs. Sci Rep 2021; 11:976. [PMID: 33441792 PMCID: PMC7806726 DOI: 10.1038/s41598-020-80083-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022] Open
Abstract
Neutrophil activation is an integral process to acute inflammation and is associated with adverse clinical sequelae. Identification of neutrophil activation in real time in the lungs of patients may permit biological stratification of patients in otherwise heterogenous cohorts typically defined by clinical criteria. No methods for identifying neutrophil activation in real time in the lungs of patients currently exist. We developed a bespoke molecular imaging probe targeting three characteristic signatures of neutrophil activation: pinocytosis, phagosomal alkalinisation, and human neutrophil elastase (HNE) activity. The probe functioned as designed in vitro and ex vivo. We evaluated optical endomicroscopy imaging of neutrophil activity using the probe in real-time at the bedside of healthy volunteers, patients with bronchiectasis, and critically unwell mechanically ventilated patients. We detected a range of imaging responses in vivo reflecting heterogeneity of condition and severity. We corroborated optical signal was due to probe function and neutrophil activation.
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Affiliation(s)
- Thomas H Craven
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
- Edinburgh Critical Care Research Group, University of Edinburgh, Edinburgh, UK.
| | - Tashfeen Walton
- School of Chemistry, EaStCHEM, University of Edinburgh, Edinburgh, UK
| | - Ahsan R Akram
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Emma Scholefield
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Neil McDonald
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Adam D L Marshall
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Duncan C Humphries
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Bethany Mills
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Thane A Campbell
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Annya Bruce
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Joanne Mair
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - James W Dear
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Adam T Hill
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Timothy S Walsh
- Edinburgh Critical Care Research Group, University of Edinburgh, Edinburgh, UK
| | - Chris Haslett
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Kevin Dhaliwal
- Translational Healthcare Technologies Group, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
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Parker HE, Perperidis A, Stone JM, Dhaliwal K, Tanner MG. Core crosstalk in ordered imaging fiber bundles. Opt Lett 2020; 45:6490-6493. [PMID: 33258850 DOI: 10.1364/ol.405764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/17/2020] [Indexed: 06/12/2023]
Abstract
Coherent fiber bundles are used widely for imaging. Commonly, disordered arrays of randomly sized fiber cores avoid proximity between like-cores, which would otherwise result in increased core crosstalk and a negative impact on imaging. Recently, stack-and-draw fiber manufacture techniques have been used to produce fibers with a controlled core layout to minimize core crosstalk. However, one must take manufacturing considerations into account during stack-and-draw fiber design in order to avoid impractical or unachievable fabrication. This comes with a set of practical compromises, such as using only a small number of different core sizes. Through characterization of core crosstalk patterns, this Letter aims to aid the understanding of crosstalk limitations imposed by such compromises in the core layout made for ease of fabrication.
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Gunasekaran R, Lalitha P, Megia-Fernandez A, Bradley M, Williams RL, Dhaliwal K, Prajna NV, Mills B. Exploratory Use of Fluorescent SmartProbes for the Rapid Detection of Microbial Isolates Causing Corneal Ulcer. Am J Ophthalmol 2020; 219:341-350. [PMID: 32574778 DOI: 10.1016/j.ajo.2020.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To explore the use of optical SmartProbes for the rapid evaluation of corneal scrapes from patients with suspected microbial keratitis, as a clinical alternative to Gram stain. DESIGN Experimental study with evaluation of a diagnostic technology. METHODS Corneal scrapes were collected from 267 patients presenting with microbial keratitis at a referral cornea clinic in South India. Corneal scrapes were flooded with SmartProbes (BAC One or BAC Two) and evaluated by fluorescence microscopy (without the need for sample washing or further processing). The SmartProbe-labeled samples were scored as bacteria/fungi/none (BAC One) or gram-negative bacteria/none (BAC Two) and compared to Gram stain results. RESULTS Compared to Gram stain, BAC One demonstrated sensitivity and specificity of 80.0% and 87.5%, respectively, positive and negative predictive values (PPV, NPV) of 93.8% and 65.1%, and an accuracy of 82.2. BAC Two demonstrated sensitivity and specificity of 93.3% and 84.8%, respectively, an NPV of 99.2%, and an accuracy of 85.6%. When the corresponding culture results were compared to the Gram stain result, the sensitivity and specificity were 73.4% and 70.7%, the PPV and NPVs were 86.5% and 51.0%, and overall accuracy was 72.6. CONCLUSIONS Fluorescent SmartProbes offer a comparative method to Gram stain for delineating gram-positive or gram-negative bacteria or fungi within corneal scrapes. We demonstrate equivalent or higher sensitivity, specificity, PPV and NPVs, and accuracy than culture to Gram stain. Our approach has scope for point-of-care clinical application to aid in the diagnosis of microbial keratitis.
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Affiliation(s)
| | - Prajna Lalitha
- Departments of Ocular Microbiology, Aravind Eye Hospital, Madurai, India
| | | | - Mark Bradley
- EaStChem, School of Chemistry, University of Edinburgh, Edinburgh, United Kingdom
| | - Rachel L Williams
- Department of Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Bethany Mills
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.
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Titmarsh HF, O'Connor R, Dhaliwal K, Akram AR. Corrigendum: The Emerging Role of the c-MET-HGF Axis in Non-small Cell Lung Cancer Tumor Immunology and Immunotherapy. Front Oncol 2020; 10:1516. [PMID: 32974185 PMCID: PMC7471926 DOI: 10.3389/fonc.2020.01516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fonc.2020.00054.].
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Affiliation(s)
- Helen F Titmarsh
- EPSRC and MRC CDT in Optical Medical Imaging, Universities of Edinburgh and Strathclyde, Edinburgh, United Kingdom.,Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh Bioquarter, Edinburgh, United Kingdom
| | - Richard O'Connor
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh Bioquarter, Edinburgh, United Kingdom
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh Bioquarter, Edinburgh, United Kingdom
| | - Ahsan R Akram
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
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