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Mullins KE, Seneviratne C, Shetty AC, Jiang F, Christenson R, Stass S. Proof of concept: Detection of cell free RNA from EDTA plasma in patients with lung cancer and non-cancer patients. Clin Biochem 2023; 118:110583. [PMID: 37182637 DOI: 10.1016/j.clinbiochem.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Nucleic acid sequencing technologies have advanced significantly in recent years, thereby allowing for the development of liquid biopsies as new means to detect cancer biomarkers and cancer heterogenicity. Most of the assays available, clinically, focus on cell free DNA (cfDNA), however, cell free RNA (cfRNA) is also present. cfRNA has the potential to complement and improve cancer detection especially in cancers like lung cancer, which are usually only diagnosed at late stages and therefore have poor long-term survival outcomes. METHODS Remnant EDTA plasma was collected from lung cancer patients and non-cancer individuals at the University of Maryland Medical Center. RNA was extracted and processed for next generation sequencing with a tagmentation-based library preparation approach. RESULTS cfRNA was successfully extracted and sequenced from 52 EDTA-treated plasma samples with volumes as low as 1.5 mL. This quantity was sufficient to prepare libraries with the length of libraries averaging from 264 bp to 381 bp and resulted in over 2.2 to 3.6 million total sequence reads respectively. Sequential dilution of cfRNA samples from healthy individuals indicated that the starting cfRNA concentration influenced the detection of differentially expressed genes. CONCLUSIONS This proof-of-concept study provides a framework for screening cfRNA for identifying biomarkers for early detection of lung cancer (and other cancers), using minimal amounts of samples (1.5 mL) from standard EDTA 3-mL collection tubes routinely used for patient care. Further studies in large populations are required to establish limit of detection and other parameters including precision, accuracy, sensitivity, and specificity, to standardize this method.
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Affiliation(s)
- Kristin E Mullins
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA; Laboratories of Pathology, University of Maryland Medical Center, Baltimore, MD, USA.
| | - Chamindi Seneviratne
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; The Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amol C Shetty
- The Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Feng Jiang
- Laboratories of Pathology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Robert Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA; Laboratories of Pathology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Sanford Stass
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA; Laboratories of Pathology, University of Maryland Medical Center, Baltimore, MD, USA
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Klein MN, Wang EW, Zimand P, Beauchamp H, Donis C, Ward MD, Martinez-Hernandez A, Tabatabai A, Baddley JW, Bloch EM, Mullins KE, Fontaine MJ. Kinetics of SARS-CoV-2 antibody responses pre-COVID-19 and post-COVID-19 convalescent plasma transfusion in patients with severe respiratory failure: an observational case-control study. J Clin Pathol 2022; 75:564-571. [PMID: 33893156 PMCID: PMC8072701 DOI: 10.1136/jclinpath-2020-207356] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/14/2021] [Accepted: 03/21/2021] [Indexed: 12/23/2022]
Abstract
AIMS While the SARS-CoV-2 pandemic may be contained through vaccination, transfusion of convalescent plasma (CCP) from individuals who recovered from COVID-19 (CCP) is considered an alternative treatment. We investigate if CCP transfusion in patients with severe respiratory failure increases plasma titres of SARS-CoV-2 antibodies and improves clinical outcomes. METHODS Patients with COVID-19 (n=34) were consented for CCP transfusion and serial blood draws pretransfusion and post-transfusion. Plasma SARS-CoV-2 antireceptor binding domain (RBD) IgG and IgM titres were measured by ELISA serially, and compared with serial plasma titre levels from control patients (n=68). The primary outcome was survival at 30 days, and secondary outcomes were length of ventilator and/or extracorporeal membrane oxygenation (ECMO) support, length of stay (LOS) in the hospital and in the intensive care unit (ICU). Outcomes were compared with matched control patients (n=34). Kinetics of antibodies and clinical outcomes were compared using LOess regression and ORs, respectively. RESULTS Prior to CCP transfusion, 74% of patients were anti-RBD seropositive for IgG (median 1:3200), and 81% were anti-RBD IgM seropositive (median 1:320), while 16% were seronegative. The kinetics of antibody titres in CCP recipients were similar to controls. CCP recipients presented with similar survival, duration on ventilatory and/or ECMO support, as well as ICU and hospital LOS compared with controls. CONCLUSIONS CCP transfusion did not increase the kinetics of SARS-CoV2 antibodies and did not result in improved clinical outcomes in patients with COVID-19 with severe respiratory failure, suggesting that CCP may not be indicated in this category of patients.
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Affiliation(s)
- Matthew N Klein
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth Wenqian Wang
- Department of Medicine, University of Maryland Saint Joseph Medical Center, Baltimore, Maryland, USA
| | - Paul Zimand
- Department of Medicine, University of Maryland Medical System, Baltimore, Maryland, USA
| | - Heather Beauchamp
- University of Maryland Upper Chesapeake Medical Center, Bel Air, Maryland, USA
| | - Caitlin Donis
- University of Maryland Upper Chesapeake Medical Center, Bel Air, Maryland, USA
| | - Matthew D Ward
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Ali Tabatabai
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John W Baddley
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kristin E Mullins
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Magali J Fontaine
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Ward MD, Mullins KE, Pickett E, Merrill V, Ruiz M, Rebuck H, Duh SH, Christenson RH. Performance of 4 Automated SARS-CoV-2 Serology Assay Platforms in a Large Cohort Including Susceptible COVID-19-Negative and COVID-19-Positive Patients. J Appl Lab Med 2021; 6:942-952. [PMID: 33693808 PMCID: PMC7989439 DOI: 10.1093/jalm/jfab014] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/26/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Anti-SARS-CoV-2 serological responses may have a vital role in controlling the spread of the disease. However, the comparative performance of automated serological assays has not been determined in susceptible patients with significant comorbidities. METHODS In this study, we used large numbers of samples from patients who were negative (n = 2030) or positive (n = 112) for COVID-19 to compare the performance of 4 serological assay platforms: Siemens Healthineers Atellica IM Analyzer, Siemens Healthineers Dimension EXL Systems, Abbott ARCHITECT, and Roche cobas. RESULTS All 4 serology assay platforms exhibited comparable negative percentage of agreement with negative COVID-19 status ranging from 99.2% to 99.7% and positive percentage of agreement from 84.8% to 87.5% with positive real-time reverse transcriptase PCR results. Of the 2142 total samples, only 38 samples (1.8%) yielded discordant results on one or more platforms. However, only 1.1% (23/2030) of results from the COVID-19-negative cohort were discordant. whereas discordance was 10-fold higher for the COVID-19-positive cohort, at 11.3% (15/112). Of the total 38 discordant results, 34 were discordant on only one platform. CONCLUSIONS Serology assay performance was comparable across the 4 platforms assessed in a large population of patients who were COVID-19 negative with relevant comorbidities. The pattern of discordance shows that samples were discordant on a single assay platform, and the discordance rate was 10-fold higher in the population that was COVID-19 positive.
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Affiliation(s)
- Matthew D Ward
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristin E Mullins
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Elizabeth Pickett
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - VeRonika Merrill
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mark Ruiz
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Heather Rebuck
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Show-Hong Duh
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
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Affiliation(s)
- Palak Shah
- Cardiovascular Genomics Center, Heart Failure and Transplantation (P.S.), Inova Heart and Vascular Institute, Falls Church, VA
| | | | - Kristin E Mullins
- Department of Pathology, University of Maryland School of Medicine, Baltimore (K.E.M.)
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Christenson RH, Duh SH, Mullins KE, LeClair MM, Grigorov IL, Peacock WF. Analytical and clinical characterization of a novel high-sensitivity cardiac troponin assay in a United States population. Clin Biochem 2020; 83:28-36. [PMID: 32485169 DOI: 10.1016/j.clinbiochem.2020.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/13/2020] [Accepted: 05/26/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiac troponin (cTn) is the keystone for diagnosis of acute myocardial infarction (AMI). We examined the analytical and clinical diagnostic characteristics of the ACCESS hsTnI assay in a United States (US) population. METHODS All measurements and studies were conducted using a lithium heparin matrix. Sex-specific 99th percentile upper reference limits (URLs) were determined for 1089 healthy women (54.6%) and men using non-parametric statistics. High-sensitivity (hs) performance was assessed to determine if the total CV was ≤10% at sex-specific URLs, and if ≥50% of cTnI values for each sex exceeded the assay's limit of detection (LoD). Precision, analytical measurement range, high-dose hook effect, and endogenous/exogenous interferences were examined with CLSI guidance. Clinical characterization included serial sampling of 1854 suspected AMI subjects presenting to 14 US Emergency Departments. AMI was adjudicated by a panel of expert cardiologists. The study's only exclusion was end stage renal disease. RESULTS 99th percentile URLs were 11.6-, 19.8- and 17.5-ng/L for respective female, male and all-subject populations. Total %CV was <8% from 6.8 to 19,000 ng/L, and <6% at sex-specific 99th percentiles; ≥99% of ACCESS hsTnI values for each sex exceeded the LoD. No high-dose hook effect or endogenous/exogenous interferences were identified. A comparison of Baseline samples collected at ≤1 h and any-time after presentation, found 4% lower sensitivity for AMI than with earlier sampling. For 1-9 h post presentation, the sensitivity was >90%, specificity >85%; and negative and positive predictive value were ≥99% and >60%, respectively. CONCLUSION Analytical and clinical performance of the ACCESS hsTnI assay meets the definition of a hs cTn method. The ACCESS hsTnI assay has good precision over a wide range, no significant interferences, and sensitivity >90% and NPV ≥99%. Performance is appropriate for aiding in AMI diagnosis.
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Affiliation(s)
- Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Show-Hong Duh
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kristin E Mullins
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Margot M LeClair
- Beckman Coulter Inc., 1000 Lake Hazeltine Dr, Chaska, MN, United States
| | - Ilya L Grigorov
- Beckman Coulter Inc., 1000 Lake Hazeltine Dr, Chaska, MN, United States
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
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Mullins KE, Maina AN, Krueger L, Jiang J, Cummings R, Drusys A, Williams G, Dhillon M, Richards AL. Rickettsial Infections among Cats and Cat Fleas in Riverside County, California. Am J Trop Med Hyg 2018; 99:291-296. [PMID: 29869607 DOI: 10.4269/ajtmh.17-0706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Presently, few studies have investigated the role of domestic cats (Felis catus) in the recrudescence of flea-borne rickettsioses in California and the southern United States. In this study, we aimed to investigate the presence of Rickettsia typhi or Rickettisa felis in domestic cats (F. catus) and the fleas (primarily Ctenocephalides felis, the cat flea) associated with these cats in Riverside County, California. Thirty cats and 64 pools of fleas collected from these cats were investigated for rickettsial infections. Three cats and 17 flea pools (from 10 cats) tested positive for rickettsial infections. polymerase chain reaction and DNA sequencing indicated that one of the cats was positive for R. felis infections, whereas two were positive for Candidatus Rickettsia senegalensis infection. In addition, 12 of the flea pools were positive for R. felis, whereas five were positive for Ca. R. senegalensis. By contrast, no cats or their associated fleas tested positive for R. typhi. Finally, eight sera from these cats contained spotted fever group Rickettsia (SFGR) antibodies. The detection of R. felis and SFGR antibodies and the lack of R. typhi and TGR antibodies support R. felis as the main rickettsial species infecting cat fleas. The detection of Ca. R. senegalensis in both fleas and cats also provides additional evidence that cats and their associated fleas are infected with other R. felis-like organisms highlighting the potential risk for human infections with R. felis or R. felis-like organisms.
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Affiliation(s)
- Kristin E Mullins
- Naval Medical Research Center, Silver Spring, Maryland.,University of Maryland School of Medicine, Baltimore, Maryland
| | - Alice N Maina
- Naval Medical Research Center, Silver Spring, Maryland
| | - Laura Krueger
- Orange County Mosquito and Vector Control District, Garden Grove, California
| | - Ju Jiang
- Naval Medical Research Center, Silver Spring, Maryland
| | - Robert Cummings
- Orange County Mosquito and Vector Control District, Garden Grove, California
| | - Allan Drusys
- Riverside County Department of Animal Services, Riverside, California
| | - Greg Williams
- Northwest Mosquito and Vector Control District, Corona, California
| | - Major Dhillon
- Northwest Mosquito and Vector Control District, Corona, California
| | - Allen L Richards
- Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Naval Medical Research Center, Silver Spring, Maryland
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Mullins KE, Hang J, Clifford RJ, Onmus-Leone F, Yang Y, Jiang J, Leguia M, Kasper MR, Maguina C, Lesho EP, Jarman RG, Richards A, Blazes D. Whole-Genome Analysis of Bartonella ancashensis, a Novel Pathogen Causing Verruga Peruana, Rural Ancash Region, Peru. Emerg Infect Dis 2018; 23:430-438. [PMID: 28221130 PMCID: PMC5382735 DOI: 10.3201/eid2303.161476] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The genus Bartonella contains >40 species, and an increasing number of these Bartonella species are being implicated in human disease. One such pathogen is Bartonella ancashensis, which was isolated in blood samples from 2 patients living in Caraz, Peru, during a clinical trial of treatment for bartonellosis. Three B. ancashensis strains were analyzed by using whole-genome restriction mapping and high-throughput pyrosequencing. Genome-wide comparative analysis of Bartonella species showed that B. ancashensis has features seen in modern and ancient lineages of Bartonella species and is more related to B. bacilliformis. The divergence between B. ancashensis and B. bacilliformis is much greater than what is seen between known Bartonella genetic lineages. In addition, B. ancashensis contains type IV secretion system proteins, which are not present in B. bacilliformis. Whole-genome analysis indicates that B. ancashensis might represent a distinct Bartonella lineage phylogenetically related to B. bacilliformis.
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Mullins KE, Hang J, Jiang J, Leguia M, Kasper MR, Ventosilla P, Maguiña C, Jarman RG, Blazes D, Richards AL. Description of Bartonella ancashensis sp. nov., isolated from the blood of two patients with verruga peruana. Int J Syst Evol Microbiol 2015; 65:3339-3343. [DOI: 10.1099/ijsem.0.000416] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Three novel isolates of the genus Bartonella were recovered from the blood of two patients enrolled in a clinical trial for the treatment of chronic stage Bartonella bacilliformis infection (verruga peruana) in Caraz, Ancash, Peru. The isolates were initially characterized by sequencing a fragment of the gltA gene, and found to be disparate from B. bacilliformis. The isolates were further characterized using phenotypic and genotypic methods, and found to be genetically identical to each other for the genes assessed, but distinct from any known species of the genus Bartonella, including the closest relative B. bacilliformis. Other characteristics of the isolates, including their morphology, microscopic and biochemical properties, and growth patterns, were consistent with members of the genus Bartonella. Based on these results, we conclude that these three isolates are members of a novel species of the genus Bartonella for which we propose the name Bartonella ancashensis sp. nov. (type strain 20.00T = ATCC BAA-2694T = DSM 29364T).
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Affiliation(s)
- Kristin E. Mullins
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- U.S. Naval Medical Research Center, Silver Spring, MD 20910, USA
| | - Jun Hang
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Ju Jiang
- U.S. Naval Medical Research Center, Silver Spring, MD 20910, USA
| | | | | | - Palmira Ventosilla
- Instituto de Medicina Tropical Alexander von Humboldt-Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ciro Maguiña
- Instituto de Medicina Tropical Alexander von Humboldt-Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Richard G. Jarman
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - David Blazes
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Allen L. Richards
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- U.S. Naval Medical Research Center, Silver Spring, MD 20910, USA
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