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Caetano CCS, Azamor T, Meyer NM, Onwubueke C, Calabrese CM, Calabrese LH, Visperas A, Piuzzi NS, Husni ME, Foo SS, Chen W. Mechanistic insights into bone remodelling dysregulation by human viral pathogens. Nat Microbiol 2024; 9:322-335. [PMID: 38316931 PMCID: PMC11045166 DOI: 10.1038/s41564-023-01586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/12/2023] [Indexed: 02/07/2024]
Abstract
Bone-related diseases (osteopathologies) associated with human virus infections have increased around the globe. Recent findings have highlighted the intricate interplay between viral infection, the host immune system and the bone remodelling process. Viral infections can disrupt bone homeostasis, contributing to conditions such as arthritis and soft tissue calcifications. Osteopathologies can occur after arbovirus infections such as chikungunya virus, dengue virus and Zika virus, as well as respiratory viruses, such as severe acute respiratory syndrome coronavirus 2 and enteroviruses such as Coxsackievirus B. Here we explore how human viruses dysregulate bone homeostasis, detailing viral factors, molecular mechanisms, host immune response changes and bone remodelling that ultimately result in osteopathologies. We highlight model systems and technologies to advance mechanistic understanding of viral-mediated bone alterations. Finally, we propose potential prophylactic and therapeutic strategies, introduce 'osteovirology' as a research field highlighting the underestimated roles of viruses in bone-related diseases, and discuss research avenues for further investigation.
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Affiliation(s)
- Camila C S Caetano
- Infection Biology Program, Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tamiris Azamor
- Infection Biology Program, Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nikki M Meyer
- Infection Biology Program, Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chineme Onwubueke
- Infection Biology Program, Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Cassandra M Calabrese
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Leonard H Calabrese
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Anabelle Visperas
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - M Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Suan-Sin Foo
- Infection Biology Program, Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Weiqiang Chen
- Infection Biology Program, Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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2
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Winchester NE, Panigrahi S, Haria A, Chakraborty A, Su X, Chen B, Morris SR, Clagett BM, Juchnowski SM, Yadavalli R, Villinger F, Paiardini M, Harth K, Kashyap VS, Calabrese LH, Margolis L, Sieg SF, Shive CL, Gianella S, Funderburg NT, Zidar DA, Lederman MM, Freeman ML. Cytomegalovirus Infection Facilitates the Costimulation of CD57+CD28- CD8 T Cells in HIV Infection and Atherosclerosis via the CD2-LFA-3 Axis. J Immunol 2024; 212:245-257. [PMID: 38047900 PMCID: PMC10843654 DOI: 10.4049/jimmunol.2300267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023]
Abstract
CD8 T cells are emerging as important mediators in atherosclerosis and cardiovascular disease (CVD). Immune activation may play a particular role in people with HIV (PWH) who are at an increased risk of CVD, even after controlling for known CVD risk factors. Latent CMV infection is associated with increased CVD risk for both PWH and people without HIV, and human CMV-specific CD4 and CD8 T cells are enriched for an immunosenescent phenotype. We previously showed that CMV coinfection in PWH promotes vascular homing and activation of inflammatory CD4 T cells through the CD2-LFA-3 axis. However, the role of CD2/LFA3 costimulation of CD8 T cells in PWH with CMV has yet to be described. In the present study, we demonstrate that CD2 expression on CX3CR1+CD57+CD28- inflammescent CD8 T cells is increased on cells from CMV-seropositive PWH. In vitro CD2/LFA-3 costimulation enhances TCR-mediated activation of these inflammatory CD8 memory T cells. Finally, we show that LFA-3 is highly expressed in aortas of SIV-infected rhesus macaques and in atherosclerotic plaques of people without HIV. Our findings are consistent with a model in which CMV infection enhances CD2 expression on highly proinflammatory CD8 T cells that can then be stimulated by LFA-3 expressed in the vasculature, even in the absence of CD28 costimulation. This model, in which CMV infection exacerbates toxic cytokine and granzyme production by CD8 T cells within the vasculature, highlights a potential therapeutic target in atherosclerosis development and progression, especially for PWH.
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Affiliation(s)
- Nicole E. Winchester
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| | - Soumya Panigrahi
- Rustbelt Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Anokhi Haria
- Rustbelt Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Archeesha Chakraborty
- Rustbelt Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Xi Su
- Rustbelt Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Bonnie Chen
- Rustbelt Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Stephen R. Morris
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Brian M. Clagett
- Rustbelt Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Steven M. Juchnowski
- Division of Cardiology, Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Raghavendra Yadavalli
- Rustbelt Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Francois Villinger
- New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, LA, USA
| | - Mirko Paiardini
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Karem Harth
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Vikram S. Kashyap
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Leonard H. Calabrese
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Leonid Margolis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Scott F. Sieg
- Rustbelt Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Carey L. Shive
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Nicholas T. Funderburg
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
| | - David A. Zidar
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Michael M. Lederman
- Rustbelt Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Michael L. Freeman
- Rustbelt Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Abstract
Long COVID is a diagnostic label currently given to those suffering from a poorly understood state of incomplete recovery or who have development of a myriad of medically unexplained symptoms occurring in the wake of infection with SARS CoV-2 that is both poorly understood and controversial. Many of the features of one of the most common clinical endotypes of Long COVID are shared by a condition well familiar to all rheumatologists and one with a large body of epidemiologic, clinical and basic research accrued over many decades namely the syndrome of fibromyalgia. Some have recently suggested that Long COVID may merely be a new name for fibromyalgia and that this diagnosis is indeed the condition that many or most may be suffering from as a post infectious sequela. In this Viewpoint we argue that while the parallels between the clinical syndrome experienced by many of those currently labeled as Long COVID and fibromyalgia are strong we should be not too quick to rename the disorder. We further argue that relabeling Long COVID as fibromyalgia is clinically reductionistic and any such relabeling may be attended by harm in both the design and execution of a future research agenda as well to patients who may be inadvertently and unfortunately pejoritised by such labeling. We further explore the parallels and differences between Long COVID and fibromyalgia and outline areas of needed future research and care.
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Affiliation(s)
| | - Philip J Mease
- Rheumatology Research, Swedish Medical Center, Seattle, Washington, USA
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Funderburg NT, Shive CL, Chen Z, Tatsuoka C, Bowman ER, Longenecker CT, McComsey GA, Clagett BM, Dorazio D, Freeman ML, Sieg SF, Moisi D, Anthony DD, Jacobson JM, Stein SL, Calabrese LH, Landay A, Flexner C, Crawford KW, Capparelli EV, Rodriguez B, Lederman MM. Interleukin 6 Blockade With Tocilizumab Diminishes Indices of Inflammation That Are Linked to Mortality in Treated Human Immunodeficiency Virus Infection. Clin Infect Dis 2023; 77:272-279. [PMID: 37011013 PMCID: PMC10371305 DOI: 10.1093/cid/ciad199] [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: 11/10/2022] [Revised: 02/23/2023] [Accepted: 03/31/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND People with human immunodeficiency virus (PWH) are at increased risk for comorbidities, and plasma interleukin 6 (IL-6) levels are among the most robust predictors of these outcomes. Tocilizumab (TCZ) blocks the receptor for IL-6, inhibiting functions of this cytokine. METHODS This was a 40-week, placebo-controlled, crossover trial (NCT02049437) where PWH on stable antiretroviral therapy (ART) were randomized to receive 3 monthly doses of TCZ or matching placebo intravenously. Following a 10-week treatment period and a 12-week washout, participants were switched to the opposite treatment. The primary endpoints were safety and posttreatment levels of C-reactive protein (CRP) and CD4+ T-cell cycling. Secondary endpoints included changes in inflammatory indices and lipid levels. RESULTS There were 9 treatment-related toxicities of grade 2 or greater during TCZ administration (mostly neutropenia) and 2 during placebo administration. Thirty-one of 34 participants completed the study and were included in a modified intent-to-treat analysis. TCZ reduced levels of CRP (median decrease, 1819.9 ng/mL, P < .0001; effect size, 0.87) and reduced inflammatory markers in PWH, including D-dimer, soluble CD14, and tumor necrosis factor receptors. T-cell cycling tended to decrease in all maturation subsets after TCZ administration, but was only significant among naive CD4 T cells. Lipid levels, including lipid classes that have been related to cardiovascular disease risk, increased during TCZ treatment. CONCLUSIONS TCZ is safe and decreases inflammation in PWH; IL-6 is a key driver of the inflammatory environment that predicts morbidity and mortality in ART-treated PWH. The clinical significance of lipid elevations during TCZ treatment requires further study. Clinical Trials Registration. NCT02049437.
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Affiliation(s)
- Nicholas T Funderburg
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, Ohio, USA
| | - Carey L Shive
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Zhengyi Chen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Curtis Tatsuoka
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Emily R Bowman
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, Ohio, USA
| | - Chris T Longenecker
- Department of Medicine and Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Grace A McComsey
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Pediatrics, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Brian M Clagett
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Dominic Dorazio
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Michael L Freeman
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Scott F Sieg
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Daniela Moisi
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Donald D Anthony
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Rheumatology Section, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Jeffrey M Jacobson
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sharon L Stein
- Department of Surgery, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Alan Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Charles Flexner
- Divisions of Clinical Pharmacology and Infectious Diseases, School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keith W Crawford
- Therapeutic Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Edmund V Capparelli
- Clinical Pediatrics and Pharmacy, University of California, San Diego, La Jolla, California, USA
| | - Benigno Rodriguez
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Michael M Lederman
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Calabrese LH. Long COVID in inflammatory rheumatic diseases-what's in a name? Lancet Rheumatol 2023; 5:S2665-9913(23)00134-0. [PMID: 37360003 PMCID: PMC10230594 DOI: 10.1016/s2665-9913(23)00134-0] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Affiliation(s)
- Leonard H Calabrese
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
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Shimoyama T, Uchino K, Calabrese LH, Hajj-Ali RA. Clinical characteristics, brain magnetic resonance imaging findings and diagnostic approach of the primary central nervous system vasculitis according to angiographic classification. Clin Exp Rheumatol 2023; 41:800-811. [PMID: 37073640 DOI: 10.55563/clinexprheumatol/a9886f] [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] [Received: 04/25/2022] [Accepted: 07/18/2022] [Indexed: 04/20/2023]
Abstract
OBJECTIVES To determine the diagnostic accuracy for high-resolution vessel wall image (HR-VWI) and brain biopsy according to angiographical classification in patients with primary central nervous system vasculitis (PCNSV). METHODS We extracted the patients with PCNSV who underwent the complete brain MRI protocol and cerebral vascular image from Cleveland Clinic prospective CNS vasculopathy Bioregistry. The large-medium vessel variant (LMVV) was defined as patients with cerebral vasculature indicating vasculitis in proximal or middle arterial segments, whereas vessel involvements in smaller distal branches or normal angiography were considered as the small vessel variant (SVV). We compared clinical demographics, magnetic resonance imaging (MRI) findings, and diagnostic approaches between two variants. RESULTS In this case-control study that included 34 PCNSV patients, the LMVV group comprised a total of 11 patients (32.4%), and 23 patients (67.6%) were classified as the SVV group. The LMVV had more strong/concentric vessel wall enhancement on HR-VWI (LMVV: 90% (9/10) vs. SVV: 7.1% (1/14), p<0.001). By contrast, meningeal/parenchymal contrast enhancement lesion was more frequently observed in the SVV group (p=0.006). The majority of SVV was diagnosed by brain biopsy (SVV: 78.3% vs. LMVV: 30.8%, p=0.022). The diagnostic accuracy of the brain biopsy was 100% (18/18) in SVV and 57.1% (4/7) in LMVV, respectively (p=0.015). CONCLUSIONS Diagnostic approach for PCNSV differs concerning the affected vessel size. HR-VWI is a useful imaging modality for the diagnosis of LMVV. Brain biopsy remains the gold standard for proving PCNSV with SVV but is still positive in almost one-third of LMVV.
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Affiliation(s)
- Takashi Shimoyama
- Cerebrovascular Centre, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ken Uchino
- Cerebrovascular Centre, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Leonard H Calabrese
- Department of Rheumatic and Immunologic Disease, Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rula A Hajj-Ali
- Department of Rheumatic and Immunologic Disease, Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, OH, USA.
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Calabrese LH, Calabrese CM. Long COVID: defining the role of rheumatology in care and research. Lancet Rheumatol 2022; 4:e812-e814. [PMID: 36211989 PMCID: PMC9529216 DOI: 10.1016/s2665-9913(22)00266-1] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Leonard H Calabrese
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
| | - Cassandra M Calabrese
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
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8
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Graham B, Jin Y, Bazeley P, Husni E, Calabrese LH. Online, low-volume meditation does not alter immune-related biomarkers. Brain Behav Immun Health 2022; 26:100531. [PMID: 36267832 PMCID: PMC9576541 DOI: 10.1016/j.bbih.2022.100531] [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: 05/26/2022] [Revised: 09/08/2022] [Accepted: 10/01/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives Prior studies of mindfulness meditation have demonstrated anti-inflammatory and immunoregulatory effects but whether meditation courses delivered online can exert similar effects is poorly understood. Barriers to large scale implementation of traditional mindfulness meditation programs has created an increased interest in the effect of less time- and resource-intensive online meditation courses. The purpose of this study was to determine whether a 6-week online mindfulness program with low time demands on nurses would lead to changes in gene expression, cytokine profiles, telomerase activity, and cortisol profiles. Methods This was a randomized, parallel pilot study comparing an online mindfulness-based stress management program to an active control group from December 2018 to May 2019. Healthy nurses with above average levels of perceived stress were randomized to receive a 6-week online mindfulness-based stress management program including ≥5 min daily meditation practice or listen to relaxing music for ≥5 min daily as the control arm. Blood samples were collected at baseline and after 6 weeks, and various self-reported measures of stress, physical and emotional health were collected at baseline, after 6 weeks, and after 12 weeks. Whole transcriptome mRNA sequencing of whole blood at baseline and after 6 weeks was performed along with measurement of plasma IL-6, IL-8, IL-10, TNF-α, and IFN-γ. Peripheral blood mononuclear cells were isolated, and telomerase activity was measured. Diurnal salivary cortisol profiles were assessed at baseline and after 6 weeks. The primary outcome was change over time in a pre-determined set of 53 genes representative of the immune-related changes seen with stress, which was analyzed using a mixed linear model. Secondary outcomes included all other self-reported measures and biomarkers mentioned above. Results A total of 61 nurses were randomized, with 52 having sufficient data to include in the final analysis. After 6 weeks, nurses in the control group reported significant reductions in stress as measured by the Perceived Stress Scale while those in the mindfulness group did not. However, after 12 weeks, the mindfulness group also showed a significant reduction in stress. When compared to the control group, no significant changes in RNA gene expression or any other biomarkers were observed in the nurses who participated in the mindfulness program. Conclusions Our study found that this brief online mindfulness-based intervention was effective in reducing stress in nurses, albeit with a delayed effect compared to listening to relaxing music. Regarding immunoregulatory effects, there were no significant differences between treatment and control groups in transcriptomic or other tested biomarkers of immune function. This study provides evidence for a floor effect of mindfulness on transcriptional and circulating biomarkers of immune function.
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Key Words
- CRP, C-reactive protein
- CTRA, conserved ranscriptional response to adversity
- IFN-γ, interferon gamma
- IL-10, interleukin-10
- IL-6, interleukin-6
- IL-8, interleukin-8
- IRF-1, interferon regulatory factor 1
- NF-κB, nuclear factor kappa B
- PROMIS, patient-reported outcomes measurement information system
- PSS, perceived stress scale
- TNF-α, tumor necrosis factor alpha
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Affiliation(s)
- Brett Graham
- Cleveland Clinic Lerner College of Medicine, 9501 Euclid Ave./EC10, Cleveland, OH, 44195, USA,Corresponding author. Vanderbilt University Medical Center, Department of Neurology, 1161 21st Avenue South, A-0118 Medical Center North, Nashville, TN, 37232, USA.
| | - Yuxuan Jin
- Cleveland Clinic Lerner Research Institute, Department of Quantitative Health Sciences, 9500 Euclid Ave. Cleveland, OH, 44195, USA
| | - Peter Bazeley
- Cleveland Clinic Lerner Research Institute, Department of Quantitative Health Sciences, 9500 Euclid Ave. Cleveland, OH, 44195, USA
| | - Elaine Husni
- Cleveland Clinic R.J. Fasenmyer Center for Clinical Immunology, 9500 Euclid Ave. Cleveland, OH, 44195, USA
| | - Leonard H. Calabrese
- Cleveland Clinic Orthopaedic & Rheumatologic Institute, 9500 Euclid Ave. Cleveland, OH, 44195, USA
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9
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Calabrese LH, Calabrese CM, Kirchner E, Winthrop K. The evolving role of the rheumatology practitioner in the care of immunocompromised patients in the COVID-19 era. Arthritis Rheumatol 2022; 74:1868-1871. [PMID: 36017821 PMCID: PMC10100242 DOI: 10.1002/art.42334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Leonard H Calabrese
- Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Cleveland, Ohio
| | - Cassandra M Calabrese
- Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Cleveland, Ohio
| | - Elizabeth Kirchner
- Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Cleveland, Ohio
| | - Kevin Winthrop
- Division of Infectious Diseases, Oregon Health & Science University, Portland, OR
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10
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Freeman ML, Clagett BM, Moisi D, Yeh E, Morris CD, Ryu A, Rodriguez B, Stein JH, Deeks SG, Currier JS, Hsue PY, Anthony DD, Calabrese LH, Ribaudo HJ, Lederman MM. Methotrexate Inhibits T Cell Proliferation but Not Inflammatory Cytokine Expression to Modulate Immunity in People Living With HIV. Front Immunol 2022; 13:924718. [PMID: 35967371 PMCID: PMC9374564 DOI: 10.3389/fimmu.2022.924718] [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: 04/21/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
Inflammation associated with increased risk of comorbidities persists in people living with HIV (PWH) on combination antiretroviral therapy (ART). A recent placebo-controlled trial of low-dose methotrexate (MTX) in PWH found that numbers of total CD4 and CD8 T cells decreased in the low-dose MTX arm. In this report we analyzed T cell phenotypes and additional plasma inflammatory indices in samples from the trial. We found that cycling (Ki67+) T cells lacking Bcl-2 were reduced by MTX but plasma inflammatory cytokines were largely unaffected. In a series of in vitro experiments to further investigate the mechanisms of MTX activity, we found that MTX did not inhibit effector cytokine production but inhibited T cell proliferation downstream of mTOR activation, mitochondrial function, and cell cycle entry. This inhibitory effect was reversible with folinic acid, suggesting low-dose MTX exerts anti-inflammatory effects in vivo in PWH largely by blocking T cell proliferation via dihydrofolate reductase inhibition, yet daily administration of folic acid did not rescue this effect in trial participants. Our findings identify the main mechanism of action of this widely used anti-inflammatory medicine in PWH and may provide insight into how MTX works in the setting of other inflammatory conditions.
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Affiliation(s)
- Michael L. Freeman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals, Cleveland Medical Center, Cleveland, OH, United States
| | - Brian M. Clagett
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals, Cleveland Medical Center, Cleveland, OH, United States
| | - Daniela Moisi
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals, Cleveland Medical Center, Cleveland, OH, United States
| | - Eunice Yeh
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Charles D. Morris
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals, Cleveland Medical Center, Cleveland, OH, United States
| | - Angela Ryu
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals, Cleveland Medical Center, Cleveland, OH, United States
| | - Benigno Rodriguez
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals, Cleveland Medical Center, Cleveland, OH, United States
| | - James H. Stein
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Steven G. Deeks
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of San Francisco School of Medicine, San Francisco, CA, United States
| | - Judith S. Currier
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Priscilla Y. Hsue
- Division of Cardiology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, United States
| | - Donald D. Anthony
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals, Cleveland Medical Center, Cleveland, OH, United States
- Louis Stokes Cleveland Veterans Affairs Medical Center, US Department of Veterans Affairs, Cleveland, OH, United States
- Division of Rheumatic Diseases, MetroHealth Medical Center, Cleveland, OH, United States
| | - Leonard H. Calabrese
- Fasenmyer Center for Immunology, Division of Rheumatic Diseases, Cleveland Clinic, Cleveland, OH, United States
| | - Heather J. Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Michael M. Lederman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals, Cleveland Medical Center, Cleveland, OH, United States
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11
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Calabrese CM, Kirchner E, Husni EM, Moss BP, Fernandez AP, Jin Y, Calabrese LH. Breakthrough SARS‐CoV‐2 infections in immune mediated disease patients undergoing B cell depleting therapy: A retrospective cohort analysis. Arthritis Rheumatol 2022; 74:1906-1915. [PMID: 35791921 PMCID: PMC9349969 DOI: 10.1002/art.42287] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/23/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Abstract
Objectives Patients with immune mediated inflammatory diseases (IMIDs) receiving B cell depleting therapy (BCDT) are among the most vulnerable to severe COVID‐19 as well as the most likely to respond sub‐optimally to SARS‐CoV‐2 vaccines. However, little is known about the frequency or severity of breakthrough infection in this population. We retrospectively analyzed a large group of vaccinated IMIDs patients undergoing BCDT in order to identify the presence of breakthrough COVID‐19 infections and assess their outcomes. Methods In this retrospective cohort study, the pharmacy records and COVID‐19 registry at the Cleveland Clinic were searched using specific ICD‐10 codes to identify IMIDs patients who (1) were treated with BCDT, (2) were vaccinated against SARS‐CoV‐2, and (3) experienced breakthrough infections. Each EMR was reviewed to extract clinical data and outcomes. Univariate and multivariable logistic/proportional‐odds regression models were used to examine the risk factors for severe outcomes. Results Of 1696 IMIDs patients on BCDT, 74 developed breakthrough COVID‐19 prior to December 16th, 2021. Outcomes were severe with 29(39.2%) hospitalized, 11(14.9%) requiring critical care, and 6(8.1%) deaths. Outpatient anti‐SARS‐CoV‐2 monoclonal antibodies were used to treat 21 with 1 hospitalization and no deaths. A comparator analysis examining 1437 unvaccinated IMIDs patients on BCDT over the same time period identified 57(3.9%) COVID‐19 cases with 28(49.1%) requiring hospitalization including 7(12.3%) deaths. Conclusions IMIDs patients on BCDT regardless of vaccine status appear vulnerable to infection with SARS‐CoV‐2 and are frequently associated with severe outcomes. Outpatient use of anti‐SARS‐CoV‐2 monoclonal antibody therapy appeared to be associated with enhanced clinical outcomes.
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Affiliation(s)
| | | | - Elaine M Husni
- Department of Rheumatic and Immunologic Diseases Cleveland Clinic
| | - Brandon P Moss
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic
| | | | - Yuxuan Jin
- Quantitative Health Sciences, Cleveland Clinic
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12
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Laster AJ, Lam GK, Gladue HS, Kashif AA, Siceloff EP, Lackey VD, Robertson CR, Toci AL, Calabrese LH. Does an adjustment to the dosing and timing of immunomodulatory drugs alter the immunogenicity of the COVID-19 vaccines in patients with autoimmune and inflammatory rheumatic disease (AIIRD)? RMD Open 2022; 8:rmdopen-2022-002203. [PMID: 35534054 PMCID: PMC9086281 DOI: 10.1136/rmdopen-2022-002203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Andrew J Laster
- Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, North Carolina, USA
| | - Gordon K Lam
- Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, North Carolina, USA
| | - Heather S Gladue
- Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, North Carolina, USA
| | - Ahmad A Kashif
- Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, North Carolina, USA
| | - Erin P Siceloff
- Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, North Carolina, USA
| | - Virginia D Lackey
- Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, North Carolina, USA
| | - Cheryl R Robertson
- Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, North Carolina, USA
| | - Ashley L Toci
- Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, North Carolina, USA
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13
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Shimoyama T, Uchino K, Calabrese LH, Hajj-Ali RA. Serial vessel wall enhancement pattern on high-resolution vessel wall magnetic resonance imaging and clinical implications in patients with central nervous system vasculitis. Clin Exp Rheumatol 2022; 40:811-818. [DOI: 10.55563/clinexprheumatol/d3h5d6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Takashi Shimoyama
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ken Uchino
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Leonard H. Calabrese
- Department of Rheumatic and Immunologic Disease, Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rula A. Hajj-Ali
- Department of Rheumatic and Immunologic Disease, Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, OH, USA.
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14
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Duarte C, Santos E, Barreira SC, Ávila-Ribeiro P, Costa F, Freitas P, Araújo F, Freitas R, Marona J, Manica SR, Ferreira J, Couto M, Guerra M, Calabrese LH, de Wit M, Ferreira RJ, da Silva JA. Can numerical rating scales of disease impact be used as targets for patient-centred management in rheumatoid arthritis? Clin Exp Rheumatol 2022; 41:704-710. [PMID: 35930489 DOI: 10.55563/clinexprheumatol/8xdgxu] [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] [Received: 03/19/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Patient centred care is an increasingly important paradigm. Applying a treat-to-target strategy to the impact of the disease in patients' lives seems a very promising tool to serve this purpose. We aimed to evaluate if maximum acceptable impact scores (target-values) defined at the population level provide an appropriate representation for most individual patients. To determine if the individually established target values of impact are consistent enough to be used in a treat-to-target strategy. METHODS Consecutive patients with rheumatoid arthritis were asked to indicate, in two consecutive visits, the maximum severity of impact they considered acceptable to live with for the rest of their lives, in the seven domains of Rheumatoid Arthritis Impact of Disease score. The individual adequacy of population-based reference values was assessed by measures of dispersion. Stability of individual target-values were evaluated through intraclass correlation coefficient. Socio-demographic, clinical and psychological features were tested as co-factors of stability. RESULTS 299 patients were included. The dispersion of targets was wide (CV>0.68), thus limiting the use of any population-based single values as targets for the individual patients. Although the mean target values were very similar in both visits for all domains, reliability was poor in all cases (ICCs: 0.37-0.47). Only 25-30% of the patients selected the same target value in the 2 visits. No explanatory factors for (non-)stability were identified. CONCLUSIONS Quantified impact targets defined at population level are not appropriate for individual patient care. Research on alternative tools to support patient-centred, target-oriented management strategies is warranted.
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Affiliation(s)
- Cátia Duarte
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, and iCBR-Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal.
| | - Eduardo Santos
- Health School of the Polytechnic Institute of Viseu, Portugal, and Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal
| | - Sofia C. Barreira
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Centro Académico de Medicina de Lisboa, and Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal
| | - Pedro Ávila-Ribeiro
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Centro Académico de Medicina de Lisboa, and Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal
| | - Flavio Costa
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Pedro Freitas
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Filipe Araújo
- Rheumatology and Osteoporosis Unit, Hospital de Sant’Ana, SCML, Lisboa, Portugal
| | - Raquel Freitas
- Department Rheumatology, Garcia de Orta Hospital, Almada, Portugal
| | - Jose Marona
- Department of Rheumatology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental Lisboa, and CEDOC, NOVA Medical School, Universidade de Lisboa, Portugal
| | - Santiago R. Manica
- Department of Rheumatology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental Lisboa, and CEDOC, NOVA Medical School, Universidade de Lisboa, Portugal
| | - Joana Ferreira
- Rheumatology Department of Health Unit of Guarda, and Faculty of Health Sciences, Beira Interior University, Covilhã, Portugal
| | - Maura Couto
- Rheumatology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Miguel Guerra
- Rheumatology Department, Centro Hospitalar de Gaia, Vila Nova de Gaia, Portugal
| | | | | | - Ricardo J.O. Ferreira
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, and Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal
| | - Jose A.P. da Silva
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, and iCBR-Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal
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15
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Lederman MM, Flier JS, Hale P, Haase AT, Powderly W, Reiss P, Silvestri G, Sekaly RP, Paiardini M, Weissman D, Kuritzkes DR, Calabrese LH, Agre P, Reyes-Teran G, Landay AL, Lewin S, Richman DD, Volberding P, Hunt PW, Schechter M. Is France Once Again Looking for a Scapegoat? Pathog Immun 2021; 6:149-152. [PMID: 35097250 PMCID: PMC8792773 DOI: 10.20411/pai.v6i2.490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
On September 10, 2021, a special tribunal established by the French government launched an inquiry into the activities of former health minister Dr. Agnes Buzyn who was charged with “endangering the lives of others”. It is surprising to learn of this accusation and inquiry into the actions of a public health official whose response to the epidemic was, to all appearances, exemplary.
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Affiliation(s)
- Michael M. Lederman
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
- CORRESPONDING AUTHOR Michael M. Lederman, MD, Case Western Reserve University, Cleveland, Ohio;
| | | | - Peter Hale
- Foundation for Vaccine Research, Washington DC
| | | | | | | | | | | | | | - Drew Weissman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Leonard H. Calabrese
- Cleveland Clinic, Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Peter Agre
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Sharon Lewin
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne Australia
| | | | - Paul Volberding
- University of California San Francisco, San Francisco, California
| | - Peter W. Hunt
- University of California San Francisco, San Francisco, California
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16
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Hojat M, DeSantis J, Cain RA, Speicher MR, Bragan L, Calabrese LH. Attitudes toward osteopathic medicine scale: development and psychometrics. Int J Med Educ 2021; 12:222-232. [PMID: 34807000 DOI: 10.5116/ijme.615c.2cfa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To develop a valid and reliable instrument for measuring attitudes toward osteopathic medicine. METHODS Participants included 5,669 first-year students from 33 U.S. colleges of osteopathic medicine, who completed an online survey at the beginning of the 2019-2020 academic year. Using data from the nationwide Project in Osteopathic Medical Education and Empathy, we developed a 13-item instrument: Attitudes Toward Osteopathic Medicine Scale (ATOMS) and demonstrated the validity and reliability of its scores. The social desirability response bias was controlled in statistical analyses. RESULTS The corrected item-total score correlations were all positive and statistically significant, and the effect sizes of item discrimination indices were large. Cronbach's coefficient alpha reliability was 0.83. Construct validity, corroborating face and content validity of the ATOMS, was supported by three components, emerged from factor analysis: "Perspectives on Osteopathic Medicine," "Osteopathic Diagnosis and Treatment," and "Holistic-Integrative Care." Correlations between ATOMS scores and scores of cognitive empathy, emotional empathy; orientation toward interprofessional collaboration; lifelong learning; and burnout were statistically significant in the expected direction, providing validity evidence for the ATOMS. Using the method of contrasted groups, significant differences in the ATOMS scores were found by gender, ethnicity, academic background, and career interest in the expected direction, supporting the validity of the ATOMS scores. National norms were developed to assess individual scores alongside national percentile ranks. CONCLUSIONS The ATOMS, developed in a nationwide study, supported by strong psychometric evidence for measuring orientation toward osteopathic medicine, has implications for the assessment of osteopathic medical education, patient outcomes, and admission decisions.
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Affiliation(s)
- Mohammadreza Hojat
- Asano-Gonnella Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jennifer DeSantis
- Asano-Gonnella Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Robert A Cain
- American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland, USA
| | - Mark R Speicher
- American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland, USA
| | - Lynn Bragan
- American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland, USA
| | - Leonard H Calabrese
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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17
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Jones JM, Faruqi AJ, Sullivan JK, Calabrese C, Calabrese LH. COVID-19 Outcomes in Patients Undergoing B Cell Depletion Therapy and Those with Humoral Immunodeficiency States: A Scoping Review. Pathog Immun 2021; 6:76-103. [PMID: 34056149 PMCID: PMC8150936 DOI: 10.20411/pai.v6i1.435] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 03/29/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The role of humoral immunity has been well established in reducing infection risk and facilitating viral clearance in patients with COVID-19. However, the relationship between specific antibody responses and severity of COVID-19 is less well understood. METHODS To address this question and identify gaps in knowledge, we utilized the methodology of a scoping review to interrogate risk of infection and clinical outcomes of COVID-19 in patients with iatrogenic and inborn humoral immunodeficiency states based on existing literature. RESULTS Among patients with iatrogenic B-cell depletion, particularly with agents targeting CD20, our analysis found increased risk of severe COVID-19 and death across a range of underlying disease states. Among patients with humoral inborn errors of immunity with COVID-19, our synthesis found that patients with dysregulated humoral immunity, predominantly common variable immunodeficiency (CVID), may be more susceptible to severe COVID-19 than patients with humoral immunodeficiency states due to X-linked agammaglobulinemia and other miscellaneous forms of humoral immunodeficiency. There were insufficient data to appraise the risk of COVID-19 infection in both populations of patients. CONCLUSIONS Our work identifies potentially significant predictors of COVID-19 severity in patients with humoral immunodeficiency states and highlights the need for larger studies to control for clinical and biologic confounders of disease severity.
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Affiliation(s)
- Jessica M. Jones
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Aiman J. Faruqi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - James K. Sullivan
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Cassandra Calabrese
- Cleveland Clinic, Department of Rheumatic and Immunologic Diseases, Cleveland, Ohio
| | - Leonard H. Calabrese
- Cleveland Clinic, Department of Rheumatic and Immunologic Diseases, Cleveland, Ohio
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18
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Affiliation(s)
| | - Kevin Winthrop
- Oregon Health and Science University School of Medicine, Portland, OR, USA
| | | | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Jolan E Walter
- Division of Pediatric Allergy/Immunology, University of South Florida at Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
- Division of Pediatric Allergy and Immunology, Massachusetts General Hospital for Children, Boston, MA, USA
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19
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Mease PJ, Calabrese LH, Callis Duffin K, Haberman RH, Firmino R, Scher JU, Schick L, Winthrop K, Merola JF. Psoriasis and Psoriatic Arthritis in the Context of the COVID-19 Pandemic: A Plenary Session From the GRAPPA 2020 Annual Meeting. J Rheumatol 2021:jrheum.201671. [PMID: 33722951 DOI: 10.3899/jrheum.201671] [Citation(s) in RCA: 3] [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] [Indexed: 11/22/2022]
Abstract
The coronavirus disease 2019 (COVID-19; caused by SARS-CoV-2) pandemic has affected the healthcare system on a global scale, and we utilized the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2020 annual meeting to examine how COVID-19 might affect patients with psoriatic disease (PsD) and the clinicians who care for them. Pressing issues and concerns identified included whether having psoriasis increased the risk of acquiring COVID-19, vaccine safety, and the acceptability of telehealth. The general message from rheumatologists, dermatologists, infectious disease specialists, and patient research partners was that data did not suggest that having PsD or its treatment significantly increased risk of infection or more severe disease course, and that the telehealth experience was a success overall.
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Affiliation(s)
- Philip J Mease
- As part of the supplement series GRAPPA 2020, this report was reviewed internally and approved by the Guest Editors for integrity, accuracy, and consistency with scientific and ethical standards. RH has received funding from the National Psoriasis Foundation, NIH/ NIAMS T32AR069515, The Riley Family Foundation, The Snyder Family Foundation, Bloomberg Philanthropies Covid-19 Response Initiative Grant, and the Rheumatology Research Foundation. 1P.J. Mease, MD, MACR, Rheumatology Research, Swedish Medical Center/ Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington; 2L.H. Calabrese, DO, Professor of Medicine, Cleveland Clinic Lerner College of Medicine, RJ Fasenmyer Chair of Clinical Immunology, Cleveland Clinic, Cleveland, Ohio; 3K. Callis Duffin, MD, MS, Professor and Chair, Department of Dermatology, University of Utah, Salt Lake City, Utah; 4R. Haberman, MD, MSCI, Clinical Instructor, Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, New York; 5R. Firmino, GRAPPA Patient Research Partner; 6J.U. Scher, MD, Department of Medicine, NYU Grossman School of Medicine, New York, New York; 7L. Schick, GRAPPA Patient Research Partner; 8K. Winthrop, MD, MPH, Oregon Health & Science University- Portland State University School of Public Health, Portland, Oregon; 9J.F. Merola, MD, MMSc, Harvard Medical School, Brigham and Women's Hospital, Department of Dermatology and Department of Medicine, Division of Rheumatology and Immunology, Boston, Massachusetts, USA. The authors report the following conflicts of interest: PJM with AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, SUN Pharma, and UCB; KCD with Amgen, AbbVie, Celgene, Eli Lilly, Janssen, Bristol Myers Squibb, Stiefel, Novartis, Pfizer, Sienna, UCB, Regeneron, Boehringer Ingelheim, and Ortho Dermatologic; RH with Janssen; JUS with AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Sanofi, and UCB; KW with Pfizer, AbbVie, UCB, Eli Lilly, Galapagos, GlaxoSmithKline, Roche, Gilead, Regeneron, Sanofi, AstraZeneca, Novartis, and BMS; JFM with Merck, Bristol Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres, and Leo Pharma. LHC, LS, and RF declare no conflicts. Address correspondence to Dr. P.J. Mease, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health, Seattle, WA 98122, USA.
| | - Leonard H Calabrese
- As part of the supplement series GRAPPA 2020, this report was reviewed internally and approved by the Guest Editors for integrity, accuracy, and consistency with scientific and ethical standards. RH has received funding from the National Psoriasis Foundation, NIH/ NIAMS T32AR069515, The Riley Family Foundation, The Snyder Family Foundation, Bloomberg Philanthropies Covid-19 Response Initiative Grant, and the Rheumatology Research Foundation. 1P.J. Mease, MD, MACR, Rheumatology Research, Swedish Medical Center/ Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington; 2L.H. Calabrese, DO, Professor of Medicine, Cleveland Clinic Lerner College of Medicine, RJ Fasenmyer Chair of Clinical Immunology, Cleveland Clinic, Cleveland, Ohio; 3K. Callis Duffin, MD, MS, Professor and Chair, Department of Dermatology, University of Utah, Salt Lake City, Utah; 4R. Haberman, MD, MSCI, Clinical Instructor, Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, New York; 5R. Firmino, GRAPPA Patient Research Partner; 6J.U. Scher, MD, Department of Medicine, NYU Grossman School of Medicine, New York, New York; 7L. Schick, GRAPPA Patient Research Partner; 8K. Winthrop, MD, MPH, Oregon Health & Science University- Portland State University School of Public Health, Portland, Oregon; 9J.F. Merola, MD, MMSc, Harvard Medical School, Brigham and Women's Hospital, Department of Dermatology and Department of Medicine, Division of Rheumatology and Immunology, Boston, Massachusetts, USA. The authors report the following conflicts of interest: PJM with AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, SUN Pharma, and UCB; KCD with Amgen, AbbVie, Celgene, Eli Lilly, Janssen, Bristol Myers Squibb, Stiefel, Novartis, Pfizer, Sienna, UCB, Regeneron, Boehringer Ingelheim, and Ortho Dermatologic; RH with Janssen; JUS with AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Sanofi, and UCB; KW with Pfizer, AbbVie, UCB, Eli Lilly, Galapagos, GlaxoSmithKline, Roche, Gilead, Regeneron, Sanofi, AstraZeneca, Novartis, and BMS; JFM with Merck, Bristol Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres, and Leo Pharma. LHC, LS, and RF declare no conflicts. Address correspondence to Dr. P.J. Mease, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health, Seattle, WA 98122, USA.
| | - Kristina Callis Duffin
- As part of the supplement series GRAPPA 2020, this report was reviewed internally and approved by the Guest Editors for integrity, accuracy, and consistency with scientific and ethical standards. RH has received funding from the National Psoriasis Foundation, NIH/ NIAMS T32AR069515, The Riley Family Foundation, The Snyder Family Foundation, Bloomberg Philanthropies Covid-19 Response Initiative Grant, and the Rheumatology Research Foundation. 1P.J. Mease, MD, MACR, Rheumatology Research, Swedish Medical Center/ Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington; 2L.H. Calabrese, DO, Professor of Medicine, Cleveland Clinic Lerner College of Medicine, RJ Fasenmyer Chair of Clinical Immunology, Cleveland Clinic, Cleveland, Ohio; 3K. Callis Duffin, MD, MS, Professor and Chair, Department of Dermatology, University of Utah, Salt Lake City, Utah; 4R. Haberman, MD, MSCI, Clinical Instructor, Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, New York; 5R. Firmino, GRAPPA Patient Research Partner; 6J.U. Scher, MD, Department of Medicine, NYU Grossman School of Medicine, New York, New York; 7L. Schick, GRAPPA Patient Research Partner; 8K. Winthrop, MD, MPH, Oregon Health & Science University- Portland State University School of Public Health, Portland, Oregon; 9J.F. Merola, MD, MMSc, Harvard Medical School, Brigham and Women's Hospital, Department of Dermatology and Department of Medicine, Division of Rheumatology and Immunology, Boston, Massachusetts, USA. The authors report the following conflicts of interest: PJM with AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, SUN Pharma, and UCB; KCD with Amgen, AbbVie, Celgene, Eli Lilly, Janssen, Bristol Myers Squibb, Stiefel, Novartis, Pfizer, Sienna, UCB, Regeneron, Boehringer Ingelheim, and Ortho Dermatologic; RH with Janssen; JUS with AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Sanofi, and UCB; KW with Pfizer, AbbVie, UCB, Eli Lilly, Galapagos, GlaxoSmithKline, Roche, Gilead, Regeneron, Sanofi, AstraZeneca, Novartis, and BMS; JFM with Merck, Bristol Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres, and Leo Pharma. LHC, LS, and RF declare no conflicts. Address correspondence to Dr. P.J. Mease, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health, Seattle, WA 98122, USA.
| | - Rebecca H Haberman
- As part of the supplement series GRAPPA 2020, this report was reviewed internally and approved by the Guest Editors for integrity, accuracy, and consistency with scientific and ethical standards. RH has received funding from the National Psoriasis Foundation, NIH/ NIAMS T32AR069515, The Riley Family Foundation, The Snyder Family Foundation, Bloomberg Philanthropies Covid-19 Response Initiative Grant, and the Rheumatology Research Foundation. 1P.J. Mease, MD, MACR, Rheumatology Research, Swedish Medical Center/ Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington; 2L.H. Calabrese, DO, Professor of Medicine, Cleveland Clinic Lerner College of Medicine, RJ Fasenmyer Chair of Clinical Immunology, Cleveland Clinic, Cleveland, Ohio; 3K. Callis Duffin, MD, MS, Professor and Chair, Department of Dermatology, University of Utah, Salt Lake City, Utah; 4R. Haberman, MD, MSCI, Clinical Instructor, Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, New York; 5R. Firmino, GRAPPA Patient Research Partner; 6J.U. Scher, MD, Department of Medicine, NYU Grossman School of Medicine, New York, New York; 7L. Schick, GRAPPA Patient Research Partner; 8K. Winthrop, MD, MPH, Oregon Health & Science University- Portland State University School of Public Health, Portland, Oregon; 9J.F. Merola, MD, MMSc, Harvard Medical School, Brigham and Women's Hospital, Department of Dermatology and Department of Medicine, Division of Rheumatology and Immunology, Boston, Massachusetts, USA. The authors report the following conflicts of interest: PJM with AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, SUN Pharma, and UCB; KCD with Amgen, AbbVie, Celgene, Eli Lilly, Janssen, Bristol Myers Squibb, Stiefel, Novartis, Pfizer, Sienna, UCB, Regeneron, Boehringer Ingelheim, and Ortho Dermatologic; RH with Janssen; JUS with AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Sanofi, and UCB; KW with Pfizer, AbbVie, UCB, Eli Lilly, Galapagos, GlaxoSmithKline, Roche, Gilead, Regeneron, Sanofi, AstraZeneca, Novartis, and BMS; JFM with Merck, Bristol Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres, and Leo Pharma. LHC, LS, and RF declare no conflicts. Address correspondence to Dr. P.J. Mease, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health, Seattle, WA 98122, USA.
| | - Rodrigo Firmino
- As part of the supplement series GRAPPA 2020, this report was reviewed internally and approved by the Guest Editors for integrity, accuracy, and consistency with scientific and ethical standards. RH has received funding from the National Psoriasis Foundation, NIH/ NIAMS T32AR069515, The Riley Family Foundation, The Snyder Family Foundation, Bloomberg Philanthropies Covid-19 Response Initiative Grant, and the Rheumatology Research Foundation. 1P.J. Mease, MD, MACR, Rheumatology Research, Swedish Medical Center/ Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington; 2L.H. Calabrese, DO, Professor of Medicine, Cleveland Clinic Lerner College of Medicine, RJ Fasenmyer Chair of Clinical Immunology, Cleveland Clinic, Cleveland, Ohio; 3K. Callis Duffin, MD, MS, Professor and Chair, Department of Dermatology, University of Utah, Salt Lake City, Utah; 4R. Haberman, MD, MSCI, Clinical Instructor, Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, New York; 5R. Firmino, GRAPPA Patient Research Partner; 6J.U. Scher, MD, Department of Medicine, NYU Grossman School of Medicine, New York, New York; 7L. Schick, GRAPPA Patient Research Partner; 8K. Winthrop, MD, MPH, Oregon Health & Science University- Portland State University School of Public Health, Portland, Oregon; 9J.F. Merola, MD, MMSc, Harvard Medical School, Brigham and Women's Hospital, Department of Dermatology and Department of Medicine, Division of Rheumatology and Immunology, Boston, Massachusetts, USA. The authors report the following conflicts of interest: PJM with AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, SUN Pharma, and UCB; KCD with Amgen, AbbVie, Celgene, Eli Lilly, Janssen, Bristol Myers Squibb, Stiefel, Novartis, Pfizer, Sienna, UCB, Regeneron, Boehringer Ingelheim, and Ortho Dermatologic; RH with Janssen; JUS with AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Sanofi, and UCB; KW with Pfizer, AbbVie, UCB, Eli Lilly, Galapagos, GlaxoSmithKline, Roche, Gilead, Regeneron, Sanofi, AstraZeneca, Novartis, and BMS; JFM with Merck, Bristol Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres, and Leo Pharma. LHC, LS, and RF declare no conflicts. Address correspondence to Dr. P.J. Mease, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health, Seattle, WA 98122, USA.
| | - Jose U Scher
- As part of the supplement series GRAPPA 2020, this report was reviewed internally and approved by the Guest Editors for integrity, accuracy, and consistency with scientific and ethical standards. RH has received funding from the National Psoriasis Foundation, NIH/ NIAMS T32AR069515, The Riley Family Foundation, The Snyder Family Foundation, Bloomberg Philanthropies Covid-19 Response Initiative Grant, and the Rheumatology Research Foundation. 1P.J. Mease, MD, MACR, Rheumatology Research, Swedish Medical Center/ Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington; 2L.H. Calabrese, DO, Professor of Medicine, Cleveland Clinic Lerner College of Medicine, RJ Fasenmyer Chair of Clinical Immunology, Cleveland Clinic, Cleveland, Ohio; 3K. Callis Duffin, MD, MS, Professor and Chair, Department of Dermatology, University of Utah, Salt Lake City, Utah; 4R. Haberman, MD, MSCI, Clinical Instructor, Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, New York; 5R. Firmino, GRAPPA Patient Research Partner; 6J.U. Scher, MD, Department of Medicine, NYU Grossman School of Medicine, New York, New York; 7L. Schick, GRAPPA Patient Research Partner; 8K. Winthrop, MD, MPH, Oregon Health & Science University- Portland State University School of Public Health, Portland, Oregon; 9J.F. Merola, MD, MMSc, Harvard Medical School, Brigham and Women's Hospital, Department of Dermatology and Department of Medicine, Division of Rheumatology and Immunology, Boston, Massachusetts, USA. The authors report the following conflicts of interest: PJM with AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, SUN Pharma, and UCB; KCD with Amgen, AbbVie, Celgene, Eli Lilly, Janssen, Bristol Myers Squibb, Stiefel, Novartis, Pfizer, Sienna, UCB, Regeneron, Boehringer Ingelheim, and Ortho Dermatologic; RH with Janssen; JUS with AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Sanofi, and UCB; KW with Pfizer, AbbVie, UCB, Eli Lilly, Galapagos, GlaxoSmithKline, Roche, Gilead, Regeneron, Sanofi, AstraZeneca, Novartis, and BMS; JFM with Merck, Bristol Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres, and Leo Pharma. LHC, LS, and RF declare no conflicts. Address correspondence to Dr. P.J. Mease, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health, Seattle, WA 98122, USA.
| | - Lori Schick
- As part of the supplement series GRAPPA 2020, this report was reviewed internally and approved by the Guest Editors for integrity, accuracy, and consistency with scientific and ethical standards. RH has received funding from the National Psoriasis Foundation, NIH/ NIAMS T32AR069515, The Riley Family Foundation, The Snyder Family Foundation, Bloomberg Philanthropies Covid-19 Response Initiative Grant, and the Rheumatology Research Foundation. 1P.J. Mease, MD, MACR, Rheumatology Research, Swedish Medical Center/ Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington; 2L.H. Calabrese, DO, Professor of Medicine, Cleveland Clinic Lerner College of Medicine, RJ Fasenmyer Chair of Clinical Immunology, Cleveland Clinic, Cleveland, Ohio; 3K. Callis Duffin, MD, MS, Professor and Chair, Department of Dermatology, University of Utah, Salt Lake City, Utah; 4R. Haberman, MD, MSCI, Clinical Instructor, Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, New York; 5R. Firmino, GRAPPA Patient Research Partner; 6J.U. Scher, MD, Department of Medicine, NYU Grossman School of Medicine, New York, New York; 7L. Schick, GRAPPA Patient Research Partner; 8K. Winthrop, MD, MPH, Oregon Health & Science University- Portland State University School of Public Health, Portland, Oregon; 9J.F. Merola, MD, MMSc, Harvard Medical School, Brigham and Women's Hospital, Department of Dermatology and Department of Medicine, Division of Rheumatology and Immunology, Boston, Massachusetts, USA. The authors report the following conflicts of interest: PJM with AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, SUN Pharma, and UCB; KCD with Amgen, AbbVie, Celgene, Eli Lilly, Janssen, Bristol Myers Squibb, Stiefel, Novartis, Pfizer, Sienna, UCB, Regeneron, Boehringer Ingelheim, and Ortho Dermatologic; RH with Janssen; JUS with AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Sanofi, and UCB; KW with Pfizer, AbbVie, UCB, Eli Lilly, Galapagos, GlaxoSmithKline, Roche, Gilead, Regeneron, Sanofi, AstraZeneca, Novartis, and BMS; JFM with Merck, Bristol Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres, and Leo Pharma. LHC, LS, and RF declare no conflicts. Address correspondence to Dr. P.J. Mease, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health, Seattle, WA 98122, USA.
| | - Kevin Winthrop
- As part of the supplement series GRAPPA 2020, this report was reviewed internally and approved by the Guest Editors for integrity, accuracy, and consistency with scientific and ethical standards. RH has received funding from the National Psoriasis Foundation, NIH/ NIAMS T32AR069515, The Riley Family Foundation, The Snyder Family Foundation, Bloomberg Philanthropies Covid-19 Response Initiative Grant, and the Rheumatology Research Foundation. 1P.J. Mease, MD, MACR, Rheumatology Research, Swedish Medical Center/ Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington; 2L.H. Calabrese, DO, Professor of Medicine, Cleveland Clinic Lerner College of Medicine, RJ Fasenmyer Chair of Clinical Immunology, Cleveland Clinic, Cleveland, Ohio; 3K. Callis Duffin, MD, MS, Professor and Chair, Department of Dermatology, University of Utah, Salt Lake City, Utah; 4R. Haberman, MD, MSCI, Clinical Instructor, Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, New York; 5R. Firmino, GRAPPA Patient Research Partner; 6J.U. Scher, MD, Department of Medicine, NYU Grossman School of Medicine, New York, New York; 7L. Schick, GRAPPA Patient Research Partner; 8K. Winthrop, MD, MPH, Oregon Health & Science University- Portland State University School of Public Health, Portland, Oregon; 9J.F. Merola, MD, MMSc, Harvard Medical School, Brigham and Women's Hospital, Department of Dermatology and Department of Medicine, Division of Rheumatology and Immunology, Boston, Massachusetts, USA. The authors report the following conflicts of interest: PJM with AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, SUN Pharma, and UCB; KCD with Amgen, AbbVie, Celgene, Eli Lilly, Janssen, Bristol Myers Squibb, Stiefel, Novartis, Pfizer, Sienna, UCB, Regeneron, Boehringer Ingelheim, and Ortho Dermatologic; RH with Janssen; JUS with AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Sanofi, and UCB; KW with Pfizer, AbbVie, UCB, Eli Lilly, Galapagos, GlaxoSmithKline, Roche, Gilead, Regeneron, Sanofi, AstraZeneca, Novartis, and BMS; JFM with Merck, Bristol Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres, and Leo Pharma. LHC, LS, and RF declare no conflicts. Address correspondence to Dr. P.J. Mease, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health, Seattle, WA 98122, USA.
| | - Joseph F Merola
- As part of the supplement series GRAPPA 2020, this report was reviewed internally and approved by the Guest Editors for integrity, accuracy, and consistency with scientific and ethical standards. RH has received funding from the National Psoriasis Foundation, NIH/ NIAMS T32AR069515, The Riley Family Foundation, The Snyder Family Foundation, Bloomberg Philanthropies Covid-19 Response Initiative Grant, and the Rheumatology Research Foundation. 1P.J. Mease, MD, MACR, Rheumatology Research, Swedish Medical Center/ Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington; 2L.H. Calabrese, DO, Professor of Medicine, Cleveland Clinic Lerner College of Medicine, RJ Fasenmyer Chair of Clinical Immunology, Cleveland Clinic, Cleveland, Ohio; 3K. Callis Duffin, MD, MS, Professor and Chair, Department of Dermatology, University of Utah, Salt Lake City, Utah; 4R. Haberman, MD, MSCI, Clinical Instructor, Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, New York; 5R. Firmino, GRAPPA Patient Research Partner; 6J.U. Scher, MD, Department of Medicine, NYU Grossman School of Medicine, New York, New York; 7L. Schick, GRAPPA Patient Research Partner; 8K. Winthrop, MD, MPH, Oregon Health & Science University- Portland State University School of Public Health, Portland, Oregon; 9J.F. Merola, MD, MMSc, Harvard Medical School, Brigham and Women's Hospital, Department of Dermatology and Department of Medicine, Division of Rheumatology and Immunology, Boston, Massachusetts, USA. The authors report the following conflicts of interest: PJM with AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, SUN Pharma, and UCB; KCD with Amgen, AbbVie, Celgene, Eli Lilly, Janssen, Bristol Myers Squibb, Stiefel, Novartis, Pfizer, Sienna, UCB, Regeneron, Boehringer Ingelheim, and Ortho Dermatologic; RH with Janssen; JUS with AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Sanofi, and UCB; KW with Pfizer, AbbVie, UCB, Eli Lilly, Galapagos, GlaxoSmithKline, Roche, Gilead, Regeneron, Sanofi, AstraZeneca, Novartis, and BMS; JFM with Merck, Bristol Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres, and Leo Pharma. LHC, LS, and RF declare no conflicts. Address correspondence to Dr. P.J. Mease, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health, Seattle, WA 98122, USA.
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Calabrese LH, Lenfant T, Calabrese C. Cytokine storm release syndrome and the prospects for immunotherapy with COVID-19, part 4: The role of JAK inhibition. Cleve Clin J Med 2021:ccjm.87a.ccc060. [PMID: 32847819 DOI: 10.3949/ccjm.87a.ccc060] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This review focuses on an alternative strategy utilizing small molecules to inhibit a key signal-transduction pathway, the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway. The JAK-STAT pathway mediates biologic activity for a large number of inflammatory cytokines and mediators.
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Affiliation(s)
- Leonard H Calabrese
- Department of Rheumatic and Immunologic Diseases, Orthopedic & Rheumatologic Institute, Cleveland Clinic
| | - Tiphaine Lenfant
- Department of Rheumatic and Immunologic Diseases, Orthopedic & Rheumatologic Institute Department of Infectious Disease, Cleveland Clinic
- Assistance Publique des Hôpitaux de Paris, Université de Paris
- Hôpital européen Georges Pompidou, Service de médecine interne, Paris, France
| | - Cassandra Calabrese
- Department of Rheumatic and Immunologic Diseases, Orthopedic & Rheumatologic Institute, and Department of Infectious Disease, Cleveland Clinic
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21
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Lenfant T, Jin Y, Kirchner E, Hajj-Ali RA, Calabrese LH, Calabrese C. Safety of Recombinant Zoster Vaccine: a Retrospective Study of 622 Rheumatology Patients. Rheumatology (Oxford) 2021; 60:5149-5157. [PMID: 33560302 DOI: 10.1093/rheumatology/keab139] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To provide insight into the safety of Recombinant Zoster Vaccine (RZV) in patients with Immune-Mediated Inflammatory Diseases (IMID). METHODS Patients who received RZV in a single center Rheumatology Department were retrospectively included. An IMID flare was defined as a) a documentation of flare in the office notes or patient portal communication or b) new prednisone prescription, in the 12 weeks after each dose. RESULTS Six-hundred twenty-two patients were included (67% female, median age 67 years), 8.5% of them experienced AEs and HZ incidence was 0.6% after median follow-up of 36 weeks. Of 359 IMID patients: 88 had RA (25%), 50 vasculitis (14%), 29 PMR (8%). At vaccination, 35% were on glucocorticoids (GC). Fifty-nine patients (16%) experienced a flare, 18 flares occurred in temporal relation to a treatment change (31%). RA patients had the highest flare rate (n = 21, 24%), 25% of patients who flared required adjustment of immunosuppression. In a multivariate analysis, use of GC at time of vaccination was associated with flare after vaccination (OR 2.31 [1.3-4.1], p = 0.004). A time-to-flare survival analysis (Cox-model) showed that GC was a significant predictor of IMID flare after first RZV dose (HR 2.4 [1.3-4.5], p = 0.0039) and that a flare after the first dose was associated with flaring after the second RZV dose (HR 3.9 [1.7-9], p = 0.0015). CONCLUSION RZV administration in patients with IMIDs was generally well-tolerated, though mild flares were not uncommon in the first 12 weeks after vaccination. These data may provide useful information for patient education when considering RZV administration.
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Affiliation(s)
- Tiphaine Lenfant
- Department of Rheumatologic and Immunologic Diseases, Orthopedic & Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.,Department of Internal Medicine, Hôpital européen Georges Pomidou, AP-HP, Université de Paris, Paris, France
| | - Yuxuan Jin
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Elizabeth Kirchner
- Department of Rheumatologic and Immunologic Diseases, Orthopedic & Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rula A Hajj-Ali
- Department of Rheumatologic and Immunologic Diseases, Orthopedic & Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Leonard H Calabrese
- Department of Rheumatologic and Immunologic Diseases, Orthopedic & Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Cassandra Calabrese
- Department of Rheumatologic and Immunologic Diseases, Orthopedic & Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.,Department of Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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22
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Abstract
The glucocorticoid dexamethasone is the standard of care in critically ill patients with COVID-19 to suppress the inappropriately heightened inflammatory response (cytokine storm), but the Janus kinase inhibitor baricitinib combined with remdesivir has received emergency use authorization for the same indication. As of this writing, in a hospitalized patient with COVID-19 who has evidence of pneumonitis or hypoxia, we recommend using either regimen, but not both together. Both regimens have shown benefit in randomized controlled trials, but we cannot state with certainty that either is superior to the other, nor whether they should be used together. Further trials are underway.
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Affiliation(s)
- Leonard H Calabrese
- Department of Rheumatic and Immunologic| Diseases, Orthopedic & Rheumatologic Institute, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Cassandra Calabrese
- Department of Rheumatic and Immunologic Diseases, Orthopedic & Rheumatologic Institute, and Department of Infectious Disease, Cleveland Clinic
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23
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Abstract
Numerous immunomodulating agents are currently being studied in clinical trials for the treatment of COVID-19, including interferon therapies. Interferons are naturally occurring host antiviral proteins upstream of the inflammatory pathway that are released by host cells in response to the presence of viral pathogens. It is known that beta coronaviruses deploy anti-interferon defenses to escape host innate immunity early in the infection course, and thus interferons have become attractive candidates for treatment of COVID-19. Questions surrounding timing, type of interferon, and route of administration all remain unanswered. Here we discuss the role of interferons in host antiviral immunity, and review the current data surrounding use of interferons in COVID-19.
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Affiliation(s)
- Leonard H Calabrese
- Department of Rheumatic and Immunologic Diseases, Orthopedic & Rheumatologic Institute, Cleveland Clinic
- Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Tiphaine Lenfant
- Department of Rheumatic and Immunologic Diseases, Orthopedic & Rheumatologic Institute, Cleveland Clinic
- Assistance Publique des Hôpitaux de Paris, Université de Paris, France, Hôpital Européen Georges Pompidou, Service de Médecine Interne, Paris, France
| | - Cassandra Calabrese
- Department of Rheumatic and Immunologic Diseases, Orthopedic & Rheumatologic Institute and Department of Infectious Disease, Cleveland Clinic
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24
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Geier CB, Farmer JR, Foldvari Z, Ujhazi B, Steininger J, Sleasman JW, Parikh S, Dilley MA, Pai SY, Henderson L, Hazen M, Neven B, Moshous D, Sharapova SO, Mihailova S, Yankova P, Naumova E, Özen S, Byram K, Fernandez J, Wolf HM, Eibl MM, Notarangelo LD, Calabrese LH, Walter JE. Vasculitis as a Major Morbidity Factor in Patients With Partial RAG Deficiency. Front Immunol 2020; 11:574738. [PMID: 33193364 PMCID: PMC7609967 DOI: 10.3389/fimmu.2020.574738] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/31/2020] [Indexed: 12/30/2022] Open
Abstract
Vasculitis can be a life-threatening complication associated with high mortality and morbidity among patients with primary immunodeficiencies (PIDs), including variants of severe and combined immunodeficiencies ((S)CID). Our understanding of vasculitis in partial defects in recombination activating gene (RAG) deficiency, a prototype of (S)CIDs, is limited with no published systematic evaluation of diagnostic and therapeutic modalities. In this report, we sought to establish the clinical, laboratory features, and treatment outcome of patients with vasculitis due to partial RAG deficiency. Vasculitis was a major complication in eight (13%) of 62 patients in our cohort with partial RAG deficiency with features of infections and immune dysregulation. Vasculitis occurred early in life, often as first sign of disease (50%) and was complicated by significant end organ damage. Viral infections often preceded the onset of predominately non-granulomatous-small vessel vasculitis. Autoantibodies against cytokines (IFN-α, -ω, and IL-12) were detected in a large fraction of the cases tested (80%), whereas the majority of patients were anti-neutrophil cytoplasmic antibodies (ANCA) negative (>80%). Genetic diagnosis of RAG deficiency was delayed up to 2 years from the onset of vasculitis. Clinical cases with sole skin manifestation responded well to first-line steroid treatment, whereas systemic vasculitis with severe end-organ complications required second-line immunosuppression and/or hematopoietic stem cell transplantation (HSCT) for definitive management. In conclusion, our data suggest that vasculitis in partial RAG deficiency is prevalent among patients with partial RAG deficiency and is associated with high morbidity. Therefore, partial RAG deficiency should be included in the differential diagnosis of patients with early-onset systemic vasculitis. Diagnostic serology may be misleading with ANCA negative findings, and search for conventional autoantibodies should be extended to include those targeting cytokines.
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Affiliation(s)
| | - Jocelyn R Farmer
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Zsofia Foldvari
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Boglarka Ujhazi
- University of South Florida and Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States
| | | | - John W Sleasman
- Division of Allergy, Immunology and Pulmonary Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Suhag Parikh
- Emory University School of Medicine, Atlanta, GA, United States
| | - Meredith A Dilley
- Department of Immunology, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
| | - Sung-Yun Pai
- Division of Hematology-Oncology, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Lauren Henderson
- Division of Immunology, Department of Rheumatology, Boston Children's Hospital, Boston, MA, United States
| | - Melissa Hazen
- Division of Immunology, Department of Rheumatology, Boston Children's Hospital, Boston, MA, United States
| | - Benedicte Neven
- Imagine Institute, Paris Descartes-Sorbonne Paris Cité University, Paris, France.,Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Laboratory "Immunogenetics of Pediatric autoimmune diseases", INSERM UMR1163, Institut Imagine, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Despina Moshous
- Imagine Institute, Paris Descartes-Sorbonne Paris Cité University, Paris, France.,Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Laboratory of Genome Dynamics in The Immune System, Paris, France
| | - Svetlana O Sharapova
- Research Department, Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Snezhina Mihailova
- Department of Clinical Immunology Medical University of Sofia, Sofia, Bulgaria
| | - Petya Yankova
- Department of Clinical Immunology Medical University of Sofia, Sofia, Bulgaria
| | - Elisaveta Naumova
- Department of Clinical Immunology Medical University of Sofia, Sofia, Bulgaria
| | - Seza Özen
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kevin Byram
- Cleveland Clinic Center for Vasculitis Care and Research, Cleveland, OH, United States
| | - James Fernandez
- Cleveland Clinic Center for Vasculitis Care and Research, Cleveland, OH, United States
| | - Hermann M Wolf
- Immunology Outpatient Clinic, Vienna, Austria.,Sigmund Freud Private University- Medical School, Vienna, Austria
| | - Martha M Eibl
- Immunology Outpatient Clinic, Vienna, Austria.,Biomedizinische Forschungs GmbH, Vienna, Austria
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, NIAID, National Institutes of Health, Bethesda, MD, United States
| | - Leonard H Calabrese
- Cleveland Clinic Center for Vasculitis Care and Research, Cleveland, OH, United States
| | - Jolan E Walter
- University of South Florida at Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States.,Division of Allergy and Immunology, Massachusetts General Hospital for Children, Boston, MA, United States
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Calabrese LH, Caporali R, Blank CU, Kirk AD. Modulating the wayward T cell: New horizons with immune checkpoint inhibitor treatments in autoimmunity, transplant, and cancer. J Autoimmun 2020; 115:102546. [PMID: 32980229 DOI: 10.1016/j.jaut.2020.102546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022]
Abstract
The T-cell response is regulated by the balance between costimulatory and coinhibitory signals. Immune checkpoints are essential for efficient T-cell activation, but also for maintaining self-tolerance and protecting tissues from damage caused by the immune system, and for providing protective immunity. Modulating immune checkpoints can serve diametric goals, such that blocking a coinhibitory molecule can unleash anti-cancer immunity whereas stimulating the same molecule can reduce an over-reaction in autoimmune disease. The purpose of this review is to examine the regulation of T-cell costimulation and coinhibition, which is central to the processes underpinning autoimmunity, transplant rejection and immune evasion in cancer. We will focus on the immunomodulation agents that regulate these unwanted over- and under-reactions. The use of such agents has led to control of symptoms and slowing of progression in patients with rheumatoid arthritis, reduced rejection rates in transplant patients, and prolonged survival in patients with cancer. The management of immune checkpoint inhibitor treatment in certain challenging patient populations, including patients with pre-existing autoimmune conditions or transplant patients who develop cancer, as well as the management of immune-related adverse events in patients receiving antitumor therapy, is examined. Finally, the future of immune checkpoint inhibitors, including examples of emerging targets that are currently in development, as well as recent insights gained using new molecular techniques, is discussed. T-cell costimulation and coinhibition play vital roles in these diverse therapeutic areas. Targeting immune checkpoints continues to be a powerful avenue for the development of agents suitable for treating autoimmune diseases and cancers and for improving transplant outcomes. Enhanced collaboration between therapy area specialists to share learnings across disciplines will improve our understanding of the opposing effects of treatments for autoimmune disease/transplant rejection versus cancer on immune checkpoints, which has the potential to lead to improved patient outcomes.
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Affiliation(s)
| | - Roberto Caporali
- University of Milan, Department of Clinical Sciences and Community Health and Rheumatology Division, ASST Pini-CTO Hospital, Milan, Italy
| | | | - Allan D Kirk
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States
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Calabrese LH, Calabrese C, Lenfant T, Kirchner E, Strand V. Infections in the Era of Targeted Therapies: Mapping the Road Ahead. Front Med (Lausanne) 2020; 7:336. [PMID: 32974356 PMCID: PMC7461856 DOI: 10.3389/fmed.2020.00336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022] Open
Abstract
Immunosuppressive treatment strategies for autoimmune diseases have changed drastically with the development of targeted therapies. While targeted therapies have changed the way we manage immune mediated diseases, their use has been attended by a variety of infectious complications—some expected, others unexpected. This perspective examines lessons learned from the use of different targeted therapies over the past several decades, and reviews existing strategies to minimize infectious risk. Several of these infectious complications were predictable in the light of preclinical models and early clinical trials (i.e., tuberculosis and TNF inhibitors; meningococcus; and eculizumab). While these scenarios can potentially help us in terms of enhancing our predictive powers (higher vigilance, earlier detection, and risk mitigation), targeted therapies have also revealed unpredictable toxicities (i.e., natalizumab and progressive multifocal leukoencephalopathy). Severe infectious complications, even if rare, can derail a promising therapeutic and highlight the need for increased awareness and meticulous adjudication. Tools are available to help mitigate infectious risks. The first step is to ensure that infection safety is adequately studied at every level of drug development prior to regulatory approval, with adequate post-marketing surveillance including registries that collect real-world adverse events in a collaborative effort. The second step is to identify high risk patients (using risk calculators such as the RABBIT risk score; big data analyses; artificial intelligence). Finally, the most underutilized interventions to prevent severe infections in patients receiving targeted therapies across the spectrum of immune mediated inflammatory diseases are vaccinations.
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Affiliation(s)
- Leonard H Calabrese
- Rheumatic & Immunologic Disease, Cleveland Clinic, Cleveland, OH, United States
| | - Cassandra Calabrese
- Rheumatic & Immunologic Disease, Cleveland Clinic, Cleveland, OH, United States
| | - Tiphaine Lenfant
- Rheumatic & Immunologic Disease, Cleveland Clinic, Cleveland, OH, United States.,Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France.,Hôpital Européen Georges Pompidou, Service de Médecine Interne, Paris, France
| | - Elizabeth Kirchner
- Rheumatic & Immunologic Disease, Cleveland Clinic, Cleveland, OH, United States
| | - Vibeke Strand
- Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA, United States
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Calabrese LH, Lenfant T, Calabrese C. Cytokine storm release syndrome and the prospects for immunotherapy with COVID-19, part 3: The role of GM-CSF. Cleve Clin J Med 2020:ccjm.87a.ccc057. [PMID: 32753517 DOI: 10.3949/ccjm.87a.ccc057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Granulocyte-macrophage colony-stimulating factor (GM-CSF) has been used experimentally in patients with acute respiratory distress syndrome. Recombinant GM-CSF administered by direct inhalation is currently being studied in a cohort of patients with advanced COVID-19.
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Affiliation(s)
- Leonard H Calabrese
- Department of Rheumatic and Immunologic Diseases, Orthopedic & Rheumatologic Institute, Cleveland Clinic
| | - Tiphaine Lenfant
- Department of Rheumatic and Immunologic Diseases, Orthopedic & Rheumatologic Institute Department of Infectious Disease, Cleveland Clinic; Assistance Publique des Hôpitaux de Paris, Université de Paris; Hôpital européen Georges Pompidou, Service de médecine interne, Paris, France
| | - Cassandra Calabrese
- Department of Rheumatic and Immunologic Diseases, Orthopedic & Rheumatologic Institute, and Department of Infectious Disease, Cleveland Clinic
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Calabrese LH, Abud-Mendoza C, Lindsey SM, Lee SH, Tatulych S, Takiya L, Iikuni N, Soma K, Luo Z, Fleischmann R. Live Zoster Vaccine in Patients With Rheumatoid Arthritis Treated With Tofacitinib With or Without Methotrexate, or Adalimumab With Methotrexate: A Post Hoc Analysis of Data From a Phase IIIb/IV Randomized Study. Arthritis Care Res (Hoboken) 2020; 72:353-359. [PMID: 31207152 PMCID: PMC7064887 DOI: 10.1002/acr.24010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/11/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To explore herpes zoster (HZ) rates and live zoster vaccine (LZV) safety in a subset of patients with rheumatoid arthritis who received LZV before tofacitinib ± methotrexate (MTX), or adalimumab (ADA) plus MTX in the ORAL Strategy. METHODS ORAL Strategy was a 1-year, phase IIIb/IV, randomized, triple-dummy, active-comparator-controlled study. MTX-inadequate responder patients received tofacitinib 5 mg twice daily (BID), tofacitinib 5 mg BID plus MTX, or ADA 40 mg every other week plus MTX (1:1:1 randomization). Eligible patients age ≥50 years could opt to receive LZV 28 days before initiating study treatment. HZ incidence rates (IRs; patients with events per 100 patient-years) were calculated. Opportunistic HZ infections (multidermatomal/disseminated), serious HZ events, and LZV-related adverse events were monitored. RESULTS In ORAL Strategy, 216 of 1,146 patients (18.8%) received LZV. Overall, 18 patients (1.6%) developed HZ (vaccinated: n = 3; nonvaccinated: n = 15). HZ IRs were 1.1 (95% confidence interval [95% CI] 0.3-2.9), 2.3 (95% CI 1.0-4.6), and 1.7 (95% CI 0.6-3.7) for tofacitinib monotherapy, tofacitinib plus MTX, and ADA plus MTX, respectively, and were generally similar between vaccinated and nonvaccinated patients. Three multidermatomal, 1 disseminated, and 2 serious HZ events occurred. No vaccinated patients had zoster-like lesions within 42 days of vaccination; 1 patient had vaccination-site erythema. CONCLUSION LZV was well tolerated, and HZ IRs were generally similar between treatment groups and vaccinated versus nonvaccinated patients. However, ORAL Strategy was not powered for comparisons between vaccinated and nonvaccinated patients because <20% of all patients were vaccinated. Furthermore, LZV has been shown to be effective only in ~50% of individuals.
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Affiliation(s)
| | | | | | - Sang-Heon Lee
- Konkuk University School of Medicine, Seoul, South Korea
| | | | | | | | | | | | - Roy Fleischmann
- Metroplex Clinical Research Center and University of Texas Southwestern Medical Center, Dallas
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Calabrese LH, Calabrese C. Cytokine release syndrome and the prospects for immunotherapy with COVID-19. Part 2: The role of interleukin 1. Cleve Clin J Med 2020:ccjm.87a.ccc044. [PMID: 32646930 DOI: 10.3949/ccjm.87a.ccc044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Interleukin 1 (IL-1) is a potential target of therapy in COVID-19 during the severe respiratory-inflammatory phase ("cytokine release syndrome"), when pulmonary macrophages are hyperactivated, releasing IL-1 and other cytokines. Preliminary evidence indicates that anakinra and canakinumab, drugs that block the action of IL-1 and have a good safety profile, improve the outcomes of patients with COVID-19 cytokine release syndrome. Results from large, randomized clinical trials are pending.
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Affiliation(s)
- Leonard H Calabrese
- Department of Rheumatic and Immunologic Diseases, Orthopedic & Rheumatologic Institute, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Cassandra Calabrese
- Department of Rheumatic and Immunologic Diseases, Orthopedic & Rheumatologic Institute, and Department of Infectious Disease, Cleveland Clinic
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Abstract
Knowledge about the pathobiology of SARS-CoV-2 as it interacts with immune defenses is limited. SARS-CoV-2 is spread by droplets that come into contact with mucous membranes. COVID-19 is characterized by 2 or 3 stages: most patients who recover experience 2 stages of illness commencing with an asymptomatic or paucisymptomatic incubation period, followed by a nonsevere symptomatic illness lasting for several weeks, occurring in about 80% of those infected. In the remainder, a third phase marked by a severe respiratory illness, often accompanied by multisystem dysfunction, coagulopathy, and shock is observed. This phase of the illness is characterized by hypercytokinemic inflammation and is often referred to as "cytokine storm." While the immunopathogenesis remains unclear, prospects of treating this severe phase of the illness with immunotherapy are evolving, with some treatments showing promise.
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Affiliation(s)
- Leonard H Calabrese
- Department of Rheumatic and Immunologic Diseases, Orthopaedic & Rheumatologic Institute, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Hojat M, DeSantis J, Shannon SC, Speicher MR, Bragan L, Calabrese LH. Empathy as related to gender, age, race and ethnicity, academic background and career interest: A nationwide study of osteopathic medical students in the United States. Med Educ 2020; 54:571-581. [PMID: 32083747 PMCID: PMC7317910 DOI: 10.1111/medu.14138] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/27/2020] [Accepted: 02/17/2020] [Indexed: 05/09/2023]
Abstract
CONTEXT Research on associations between medical student empathy and demographics, academic background and career interest is limited, lacks representative samples and suffers from single institutional features. This study was designed to fill the gap by examining associations between empathy in patient care, and gender, age, race and ethnicity, academic background and career interest in nationwide, multi-institutional samples of medical students in the United States and to provide more definitive answers regarding the aforementioned associations, with more confidence in the internal and external validity of the findings. METHODS Four nationwide samples participated in this study (n = 10 751). Samples 1, 2, 3 and 4 included 3616 first-year, 2764 second-year, 2413 third-year and 1958 fourth-year students who completed a web-based survey at the end of the 2017-2018 academic year. The survey included questions on demographics, academic background and career interest, the Jefferson Scale of Empathy, and the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire to control for the effect of 'good impression' response bias. RESULTS Statistically significant and practically important associations were found between empathy scores and gender (in favour of women), race and ethnicity (in favour of African-American and Hispanic/Latino/Spanish), academic background (in favour of 'Social and Behavioural Sciences' and 'Arts and Humanities' in Samples 1 and 2) and career interest (in favour of 'People-Oriented' and 'Psychiatry' specialties). CONCLUSIONS Special features of this study (eg, nationwide representative samples, use of a validated instrument for measuring empathy in patient care, statistical control for the effect of 'good impression' response bias, and consistency of findings in different samples from multiple institutions) provide more definitive answers to the issue of correlates of empathy in medical students and increase our confidence in the validity, reliability and generalisability of the results. Findings have implications for career counselling and targeting students who need more guidance to enhance their empathic orientation.
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Affiliation(s)
- Mohammadreza Hojat
- Asano‐Gonnella Center for Research in Medical Education and HealthcareSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Jennifer DeSantis
- Asano‐Gonnella Center for Research in Medical Education and HealthcareSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Stephen C. Shannon
- American Association of Colleges of Osteopathic MedicineBethesdaMarylandUSA
| | - Mark R. Speicher
- American Association of Colleges of Osteopathic MedicineBethesdaMarylandUSA
| | - Lynn Bragan
- American Association of Colleges of Osteopathic MedicineBethesdaMarylandUSA
| | - Leonard H. Calabrese
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandOhioUSA
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Hojat M, Shannon SC, DeSantis J, Speicher MR, Bragan L, Calabrese LH. Does Empathy Decline in the Clinical Phase of Medical Education? A Nationwide, Multi-Institutional, Cross-Sectional Study of Students at DO-Granting Medical Schools. Acad Med 2020; 95:911-918. [PMID: 31977341 PMCID: PMC7242173 DOI: 10.1097/acm.0000000000003175] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
PURPOSE To examine differences in students' empathy in different years of medical school in a nationwide study of students of U.S. DO-granting medical schools. METHOD Participants in this cross-sectional study included 10,751 students enrolled in 41 of 48 campuses of DO-granting medical schools in the United States (3,616 first-year, 2,764 second-year, 2,413 third-year, and 1,958 fourth-year students). They completed a web-based survey at the end of the 2017-2018 academic year that included the Jefferson Scale of Empathy and the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire for measuring "good impression" response bias. Comparisons were made on empathy scores among students in different years of medical school using analysis of covariance, controlling for the effect of "good impression" response bias. Also, comparisons were made with preexisting data from students of U.S. MD-granting medical schools. RESULTS A statistically significant decline in empathy scores was observed when comparing students in the preclinical (years 1 and 2) and the clinical (years 3 and 4) phases of medical school (P < .001); however, the magnitude of the decline was negligible (effect size =0.13). Comparison of findings with MD students showed that while the pattern of empathy decline was similar, the magnitude of the decline was less pronounced in DO students. CONCLUSIONS Differences in DO-granting and MD-granting medical education systems, such as emphasis on provision of holistic care, hands-on approaches to diagnosis and treatment, and patient-centered care, provide plausible explanations for disparity in the magnitude of empathy decline in DO compared with MD students. More research is needed to examine changes in empathy in longitudinal study and explore reasons for changes to avert erosion of empathy in medical school.
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Affiliation(s)
- Mohammadreza Hojat
- M. Hojat is research professor of psychiatry and human behavior, Department of Psychiatry and Human Behavior, and director, Jefferson Longitudinal Study of Medical Education, Asano-Gonnella Center for Research in Medical Education and Health Care, and Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; ORCID: https:///orcid.org/0000-0002-8841-3269
| | - Stephen C. Shannon
- S.C. Shannon is emeritus president, American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland
| | - Jennifer DeSantis
- J. DeSantis is senior research study analyst, Asano-Gonnella Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark R. Speicher
- M.R. Speicher is senior vice president for medical education and research, American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland
| | - Lynn Bragan
- L. Bragan is project manager, American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland
| | - Leonard H. Calabrese
- L.H. Calabrese is professor of medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, R.J. Fasenmyer Chair of clinical immunology, Theodore F. Classen DO Chair of osteopathic research and education, and vice chair, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
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Hojat M, Shannon SC, DeSantis J, Speicher MR, Bragan L, Calabrese LH. Empathy in Medicine National Norms for the Jefferson Scale of Empathy: A Nationwide Project in Osteopathic Medical Education and Empathy (POMEE). J Osteopath Med 2020; 119:520-532. [PMID: 31355891 DOI: 10.7556/jaoa.2019.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Context National norms are necessary to assess individual scores from validated instruments. Before undertaking this study, no national norms were available on empathy scores. The Project in Osteopathic Medical Education and Empathy (POMEE) provided a unique opportunity to develop the first national norms for medical students. Objective To develop national norms for the assessments of osteopathic medical students' empathy scores on the broadly used and well-validated Jefferson Scale of Empathy (JSE) at all levels of osteopathic medical school education. Methods Participants were students from 41 of 48 participating campuses of osteopathic medical schools. Students were invited to complete a web-based survey, which included the JSE, in the 2017-2018 academic year. Results A total of 16,149 completed surveys were used to create national norm tables. Three national norm tables were developed for first-year matriculants and for students in preclinical (years 1 and 2) and clinical (years 3 and 4) phases of medical school. The norm tables allow any raw score on the JSE for male and female osteopathic medical students from matriculation to graduation to be converted to a percentile rank to assess an individual's score against national data. Conclusions National norms developed in this project, for men and women and at different levels of medical school education, can not only be used for the assessment of student's individual scores on the JSE, but can also serve as a supplementary measure for admissions to medical school and postgraduate medical education programs.
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Kostine M, Finckh A, Bingham CO, Visser K, Leipe J, Schulze-Koops H, Choy EH, Benesova K, Radstake TRDJ, Cope AP, Lambotte O, Gottenberg JE, Allenbach Y, Visser M, Rusthoven C, Thomasen L, Jamal S, Marabelle A, Larkin J, Haanen JBAG, Calabrese LH, Mariette X, Schaeverbeke T. EULAR points to consider for the diagnosis and management of rheumatic immune-related adverse events due to cancer immunotherapy with checkpoint inhibitors. Ann Rheum Dis 2020; 80:36-48. [PMID: 32327425 PMCID: PMC7788064 DOI: 10.1136/annrheumdis-2020-217139] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [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: 02/10/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022]
Abstract
Background Rheumatic and musculoskeletal immune-related adverse events (irAEs) are observed in about 10% of patients with cancer receiving checkpoint inhibitors (CPIs). Given the recent emergence of these events and the lack of guidance for rheumatologists addressing them, a European League Against Rheumatism task force was convened to harmonise expert opinion regarding their identification and management. Methods First, the group formulated research questions for a systematic literature review. Then, based on literature and using a consensus procedure, 4 overarching principles and 10 points to consider were developed. Results The overarching principles defined the role of rheumatologists in the management of irAEs, highlighting the shared decision-making process between patients, oncologists and rheumatologists. The points to consider inform rheumatologists on the wide spectrum of musculoskeletal irAEs, not fulfilling usual classification criteria of rheumatic diseases, and their differential diagnoses. Early referral and facilitated access to rheumatologist are recommended, to document the target organ inflammation. Regarding therapeutic, three treatment escalations were defined: (1) local/systemic glucocorticoids if symptoms are not controlled by symptomatic treatment, then tapered to the lowest efficient dose, (2) conventional synthetic disease-modifying antirheumatic drugs, in case of inadequate response to glucocorticoids or for steroid sparing and (3) biological disease-modifying antirheumatic drugs, for severe or refractory irAEs. A warning has been made on severe myositis, a life-threatening situation, requiring high dose of glucocorticoids and close monitoring. For patients with pre-existing rheumatic disease, baseline immunosuppressive regimen should be kept at the lowest efficient dose before starting immunotherapies. Conclusion These statements provide guidance on diagnosis and management of rheumatic irAEs and aim to support future international collaborations.
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Affiliation(s)
- Marie Kostine
- Rheumatology, University Hospital of Bordeaux, Bordeaux, France
| | - Axel Finckh
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Karen Visser
- Rheumatology, Haga Hospital, Den Haag, The Netherlands
| | - Jan Leipe
- Department of Medicine V, Division of Rheumatology, University Hospital Centre, Mannheim, Germany.,Department of Internal Medicine IV, Division of Rheumatology and Clinical Immunology, University of Munich, Munich, Germany
| | - Hendrik Schulze-Koops
- Department of Internal Medicine IV, Division of Rheumatology and Clinical Immunology, University of Munich, Munich, Germany
| | - Ernest H Choy
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | | | | | - Andrew P Cope
- Academic Department of Rheumatology, King's College London, London, UK
| | - Olivier Lambotte
- Internal Medicine and Clinical Immunology, Hopital Bicetre, Le Kremlin-Bicetre, France
| | | | - Yves Allenbach
- Internal Medicine and Clinical Immunology, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - Marianne Visser
- EULAR PARE Patient Research Partners, Amsterdam, The Netherlands
| | - Cindy Rusthoven
- EULAR PARE Patient Research Partners, Amsterdam, The Netherlands
| | | | - Shahin Jamal
- Rheumatology, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - James Larkin
- Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - John B A G Haanen
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | | | - Xavier Mariette
- Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux universitaires Paris-Sud - Hôpital Bicêtre, Le Kremlin Bicêtre, France.,3Université Paris-Sud, Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Université Paris-Saclay, Le Kremlin Bicêtre, France
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Saygin D, Jones S, Sundaram P, Calabrese LH, Messner W, Tavee JO, Hajj-Ali RA. Differentiation between neurosarcoidosis and primary central nervous system vasculitis based on demographic, cerebrospinal and imaging features. Clin Exp Rheumatol 2020; 38 Suppl 124:135-138. [PMID: 31928590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Neurosarcoidosis (NS) and primary angiitis of central nervous system (PACNS) are inflammatory diseases affecting central nervous system, with overlapping clinical and pathological characteristics. Distinguishing these diseases is important given distinct therapeutic implications. In this study, we aimed to compare demographic, CSF and MRI characteristics between these two conditions. METHODS All the clinical, CSF and laboratory characteristics at the time of presentation were retrieved from electronic medical records. Brain and/or spinal cord MRI performed near the time of presentation were blindly evaluated by two neuroradiologists. Data regarding involvement of pachy- and leptomeninges, basal meninges, cranial nerves, cerebral grey and white matter, and spinal cord were recorded for each patient. RESULTS 78 patients with PACNS and 25 patients with NS were included in the study. Mean age of patients was 43.7 (±16.7) and 43.6 (±12.5) in PACNS and NS, respectively. African-American race was found to be associated with the diagnosis of NS rather than PACNS. Patients with PACNS had higher frequency of cerebral involvement, while patients with NS demonstrated more frequent spinal cord, basal meningeal and cranial nerve involvements. CONCLUSIONS These findings suggest that MRI can be an efficient tool in distinguishing PACNS from NS. A follow-up study with a larger sample size would be required to validate our results.
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Affiliation(s)
- Didem Saygin
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephen Jones
- Department of Neuroradiology, Cleveland Clinic, Cleveland, OH, USA
| | - Priya Sundaram
- Department of Diagnostic Radiology, University Hospitals Parma Medical Center
| | | | - William Messner
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Jinny O Tavee
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Rula A Hajj-Ali
- Department of Rheumatology, Cleveland Clinic, Cleveland, OH, USA.
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Wilson MR, O'Donovan BD, Gelfand JM, Sample HA, Chow FC, Betjemann JP, Shah MP, Richie MB, Gorman MP, Hajj-Ali RA, Calabrese LH, Zorn KC, Chow ED, Greenlee JE, Blum JH, Green G, Khan LM, Banerji D, Langelier C, Bryson-Cahn C, Harrington W, Lingappa JR, Shanbhag NM, Green AJ, Brew BJ, Soldatos A, Strnad L, Doernberg SB, Jay CA, Douglas V, Josephson SA, DeRisi JL. Chronic Meningitis Investigated via Metagenomic Next-Generation Sequencing. JAMA Neurol 2019; 75:947-955. [PMID: 29710329 DOI: 10.1001/jamaneurol.2018.0463] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Identifying infectious causes of subacute or chronic meningitis can be challenging. Enhanced, unbiased diagnostic approaches are needed. Objective To present a case series of patients with diagnostically challenging subacute or chronic meningitis using metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) supported by a statistical framework generated from mNGS of control samples from the environment and from patients who were noninfectious. Design, Setting, and Participants In this case series, mNGS data obtained from the CSF of 94 patients with noninfectious neuroinflammatory disorders and from 24 water and reagent control samples were used to develop and implement a weighted scoring metric based on z scores at the species and genus levels for both nucleotide and protein alignments to prioritize and rank the mNGS results. Total RNA was extracted for mNGS from the CSF of 7 participants with subacute or chronic meningitis who were recruited between September 2013 and March 2017 as part of a multicenter study of mNGS pathogen discovery among patients with suspected neuroinflammatory conditions. The neurologic infections identified by mNGS in these 7 participants represented a diverse array of pathogens. The patients were referred from the University of California, San Francisco Medical Center (n = 2), Zuckerberg San Francisco General Hospital and Trauma Center (n = 2), Cleveland Clinic (n = 1), University of Washington (n = 1), and Kaiser Permanente (n = 1). A weighted z score was used to filter out environmental contaminants and facilitate efficient data triage and analysis. Main Outcomes and Measures Pathogens identified by mNGS and the ability of a statistical model to prioritize, rank, and simplify mNGS results. Results The 7 participants ranged in age from 10 to 55 years, and 3 (43%) were female. A parasitic worm (Taenia solium, in 2 participants), a virus (HIV-1), and 4 fungi (Cryptococcus neoformans, Aspergillus oryzae, Histoplasma capsulatum, and Candida dubliniensis) were identified among the 7 participants by using mNGS. Evaluating mNGS data with a weighted z score-based scoring algorithm reduced the reported microbial taxa by a mean of 87% (range, 41%-99%) when taxa with a combined score of 0 or less were removed, effectively separating bona fide pathogen sequences from spurious environmental sequences so that, in each case, the causative pathogen was found within the top 2 scoring microbes identified using the algorithm. Conclusions and Relevance Diverse microbial pathogens were identified by mNGS in the CSF of patients with diagnostically challenging subacute or chronic meningitis, including a case of subarachnoid neurocysticercosis that defied diagnosis for 1 year, the first reported case of CNS vasculitis caused by Aspergillus oryzae, and the fourth reported case of C dubliniensis meningitis. Prioritizing metagenomic data with a scoring algorithm greatly clarified data interpretation and highlighted the problem of attributing biological significance to organisms present in control samples used for metagenomic sequencing studies.
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Affiliation(s)
- Michael R Wilson
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco
| | | | - Jeffrey M Gelfand
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco
| | - Hannah A Sample
- Department of Biochemistry and Biophysics, UCSF, San Francisco
| | - Felicia C Chow
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco.,Division of Infectious Diseases, Department of Medicine, UCSF, San Francisco
| | - John P Betjemann
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco.,Web Editor
| | - Maulik P Shah
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco
| | - Megan B Richie
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco.,Images in Neurology Editor
| | - Mark P Gorman
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Rula A Hajj-Ali
- Department of Rheumatology/Immunology, Cleveland Clinic, Cleveland, Ohio
| | | | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, UCSF, San Francisco
| | - Eric D Chow
- Department of Biochemistry and Biophysics, UCSF, San Francisco
| | - John E Greenlee
- Neurology Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Neurology, University of Utah Health, Salt Lake City
| | | | - Gary Green
- Permanente Medical Group, Inc, Oakland, California.,Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, California
| | - Lillian M Khan
- Department of Biochemistry and Biophysics, UCSF, San Francisco
| | - Debarko Banerji
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco
| | - Charles Langelier
- Division of Infectious Diseases, Department of Medicine, UCSF, San Francisco
| | - Chloe Bryson-Cahn
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle
| | - Whitney Harrington
- Department of Pediatrics, University of Washington, Seattle.,Seattle Children's Hospital, Seattle, Washington
| | - Jairam R Lingappa
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle.,Department of Pediatrics, University of Washington, Seattle.,Department of Pediatric Infectious Diseases, Seattle Children's Hospital, Seattle, Washington.,Department of Global Health, University of Washington, Seattle
| | - Niraj M Shanbhag
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco
| | - Ari J Green
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco.,Associate Editor
| | - Bruce J Brew
- Department of Neurology, St Vincent's Hospital, Darlinghurst, New South Wales, Australia.,The University of New South Wales, Sydney, New South Wales, Australia
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Services Bethesda, Maryland
| | - Luke Strnad
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland
| | - Sarah B Doernberg
- Division of Infectious Diseases, Department of Medicine, UCSF, San Francisco
| | - Cheryl A Jay
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco
| | - Vanja Douglas
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco
| | - S Andrew Josephson
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco.,Editor
| | - Joseph L DeRisi
- Department of Biochemistry and Biophysics, UCSF, San Francisco.,Chan Zuckerberg Biohub, San Francisco, California
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Pallotta AM, Pirzada SA, Shrestha RK, Yen-Lieberman B, Calabrese LH, Taege AJ, Butler RS, Abbas UL. Presentation to HIV care and antiretroviral therapy initiation and response in clinical practice from 2003 through 2013. Int J STD AIDS 2019; 30:853-860. [PMID: 31280687 DOI: 10.1177/0956462419841219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Universal HIV screening and treatment initiation of HIV-positive persons are well-established standards. However, late presentation to care is a barrier to early antiretroviral therapy (ART) and prevention of HIV transmission. We sought to determine the immunodeficiency at presentation to care and characterize the initiation and response to ART among HIV-positive persons over 2003–2013 in our urban HIV clinical practice at the Cleveland Clinic. Using a retrospective cohort study design, we assessed the CD4 cell count of HIV-positive patients at entry into care for each year and evaluated the trend over time. For patients who initiated treatment, we assessed the pretreatment CD4 cell count, consistency of timing and regimen with US treatment guidelines, and HIV RNA level at one-year and last follow-up visits. Regression analyses were used to determine predictors of study outcomes. We found that the cohort (N = 452) median CD4 cell count at presentation to care was 297 cells/mm3 (inter-quartile range: 104–479 cells/mm3), without any significant change over time (P = 0.62), and with 37% and 21% of presentations being late and advanced, respectively. Guideline-consistency (85%–100%) and regimen-consistency (41%–100%) were moderate to high and improved over time. Virologic suppression (<400 copies/ml) at one year and last follow-up was high (79% and 92%) and associated with regimen selection and durability. We conclude that CD4 cell count at first presentation to HIV care remained less than 350 cells/mm3 for 11 years in our clinical practice, despite advances in HIV testing and treatment guidelines. Early diagnosis and linkage to care and treatment are critical for ending the HIV epidemic.
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Affiliation(s)
| | | | | | | | | | | | | | - Ume L Abbas
- 1 Cleveland Clinic, Cleveland, OH, USA.,2 Baylor College of Medicine, Houston, TX, USA
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Mandel-Brehm C, Retallack H, Knudsen GM, Yamana A, Hajj-Ali RA, Calabrese LH, Tihan T, Sample HA, Zorn KC, Gorman MP, Madan Cohen J, Sreih AG, Marcus JF, Josephson SA, Douglas VC, Gelfand JM, Wilson MR, DeRisi JL. Exploratory proteomic analysis implicates the alternative complement cascade in primary CNS vasculitis. Neurology 2019; 93:e433-e444. [PMID: 31270218 DOI: 10.1212/wnl.0000000000007850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 03/12/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To identify molecular correlates of primary angiitis of the CNS (PACNS) through proteomic analysis of CSF from a biopsy-proven patient cohort. METHODS Using mass spectrometry, we quantitatively compared the CSF proteome of patients with biopsy-proven PACNS (n = 8) to CSF from individuals with noninflammatory conditions (n = 11). Significantly enriched molecular pathways were identified with a gene ontology workflow, and high confidence hits within enriched pathways (fold change >1.5 and concordant Benjamini-Hochberg-adjusted p < 0.05 on DeSeq and t test) were identified as differentially regulated proteins. RESULTS Compared to noninflammatory controls, 283 proteins were differentially expressed in the CSF of patients with PACNS, with significant enrichment of the complement cascade pathway (C4-binding protein, CD55, CD59, properdin, complement C5, complement C8, and complement C9) and neural cell adhesion molecules. A subset of clinically relevant findings were validated by Western blot and commercial ELISA. CONCLUSIONS In this exploratory study, we found evidence of deregulation of the alternative complement cascade in CSF from biopsy-proven PACNS compared to noninflammatory controls. More specifically, several regulators of the C3 and C5 convertases and components of the terminal cascade were significantly altered. These preliminary findings shed light on a previously unappreciated similarity between PACNS and systemic vasculitides, especially anti-neutrophil cytoplasmic antibody-associated vasculitis. The therapeutic implications of this common biology and the diagnostic and therapeutic utility of individual proteomic findings warrant validation in larger cohorts.
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Affiliation(s)
- Caleigh Mandel-Brehm
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Hanna Retallack
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Giselle M Knudsen
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Alex Yamana
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Rula A Hajj-Ali
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Leonard H Calabrese
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Tarik Tihan
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Hannah A Sample
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Kelsey C Zorn
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Mark P Gorman
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Jennifer Madan Cohen
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Antoine G Sreih
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Jacqueline F Marcus
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - S Andrew Josephson
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Vanja C Douglas
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Jeffrey M Gelfand
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Michael R Wilson
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA
| | - Joseph L DeRisi
- From the Departments of Biochemistry and Biophysics (C.M.-B., H.R., H.A.S., K.C.Z., J.L.D.), Pharmaceutical Chemistry (G.M.K., A.Y.), Pathology and Laboratory Medicine (T.T.), and Neurology (S.A.J., V.C.D., J.M.G., M.R.W.), University of California, San Francisco; Department of Rheumatology/Immunology (R.A.H.-A., L.H.C.), Cleveland Clinic, OH; Department of Neurology (M.P.G.), Boston Children's Hospital, MA; Division of Neurology (J.M.C.), Connecticut Children's Medical Center, Hartford; Division of Rheumatology (A.G.S.), University of Pennsylvania, Philadelphia; Kaiser Permanente (J.F.M.), San Francisco Medical Center; UCSF Weill Institute for Neurosciences (S.A.J., V.C.D., J.M.G., M.R.W.); and Chan Zuckerberg Biohub (J.L.D.), San Francisco, CA.
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Ornstein MC, Calabrese C, Wood LS, Kirchner E, Profusek P, Allman KD, Martin A, Kontzias A, Grivas P, Garcia JA, Calabrese LH, Rini BI. Myalgia and Arthralgia Immune-related Adverse Events (irAEs) in Patients With Genitourinary Malignancies Treated With Immune Checkpoint Inhibitors. Clin Genitourin Cancer 2019; 17:177-182. [DOI: 10.1016/j.clgc.2019.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/31/2019] [Indexed: 01/04/2023]
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Abstract
RA is a chronic, systemic, autoimmune disease characterized by inflammation and degradation of the joints, causing significant negative impact on quality of life. In addition to joint disease, symptoms and co-morbidities associated with RA-namely pain, fatigue and mood disorders-are often as debilitating as the disease itself. The pro-inflammatory cytokine IL-6 plays a critical role in RA-associated pathology. However, a greater understanding of the translational effects of IL-6 outside of the immune system is needed. This review discusses our current understanding of emerging aspects of IL-6 in RA-associated pain, fatigue and mood disorders such as depression and anxiety. This review also describes the clinical effects of IL-6 inhibition on these symptoms and co-morbidities in patients with RA.
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Affiliation(s)
- Ernest H S Choy
- Section of Rheumatology, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
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Getz TM, Hoffman GS, Padmanabhan R, Villa-Forte A, Roselli EE, Blackstone E, Johnston D, Pettersson G, Soltesz E, Svensson LG, Calabrese LH, Clifford AH, Eng C. Microbiomes of Inflammatory Thoracic Aortic Aneurysms Due to Giant Cell Arteritis and Clinically Isolated Aortitis Differ From Those of Non-Inflammatory Aneurysms. Pathog Immun 2019; 4:105-123. [PMID: 30993253 PMCID: PMC6438704 DOI: 10.20411/pai.v4i1.269] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 10/13/2018] [Accepted: 02/21/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE We sought to characterize microbiomes of thoracic aortas from patients with non-infectious aortitis due to giant cell arteritis (GCA) and clinically isolated aortitis (CIA) and to compare them to non-inflammatory aorta aneurysm controls. We also compared microbiomes from concurrently processed and separately reported temporal arteries (TA) and aortas. METHODS From 220 prospectively enrolled patients undergoing surgery for thoracic aorta aneurysm, 49 were selected. Inflammatory and non-inflammatory cases were selected based on ability to match for age (+/-10 years), gender, and race. Biopsies were collected under aseptic conditions and snap-frozen. Taxonomic classification of bacterial sequences was performed to the genus level and relative abundances were calculated. Microbiome differential abundances were analyzed by principal coordinates analysis. RESULTS Forty-nine patients with thoracic aortic aneurysms (12 CIA, 14 GCA, 23 non-inflammatory aneurysms) were enrolled. Alpha (P=0.018) and beta (P=0.024) diversity differed between specimens from aortitis cases and controls. There were no significant differences between CIA and GCA (P>0.7). The largest differential abundances between non-infectious aortitis and non-inflammatory control samples included Enterobacteriaceae, Phascolarctobacterium, Acinetobactor, Klebsiella, and Prevotella. Functional metagenomic predictions with PICRUSt revealed enrichment of oxidative phosphorylation and porphyrin metabolism pathways and downregulation of transcription factor pathways in aortitis compared to controls. Microbiomes of aortic samples differed significantly from temporal artery samples from a companion study, in both control and GCA groups (P=0.0002). CONCLUSION Thoracic aorta aneurysms, far from being sterile, contain unique microbiomes that differ from those found in temporal arteries. The aorta microbiomes are most similar between aneurysms that were associated with inflammation, GCA, and CIA, but differed from those associated with non-inflammatory etiologies. These findings are promising in that they indicate that microbes may play a role in the pathogenesis of aortitis-associated aneurysms or non-inflammatory aneurysms by promoting or protecting against inflammation. However, we cannot rule out that these changes are related to alterations in tissue substrate that favor secondary changes in microbial communities.
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Affiliation(s)
- Ted M. Getz
- Genomic Medicine Institute; Lerner Research Institute; Cleveland Clinic; Cleveland, Ohio
| | - Gary S. Hoffman
- Center for Vasculitis Care and Research; Department of Rheumatic and Immunologic Diseases; Cleveland Clinic; Cleveland, Ohio
| | - Roshan Padmanabhan
- Genomic Medicine Institute; Lerner Research Institute; Cleveland Clinic; Cleveland, Ohio
| | - Alexandra Villa-Forte
- Center for Vasculitis Care and Research; Department of Rheumatic and Immunologic Diseases; Cleveland Clinic; Cleveland, Ohio
| | - Eric E. Roselli
- Center for Aortic Diseases; Heart Vascular Institute; Cleveland Clinic; Cleveland, Ohio
| | - Eugene Blackstone
- Center for Aortic Diseases; Heart Vascular Institute; Cleveland Clinic; Cleveland, Ohio
| | - Douglas Johnston
- Center for Aortic Diseases; Heart Vascular Institute; Cleveland Clinic; Cleveland, Ohio
| | - Gosta Pettersson
- Center for Aortic Diseases; Heart Vascular Institute; Cleveland Clinic; Cleveland, Ohio
| | - Edward Soltesz
- Center for Aortic Diseases; Heart Vascular Institute; Cleveland Clinic; Cleveland, Ohio
| | - Lars G. Svensson
- Center for Aortic Diseases; Heart Vascular Institute; Cleveland Clinic; Cleveland, Ohio
| | - Leonard H. Calabrese
- Center for Vasculitis Care and Research; Department of Rheumatic and Immunologic Diseases; Cleveland Clinic; Cleveland, Ohio
| | - Alison H. Clifford
- Center for Vasculitis Care and Research; Department of Rheumatic and Immunologic Diseases; Cleveland Clinic; Cleveland, Ohio
- Division of Rheumatology; Department of Medicine; University of Alberta; Edmonton, Alberta T6G 2R7, Canada
| | - Charis Eng
- Genomic Medicine Institute; Lerner Research Institute; Cleveland Clinic; Cleveland, Ohio
- Taussig Cancer Institute; Cleveland Clinic; Cleveland, Ohio
- Department of Genetics and Genome Sciences; Case Western Reserve University School of Medicine; Cleveland, Ohio
- Germline High Risk Focus Group; CASE Comprehensive Cancer Center; Case Western Reserve University School of Medicine; Cleveland, Ohio
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Calabrese LH, Emery P, Kivitz AJ, Tesser JRP. Evolving treatment paradigms for rheumatoid arthritis: Translating comprehensive patient evaluations into personalized therapy. Semin Arthritis Rheum 2019; 50:1549. [PMID: 30850126 DOI: 10.1016/j.semarthrit.2019.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Leonard H Calabrese
- Professor of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, RJ Fasenmyer Chair of Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Paul Emery
- Arthritis Research UK Professor of Rheumatology, Director, Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Director, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Alan J Kivitz
- President, Altoona Center for Clinical Research, President, Altoona Arthritis and Osteoporosis Center, Duncansville, Pennsylvania
| | - John R P Tesser
- Rheumatologist, Arizona Arthritis and Rheumatology Associates, PC, Adjunct Clinical Associate Professor, College of Health Sciences, Adjunct Assistant Professor, Division of Clinical Education, Midwestern University, Arizona College of Osteopathic Medicine, Phoenix, Arizona
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Getz TM, Hoffman GS, Padmanabhan R, Villa-Forte A, Roselli EE, Blackstone E, Johnston D, Pettersson G, Soltesz E, Svensson LG, Calabrese LH, Clifford AH, Eng C. 183. MICROBIOME IN AORTITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez060.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ted M Getz
- Genomic Medicine Institute, Lerner Research Institute Cleveland, OH USA
| | | | | | | | - Eric E Roselli
- Center for Aortic Diseases, Heart Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Eugene Blackstone
- Center for Aortic Diseases, Heart Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Douglas Johnston
- Center for Aortic Diseases, Heart Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Gosta Pettersson
- Center for Aortic Diseases, Heart Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Edward Soltesz
- Center for Aortic Diseases, Heart Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Lars G Svensson
- Center for Aortic Diseases, Heart Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | | | - Alison H Clifford
- Cleveland Clinic Cleveland, OH USA
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute Cleveland, OH USA
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH USA
- Department of Genetics and Genome Sciences Germline High Risk Focus Group Cleveland, OH USA
- CASE Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH USA
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Hoffman GS, Getz TM, Padmanabhan R, Villa-Forte A, Calabrese LH, Clifford AH, Funchain P, Sankhunny M, Perry JD, Blandford A, Kosmorsky G, Lystad L, Eng C. 184. THE MICROBIOME OF TEMPORAL ARTERIES. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez060.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gary S Hoffman
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases Cleveland, OH USA
| | - Ted M Getz
- Genomic Medicine Institute, Lerner Research Institute Cleveland, OH USA
| | | | - Alexandra Villa-Forte
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases Cleveland, OH USA
| | - Leonard H Calabrese
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases Cleveland, OH USA
| | - Alison H Clifford
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases Cleveland, OH USA
- Department of Genetics and Genome Sciences Germline High Risk Focus Group Cleveland, OH USA
| | | | | | - Julian D Perry
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases Cleveland, OH USA
| | - Alexander Blandford
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases Cleveland, OH USA
| | - Gregory Kosmorsky
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases Cleveland, OH USA
| | - Lisa Lystad
- Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases Cleveland, OH USA
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute Cleveland, OH USA
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH USA
- Department of Genetics and Genome Sciences Germline High Risk Focus Group Cleveland, OH USA
- CASE Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH USA
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Hajj-Ali RA, Saygin D, Ray E, Morales-Mena A, Messner W, Sundaram P, Jones S, Calabrese LH. Long-term outcomes of patients with primary angiitis of the central nervous system. Clin Exp Rheumatol 2019; 37 Suppl 117:45-51. [PMID: 30789149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/31/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Primary angiitis of the central nervous system (PACNS) is a vasculitis confined to the brain and spinal cord, which often presents with severe cognitive and functional deficits. Despite progress in diagnosis, little is still known about long-term outcomes. Our aim was to evaluate long-term functional capabilities, quality of life, and depression, and to determine the effect of treatment duration on patient outcomes. METHODS We identified patients by ICD-9 codes for cerebral angiitis, and included them if they met two of the three following criteria: inflammatory cerebrospinal fluid (CSF), cerebral angiogram typical of vasculitis, or findings of vasculitis on pathologic examination of brain tissue. Disability was assessed by the Barthel Index, quality of life was assessed by EuroQol, and depression was assessed with Patient Health Questionnaire. RESULTS Seventy-eight patients met the inclusion criteria, of which 27 responded to the questionnaire (34.6%). Mean follow-up of those who responded was 5.5 years (± 4.7). Nineteen of 27 patients (70.4%) had mild disability; meanwhile, 5 (18.5%) had severe disability. Fourteen of 27 patients (51.9%) had no mobility problem, 18 (66.7%) had no problems with self-care, 15 (55.6%) had no problems with usual activities, 14 (51.9%) had no pain, and 8 (29.6%) had no anxiety. Approximately 70% of patients had minimal or no depression. CONCLUSIONS This is the longest reported follow-up of patients with PACNS described in the literature to date. Most patients had mild long-term disability and minimal to no depression, which may be reflective of treatment advances.
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Affiliation(s)
- Rula A Hajj-Ali
- Department of Rheumatic & Immunologic Disease, Cleveland Clinic, Cleveland, OH, USA.
| | - Didem Saygin
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Elisabeth Ray
- Department of Rheumatic & Immunologic Disease, Cleveland Clinic, Cleveland, OH, USA
| | | | - William Messner
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Priya Sundaram
- Department of Radiology, University Hospitals, Cleveland, OH, USA
| | - Stephen Jones
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Leonard H Calabrese
- Department of Rheumatic & Immunologic Disease, Cleveland Clinic, Cleveland, OH, USA
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Hoffman GS, Getz TM, Padmanabhan R, Villa-Forte A, Clifford AH, Funchain P, Sankunny M, Perry JD, Blandford A, Kosmorsky G, Lystad L, Calabrese LH, Eng C. The Microbiome of Temporal Arteries. Pathog Immun 2019; 4:21-38. [PMID: 30993251 PMCID: PMC6423729 DOI: 10.20411/pai.v4i1.270] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 10/30/2018] [Accepted: 02/01/2019] [Indexed: 12/23/2022] Open
Abstract
Objective A role for microorganisms in giant cell arteritis (GCA) has long been suspected. We describe the microbiomes of temporal arteries from patients with GCA and controls. Methods Temporal artery biopsies from patients suspected to have GCA were collected under aseptic conditions and snap-frozen. Fluorescence in situ hybridization (FISH) and long-read 16S rRNA-gene sequencing was used to examine microbiomes of temporal arteries. Taxonomic classification of bacterial sequences was performed to the genus level and relative abundances were calculated. Microbiome differential abundances were analyzed by principal coordinate analysis (PCoA) with comparative Unifrac distances and predicted functional profiling using PICRUSt. Results Forty-seven patients, including 9 with biopsy-positive GCA, 15 with biopsy-negative GCA and 23 controls without GCA, were enrolled. FISH for bacterial DNA revealed signal in the arterial media. Beta, but not alpha, diversity differed between GCA and control temporal arteries (P = 0.042). Importantly, there were no significant differences between biopsy-positive and biopsy-negative GCA (P > 0.99). The largest differential abundances seen between GCA and non-GCA temporal arteries included Proteobacteria (P), Bifidobacterium (g), Parasutterella (g), and Granulicatella (g) [Log 2-fold change ≥ 4]. Conclusion Temporal arteries are not sterile, but rather are inhabited by a community of bacteria. We have demonstrated that there are microbiomic differences between GCA and non-GCA temporal arteries, but not between biopsy-positive and biopsy-negative GCA.
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Affiliation(s)
- Gary S Hoffman
- Center for Vasculitis Care and Research; Department of Rheumatic and Immunologic Diseases; Cleveland Clinic; Cleveland, Ohio
| | - Ted M Getz
- Genomic Medicine Institute; Lerner Research Institute; Cleveland Clinic; Cleveland, Ohio
| | - Roshan Padmanabhan
- Genomic Medicine Institute; Lerner Research Institute; Cleveland Clinic; Cleveland, Ohio
| | - Alexandra Villa-Forte
- Center for Vasculitis Care and Research; Department of Rheumatic and Immunologic Diseases; Cleveland Clinic; Cleveland, Ohio
| | - Alison H Clifford
- Center for Vasculitis Care and Research; Department of Rheumatic and Immunologic Diseases; Cleveland Clinic; Cleveland, Ohio.,Division of Rheumatology, University of Alberta, Canada
| | - Pauline Funchain
- Genomic Medicine Institute; Lerner Research Institute; Cleveland Clinic; Cleveland, Ohio.,Taussig Cancer Institute; Cleveland Clinic; Cleveland, Ohio
| | - Madhav Sankunny
- Genomic Medicine Institute; Lerner Research Institute; Cleveland Clinic; Cleveland, Ohio
| | | | | | | | - Lisa Lystad
- Cole Eye Institute; Cleveland Clinic; Cleveland, Ohio
| | - Leonard H Calabrese
- Center for Vasculitis Care and Research; Department of Rheumatic and Immunologic Diseases; Cleveland Clinic; Cleveland, Ohio
| | - Charis Eng
- Genomic Medicine Institute; Lerner Research Institute; Cleveland Clinic; Cleveland, Ohio.,Taussig Cancer Institute; Cleveland Clinic; Cleveland, Ohio.,Department of Genetics and Genome Sciences; Case Western Reserve University School of Medicine; Cleveland, Ohio.,Germline High Risk Focus Group; CASE Comprehensive Cancer Center; Case Western Reserve University School of Medicine; Cleveland, Ohio
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Kostine M, Cappelli LC, Calabrese C, Calabrese LH, Bingham CO, Richez C, Gottenberg JE, Lambotte O. Addressing immune-related adverse events of cancer immunotherapy: how prepared are rheumatologists? Ann Rheum Dis 2019; 78:860-862. [PMID: 30659050 DOI: 10.1136/annrheumdis-2018-214748] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/02/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Marie Kostine
- Rheumatology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Laura C Cappelli
- Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | | | - Christophe Richez
- Rheumatology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Olivier Lambotte
- Internal Medicine and Clinical Immunology, Hopital Bicetre, Le Kremlin-Bicetre, France
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Hojat M, DeSantis J, Shannon SC, Mortensen LH, Speicher MR, Bragan L, LaNoue M, Calabrese LH. The Jefferson Scale of Empathy: a nationwide study of measurement properties, underlying components, latent variable structure, and national norms in medical students. Adv Health Sci Educ Theory Pract 2018; 23:899-920. [PMID: 29968006 PMCID: PMC6245107 DOI: 10.1007/s10459-018-9839-9] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [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: 04/23/2018] [Accepted: 06/18/2018] [Indexed: 05/22/2023]
Abstract
The Jefferson Scale of Empathy (JSE) is a broadly used instrument developed to measure empathy in the context of health professions education and patient care. Evidence in support of psychometrics of the JSE has been reported in health professions students and practitioners with the exception of osteopathic medical students. This study was designed to examine measurement properties, underlying components, and latent variable structure of the JSE in a nationwide sample of first-year matriculants at U.S. colleges of osteopathic medicine, and to develop a national norm table for the assessment of JSE scores. A web-based survey was administered at the beginning of the 2017-2018 academic year which included the JSE, a scale to detect "good impression" responses, and demographic/background information. Usable surveys were received from 6009 students enrolled in 41 college campuses (median response rate = 92%). The JSE mean score and standard deviation for the sample were 116.54 and 10.85, respectively. Item-total score correlations were positive and statistically significant (p < 0.01), and Cronbach α = 0.82. Significant gender differences were observed on the JSE scores in favor of women. Also, significant differences were found on item scores between top and bottom third scorers on the JSE. Three factors of Perspective Taking, Compassionate Care, and Walking in Patient's Shoes emerged in an exploratory factor analysis by using half of the sample. Results of confirmatory factor analysis with another half of the sample confirmed the 3-factor model. We also developed a national norm table which is the first to assess students' JSE scores against national data.
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Affiliation(s)
- Mohammadreza Hojat
- Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut Street, Suite 320, Philadelphia, PA, 19107, USA.
| | - Jennifer DeSantis
- Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut Street, Suite 320, Philadelphia, PA, 19107, USA
| | - Stephen C Shannon
- American Association of Colleges of Osteopathic Medicine, Bethesda, MD, USA
| | - Luke H Mortensen
- American Association of Colleges of Osteopathic Medicine, Bethesda, MD, USA
| | - Mark R Speicher
- American Association of Colleges of Osteopathic Medicine, Bethesda, MD, USA
| | - Lynn Bragan
- American Association of Colleges of Osteopathic Medicine, Bethesda, MD, USA
| | - Marianna LaNoue
- Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut Street, Suite 320, Philadelphia, PA, 19107, USA
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Younes SA, Talla A, Pereira Ribeiro S, Saidakova EV, Korolevskaya LB, Shmagel KV, Shive CL, Freeman ML, Panigrahi S, Zweig S, Balderas R, Margolis L, Douek DC, Anthony DD, Pandiyan P, Cameron M, Sieg SF, Calabrese LH, Rodriguez B, Lederman MM. Cycling CD4+ T cells in HIV-infected immune nonresponders have mitochondrial dysfunction. J Clin Invest 2018; 128:5083-5094. [PMID: 30320604 DOI: 10.1172/jci120245] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 09/04/2018] [Indexed: 01/06/2023] Open
Abstract
Immune nonresponder (INR) HIV-1-infected subjects are characterized by their inability to reconstitute the CD4+ T cell pool after antiretroviral therapy. This is linked to poor clinical outcome. Mechanisms underlying immune reconstitution failure are poorly understood, although, counterintuitively, INRs often have increased frequencies of circulating CD4+ T cells in the cell cycle. While cycling CD4+ T cells from healthy controls and HIV+ patients with restored CD4+ T cell numbers complete cell division in vitro, cycling CD4+ T cells from INRs do not. Here, we show that cells with the phenotype and transcriptional profile of Tregs were enriched among cycling cells in health and in HIV infection. Yet there were diminished frequencies and numbers of Tregs among cycling CD4+ T cells in INRs, and cycling CD4+ T cells from INR subjects displayed transcriptional profiles associated with the impaired development and maintenance of functional Tregs. Flow cytometric assessment of TGF-β activity confirmed the dysfunction of Tregs in INR subjects. Transcriptional profiling and flow cytometry revealed diminished mitochondrial fitness in Tregs among INRs, and cycling Tregs from INRs had low expression of the mitochondrial biogenesis regulators peroxisome proliferator-activated receptor γ coactivator 1-α (PGC1α) and transcription factor A for mitochondria (TFAM). In vitro exposure to IL-15 allowed cells to complete division, restored the expression of PGC1α and TFAM, and regenerated mitochondrial fitness in the cycling Tregs of INRs. Our data suggest that rescuing mitochondrial function could correct the immune dysfunction characteristic of Tregs in HIV-1-infected subjects who fail to restore CD4+ T cells during antiretroviral therapy.
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Affiliation(s)
| | - Aarthi Talla
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | - Carey L Shive
- Division of Infectious Disease and.,Divisions of Infectious and Rheumatic Diseases, University Hospitals Case Medical Center, The Cleveland VA Medical Center, and the Center for AIDS Research, Cleveland, Ohio, USA
| | | | | | | | | | - Leonid Margolis
- National Institute of Child Health and Human Development and
| | - Daniel C Douek
- Human Immunology Section, Vaccine Research Center, National Institutes of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Donald D Anthony
- Division of Infectious Disease and.,Divisions of Infectious and Rheumatic Diseases, University Hospitals Case Medical Center, The Cleveland VA Medical Center, and the Center for AIDS Research, Cleveland, Ohio, USA
| | - Pushpa Pandiyan
- School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mark Cameron
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Leonard H Calabrese
- Rheumatologic and Immunologic Disease, Cleveland Clinic, Cleveland, Ohio, USA
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Calabrese LH, Calabrese C, Kirchner E. The 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis Should Include New Standards for Hepatitis B Screening: Comment on the Article by Singh et al. Arthritis Care Res (Hoboken) 2018; 68:723-4. [PMID: 26866816 DOI: 10.1002/acr.22865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/02/2016] [Indexed: 12/19/2022]
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