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Ng MTH, Borst R, Gacaferi H, Davidson S, Ackerman JE, Johnson PA, Machado CC, Reekie I, Attar M, Windell D, Kurowska-Stolarska M, MacDonald L, Alivernini S, Garvilles M, Jansen K, Bhalla A, Lee A, Charlesworth J, Chowdhury R, Klenerman P, Powell K, Hackstein CP, Furniss D, Rees J, Gilroy D, Coles M, Carr AJ, Sansom SN, Buckley CD, Dakin SG. A single cell atlas of frozen shoulder capsule identifies features associated with inflammatory fibrosis resolution. Nat Commun 2024; 15:1394. [PMID: 38374174 PMCID: PMC10876649 DOI: 10.1038/s41467-024-45341-9] [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: 03/31/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Frozen shoulder is a spontaneously self-resolving chronic inflammatory fibrotic human disease, which distinguishes the condition from most fibrotic diseases that are progressive and irreversible. Using single-cell analysis, we identify pro-inflammatory MERTKlowCD48+ macrophages and MERTK + LYVE1 + MRC1+ macrophages enriched for negative regulators of inflammation which co-exist in frozen shoulder capsule tissues. Micro-cultures of patient-derived cells identify integrin-mediated cell-matrix interactions between MERTK+ macrophages and pro-resolving DKK3+ and POSTN+ fibroblasts, suggesting that matrix remodelling plays a role in frozen shoulder resolution. Cross-tissue analysis reveals a shared gene expression cassette between shoulder capsule MERTK+ macrophages and a respective population enriched in synovial tissues of rheumatoid arthritis patients in disease remission, supporting the concept that MERTK+ macrophages mediate resolution of inflammation and fibrosis. Single-cell transcriptomic profiling and spatial analysis of human foetal shoulder tissues identify MERTK + LYVE1 + MRC1+ macrophages and DKK3+ and POSTN+ fibroblast populations analogous to those in frozen shoulder, suggesting that the template to resolve fibrosis is established during shoulder development. Crosstalk between MerTK+ macrophages and pro-resolving DKK3+ and POSTN+ fibroblasts could facilitate resolution of frozen shoulder, providing a basis for potential therapeutic resolution of persistent fibrotic diseases.
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Affiliation(s)
| | | | | | | | | | | | - Caio C Machado
- University of Oxford, Oxford, UK
- University of Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | - Lucy MacDonald
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, Glasgow, UK
| | - Stefano Alivernini
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
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2
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Baker KF, McDonald D, Hulme G, Hussain R, Coxhead J, Swan D, Schulz AR, Mei HE, MacDonald L, Pratt AG, Filby A, Anderson AE, Isaacs JD. Single-cell insights into immune dysregulation in rheumatoid arthritis flare versus drug-free remission. Nat Commun 2024; 15:1063. [PMID: 38316770 PMCID: PMC10844292 DOI: 10.1038/s41467-024-45213-2] [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: 01/22/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
Immune-mediated inflammatory diseases (IMIDs) are typically characterised by relapsing and remitting flares of inflammation. However, the unpredictability of disease flares impedes their study. Addressing this critical knowledge gap, we use the experimental medicine approach of immunomodulatory drug withdrawal in rheumatoid arthritis (RA) remission to synchronise flare processes allowing detailed characterisation. Exploratory mass cytometry analyses reveal three circulating cellular subsets heralding the onset of arthritis flare - CD45RO+PD1hi CD4+ and CD8+ T cells, and CD27+CD86+CD21- B cells - further characterised by single-cell sequencing. Distinct lymphocyte subsets including cytotoxic and exhausted CD4+ memory T cells, memory CD8+CXCR5+ T cells, and IGHA1+ plasma cells are primed for activation in flare patients. Regulatory memory CD4+ T cells (Treg cells) increase at flare onset, but with dysfunctional regulatory marker expression compared to drug-free remission. Significant clonal expansion is observed in T cells, but not B cells, after drug cessation; this is widespread throughout memory CD8+ T cell subsets but limited to the granzyme-expressing cytotoxic subset within CD4+ memory T cells. Based on our observations, we suggest a model of immune dysregulation for understanding RA flare, with potential for further translational research towards novel avenues for its treatment and prevention.
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Affiliation(s)
- Kenneth F Baker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
- Musculoskeletal Unit, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - David McDonald
- Flow Cytometry Core Facility, Newcastle University, Newcastle upon Tyne, UK
| | - Gillian Hulme
- Flow Cytometry Core Facility, Newcastle University, Newcastle upon Tyne, UK
| | - Rafiqul Hussain
- Genomics Core Facility, Newcastle University, Newcastle upon Tyne, UK
| | - Jonathan Coxhead
- Genomics Core Facility, Newcastle University, Newcastle upon Tyne, UK
| | - David Swan
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Axel R Schulz
- Deutsches Rheuma-Forschungszentrum Berlin, A Leibniz Institute, Berlin, Germany
| | - Henrik E Mei
- Deutsches Rheuma-Forschungszentrum Berlin, A Leibniz Institute, Berlin, Germany
| | - Lucy MacDonald
- School of Infection and Immunity, Glasgow University, Glasgow, UK
| | - Arthur G Pratt
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Musculoskeletal Unit, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Filby
- Flow Cytometry Core Facility, Newcastle University, Newcastle upon Tyne, UK
| | - Amy E Anderson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Musculoskeletal Unit, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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3
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Rodrigues CMC, MacDonald L, Ure R, Smith A, Cameron JC, Maiden MCJ. Exploiting Real-Time Genomic Surveillance Data To Assess 4CMenB Meningococcal Vaccine Performance in Scotland, 2015 to 2022. mBio 2023; 14:e0049923. [PMID: 37036356 PMCID: PMC10127610 DOI: 10.1128/mbio.00499-23] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
The United Kingdom implemented the first national infant immunization schedule for the meningococcal vaccine 4CMenB (Bexsero) in September 2015, targeting serogroup B invasive meningococcal disease (IMD). Bexsero contains four variable subcapsular proteins, and postimplementation IMD surveillance was necessary, as nonhomologous protein variants can evade Bexsero-elicited protection. We investigated postimplementation IMD cases reported in Scotland from 1 September 2015 to 30 June 2022. Patient demographics and vaccination status were combined with genotypic data from the causative meningococci, which were used to assess vaccine coverage with the meningococcal deduced vaccine antigen reactivity (MenDeVAR) index. Eighty-two serogroup B IMD cases occurred in children >5 years of age, 48 (58.5%) of which were in unvaccinated children and 34 (41%) of which were in children who had received ≥1 Bexsero dose. Fifteen of the 34 vaccinated children had received one dose, 17 had received two doses, and two had received three doses. For 39 cases, meningococcal sequence data were available, enabling MenDeVAR index deductions of vaccine-preventable (M-VP) and non-vaccine-preventable (M-NVP) meningococci. Notably, none of the 19 of the children immunized ≥2 times had IMD caused by M-VP meningococci, with 2 cases of NVP meningococci, and no deduction possible for 17. Among the 15 children partially vaccinated according to schedule (1 dose), 7 were infected by M-VP meningococci and 2 with M-NVP meningococci, with 6 for which deductions were not possible. Of the unvaccinated children with IMD, 40/48 were ineligible for vaccination and 20/48 had IMD caused by M-VP meningococci, with deductions not being possible for 14 meningococci. IMPORTANCE This study demonstrates the value of postimplementation genomic surveillance of vaccine-preventable pathogens in providing information on real-world vaccine performance. The data are consistent with 2 and 3 doses of Bexsero, delivered according to schedule, providing good protection against invasive disease caused by meningococci deduced from genomic data to be vaccine preventable. Single doses provide poorer protection to infants. In practical terms, these data can provide public health reassurance when vaccinated individuals develop IMD with non-vaccine-preventable variants. They further indicate that additional testing is needed on variants for which no immunological data exist to improve estimates of protection, although these data suggest that the uncharacterized variants are unlikely to be covered by Bexsero. Finally, the confirmation that incomplete or absent doses in infancy lead to reduced protection supports public health and general practitioners in promoting vaccination according to schedule.
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Affiliation(s)
- C M C Rodrigues
- Department of Biology, University of Oxford, Oxford, United Kingdom
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - L MacDonald
- Public Health Scotland, Glasgow/Edinburgh, United Kingdom
| | - R Ure
- Bacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - A Smith
- Bacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, United Kingdom
| | - J C Cameron
- Public Health Scotland, Glasgow/Edinburgh, United Kingdom
| | - M C J Maiden
- Department of Biology, University of Oxford, Oxford, United Kingdom
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4
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Dyer TA, Glenny AM, MacDonald L, Marshman Z, Jones K. Effectiveness of strategies to increase participation in school-based epidemiological surveys: a rapid review. Community Dent Health 2023; 40:53-59. [PMID: 36696488 DOI: 10.1922/cdh_00242dyer07] [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] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/19/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Rapid review of the literature on strategies to increase participation rates in school-based epidemiological surveys. BASIC RESEARCH DESIGN Rapid review. MEDLINE and Embase databases were searched for articles written in English from 2000 onwards. Synthesised evidence and primary research were included as data sources from peer reviewed journals and reports. INTERVENTIONS Any strategy aiming to increase participation in school-based health surveys. The comparator was usual procedure or an alternative strategy to increase participation. MAIN OUTCOME MEASURES Primary outcomes included participation and consent rates. Secondary outcomes were feasibility, acceptability and adverse effects. RESULTS The search identified 591 unique records, of which 587 were excluded. Four studies were suitable for inclusion, including one systematic review, one randomised controlled trial, one cross-sectional study and one retrospective analysis. Based on very low certainty evidence, recommendations for maximising participation rates in one systematic review of US studies included: promoting the survey to school staff, parents and students; disseminating study information using direct rather than mediated methods; offering incentives to schools, staff and participants; following up non-responders; and employing a research team member to co-ordinate and monitor recruitment. However, UK studies found that different strategies did not increase participation more than that achieved by a standard approach (delivery of covering letter/consent forms via the child with no follow-up of non-responders). CONCLUSION Given the lack of evidence of effectiveness of alternative strategies in the UK, additional measures beyond existing standard approaches for active consent cannot be recommended.
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Affiliation(s)
- T A Dyer
- School of Clinical Dentistry, University of Sheffield, UK
| | - A-M Glenny
- Division of Dentistry, The University of Manchester, UK
| | - L MacDonald
- Cochrane Oral Health, Division of Dentistry, The University of Manchester UK
| | - Z Marshman
- School of Clinical Dentistry, University of Sheffield, UK
| | - K Jones
- Office for Health Improvement and Disparities, London, UK
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5
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Crespo E, Nosalski R, Park I, Goddard M, MacDonald L, McBride MW, Monaco C, Maffia P, Otto T, Guzik T. Single cell atlas of cd45+ cells in angiotensin II-induced hypertension. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2169] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Hypertension has been recently identified as an inflammatory disease. Immune cell infiltration is a characteristic feature in the vasculature and the kidneys in experimental hypertension, but the unique nature of such inflammatory infiltrates has not yet been comprehensively characterised.
Accordingly, we aimed to provide in-depth characteristics of immune cells in the vasculature and the kidneys in experimental hypertension.
To achieve this, we used single-cell RNA-sequencing of leukocytes (CD45+ cells were sorted) using the 10x Genomics platform in the aortas and the kidneys of male 12-week-old C57BL/6J mice (n=16–17/group) upon AngII (490 ng/min/kg) or sham buffer 14-day infusion, using osmotic minipumps. Samples were pooled to analyse three independent replicates. Bioinformatics analysis used Seurat/R to identify immune cell subpopulations and characterise differentially expressed genes (DEGs), pathways, and interactions signatures.
Ang II infusion increases the total number of CD45+ leukocytes in the aorta (346.7±89.1 vs. 1210±214.3; p=0,048), while in the kidneys, this was much less pronounced (1.1±0.5 fold vs. sham). Fifteen leukocyte populations/clusters were identified in the aorta and kidney based on their unique markers. In the aorta, shifts in numerous populations were evident, with the most significant differences in tissue-resident macrophages and activated tissue-resident macrophages, monocyte-derived dendritic cells and NK cells (Figure 1). Kidneys did not display such profound changes. The transcriptomic profile analysis showed 767 significant DEGs in the aorta and only 35 in the kidney. CellChat analysis also indicated more robust interactions between the immune cells in the aorta than in kidneys. These included Ifitm1, Apoe, Il1b, and C1q a/b/c, which were shared between aorta and kidney and may play an immunoregulatory role, affecting smooth muscle cell proliferation and arterial vascular remodelling. Top up-regulated leukocyte genes in the aorta included Ccl8, Ccl3, Cxcl2, Lyz2, and Spp1, while in the kidney, Cd74, Cst3, Fos, Fcer1g, Tyrobp, and Ccl4. GO pathway signatures of aortic leukocyte DEGs revealed pathways related to leukocyte migration, cytokine production, T cell activation, and leukocyte activation and adhesion. Cell-specific analysis showed that macrophage subpopulations most strongly increased in Ang II-induced hypertension displayed the most pronounced changes in the transcriptome profiles and cell-cell interactions.
Comprehensive single-cell RNA sequencing identifies tissue-resident macrophages, monocyte-derived dendritic cells, and NK cells as most affected leukocyte subpopulations in hypertensive vasculature. Differentially expressed genes support the role of these cells in vascular remodelling and propagation of inflammation, further supporting the identification of these cells as potential future targets for therapeutic interventions in hypertension.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Council
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Affiliation(s)
- E Crespo
- University of Glasgow , Glasgow , United Kingdom
| | - R Nosalski
- University of Glasgow , Glasgow , United Kingdom
| | - I Park
- Kennedy Institute of Rheumatology , Oxford , United Kingdom
| | - M Goddard
- Kennedy Institute of Rheumatology , Oxford , United Kingdom
| | - L MacDonald
- University of Glasgow , Glasgow , United Kingdom
| | - M W McBride
- University of Glasgow , Glasgow , United Kingdom
| | - C Monaco
- Kennedy Institute of Rheumatology , Oxford , United Kingdom
| | - P Maffia
- University of Glasgow , Glasgow , United Kingdom
| | - T Otto
- University of Glasgow , Glasgow , United Kingdom
| | - T Guzik
- University of Glasgow , Glasgow , United Kingdom
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6
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Farina L, Minnone G, Alivernini S, Caiello I, MacDonald L, Soligo M, Manni L, Tolusso B, Coppola S, Zara E, Conti LA, Aquilani A, Magni-Manzoni S, Kurowska-Stolarska M, Gremese E, De Benedetti F, Bracci-Laudiero L. Pro Nerve Growth Factor and Its Receptor p75NTR Activate Inflammatory Responses in Synovial Fibroblasts: A Novel Targetable Mechanism in Arthritis. Front Immunol 2022; 13:818630. [PMID: 35309353 PMCID: PMC8931659 DOI: 10.3389/fimmu.2022.818630] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/14/2022] [Indexed: 12/17/2022] Open
Abstract
We have recently provided new evidence for a role of p75NTR receptor and its preferential ligand proNGF in amplifying inflammatory responses in synovial mononuclear cells of chronic arthritis patients. In the present study, to better investigate how activation of the p75NTR/proNGF axis impacts synovial inflammation, we have studied the effects of proNGF on fibroblast-like synoviocytes (FLS), which play a central role in modulating local immune responses and in activating pro-inflammatory pathways. Using single cell RNA sequencing in synovial tissues from active and treatment-naïve rheumatoid arthritis (RA) patients, we demonstrated that p75NTR and sortilin, which form a high affinity receptor complex for proNGF, are highly expressed in PRG4pos lining and THY1posCOL1A1pos sublining fibroblast clusters in RA synovia but decreased in RA patients in sustained clinical remission. In ex vivo experiments we found that FLS from rheumatoid arthritis patients (RA-FLS) retained in vitro a markedly higher expression of p75NTR and sortilin than FLS from osteoarthritis patients (OA-FLS). Inflammatory stimuli further up-regulated p75NTR expression and induced endogenous production of proNGF in RA-FLS, leading to an autocrine activation of the proNGF/p75NTR pathway that results in an increased release of pro-inflammatory cytokines. Our data on the inhibition of p75NTR receptor, which reduced the release of IL-1β, IL-6 and TNF-α, further confirmed the key role of p75NTR activation in regulating inflammatory cytokine production. In a set of ex vivo experiments, we used RA-FLS and cultured them in the presence of synovial fluids obtained from arthritis patients that, as we demonstrated, are characterized by a high concentration of proNGF. Our data show that the high levels of proNGF present in inflamed synovial fluids induced pro-inflammatory cytokine production by RA-FLS. The blocking of NGF binding to p75NTR using specific inhibitors led instead to the disruption of this pro-inflammatory loop, reducing activation of the p38 and JNK intracellular pathways and decreasing inflammatory cytokine production. Overall, our data demonstrate that an active proNGF/p75NTR axis promotes pro-inflammatory responses in synovial fibroblasts, thereby contributing to chronic synovial inflammation, and point to the possible use of p75NTR inhibitors as a novel therapeutic approach in chronic arthritis.
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Affiliation(s)
- Luciapia Farina
- Department of Immunology, Laboratory of ImmunoRheumatology, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Gaetana Minnone
- Department of Immunology, Laboratory of ImmunoRheumatology, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Stefano Alivernini
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Ivan Caiello
- Department of Immunology, Laboratory of ImmunoRheumatology, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Lucy MacDonald
- Inflammatory Arthritis Centre Versus Arthritis (RACE), Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Marzia Soligo
- Institute of Translational Pharmacology (IFT-CNR), Consiglio Nazionale delle Ricerche, Rome, Italy
| | - Luigi Manni
- Institute of Translational Pharmacology (IFT-CNR), Consiglio Nazionale delle Ricerche, Rome, Italy
| | - Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Simona Coppola
- National Centre for Rare Diseases, Istituto Superiore di Sanita’, Rome, Italy
| | - Erika Zara
- National Centre for Rare Diseases, Istituto Superiore di Sanita’, Rome, Italy
| | - Libenzio Adrian Conti
- Confocal Microscopy Core Facility, Research Center, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Angela Aquilani
- Division of Rheumatology, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Silvia Magni-Manzoni
- Division of Rheumatology, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Mariola Kurowska-Stolarska
- Inflammatory Arthritis Centre Versus Arthritis (RACE), Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Fabrizio De Benedetti
- Department of Immunology, Laboratory of ImmunoRheumatology, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Division of Rheumatology, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Luisa Bracci-Laudiero
- Department of Immunology, Laboratory of ImmunoRheumatology, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Institute of Translational Pharmacology (IFT-CNR), Consiglio Nazionale delle Ricerche, Rome, Italy
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7
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Micheroli R, Elhai M, Edalat S, Frank-Bertoncelj M, Bürki K, Ciurea A, MacDonald L, Kurowska-Stolarska M, Lewis MJ, Goldmann K, Cubuk C, Kuret T, Distler O, Pitzalis C, Ospelt C. Role of synovial fibroblast subsets across synovial pathotypes in rheumatoid arthritis: a deconvolution analysis. RMD Open 2022; 8:e001949. [PMID: 34987094 PMCID: PMC8734041 DOI: 10.1136/rmdopen-2021-001949] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/01/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To integrate published single-cell RNA sequencing (scRNA-seq) data and assess the contribution of synovial fibroblast (SF) subsets to synovial pathotypes and respective clinical characteristics in treatment-naïve early arthritis. METHODS In this in silico study, we integrated scRNA-seq data from published studies with additional unpublished in-house data. Standard Seurat, Harmony and Liger workflow was performed for integration and differential gene expression analysis. We estimated single cell type proportions in bulk RNA-seq data (deconvolution) from synovial tissue from 87 treatment-naïve early arthritis patients in the Pathobiology of Early Arthritis Cohort using MuSiC. SF proportions across synovial pathotypes (fibroid, lymphoid and myeloid) and relationship of disease activity measurements across different synovial pathotypes were assessed. RESULTS We identified four SF clusters with respective marker genes: PRG4+ SF (CD55, MMP3, PRG4, THY1neg ); CXCL12+ SF (CXCL12, CCL2, ADAMTS1, THY1low ); POSTN+ SF (POSTN, collagen genes, THY1); CXCL14+ SF (CXCL14, C3, CD34, ASPN, THY1) that correspond to lining (PRG4+ SF) and sublining (CXCL12+ SF, POSTN+ + and CXCL14+ SF) SF subsets. CXCL12+ SF and POSTN+ + were most prominent in the fibroid while PRG4+ SF appeared highest in the myeloid pathotype. Corresponding, lining assessed by histology (assessed by Krenn-Score) was thicker in the myeloid, but also in the lymphoid pathotype + the fibroid pathotype. PRG4+ SF correlated positively with disease severity parameters in the fibroid, POSTN+ SF in the lymphoid pathotype whereas CXCL14+ SF showed negative association with disease severity in all pathotypes. CONCLUSION This study shows a so far unexplored association between distinct synovial pathologies and SF subtypes defined by scRNA-seq. The knowledge of the diverse interplay of SF with immune cells will advance opportunities for tailored targeted treatments.
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Affiliation(s)
- Raphael Micheroli
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Muriel Elhai
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Sam Edalat
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Mojca Frank-Bertoncelj
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Kristina Bürki
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Adrian Ciurea
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Lucy MacDonald
- Research Into Inflammatory Arthritis Centre Versus Arthritis (RACE), Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Mariola Kurowska-Stolarska
- Research Into Inflammatory Arthritis Centre Versus Arthritis (RACE), Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Myles J Lewis
- Centre for Experimental Medicine and Rheumatology, Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, London, UK
| | - Katriona Goldmann
- Centre for Experimental Medicine and Rheumatology, Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, London, UK
| | - Cankut Cubuk
- Centre for Experimental Medicine and Rheumatology, Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, London, UK
| | - Tadeja Kuret
- Department of Rheumatology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Oliver Distler
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Costantino Pitzalis
- Centre for Experimental Medicine and Rheumatology, Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, London, UK
| | - Caroline Ospelt
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
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8
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Clayton SA, Daley KK, MacDonald L, Fernandez-Vizarra E, Bottegoni G, O’Neil JD, Major T, Griffin D, Zhuang Q, Adewoye AB, Woolcock K, Jones SW, Goodyear C, Elmesmari A, Filer A, Tennant DA, Alivernini S, Buckley CD, Pitceathly RDS, Kurowska-Stolarska M, Clark AR. Inflammation causes remodeling of mitochondrial cytochrome c oxidase mediated by the bifunctional gene C15orf48. Sci Adv 2021; 7:eabl5182. [PMID: 34878835 PMCID: PMC8654286 DOI: 10.1126/sciadv.abl5182] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/18/2021] [Indexed: 05/10/2023]
Abstract
Dysregulated mitochondrial function is a hallmark of immune-mediated inflammatory diseases. Cytochrome c oxidase (CcO), which mediates the rate-limiting step in mitochondrial respiration, is remodeled during development and in response to changes of oxygen availability, but there has been little study of CcO remodeling during inflammation. Here, we describe an elegant molecular switch mediated by the bifunctional transcript C15orf48, which orchestrates the substitution of the CcO subunit NDUFA4 by its paralog C15ORF48 in primary macrophages. Expression of C15orf48 is a conserved response to inflammatory signals and occurs in many immune-related pathologies. In rheumatoid arthritis, C15orf48 mRNA is elevated in peripheral monocytes and proinflammatory synovial tissue macrophages, and its expression positively correlates with disease severity and declines in remission. C15orf48 is also expressed by pathogenic macrophages in severe coronavirus disease 2019 (COVID-19). Study of a rare metabolic disease syndrome provides evidence that loss of the NDUFA4 subunit supports proinflammatory macrophage functions.
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Affiliation(s)
- Sally A. Clayton
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Universities of Glasgow, Birmingham, Newcastle, Oxford, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Kalbinder K. Daley
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Universities of Glasgow, Birmingham, Newcastle, Oxford, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Lucy MacDonald
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Universities of Glasgow, Birmingham, Newcastle, Oxford, UK
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Giovanni Bottegoni
- Dipartimento di Scienze Biomolecolari, University of Urbino, Urbino, Italy
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - John D. O’Neil
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Universities of Glasgow, Birmingham, Newcastle, Oxford, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Triin Major
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Daniel Griffin
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Qinqin Zhuang
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Adeolu B. Adewoye
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Kieran Woolcock
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Universities of Glasgow, Birmingham, Newcastle, Oxford, UK
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Simon W. Jones
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Universities of Glasgow, Birmingham, Newcastle, Oxford, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Carl Goodyear
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Universities of Glasgow, Birmingham, Newcastle, Oxford, UK
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Aziza Elmesmari
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Universities of Glasgow, Birmingham, Newcastle, Oxford, UK
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Andrew Filer
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Universities of Glasgow, Birmingham, Newcastle, Oxford, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Daniel A. Tennant
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Stefano Alivernini
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Universities of Glasgow, Birmingham, Newcastle, Oxford, UK
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Christopher D. Buckley
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Universities of Glasgow, Birmingham, Newcastle, Oxford, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Robert D. S. Pitceathly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Mariola Kurowska-Stolarska
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Universities of Glasgow, Birmingham, Newcastle, Oxford, UK
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Andrew R. Clark
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Universities of Glasgow, Birmingham, Newcastle, Oxford, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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9
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MacDonald L, Alivernini S, Tolusso B, Elmesmari A, Somma D, Perniola S, Paglionico A, Petricca L, Bosello SL, Carfì A, Sali M, Stigliano E, Cingolani A, Murri R, Arena V, Fantoni M, Antonelli M, Landi F, Franceschi F, Sanguinetti M, McInnes IB, McSharry C, Gasbarrini A, Otto TD, Kurowska-Stolarska M, Gremese E. COVID-19 and RA share an SPP1 myeloid pathway that drives PD-L1+ neutrophils and CD14+ monocytes. JCI Insight 2021; 6:147413. [PMID: 34143756 PMCID: PMC8328085 DOI: 10.1172/jci.insight.147413] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022] Open
Abstract
We explored the potential link between chronic inflammatory arthritis and COVID-19 pathogenic and resolving macrophage pathways and their role in COVID-19 pathogenesis. We found that bronchoalveolar lavage fluid (BALF) macrophage clusters FCN1+ and FCN1+SPP1+ predominant in severe COVID-19 were transcriptionally related to synovial tissue macrophage (STM) clusters CD48hiS100A12+ and CD48+SPP1+ that drive rheumatoid arthritis (RA) synovitis. BALF macrophage cluster FABP4+ predominant in healthy lung was transcriptionally related to STM cluster TREM2+ that governs resolution of synovitis in RA remission. Plasma concentrations of SPP1 and S100A12 (key products of macrophage clusters shared with active RA) were high in severe COVID-19 and predicted the need for Intensive Care Unit transfer, and they remained high in the post-COVID-19 stage. High plasma levels of SPP1 were unique to severe COVID-19 when compared with other causes of severe pneumonia, and IHC localized SPP1+ macrophages in the alveoli of COVID-19 lung. Investigation into SPP1 mechanisms of action revealed that it drives proinflammatory activation of CD14+ monocytes and development of PD-L1+ neutrophils, both hallmarks of severe COVID-19. In summary, COVID-19 pneumonitis appears driven by similar pathogenic myeloid cell pathways as those in RA, and their mediators such as SPP1 might be an upstream activator of the aberrant innate response in severe COVID-19 and predictive of disease trajectory including post-COVID-19 pathology.
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Affiliation(s)
- Lucy MacDonald
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
| | - Stefano Alivernini
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
- Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Barbara Tolusso
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Aziza Elmesmari
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
| | - Domenico Somma
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
| | - Simone Perniola
- Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Annamaria Paglionico
- Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Petricca
- Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Silvia L. Bosello
- Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angelo Carfì
- Institute of Internal Medicine and Geriatrics and
| | - Michela Sali
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Egidio Stigliano
- Department of Woman and Child Health and Public Health, Area of Pathology, and U.O.S.D. Coordinamento attività di Settorato, and
| | - Antonella Cingolani
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rita Murri
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Arena
- Department of Woman and Child Health and Public Health, Area of Pathology, and U.O.S.D. Coordinamento attività di Settorato, and
| | - Massimo Fantoni
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Antonelli
- Emergency Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Emergency Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Francesco Franceschi
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Iain B. McInnes
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
| | - Charles McSharry
- Institute of Infection, Immunity and Inflammation, University of Glasgow, United Kingdom
| | - Antonio Gasbarrini
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Thomas D. Otto
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
| | - Mariola Kurowska-Stolarska
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
| | - Elisa Gremese
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, United Kingdom
- Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
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10
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Akbar M, MacDonald L, Crowe LAN, Carlberg K, Kurowska-Stolarska M, Ståhl PL, Snelling SJB, McInnes IB, Millar NL. Single cell and spatial transcriptomics in human tendon disease indicate dysregulated immune homeostasis. Ann Rheum Dis 2021; 80:1494-1497. [PMID: 34001518 PMCID: PMC8522454 DOI: 10.1136/annrheumdis-2021-220256] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/05/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Moeed Akbar
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Lucy MacDonald
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, Glasgow, UK
| | - Lindsay A N Crowe
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Konstantin Carlberg
- Science for Life Laboratory, Dept. of Gene Technology, KTH Royal Institute of Technology, Solna, Sweden
| | - Mariola Kurowska-Stolarska
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, Glasgow, UK
| | - Patrik L Ståhl
- Science for Life Laboratory, Dept. of Gene Technology, KTH Royal Institute of Technology, Solna, Sweden
| | - Sarah J B Snelling
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, Glasgow, UK
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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11
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Clayton SA, MacDonald L, Kurowska-Stolarska M, Clark AR. Mitochondria as Key Players in the Pathogenesis and Treatment of Rheumatoid Arthritis. Front Immunol 2021; 12:673916. [PMID: 33995417 PMCID: PMC8118696 DOI: 10.3389/fimmu.2021.673916] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 02/28/2021] [Accepted: 04/12/2021] [Indexed: 12/22/2022] Open
Abstract
Mitochondria are major energy-producing organelles that have central roles in cellular metabolism. They also act as important signalling hubs, and their dynamic regulation in response to stress signals helps to dictate the stress response of the cell. Rheumatoid arthritis is an inflammatory and autoimmune disease with high prevalence and complex aetiology. Mitochondrial activity affects differentiation, activation and survival of immune and non-immune cells that contribute to the pathogenesis of this disease. This review outlines what is known about the role of mitochondria in rheumatoid arthritis pathogenesis, and how current and future therapeutic strategies can function through modulation of mitochondrial activity. We also highlight areas of this topic that warrant further study. As producers of energy and of metabolites such as succinate and citrate, mitochondria help to shape the inflammatory phenotype of leukocytes during disease. Mitochondrial components can directly stimulate immune receptors by acting as damage-associated molecular patterns, which could represent an initiating factor for the development of sterile inflammation. Mitochondria are also an important source of intracellular reactive oxygen species, and facilitate the activation of the NLRP3 inflammasome, which produces cytokines linked to disease symptoms in rheumatoid arthritis. The fact that mitochondria contain their own genetic material renders them susceptible to mutation, which can propagate their dysfunction and immunostimulatory potential. Several drugs currently used for the treatment of rheumatoid arthritis regulate mitochondrial function either directly or indirectly. These actions contribute to their immunomodulatory functions, but can also lead to adverse effects. Metabolic and mitochondrial pathways are attractive targets for future anti-rheumatic drugs, however many questions still remain about the precise role of mitochondrial activity in different cell types in rheumatoid arthritis.
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Affiliation(s)
- Sally A Clayton
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Birmingham, United Kingdom
| | - Lucy MacDonald
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Glasgow, United Kingdom.,Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Mariola Kurowska-Stolarska
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Glasgow, United Kingdom.,Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Andrew R Clark
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Birmingham, United Kingdom
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12
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Garcia-Melchor E, Cafaro G, MacDonald L, Crowe LAN, Sood S, McLean M, Fazzi UG, McInnes IB, Akbar M, Millar NL. Novel self-amplificatory loop between T cells and tenocytes as a driver of chronicity in tendon disease. Ann Rheum Dis 2021; 80:1075-1085. [PMID: 33692018 PMCID: PMC8292554 DOI: 10.1136/annrheumdis-2020-219335] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Increasing evidence suggests that inflammatory mechanisms play a key role in chronic tendon disease. After observing T cell signatures in human tendinopathy, we explored the interaction between T cells and tendon stromal cells or tenocytes to define their functional contribution to tissue remodelling and inflammation amplification and hence disease perpetuation. METHODS T cells were quantified and characterised in healthy and tendinopathic tissues by flow cytometry (FACS), imaging mass cytometry (IMC) and single cell RNA-seq. Tenocyte activation induced by conditioned media from primary damaged tendon or interleukin-1β was evaluated by qPCR. The role of tenocytes in regulating T cell migration was interrogated in a standard transwell membrane system. T cell activation (cell surface markers by FACS and cytokine release by ELISA) and changes in gene expression in tenocytes (qPCR) were assessed in cocultures of T cells and explanted tenocytes. RESULTS Significant quantitative differences were observed in healthy compared with tendinopathic tissues. IMC showed T cells in close proximity to tenocytes, suggesting tenocyte-T cell interactions. On activation, tenocytes upregulated inflammatory cytokines, chemokines and adhesion molecules implicated in T cell recruitment and activation. Conditioned media from activated tenocytes induced T cell migration and coculture of tenocytes with T cells resulted in reciprocal activation of T cells. In turn, these activated T cells upregulated production of inflammatory mediators in tenocytes, while increasing the pathogenic collagen 3/collagen 1 ratio. CONCLUSIONS Interaction between T cells and tenocytes induces the expression of inflammatory cytokines/chemokines in tenocytes, alters collagen composition favouring collagen 3 and self-amplifies T cell activation via an auto-regulatory feedback loop. Selectively targeting this adaptive/stromal interface may provide novel translational strategies in the management of human tendon disorders.
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Affiliation(s)
- Emma Garcia-Melchor
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Giacomo Cafaro
- Rheumatology Unit - Department of Medicine, University of Perugia, Perugia, Italy
| | - Lucy MacDonald
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Lindsay A N Crowe
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Shatakshi Sood
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Michael McLean
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Umberto G Fazzi
- Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Moeed Akbar
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK .,Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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13
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Alivernini S, MacDonald L, Elmesmari A, Finlay S, Tolusso B, Gigante MR, Petricca L, Di Mario C, Bui L, Perniola S, Attar M, Gessi M, Fedele AL, Chilaka S, Somma D, Sansom SN, Filer A, McSharry C, Millar NL, Kirschner K, Nerviani A, Lewis MJ, Pitzalis C, Clark AR, Ferraccioli G, Udalova I, Buckley CD, Gremese E, McInnes IB, Otto TD, Kurowska-Stolarska M. Distinct synovial tissue macrophage subsets regulate inflammation and remission in rheumatoid arthritis. Nat Med 2020; 26:1295-1306. [PMID: 32601335 DOI: 10.1038/s41591-020-0939-8] [Citation(s) in RCA: 268] [Impact Index Per Article: 67.0] [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: 09/23/2019] [Accepted: 05/12/2020] [Indexed: 12/28/2022]
Abstract
Immune-regulatory mechanisms of drug-free remission in rheumatoid arthritis (RA) are unknown. We hypothesized that synovial tissue macrophages (STM), which persist in remission, contribute to joint homeostasis. We used single-cell transcriptomics to profile 32,000 STMs and identified phenotypic changes in patients with early/active RA, treatment-refractory/active RA and RA in sustained remission. Each clinical state was characterized by different frequencies of nine discrete phenotypic clusters within four distinct STM subpopulations with diverse homeostatic, regulatory and inflammatory functions. This cellular atlas, combined with deep-phenotypic, spatial and functional analyses of synovial biopsy fluorescent activated cell sorted STMs, revealed two STM subpopulations (MerTKposTREM2high and MerTKposLYVE1pos) with unique remission transcriptomic signatures enriched in negative regulators of inflammation. These STMs were potent producers of inflammation-resolving lipid mediators and induced the repair response of synovial fibroblasts in vitro. A low proportion of MerTKpos STMs in remission was associated with increased risk of disease flare after treatment cessation. Therapeutic modulation of MerTKpos STM subpopulations could therefore be a potential treatment strategy for RA.
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MESH Headings
- Arthritis, Rheumatoid/genetics
- Arthritis, Rheumatoid/immunology
- Arthritis, Rheumatoid/metabolism
- Arthritis, Rheumatoid/pathology
- Biopsy
- Cell Lineage/genetics
- Humans
- Inflammation/genetics
- Inflammation/immunology
- Inflammation/metabolism
- Inflammation/pathology
- Joints/immunology
- Joints/metabolism
- Joints/pathology
- Lectins, C-Type/genetics
- Lectins, C-Type/immunology
- Macrophages/immunology
- Macrophages/metabolism
- Mannose Receptor
- Mannose-Binding Lectins/genetics
- Mannose-Binding Lectins/immunology
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/immunology
- Receptors, Immunologic/genetics
- Receptors, Immunologic/immunology
- Synovial Fluid/immunology
- Synovial Fluid/metabolism
- Synovial Membrane
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Affiliation(s)
- Stefano Alivernini
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), .
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK.
| | - Lucy MacDonald
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Aziza Elmesmari
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Samuel Finlay
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Rita Gigante
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Petricca
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Clara Di Mario
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Bui
- Division of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simone Perniola
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Moustafa Attar
- The Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Marco Gessi
- Division of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anna Laura Fedele
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sabarinadh Chilaka
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Domenico Somma
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Stephen N Sansom
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- The Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Andrew Filer
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Charles McSharry
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Neal L Millar
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Alessandra Nerviani
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Myles J Lewis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Costantino Pitzalis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Andrew R Clark
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Irina Udalova
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- The Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Christopher D Buckley
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- The Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Elisa Gremese
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Iain B McInnes
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Thomas D Otto
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), .
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK.
| | - Mariola Kurowska-Stolarska
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), .
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK.
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14
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Elmesmari A, MacDonald L, Vaughan D, Tolusso B, Bui L, Gigante MR, Federico F, Ferraccioli G, Gremese E, McInnes IB, Alivernini S, Kurowska-Stolarska M. P234 Characterisation of human synovial tissue dendritic cells in rheumatoid arthritis patients. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Dendritic cells (DCs) direct immune responses against pathogens while maintaining tolerance to self-antigens. However, their aberrant activation can lead to autoimmunity and inflammation. DCs consist of two subtypes: plasmacytoid and myeloid DCs. Recently, single-cell sequencing has revealed complex heterogeneity within myeloid DCs. These cells can be divided into CD141pos (DC1), DC2 defined as CD1highCD163neg and DC3 defined as CD1clowCD163high. In addition, a population of CD1cnegCD141negCD16pos (DC4), which share some gene expression with CD16pos monocytes, has been identified. To date, most studies of RA investigated DC precursors in circulation or synovial fluid (SF). However, DCs perform their functions within lymphoid or peripheral tissue. Therefore, in this study, we sought to characterise myeloid DC subsets in synovial tissue (ST) with the prospect of better understanding their role in driving autoimmunity in RA.
Methods
We developed a flow sorting strategy to characterise the phenotype of distinct myeloid DC subsets in multiple biological compartments (PB, SF, and ST). Ultrasound-guided ST biopsies (RA n = 9; Psoriatic arthritis n = 3 with active disease) were digested with liberase prior to analysis. PB DCs (RA n = 19, Psoriatic arthritis n = 16, healthy donors n = 12), and SF DC (n = 3) were used as comparators. ST, SF and PB DCs were sorted then microRNA, pro-inflammatory and regulatory cytokine expression analysed by amplified qPCR. To evaluate the role of miR-155 in RA CD1cpos DC activation, CD1cpos cells were computationally sub-setted from a scRNAseq synovial dataset comparing synovial tissues of healthy individuals (n = 4) with patients with active RA (n = 7) and those in sustained clinical and ultrasound remission (n = 7). To elucidate the role of miR-155, CD1cpos DC from RA patients (n = 10) were sorted then transfected with miR-155 mimic or control mimic and the cytokines expression and produced were evaluated using quantitative RT-PCR and Luminex, respectively.
Results
Our data revealed that whilst all myeloid DCs subsets can be present in inflamed RA synovium they occur with variable frequencies. CD1cpos (DC2/3) being the most abundant, followed by CD16pos DCs (DC4), whilst CD141pos DCs (DC1) occur in low numbers or are absent. CD1cpos DC sorted from RA ST express high levels of epigenetic regulators of inflammatory response miR-155, IL-6, TNF-a and IL-23 as compared to circulating cells.Unsupervised clustering of synovial CD1c cells identified 4 separate clusters including a distinctive miR155 positive CD1c cluster in RA patients. These cells showed significantly higher expression of pro-inflammatory cytokines and co-stimulatory molecules compared to other synovial CD1c clusters. Overexpression of miR-155 in CD1cpos leads to increased production of TNF-a and IL-23.
Conclusion
Our data show that miR-155 is strongly implicated as an epigenetic regulator of the pro-inflammatory synovial CD1cpos DCs sub-cluster and contributes to exacerbating RA.
Disclosures
A. Elmesmari None. L. MacDonald None. D. Vaughan None. B. Tolusso None. L. Bui None. M. Gigante None. F. Federico None. G. Ferraccioli None. E. Gremese None. I. B McInnes None. S. Alivernini None. M. Kurowska-Stolarska None.
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Affiliation(s)
- Aziza Elmesmari
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
| | - Lucy MacDonald
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
| | - Diane Vaughan
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
| | - Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ITALY
| | - Laura Bui
- Institute of Pathology, Fondazione Policlinico Universitario A. Gemelli – Catholic University of the Sacred Heart, Rome, ITALY
| | - Maria Rita Gigante
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ITALY
| | - Francesco Federico
- Institute of Pathology, Fondazione Policlinico Universitario A. Gemelli – Catholic University of the Sacred Heart, Rome, ITALY
| | | | - Elisa Gremese
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, ITALY
| | - Iain B McInnes
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
| | - Stefano Alivernini
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, ITALY
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Cairns S, Gibbons C, Milne A, King H, Llano M, MacDonald L, Malcolm W, Robertson C, Sneddon J, Weir J, Reilly J. Results from the third Scottish National Prevalence Survey: is a population health approach now needed to prevent healthcare-associated infections? J Hosp Infect 2018; 99:312-317. [PMID: 29621601 DOI: 10.1016/j.jhin.2018.03.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Healthcare-associated infections (HCAIs) are a major public health concern and a significant cause of morbidity and mortality. A robust and current evidence base that is specific to local, national and Europe-wide settings is necessary to inform the development of strategies to reduce HCAI and contain antimicrobial resistance. AIM To measure the prevalence of HCAI and antimicrobial prescribing and identify key priority areas for interventions to reduce the burden of infection. METHODS A national rolling point-prevalence survey (PPS) in National Health Service (NHS) acute, NHS non-acute, NHS paediatric, and independent hospitals was carried out between September and November 2016 using the European Centre for Disease Prevention and Control protocol designed for the European PPS. FINDINGS The prevalence of HCAI was 4.6%, 2.7%, and 3.2% in acute adults, paediatric and non-acute patient groups, respectively. The most frequent HCAI types reported in adult patients were urinary tract infection and pneumonia. The prevalence of antimicrobial prescribing was 35.7%, 29.3%, and 13.8% in acute adults, paediatric, and non-acute patient groups, respectively. Respiratory, skin and soft tissue, gastrointestinal, and urinary tract infections were the most common infections being treated at the time of survey. CONCLUSION HCAI continues to be a public health concern in Scotland. Urinary tract infection and pneumonia continue to place a significant burden on patients and on healthcare delivery, including those that develop in the community and require hospital admission. A broader population health approach which focuses on reducing the risk of infection upstream would reduce these infections in both community and hospital settings.
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Affiliation(s)
- S Cairns
- National Services Scotland, Health Protection Scotland, Glasgow, UK.
| | - C Gibbons
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - A Milne
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - H King
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - M Llano
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - L MacDonald
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - W Malcolm
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - C Robertson
- National Services Scotland, Health Protection Scotland, Glasgow, UK; University of Strathclyde, Glasgow, UK
| | - J Sneddon
- Healthcare Improvement Scotland, Glasgow, UK
| | - J Weir
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - J Reilly
- National Services Scotland, Health Protection Scotland, Glasgow, UK; Glasgow Caledonian University, Glasgow, UK
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16
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Pierce LA, Pedemonte S, DeWitt D, MacDonald L, Hunter WCJ, Van Leemput K, Miyaoka R. Characterization of highly multiplexed monolithic PET / gamma camera detector modules. Phys Med Biol 2018; 63:075017. [PMID: 29498361 PMCID: PMC5908720 DOI: 10.1088/1361-6560/aab380] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PET detectors use signal multiplexing to reduce the total number of electronics channels needed to cover a given area. Using measured thin-beam calibration data, we tested a principal component based multiplexing scheme for scintillation detectors. The highly-multiplexed detector signal is no longer amenable to standard calibration methodologies. In this study we report results of a prototype multiplexing circuit, and present a new method for calibrating the detector module with multiplexed data. A [Formula: see text] mm3 LYSO scintillation crystal was affixed to a position-sensitive photomultiplier tube with [Formula: see text] position-outputs and one channel that is the sum of the other 64. The 65-channel signal was multiplexed in a resistive circuit, with 65:5 or 65:7 multiplexing. A 0.9 mm beam of 511 keV photons was scanned across the face of the crystal in a 1.52 mm grid pattern in order to characterize the detector response. New methods are developed to reject scattered events and perform depth-estimation to characterize the detector response of the calibration data. Photon interaction position estimation of the testing data was performed using a Gaussian Maximum Likelihood estimator and the resolution and scatter-rejection capabilities of the detector were analyzed. We found that using a 7-channel multiplexing scheme (65:7 compression ratio) with 1.67 mm depth bins had the best performance with a beam-contour of 1.2 mm FWHM (from the 0.9 mm beam) near the center of the crystal and 1.9 mm FWHM near the edge of the crystal. The positioned events followed the expected Beer-Lambert depth distribution. The proposed calibration and positioning method exhibited a scattered photon rejection rate that was a 55% improvement over the summed signal energy-windowing method.
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Affiliation(s)
- L A Pierce
- Imaging Research Laboratory, Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle WA, United States of America
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17
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Cook T, Boniface N, Seller C, Hughes J, Damen C, MacDonald L, Kelly F. Universal videolaryngoscopy: a structured approach to conversion to videolaryngoscopy for all intubations in an anaesthetic and intensive care department. Br J Anaesth 2018; 120:173-180. [DOI: 10.1016/j.bja.2017.11.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/20/2022] Open
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18
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Gill N, Sabri S, Arsenault D, Burge F, Clarke B, Fleming M, Grandy M, Harrigan K, MacDonald L, Nichols N. DEVELOPING A CASE DEFINITION FOR CONGESTIVE HEART FAILURE USING PRIMARY CARE EMR DATA. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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19
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Petrov ME, Long L, Grandner MA, MacDonald L, Cribbet MR, Robbins R, Cundiff J, Molano JR, Hoffmann N, Howard G, Howard VJ. 0830 SLEEP DURATION BY SOCIODEMOGRAPHIC, SOCIOECONOMIC, AND GEOGRAPHICAL STATUS: THE REGARDS STUDY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Malow BA, Drury BC, MacDonald L, Loring W, Alder M, Matthews M, Wofford D, Lutz J. 0899 INVOLVING COMMUNITY PARTNERS IN PARENT-BASED SLEEP EDUCATION. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
PURPOSE Theories provide a structural knowing about concept relationships, practice intricacies, and intuitions and thus shape the distinct body of the profession. Capturing ways of knowing and being is essential to any professions' practice, education and research. This process defines the phenomenon of the profession - its existence or experience. Theory evaluation is a systematic criterion-based assessment of a specific theory. This study presents a theory analysis of the Dental Hygiene Human Needs Conceptual Model (DH HNCM). METHODS Using the Walker and Avant Theory Analysis, a seven-step process, the DH HNCM, was analysed and evaluated for its meaningfulness and contribution to dental hygiene. The steps include the following: (i) investigate the origins; (ii) examine relationships of the theory's concepts; (iii) assess the logic of the theory's structure; (iv) consider the usefulness to practice; (v) judge the generalizability; (vi) evaluate the parsimony; and (vii) appraise the testability of the theory. FINDINGS Human needs theory in nursing and Maslow's Hierarchy of Need Theory prompted this theory's development. The DH HNCM depicts four concepts based on the paradigm concepts of the profession: client, health/oral health, environment and dental hygiene actions, and includes validated eleven human needs that evolved overtime to eight. It is logical, simplistic, allows scientific predictions and testing, and provides a unique lens for the dental hygiene practitioner. With this model, dental hygienists have entered practice, knowing they enable clients to meet their human needs. CONCLUSION For the DH HNCM, theory analysis affirmed that the model is reasonable and insightful and adds to the dental hygiene professions' epistemology and ontology.
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Affiliation(s)
- L MacDonald
- School of Dental Hygiene, College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - D M Bowen
- Department of Dental Hygiene, Division of Health Sciences, Idaho State University, Pocatello, ID, USA
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23
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MacDonald L, Thomas C, Syme A. WE-AB-209-06: Dynamic Collimator Trajectory Algorithm for Use in VMAT Treatment Deliveries. Med Phys 2016. [DOI: 10.1118/1.4957775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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24
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MacDonald L, Robar J, Thomas C. PO-0841: Cranial stereotactic trajectory optimization via patient-specific overlap atlas. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32091-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grant R, Bulbeck H, Oliver K, Quinn G, MacDonald L, Day J, Zienius K, Morley R. OP01THE UK TOP 10 CLINICAL RESEARCH PRIORITIES IN NEURO-ONCOLOGY. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov283.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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26
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Eadie D, Stead M, MacKintosh AM, MacDonald L, Purves R, Pearce J, Tisch C, van der Sluijis W, Amos A, MacGregor A, Haw S. E-cigarette marketing in UK stores: an observational audit and retailers' views. BMJ Open 2015; 5:e008547. [PMID: 26362665 PMCID: PMC4567676 DOI: 10.1136/bmjopen-2015-008547] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/16/2015] [Accepted: 08/04/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To explore how e-cigarettes are being promoted at point of sale in the UK and how retailers perceive market trends. SETTING Fixed retail outlets subject to a ban on the display of tobacco products. PARTICIPANTS Observational audit of all stores selling tobacco products (n=96) in 4 Scottish communities, conducted over 2 waves 12 months apart (2013-2014), and qualitative interviews with small retailers (n=25) in 4 matched communities. PRIMARY AND SECONDARY OUTCOME MEASURES The audit measured e-cigarette display characteristics, advertising materials and proximity to other products, and differences by area-level disadvantage. Interviews explored retailers' perceptions of e-cigarette market opportunities and risks, and customer responses. RESULTS The number of e-cigarette point-of-sale display units and number of brands displayed increased between waves. E-cigarettes were displayed close to products of interest to children in 36% of stores. Stores in more affluent areas were less likely to have external e-cigarette advertising than those in deprived areas. Although e-cigarettes delivered high profit margins, retailers were confused by the diversity of brands and products, and uncertain of the sector's viability. Some customers were perceived to purchase e-cigarettes as cessation aids, and others, particularly low-income smokers, as a cheaper adjunct to conventional tobacco. CONCLUSIONS E-cigarette point-of-sale displays and number of brands displayed increased over 12 months, a potential cause for concern given their lack of regulation. Further scrutiny is needed of the content and effects of such advertising, and the potentially normalising effects of placing e-cigarettes next to products of interest to children.
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Affiliation(s)
- D Eadie
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - M Stead
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - A M MacKintosh
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - L MacDonald
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - R Purves
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - J Pearce
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - C Tisch
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - W van der Sluijis
- Child and Adolescent Health Research Unit, University of St Andrews, St Andrews, UK
| | - A Amos
- Centre for Population Health Sciences, School of Molecular Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - S Haw
- School of Health Sciences, University of Stirling, Stirling, UK
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Bradley AJ, MacDonald L, Whiteside S, Johnson RJ, Ramani VAC. Accuracy of preoperative CT T staging of renal cell carcinoma: which features predict advanced stage? Clin Radiol 2015; 70:822-9. [PMID: 25953656 DOI: 10.1016/j.crad.2015.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 03/01/2015] [Accepted: 03/24/2015] [Indexed: 01/13/2023]
Abstract
AIMS To characterise CT findings in renal cell carcinoma (RCC), and establish which features are associated with higher clinical T stage disease, and to evaluate patterns of discrepancy between radiological and pathological staging of RCC. MATERIALS AND METHODS Preoperative CT studies of 92 patients with 94 pathologically proven RCCs were retrospectively reviewed. CT stage was compared with pathological stage using the American Joint Committee on Cancer (AJCC), 7(th) edition (2010). The presence or absence of tumour necrosis, perinephric fat standing, thickening of Gerota's fascia, collateral vessels were noted, and correlated with pT stage. The sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) for predicting pT stage ≥pT3a were derived separately for different predictors using cross-tabulations. RESULTS Twenty-four lesions were pathological stage T1a, 21 were T1b, seven were T2a, 25 were T3a, 11 were T3b, four were T3c, and two were T4. There were no stage T2b. Sixty-three (67%) patients had necrosis, 27 (29%) thickening of Gerota's fascia (1 T1a), 25 had collateral vessels (0 T1a), 28 (30%) had fat stranding of <2 mm, 20 (21%) of 2-5mm and one (1%) of >5 mm. For pT stage ≥pT3a, the presence of perinephric fat stranding had a sensitivity, specificity, PPV and NPV of 74%, 65%, 63%, and 76%, respectively. Presence of tumour necrosis had a sensitivity, specificity, PPV, and NPV of 81%, 44%, 54%, and 72%, respectively. Thickening of Gerota's fascia had a sensitivity, specificity, PPV, and NPV of 52%, 90%, 81% and 70%, respectively; and enlarged collateral vessels had a sensitivity, specificity, PPV, and NPV value of 52%, 94%, 88%, and 71% respectively. CONCLUSION The presence of perinephric stranding and tumour necrosis were not reliable signs for pT stage >T3a. Thickening of Gerota's fascia and the presence of collateral vessels in the peri- or paranephric fat had 90% and 94% specificity, with 82% and 88% PPV, respectively, for the presence of tumour stage for pT stage >T3a. These are considered reliable signs of locally advanced renal cancer.
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Affiliation(s)
- A J Bradley
- Department of Radiology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK.
| | - L MacDonald
- Department of Radiology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | - S Whiteside
- Department of Medical Statistics, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | - R J Johnson
- Department of Radiology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | - V A C Ramani
- Department of Urology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
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Winters ZE, Emson M, Griffin C, Mills J, Hopwood P, Bidad N, MacDonald L, Turton EPL, Horne R, Bliss JM. Learning from the QUEST multicentre feasibility randomization trials in breast reconstruction after mastectomy. Br J Surg 2015; 102:45-56. [PMID: 25451179 DOI: 10.1002/bjs.9690] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 03/26/2014] [Revised: 05/08/2014] [Accepted: 09/30/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Breast reconstruction aims to improve health-related quality of life after mastectomy. However, evidence guiding patients and surgeons in shared decision-making concerning the optimal type or timing of surgery is lacking. METHODS QUEST comprised two parallel feasibility phase III randomized multicentre trials to assess the impact of the type and timing of latissimus dorsi breast reconstruction on health-related quality of life when postmastectomy radiotherapy is unlikely (QUEST A) or highly probable (QUEST B). The primary endpoint for the feasibility phase was the proportion of women who accepted randomization, and it would be considered feasible if patient acceptability rates exceeded 25 per cent of women approached. A companion QUEST Perspectives Study (QPS) of patients (both accepting and declining trial participation) and healthcare professionals assessed trial acceptability. RESULTS The QUEST trials opened in 15 UK centres. After 18 months of recruitment, 17 patients were randomized to QUEST A and eight to QUEST B, with overall acceptance rates of 19 per cent (17 of 88) and 22 per cent (8 of 36) respectively. The QPS recruited 56 patients and 51 healthcare professionals. Patient preference was the predominant reason for declining trial entry, given by 47 (53 per cent) of the 88 patients approached for QUEST A and 22 (61 per cent) of the 36 approached for QUEST B. Both trials closed to recruitment in December 2012, acknowledging the challenges of achieving satisfactory patient accrual. CONCLUSION Despite extensive efforts to overcome recruitment barriers, it was not feasible to reach timely recruitment targets within a feasibility study. Patient preferences for breast reconstruction types and timings were common, rendering patients unwilling to enter the trial.
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Affiliation(s)
- Z E Winters
- Breast Reconstruction Patient Reported and Clinical Outcomes Research Group, School of Clinical Sciences, University of Bristol and North Bristol Trust, Bristol, UK
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29
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MacDonald L, Thomas C. TH-C-12A-05: Dynamic Couch Motion for Improvement of Radiation Therapy Trajectories in DCA and VMAT. Med Phys 2014. [DOI: 10.1118/1.4889642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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30
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Abstract
Acute right iliac fossa pain is a common surgical presentation. The presentation is often non-specific and encompasses a wide differential, which creates a diagnostic challenge. Ultrasound is commonly the initial cross-sectional imaging modality and can be used as a tool to triage patients appropriately; assessing for appendicitis and other salient findings, which may indicate an alternative condition. Additionally, the dynamic nature of this imaging modality enables patient interaction. Following a systematic assessment of the abdomen and pelvis, a more focused interrogation of the right iliac fossa is performed. In this pictorial review, we illustrate the sonographic features of appendicitis and other conditions that can mimic appendicitis in its presentation. This highlights that through a systematic approach, it is possible to distinguish between these different pathologies, enabling clinicians to optimally manage the patient.
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Affiliation(s)
- E K White
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
| | - L MacDonald
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
| | - G Johnson
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
| | - V Rudralingham
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
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31
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MacDonald L, Yankeelov T, Karellas A, Boone J. WE-A-141-01: Advanced Imaging for Breast Cancer: Screening, Diagnosis, and Assessing Response to Therapy. Med Phys 2013. [DOI: 10.1118/1.4815506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bloomfield K, MacDonald L, Finucane G, Snow B, Roxburgh R. Use of antipsychotic medications in patients with Parkinson's disease at Auckland City Hospital. Intern Med J 2013; 42:e151-6. [PMID: 21470354 DOI: 10.1111/j.1445-5994.2011.02499.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The American Academy of Neurology considers clozapine first line treatment for psychosis in Parkinson's disease (PD). In practice, patients are typically treated with quetiapine initially despite only level C evidence for use due to concern about side-effects, and changed to clozapine if they fail this. AIM To review the use of antipsychotics in patients with PD and the demographics of PD patients who develop psychosis. METHODS Patients with PD on antipsychotic medications were identified by the Movement Disorder Nurse Specialist database and by reviewing patients admitted to Auckland City Hospital from January 2006 until March 2008. The demographic data, details of PD and antipsychotic use and comorbidities were recorded. RESULTS Sixty-six patients with PD on antipsychotics were identified. The mean age was 75 years and 48 (73%) were in residential care. Patients admitted on antipsychotics had longer disease duration (P < 0.001) and were more likely to have cognitive impairment (P= 0.02) than those admitted not on antipsychotics. The most common indication for use was hallucinations. Patients on clozapine were younger (P < 0.005) and had less comorbidity (P= 0.04) than those on quetiapine. Fifty per cent (6/12) of patients on clozapine had previously failed quetiapine. CONCLUSION Quetiapine has a good efficacy rate with minimal side-effects. This study lends support to the assumption that quetiapine is a useful medication. However, clozapine also was well tolerated and could be considered for use more frequently than it is.
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Affiliation(s)
- K Bloomfield
- Department of Geriatric Medicine, University of Auckland and Waitemata District Health Board, Shakespeare Road, PO Box 93 503, Takapuna, Northshore 0740, Auckland, New Zealand.
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Wilson C, Sampson D, MacIsaac-Delorey S, MacDonald L. N004 The development and implementation of a Chronic Total Occlusion (CTO) angioplasty program. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Berinstein NL, Morse M, Kaufman H, Nemunaitis JJ, Odunsi K, Chatta GS, Weir G, MacDonald L, Stanford M, Karkada M, Nigam R, Mansour M. A phase I study of the safety and immunogenicity of a therapeutic vaccine, DPX-0907 in patients with advanced-stage ovarian, breast, or prostate cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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MacDonald L, Fricke M, Wener P, Nelson M, Schönwetter DJ, Anderson JE, The Manitoba Initiative For Interpr. De novo learning in creating a graduate studies course on Interprofessional Education for Collaborative Patient-Centred Practice (IECPCP). J Interprof Care 2009; 23:195-7. [DOI: 10.1080/13561820802293071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jackson ST, Mullings AM, Booth TF, MacDonald L, Henry SO, Khan CA, McLaughlin PD. Molecular analysis and implications of neurovirulent circulating vaccine-derived poliovirus in Jamaica. A case report and review of literature. W INDIAN MED J 2008; 57:511-514. [PMID: 19565986] [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] [Indexed: 05/28/2023]
Abstract
As the goal to eradicate wild polio virus (WPV) is approached, outbreaks associated with vaccine derived polioviruses (VDPV) with neurovirulent properties have emerged. The relevance for the spread of infection by nonparalytic cVDPV cases, with mutations associated with neurovirulence, is discussed with reference to the molecular analysis of a VDPV isolated from a Jamaican child who presented with aseptic meningitis. Potential risks to the Jamaican community resulting from circulation of cVDPV and critical factors defined by the World Health Organization (WHO) in the global eradication of Polio are analyzed in the context of immunization coverage, and the need to stop all Oral Polio Vaccine (OPV) use once wild polioviruses (WPVs) have been eradicated.
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Affiliation(s)
- S T Jackson
- Department of Micobiology, The University of the West Indies, Kingston 7, Jamaica, West Indies.
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MacLeod A, Branch A, Cassidy J, McDonald A, Mohammed N, MacDonald L. A nurse-/pharmacy-led capecitabine clinic for colorectal cancer: Results of a prospective audit and retrospective survey of patient experiences. Eur J Oncol Nurs 2007; 11:247-54. [PMID: 17188937 DOI: 10.1016/j.ejon.2006.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 09/21/2006] [Accepted: 10/03/2006] [Indexed: 12/27/2022]
Abstract
Oral chemotherapy agents provide patients with choice and home-based therapy but demand greater emphasis on patient support and education to minimise toxicities. To meet this demand, a nurse-/pharmacy-led clinic was established at the Beatson Oncology Centre in 2003 for the provision of oral capecitabine to metastatic colorectal cancer patients to provide a controlled and supportive environment. We conducted a prospective audit of 52 patients attending the clinic from March 2003 to June 2004 and a retrospective survey of patient experiences to assess clinic effectiveness. Of 52 patients, 79% completed at least 3 cycles of treatment (mean 3.5). Capecitabine was well tolerated. The dose was reduced on at least one occasion in 15 (29%) patients and 17 (30%) patients experienced at least one delay. Patient satisfaction, indicated by questionnaire responses (n=27), was high. Most patients (> or =85%) thought that the service provision was useful and well organised. The results indicate that a nurse-/pharmacy-led clinic for the provision of home-based oral capecitabine is safe, effective and acceptable to most patients. The success of this clinic can provide a model for use in other centres and in other types of cancer, such as breast cancer, where oral chemotherapy is a treatment option.
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Affiliation(s)
- A MacLeod
- Beatson Oncology Center, Dumbarton Road, Glasgow, G11 6NT, UK.
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MacDonald L, Cohen A, Baron S, Burchfiel C. Current Practices in the Collection and Use of Occupational Measures in Population-Based Cardiovascular Studies in the United States. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s214-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gallant J, Bonthuis P, Lindsley D, Cabellon J, Gill G, Heaton K, Kelley-Clarke B, MacDonald L, Mercer S, Vu H, Worsley A. On the role of the starved codon and the takeoff site in ribosome bypassing in Escherichia coli. J Mol Biol 2004; 342:713-24. [PMID: 15342232 DOI: 10.1016/j.jmb.2004.07.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2004] [Revised: 07/13/2004] [Accepted: 07/14/2004] [Indexed: 11/25/2022]
Abstract
Translating ribosomes can skip over stretches of messenger RNA and resume protein chain elongation after a "bypassed" region. We have previously shown that limitation for isoleucyl-tRNA can initiate a ribosome bypass when an AUA codon is in the ribosomal A-site. We have now generalized this effect to other "hungry" codons calling for four different limiting aminoacyl-tRNA species, suggesting that a pause at any A-site will have this effect. We have assessed bypassing in a large family of reporters with nearly every different triplet in the "takeoff site", i.e. the P-site on the 5' side of the hungry codon, and an identical "landing site" codon 16 nucleotides downstream. The different takeoff sites vary over a factor of 50 in bypassing proficiency. At least part of this variation appears to reflect stability of the codon Colon, two colons anticodon interaction at the takeoff site, as indicated by the following: (a) the bypassing proficiency of different tRNAs shows a rough correlation with the frequency of A Colon, two colons U as opposed to G Colon, two colons C pairs in the codon Colon, two colons anticodon association; (b) specific tRNAs bypass more frequently from codons ending in U than from their synonym ending in C; (c) an arginine tRNA with Inosine in the wobble position which reads CGU, CGC, and CGA bypasses much more frequently from the last codon than the first two synonyms.
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Affiliation(s)
- J Gallant
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA.
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Hutchinson SJ, Goldberg DJ, King M, Cameron SO, Shaw LE, Brown A, MacKenzie J, Wilson K, MacDonald L. Hepatitis C virus among childbearing women in Scotland: prevalence, deprivation, and diagnosis. Gut 2004; 53:593-8. [PMID: 15016757 PMCID: PMC1774001 DOI: 10.1136/gut.2003.027383] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2003] [Indexed: 12/08/2022]
Abstract
OBJECTIVES (A) To examine the prevalence and demographic characteristics of hepatitis C virus (HCV) infection among childbearing women in Scotland; and (B) to determine the extent of maternal HCV infection diagnosed prior to birth. METHODS (A) Residual dried blood spot samples from routine neonatal screening, collected throughout Scotland during March-October 2000, were unlinked from identifiers and tested anonymously for HCV antibodies; and (B) electronic record linkage of Scotland's databases of births and diagnosed HCV infections was performed. RESULTS (A) Of 30,259 samples, 121 were enzyme linked immunosorbent assay repeat reactive and 88 of these were confirmed as anti-HCV positive in the recombinant immunoblot assay, representing a seroprevalence of 0.29-0.40%. HCV seroprevalence was high among 25-29 year olds (0.4-0.57%), in high deprivation areas (0.92-1.07%), and in Greater Glasgow (0.83-0.96%) and Grampian (0.38-0.62%). Adjusted relative risk for HCV infection was highest among residents in high deprivation areas of Glasgow (7.2 (95% confidence interval 2.0-25.5)). (B) Of 121 HCV infections found among women at delivery, 24% and 46% were estimated to have been diagnosed prior to pregnancy and birth, respectively. CONCLUSIONS HCV prevalence among Scottish childbearing women is consistent with that expected from injecting drug use. Based on reported rates of mother to child transmission, 8-11 paediatric infections are expected per annum. Diagnosis in only 24% of infected women prior to pregnancy indicates the extent to which HCV goes unrecognised in the injecting community. The current HCV screening approach-to test only those with a history of injecting drug use (or other risk factors for infection)-identifies approximately a quarter of previously undetected infections among pregnant women.
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Affiliation(s)
- S J Hutchinson
- Scottish Centre for Infection and Environmental Health, and Public Health and Health Policy Section, University of Glasgow, Glasgow, UK.
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Roy KM, Goldberg DJ, Hutchinson S, Cameron SO, Wilson K, MacDonald L. Hepatitis C virus among self declared non-injecting sexual partners of injecting drug users. J Med Virol 2004; 74:62-6. [PMID: 15258969 DOI: 10.1002/jmv.20146] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
While much is known about hepatitis C virus (HCV) among injecting drug users (IDUs), there is scant information about the risk of HCV infection to non-injecting sexual partners of injecting drug users; it is possible that such individuals may have a greater risk of acquiring HCV than any other group barring injecting drug users. This study examines the prevalence of HCV among a population of non-injecting sexual partners of injecting drug users. Unlinked anonymous testing for anti-HCV of residual sera stored following the named HIV testing of specimens originally from persons who had indicated to their attending clinicians that they were non-injecting sexual partners of injecting drug users. The prevalence of anti-HCV among the sexual partners was 4.1% (25/611) overall, 6.4% (13/202) among heterosexual male and 3.0% (12/397) among the heterosexual female partners. None of the homosexual/bisexual partners were HCV antibody positive (0/12). Although we cannot be sure how non-injecting partners of injecting drug users acquire their HCV infection, having a relationship with someone who injects drugs may place an individual at appreciable risk of being infected; such individuals should consider being tested for HCV.
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Affiliation(s)
- K M Roy
- Blood-borne Virus Section, Scottish Centre for Infection and Environmental Health, Glasgow, United Kingdom.
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Roy KM, Goldberg D, Taylor A, Hutchinson S, MacDonald L, Wilson KS, Cameron SO. A method to detect the incidence of hepatitis C infection among injecting drug users in Glasgow 1993-98. J Infect 2001; 43:200-5. [PMID: 11798260 DOI: 10.1053/jinf.2001.0908] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To determine the incidence of HCV infection in a selected population of Glasgow injectors during the mid-1990s, using a retrospective cohort design. METHODS Unlinked anonymous anti-HCV testing was undertaken on serum residues collected from injecting drug users (IDUs) having two or more voluntary named HIV tests between 1993 and 1998. RESULTS Seventy-seven percent (164/212) of IDUs had detectable HCV antibody in their first specimen collected. Of the 44 IDUs who were initially HCV seronegative and had a subsequent specimen available for testing, 11 (25%) seroconverted, giving an estimated incidence of 28.4 per 100 person-years (95% CI 15.7-51.2); the incidence of infection was greatest amongst older males. CONCLUSION This study provides evidence of continuing transmission of HCV among Glasgow IDUs during an era of interventions to prevent the spread of bloodborne infections in this population and demonstrates the application of the unlinked anonymous testing approach to gauge incidence rather than prevalence of infection.
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Affiliation(s)
- K M Roy
- Scottish Centre for Infection and Environmental Health, Glasgow, UK.
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Abstract
Little is known about the "stigmatizing" effects of Spasmodic Torticollis--a condition that produces physical disfigurement. This is important in understanding the social dimensions of this disorder. This study examined the presence, the dimensions, and the degree of perceived stigma in patients with Spasmodic Torticollis. The study was completed in two stages. In the first stage, ten patients were interviewed to identify the effects of their condition on their social interactions. In the second stage, a self-rating measure of stigma and questions about the impact of the condition on the patients' lives were devised. Perceived stigma was defined as avoidance of others, avoidance by others, self-consciousness, feeling unattractive, feeling apologetic, and feeling different from others. The questionnaires were sent to one hundred patients. The majority of the patients perceived "some" or "severe" stigma. Stigma was found to affect the patients' social, private, and working lives. It is suggested that stigma in Spasmodic Torticollis needs to be considered as a parameter relevant to the clinical management of these patients.
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Affiliation(s)
- I Papathanasiou
- Therapy Services, National Hospital for Neurology and Neurosurgery, United Kingdom.
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MacDonald L. "Minister of the gospel and doctor of medicine": Dr. Robert Grierson physician missionary to Korea, 1898-1913. J Can Church Hist Soc 2001; 43:171-190. [PMID: 18437765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Mai KT, Yazdi HM, MacDonald L. Fine needle aspiration biopsy of primary squamous cell carcinoma of the thyroid gland. Acta Cytol 1999; 43:1194-6. [PMID: 10579006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Abstract
In papillary thyroid carcinoma (PTC) in cytological and surgical specimens, fine chromatin, nuclear grooves and nuclear pseudoinclusions are the hallmarks of diagnosis. We investigated the significance of these nuclear changes in neoplastic non-PTC lesions. Fine needle aspiration biopsies (FNAB) of thyroid lesions were reviewed with histologic correlation. Twenty-five low-grade PTC and 35 neoplastic non-PTC lesions with a fine chromatin pattern in cytology specimens were identified. These lesions were studied along with five multinodular goiters and five follicular adenomas with a coarse chromatin pattern. The neoplastic non-PTC lesions were selected from cases with a histopathologic diagnosis of follicular neoplasm (accompanied by cytopathologic examination) but lacking a coarse chromatin pattern. The nuclear changes were separated into three grades of nuclear atypia with a fine chromatin pattern, depending on the degree of nuclear enlargement and nuclear membrane thickening, or the presence of nuclear grooves or pseudoinclusions. Thyroid lesions with a higher grade of nuclear atypia with a fine chromatin pattern were associated with larger nuclei and more readily visible nucleoli. These lesions correlated histologically with PTC and follicular adenomas with a fine chromatin pattern. The latter could be divided into three grades: grade 1 lesions having a fine chromatin pattern similar to that of nuclei with open chromatin seen in areas of nodular goiter; grade 3 lesions having nuclear features closest to those of PTC; and grade 2 lesions showing intermediate changes. In conclusion, there is a spectrum of nuclear changes in neoplastic non-PTC lesions with a fine chromatin pattern. These lesions are often diagnosed as follicular adenomas in surgical pathology and pose cytopathologic diagnostic problems between nodular goiter, follicular adenoma and PTC. The significance of follicular adenomas with a fine chromatin pattern will be discussed.
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Affiliation(s)
- K T Mai
- Department of Laboratory Medicine and Ottawa Civic Hospital, Ontario, Canada.
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Abstract
OBJECTIVE To determine the accuracy of cytologic interpretation in the diagnosis of Hashimoto's thyroiditis (HT). STUDY DESIGN At Ottawa Hospital from 1987 to 1994, 1,638 fine needle aspiration biopsies (FNABs) from thyroid were performed. HT was suggested in 184 FNAB samples taken from 157 patients. Of the 184 aspirates diagnosed with HT, 39 had corresponding surgical specimens taken from 31 patients. A retrospective review of these FNABs and surgical pathology slides formed the basis of this study. RESULTS In 27 (69%) aspirates, HT was diagnosed on both the FNAB and surgical specimens. In 10 of 27 FNABs an associated lesion was not sampled by FNAB. In four of these 10 aspirates some of the cellular features of HT were misinterpreted, and the possibility of an associated neoplasm could not be ruled out. This resulted in four false positive diagnoses. In 12 (31%) FNABs from nine patients, the cytologic diagnosis of HT was not confirmed histologically. These cases included five Hürthle cell adenomas and one case each of follicular adenoma, nodular goiter, macrofollicular adenoma and malignant lymphoma. This resulted in five false negative diagnoses. CONCLUSION These results support the value of FNAB in the diagnosis of HT. The presence of hyperplastic follicular cells on FNAB samples from HT may mimic a follicular neoplasm and result in a false positive interpretation. Adequate sampling of the thyroid is important, particularly when there is an associated lesion. The diagnosis of lymphocytic thyroiditis should not be made when only a few lymphocytes are present. Finally, pleomorphic Hürthle cells may be present in aspirates from Hürthle cell neoplasms and underdiagnosed as HT, especially when they are associated with a few lymphocytes.
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Affiliation(s)
- L MacDonald
- Department of Laboratory Medicine, Ottawa Hospital, Ontario, Canada
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Abstract
Candida species are increasingly important nosocomial pathogens in critically ill children. A 2.3-fold increase in the rate of nosocomial candidemia at our 200-bed tertiary care children's hospital prompted a study to identify risk factors for this infection. Twenty-six cases were identified between 1992 and 1993, representing 21% of all nosocomial bloodstream infections. Candida albicans was the most frequent isolate (58%), followed by Candida parapsilosis (27%). A case-control study revealed that there was a statistically significant association between the occurrence of candidemia and placement of a central venous catheter in the femoral vein (P = .03), the use of a tunneled central venous catheter (P = .05), and prolonged hyperalimentation (P = .04). Patients with candidemia also were noted to have candiduria more often than controls (P = .003) and were more likely to have had topical antifungal agents prescribed (P = .04). Multivariate analysis showed that hyperalimentation was an independent risk factor for the development of candidemia. We conclude that measures must be taken to reduce these risk factors whenever possible.
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Affiliation(s)
- L MacDonald
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0378, USA
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