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Hazenberg P, Robinson RE, Farrar M, Solorzano C, Hyder-Wright A, Liatsikos K, Brunning J, Fleet H, Bettam A, Howard A, Kenny-Nyazika T, Urban B, Mitsi E, El Safadi D, Davies K, Lesosky M, Gordon SB, Ferreira DM, Collins AM. Serotype 3 Experimental Human Pneumococcal Challenge (EHPC) study protocol: dose ranging and reproducibility in a healthy volunteer population (challenge 3). BMJ Open 2024; 14:e075948. [PMID: 38199622 PMCID: PMC10806732 DOI: 10.1136/bmjopen-2023-075948] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/19/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Since the introduction of pneumococcal conjugate vaccines, pneumococcal disease rates have declined for many vaccine-type serotypes. However, serotype 3 (SPN3) continues to cause significant disease and is identified in colonisation epidemiological studies as one of the top circulating serotypes in adults in the UK. Consequently, new vaccines that provide greater protection against SPN3 colonisation/carriage are urgently needed. The Experimental Human Pneumococcal Challenge (EHPC) model is a unique method of determining pneumococcal colonisation rates, understanding acquired immunity, and testing vaccines in a cost-effective manner. To enhance the development of effective pneumococcal vaccines against SPN3, we aim to develop a new relevant and safe SPN3 EHPC model with high attack rates which could be used to test vaccines using small sample size. METHODS AND ANALYSIS This is a human challenge study to establish a new SPN3 EHPC model, consisting of two parts. In the dose-ranging/safety study, cohorts of 10 healthy participants will be challenged with escalating doses of SPN3. If first challenge does not lead into colonisation, participants will receive a second challenge 2 weeks after. Experimental nasopharyngeal (NP) colonisation will be determined using nasal wash sampling. Using the dose that results in ≥50% of participants being colonised, with a high safety profile, we will complete the cohort with another 33 participants to check for reproducibility of the colonisation rate. The primary outcome of this study is to determine the optimal SPN3 dose and inoculation regime to establish the highest rates of NP colonisation in healthy adults. Secondary outcomes include determining density and duration of experimental SPN3 NP colonisation and characterising mucosal and systemic immune responses to SPN3 challenge. ETHICS AND DISSEMINATION This study is approved by the NHS Research and Ethics Committee (reference 22/NW/0051). Findings will be published in peer-reviewed journals and reports will be made available to participants.
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Affiliation(s)
- Phoebe Hazenberg
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ryan E Robinson
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Madlen Farrar
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solorzano
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Angela Hyder-Wright
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Jaye Brunning
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hannah Fleet
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Amy Bettam
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ashleigh Howard
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Britta Urban
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Elena Mitsi
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Dima El Safadi
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kelly Davies
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Maia Lesosky
- Global Health Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stephen B Gordon
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Daniela M Ferreira
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Andrea M Collins
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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2
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Mitsi E, Diniz MO, Reiné J, Collins AM, Robinson RE, Hyder-Wright A, Farrar M, Liatsikos K, Hamilton J, Onyema O, Urban BC, Solórzano C, Belij-Rammerstorfer S, Sheehan E, Lambe T, Draper SJ, Weiskopf D, Sette A, Maini MK, Ferreira DM. Respiratory mucosal immune memory to SARS-CoV-2 after infection and vaccination. Nat Commun 2023; 14:6815. [PMID: 37884506 PMCID: PMC10603102 DOI: 10.1038/s41467-023-42433-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
Respiratory mucosal immunity induced by vaccination is vital for protection from coronavirus infection in animal models. In humans, the capacity of peripheral vaccination to generate sustained immunity in the lung mucosa, and how this is influenced by prior SARS-CoV-2 infection, is unknown. Here we show using bronchoalveolar lavage samples that donors with history of both infection and vaccination have more airway mucosal SARS-CoV-2 antibodies and memory B cells than those only vaccinated. Infection also induces populations of airway spike-specific memory CD4+ and CD8+ T cells that are not expanded by vaccination alone. Airway mucosal T cells induced by infection have a distinct hierarchy of antigen specificity compared to the periphery. Spike-specific T cells persist in the lung mucosa for 7 months after the last immunising event. Thus, peripheral vaccination alone does not appear to induce durable lung mucosal immunity against SARS-CoV-2, supporting an argument for the need for vaccines targeting the airways.
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Affiliation(s)
- Elena Mitsi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Mariana O Diniz
- Division of Infection and Immunity and Institute of Immunity and Transplantation, UCL, London, UK
| | - Jesús Reiné
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Andrea M Collins
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ryan E Robinson
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Angela Hyder-Wright
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Madlen Farrar
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Josh Hamilton
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Onyia Onyema
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Britta C Urban
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solórzano
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Emma Sheehan
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Teresa Lambe
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK
| | - Simon J Draper
- Department of Biochemistry, University of Oxford, Oxford, UK
| | - Daniela Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, USA
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, USA
| | - Mala K Maini
- Division of Infection and Immunity and Institute of Immunity and Transplantation, UCL, London, UK
| | - Daniela M Ferreira
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK.
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3
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Hill H, Mitsi E, Nikolaou E, Blizard A, Pojar S, Howard A, Hyder-Wright A, Devin J, Reiné J, Robinson R, Solórzano C, Jochems SP, Kenny-Nyazika T, Ramos-Sevillano E, Weight CM, Myerscough C, McLenaghan D, Morton B, Gibbons E, Farrar M, Randles V, Burhan H, Chen T, Shandling AD, Campo JJ, Heyderman RS, Gordon SB, Brown JS, Collins AM, Ferreira DM. A Randomized Controlled Clinical Trial of Nasal Immunization with Live Virulence Attenuated Streptococcus pneumoniae Strains Using Human Infection Challenge. Am J Respir Crit Care Med 2023; 208:868-878. [PMID: 37556679 DOI: 10.1164/rccm.202302-0222oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/06/2023] [Accepted: 08/09/2023] [Indexed: 08/11/2023] Open
Abstract
Rationale: Pneumococcal pneumonia remains a global health problem. Pneumococcal colonization increases local and systemic protective immunity, suggesting that nasal administration of live attenuated Streptococcus pneumoniae (Spn) strains could help prevent infections. Objectives: We used a controlled human infection model to investigate whether nasopharyngeal colonization with attenuated S. pneumoniae strains protected against recolonization with wild-type (WT) Spn (SpnWT). Methods: Healthy adults aged 18-50 years were randomized (1:1:1:1) for nasal administration twice (at a 2-wk interval) with saline solution, WT Spn6B (BHN418), or one of two genetically modified Spn6B strains, SpnA1 (Δfhs/piaA) or SpnA3 (ΔproABC/piaA) (Stage I). After 6 months, participants were challenged with SpnWT to assess protection against the homologous serotype (Stage II). Measurements and Main Results: 125 participants completed both study stages per intention to treat. No serious adverse events were reported. In Stage I, colonization rates were similar among groups: SpnWT, 58.1% (18 of 31); SpnA1, 60% (18 of 30); and SpnA3, 59.4% (19 of 32). Anti-Spn nasal IgG levels after colonization were similar in all groups, whereas serum IgG responses were higher in the SpnWT and SpnA1 groups than in the SpnA3 group. In colonized individuals, increases in IgG responses were identified against 197 Spn protein antigens and serotype 6 capsular polysaccharide using a pangenome array. Participants given SpnWT or SpnA1 in Stage I were partially protected against homologous challenge with SpnWT (29% and 30% recolonization rates, respectively) at stage II, whereas those exposed to SpnA3 achieved a recolonization rate similar to that in the control group (50% vs. 47%, respectively). Conclusions: Nasal colonization with genetically modified live attenuated Spn was safe and induced protection against recolonization, suggesting that nasal administration of live attenuated Spn could be an effective strategy for preventing pneumococcal infections. Clinical trial registered with the ISRCTN registry (ISRCTN22467293).
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Affiliation(s)
- Helen Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elena Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Elissavet Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Annie Blizard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sherin Pojar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ashleigh Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Angela Hyder-Wright
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Jack Devin
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jesus Reiné
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Ryan Robinson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Carla Solórzano
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Simon P Jochems
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tinashe Kenny-Nyazika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elisa Ramos-Sevillano
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Caroline M Weight
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Chris Myerscough
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Daniella McLenaghan
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ben Morton
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Emily Gibbons
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Madlen Farrar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Victoria Randles
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Hassan Burhan
- Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Joe J Campo
- Antigen Discovery Inc, Irvine, California; and
| | - Robert S Heyderman
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome-Trust Programme, Blantyre, Malawi
| | - Jeremy S Brown
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Daniela M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
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4
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Walker NF, Byrne RL, Howard A, Nikolaou E, Farrar M, Glynn S, Cheliotis KS, Cubas Atienzar AI, Davies K, Reiné J, Rashid-Gardner Z, German EL, Solórzano C, Blandamer T, Hitchins L, Myerscough C, Gessner BD, Begier E, Collins AM, Beadsworth M, Todd S, Hill H, Houlihan CF, Nastouli E, Adams ER, Mitsi E, Ferreira DM. Detection of SARS-CoV-2 infection by saliva and nasopharyngeal sampling in frontline healthcare workers: An observational cohort study. PLoS One 2023; 18:e0280908. [PMID: 36706119 PMCID: PMC9882898 DOI: 10.1371/journal.pone.0280908] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic has caused an unprecedented strain on healthcare systems worldwide, including the United Kingdom National Health Service (NHS). We conducted an observational cohort study of SARS-CoV-2 infection in frontline healthcare workers (HCW) working in an acute NHS Trust during the first wave of the pandemic, to answer emerging questions surrounding SARS-CoV-2 infection, diagnosis, transmission and control. METHODS Using self-collected weekly saliva and twice weekly combined oropharyngeal/nasopharyngeal (OP/NP) samples, in addition to self-assessed symptom profiles and isolation behaviours, we retrospectively compared SARS-CoV-2 detection by RT-qPCR of saliva and OP/NP samples. We report the association with contemporaneous symptoms and isolation behaviour. RESULTS Over a 12-week period from 30th March 2020, 40·0% (n = 34/85, 95% confidence interval 31·3-51·8%) HCW had evidence of SARS-CoV-2 infection by surveillance OP/NP swab and/or saliva sample. Symptoms were reported by 47·1% (n = 40) and self-isolation by 25·9% (n = 22) participants. Only 44.1% (n = 15/34) participants with SARS-CoV-2 infection reported any symptoms within 14 days of a positive result and only 29·4% (n = 10/34) reported self-isolation periods. Overall agreement between paired saliva and OP/NP swabs was 93·4% (n = 211/226 pairs) but rates of positive concordance were low. In paired samples with at least one positive result, 35·0% (n = 7/20) were positive exclusively by OP/NP swab, 40·0% (n = 8/20) exclusively by saliva and in only 25·0% (n = 5/20) were the OP/NP and saliva result both positive. CONCLUSIONS HCW are a potential source of SARS-CoV-2 transmission in hospitals and symptom screening will identify the minority of infections. Without routine asymptomatic SARS-CoV-2 screening, it is likely that HCW with SARS-CoV-2 infection would continue to attend work. Saliva, in addition to OP/NP swab testing, facilitated ascertainment of symptomatic and asymptomatic SARS-CoV-2 infections. Combined saliva and OP/NP swab sampling would improve detection of SARS-CoV-2 for surveillance and is recommended for a high sensitivity strategy.
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Affiliation(s)
- Naomi F. Walker
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Rachel L. Byrne
- Centre for Drugs and Diagnostics, Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ashleigh Howard
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elissavet Nikolaou
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Infection and Immunity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Madlen Farrar
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sharon Glynn
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Ana I. Cubas Atienzar
- Centre for Drugs and Diagnostics, Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kelly Davies
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jesús Reiné
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Zalina Rashid-Gardner
- NIHR Liverpool and Broadgreen Clinical Research Facility, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Esther L. German
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Carla Solórzano
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Tess Blandamer
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lisa Hitchins
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | | | - Elizabeth Begier
- Pfizer Vaccines, Collegeville, Pennsylvania, United States of America
| | - Andrea M. Collins
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- National Institute for Health Research North West Coast, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Mike Beadsworth
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Stacy Todd
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Liverpool Health Partners, Liverpool, United Kingdom
| | - Helen Hill
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Catherine F. Houlihan
- Department of Clinical Virology, University College London Hospitals, London, United Kingdom
- Department of Infection, Immunity and inflammation, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Eleni Nastouli
- Department of Clinical Virology, University College London Hospitals, London, United Kingdom
| | - Emily R. Adams
- Centre for Drugs and Diagnostics, Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elena Mitsi
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Daniela M. Ferreira
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
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5
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Robinson RE, Mitsi E, Nikolaou E, Pojar S, Chen T, Reiné J, Nyazika TK, Court J, Davies K, Farrar M, Gonzalez-Dias P, Hamilton J, Hill H, Hitchins L, Howard A, Hyder-Wright A, Lesosky M, Liatsikos K, Matope A, McLenaghan D, Myerscough C, Murphy A, Solórzano C, Wang D, Burhan H, Gautam M, Begier E, Theilacker C, Beavon R, Anderson AS, Gessner BD, Gordon SB, Collins AM, Ferreira DM. Human Infection Challenge with Serotype 3 Pneumococcus. Am J Respir Crit Care Med 2022; 206:1379-1392. [PMID: 35802840 DOI: 10.1164/rccm.202112-2700oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rationale: Streptococcus pneumoniae serotype 3 (SPN3) is a cause of invasive pneumococcal disease and associated with low carriage rates. Following the introduction of pediatric 13-valent pneumococcal conjugate vaccine (PCV13) programs, SPN3 declines are less than other vaccine serotypes and incidence has increased in some populations coincident with a shift in predominant circulating SPN3 clade, from I to II. A human challenge model provides an effective means for assessing the impact of PCV13 on SPN3 in the upper airway. Objectives: To establish SPN3's ability to colonize the nasopharynx using different inoculum clades and doses, and the safety of an SPN3 challenge model. Methods: In a human challenge study involving three well-characterized and antibiotic-sensitive SPN3 isolates (PFESP306 [clade Ia], PFESP231 [no clade], and PFESP505 [clade II]), inoculum doses (10,000, 20,000, 80,000, and 160,000 cfu/100 μl) were escalated until maximal colonization rates were achieved, with concurrent acceptable safety. Measurement and Main Results: Presence and density of experimental SPN3 nasopharyngeal colonization in nasal wash samples, assessed using microbiological culture and molecular methods, on Days 2, 7, and 14 postinoculation. A total of 96 healthy participants (median age 21, interquartile range 19-25) were inoculated (n = 6-10 per dose group, 10 groups). Colonization rates ranged from 30.0-70.0% varying with dose and isolate. 30.0% (29/96) reported mild symptoms (82.8% [24/29] developed a sore throat); one developed otitis media requiring antibiotics. No serious adverse events occurred. Conclusions: An SPN3 human challenge model is feasible and safe with comparable carriage rates to an established Serotype 6B human challenge model. SPN3 carriage may cause mild upper respiratory symptoms.
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Affiliation(s)
- Ryan E Robinson
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Elena Mitsi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elissavet Nikolaou
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sherin Pojar
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tao Chen
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jesús Reiné
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tinashe K Nyazika
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - James Court
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kelly Davies
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Madlen Farrar
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Josh Hamilton
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen Hill
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lisa Hitchins
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ashleigh Howard
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Angela Hyder-Wright
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Maia Lesosky
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Agnes Matope
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Daniella McLenaghan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Annabel Murphy
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solórzano
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duolao Wang
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hassan Burhan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Manish Gautam
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | | | | | | | | | - Stephen B Gordon
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Andrea M Collins
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Daniela M Ferreira
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
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6
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Rutter K, Peake M, Hawkshaw N, Farrar M, Rhodes L. 521 Deciphering Pathomechanisms in Solar Urticaria. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.536] [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: 11/19/2022]
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7
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Chiriboga C, Servais L, Baranello G, Darras B, Day J, Deconinck N, Farrar M, Finkel R, Bertini E, Kirschner J, Masson R, Mazurkiewicz-Bełdzińska M, Vlodavets D, Bader-Weder S, Gorni K, Jaber B, McIver T, Papp G, Scalco R, Mercuri E. P.113 Safety update: Risdiplam clinical trial development program. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.198] [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]
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8
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Darras B, Hagenacker T, Finkel R, Mercuri E, Montes J, Kuntz N, Farrar M, Sansone V, Berger Z, MacCannell D, Shen C, Paradis A, Bohn J, Wagner J, Somera-Molina K. P.100 Rationale/design of the phase 3b ASCEND study of investigational higher dose nusinersen in participants with SMA previously treated with risdiplam. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.185] [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]
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Finkel R, Farrar M, Vlodavets D, Zanoteli E, Al-Muhaizea M, Nelson L, Prufer A, Servais L, Wang Y, Fisher C, Gerber M, Gorni K, Kletzl H, Palfreeman L, Scalco R, Bertini E. FP.24 RAINBOWFISH: Preliminary efficacy and safety data in risdiplam-treated infants with presymptomatic spinal muscular atrophy (SMA). Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.183] [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]
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10
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Akram F, Pidcock M, Oake D, Sholler G, Farrar M, Kasparian N. “The Usual Challenges of Work Are All Magnified”: Australian Paediatric Health Professionals’ Experiences During the COVID-19 Pandemic. Heart Lung Circ 2022. [PMCID: PMC9345548 DOI: 10.1016/j.hlc.2022.06.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Servais L, Al-Muhaizea M, Farrar M, Nelson L, Prufer A, Finkel R, Wang Y, Zanoteli E, El-Khairi M, Gerber M, Gorni K, Kletzl H, Palfreeman L, Scalco R, Bertini E. CLINICAL TRIAL HIGHLIGHTS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Lundt L, Farrar M, Franey E, Yonan C. Patient perspective of Tardive dyskinesia: Results from a Social Media Listening Study. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Strauss K, Farrar M, Swoboda K, Saito K, Chiriboga C, Finkel R, Iannaccone S, Krueger J, Kwon J, McMillan H, Servais L, Mendell J, Parsons J, Scoto M, Shieh P, Zaidman C, Schultz M, Ogrinc F, Group S, Muntoni F. SMA – THERAPY. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Schultz M, Swoboda K, Farrar M, McMillan H, Parsons J, Kernbauer E, Farrow M, Ogrinc F, Kavanagh S, Feltner D, McGill B, Spector S, L'Italien J, Sproule D, Strauss K. P.350Onasemnogene abeparvovec gene-replacement therapy (GRT) in pre-symptomatic spinal muscular atrophy (SMA). Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.512] [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: 11/15/2022]
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15
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Kirschner J, Darras B, Farrar M, Mercuri E, Chiriboga C, Kuntz N, Shieh P, Tulinius M, Montes J, Reyna S, Gambino G, Foster R, Bhan I, Wong J, Farwell W. P.352Interim report on the safety and efficacy of longer-term treatment with nusinersen in later-onset spinal muscular atrophy (SMA): results from the SHINE study. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Sampaio H, Farrar M, Al Safar A. LGMD AUTOSOMAL RESSESSIVE AND DOMINANT. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.129] [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: 10/28/2022]
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17
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Sampaio H, Farrar M, Al Safar A. METABOLIC MYOPATHIES I. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.315] [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: 10/28/2022]
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18
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19
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Oates E, Yau K, Jones K, Smith J, Cummings B, Farrar M, Cooper S, Lek M, Hoffman E, Straub V, Ferreiro A, Udd B, Beggs A, Bönnemann C, North K, MacArthur D, Granzier H, Muntoni F, Davis M, Laing N. Do titin developmental isoforms contribute to the pathogenesis of congenital titinopathy? Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.513] [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: 11/30/2022]
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20
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Servais L, Farrar M, Finkel R, Kirschner J, Muntoni F, Sun P, Gheuens S, Schneider E, Farwell W. Nusinersen demonstrates greater efficacy in infants with shorter disease duration: End of study results from the ENDEAR study in infants with spinal muscular atrophy (SMA). Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Farrar M, Sandison A, Peston D, Gailani M. Immunocytochemical analysis of AE1/AE3, CK 14, Ki-67 and p53 expression in benign, premalignant and malignant oral tissue to establish putative markers for progression of oral carcinoma. Br J Biomed Sci 2016; 61:117-24. [PMID: 15462255 DOI: 10.1080/09674845.2004.11732655] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Squamous cell carcinoma (SCC) is the most common form of oral malignancy and is often preceded by premalignant lesions, some of which are more likely to progress to carcinoma than others. In this study, a panel of monoclonal antibodies (AE1/AE3, cytokeratin [CK] 14, Ki-67 and p53) is applied to 10 cases of human oral tissue in each of six categories to establish staining patterns indicative of which lesions are more likely to progress to malignancy. The six tissue categories are normal tissue; abnormal benign lesions; mild, moderate and severe dysplasia; and SCC. A statistical analysis of Ki-67 and p53 immunoexpression is performed. The results showed that AE1/AE3 and CK 14 expression was reduced as a late event in oral carcinogenesis, particularly in poorly differentiated SCC. Expression of Ki-67 and p53 proved to be a weak but statistically significant predictor of malignant progression in oral tissue.
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Affiliation(s)
- M Farrar
- Department of Histopathology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF.
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22
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23
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Akdis M, Trautmann A, Klunker S, Daigle I, Kücüksezer UC, Deglmann W, Disch R, Blaser K, Akdis CA, Forschner K, Zuberbier T, Worm M, Gutermuth J, Huss-Marp J, Eberlein-König B, Breuer K, Mair S, Darsow U, Ansel A, Krämer U, Mayer E, Gertis K, Ring J, Behrendt H, Jappe U, Farrar M, Ingham E, Holland K, Karamloo F, Schmid-Grendelmeier P, Kussebi F, Manhart C, Soldatova L, Hously-Markovic Z, Spangfort MD, Kunzmann S, Schmidt-Weber CB, Mahler V, Gutgesell C, Fuchs T, Kraft D, Valenta R, Münch D, Borelli S, Fukrop R, Reese I, Hipler UC, Weissenbacher S, Engst R, Rakoski J, Ollert M, Wilkening R, Soost S, Klinger R, Wuske T. Poster-Abstracts. Allergo J 2002. [DOI: 10.1007/bf03361028] [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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24
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Abstract
The Sheffield hybrid fixator (SHF) was developed to complement and extend the use of current monolateral fixation systems. Unlike other hybrid designs, it relies on rings for the diaphyseal as well as the metaphyseal support. Since it is an all ring system it may be used to cross joints and perform progressive deformity and contracture correction. Unlike the Ilizarov system only one ring is required at each level and diaphyseal transfixation is avoided. Initial biomechanical testing has demonstrated similar mechanical characteristics to an all wire Ilizarov fixator, however, increased shear motion was noted due to the stiffness asymmetry between the segments controlled by wires and screws. The first 100 cases were reviewed with good patient compliance and satisfactory results. Minor component problems were identified and corrected during this period and no significant complications occurred. The device is recommended for a wide range of complex trauma and limb reconstruction uses.
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Affiliation(s)
- M Farrar
- Limb Reconstruction Unit, The Academic and Traumatic Surgery Unit, Sheffield Teaching Hospitals, NHS Trust, Clinical Sciences Centre, Northern General Hospital, University of Sheffield, Herries Road, Sheffield S5 7AU, UK
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25
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Ojha RP, Dhingra MM, Sarma MH, Shibata M, Farrar M, Turner CJ, Sarma RH. DNA bending and sequence-dependent backbone conformation NMR and computer experiments. Eur J Biochem 1999; 265:35-53. [PMID: 10491156 DOI: 10.1046/j.1432-1327.1999.00639.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although DNA bending plays a crucial role in several biological processes, very little is known experimentally about the relationship between sugar phosphate conformation and sequence directed bending. In this paper, we determine the coupling constants for a nonself-complementary 11-mer A-tract DNA duplex from 2D NMR experiments and along each chain of the duplex, we report the sugar pucker, torsional preferences and conformational averaging about the C3'-O3', C4'-C5' and C5'-O5' bonds for each nucleotide. The A-tract exists as an equilibrium blend of canonical B-form and noncanonical B-form in which the exocyclic C4'-C5' bond is in trans conformation as in the original Watson-Crick model [Crick, F.H.C. & Watson, J.D. (1954) Proc. Roy. Soc. (London), A223, 80-96]. The trans conformation at the C4'-C5' can increase the interphosphate distance and lead to local unwinding of the duplex and rolling of the base pair into the major groove. This will create a kink or hinge. At the 3'-end of the A-tract in the purine-thymine step, the duplex is compressed by the presence of a junction between A and B forms of DNA exclusively in one strand, with consequent reduction of the phosphate-phosphate distance. The coupling constant data seriously disagree with the A-tract DNA bending model of Crothers [Koo, H.-S., Wu, H.-M. & Crothers, D.M. (1986) Nature 320, 501-506], but is in agreement with the finding of Leroy et al. [Leroy, J.-L., Charretier, E., Kochoyan, M. & Gueron, M. (1988) Biochemistry 27, 8894-8898] that the structure that drives bending in the A-tract is locally different from B-DNA. Structural distortions are extremely localized with little or no propagation. It is likely that transcription factor proteins recognize these preexisting deformations in the free DNA itself and mold it into the matrix of the protein.
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Affiliation(s)
- R P Ojha
- Institute of Biomolecular Stereodynamics, Dept. of Chemistry, University at Albany, NY, USA
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26
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Miller DD, Bach RG, Tio FO, Bailey SR, Waters CA, Woodworth TG, Nichols JC, Paige SB, Farrar M. Interleukin-2 receptor-specific fusion toxin inhibits barotrauma-induced arterial atherosclerosis. Atherosclerosis 1996; 126:1-14. [PMID: 8879429 DOI: 10.1016/0021-9150(96)05843-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Immunocytochemical analyses of human plaques and experimental arterial lesions have implicated activated lymphocytes and monocytes in the pathogenesis of atherosclerosis, as demonstrated by the expression of interleukin-2 (IL-2) membrane receptors and major histocompatibility complex class II epitopes. The objective is to determine if targeting these cells with an IL-2 receptor-specific chimeric toxin, DAB486-IL-2, can inhibit experimental post-angioplasty vascular neointimal thickening. Twenty-two atherogenically modeled rabbits were treated in vivo with DAB486-IL-2 (0.1 mg/kg per day i.v.; n = 11) or placebo (n = 11) for 10 days following aortic balloon angioplasty (4 atm x 30 s each x 2 dilatations). In vitro 3H-leucine incorporation studies of mononuclear leukocyte and vascular smooth muscle cell protein synthesis inhibition by DAB486-IL-2 were also performed. Angioplasty sites were examined for evidence of hyperproliferative atherosclerotic narrowing by quantitative angiography and histomorphometry of neointimal cross-sectional area at baseline and 6 weeks after injury. In vitro Concanavalin-A stimulated rabbit mononuclear leukocyte protein synthesis was 50% inhibited by DAB486-IL-2 at a concentration (IC50) of 6 x 10(-11) M. Rabbit vascular smooth muscle cells were approximately 150-fold less sensitive to DAB486-IL-2 (IC50 = 10(-8) M). In vivo studies showed no change in angioplasty site angiographic minimum luminal diameter at 6 weeks in DAB486-IL-2 treated animals (from 2.96 +/- 0.52 to 2.96 +/- 0.48 mm; percent cross-sectional area reduction = 1 +/- 10%; P = N.S.). In control animals, luminal diameter decreased from 2.79 +/- 0.4 to 2.32 +/- 0.52 mm at 6 weeks, and percent cross-sectional area was reduced by 34 +/- 14% (P < 0.01 vs. placebo). Quantitative histomorphometric angioplasty segmental intimal cross-sectional area reduction of treated and placebo vessels also differed significantly (19 +/- 16% vs. 31 +/- 21%; P < 0.05). DAB486-IL-2 caused no adverse effects on animal survival, weight or hepatic transaminase levels. We conclude that post-angioplasty administration of the chimeric toxin DAB486-IL-2 inhibits angiographic narrowing and neointimal thickening in the atherogenic rabbit model. Although this IL-2 receptor-specific molecule was cytotoxic in vitro for activated mononuclear leukocytes and vascular smooth muscle cells, systemic toxicity did not occur in vivo at a dose comparable to that evaluated in clinical trials of this agent. Potential anti-proliferative effects of this chimeric toxin may be mediated by direct local inhibition of leukocyte-mediated inflammation, or through the indirect modification of vascular cell mitogenesis and cytokine release.
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MESH Headings
- Angioplasty, Balloon/adverse effects
- Animals
- Aorta, Abdominal/injuries
- Aorta, Abdominal/pathology
- Arteriosclerosis/etiology
- Arteriosclerosis/prevention & control
- Arteriosclerosis/therapy
- Concanavalin A/pharmacology
- Cytotoxins/pharmacology
- Cytotoxins/therapeutic use
- Diet, Atherogenic
- Diphtheria Toxin/genetics
- Diphtheria Toxin/pharmacology
- Diphtheria Toxin/therapeutic use
- Female
- Iliac Artery/injuries
- Iliac Artery/pathology
- Interleukin-2/genetics
- Interleukin-2/pharmacology
- Interleukin-2/therapeutic use
- Leukocytes, Mononuclear/drug effects
- Leukocytes, Mononuclear/immunology
- Lymphocyte Activation/drug effects
- Male
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/pathology
- Rabbits
- Receptors, Interleukin-2/drug effects
- Recombinant Fusion Proteins/genetics
- Recombinant Fusion Proteins/pharmacology
- Recombinant Fusion Proteins/therapeutic use
- Recurrence
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Affiliation(s)
- D D Miller
- Department of Internal Medicine, St. Louis University Medical Center, MO 63110-0250, USA
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Abstract
A case is reported of dislocation of the pisiform, successfully treated by conservative means.
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Sharara KH, Farrar M. Traumatic lateral instability of the cervical spine. Injury 1993; 24:266-7. [PMID: 8325687 DOI: 10.1016/0020-1383(93)90184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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29
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Iverson LI, Duhaylongsod FG, Young JN, Ecker RR, Ennix CL, Moretti RL, Farrar M, Hayes R, Lee J, May IA. Porcine heparin increases postoperative bleeding in cardiopulmonary bypass patients. Cardiovasc Drugs Ther 1990; 4:269-72. [PMID: 2285620 DOI: 10.1007/bf01857644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
One hundred thirteen patients undergoing cardiopulmonary bypass were randomly assigned to receive either bovine or porcine heparin. Heparin was infused at 4.5 mg/kg during bypass and administered at the lesser of 70 units/kg or 5000 units/dose at 12-hour intervals postoperatively. Platelet counts decreased to 45% of preoperative levels during the first 3 days postoperatively (porcine, 44 +/- 13%, n = 50; bovine, 46 +/- 15%), but returned to preoperative levels by the seventh postoperative day. The average blood loss in the porcine heparin group significantly exceeded that of the bovine heparin group (porcine, 1350.7 +/- 727.8 ml; bovine, 1059.6 +/- 381.0 ml; p less than .01). Consequently, the platelet transfusion requirement was greater in the porcine heparin group (porcine, 1.7 +/- 3.9 units; bovine, 0.5 +/- 1.7 units; p less than .05); however, blood and blood component (with the exception of platelets) administration was not significantly different between the two groups. The four patients taking anticoagulants or antiinflammatory agents in the porcine group required a mean of 8.5 units of red blood cells (RBC) plus supplemental platelets. The seven such patients in the bovine group received a mean of 3.0 units of RBC and no platelets. Thus, the use of porcine heparin resulted in a generalized increase in postoperative bleeding with increased management problems in patients undergoing cardiopulmonary bypass.
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Affiliation(s)
- L I Iverson
- Cardiothoracic Surgery Department, Samuel Merritt Hospital, Oakland, CA
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Farrar M, Thorland W. Relationship between isokinetic strength and sprint times in college-age men. J Sports Med Phys Fitness 1987; 27:368-72. [PMID: 3431122] [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: 01/05/2023]
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31
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Bloom M, Farrar M. Perspectives on becoming a professional social worker. Gerontologist 1969; 9:209-13. [PMID: 5388737 DOI: 10.1093/geront/9.3_part_1.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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