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Nong MZ, Dove D, Fischer DA, Hourdequin KC, Ripple GH, Amin MA, McGrath EB, Zaki BI, Smith KD, Brooks GA. Surveillance With Serial Imaging and CA 19-9 Tumor Marker Testing After Resection of Pancreatic Cancer: A Single-Center Retrospective Study. Am J Clin Oncol 2024; 47:25-29. [PMID: 37812021 PMCID: PMC10844891 DOI: 10.1097/coc.0000000000001052] [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] [Indexed: 10/10/2023]
Abstract
OBJECTIVES Most patients receiving curative-intent surgery for pancreatic cancer will experience cancer recurrence. However, evidence that postoperative surveillance testing improves survival or quality of life is lacking. We evaluated the use and characteristics of surveillance with serial imaging and CA 19-9 tumor marker testing at an NCI-designated comprehensive cancer center. METHODS We conducted a retrospective cohort study of patients who entered surveillance after curative-intent resection of pancreatic adenocarcinoma. We abstracted information from the electronic medical record about oncology office visits, surveillance testing (cross-sectional imaging and CA 19-9 tumor marker testing), and pancreatic cancer recurrence, with follow-up through 2 years after pancreatectomy. We conducted analyses to describe the use of surveillance testing and to characterize the sensitivity and specificity of CA 19-9 tumor marker testing for the identification of cancer recurrence. RESULTS We identified 90 patients entering surveillance after pancreatectomy. CA 19-9 was the most frequently used surveillance test, followed by CT imaging. Forty-seven patients (52.2%) experienced recurrence within two years of pancreatectomy. Recurrence risk was 58.8% versus 31.8% in patients with elevated versus normal CA 19-9 at diagnosis ( P =0.03). Elevated CA 19-9 at any point during surveillance was significantly associated with 2-year recurrence risk ( P <0.001). Elevated CA 19-9 had a sensitivity of 83% (95% CI 0.72-0.95) and specificity of 87% (0.76-0.98) for identification of recurrence within 2 years of pancreatectomy. CONCLUSIONS CA 19-9 demonstrates clinical validity for identifying recurrence of pancreatic cancer during surveillance. Surveillance approaches with reduced reliance on imaging should be prospectively evaluated.
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Affiliation(s)
| | - Devanshi Dove
- Division of Endocrinology and Metabolism, Department of
Medicine, University of California San Francisco, San Francisco, CA
| | - Dawn A. Fischer
- Department of Surgery, Dartmouth Hitchcock Medical Center,
Lebanon, NH
| | - Kathryn C. Hourdequin
- Dartmouth Cancer Center at Dartmouth Hitchcock Medical
Center, Lebanon, NH
- Geisel School of Medicine, Lebanon, NH
| | - Gregory H. Ripple
- Dartmouth Cancer Center at Dartmouth Hitchcock Medical
Center, Lebanon, NH
- Geisel School of Medicine, Lebanon, NH
| | - Manik A. Amin
- Dartmouth Cancer Center at Dartmouth Hitchcock Medical
Center, Lebanon, NH
- Geisel School of Medicine, Lebanon, NH
| | - Elizabeth B. McGrath
- Dartmouth Cancer Center at Dartmouth Hitchcock Medical
Center, Lebanon, NH
- Geisel School of Medicine, Lebanon, NH
| | - Bassem I. Zaki
- Dartmouth Cancer Center at Dartmouth Hitchcock Medical
Center, Lebanon, NH
- Geisel School of Medicine, Lebanon, NH
| | - Kerrington D. Smith
- Department of Surgery, Dartmouth Hitchcock Medical Center,
Lebanon, NH
- Dartmouth Cancer Center at Dartmouth Hitchcock Medical
Center, Lebanon, NH
- Geisel School of Medicine, Lebanon, NH
| | - Gabriel A. Brooks
- Dartmouth Cancer Center at Dartmouth Hitchcock Medical
Center, Lebanon, NH
- Geisel School of Medicine, Lebanon, NH
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Grierson PM, Tan B, Pedersen KS, Park H, Suresh R, Amin MA, Trikalinos NA, Knoerzer D, Kreider B, Reddy A, Liu J, Der CJ, Wang-Gillam A, Lim KH. Phase Ib Study of Ulixertinib Plus Gemcitabine and Nab-Paclitaxel in Patients with Metastatic Pancreatic Adenocarcinoma. Oncologist 2023; 28:e115-e123. [PMID: 36427020 PMCID: PMC9907047 DOI: 10.1093/oncolo/oyac237] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/14/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Ulixertinib is a novel oral ERK inhibitor that has shown promising single-agent activity in a phase I clinical trial that included patients with RAS-mutant cancers. METHODS We conducted a phase Ib trial combining ulixertinib with gemcitabine and nab-paclitaxel (GnP) for untreated metastatic pancreatic adenocarcinoma. The trial comprised a dose de-escalation part and a cohort expansion part at the recommended phase II dose (RP2D). Primary endpoint was to determine the RP2D of ulixertinib plus GnP and secondary endpoints were to assess toxicity and safety profile, biochemical and radiographic response, progression-free survival (PFS) and overall survival (OS). RESULTS Eighteen patients were enrolled. Ulixertinib 600 mg PO twice daily (BID) with GnP was initially administered but was de-escalated to 450 mg BID as RP2D early during dose expansion due to poor tolerability, which ultimately led to premature termination of the study. Common treatment-related adverse events (TRAEs) were anemia, thrombocytopenia, rash and diarrhea. For 5 response evaluable patients, one patient achieved a partial response and 2 patients achieved stable disease. For 15 patients who received the triplet, median PFS and OS were 5.46 and 12.23 months, respectively. CONCLUSION Ulixertinib plus GnP had similar frequency of grade ≥3 TRAEs and potentially efficacy as GnP, however was complicated by a high rate of all-grade TRAEs (ClinicalTrials.gov Identifier: NCT02608229).
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Affiliation(s)
- Patrick M Grierson
- Division of Medical Oncology, Department of Internal Medicine, Washington University, St. Louis, MO, USA
| | - Benjamin Tan
- Division of Medical Oncology, Department of Internal Medicine, Washington University, St. Louis, MO, USA
| | - Katrina S Pedersen
- Division of Medical Oncology, Department of Internal Medicine, Washington University, St. Louis, MO, USA
| | - Haeseong Park
- Division of Medical Oncology, Department of Internal Medicine, Washington University, St. Louis, MO, USA
| | - Rama Suresh
- Division of Medical Oncology, Department of Internal Medicine, Washington University, St. Louis, MO, USA
| | - Manik A Amin
- Section of Hematology/Oncology, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Nikolaos A Trikalinos
- Division of Medical Oncology, Department of Internal Medicine, Washington University, St. Louis, MO, USA
| | | | | | | | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO, USA
| | - Channing J Der
- Department of Pharmacology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA
| | - Andrea Wang-Gillam
- Division of Medical Oncology, Department of Internal Medicine, Washington University, St. Louis, MO, USA
| | - Kian-Huat Lim
- Division of Medical Oncology, Department of Internal Medicine, Washington University, St. Louis, MO, USA
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Spiliopoulou P, Kasi A, Abushahin LI, Cardin DB, Lenz HJ, Dayyani F, Messersmith WA, Ezenwajiaku N, Oberstein PE, Paluri RK, Patel RA, Kim E, Kalyan A, Smaglo BG, Amin MA, Al Hallak MN, Gbolahan OB, Siu LL, Moscow J, Spreafico A. Phase Ib study of anetumab ravtansive in combination with immunotherapy or immunotherapy plus chemotherapy in mesothelin-enriched advanced pancreatic adenocarcinoma: NCI10208. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4136] [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: 11/20/2022] Open
Abstract
4136 Background: Mesothelin (MSLN) is overexpressed in 80-85% of pancreatic adenocarcinomas (PDAC). Anetumab ravtansine (AR) is a fully human anti-MSLN immunoglobulin G1 antibody conjugated to the anti-tubulin maytansinoid DM4. Through NCI-ETCTN, the North American Star Consortium conducted a phase I study to evaluate the safety/tolerability of AR in various combinations in patients (pts) with PDAC. Here, we report preliminary results of the escalation part. Methods: Pts with advanced PDAC after at least one line of treatment were included. AR was combined with nivolumab (ARM1), nivolumab/ipilimumab (ARM 2), or nivolumab plus gemcitabine (Gem) (ARM3), using an integrated biomarker analysis. Two dose levels (DL) of AR were evaluated, DL1=5.5mg/kg and DL2=6.5mg/kg (established RP2D). Key eligibility criterion was MSLN expression in >5% of tumor cells by immunohistochemistry. Pts with prior anti-PD1/anti-CTLA4 treatment were excluded but treatment with prior Gem was allowed. Mandatory blood and paired tumor samples were collected for investigation of the immune microenvironment, genomic/transcriptomic changes and for an in-depth description of AR pharmacokinetics. Results: Data cut-off date was 22/01/2022. A total of n=33 pts were enrolled, n=11 (ARM 1), n=13 (ARM 2) and n=9 (ARM3). Median age of pts was 66 (40-83), 33% of PS=0 and 66% of PS=1. Twenty-six pts (79%) had previously been exposed to Gem. Median number of prior lines of treatment was 3 (1-7). Twenty-eight patients were evaluable for DLT. Grade (G)3/4 TRAEs: 0% in ARM1DL1, 5.3% in ARM1DL2, 0% in ARM2DL1, 16.9% in ARM2DL2, 8.6% in ARM3DL1 and 19.5% in ARM3DL2. There were 2 dose-limiting toxicities in ARM2DL2, one G3 upper gastrointestinal haemorrhage, possibly related to AR, and one G3 thrombocytopenia and G3 anaemia, definitely related to AR. Ocular toxicity events were G1/2 blurred vision in 5/33 (15%) and G1 xerophthalmia in 1/33 (3%), related to both AR and anti-PD1; G2 keratitis in 1/33 (3%), related to AR only. Only G1 peripheral neuropathy was observed in 4/33 (12%) pts. Efficacy data is presented in the table. In ARM3, the range of tumor measurement (ΤΜ) change was ΔTM=–16.8% to +16.2% and 3/8 (36%) pts with SD had previously been exposed to Gem. Conclusions: Based on the observed disease control rate and acceptable toleratbility, ARM3 (both DL1 and DL2) will be tested in the expansion part. A further 20 patients will be recruited for dose confirmation and comprehensive biomarker evaluation. Pharmacokinetic/pharmacodynamic analysis is under way. Clinical trial information: NCT03816358. [Table: see text]
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Affiliation(s)
| | - Anup Kasi
- University of Kansas Cancer Center, Westwood, KS
| | | | | | | | | | | | | | | | - Ravi Kumar Paluri
- Department of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Edward Kim
- Department of Medicine, Division of Hematology and Oncology, University of California at Davis, Sacramento, CA
| | | | - Brandon George Smaglo
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Lillian L. Siu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Park R, Amin MA, Trikalinos NA. Temozolomide treatment duration and secondary hematological neoplasms: A review of the literature and implications for patients with neuroendocrine tumors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.510] [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: 11/20/2022] Open
Abstract
510 Background: Evidence-based recommendations for the optimal duration of temozolomide-based treatment in advanced neuroendocrine neoplasms are lacking. Because of the relatively long median survival of NEN and the potential long-term myelotoxicities of temozolomide, suggestions have been made to optimize the duration of temozolomide-based therapy. Here, we have conducted a systematic review of the literature for a descriptive analysis of temozolomide-associated myelodysplasias and leukemias to guide treatment planning. Methods: A database search of PubMed and Embase was conducted to identify case reports and/or case series reporting secondary myelodysplasias or leukemias in the setting of temozolomide therapy. Key data items extracted from the studies were the temozolomide dose and duration, latency to hematologic disorder, type of secondary malignancy and cytogenetics. Reported cases were summarized graphically and descriptively analyzed. Results: A total of 14 studies with 25 patient cases of therapy-related hematologic neoplasms were identified, all of which were case reports or case series. The median treatment duration and cumulative dose were 15 months and 18000 mg/m 2 respectively. Most patients (20/25) were diagnosed on or after 12 months while only one patient was diagnosed before 6 months of treatment. Majority of the patients were diagnosed while still on treatment with temozolomide. Graphically, cases clustered around a cumulative dose of 10,000 to 30,000 mg/m 2 and a latency period of 10 to 40 months which translates to an approximate treatment duration of 12.5 – 37.5 months. Conclusions: Taken together, treatment-related hematologic neoplasms appear to develop beyond the 12-month mark while still on treatment with temozolomide. We suggest an approach to optimizing treatment duration by establishing disease response at 6 months before continuing further treatment and restricting treatment to 12 months or establishing closer vigilance beyond 12 months.
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Affiliation(s)
- Robin Park
- MetroWest Medical Center, Framingham, MA
| | - Manik A. Amin
- University of Kansas Medical Center, Kansas City, KS
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5
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Grierson P, Suresh R, Tan BR, Pedersen KS, Amin MA, Park H, Trikalinos N, Liu J, Lim KH, wang-gillam A. A pilot study of liposomal irinotecan plus 5-FU/ LV combined with paricalcitol in patients with advanced pancreatic cancer which progressed on gemcitabine-based therapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
566 Background: 5-FU-based chemotherapy is the standard of care for patients with advanced pancreatic cancer progressed on gemcitabine-based therapy. Based on the NAPOLI-1 study, liposomal irinotecan and 5-FU/LV is currently an FDA-approved regimen in this setting with median progression free survival (mPFS) 3.1 months, median overall survival (mOS) 6.1 months and ORR 16%. In pancreatic cancer mouse models, vitamin D was shown to remodel the desmoplastic stroma and when combined with chemotherapy significantly improved animal survival. Methods: We conducted a pilot study in patients with advanced pancreatic cancer progressed on gemcitabine-based therapy treated with 5FU (2,400mg/m2)/LV (400mg/m2)/liposomal irinotecan (70mg/m2) with paricalcitol in two dose level cohorts: paricalcitol 75mcg IV on day 1 weekly (N = 10, dose level 1) or 7mcg/kg IV on day 1 weekly (N = 10, dose level 2). The primary endpoint was the occurrence of grade 3 and 4 toxicities. Dose-limiting toxicities (DLT) were assessed during cycle 1. Secondary endpoints include objective response rate (ORR), progression-free survival (PFS) and overall survival (OS). Results: Between 8/29/2019 to 5/6/2021, a total of 20 patients were enrolled in the study. No DLTs or grade 4 adverse events were observed in either paricalcitol cohort. The most common toxicities were gastrointestinal (nausea, diarrhea), fatigue and anemia and were similar in both cohorts. Only one grade 3 adverse event was possibly due to paricalcitol (spinal fracture). 2/10 patients experienced an objective response, one of which was confirmed. Median follow up was 6.1 months. At the time of analysis, one patient remains on liposomal irinotecan and 5-FU/LV and mPFS of all patients is 3.57 months and mOS is 6.15 months. The mPFS is 3.55 months for dose level 1 and 5.34 months for dose level 2 (p = 0.3). The mOS is 6.15 months for dose level 1 and 6.66 months for dose level 2 (p = 0.4). Conclusions: Administration of paricalcitol in combination with liposomal irinotecan and 5-FU/LV is well tolerated in patients with advanced pancreatic cancer, however does not appear to improve response rate or survival outcomes. Correlative analyses are ongoing. Clinical trial information: NCT03883919.
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Affiliation(s)
- Patrick Grierson
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Rama Suresh
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Benjamin R. Tan
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | | | - Manik A. Amin
- University of Kansas Medical Center, Kansas City, KS
| | - Haeseong Park
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | | | - Jingxia Liu
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Kian-Huat Lim
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Andrea wang-gillam
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
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Brooks GA, Waleed M, McGrath EB, Beloin K, Walsh SK, Benoit PR, Khan WA, Tsongalis GJ, Amin MA, Faris JE, Ripple GH, Hourdequin KC. Sustainability and clinical outcomes of routine screening for pathogenic DPYD gene variants prior to fluoropyrimidine (FP) chemotherapy for gastrointestinal (GI) cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
216 Background: Dihyropyrimidine dehydrogenase (DPD) deficiency is present in 3-5% of patients, and is associated with substantially increased risk of severe and/or fatal toxicity during standard-dose FP chemotherapy. Genotyping of pathogenic DPYD variants is a readily available screening test for DPD deficiency, and prospective studies show that dose-reduced FP chemotherapy can be used safely in heterozygous DPYD variant carriers. Methods: Following a sentinel toxicity event the GI medical oncology group at the Norris Cotton Cancer Center adopted a shared practice of routine screening for pathogenic DPYD gene variants prior to FP chemotherapy (5-FU or capecitabine). Screening procedures involved physicians, NP/PAs, nurses, pharmacists, and schedulers. Testing was completed at a send-out lab until late 2020, when an in-house test became available. The current test panel evaluates for 3 gene variants: c.1905+1G > A (*2A), c.1679T > G (*13), and c.2846A > T. We report on the sustainability and clinical outcomes of DPYD gene variant screening. We identified all patients starting new FP-containing intravenous chemotherapy regimens (e.g., FOLFOX, CAPOX) for treatment of GI cancer at two sites (LEB & STJ) between Jan. 2019 and May 2021. We used electronic medical records to evaluate for completion of DPYD genotyping, and we describe the prevalence and management of DPYD gene variant carriers. Results: We identified 333 patients starting FP-containing chemotherapy regimens during the study period, including 287 patients without prior history of FP chemotherapy. Screening with DPYD genotyping was completed in 228 of 287 eligible patients (79%). Screening rates increased from 34% in Q1 of 2019 to 90% in Jan-May 2021. Five GI oncology sub-specialists accounted for 89% of screen-eligible patients and 96% of completed tests, but 10 unique physicians ordered ≥1 test. Of 228 screened patients, six (2.6%) were heterozygous carriers of pathogenic DPYD gene variants (*2A [2 patients], *13 [1], and c.2846A > T [3]). Variant carriers started FP chemotherapy with a 33-50% reduction. Two of six patients required further dose reduction due to FP-related toxicity (grade 4 neutropenia, grade 3 diarrhea). All evaluable variant carriers completed planned initial treatment. Implementation challenges included variable insurance coverage of DPYD genotyping, site-specific test ordering and reporting processes, and inconsistent turn-around time for send-out testing (resolved with on-site testing). Conclusions: Routine screening for pathogenic DPYD gene variants prior to FP chemotherapy is feasible and sustainable in the U.S. DPYD genotyping coupled with chemotherapy dose reductions for DPYD variant carriers facilitates safe and timely completion of planned chemotherapy treatments.
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Affiliation(s)
| | | | | | - Kara Beloin
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | | | - Gregory J. Tsongalis
- The Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
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7
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Attia SS, Rafla M, El-Nefiawy NE, Abdel Hamid HF, Amin MA, Fetouh MA. A potential role of mesenchymal stem cells derived from human umbilical cord blood in ameliorating psoriasis-like skin lesion in the rats. Folia Morphol (Warsz) 2021; 81:614-631. [PMID: 34355785 DOI: 10.5603/fm.a2021.0076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Psoriasis is a common autoimmune inflammatory skin disease, with no clear cause, treated with topical agents and phototherapy to conventional immunosuppressant drugs and biologic agents. Stem cell therapy has showed significant interest in regenerative medicine. The aim of this study was to use mesenchymal stem cell (MSC) therapy compared to the topical application of the standard conventional corticosteroid cream. MATERIALS AND METHODS 40 male adult albino rats were used, divided into 4 groups, 10 rats each. Group I (control), Group II (Psoriasis-like lesions induced by usage of Aldara cream), Group III (treated with Betamethasone) and Group IV (treated with mesenchymal stem cells). Specimens were stained with Hematoxylin & Eosin, Masson's trichrome, immune-histochemical technique for CD4, CD8 and CD31. Ultra-sections were prepared for transmission electron microscope examination. RESULTS MSCs demonstrated efficacy in reduction of disease severity in the form of uniform epidermal thickness covered by a very thin keratin layer. Normally- arranged layers of epidermal layers, with a clear border demarcation was seen between the epidermis and the dermis with apparently intact basement membrane. TEM showed absence of gaps between the tightly connected cells of the basal layer and the resting basement membrane. CONCLUSIONS application of MSCs raises hope for developing a new, safe and effective therapy for psoriatic patients, avoiding the side effects of betamethasone.
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Affiliation(s)
- S S Attia
- Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M Rafla
- Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - N E El-Nefiawy
- Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - H F Abdel Hamid
- Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M A Amin
- Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M A Fetouh
- Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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8
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Bendell JC, LoRusso P, Overman MJ, Noonan AM, Kim DW, Strickler J, Kim SW, Clarke SJ, George TJ, Grimison PS, Barve MA, Amin MA, Desai J, Wise-Draper T, Cooper Z, Elgeioushi N, Mueller NK, Kumar R, Wu KY, Patel SP. Safety and efficacy of the anti-CD73 monoclonal antibody (mAb) oleclumab ± durvalumab in patients (pts) with advanced colorectal cancer (CRC), pancreatic ductal adenocarcinoma (PDAC), or EGFR-mutant non-small cell lung cancer (EGFRm NSCLC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9047] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9047 Background: Upregulation of CD73 in multiple cancers increases adenosine production, leading to local immunosuppression. Oleclumab, a human IgG1λ mAb, inhibits CD73 function and may increase antitumor immunity. Initial data from a Phase I, first-in-human, dose-escalation and expansion study showed that oleclumab ± durvalumab had manageable safety and encouraging clinical activity in pts with advanced CRC or PDAC. We report updated safety and activity in these cohorts and the first results in an expansion cohort of pts with advanced EGFRm NSCLC. Methods: Previously treated pts with histologically or cytologically confirmed microsatellite stable CRC, PDAC, or EGFRm NSCLC received oleclumab 5–40 mg/kg (escalation) and 40 mg/kg (expansion) IV Q2W, alone (escalation only) or with durvalumab 10 mg/kg IV Q2W. The primary objective was safety; secondary efficacy objectives included objective response (OR) per RECIST v1.1 and duration of response (DoR). Results: 66 pts were enrolled in the escalation phase (35 CRC, 31 PDAC) and 126 in the expansion phase (42 CRC, 42 PDAC, 42 EGFRm NSCLC). At data cutoff (DCO; June 9, 2020), the median number of oleclumab doses was 4 in pts on monotherapy (range 1–26) and 4 in pts on combination therapy across both phases (range 1–76). In the escalation phase, there were no DLTs in pts on monotherapy or combination therapy; treatment-related adverse events (TRAEs) occurred in 54.8% of pts on monotherapy (Grade 3–4 in 7.1%) and 54.2% of pts on combination therapy (Grade 3–4 in 20.8%); fatigue was the most common TRAE with both regimens. No TRAEs resulted in death. In previous interim analyses before this DCO, no ORs were reported in the escalation phase. In the expansion phase, 5 pts were treated for ≥12 mos; 6 pts were ongoing at DCO. TRAEs occurred in 54.0% (Grade 3–5 in 15.1%); the most common TRAEs were fatigue (15.1%), diarrhea (9.5%), and rash (7.1%). One pt had a TRAE resulting in death (systemic inflammatory response syndrome). ORs were seen in 1 CRC pt (DoR 35.9+ mos [+ = ongoing response]), 2 PDAC pts (DoR 22.1+ and 28.6+ mos), and 4 EGFRm NSCLC pts (DoR range 5.6 to 15.7+ mos, median not reached; only 1 of the 4 pts had ≥25% programmed cell death ligand-1 [PD-L1]+ tumor cells). Nine CRC pts, 8 PDAC pts, and 9 EGFRm NSCLC pts had SD. Of 6 pts with matched biopsies who received combination therapy, 5 had increases in CD8+ T cells, PD-L1, and granzyme B. Baseline tumor CD73 expression and association with clinical response will be presented. Conclusions: Oleclumab ± durvalumab had a tolerable safety profile and combination therapy showed promising antitumor activity in EGFRm NSCLC. ORs and SD were durable, even in tumor types that are generally immunotherapy-resistant. Clinical trial information: NCT02503774.
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Affiliation(s)
| | | | | | - Anne M. Noonan
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Dong-Wan Kim
- Seoul National University Hospital, Seoul, South Korea
| | | | | | | | | | | | | | - Manik A. Amin
- Washington University School of Medicine, St. Louis, MO
| | - Jayesh Desai
- Royal Melbourne Hospital, Parkville, VIC, Australia
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9
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Jin R, Park H, Wang-Gillam A, Suresh R, Rigden CE, Amin MA, Tan BR, Pedersen K, Lim KH, Trikalinos N, Acharya A, Copsey M, Navo K, Morton A, Gao F, Lockhart AC. Final results of a phase II trial of first-line FOLFIRINOX for advanced gastroesophageal cancers. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4532] [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: 11/20/2022] Open
Abstract
4532 Background: Standard first-line regimens for patients with metastatic gastroesophageal adenocarcinomas have moderate clinical benefit with objective response rates (ORR) of approximately 40-50%. FOLFIRINOX has been shown to be an effective and well-tolerated first line therapy in other GI cancers. In this open-label, single-arm phase II study of patients with advanced gastroesophageal adenocarcinomas, we sought to evaluate the safety and clinical activity of FOLFIRINOX. Methods: The primary endpoint was ORR, and secondary endpoints included safety profile, progression free survival (PFS), overall survival (OS), time to progression (TTP), clinical benefit rate (CBR), and duration of response. Estimated sample size included 41 patients with HER2 negative disease with 90% power to detect an ORR≥60% with alpha of 0.10. No enrollment goal was planned for HER2 positive patients, but they were allowed participation to receive study treatment in combination with trastuzumab. Treatment consisted of 400mg/m2 5-FU bolus, 400 mg/m2 leucovorin, 2400 mg/m2 5-FU infusion over 46 hours, 180 mg/m2 irinotecan, and 85 mg/m2 oxaliplatin. Trastuzumab was administered intravenously as a 6 mg/kg loading dose then given 4 mg/kg every 14 days for HER2 positive patients. This trial is registered with ClinicalTrials.gov, NCT01928290. Results: From November 2013 to May 2019, 67 patients were enrolled, of which 26 (39%) had HER2 positive disease. Median follow-up was 16.1 months. ORR was 61% (25/41) for HER2 negative and 85% (22/26) for HER2 positive groups. Overall, one patient (2%) had a complete response, 36 patients (69%) had partial responses, and 13 patients (19%) had stable disease for >6 months; therefore, CBR was 96%. Median PFS was 11.9 months, median OS was 17.4 months. 41 patients (83.7%) had dose modification or treatment delay with the most common toxicities being neutropenia, diarrhea, peripheral sensory neuropathy, and nausea with no unexpected toxicities. Conclusions: FOLFIRINOX is a highly effective three-drug regimen for first-line treatment of advanced gastroesophageal cancer with expected, tolerable toxicities. Clinical trial information: NCT01928290 .
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Affiliation(s)
- Ramon Jin
- Washington University School of Medicine, St. Louis, MO
| | - Haeseong Park
- Washington University School of Medicine, St. Louis, MO
| | | | - Rama Suresh
- Washington University School of Medicine, St. Louis, MO
| | - Caron E. Rigden
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Manik A. Amin
- Washington University School of Medicine, St. Louis, MO
| | | | | | - Kian-Huat Lim
- Washington University School of Medicine, St. Louis, MO
| | | | - Abhi Acharya
- Washington University School of Medicine, St. Louis, MO
| | - Megan Copsey
- Washington University School of Medicine, St. Louis, MO
| | - Katie Navo
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ashley Morton
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Feng Gao
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - A. Craig Lockhart
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
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10
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Grierson P, Wang-Gillam A, Park H, Pedersen K, Tan BR, Amin MA, Suresh R, Trikalinos N, Liu J. A pilot study of liposomal irinotecan plus 5-FU/LV combined with paricalcitol in patients with advanced pancreatic cancer progressed on gemcitabine-based therapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.tps793] [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: 11/20/2022] Open
Abstract
TPS793 Background: Pancreatic ductal adenocarcinoma (PDAC) is predicted to be the second leading cause of cancer-related death by 2030, and is characterized by resistance to chemo- and radiotherapy and a highly fibrotic tumor microenvironment. Front-line therapies for advanced PDAC include FOLFIRINOX and gemcitabine/nab-paclitaxel with median overall survival ranging from 8.5 to 11 months. After progression on gemcitabine-containing therapy, 5-FU/LV/liposomal irinotecan is a standard second-line option, however outcomes are still poor. Retrospective studies demonstrate superior survival of advanced PDAC in patients with high serum levels of 25(OH) vitamin D. Notably, the PDAC tumor microenvironment is enriched in cancer-associated fibroblasts that favorably respond to vitamin D, prolonging survival in combination with chemotherapy in mouse models. Furthermore, vitamin D suppresses catabolism of irinotecan in gastrointestinal cancer cells, potentiating its efficacy. Therefore, we are conducing an investigator-initiated study of 5FU/LV/liposomal irinotecan with paricalcitol as second-line therapy in advanced PDAC. Methods: This is a pilot study of 5FU/LV/liposomal irinotecan combined with paricalcitol in patients with advanced PDAC progressed on gemcitabine-based therapy. All patients receive liposomal irinotecan, LV, 5-FU and paricalcitol. Liposomal irinotecan is given at 70 mg/m2 IV over 90 minutes, LV at 400 mg/m2 IV over 30 minutes, and 5-FU at 2400 mg/m2 continuous IV infusion over 46 hours, on Day 1 of each 14-day cycle. Paricalcitol IV infusion will precede the above, given according to assigned cohort (75 mcg weekly or 7 mcg/kg weekly). The primary objective of this study is to determine the tolerability between two different dose levels of paricalcitol added to the combination regimen of 5-FU/LV/liposomal irinotecan in patients with advanced PDAC. Secondary objectives are measures of efficacy (ORR, PFS, OS, CA19-9 biochemical response rate). Clinical trial information: NCT03883919.
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Affiliation(s)
| | | | - Haeseong Park
- Washington University School of Medicine, St. Louis, MO
| | | | | | - Manik A. Amin
- Washington University School of Medicine, St. Louis, MO
| | - Rama Suresh
- Washington University School of Medicine, St. Louis, MO
| | | | - Jingxia Liu
- Washington University School of Medicine in St. Louis, St. Louis, MO
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11
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Amin MA, Trikalinos N. Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) of gastrointestinal (GI) tract: A single institution experience. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.633] [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: 11/20/2022] Open
Abstract
633 Background: MiNENs are heterogeneous group of rare tumors and represent less than 1% of all GI malignancies. These are pathologically classifiable according to neuroendocrine component into low grade, intermediate grade and high grade MiNENs but and managed based upon non-neuroendocrine component rather than true NENs. They have poor prognosis and less is known about treatment options. Methods: We identified 34 cases of MiNENs from 1/1/2000 to 1/1/2018 from Siteman Cancer Registry Database at Siteman Cancer Center, Washington University, St. Louis. Treatment and follow up information was obtained from medical charts of patients. Results: Of 34 identified cases of MiNENs, our database showed equal distribution of MiNENs in male and female patients (N = 17 each). Site of origin included appendix (N = 14), colon (N = 10), esophageal (N = 2), stomach (N = 3), rectum (N = 3), small intestine (N = 1) and ampulla of Vater (N = 1) locations. Histology was high grade (N = 22), intermediate grade (N = 8), low grade (N = 3) and unknown (1). Twenty nine (85%) underwent surgical resection with curative intent and 13 (40%) patients were disease free at five years of follow up. Disease was localized in 15 patients (44%) and distant metastasis were reported in 13 patients (40%). Ten out of 15 patient with localized disease were disease free with combined modality therapy of surgery and chemotherapy. Most common chemotherapy regimen used in the metastatic setting was FOLFOX (11), 5FU/capecitabine (3), and carboplatin plus etoposide (5). Next generation sequencing analysis was available on limited patients which showed MMR proficient (3), MMR deficiency (1), BRAF V600E mutation (1) and KRAS wild type (1). Conclusions: MiNENs of GI tract are rare and aggressive tumors and represent a distinct entity. Surgical resection whenever possible offers curative option. Our database of GI MiNENs showed efficacy with commonly used GI chemotherapy regimens. Patients with low grade tumor histology had better survival as compared to moderately and poorly differentiated tumors. Genomic testing through NGS would be recommended for personalized treatment decisions given poor prognosis in these patients.
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Affiliation(s)
- Manik A. Amin
- Washington University School of Medicine, St. Louis, MO
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12
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Park H, Trikalinos N, Sanjeevaiah A, Pedersen K, Bagegni NA, Nixon AB, Huffman J, Tan BR, Suresh R, Lim KH, Amin MA, Wang-Gillam A, Lockhart AC. Ramucirumab and irinotecan in patients with previously treated gastroesophageal adenocarcinoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps4150] [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: 11/20/2022] Open
Abstract
TPS4150 Background: Ramucirumab is used for treatment of metastatic gastroesophageal adenocarcinoma after disease progression on first-line chemotherapy. Superior survival outcome is expected when combined with paclitaxel. However, many patients suffer from neuropathy after oxaliplatin-containing first-line chemotherapy and are unable to tolerate paclitaxel. Irinotecan has shown survival benefit as a single agent or in combination with other agents, but has not been used in combination with ramucirumab for treatment with gastroesophageal cancer. We hypothesize that this combination regimen of irinotecan plus ramucirumab administered as second-line treatment will be well-tolerated with improved outcomes similar to paclitaxel plus ramucirumab in patients with advanced gastroesophageal cancer. Circulating levels of angiogenic factors are correlatives of particular interest in this study. Methods: This is a multi-institutional, single-arm phase II clinical trial of ramucirumab and irinotecan. Primary objective of the study is to determine the progression-free survival in patients treated with this combination after disease progression on first-line chemotherapy. Secondary objectives are to determine other indices of efficacy including overall survival, time to progression, objective response rate, and clinical benefit rate; and to evaluate toxicity and tolerability. Patients with confirmed diagnosis of gastroesophageal adenocarcinoma with measurable disease are included. Patients are required of have disease progression during or within 4 months of first line chemotherapy. Key exclusion criteria include squamous histology; prior irinotecan or ramucirumab use; active brain metastases; or other contraindications to ramucirumab including recent history of gastrointestinal bleeding or perforation, thromboembolic event, and uncontrolled hypertension. Patients receive ramucirumab 8mg/kg with irinotecan 180mg/m2 IV every 14 days. We plan to enroll 40 patients which will provide 85% power at a 0.05 significance level to detect a median progression free survival time of 4 months compared to historic control of 2.5 months. 25% of patient accrual is complete as of February 2019. Clinical trial information: NCT03141034.
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Affiliation(s)
- Haeseong Park
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | | | | | - Jesse Huffman
- Washington University School of Medicine, St. Louis, MO
| | | | - Rama Suresh
- Washington University School of Medicine, St. Louis, MO
| | - Kian-Huat Lim
- Washington University School of Medicine, St. Louis, MO
| | - Manik A. Amin
- Washington University School of Medicine, St. Louis, MO
| | | | - A. Craig Lockhart
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
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13
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Bagegni NA, Tan BR, Park H, Kraft K, Amin MA, Lim KH, Morgensztern D, Pedersen K, Suresh R, Trikalinos N, Wang-Gillam A. A phase Ib trial of anti-VEGFR/PDGFR vorolanib combined with immune checkpoint inhibitors (CPIs) in solid tumors. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.tps472] [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: 11/20/2022] Open
Abstract
TPS472 Background: Immune CPIs have become a standard treatment option for many advanced malignancies, including gastric (G)/GE junction (GEJ) and hepatocellular cancer (HCC), but resistance is inevitable. Data suggests angiogenesis plays a key role in tumor-mediated immune regulation. Vascular endothelial growth factor (VEGF) can inhibit intra-tumor T cell trafficking, while anti-VEGF therapy can improve T cell infiltration, potentially enhancing response to CPIs to overcome resistance. Vorolanib (V), a potent oral VEGFR/PDGFR inhibitor, has anti-angiogenic properties with a favorable toxicity profile. This phase 1b study is aimed to assess the safety and efficacy of V + CPIs, pembrolizumab (P) or nivolumab (N), in pts with advanced solid tumors. Methods: The primary objective is to determine the recommended phase 2 dose (RP2D) of V + CPIs. Secondary objectives include safety, toxicity and objective response rate (ORR) and survival outcomes. Correlatives include analysis of angiogenic factors and tumor infiltrating lymphocytes as response biomarkers in archived tumor tissue and peripheral blood. Key eligibility for dose escalation cohort includes pts with solid tumors who can receive standard P or N, and for dose expansion cohort includes pts with PD-L1+ G/GEJ cancer who progressed on one or two lines of chemo, refused or are not candidates for chemo; or HCC Child-Pugh A treated with or refused sorafenib, ECOG PS 0-1 and adequate organ function. Key exclusions include prior CPI, significant bleeding, thrombosis, autoimmune disease or condition requiring corticosteroid use. A 3+3 design will be utilized to determine maximum tolerated dose and RP2D. V starts at 300 mg PO daily, pts receive N 480 mg IV Q 28-day cycle or P 200 mg IV Q 21-day cycle (max 36 pts). Dose level advancement occurs when all pts complete cycle 1 of assessed level. 20 additional pts (10 HCC, 10 G/GEJ cancer) will be treated at RP2D. Response assessment by RECIST v1.1 occurs Q 3 cycles on P or Q 2 cycles on N. ORR of 20% or greater warrants further investigation. Enrollment is ongoing. Clinical trial information: NCT03511222.
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Affiliation(s)
| | - Benjamin R. Tan
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Haeseong Park
- Washington University School of Medicine, St. Louis, MO
| | - Katlyn Kraft
- Washington University School of Medicine, St Louis, MO
| | - Manik A. Amin
- Washington University School of Medicine, St. Louis, MO
| | - Kian-Huat Lim
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | - Katrina Pedersen
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Rama Suresh
- Washington University School of Medicine in St. Louis, St. Louis, MO
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14
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Overman MJ, LoRusso P, Strickler JH, Patel SP, Clarke SJ, Noonan AM, Prasanna T, Amin MA, Nemunaitis JJ, Desai J, O'Byrne KJ, George TJ, Englert J, She D, Cooper ZA, Wu Y, Khan A, Kumar R, Bendell JC. Safety, efficacy and pharmacodynamics (PD) of MEDI9447 (oleclumab) alone or in combination with durvalumab in advanced colorectal cancer (CRC) or pancreatic cancer (panc). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4123] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - John H. Strickler
- Duke Comprehensive Cancer Center-Duke Cancer Institute Duke University Health System, Durham, NC
| | | | | | - Anne M. Noonan
- 6Arthur G. James Cancer Hospital and Solove Research Institute, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Manik A. Amin
- Washington University School of Medicine, St. Louis, MO
| | | | - Jayesh Desai
- Royal Melbourne Hospital, Parkville Victoria, Australia
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15
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Grierson P, Oza A, Doyle MM, Fowler K, Fields R, Hawkins WG, Hammill C, Wang-Gillam A, Amin MA, Pedersen K, Lim KH, Morton A, Cordova C, Tan BR, Chapman WC. Phase I study of hepatic arterial infusion (HAI) therapy with floxuridine (FUDR) combined with systemic gemcitabine and oxaliplatin in patients with locally advanced intrahepatic cholangiocarcinoma (ICC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.417] [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: 11/20/2022] Open
Abstract
417 Background: The standard of care for unresectable ICC is palliative systemic chemotherapy with cisplatin and gemcitabine. HAI therapy with FUDR in ICC resulted in high response rates [Kemeny 2011]. The use of HAI FUDR with systemic chemotherapy may improve outcomes. We conducted a phase 1 study of HAI FUDR with systemic gemcitabine and oxaliplatin. Methods: We enrolled patients in 3 cohorts: FUDR 0.16mg/kg/day x 14 days (Cohort 1), FUDR 0.12 mg/kg/day x 14 days with gemcitabine 1000mg/m2 on days 1, 8, 15 (Cohort 2), and FUDR 0.10 mg/kg/day x 14 days with gemcitabine 800mg/m2 days 1, 15 and oxaliplatin 85mg/m2 days 1, 15 (Cohort 3). The primary endpoint was the recommended phase 2 dose (RP2D) for Cohort 3. DLTs were assessed during cycle 1. Secondary objectives were response rate and survival. Results: We enrolled 24 patients, 6 male, age range 42-81 years (median 64). No DLTs were observed in Cohort 1 (FUDR). In Cohort 2 (FUDR + Gem), the addition of gemcitabine at 1000mg/m2 days 1, 8, 15 resulted in grade 3 LFT elevation in 2 patients; for subsequent patients, the gemcitabine dose was reduced to 800mg/m2, and no further DLT were noted. No DLT were observed in Cohort 3 (FUDR + GemOx). 10 patients experienced partial responses and conversion to resectable disease occurred in all cohorts. No other significant toxicities occurred. Conclusions: FUDR via HAI with systemic gemcitabine and oxaliplatin is well-tolerated in patients with unresectable cholangiocarcinoma, with a high rate of response and disease control, allowing for resection in some patients. Our RP2D is FUDR 0.10 mg/kg/day x 14 days, with gemcitabine 800mg/m2 days 1, 15 and oxaliplatin 85mg/m2 days 1, 15. Collaboration with MSKCC is ongoing. Clinical trial information: NCT01525069. [Table: see text]
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Affiliation(s)
| | - Aabha Oza
- Indiana University, Indianapolis, IN
| | | | - Kathryn Fowler
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ryan Fields
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | - Chet Hammill
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | - Manik A. Amin
- University of Kansas Medical Center, Kansas City, KS
| | | | - Kian-Huat Lim
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ashley Morton
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Christine Cordova
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Benjamin R. Tan
- Washington University School of Medicine in St. Louis, St. Louis, MO
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16
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Park H, Wang-Gillam A, Suresh R, Rigden CE, Amin MA, Tan BR, Pedersen K, Lim KH, Trikalinos N, Navo K, Morton A, Schrumpf L, Marquez S, Trinkaus K, Lockhart AC. A phase II trial of first-line FOLFIRINOX for patients with advanced gastroesophageal adenocarcinoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
89 Background: Standard first-line regimens for patients with metastatic gastroesophageal adenocarcinomas have an approximate 40% objective response rate (ORR). FOLFIRINOX has been used in first line therapy in other GI cancers (i.e pancreatic and CRC) with impressive efficacy signals. Methods: This is a phase II study of first line combination chemotherapy with fluorouracil (5-FU), irinotecan, and oxaliplatin in patients with advanced gastric, esophageal, or gastroesophageal junction adenocarcinoma (NCT01928290). Starting doses were 5-FU 400mg/m2 bolus followed by 2400 mg/m2 over 46 hours with leucovorin 400 mg/m2, irinotecan 180 mg/m2, and oxaliplatin 85 mg/m2. Trastuzumab was administered as 6 mg/kg loading dose then 4 mg/kg every 14 days if patients had HER2+ cancer. The primary endpoint was overall response rate (ORR). Secondary endpoints included progression free survival (PFS), overall survival (OS), time to progression (TTP), clinical benefit rate (CBR), and duration of response. Enrollment of 41 patients with HER2- disease was planned to reach one-sided = 0.10 and power 0.90 with goal of detecting true ORR60%. No enrollment goal was planned for HER2+. Results: From Nov 2013 to July 2017, 58 patients were enrolled, 25 out of 58 (43%) had HER2+ disease. Forty-nine patients were evaluable for response as they completed at least one restaging scan. ORR was 78% (38/49) in all patients, 67% (18/27) in HER2-, 91% (20/22) in HER2+. One patient (2%) had complete response, 37 (76%) had partial response, 7 (14%) had stable disease > 6 months; therefore, CBR was 92%. Median PFS is 11.9 months, median OS is 17.4 months and median follow up time 16.1 months. 41 (83.7%) had dose modification or delay during treatment. There were no unexpected toxicities. Conclusions: FOLFIRINOX with or without trastuzumab showed remarkable ORR and PFS in patients with advanced gastroesophageal adenocarcinoma in the first-line setting. This regimen may be a reasonable therapeutic option for patients with preserved performance status. Further investigation in larger population is warranted. Clinical trial information: NCT01928290.
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Affiliation(s)
- Haeseong Park
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | - Rama Suresh
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Caron E. Rigden
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Manik A. Amin
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Benjamin R. Tan
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Katrina Pedersen
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Kian-Huat Lim
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | - Katherine Navo
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ashley Morton
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Lindsey Schrumpf
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Samantha Marquez
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Kathryn Trinkaus
- Washington University School of Medicine in St. Louis Siteman Cancer Center, St. Louis, MO
| | - A. Craig Lockhart
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
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Wang-Gillam A, Lockhart AC, Tan BR, Suresh R, Singh PP, Lim KH, Pedersen K, Amin MA, Hawkins WG, DeNardo DG. Phase I study of defactinib combined with pembrolizumab and gemcitabine in advanced cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.tps505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS505 Background: Focal adhesion kinase (FAK) is consistently hyperactivated in pancreatic ductal adenocarcinoma (PDAC), and FAK signaling is a key driver in forming its fibrotic and proinflammatory tumor microenvironment. Inhibition of FAK signaling leads to significant reduction of pancreatic tumor growth in animal models. Indeed, tumors treated with FAK inhibitors displayed markedly reduced tumor fibrosis and decreased immunosuppressive myeloid cells. Furthermore, our preclinical work has demonstrated that FAK- and PD-1 inhibitors elicit significant tumor regression, and the maximal response was achieved by combining FAK- and PD-1 inhibitors with gemcitabine, suggesting the need for a cytotoxic agent to bolster antigen presentation (Jiang H et al, Nature Medicine 2016). Defactinib is an orally available, potent ATP-competitive, FAK inhibitor with a recommended phase II dose (RP2D) of 400 mg twice daily. Methods: Eligible patients will be treated according to the dose escalation schema. A 3+3 design is used until the first occurrence of dose-limiting toxicity, and then switches to a continuous assessment design. The study has an expansion portion (group A and B) at the RP2D. Group A includes metastatic PDAC patients who are stable at least 4 months on front-line nab-paclitaxel/gemcitabine, and group B includes metastatic PDAC patients progressed on ≥ 1 chemotherapy line. Key eligibility criteria include patients with advanced solid tumors (dose escalation portion) or advanced PDAC (expansion cohort); age ≥18 years; ECOG score ≤1; normal organ function; and no history autoimmunity. The primary endpoint is to determine the RP2D. Secondary endpoints include objective response rate, progression-free survival and overall survival. The exploratory endpoints include developing a molecular and immune signature for treatment response. This trial is actively enrolling and funded by Precision Medicine Research Associate and Barnes Jewish Foundation. Clinical trial information: NCT02546531. [Table: see text]
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Affiliation(s)
| | | | - Benjamin R. Tan
- Division of Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Rama Suresh
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | - Preet Paul Singh
- Division of Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Kian-Huat Lim
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | | | - Manik A. Amin
- Division of Oncology, Washington University School of Medicine, Saint Louis, MO
| | - William G. Hawkins
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
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Wang-Gillam A, Du L, Teague AS, Suresh R, Lim KH, Amin MA, Pedersen K, Tan BR, Huffman J, Lockhart AC. A phase I/II study combining tosedostat with capecitabine in patients with metastatic pancreatic ductal adenocarcinoma (PDAC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
410 Background: Recent advances in front-line therapy have improved survival in patients with advanced PDAC. A fluorouracil-based regimen is recommended for patients who progress on a gemcitabine-based therapy. Tosedostat is an oral aminopeptidase inhibitor that disrupts the cleavage of amino acids from peptides downstream of proteasomal degradation. It prevents the recycling of free amino acids, leads to intracellular depletion of amino acids, and triggers an amino acid deprivation response that subsequently results in apoptosis. Because PDAC cells frequently upregulate expression of these aminopeptidases, tosedostat offers therapeutic promise, particularly in combination with fluoropyrimidines. Methods: This is a single institution phase I/II trial to evaluate the safety and toxicity of tosedostat plus capecitabine in patients with metastatic PDAC progressed on a gemcitabine-based therapy. The phase I portion is being conducted in a dose de-escalation fashion, with two dose levels of tosedostat (120 mg or 60 mg) p.o. daily on days 1 to 21 with capecitabine 1000 mg/m2 p.o. BID on days 1 to 14 of a 21-day cycle. If more than one out of 6 patients in the tosedostat (120 mg) cohort experience a dose limiting toxicity (DLT), then 6 more will be enrolled to the tosedostat (60 mg) cohort. The primary objective of the phase I portion is to determine the optimal phase II dose. The primary objective of the phase II portion is to determine the progression-free survival at 3 months. Secondary objectives include the overall response rate, overall survival and CA 19-9 response. To avoid futility, interim analysis is planned after 10 evaluable patients enrolled. Results: Up to date, a total of 11 patients have been enrolled in the study, and 10 patients are evaluable. No DLT have been observed. Tosedostat at a dose of 120 mg with capecitabine is extremely well tolerated. Prolonged stable disease has been observed in 4 (40%) patients with a time on treatment of 10 months, 7.5 months, 5.5 months and 4 months, and 3 of the 4 patients remain on the trial. Conclusions: The combination of tosedostat and capecitabine is a well-tolerated regimen with impressive clinical activity in the subset of patients studied thus far. Clinical trial information: NCT02352831.
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Affiliation(s)
| | | | - Andrea S. Teague
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Rama Suresh
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | - Kian-Huat Lim
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Manik A. Amin
- University of Kansas Medical Center, Kansas City, KS
| | | | - Benjamin R. Tan
- Division of Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Jess Huffman
- Washington University in St.Louis, St. Louis, MO
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Abouhmad A, Mamo G, Dishisha T, Amin MA, Hatti-Kaul R. T4 lysozyme fused with cellulose-binding module for antimicrobial cellulosic wound dressing materials. J Appl Microbiol 2016; 121:115-25. [PMID: 27028513 DOI: 10.1111/jam.13146] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 09/09/2015] [Revised: 03/13/2016] [Accepted: 03/23/2016] [Indexed: 12/19/2022]
Abstract
AIMS Bacterial infection is a major challenge in wound care. Antimicrobial wound dressings are of great value for treating wound infections. Endolysins are evolving as a new class of antimicrobials with multiple applications. This study describes the production and evaluation of T4 lysozyme (T4Lyz), product of gene e of the T4 bacteriophage, fused with Cellulose Binding Module (CBM) for facile immobilization to cellulosic wound dressing. METHODS AND RESULTS Genes encoding T4Lyz-CBM and T4Lyz were cloned and expressed in Escherichia coli and the enzymes were purified by cation exchange chromatography. While the CBM tag did not alter the optimum pH and stability features of T4Lyz, the lytic activity of the fusion protein was lowered. The bactericidal activity of T4Lyz-CBM, determined by viable count plating assay after 1 h incubation with Micrococcus lysodeikticus was 97·5% with 10 μg ml(-1) , and 99·96% and 95% for E. coli and Pseudomonas mendocina, respectively, with 200 μg ml(-1) enzyme. T4Lyz-CBM was immobilized to wound dressing gauze with a capacity of 5·5 μg mg(-1) matrix, whereas the unmodified T4Lyz did not exhibit any binding. The immobilized protein retained its bactericidal activity against Gram-positive and Gram-negative bacteria. Both free and immobilized T4Lyz-CBM, after heat denaturation, retained their bactericidal activities against Gram-negative bacteria only. The immobilized enzyme exhibited higher stability than the free enzyme when stored in dry form or in the presence of polyol stabilizers. CONCLUSION Tagging T4Lyz with CBM provides a facile, irreversible binding to cellulosic wound dressing while retaining its activity. This approach may be suitable even for other antimicrobial enzymes and -peptides. SIGNIFICANCE AND IMPACT OF THE STUDY The spread of antibiotic resistance requires innovative strategies for discovery and development of effective antimicrobial alternatives. This report presents a novel strategy for producing antimicrobial wound dressing materials.
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Affiliation(s)
- A Abouhmad
- Division of Biotechnology, Center for Chemistry and Chemical Engineering, Lund University, Lund, Sweden.,Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Assiut, Egypt
| | - G Mamo
- Division of Biotechnology, Center for Chemistry and Chemical Engineering, Lund University, Lund, Sweden
| | - T Dishisha
- Division of Biotechnology, Center for Chemistry and Chemical Engineering, Lund University, Lund, Sweden.,Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - M A Amin
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - R Hatti-Kaul
- Division of Biotechnology, Center for Chemistry and Chemical Engineering, Lund University, Lund, Sweden
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20
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Amin MA, Wang-Gillam A, Tan BR, Suresh R, Picus J, Singh PP, Lim KH, Masood A, Lockhart AC. Impact of comorbidities using Adult Comorbidity Evaluation-27 (ACE-27) score on survival in stage II colon cancer: Age, TNM staging, and pathological high risk-disease. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.659] [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: 11/20/2022] Open
Abstract
659 Background: Impact of comorbidities is identified in stage III colon cancer patients (CCPs) receiving adjuvant chemotherapy (Wildes et al, PMID 21113435) but is not well defined in predicting overall survival (OS) in stage II CCPs undergoing either adjuvant treatment or observation depending upon high-risk disease. The goal of this study was to identify impact of comorbidities on OS in this potentially curable disease using ACE-27 score, which uses 27 different patient comorbid conditions has been developed and validated by Piccirrillo et al at Barnes Jewish Hospital (BJH) (PMID: 24933715). Methods: We identified stage II CCPs treated at BJH, Siteman cancer center from January 1, 1996 to October 31st, 2013 from BJH oncology data cancer registry. The primary outcome was OS, defined as the time from date of surgery to death from any cause, censored at the time of last follow-up. Patient comorbidities at diagnosis were recorded using ACE-27 score, assigning a comorbidity score of none, mild, moderate and severe to the patients. Survival analysis was done using Cox proportional hazard modelling using STATA/SE 11.2 software. Pathological high risk features such as T4 lesions, < 12 LN, perineural, lymphovascular invasion, positive margins & perforation/obstruction were identified. Results: Out of 579 stage II CCPs, 48% male and 51% were females. High risk features were identified in 45% of patients. ACE-27 comorbidity score of none (n = 146), mild (n = 229), moderate (n = 132) and severe (n = 72) was calculated. 497 patients had T3N0M0 and 82 had T4N0M0 staging. Cox regression hazard model using histological prognostic factors, age at surgery, sex, race, prior cancer history and TNM staging showed that ACE-27 score of moderate and severe were independent predictors of OS with a hazard ratio of 1.6 (95% CI 1.0-2.4), P = 0.036 and 2.5 (95% CI 1.5-4.0), P = 0.00 respectively. Conclusions: Highest commodity burden using ACE-27 comorbidity score was associated with poor OS in stage II CCPs and was independent of other prognostic risk factors including high-risk features. Treatment related mortality will be calculated in patients with high risk disease.
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Affiliation(s)
| | | | - Benjamin R. Tan
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | - Rama Suresh
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | - Joel Picus
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | - Preet Paul Singh
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | - Ashiq Masood
- Washington University in St. Louis, St. Louis, MO
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Teague AS, Amin MA, Lim KH, Lockhart AC, Masood A, Picus J, Singh PP, Suresh R, Tan BR, Wang-Gillam A. A phase I/II study combining tosedostat with capecitabine in patients with metastatic pancreatic adenocarcinoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.tps471] [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: 11/20/2022] Open
Abstract
TPS471 Background: Metastatic pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis. Recent advances with fluorouracil in combination with oxaliplatin and irinotecan (FOLFIRINOX) and nab-paclitaxel combined with gemcitabine (AG) have improved survival in patients with PDAC. A fluorouracil-based regimen is recommended for patients who progress after a gemcitabine-based regimen. Tosedostat is an oral aminopeptidase inhibitor shown to have anti-proliferative effects in malignancies. Aminopeptidase inhibitors disrupt the cleavage of amino acids from peptides downstream of proteasomal degradation, preventing the recycling of amino acids needed for new protein synthesis. This leads to intracellular depletion of amino acids, resulting in a cellular stress response known as the amino acid deprivation response, which leads to apoptosis. Because pancreatic cancer cells frequently upregulate expression of these aminopeptidases, aminopeptidases inhibitors hold therapeutic promise. Methods: This is a single institution phase I/II open-label trial to evaluate the safety and tolerability of tosedostat plus capecitabine in patients with metastatic PDAC that have progressed after a gemcitabine-based regimen. The phase I part will be conducted in a dose de-escalation fashion, with two planned dose levels of tosedostat (120mg or 60mg) p.o. daily on days 1 to 21 with capecitabine 1000 mg/m2 p.o. BID on days 1 to 14 of a 21-day cycle. If more than one patient in the tosedostat (120 mg) cohort experiences a dose limiting toxicity (DLT), then 6 more patient will be enrolled to the tosedostat (60 mg) cohort. A total of 36 patients will be enrolled in the phase II portion. Primary objective of the phase I portion is to determine the maximum tolerated dose and DLTs of tosedostat and capecitabine combination therapy. Primary objective of the phase II portion is to determine the progression-free survival at 3 months. Secondary objectives are to determine the overall response rate, time-to-progression, overall survival and CA 19-9 response. Exploratory objectives are to explore the predictive molecular biomarkers for treatment response and to explore the prognostic biomarkers. Clinical trial: NCT02352831. Clinical trial information: NCT02352831.
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Affiliation(s)
- Andrea S. Teague
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | | | | | - Ashiq Masood
- Washington University in St. Louis, St. Louis, MO
| | - Joel Picus
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | - Preet Paul Singh
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Rama Suresh
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Benjamin R. Tan
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
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Olsen JR, Parikh PJ, DeWees TA, Olsen L, Hawkins WG, Strasberg SM, Lim KH, Singh PP, Suresh R, Tan BR, Ratner L, Fields RC, Amin MA, Wang-Gillam A. Prospective phase I study of nab-paclitaxel plus gemcitabine with concurrent MR-guided IMRT in patients with locally advanced or borderline resectable pancreatic cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.tps480] [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: 11/20/2022] Open
Abstract
TPS480 Background: Radiotherapy (RT) for locally advanced and borderline resectable pancreatic cancer (LABPC) is controversial as potential local control benefits are often obscured by high rates of distant progression. However, local failure remains a significant cause of morbidity among patients without distant progression after initial chemotherapy, although toxicity concerns may limit delivery of optimal systemic therapy concurrent with RT. Given known systemic efficacy and radiosensitization effects of nab-paclitaxel (A) with gemcitabine (G), we initiated a phase I study of nab-paclitaxel with gemcitabine (AG) and concurrent intensity modulated radiation therapy with magnetic resonance guidance (MR-IMRT) for LABPC. Methods: A planned 24 patients with LABPC will be enrolled to a phase I dose escalation trial using the Time-to-Event Continual Reassessment Method (TITE-CRM) design. Following one lead-in cycle of GA, MR-IMRT is administered daily with concurrent weekly GA for a total of 25 fractions in 5 weeks. The initial dose levels for RT and AG, respectively, are: 40 Gy MR-IMRT, 75 mg/m2 A and 600mg/m2 G. The maximum possible dose level is 60 Gy MR-IMRT, 100mg/m2 A and 1000mg/m2 G. To reduce toxicity risk, MR-IMRT volumes include the primary tumor only, with cine-MR used for intra-fraction tumor tracking in place of fiducial markers. The primary endpoint is determination of the maximum tolerated dose level, with secondary endpoints including rate of conversion to resectable disease, progression- free survival, overall survival, and patient reported quality of life. Clinical trial information: NCT02283372.
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Affiliation(s)
- Jeffrey R. Olsen
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Parag J. Parikh
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Todd A. DeWees
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Lindsey Olsen
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | | | - Steven M. Strasberg
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Preet Paul Singh
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Rama Suresh
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | - Benjamin R. Tan
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | - Lee Ratner
- Washington University in St. Louis, St. Louis, MO
| | - Ryan C. Fields
- Department of Surgery, Washington University in St. Louis, St. Louis, MO
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Hashem YA, Yassin AS, Amin MA. Molecular characterization of Enterococcus spp. clinical isolates from Cairo, Egypt. Indian J Med Microbiol 2015; 33 Suppl:80-6. [DOI: 10.4103/0255-0857.148836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Wang-Gillam A, Nywening TM, Sanford DE, Lockhart AC, Suresh R, Tan BR, Lim KH, Sorscher S, Fowler K, Amin MA, Roshal A, Adkins D, Nieman R, Panni RZ, DeNardo DG, Goedegebuure PS, Hawkins WG, Fields RC, Strasberg SM, Linehan D. Phase IB study of FOLFIRINOX plus PF-04136309 in patients with borderline resectable and locally advanced pancreatic adenocarcinoma (PC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.338] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
338 Background: PF-04136309 (a novel CCR2 inhibitor) has shown anti-tumor activity in the preclinical setting in PC by depleting inflammatory monocytes and tumor associated macrophages (TAM) that contribute to an immunosuppressive tumor microenvironment. We hypothesized that combining PF-04136309 with FOLFIRINOX may improve clinical outcomes in PC. Methods: This is a phase Ib study with a dose de-escalation schema given the minimal toxicity of PF-04136309. The study includes Arm A (FOLFIRINOX only), Arm B (FOLFIRINOX plus PF-04136309) and an expansion cohort at the rapid phase II dose (RP2D). FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, LV 400 mg/m2, 5FU bolus 400 mg/m2 and 2,400 mg/m2over 46 hours) was administered every two weeks. PF-04136309 at 500 mg twice daily via oral route was the starting dose level for Arm B. Treatment response was assessed after 6 cycles of treatment. Bone marrow biopsy and EUS/FNA at baseline and post 2 cycles were performed to assess the impact of treatment on the prevalence and function of inflammatory monocytes in the blood, bone marrow and tumor. Results: A total of 41 patients have been enrolled in the study to date (6 in Arm A, 8 in Arm B and 27 in the expansion cohort). The mean age of patients was 61.1 (range 45-75 yrs), male/female: 21/20, Caucasian/others: 32/9, borderline/locally advanced: 7/34. PF-04136309 at the starting dose did not result in additional toxicities when combined with FOLFIRINOX and it is the RP2D. Out of 35 patients treated with FOLFIRINOX plus PF-04136309, 6 are still in treatment, 6 are non-evaluable (withdrew consent or had poor tolerance). Of the 23 evaluable patients, 21 (91.3%) completed all 6 cycles; 12 (52.2%) had PR by RECIST and 11 (47.8%) had SD. Curative resections were achieved in 4 out of 5 with borderline resectable and 2 with locally advanced PC. Moreover, blockade of TAM mobilization was demonstrated by FACS and qPCR analysis of baseline and post-treatment FNA biopsies. Conclusions: Combing PF-04136309 with FOLFIRINOX is safe and tolerable. The regimen resulted in impressive treatment response and it further validated CCR2 inhibition in PC. Survival data and more correlative science will be forthcoming. Clinical trial information: 01413022.
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Affiliation(s)
| | | | | | | | - Rama Suresh
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | - Benjamin R. Tan
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | - Kian-Huat Lim
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Steven Sorscher
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | - Kathryn Fowler
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Manik A. Amin
- University of Kansas Medical Center, Kansas City, KS
| | - Anna Roshal
- Washington University in St. Louis, St. Louis, MO
| | - Douglas Adkins
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | | | | | | | | | | | - Steven M. Strasberg
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - David Linehan
- Washington University School of Medicine in St. Louis, St. Louis, MO
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Khalifa MEA, Amin MA, Mosselhi MAN. Site selectivity in reactions of hydrazonoyl halides with heterocycles containing amino and thione groups leading to fused heterocycles of potential antimicrobial activity. Bioorg Khim 2014; 40:117-124. [PMID: 25898730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Reaction of hydrazonoyl halides with 6-(benzylidenamino)-2-thioxo-2,3-dihydro-1H-pyrimidin-4-one and 2,3-diaminoquinazolin-4-one site-selectively afforded 3-substituted-7-(benzylidenamino)-1-phenyl-[1,2,4]triazolo[4,3-a]-pyrimidin-5(1H)-ones, [1,2,4,5]tetrazino[6,1-b]quinazolin-6(4H)-one, and 3-methyl-2-(4-substituted-phenylhydrazo)-[1,2,4]triazino[3,2-b]quinazolin-10-ones in good yields. The structures of the newly synthesized compounds were elucidated by chemical evidence and their IR, 1H, 13C NMR, and MS spectra. Furthermore, some of the products were screened against different strains of bacteria and fungi.
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Chowdhury RN, Hasan MH, Rahman KM, Dev SR, Amin MA, Miah T. Precipitating factor of seizure in epilepsy: experience in a tertiary care hospital. Mymensingh Med J 2014; 23:56-61. [PMID: 24584374] [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: 06/03/2023]
Abstract
Patients with epilepsy experience recurrent, unprovoked seizures. In most of the cases seizure occurs spontaneously, but there may be association with various triggers. These triggers may act as seizure precipitating factors (SPFs). This study was done to find out the most common SPFs and their relationship to different types epileptic patients attending a tertiary care hospital in Bangladesh. This cross sectional study was carried out in specialized epilepsy weekly outdoor clinic and Medicine outpatient department (OPD) of Dhaka Medical College Hospital from January 2008 to July 2011, which included 1168 epilepsy patients. All patients attending the clinic were included in the study. Epilepsy syndromes were broadly classified into four categories using the classification system of international league against epilepsy (ILAE) namely, generalized epilepsy (GE), localization related epilepsy (LRE), symptomatic and unclassified. Each patient was evaluated and classified by consultant neurologist. All participants were interviewed through a predesigned close ended questionnaire that included a long list of 30 precipitating factors. Among all the patients 71.5% were male, with most common age group 11-20 years (36.8%). About 62% could indentify at least one precipitator. Excitation (25.2%) was the most common SPF reported by patients followed by emotional stress in 17.7%. Fever precipitated seizure in 16.4% of the subjects. A good number of them (15.5%) noticed that whenever there was sleep deprivation, they had an attack of epilepsy. However, drug withdrawal, playing outside and head trauma were also common among the patients, about 11.7%, 11.3% and 8.4% respectively. Most of the patients can identify their seizure precipitant and clustering of many SPFs suggests a common patho-physiologic mechanism for these triggers. Excitation, sleep deprivation, fever, watching television and head trauma showed a strong association with generalized epilepsy. Patients with seizure disorder should be evaluated for presence of SPFs, because identification of these might help in proper management of epilepsy.
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Affiliation(s)
- R N Chowdhury
- Dr Rajib Nayan Chowdhury, Assistant Professor, Department of Neurology, Dhaka Medical College & Hospital, Dhaka, Bangladesh
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Al Ghahtani AG, Amin MA. Progress achieved in the elimination of schistosomiasis from the Jazan region of Saudi Arabia. Annals of Tropical Medicine & Parasitology 2013; 99:483-90. [PMID: 16004707 DOI: 10.1179/136485905x51292] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Among the inhabitants of the Jazan region of Saudi Arabia, the prevalence and intensity of Schistosoma haematobium infection have been kept very low for several years, by sustained control efforts. The success of the interventions, which were based on case finding, the treatment of infected individuals, and the chemical and environmental control of freshwater snails, led, in mid-2002, to a strategy to eliminate human infection with S. haematobium from Jazan. The strategy, which was based on regular chemotherapy, snail control (made easier by the focality of transmission in the area) and health education, with screening at primary-healthcare centres, by mobile teams and at diagnostic units, appears to have been successful. No infected snails can now be found in the region and new cases of human infection with S. haematobium are only being detected in border villages (and are attributed to infections beyond the region, in areas where active transmission is still taking place). Total elimination appears possible if the health authorities in neighbouring areas can be persuaded to adopt a similar strategy of control.
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Affiliation(s)
- A G Al Ghahtani
- Health Affairs, Malaria Division, Jazan Region, Saudi Arabia
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Somiya G, Alsarag MS, Amin MA. Relationship between Anthropometric Indices and Dyslipidemia among Sudanese Women in Khartoum State. Sud Jnl Med Sci 2011. [DOI: 10.4314/sjms.v6i2.72464] [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: 11/17/2022] Open
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29
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Amin MA, Elhussin DM. Challenges in prevention and control of schistosomiasis in the Sudan. Sud Jnl Med Sci 2009. [DOI: 10.4314/sjms.v4i1.44885] [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: 11/17/2022] Open
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Mamtani MR, Thakre TP, Kalkonde MY, Amin MA, Kalkonde YV, Amin AP, Kulkarni H. A simple method to combine multiple molecular biomarkers for dichotomous diagnostic classification. BMC Bioinformatics 2006; 7:442. [PMID: 17032455 PMCID: PMC1618410 DOI: 10.1186/1471-2105-7-442] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Accepted: 10/10/2006] [Indexed: 11/29/2022] Open
Abstract
Background In spite of the recognized diagnostic potential of biomarkers, the quest for squelching noise and wringing in information from a given set of biomarkers continues. Here, we suggest a statistical algorithm that – assuming each molecular biomarker to be a diagnostic test – enriches the diagnostic performance of an optimized set of independent biomarkers employing established statistical techniques. We validated the proposed algorithm using several simulation datasets in addition to four publicly available real datasets that compared i) subjects having cancer with those without; ii) subjects with two different cancers; iii) subjects with two different types of one cancer; and iv) subjects with same cancer resulting in differential time to metastasis. Results Our algorithm comprises of three steps: estimating the area under the receiver operating characteristic curve for each biomarker, identifying a subset of biomarkers using linear regression and combining the chosen biomarkers using linear discriminant function analysis. Combining these established statistical methods that are available in most statistical packages, we observed that the diagnostic accuracy of our approach was 100%, 99.94%, 96.67% and 93.92% for the real datasets used in the study. These estimates were comparable to or better than the ones previously reported using alternative methods. In a synthetic dataset, we also observed that all the biomarkers chosen by our algorithm were indeed truly differentially expressed. Conclusion The proposed algorithm can be used for accurate diagnosis in the setting of dichotomous classification of disease states.
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Affiliation(s)
| | - Tushar P Thakre
- Lata Medical Research Foundation, Nagpur, India
- University of North Texas Health Science Center, Fort Worth, Texas, USA
| | | | | | | | - Amit P Amin
- Lata Medical Research Foundation, Nagpur, India
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Essam T, Tamer E, Amin MA, El Tayeb O, Mattiasson B, Guieysse B, Ossama ET, Bo M, Benoit G. Biological treatment of industrial wastes in a photobioreactor. Water Sci Technol 2006; 53:117-25. [PMID: 16862781] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
An algal-bacterial consortium was tested for the treatment from a coke factory. A Chlorella vulgaris strain and a phenol-degrading Alcaligenes sp. were first isolated from the wastewater treatment plant to serve as inocula in the subsequent biodegradation tests. Batch tests were then conducted with samples from the real wastewater or using a synthetic wastewater containing 325 mg phenol/l and 500 mg NH4+/l as target pollutants. Direct biological treatment of the real wastewater was not possible due to the toxicity of organic compounds. Activated carbon adsorption and UV(A-B)-irradiation were efficient in detoxifying the effluent for subsequent biological treatment as inoculation of pretreated samples with the algal-bacterial consortium was followed by complete phenol removal and NH4+ removal of 45%. Complete phenol removal and 33% NH4+ removal were achieved during the fed-batch treatment of artificial wastewater at 6 d hydraulic retention time (HRT). Under continuous feeding at 3.6 d HRT, phenol and NH4+ removal dropped to 58 and 18%, respectively. However, complete phenol removal and 29% NH4+ removal were achieved when 8 g NaHCO3/l was added to the artificial wastewater to enhance algal growth. This study confirms the potential of solar-based industrial wastewater treatment based on solar-based UV pretreatment followed by algal-bacterial biodegradation.
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Affiliation(s)
- T Essam
- Department of Biotechnology, Lund University, Sweden.
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Amin MA, Bailey BMW, Swinson B, Witherow H. Use of the buccal fat pad in the reconstruction and prosthetic rehabilitation of oncological maxillary defects. Br J Oral Maxillofac Surg 2005; 43:148-54. [PMID: 15749216 DOI: 10.1016/j.bjoms.2004.10.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2004] [Indexed: 11/18/2022]
Abstract
We evaluated the effectiveness of the buccal fat pad as a pedicled flap for intraoral reconstruction after partial maxillectomy for neoplastic disease in 24 patients, and subsequently, in providing support for a denture. In all patients the buccal fat pad was covered with a split-skin graft and an acrylic plate. There was complete healing of the buccal fat pad flap within 6 weeks in 18 patients with no major complications, and minimal effects on speech and eating. In six cases there was partial dehiscence of the flap, which healed spontaneously in one patient and was repaired with local flaps in two others. There were no cases of complete breakdown of the flap. Eight patients so far have been rehabilitated with small dentures. In conclusion, the buccal fat pad flap is a simple, quick, and reliable method of reconstruction of small to medium-sized posterior maxillary alveolar defects.
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Affiliation(s)
- M A Amin
- S.W. London Regional Maxillofacial Service, St. George's Hospital Medical School, Blackshaw Road, Tooting, London SW170QT, UK.
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Amin MA, Amin AP, Kulkarni HR. Platelet distribution width (PDW) is increased in vaso-occlusive crisis in sickle cell disease. Ann Hematol 2004; 83:331-5. [PMID: 15052371 DOI: 10.1007/s00277-003-0833-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [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: 07/20/2003] [Accepted: 11/19/2003] [Indexed: 10/26/2022]
Abstract
Considering the multigenic and multifactorial nature of the disease, we argue that a generalized bone marrow hyperplasia-and not merely erythroid hyperplasia-will occur in sickle cell disease. Consequently, we expect the hematological parameters to depict erythroid, myeloid as well as megakaryocyte hyperplasia. In the light of this expectation, we hypothesized that platelet distribution width (PDW) will increase in sickle cell disease. Here, we report the results from a cross-sectional study of 216 children admitted with complaints suggestive of vaso-occlusive crisis. We observed a strong association between PDW and sickle cell disease as compared to children who had HbAA genotype. Our findings bridge previous inconsistencies relating to the role of platelets in sickle cell disease. Implications of this finding are discussed.
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Abstract
Two infants presented with unilateral cystic swellings in the floor of the mouth as a result of imperforate submandibular ducts. This is thought to result from a congenital failure of canalization of the terminal end of the duct. Both cases responded to simple incision and decompression of the fluid-filled duct. Early treatment is important to avoid feeding difficulties and to prevent later complications such as ranula or sialadenitis.
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Affiliation(s)
- M A Amin
- SW London Maxillofacial Service, Department of Oral and Maxillofacial Surgery, Queen Mary's University Hospital, Roehampton, London SW15 5PN, UK
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36
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Abstract
Angiogenesis is an important aspect of the vasculoproliferation found in the rheumatoid arthritic (RA) pannus. We have previously implicated members of the CXC chemokine family as potent angiogenic mediators in RA. We investigated the possibility that the sole member of the CX(3)C chemokine family, fractalkine (fkn), induces angiogenesis and that fkn might mediate angiogenesis in RA. Recombinant human fkn significantly induced migration of human dermal microvascular endothelial cells (HMVECs), a facet of the angiogenic response, in the pmol/L range in a concentration-dependent manner (P < 0.05). Fkn also induced the formation of significantly more endothelial tubes on Matrigel than did a negative control (P < 0.05). Fkn significantly induced 2.3-fold more blood vessel growth than control in the in vivo Matrigel plug assays (P < 0.05). We identified HMVEC expression of the fkn receptor, CX(3)CR1. Next, we determined if RA synovial fluid (SF)-induced angiogenesis was fkn-dependent. SFs from six RA patients immunodepleted of soluble fkn induced 56% less migration of HMVECs than did sham-depleted RA SFs (P < 0.05). In vivo, immunodepletion of fkn from six RA SFs significantly inhibited their angiogenic activity in Matrigel plug assays (P < 0.05). Immunodepletion of fkn from five RA synovial tissue homogenates inhibited their ability to induce angiogenesis in in vivo Matrigel plug assays (P < 0.05). These results establish a new function for fkn as an angiogenic mediator and suggest that it may mediate angiogenesis in RA.
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MESH Headings
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/physiopathology
- CX3C Chemokine Receptor 1
- Cell Division/drug effects
- Cells, Cultured
- Chemokine CX3CL1
- Chemokines, CX3C/pharmacology
- Chemokines, CX3C/physiology
- Chemotactic Factors/metabolism
- Chemotaxis/physiology
- Collagen/pharmacology
- Drug Combinations
- Endothelium, Vascular/cytology
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/physiology
- Humans
- Laminin/pharmacology
- Membrane Proteins/pharmacology
- Membrane Proteins/physiology
- Microcirculation
- Neovascularization, Pathologic/etiology
- Neovascularization, Pathologic/pathology
- Proteoglycans/pharmacology
- Receptors, Cytokine/metabolism
- Receptors, HIV/metabolism
- Skin/blood supply
- Synovial Fluid/drug effects
- Synovial Fluid/metabolism
- Synovial Fluid/physiology
- Synovial Membrane/physiopathology
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Affiliation(s)
- M V Volin
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
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Amin MA, Bailey BM, Patel SR. Clinical and radiological evidence to support superficial parotidectomy as the treatment of choice for chronic parotid sialadenitis: a retrospective study. Br J Oral Maxillofac Surg 2001; 39:348-52. [PMID: 11601814 DOI: 10.1054/bjom.2001.0671] [Citation(s) in RCA: 23] [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: 11/18/2022]
Abstract
We present a retrospective series of 23 consecutive parotidectomies, over a 10-year period (1989-1999) for 22 patients with chronic sialadenitis unresponsive to conservative measures. There were 10 male and 12 female patients. Mean age was 52 years (range 12-72), and mean duration of symptoms 4.5 years (range 8 months-30 years). All patients had preoperative sialography and 2 had computed tomography to exclude a neoplasm. A complete superficial parotidectomy with preservation of the main duct was done in all cases. Fifteen patients developed temporary facial nerve weakness postoperatively and 7 developed Frey's syndrome. There were no cases of permanent facial nerve palsy. Nineteen patients reported complete resolution of their symptoms and 3 patients had mild persisting symptoms that did not necessitate any further treatment. Histologically there was evidence of sialadenosis in one case and benign lymphoepithelial lesion in another; the others showed evidence of chronic sialadenitis of varying degrees of severity. Fifteen patients had postoperative sialograms, of which 11 showed evidence of some filling of residual parotid gland parenchyma and in 8 patients there was filling of a normal-looking accessory lobe. In this series, superficial parotidectomy with preservation of the main duct was safe and effective, with minimal long-term complications, for most patients with chronic parotid sialadenitis that was unresponsive to conservative measures and, in some patients, it allowed some preservation of function. The potential damage to the facial nerve and the cosmetic problems associated with a total or near-total parotidectomy were avoided.
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Affiliation(s)
- M A Amin
- SW London Maxillofacial Service, Queen Mary's University Hospital, Roehampton, London, UK
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38
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Abstract
Angiogenesis, or new blood vessel growth, is a key process in the development of synovial inflammation in rheumatoid arthritis (RA). Integral to this pathologic proliferation are proinflammatory cytokines. We hypothesized a role for IL-18 as an angiogenic mediator in RA. We examined the effect of human IL-18 on human microvascular endothelial cell (HMVEC) migration. IL-18 induced HMVEC migration at 1 nM (p < 0.05). RA synovial fluids potently induced endothelial cell migration, but IL-18 immunodepletion resulted in a 68 +/- 5% decrease in HMVEC migration (p < 0.05). IL-18 appears to act on HMVECs via alpha(v)beta(3) integrin. To test whether IL-18 induced endothelial cell tube formation in vitro, we quantitated the degree of tube formation on Matrigel matrix. IL-18, 1 or 10 nM, resulted in a 77% or 87% increase in tube formation compared with control (p < 0.05). To determine whether IL-18 may be angiogenic in vivo, we implanted IL-18 in Matrigel plugs in mice, and IL-18 at 1 and 10 nM induced angiogenesis (p < 0.05). The angiogenesis observed appears to be independent of the contribution of local TNF-alpha, as evidenced by adding neutralizing anti-TNF-alpha Ab to the Matrigel plugs. In an alternative in vivo model, sponges embedded with IL-18 or control were implanted into mice. IL-18 (10 nM) induced a 4-fold increase in angiogenesis vs the control (p < 0.05). These findings support a novel function for IL-18 as an angiogenic factor in RA and may elucidate a potential therapeutic target for angiogenesis-directed diseases.
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Affiliation(s)
- C C Park
- Department of Medicine, Northwestern University Medical School, 303 East Chicago Avenue, Chicago, IL 60611, USA
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Amin MA, Khan MZ, Khan MA, Tariq NA. Diagnosis of deep vein thrombosis in the leg by using colour coded duplex sonography. J Ayub Med Coll Abbottabad 2001; 13:22-3. [PMID: 11873393] [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: 02/23/2023]
Abstract
BACKGROUND Deep Vein Thrombosis (DVT) is regarded rare [not readable: see text] Asia. There is no documentation of the incidence of DVT in Pakistan. Clinical diagnosis of Deep Vein Thrombosis is inaccurate. Venography is the most reliable method of diagnosis, but it has several disadvantages. Many non-invasive diagnostic methods have therefore been developed in the past decade. Of these only duplex sonography has comparable accuracy. METHODS We studied 100 cases of suspected DVT by using colour coded duplex sonography. We report the results of a prospective study in patients with suspected deep vein thrombosis evaluated by both colour coded Doppler sonography and venography. CONCLUSION We conclude that colour coded duplex sonography is a highly accurate, simple, non-invasive method for detecting femoropopliteal thrombosis. Additional venography is not necessary. Its value in diagnosing isolated calf vein thrombosis remains to be established.
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Affiliation(s)
- M A Amin
- Department of Surgery, Unit-II, Nishtar Hospital, Multan
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Amin MA, Khan MA, Ayub M, Mahmood M, Ashraf M, Choudhry AR. Delay in the diagnosis and prognosis of caecal carcinoma--a study of 20 cases. J Ayub Med Coll Abbottabad 2001; 13:28-31. [PMID: 11732217] [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: 02/22/2023]
Abstract
BACKGROUND Caecum is the dilated part of the right colon situated in the right iliac fossa, therefore the etiology of this cancer is similar to those of the rest of the colon. Caecal carcinoma is more common in developed countries but it is not a rare disease in underdeveloped countries. This is more common in high socio-economic people who use less fibrous and purified diet. With improvement in health education and social status of the people of Pakistan, there is an emerging trend of Westernization in our society. This may increase the incidence of cancer in Pakistan. Carcinoma of caecum is curable disease is diagnosed early and treated. If we are aware of the pathogenesis, etiology, clinical presentation and management of the disease, we can offer a lot to these patients by diagnosing the caecal carcinoma at an earlier stage, this was the aim of this study. METHODS 20 cases (15 males and 5 females) of Carcinoma of Caecum were studied from January 1997 to December 1999. Out of these six patients presented in emergency ward, 2 as acute appendicitis and 4 as intestinal obstruction. After routine non-specific investigations, our specific investigations included USG abdomen, barium contrast studies and colonoscopy, Barium study and USG remained of primary importance. RESULTS Most of the patients were between age 45-65 years, oldest patient being 80 years old and the youngest was of only 30 years. Most of the patients presented as mass in the right iliac fossa and only some patients as intestinal obstruction. Right hemicolectomy with primary ileo-transverse anastomosis was our standard surgical procedure and was done in about 14 cases. But in some cases ileo-transverse by-pass operation was done as the growth was locally advanced. However, only the omental biopsy was taken in the cases where carcinoma was too advanced. CONCLUSIONS We think that our sociodemographic factors put a hindrance in detection of this carcinoma at early stages and therefore curative procedures are difficult to bear good results.
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Affiliation(s)
- M A Amin
- Department of Surgery, Unit-II, Nishtar Hospital, Multan
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Woods JM, Katschke KJ, Volin MV, Ruth JH, Woodruff DC, Amin MA, Connors MA, Kurata H, Arai K, Haines GK, Kumar P, Koch AE. IL-4 adenoviral gene therapy reduces inflammation, proinflammatory cytokines, vascularization, and bony destruction in rat adjuvant-induced arthritis. J Immunol 2001; 166:1214-22. [PMID: 11145704 DOI: 10.4049/jimmunol.166.2.1214] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
IL-4 is a cytokine with anti-inflammatory properties on activated macrophages. Rheumatoid arthritis, an autoimmune inflammatory disease, is characterized by a paucity of IL-4 and an abundance of synovial macrophage-derived mediators. Herein, the effect of a single injection of adenovirus-producing rat IL-4 (AxCAIL-4) or a control virus with no inserted gene was compared with the effect of PBS injection into rat ankles. Ankles were injected before arthritis onset or at maximal inflammation. Preventatively, AxCAIL-4 reduced adjuvant-induced arthritis (AIA)- and/or AIA/adenoviral-induced ankle inflammation, decreasing articular index scores, ankle circumferences, paw volumes, radiographic scores, mean levels of monocyte chemoattractant protein-1, the number of inflammatory cells, and the number of synovial blood vessels. Therapeutically, AxCAIL-4 also decreased ankle circumferences and paw volumes in comparison with a control virus with no inserted gene and PBS groups. After arthritis onset, mean levels of TNF-alpha, IL-1beta, macrophage inflammatory protein-2, and RANTES were decreased in AxCAIL-4 rat ankle homogenates compared with PBS-treated homogenates. Thus, increased expression of IL-4 via gene therapy administered in a preventative and/or therapeutic manner reduced joint inflammation, synovial cellularity, levels of proinflammatory cytokines, vascularization, and bony destruction in rat AIA, suggesting that a similar treatment in humans may be beneficial.
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MESH Headings
- Adenoviruses, Human/genetics
- Adenoviruses, Human/immunology
- Animals
- Arthritis, Experimental/immunology
- Arthritis, Experimental/pathology
- Arthritis, Experimental/physiopathology
- Arthritis, Experimental/prevention & control
- Bone Resorption/immunology
- Bone Resorption/pathology
- Bone Resorption/physiopathology
- Bone Resorption/prevention & control
- Chickens
- Cytokines/antagonists & inhibitors
- Dose-Response Relationship, Immunologic
- Female
- Genetic Therapy/methods
- Genetic Vectors/administration & dosage
- Genetic Vectors/immunology
- Hindlimb
- Humans
- Inflammation Mediators/antagonists & inhibitors
- Injections, Intra-Articular
- Interleukin-4/biosynthesis
- Interleukin-4/genetics
- Mutagenesis, Insertional/methods
- Neovascularization, Pathologic/immunology
- Neovascularization, Pathologic/pathology
- Neovascularization, Pathologic/physiopathology
- Neovascularization, Pathologic/prevention & control
- Rats
- Rats, Inbred Lew
- Viral Plaque Assay/methods
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Affiliation(s)
- J M Woods
- Departments of. Medicine and Pathology, Northwestern University Medical School, Chicago, IL 60611, USA
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Volin MV, Harlow LA, Woods JM, Campbell PL, Amin MA, Tokuhira M, Koch AE. Treatment with sulfasalazine or sulfapyridine, but not 5-aminosalicyclic acid, inhibits basic fibroblast growth factor-induced endothelial cell chemotaxis. Arthritis Rheum 1999; 42:1927-35. [PMID: 10513809 DOI: 10.1002/1529-0131(199909)42:9<1927::aid-anr19>3.0.co;2-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is characterized by leukocyte recruitment and angiogenesis. We investigated the effects of sulfasalazine (SSZ) and its metabolites, sulfapyridine (SP) and 5-aminosalicylic acid (5-ASA), on components of angiogenesis, namely, endothelial cell (EC) chemotaxis and proliferation, as well as on EC chemokine and soluble adhesion molecule expression. METHODS SSZ, SP, and 5-ASA were assayed for their effects on basic fibroblast growth factor (bFGF)-induced human dermal microvascular endothelial cell (HMVEC) chemotaxis and proliferation. EC were plated on Matrigel to assess the effect of SSZ on EC tube formation. Enzyme-linked immunosorbent assays were performed to determine changes in HMVEC production of interleukin-8 (IL-8), monocyte chemoattractant protein-1 (MCP-1), growth-related oncogene alpha (GROalpha), epithelial neutrophil-activating peptide 78 (ENA-78), soluble E-selectin (sE-selectin), and soluble intercellular adhesion molecule 1 (sICAM-1) upon treatment with SSZ or its metabolites. RESULTS HMVEC incubated with SSZ or SP exhibited reduced bFGF-induced chemotaxis (59%, [n = 7] and 22%, [n = 3], respectively) (P<0.05). SSZ and SP decreased basal HMVEC proliferation, while 5-ASA increased proliferation (P<0.05; [n = 5]). SSZ decreased bFGF-induced HMVEC proliferation (P<0.05 [n = 5]). SSZ inhibited phorbol 12-myristate 13-acetate-induced HMVEC tube formation (P<0.05; [minimum n = 5]). Tumor necrosis factor alpha-stimulated HMVEC shedding of sICAM-1 was reduced by incubation with either SSZ (19%) or 5-ASA (23%) (P<0.05; [n = 6]). SP inhibited cytokine-stimulated HMVEC expression of IL-8 and MCP-1 (P<0.05; [n = 4]). Neither SSZ nor its metabolites had any effect on HMVEC production of sE-selectin, GROalpha, or ENA-78. CONCLUSION These results demonstrate that SSZ and its metabolite SP may affect the pathogenesis of RA by inhibiting EC chemotaxis, proliferation, tube formation, and expression of sICAM-1, IL-8, and MCP-1.
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Affiliation(s)
- M V Volin
- Department of Medicine, Northwestern University Medical School, Chicago, Illinois 60611, USA
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Ageel AR, Amin MA. Integration of schistosomiasis-control activities into the primary-health-care system in the Gizan region, Saudi Arabia. Ann Trop Med Parasitol 1997; 91:907-15. [PMID: 9579210 DOI: 10.1080/00034989760293] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A few decades ago, the prevalence of Schistosoma haematobium infection in the human inhabitants of the Gizan region of Saudi Arabia was very high (43%-91%). A vertical programme for the control of the disease, by case finding, treatment of infected individuals and by chemical snail control, was begun in 1974 and led to significant reductions in prevalence in most areas. In 1989 the control activities were gradually integrated into the primary-health-care (PHC) system. Several schools in the area recently participated in the detection of ova (among schoolchildren and neighbouring communities) and organized health-education sessions. The records taken during the vertical and PHC programmes indicate that there were more diagnoses and higher chemotherapy coverage in the latter. The PHC programme has maintained the overall prevalence of infection at an extremely low level (< 1%) and the infection has been completely eradicated in several areas. The participation of schools proved to be particularly useful in terms of population coverage and health education.
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Fahim FA, Esmat AY, Mady EA, Amin MA. Serum LDH and ALP isozyme activities in mice bearing solid Ehrlich carcinoma and/or treated with the maximum tolerated dose (MTD) of aloin. Dis Markers 1997; 13:183-93. [PMID: 9405931] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Determination of total LDH and ALP activities and their isozyme patterns in the sera of normal and tumour-bearing animals treated with aloin, a natural anthraquinone with potential antitumour activity, was carried out at 3, 6 and 9 weeks of treatment. Treatment of normal mice with the MTD of aloin (50 mg/Kg b.w.) showed non-significant changes in serum total LDH and ALP activities along with their isozymes throughout the experimental periods. In untreated tumour-bearing animals, serum LDH activity and its isozymes: LDH1-LDH5 showed highly significant increases (192, 32.4, 25.2, 24.7, 29.2 and 30.6%, respectively) after 3 weeks. Highly significant inhibition was recorded in serum total ALP activity and its intestinal and bone isozymes (64, 100 and 56%, respectively), while liver ALP isozyme was increased by 82.3%. Treatment of tumour-bearing mice with the MTD of aloin manifested a significant gradual improvement in both enzyme activities and their isozymes, which were normalized at the end of the experiment (9 weeks), with the exception of intestinal ALP isozyme. All results were reported in comparison to the normal control group.
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Affiliation(s)
- F A Fahim
- Dept. of Biochemistry, Faculty of Science, Ain Shams University, Cairo, Egypt
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Nelson RC, Amin MA. Falls in the elderly. Emerg Med Clin North Am 1990; 8:309-24. [PMID: 2187685] [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: 12/30/2022]
Abstract
Finally, we conclude with a reminder that the causes of falls in the elderly are multifactorial and that some of these factors may be summative. Most falls result from interaction of intrinsic and extrinsic (environmental) factors. In the Emergency Department, it is very important to take a detailed history of the circumstances leading to the fall and to perform a thorough physical examination. Every attempt should be made to identify predisposing factors for the fall and for preventive measures to be initiated. These may include geriatric consultation or a home visit to evaluate home environment. There is a great need for additional research in this field. Falls are one of the syndromes common in the elderly that deserve more careful attention and are considered amenable to both primary and secondary prevention measures.
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Affiliation(s)
- R C Nelson
- Western Pennsylvania Hospital, Pittsburgh
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Ghally SE, Serag el-Din OS, Amin MA. Effects of the parasitic nematodes on total proteins and total lipids of Ceratitis capitata Wied (Diptera, Trypetidae). J Egypt Soc Parasitol 1988; 18:619-27. [PMID: 3418160] [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: 01/05/2023]
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Rengaraju S, Narayanan S, Ganju PL, Amin MA, Iyengar MR, Gomi S, Itoh J, Miyadoh S, Shomura T, Sezaki M. 3-N-methylparomomycin I produced by a Streptomyces. J Antibiot (Tokyo) 1986; 39:1598-601. [PMID: 3793628 DOI: 10.7164/antibiotics.39.1598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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49
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Karoum KO, Amin MA. Domestic and wild animals naturally infected with Schistosoma mansoni in the Gezira Irrigated Scheme, Sudan. J Trop Med Hyg 1985; 88:83-9. [PMID: 4032533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Domestic and wild animals were examined for natural infection with human schistosomiasis in Northern Gezira, Sudan. Postmortem examination of animals in a number of slaughterhouses revealed no infections in either sheep or goats but Schistosoma mansoni worms were found in two of the 98 cattle examined. Nile rats (Arvicanthus niloticus) were trapped and stray dogs were shot and examined for evidence of schistosome infection. The infection rate in Nile rats was 4.9% (8/164) and in dogs 27.3% (15/55) but whereas viable eggs were found in the excreta and tissues of the rats no eggs could be found in dog faeces. In the laboratory nine puppies were each exposed to 10 000 cercariae but there was no evidence that the infection had taken. It is concluded that A. niloticus, present in large numbers and often found in or near the canals, may be involved in S. mansoni transmission and could act as reservoir hosts, but that dogs are probably infected only in exceptional situations and are unlikely to play a major role in S. mansoni transmission.
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50
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Abstract
The use of nail varnish to mark snails for release and recapture in aquatic habitats in the Gezira Irrigation Canals has been evaluated. The nail varnish withstood immersion in canal water and adhered to the snail shell. The recovery of marked snails from a backwater site in a slow moving canal was satisfactory and indicated the usefulness of the technique in predicting changing patterns of immigration and emigration of snails. The method may also indicate ecological changes which affect the stability and mobility of snail populations and yield data on growth rates and longevity.
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