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Westcott MM, Morse AE, Troy G, Blevins M, Wierzba T, Sanders JW. Photochemical inactivation as an alternative method to produce a whole-cell vaccine for uropathogenic Escherichia coli (UPEC). Microbiol Spectr 2024; 12:e0366123. [PMID: 38315025 PMCID: PMC10913755 DOI: 10.1128/spectrum.03661-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
Uropathogenic Escherichia coli (UPEC) is the primary causative agent of lower urinary tract infection (UTI). UTI presents a serious health risk and has considerable secondary implications including economic burden, recurring episodes, and overuse of antibiotics. A safe and effective vaccine would address this widespread health problem and emerging antibiotic resistance. Killed, whole-cell vaccines have shown limited efficacy to prevent recurrent UTI in human trials. We explored photochemical inactivation with psoralen drugs and UVA light (PUVA), which crosslinks nucleic acid, as an alternative to protein-damaging methods of inactivation to improve whole-cell UTI vaccines. Exposure of UPEC to the psoralen drug AMT and UVA light resulted in a killed but metabolically active (KBMA) state, as reported previously for other PUVA-inactivated bacteria. The immunogenicity of PUVA-UPEC as compared to formalin-inactivated UPEC was compared in mice. Both generated high UPEC-specific serum IgG titers after intramuscular delivery. However, using functional adherence as a measure of surface protein integrity, we found differences in the properties of PUVA- and formalin-inactivated UPEC. Adhesion mediated by Type-1 and P-fimbriae was severely compromised by formalin but was unaffected by PUVA, indicating that PUVA preserved the functional conformation of fimbrial proteins, which are targets of protective immune responses. In vitro assays indicated that although they retained metabolic activity, PUVA-UPEC lost virulence properties that could negatively impact vaccine safety. Our results imply the potential for PUVA to improve killed, whole-cell UTI vaccines by generating bacteria that more closely resemble their live, infectious counterparts relative to vaccines generated with protein-damaging methods. IMPORTANCE Lower urinary tract infection (UTI), caused primarily by uropathogenic Escherichia coli, represents a significant health burden, accounting for 7 million primary care and 1 million emergency room visits annually in the United States. Women and the elderly are especially susceptible and recurrent infection (rUTI) is common in those populations. Lower UTI can lead to life-threatening systemic infection. UTI burden is manifested by healthcare dollars spent (1.5 billion annually), quality of life impact, and resistant strains emerging from antibiotic overuse. A safe and effective vaccine to prevent rUTI would address a substantial healthcare issue. Vaccines comprised of inactivated uropathogenic bacteria have yielded encouraging results in clinical trials but improvements that enhance vaccine performance are needed. To that end, we focused on inactivation methodology and provided data to support photochemical inactivation, which targets nucleic acid, as a promising alternative to conventional protein-damaging inactivation methods to improve whole-cell UTI vaccines.
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Affiliation(s)
- Marlena M. Westcott
- Department of Microbiology and Immunology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Alexis E. Morse
- Department of Microbiology and Immunology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Gavin Troy
- Department of Microbiology and Immunology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Maria Blevins
- Department of Internal Medicine, Infectious Diseases Section, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Thomas Wierzba
- Department of Internal Medicine, Infectious Diseases Section, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - John W. Sanders
- Department of Internal Medicine, Infectious Diseases Section, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
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Westcott MM, Blevins M, Wierzba TF, Morse AE, White KR, Sanders LA, Sanders JW. The Immunogenicity and Properties of a Whole-Cell ETEC Vaccine Inactivated with Psoralen and UVA Light in Comparison to Formalin. Microorganisms 2023; 11:2040. [PMID: 37630600 PMCID: PMC10458022 DOI: 10.3390/microorganisms11082040] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
Inactivated whole-cell vaccines present a full repertoire of antigens to the immune system. Formalin treatment, a standard method for microbial inactivation, can modify or destroy protein antigenic epitopes. We tested the hypothesis that photochemical inactivation with psoralen and UVA light (PUVA), which targets nucleic acid, would improve the immunogenicity of an Enterotoxigenic E. coli (ETEC) vaccine relative to a formalin-inactivated counterpart. Exposure of ETEC H10407 to PUVA using the psoralen drug 4'-Aminomethyltrioxsalen hydrochloride (AMT) yielded replication-incompetent bacteria that retained their metabolic activity. CFA/I-mediated mannose-resistant hemagglutination (MRHA) was equivalent for PUVA-inactivated and live ETEC, but was severely reduced for formalin-ETEC, indicating that PUVA preserved fimbrial protein functional integrity. The immunogenicity of PUVA-ETEC and formalin-ETEC was compared in mice ± double mutant heat-labile enterotoxin (dmLT) adjuvant. Two weeks after an intramuscular prime/boost, serum anti-ETEC IgG titers were similar for the two vaccines and were increased by dmLT. However, the IgG responses raised against several conserved ETEC proteins were greater after vaccination with PUVA-ETEC. In addition, PUVA-ETEC generated IgG specific for heat-labile toxin (LT) in the absence of dmLT, which was not a property of formalin-ETEC. These data are consistent with PUVA preserving ETEC protein antigens in their native-like form and justify the further testing of PUVA as a vaccine platform for ETEC using murine challenge models.
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Affiliation(s)
- Marlena M. Westcott
- Department of Microbiology and Immunology, Wake Forest University School of Medicine, 575 Patterson Ave, Winston Salem, NC 27101, USA; (A.E.M.); (K.R.W.)
| | - Maria Blevins
- Infectious Diseases Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA; (M.B.); (T.F.W.); (L.A.S.); (J.W.S.)
| | - Thomas F. Wierzba
- Infectious Diseases Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA; (M.B.); (T.F.W.); (L.A.S.); (J.W.S.)
| | - Alexis E. Morse
- Department of Microbiology and Immunology, Wake Forest University School of Medicine, 575 Patterson Ave, Winston Salem, NC 27101, USA; (A.E.M.); (K.R.W.)
| | - Kinnede R. White
- Department of Microbiology and Immunology, Wake Forest University School of Medicine, 575 Patterson Ave, Winston Salem, NC 27101, USA; (A.E.M.); (K.R.W.)
| | - Leigh Ann Sanders
- Infectious Diseases Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA; (M.B.); (T.F.W.); (L.A.S.); (J.W.S.)
| | - John W. Sanders
- Infectious Diseases Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA; (M.B.); (T.F.W.); (L.A.S.); (J.W.S.)
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El Helou G, Goodman JF, Blevins M, Caudell DL, Ponzio TA, Sanders JW. Retrograde Parotid Gland Infusion through Stensen's Duct in a Non-Human Primate for Vectored Gene Delivery. J Vis Exp 2021. [PMID: 34459821 DOI: 10.3791/62645] [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: 10/31/2022] Open
Abstract
Salivary glands are an attractive tissue target for gene therapy with promising results already leading to human trials. They are inherently capable of secreting proteins into the bloodstream and are easily accessible, making them potentially superior tissue sites for replacement hormone production or vaccination by gene transfer. Suggested methods for gene delivery include transcutaneous injection and retrograde infusion through salivary ducts. We demonstrate how to perform Retrograde Salivary Gland Infusion (RSGI) in non-human primates. We describe the important anatomic landmarks including identification of the parotid papilla, an atraumatic method of cannulating and sealing Stensen's Duct utilizing basic dental tools, polyethylene tubing, and cyanoacrylate, and the appropriate rate of infusion. While this is the least traumatic method of delivery, the method is still limited by the volume able to be delivered (<0.5 mL) and the potential for trauma to the duct and gland. We demonstrate using fluoroscopy that an infusate can be fully delivered into the gland, and further demonstrate by immunohistochemistry the transduction of a typical vector and expression of the delivered gene.
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Affiliation(s)
- Guy El Helou
- Department of Medicine, Division of Infectious Diseases and Global Medicine, University of Florida;
| | - Joseph F Goodman
- Department of Otolaryngology, George Washington University School of Medicine
| | - Maria Blevins
- Department of Medicine, Section on Infectious Diseases, Wake Forest Baptist Medical Center
| | | | - Todd A Ponzio
- Department of Medicine, Section on Infectious Diseases, Wake Forest Baptist Medical Center
| | - John W Sanders
- Department of Medicine, Section on Infectious Diseases, Wake Forest Baptist Medical Center; Department of Medicine, Section of Infectious Diseases, Hefner Veterans Affairs Medical Center
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El Helou G, Ponzio TA, Goodman JF, Blevins M, Caudell DL, Raviprakash KS, Ewing D, Williams M, Porter KR, Sanders JW. Tetravalent dengue DNA vaccine is not immunogenic when delivered by retrograde infusion into salivary glands. Trop Dis Travel Med Vaccines 2020; 6:10. [PMID: 32518668 PMCID: PMC7268334 DOI: 10.1186/s40794-020-00111-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/25/2020] [Indexed: 11/10/2022]
Abstract
Introduction and background A tetravalent DNA vaccine for Dengue virus is under development but has not yet achieved optimal immunogenicity. Salivary glands vaccination has been reported efficacious in rodents and dogs. We report on a pilot study testing the salivary gland as a platform for a Dengue DNA vaccine in a non-human primate model. Materials and methods Four cynomolgus macaques were used in this study. Each macaque was pre-medicated with atropine and sedated with ketamine. Stensen’s duct papilla was cannulated with a P10 polyethylene tube, linked to a 500ul syringe. On the first two infusions, all macaques were infused with 300ul of TVDV mixed with 2 mg of zinc. For the 3rd infusion, to increase transfection into salivary tissue, two animals received 100uL TVDV mixed with 400uL polyethylenimine 1μg/ml (PEI) and the other two animals received 500uL TVDV with zinc. Antibody titers were assessed 4 weeks following the second and third infusion. Results and conclusions SGRI through Stensen’s duct is a well-tolerated, simple and easy to reproduce procedure. TVDV infused into macaques salivary glands elicited a significantly weaker antibody response than with different delivery methods.
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Affiliation(s)
- Guy El Helou
- Department of Medicine, Division of Infectious Diseases and Global Medicine, University of Florida, Gainesville, FL USA
| | - Todd A Ponzio
- Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Joseph F Goodman
- Department of Otolaryngology, George Washington School of Medicine and Health Sciences, Washington, DC 20037 USA
| | - Maria Blevins
- Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - David L Caudell
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, NC USA
| | | | - Daniel Ewing
- Naval Medical Research Center, Silver Spring, MD USA
| | - Maya Williams
- Naval Medical Research Center, Silver Spring, MD USA
| | | | - John W Sanders
- Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC USA
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Sundaram AK, Ewing D, Blevins M, Liang Z, Sink S, Lassan J, Raviprakash K, Defang G, Williams M, Porter KR, Sanders JW. Comparison of purified psoralen-inactivated and formalin-inactivated dengue vaccines in mice and nonhuman primates. Vaccine 2020; 38:3313-3320. [PMID: 32184032 DOI: 10.1016/j.vaccine.2020.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 02/06/2023]
Abstract
Dengue fever, caused by dengue viruses (DENV 1-4) is a leading cause of illness and death in the tropics and subtropics. Therefore, an effective vaccine is urgently needed. Currently, the only available licensed dengue vaccine is a chimeric live attenuated vaccine that shows varying efficacy depending on serotype, age and baseline DENV serostatus. Accordingly, a dengue vaccine that is effective in seronegative adults, children of all ages and in immunocompromised individuals is still needed. We are currently researching the use of psoralen to develop an inactivated tetravalent dengue vaccine. Unlike traditional formalin inactivation, psoralen inactivates pathogens at the nucleic acid level, potentially preserving envelope protein epitopes important for protective anti-dengue immune responses. We prepared highly purified monovalent vaccine lots of formalin- and psoralen-inactivated DENV 1-4, using Capto DeVirS and Capto Core 700 resin based column chromatography. Tetravalent psoralen-inactivated vaccines (PsIV) and formalin-inactivated vaccines (FIV) were prepared by combining the four monovalent vaccines. Mice were immunized with either a low or high dose of PsIV or FIV to evaluate the immunogenicity of monovalent as well as tetravalent formulations of each inactivation method. In general, the monovalent and tetravalent PsIVs elicited equivalent or higher titers of neutralizing antibodies to DENV than the FIV dengue vaccines and this response was dose dependent. The immunogenicity of tetravalent dengue PsIVs and FIVs were also evaluated in nonhuman primates (NHPs). Consistent with what was observed in mice, significantly higher neutralizing antibody titers for each dengue serotype were observed in the NHPs vaccinated with the tetravalent dengue PsIV compared to those vaccinated with the tetravalent dengue FIV, indicative of the importance of envelope protein epitope preservation during psoralen inactivation of DENV.
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Affiliation(s)
- Appavu K Sundaram
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Bethesda, MD 20817, USA.
| | - Daniel Ewing
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Maria Blevins
- Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Zhaodong Liang
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Bethesda, MD 20817, USA
| | - Sandy Sink
- Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Josef Lassan
- Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Kanakatte Raviprakash
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Gabriel Defang
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Maya Williams
- Infectious Diseases Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Kevin R Porter
- Infectious Diseases Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - John W Sanders
- Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
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Ladanyi C, Sticco PL, Blevins M, Boyd S, Gutmann D, Holcombe J, Mohling S. Increased Same Day Discharge Rate After Laparoscopic Guided 4-Point Transversus Abdominis Plane Block for Robotic Assisted Gynecologic Procedures. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.061] [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: 11/29/2022]
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7
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Mohling S, Blevins M. Robotic Myomectomy of a 600 Gram Fibroid. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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8
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Radtke S, Blevins M, Mashak Z, Holcombe J, Boren T, DePasquale S. Para-Cervical Block Prior to Laparoscopic Hysterectomy as an Adjuvant Strategy to Reduce Postoperative Pain: A Randomized Controlled Trial. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Radtke S, Blevins M, Furr R. Robotically Assisted Laparoscopic Resection of Retroperitoneal Endometrioma with Ureteral Involvement. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Bischoff W, Turner J, Russell GB, Blevins M, Stehle J. Evaluation of a Novel Powered Air-purifying respirator (PAPR) vs. a N95 Respirator Mask for the Protection Against Influenza in a Human Exposure Model. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Heimburger D, Blevins M, Carothers CL, Warner T, Vermund S. Outcomes of the NIH fogarty international clinical research program:
Early alumni publications. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Silvestri D, Blevins M, Afzal A, Andrews B, Derbew M, Kaur S, Mipando M, Mkony C, Mwachaka P, Ranjit N, Vermund S. Medical and nursing students' intentions to work abroad or in rural
areas: An eight-country cross-sectional survey in Asia and Africa. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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13
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Stehle J, Blevins M, Turner J, Pajewski N, Bischoff W. 1375Reduction of Bacterial Air Burden During Routine Patient Care by a Novel Mobile Air Purification System (PhotoxAir). Open Forum Infect Dis 2014. [DOI: 10.1093/ofid/ofu052.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John Stehle
- Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Maria Blevins
- Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jolyn Turner
- Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Nicholas Pajewski
- Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Werner Bischoff
- Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC
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14
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Stehle J, Mcnall R, Blevins M, Turner J, Rota P, Bischoff W. 1221Air and Surface Burden of Measles Virus in a Hospital Setting. Open Forum Infect Dis 2014. [PMCID: PMC5781480 DOI: 10.1093/ofid/ofu051.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- John Stehle
- Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Rebecca Mcnall
- Measles, Mumps, Rubella and Herpesviruses Laboratory Branch Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Maria Blevins
- Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jolyn Turner
- Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Paul Rota
- Measles, Mumps, Rubella and Herpesviruses Laboratory Branch Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Werner Bischoff
- Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC
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15
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Blevins M, Smart A, Warner T, Carothers CL, Vermund S, Heimburger D. Outcomes and collaborations among alumni of the NIH Fogarty International
Clinical Research Program: Results from a 2013 impact evaluation. Ann Glob Health 2014. [DOI: 10.1016/j.aogh.2014.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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16
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Strowd RE, Swett K, Harmon M, Carter AF, Pop-Vicas A, Chan M, Tatter SB, Ellis T, Blevins M, High K, Lesser GJ. Influenza vaccine immunogenicity in patients with primary central nervous system malignancy. Neuro Oncol 2014; 16:1639-44. [PMID: 24714522 DOI: 10.1093/neuonc/nou051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with central nervous system (CNS) malignancies represent an "at-risk" population for contracting influenza, particularly if they are receiving ongoing chemotherapy, radiation, and/or glucocorticoid treatment. The Centers for Disease Control endorses vaccination for these patients, although data are not available to indicate whether they mount an immunologic response adequate to achieve clinical protection. METHODS A pilot prospective cohort study was designed to evaluate the immunogenicity of the standard-dose trivalent inactivated influenza vaccine in patients with malignant CNS tumors. Baseline data collection included diagnosis, chemotherapy, timing of chemotherapy or radiation relative to vaccination, and glucocorticoid dose. Serum samples were collected at baseline, day 14, day 28, and month 3 following vaccination. Samples were tested using hemagglutinin inhibition to determine seroconversion (4-fold rise in titer) and seroprotection (titer >1:40). RESULTS A total of 38 patients were enrolled (mean age, 54 years ±13.5 years, 60.5% male, 94.7% Caucasian, and 5.3% African American). CNS tumor diagnoses included glioblastoma multiforme (55.2%), other high-grade glioma (13.2%), low-grade glioma (15.8%), and primary CNS lymphoma (15.8%). At enrollment, 20 patients (52.6%) were taking glucocorticoids, 25 (65.8%) were on active chemotherapy, and 3 (7.9%) were undergoing radiation. Seroconversion rates at day 28 for the A/H1N1, A/H3N2, and B strains were 37%, 23% and 23%, respectively. Seroprotection was 80%, 69%, and 74%, respectively. All rates were significantly lower than published rates in healthy adults (P < .001). CONCLUSION Influenza vaccine immunogenicity is significantly reduced in patients with CNS malignancies. Future studies are needed to determine the causative etiologies and appropriate vaccination strategies.
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Affiliation(s)
- Roy E Strowd
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina (R.E.S.); Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, Winston-Salem, North Carolina (K.S.); Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.H., A.F.C., G.J.L.); Division of Infectious Disease, Alpert Medical School at Brown University, Providence, Rhode Island (A.P.); Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.C.); Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.T.); Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.B., K.H.)
| | - Katrina Swett
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina (R.E.S.); Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, Winston-Salem, North Carolina (K.S.); Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.H., A.F.C., G.J.L.); Division of Infectious Disease, Alpert Medical School at Brown University, Providence, Rhode Island (A.P.); Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.C.); Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.T.); Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.B., K.H.)
| | - Michele Harmon
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina (R.E.S.); Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, Winston-Salem, North Carolina (K.S.); Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.H., A.F.C., G.J.L.); Division of Infectious Disease, Alpert Medical School at Brown University, Providence, Rhode Island (A.P.); Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.C.); Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.T.); Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.B., K.H.)
| | - Annette F Carter
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina (R.E.S.); Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, Winston-Salem, North Carolina (K.S.); Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.H., A.F.C., G.J.L.); Division of Infectious Disease, Alpert Medical School at Brown University, Providence, Rhode Island (A.P.); Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.C.); Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.T.); Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.B., K.H.)
| | - Aurora Pop-Vicas
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina (R.E.S.); Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, Winston-Salem, North Carolina (K.S.); Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.H., A.F.C., G.J.L.); Division of Infectious Disease, Alpert Medical School at Brown University, Providence, Rhode Island (A.P.); Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.C.); Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.T.); Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.B., K.H.)
| | - Michael Chan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina (R.E.S.); Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, Winston-Salem, North Carolina (K.S.); Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.H., A.F.C., G.J.L.); Division of Infectious Disease, Alpert Medical School at Brown University, Providence, Rhode Island (A.P.); Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.C.); Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.T.); Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.B., K.H.)
| | - Stephen B Tatter
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina (R.E.S.); Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, Winston-Salem, North Carolina (K.S.); Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.H., A.F.C., G.J.L.); Division of Infectious Disease, Alpert Medical School at Brown University, Providence, Rhode Island (A.P.); Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.C.); Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.T.); Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.B., K.H.)
| | - Thomas Ellis
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina (R.E.S.); Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, Winston-Salem, North Carolina (K.S.); Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.H., A.F.C., G.J.L.); Division of Infectious Disease, Alpert Medical School at Brown University, Providence, Rhode Island (A.P.); Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.C.); Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.T.); Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.B., K.H.)
| | - Maria Blevins
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina (R.E.S.); Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, Winston-Salem, North Carolina (K.S.); Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.H., A.F.C., G.J.L.); Division of Infectious Disease, Alpert Medical School at Brown University, Providence, Rhode Island (A.P.); Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.C.); Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.T.); Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.B., K.H.)
| | - Kevin High
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina (R.E.S.); Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, Winston-Salem, North Carolina (K.S.); Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.H., A.F.C., G.J.L.); Division of Infectious Disease, Alpert Medical School at Brown University, Providence, Rhode Island (A.P.); Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.C.); Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.T.); Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.B., K.H.)
| | - Glenn J Lesser
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina (R.E.S.); Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, Winston-Salem, North Carolina (K.S.); Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.H., A.F.C., G.J.L.); Division of Infectious Disease, Alpert Medical School at Brown University, Providence, Rhode Island (A.P.); Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.C.); Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.T.); Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.B., K.H.)
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Cohen JJ, Blevins M, Mapenzi A, Reppart L, Reppart J, Mainthia R, Wester CW. Overcoming the perceived barriers to health care access among single mothers in coastal Kenya. Int J Public Health 2013; 59:189-96. [PMID: 24057600 DOI: 10.1007/s00038-013-0511-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 08/16/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES This study assesses the effects of a comprehensive empowerment intervention on barriers to health care access for single mothers in coastal Kenya. METHODS We surveyed 41 single mothers who completed a pilot empowerment program and 60 single mothers who had not yet initiated the program. Comparisons were made using bivariate tests of association and logistic regression. RESULTS Women in the pilot program were less likely to report transportation costs (OR = 0.26; 95 % CI [0.11-0.59], p = 0.001) and hospital fees (OR = 0.22 [0.10-0.49], p < 0.001) as barriers. Pilot program mothers were more likely to visit a public hospital for their children (OR = 4.38; [1.58-12.1], p = 0.004) and self (OR = 4.70; [1.54-14.4], p = 0.007) when ill. CONCLUSIONS Empowerment programs can alleviate perceived barriers to health care among vulnerable populations.
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Affiliation(s)
- J J Cohen
- Vanderbilt University School of Medicine, Nashville, TN, USA,
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Habets EJ, Taphoorn MJ, Nederend S, Klein M, Delgadillo D, Hoang-Xuan K, Bottomley A, Allgeier A, Seute T, Gijtenbeek AM, De Gans J, Enting RH, Tijssen CC, Van den Bent MJ, Reijneveld JC, Xu H, Halbert K, Bliss R, Trusheim J, Hunt MA, Bunevicius A, Tamasauskas S, Tamasauskas A, Deltuva V, Field KM, Guyatt N, Fleet M, Rosenthal MA, Drummond KJ, Field KM, Fleet M, Guyatt N, Drummond KJ, Rosenthal MA, Oliver H, Tobias M, Eva V, Matthias S, Johannes S, Oliver S, Christian TJ, Dietmar K, Gabriele S, Thomas R, Nikkhah G, Uwe S, Markus L, Michael W, Manfred W, Strowd RE, Swett K, Harmon M, Pop-Vicas A, Chan M, Tatter SB, Ellis TL, Blevins M, High K, Lesser GJ, Benouaich-Amiel A, Taillandier L, Vercueil L, Valton L, Szurhaj W, Idbaih A, Delattre JY, Loiseau H, Klein I, Block V, Ramirez C, Laigle-Donadey F, Le Rhun E, Harrison C, Van Horn A, Sapienza C, Schlimper C, Schlag H, Weber F, Acquaye AA, Gilbert MR, Armstrong TS, Acquaye AA, Vera-Bolanos E, Gilbert MR, Armstrong TS, Walbert T, Armstrong TS, Elizabeth VB, Gilbert M, Affronti ML, Woodring S, Allen K, Herndon JE, McSherry F, Peters KB, Friedman HS, Desjardins A, Freeman W, Cheshire S, Cone C, Kalinowski KH, Kim JY, Lay HH, Poillucci V, Southerland C, Tetterton J, Kirkpatrick J, Vredenburgh JJ, Affronti ML, Woodring S, Herndon JE, McSherry F, Peters KB, Friedman HS, Desjardins A, Freeman W, Cheshire S, Cone C, Kalinowski KH, Kim JY, Lay HH, Poillucci V, Southerland C, Tetterton J, Vredenburgh JJ, Edelstein K, Coate L, Mason WP, Jewitt NC, Massey C, Devins GM, Lin L, Chiang HH, Acquaye AA, Vera-Bolanos E, Cahill JE, Gilbert MR, Armstrong TS, Amidei CM, Lovely M, Page MD, Mogensen K, Arzbaecher J, Lupica K, Maher ME, Lin L, Acquaye AA, Vera-Bolanos E, Cahill JE, Gilbert MR, Armstrong TS, Duong HT, Kelly DF, Peters KB, Woodring S, Herndon JE, McSherry F, Vredenburgh JJ, Desjardins A, Friedman HS, Gning I, Armstrong TS, Wefel JS, Acquaye AA, Vera-Bolanos E, Mendoza TR, Gilbert MR, Cleeland CS, Guthikonda B, Thakur JD, Banerjee A, Shorter C, Sonig A, Khan IS, Gardner GL, Nanda A, Reddy K, Gaspar L, Kavanagh B, Waziri A, Chen C, Boele F, Hoeben W, Hilverda K, Lenting J, Calis AL, Sizoo E, Collette E, Heimans J, Postma T, Taphoorn M, Reijneveld J, Klein M. CLIN-SYMPTOM MANAGEMENT/QUALITY OF LIFE. Neuro Oncol 2012; 14:vi153-vi159. [PMCID: PMC3488794 DOI: 10.1093/neuonc/nos240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
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19
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Moon TD, Burlison JR, Blevins M, Shepherd BE, Baptista A, Sidat M, Vergara AE, Vermund SH. Enrolment and programmatic trends and predictors of antiretroviral therapy initiation from president's emergency plan for AIDS Relief (PEPFAR)-supported public HIV care and treatment sites in rural Mozambique. Int J STD AIDS 2012; 22:621-7. [PMID: 22096045 DOI: 10.1258/ijsa.2011.010442] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Many countries in sub-Saharan Africa have made antiretroviral therapy (ART) available in urban settings, but the progress of treatment expansion into rural Africa has been slower. We analysed routine data for patients enrolled in a rural HIV treatment programme in Zambézia Province, Mozambique (1 June 2006 through 30 March 2009). There were 12,218 patients who were ≥15 years old enrolled (69% women). Median age was 25 years for women and 31 years for men. Older age and higher level of education were strongly predictive of ART initiation (P < 0.001). Patients with a CD4+ count of 350 cells/μL versus 50 cells/μL were less likely to begin ART (odds ratio [OR]: 0.19, 95% confidence interval [CI]: 0.16-0.23). In rural sub-Saharan Africa, HIV testing, linkage to care, logistics for ART initiation and fears among some patients to take ART require specialized planning to maximize successes. Sustainability will require improved health manpower, infrastructure, stable funding, continuous drug supplies, patient record systems and, most importantly, community engagement.
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Affiliation(s)
- T D Moon
- Vanderbilt Institute for Global Health and Departments of Pediatrics, Biostatistics, and Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
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20
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Arteaga-Cortes L, Pasquali A, Blevins M, Jorgensen M, Leland M, Kaplan J, Rice K, Dube P, Stacy S, High K, Kraig E. Effects of aging on vaccine efficacy in nonhuman primate models (104.1). The Journal of Immunology 2011. [DOI: 10.4049/jimmunol.186.supp.104.1] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Vaccines are frequently less efficacious in the elderly and correlates of protection in older adults often differ from those seen in younger individuals. However, clinical testing of new vaccine formulations is typically limited and does not include elderly subjects. In order to identify a nonhuman primate (NHP) model that would recapitulate the effects of immunosenescence in humans, we assessed immune responses in three different NHPs: baboons (Papio), rhesus macaques (Macaca), and African green monkeys (Chlorocebus). The F1-antigen, a capsular protein encoded on the plague bacterium Y. pestis pFra plasmid, was chosen because it should elicit naive responses in all subjects. The animals were bled following primary and booster immunizations; B cell (antibody titer) and T cell parameters were assessed. As in humans, significant heterogeneity between individuals was seen. In rhesus and vervets, T cell responses to F1 were generally lower with increasing age. However, less of an age effect was observed in the baboons; this is consistent with the finding that antibody titers to F1 were not significantly diminished in older baboons and with our previous work showing immunization of old baboons with Y. pestis LcrV elicited high titer protective antibodies [JI 181:109]. Flow cytometric analyses of the T cell populations in old and young NHPs reveal differences across the species and provide additional insight into the immune parameters that correlate with healthy aging.
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Affiliation(s)
- Lourdes Arteaga-Cortes
- 1Cellular and Structural Biology, Univ of Texas Health Sci Center, San Antonio, San Antonio, TX
| | - Amanda Pasquali
- 1Cellular and Structural Biology, Univ of Texas Health Sci Center, San Antonio, San Antonio, TX
| | - Maria Blevins
- 3Wake Forest University Sch. of Med., Winston-Salem, NC
| | | | - Michelle Leland
- 1Cellular and Structural Biology, Univ of Texas Health Sci Center, San Antonio, San Antonio, TX
| | - Jay Kaplan
- 4Wake Forest University Primate Center, Winston-Salem, NC
| | - Karen Rice
- 2Southwest Fndn. for Biomed. Res., San Antonio, TX
| | - Peter Dube
- 1Cellular and Structural Biology, Univ of Texas Health Sci Center, San Antonio, San Antonio, TX
| | - Sue Stacy
- 1Cellular and Structural Biology, Univ of Texas Health Sci Center, San Antonio, San Antonio, TX
| | - Kevin High
- 3Wake Forest University Sch. of Med., Winston-Salem, NC
| | - Ellen Kraig
- 1Cellular and Structural Biology, Univ of Texas Health Sci Center, San Antonio, San Antonio, TX
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Laudenslager ML, Natvig C, Mikulich-Gilbertson SM, Blevins M, Corcoran C, Pierre PJ, Bennett AJ. Challenges to bonnet monkey (Macaca radiata) social groups: Mother-infant dyad and infant social interactions. Dev Psychobiol 2010; 52:465-74. [PMID: 20583143 PMCID: PMC4370343 DOI: 10.1002/dev.20449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/11/2022]
Abstract
The mother-infant dyad is crucial to early development in a variety of species. The complexity of social groupings in nonhuman primates makes this relationship resilient as well as susceptible to early challenges associated with environmental chaos. Quantitative behavior observations of bonnet monkey mother-infant interactions were collected from 28 mother-infant dyads between one and twelve months of age. Social groups were subjected to several prenatal and/or postnatal housing relocations within a single year resulting in two study groups. One group experienced relocations (ATYPICAL, n = 14) and the second group (TYPICAL, n = 14) was conceived and reared in the same location. Behaviors in the ethogram included mother-infant interactions and infant social interactions with other members of the group. Observations between ages of two to four months were analyzed by a mixed model analysis of variance including fixed effects of per and postnatal history (TYPICAL, ATYPICAL), age, and history by age interaction and random effects of mother and infant nested within mother. A significant effect of relocation history was noted on a number of infant behaviors. ATYPICAL infants were out of direct contact with their mother at an earlier age but remained in her proximity. Control of proximity shifted to offsrping in the ATYPICAL group compared to the TYPICAL group. Furthermore, greater social interactions between two and four months of age with other members of the social group as well as the ir mother were observed in the ATYPICAL group. It is suggested that continuous challenge associated with relocation may affect the infant at later developmental ages due to these early differences in ways that are yet unclear.
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Affiliation(s)
- Mark L Laudenslager
- Department of Psychiatry, School of Medicine, University of Colorado Denver, Denver, CO 80220, USA.
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Van den Abbeele AD, Gatsonis C, de Vries DJ, Melenevsky Y, Szot Barnes A, Yap JT, Godwin AK, Blevins M, Eisenberg B, Siegel BA. ACRIN 6665/RTOG 0132 phase II trial of neoadjuvant imatinib mesylate (IM) for primary and recurrent operable malignant GIST: Imaging findings and correlation with genotype and GLUT4 expression. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.10552] [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
10552 Background: IM has improved the treatment of GIST patients (pts), but few achieve objective response despite significant clinical benefit. Imaging of tumor metabolism may provide earlier assessment of therapeutic response. In this study, FDG-PET metabolic response (MR) was compared with RECIST, GLUT4 expression, and KIT/PDGFRA mutation status. Methods: FDG-PET was done at baseline, 1–7 days, and 4 or 8 weeks (wk) after IM initiation. Best objective response was defined by RECIST. Immunohistochemical (IHC) tumor GLUT4 expression and mutation analyses were done at baseline and/or surgery. Background-subtracted SUVmax was measured in all lesions and summed; MR based on EORTC criteria was compared to RECIST, GLUT4 expression, and KIT/PDGFRA mutation status. Results: FDG-PET showed high tumor glycolytic activity at baseline (mean SUVmax = 14.2, range: 1.3–53.2), decreasing after 1 wk of IM (5.5, range: 0.5–47.7, p < 0.001, n = 44), and again prior to surgery (3.0, range: 0.5–36.1, p < 0.001, n = 40). FDG-PET response at wk 1 was 3 complete MR (CMR), 33 partial MR (PMR), 6 stable metabolic disease (SMD), and 2 progressive metabolic disease (PMD). Prior to surgery, FDG-PET response was 3 CMR, 33 PMR, 4 SMD, and no PMD. For 39 pts, RECIST best response was 2 PR, 36 SD, and 1 PD. GLUT4 expression decreased in 19 pts with PMR, and 3 with SMD. Among 12 pts with exon 11 mutation, 11 had PMR, 1 SMD; among 5 pts with wild-type genotype, 4 had PMR, and 1 SMD. Conclusions: After IM initiation, MR by FDG-PET was documented earlier (1–7 days), and was of much greater magnitude (36/40) than that documented by RECIST (2/39). IHC data suggest that: (1) GLUT4 plays a role in FDG uptake in GIST; (2) GLUT4 decreases in most pts with PMR; and, (3) the biologic action of IM interacts with glycolysis and GLUT4 expression. No difference in PMR was seen in pts with exon 11 vs. wild type mutations. [Table: see text]
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Affiliation(s)
- A. D. Van den Abbeele
- Dana-Farber Cancer Institute, Boston, MA; Brown University, Providence, RI; Fox Chase Cancer Center, Philadelphia, PA; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mallinckrodt Institute of Radiology, St. Louis, MO
| | - C. Gatsonis
- Dana-Farber Cancer Institute, Boston, MA; Brown University, Providence, RI; Fox Chase Cancer Center, Philadelphia, PA; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mallinckrodt Institute of Radiology, St. Louis, MO
| | - D. J. de Vries
- Dana-Farber Cancer Institute, Boston, MA; Brown University, Providence, RI; Fox Chase Cancer Center, Philadelphia, PA; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mallinckrodt Institute of Radiology, St. Louis, MO
| | - Y. Melenevsky
- Dana-Farber Cancer Institute, Boston, MA; Brown University, Providence, RI; Fox Chase Cancer Center, Philadelphia, PA; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mallinckrodt Institute of Radiology, St. Louis, MO
| | - A. Szot Barnes
- Dana-Farber Cancer Institute, Boston, MA; Brown University, Providence, RI; Fox Chase Cancer Center, Philadelphia, PA; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mallinckrodt Institute of Radiology, St. Louis, MO
| | - J. T. Yap
- Dana-Farber Cancer Institute, Boston, MA; Brown University, Providence, RI; Fox Chase Cancer Center, Philadelphia, PA; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mallinckrodt Institute of Radiology, St. Louis, MO
| | - A. K. Godwin
- Dana-Farber Cancer Institute, Boston, MA; Brown University, Providence, RI; Fox Chase Cancer Center, Philadelphia, PA; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mallinckrodt Institute of Radiology, St. Louis, MO
| | - M. Blevins
- Dana-Farber Cancer Institute, Boston, MA; Brown University, Providence, RI; Fox Chase Cancer Center, Philadelphia, PA; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mallinckrodt Institute of Radiology, St. Louis, MO
| | - B. Eisenberg
- Dana-Farber Cancer Institute, Boston, MA; Brown University, Providence, RI; Fox Chase Cancer Center, Philadelphia, PA; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mallinckrodt Institute of Radiology, St. Louis, MO
| | - B. A. Siegel
- Dana-Farber Cancer Institute, Boston, MA; Brown University, Providence, RI; Fox Chase Cancer Center, Philadelphia, PA; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mallinckrodt Institute of Radiology, St. Louis, MO
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