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Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, 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D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, 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Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, 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Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Jayadas TP, Jeewandara C, Jayathilaka D, Ranasinghe D, Ariyarathne D, Wijesinghe A, Gunasinghe D, Gomes L, Madushanka D, Dissanayake O, Harvie M, Bary F, Malavige N. Feasibility and accuracy of variant PCR assays for low- and middle-income countries in SARS-CoV-2 surveillance. Int J Infect Dis 2022. [PMCID: PMC8884795 DOI: 10.1016/j.ijid.2021.12.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose Surveillance of different SARS-CoV-2 variants of concern (VOCs) is a crucial aspect in control of the pandemic. Although sequencing is the gold-standard to detect VOCs, it is labor intensive and is costly. We compared a cost-effective real-time PCR assay that detects single nucleotide polymorphisms (SNPs) of VOCs, with next generation sequencing (NGS) in surveillance of VOCs. Methods & Materials A total of 782 SARS CoV-2 PCR positive samples From May – August 2021 were screened using two variant RT-qPCR assays (Seegene Allplex™ SARS-CoV-2 Variant Assay I and II), which detects 7 SNPs in the spike protein assigning them to one of the VOCs. We compared the results of the variant RT-qPCR with Illumina (n=97) and Oxford Nanopore (n=53) platforms in a subset of samples (n=150). Sequences with > 25x coverage were used and assigned to a Pangolin lineage. Results 516 samples amplified for N501Y and HV69/70 deletion of the spike protein were assigned as alpha (B.1.1.7). Two samples with spike K417N mutation along with N501Y and E484K were considered to be beta (B.1.351) and 175 samples which are only positive for spike L452R mutation were considered to be delta (B.1.617). 120/156 samples designated as alpha, 22/175 designated as delta and 2 samples designated as beta by RT-qPCR were sequenced either by Illumina or Oxford nanopore platforms. The sequencing results showed a 100% accuracy with the variant RT-qPCR for identification of VOCs. Conclusion RT-qPCR that detected SNPs specific for VOCs, appear to be highly sensitive and specific in detection of VOCs and had a similar specificity of genomic sequencing. Therefore, this could be a rapid and less expensive method for surveillance of VOCs, in lower income countries. However, as it only detects specific SNPs, any emerging mutations of concern in these VOCs or newly emerging variants, will not be detected.
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Ramu S, Jeewandara C, Kuruppu H, Pushpakumara P, Harvie M, Dayarathna S, Jayadas T, Ranasinghe T, Aberathna I, Danasekara S, Dissanayake O, Gamalath N, Ekanayake D, Jayamali J, Guruge D, Wijayamuni R, Ogg G, Malavige N. Memory B Cell Responses at 16 Weeks Following a Single Dose of AZD1222/Covishield in Sri Lankan Individuals. Int J Infect Dis 2022. [DOI: 10.1016/j.ijid.2021.12.148] [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: 10/19/2022] Open
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Tebeje BM, Harvie M, You H, Rivera V, McManus DP. T cell-mediated immunity in CBA mice during Schistosoma japonicum infection. Exp Parasitol 2019; 204:107725. [PMID: 31306646 DOI: 10.1016/j.exppara.2019.107725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/05/2019] [Revised: 04/23/2019] [Accepted: 07/04/2019] [Indexed: 12/21/2022]
Abstract
Characterisation of the cellular immune response to schistosomiasis is well established for Schistosoma mansoni but a comprehensive description of T cell-mediated immune responses against S. japonicum infection is lacking. Accordingly, 20 CBA mice were infected with cercariae of S. japonicum and the immune response at different time points was determined. Mouse spleen and liver lymphocytes were isolated from the mice and stimulated with schistosomal adult worm antigen preparation (SWAP) and schistosomal soluble egg antigen (SEA). There was a relatively higher Th1 immune response to SWAP compared to SEA at the early phase of infection (up to week 5 post challenge). However, a Th2 immune response directed against SEA was dominant at week 6 post-infection, a time point when the highest IgG response against both SWAP and, especially, SEA was generated. The regulatory immune response was highest at the early phase of the immune response (up to week 5 post challenge) followed by a rapid decline at week 6-post infection. Before egg-laying, S. japonicum induced a regulatory T cell immune response which may limit the early Th1-mediated immune response that is believed to be protective in murine schistosomiasis. Following egg laying, the immune response was polarized to a Th2 immune response mainly directed against the eggs and this may contribute to parasite survival.
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Affiliation(s)
- Biniam Mathewos Tebeje
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 300 Herston Road, Brisbane, QLD, 4006, Australia; School of Public Health, University of Queensland, Brisbane, Australia.
| | - Marina Harvie
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 300 Herston Road, Brisbane, QLD, 4006, Australia
| | - Hong You
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 300 Herston Road, Brisbane, QLD, 4006, Australia
| | - Vanessa Rivera
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 300 Herston Road, Brisbane, QLD, 4006, Australia
| | - Donald P McManus
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 300 Herston Road, Brisbane, QLD, 4006, Australia.
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Williams GM, Li YS, Gray DJ, Zhao ZY, Harn DA, Shollenberger LM, Li SM, Yu X, Feng Z, Guo JG, Zhou J, Dong YL, Li Y, Guo B, Driguez P, Harvie M, You H, Ross AG, McManus DP. Field Testing Integrated Interventions for Schistosomiasis Elimination in the People's Republic of China: Outcomes of a Multifactorial Cluster-Randomized Controlled Trial. Front Immunol 2019; 10:645. [PMID: 31001264 PMCID: PMC6456715 DOI: 10.3389/fimmu.2019.00645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/11/2019] [Indexed: 11/13/2022] Open
Abstract
Despite significant progress, China faces the challenge of re-emerging schistosomiasis transmission in currently controlled areas due, in part, to the presence of a range of animal reservoirs, notably water buffalo and cattle, which can harbor Schistosoma japonicum infections. Environmental, ecological and social-demographic changes in China, shown to affect the distribution of oncomelanid snails, can also impact future schistosomiasis transmission. In light of their importance in the S. japonicum, lifecycle, vaccination has been proposed as a means to reduce the excretion of egg from cattle and buffalo, thereby interrupting transmission from these reservoir hosts to snails. A DNA-based vaccine (SjCTPI) our team developed showed encouraging efficacy against S. japonicum in Chinese water buffaloes. Here we report the results of a double-blind cluster randomized trial aimed at determining the impact of a combination of the SjCTPI bovine vaccine (given as a prime-boost regimen), human mass chemotherapy and snail control on the transmission of S. japonicum in 12 selected administrative villages around the Dongting Lake in Hunan province. The trial confirmed human praziquantel treatment is an effective intervention at the population level. Further, mollusciciding had an indirect ~50% efficacy in reducing human infection rates. Serology showed that the SjCTPI vaccine produced an effective antibody response in vaccinated bovines, resulting in a negative correlation with bovine egg counts observed at all post-vaccination time points. Despite these encouraging outcomes, the effect of the vaccine in preventing human infection was inconclusive. This was likely due to activities undertaken by the China National Schistosomiasis Control Program, notably the treatment, sacrifice or removal of bovines from trial villages, over which we had no control; as a result, the trial design was compromised, reducing power and contaminating outcome measures. This highlights the difficulties in undertaking field trials of this nature and magnitude, particularly over a long period, and emphasizes the importance of mathematical modeling in predicting the potential impact of control intervention measures. A transmission blocking vaccine targeting bovines for the prevention of S. japonicum with the required protective efficacy would be invaluable in tandem with other preventive intervention measures if the goal of eliminating schistosomiasis from China is to become a reality.
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Affiliation(s)
- Gail M Williams
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Yue-Sheng Li
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Hunan Institute of Parasitic Diseases, Yueyang, China
| | - Darren J Gray
- School of Public Health, University of Queensland, Brisbane, QLD, Australia.,Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Zheng-Yuan Zhao
- World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Hunan Institute of Parasitic Diseases, Yueyang, China
| | - Donald A Harn
- Department of Infectious Diseases, College of Veterinary Medicine and Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
| | - Lisa M Shollenberger
- Department of Biological Sciences, Old Dominion University, Norfolk, VA, United States
| | - Sheng-Ming Li
- World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Hunan Institute of Parasitic Diseases, Yueyang, China
| | - Xinglin Yu
- World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Hunan Institute of Parasitic Diseases, Yueyang, China
| | - Zeng Feng
- Chinese Centre for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, China
| | - Jia-Gang Guo
- World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Hunan Institute of Parasitic Diseases, Yueyang, China
| | - Jie Zhou
- World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Hunan Institute of Parasitic Diseases, Yueyang, China
| | - Yu-Lan Dong
- World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Hunan Institute of Parasitic Diseases, Yueyang, China
| | - Yuan Li
- Centre of Cell and Molecular Biology Experiment, Xiangya School of Medicine, Central South University, Changsha, China
| | - Biao Guo
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Patrick Driguez
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Marina Harvie
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Hong You
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Allen G Ross
- Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia.,International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
| | - Donald P McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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You H, Harvie M, Du X, Rivera V, Zhang P, McManus DP. Protective Immune Responses Generated in a Murine Model Following Immunization with Recombinant Schistosoma japonicum Insulin Receptor. Int J Mol Sci 2018; 19:ijms19103088. [PMID: 30304851 PMCID: PMC6213549 DOI: 10.3390/ijms19103088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 02/07/2023] Open
Abstract
There is a pressing need to develop vaccines for schistosomiasis given the current heavy dependency on praziquantel as the only available drug for treatment. We previously showed the ligand domain of the Schistosoma japonicum insulin receptor 1 and 2 (rSjLD1 and 2) fusion proteins conferred solid protection in mice against challenge infection with S. japonicum. To improve vaccine efficacy, we compared the immunogenicity and protective efficacy of rSjLD1 on its own and in combination with S. japonicum triose-phosphate isomerase (SjTPI), formulated with either of two adjuvants (QuilA and montanide ISA 720VG) in murine vaccine trials against S. japonicum challenge. The level of protection was higher in mice vaccinated only with rSjLD1 formulated with either adjuvant; rSjTPI or the rSjTPI-rSjLD1 combination resulted in a lower level of protection. Mirroring our previous results, there were significant reductions in the number of female worms (30–44%), faecal eggs (61–68%), liver eggs (44–56%), intestinal eggs (46–48%) and mature intestinal eggs (58–63%) in the rSjLD1-vaccinated mice compared with the adjuvant only groups. At 6-weeks post-cercarial challenge, a significantly increased production of interferon gamma (IFNγ) in rSjLD1-stimulated splenic CD4+ T cells was observed in the rSjLD1-vaccinated mice suggesting a Th1-type response is associated with the generated level of protective efficacy.
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Affiliation(s)
- Hong You
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane QLD4006, Queensland, Australia.
| | - Marina Harvie
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane QLD4006, Queensland, Australia.
| | - Xiaofeng Du
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane QLD4006, Queensland, Australia.
| | - Vanessa Rivera
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane QLD4006, Queensland, Australia.
| | - Ping Zhang
- Translational Cancer Immunotherapy Laboratory, QIMR Berghofer Medical Research Institute, Brisbane QLD4006, Queensland, Australia.
| | - Donald P McManus
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane QLD4006, Queensland, Australia.
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Ranasinghe SL, Duke M, Harvie M, McManus DP. Kunitz-type protease inhibitor as a vaccine candidate against schistosomiasis mansoni. Int J Infect Dis 2018; 66:26-32. [DOI: 10.1016/j.ijid.2017.10.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 01/08/2023] Open
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Abstract
Schistosomiasis, caused mainly by S. mansoni, S. haematobium and S. japonicum, continues to be a serious tropical disease and public health problem resulting in an unacceptably high level of morbidity in countries where it is endemic. Praziquantel, the only drug currently available for treatment, is unable to kill developing schistosomes, it does not prevent re-infection and its continued extensive use may result in the future emergence of drug-resistant parasites. This scenario provides impetus for the development and deployment of anti-schistosome vaccines to be used as part of an integrated approach for the prevention, control and eventual elimination of schistosomiasis. This review considers the present status of candidate vaccines for schistosomiasis, and provides some insight on future vaccine discovery and design.
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Affiliation(s)
- Biniam Mathewos Tebeje
- QIMR Berghofer Medical Research Institute, Brisbane, Australia. .,School of Public Health, University of Queensland, Brisbane, Australia. .,Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Marina Harvie
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Hong You
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Alex Loukas
- Centre for Biodiscovery and Molecular Development of Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
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Gobert GN, Nawaratna SK, Harvie M, Ramm GA, McManus DP. An ex vivo model for studying hepatic schistosomiasis and the effect of released protein from dying eggs. PLoS Negl Trop Dis 2015; 9:e0003760. [PMID: 25965781 PMCID: PMC4428699 DOI: 10.1371/journal.pntd.0003760] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/14/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND We report the use of an ex vivo precision cut liver slice (PCLS) mouse model for studying hepatic schistosomiasis. In this system, liver tissue is unfixed, unfrozen, and alive for maintenance in culture and subsequent molecular analysis. METHODS AND FINDINGS Using thick naive mouse liver tissue and sterile culture conditions, the addition of soluble egg antigen (SEA) derived from Schistosoma japonicum eggs, followed 4, 24 and 48 hrs time points. Tissue was collected for transcriptional analysis and supernatants collected to quantitate liver enzymes, cytokines and chemokines. No significant hepatotoxicity was demonstrated by supernatant liver enzymes due to the presence of SEA. A proinflammatory response was observed both at the transcriptional level and at the protein level by cytokine and chemokine bead assay. Key genes observed elevated transcription in response to the addition of SEA included: IL1-α and IL1-β, IL6, all associated with inflammation. The recruitment of antigen presenting cells was reflected in increases in transcription of CD40, CCL4 and CSF1. Indications of tissue remodeling were seen in elevated gene expression of various Matrix MetalloProteinases (MMP3, 9, 10, 13) and delayed increases in TIMP1. Collagen deposition was significantly reduced in the presence of SEA as shown in COL1A1 expression by qPCR after 24 hrs culture. Cytokine and chemokine analysis of the culture supernatants confirmed the elevation of proteins including IL6, CCL3, CCL4 and CXCL5. CONCLUSIONS This ex vivo model system for the synchronised delivery of parasite antigen to liver tissue provides an insight into the early phase of hepatic schistosomiasis, corresponding with the release of soluble proteins from dying schistosome eggs.
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Affiliation(s)
- Geoffrey N. Gobert
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- * E-mail:
| | | | - Marina Harvie
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Grant A. Ramm
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Donald P. McManus
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
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Bouchery T, Kyle R, Camberis M, Shepherd A, Filbey K, Smith A, Harvie M, Painter G, Johnston K, Ferguson P, Jain R, Roediger B, Delahunt B, Weninger W, Forbes-Blom E, Le Gros G. ILC2s and T cells cooperate to ensure maintenance of M2 macrophages for lung immunity against hookworms. Nat Commun 2015; 6:6970. [DOI: 10.1038/ncomms7970] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/20/2015] [Indexed: 02/06/2023] Open
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12
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Mearns H, Forbes-Blom EE, Camberis M, Tang SC, Kyle R, Harvie M, Kleinschek MA, Le Gros G. IL-25 exhibits disparate roles during Th2-cell differentiation versus effector function. Eur J Immunol 2014; 44:1976-80. [PMID: 24737448 DOI: 10.1002/eji.201344400] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/10/2014] [Accepted: 04/10/2014] [Indexed: 11/10/2022]
Abstract
A keenly sought therapeutic approach for the treatment of allergic disease is the identification and neutralization of the cytokine that regulates the differentiation of T helper 2 (Th2) cells. Th2 cells are exciting targets for asthma therapies. Recently, the cytokine IL-25 has been shown to enhance Th2-type immune activity and play important roles in mediating allergic inflammatory responses. To investigate this further, we crossed IL-25(-/-) C57BL/6 mice with G4 IL-4 C57BL/6 reporter mice and developed an assay for in vitro and in vivo IL-4-independent Th2-cell differentiation. These assays were used to determine whether IL-25 was critical for the formation of Th2 cells. We found there was no physiological role for IL-25 in either the differentiation of Th2 cells or their development to effector or memory Th2-cell subsets. Importantly, this data challenges the newly found and growing status of the cytokine IL-25 and its proposed role in promoting Th2-cell responses.
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Affiliation(s)
- Helen Mearns
- Malaghan Institute of Medical Research, Wellington, New Zealand
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13
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Evans G, Stavrinos P, Dawe S, Harvie M, Wilson M, Maxwell A, Brentnall A, Cuzick J, Astley S, Howell A. 8LBA Assessing individual breast cancer risk within the UK National Health Service Breast Screening Programme: First prospective results from PROCAS. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70116-9] [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: 11/25/2022]
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14
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Baillet A, Rehaume L, Benham H, O’Meara C, Armitage C, Harvie M, Velasco J, Beagley K, Thomas R. THU0425 Chlamydia Muridarum Induces Reactive Arthritis in SKG Mice: Relationship of Host Immune Control to Inflammatory Disease. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.953] [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: 11/04/2022]
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O'Meara C, Armitage C, Harvie M, Timms P, Lycke N, Beagley K. Targeting chlamydial pathogenesis: a novel vaccine design (P4387). The Journal of Immunology 2013. [DOI: 10.4049/jimmunol.190.supp.205.3] [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: 01/03/2023]
Abstract
Abstract
Chlamydial vaccine design is focused on eradicating infection. However, infection-associated infertility is the direct consequence of the same pro-inflammatory immune response required to eliminate the infection, which complicates vaccine design. Using the mouse model of Chlamydia pathogenesis, we immunized animals with the chlamydial Major Outer Membrane Protein (MOMP), via various routes of administration, with a number of adjuvant combinations (CTA1-DD, CT and CpG). This approach identified two contrasting vaccine candidates. One vaccine (sublingual delivered MOMP/CTA1-DD) induced a 70% reduction in infertility, without altering the course of infection. Another vaccine (intranasal delivered MOMP/CT/CpG) eradicated the infection in the upper reproductive tract, yet lacked any beneficial influence on incidence of infertility. This presented a unique opportunity to study how immunity against pathology can develop independently from immunity against infection. Comparing the gene expression in disease susceptible oviduct tissues, between infertility- and infection-protected vaccinated animals, identified a major difference in IL-17 signaling. While both vaccines expressed high levels of IL-17 cytokines, the infertility-protected group displayed reduced expression of corresponding IL-17 receptors. Therefore, the inhibition of IL-17 signaling in infertility-protected mice suggests a role for IL-17 not only in the resolution of infection, but also the development of infertility.
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Affiliation(s)
- Connor O'Meara
- 1Institute of Health and Biomedical Innovation, Queensland Univ. of Technol., Kelvin Grove, QLD, Australia
| | - Charles Armitage
- 1Institute of Health and Biomedical Innovation, Queensland Univ. of Technol., Kelvin Grove, QLD, Australia
| | - Marina Harvie
- 1Institute of Health and Biomedical Innovation, Queensland Univ. of Technol., Kelvin Grove, QLD, Australia
| | - Peter Timms
- 1Institute of Health and Biomedical Innovation, Queensland Univ. of Technol., Kelvin Grove, QLD, Australia
| | - Nils Lycke
- 2Mucosal Immunobiology and Vaccine Centre, University of Gothenburg, Gothenburg, Sweden
| | - Kenneth Beagley
- 1Institute of Health and Biomedical Innovation, Queensland Univ. of Technol., Kelvin Grove, QLD, Australia
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16
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Harvie M, Camberis M, Le Gros G. Development of CD4 T Cell Dependent Immunity Against N. brasiliensis Infection. Front Immunol 2013; 4:74. [PMID: 23518620 PMCID: PMC3603274 DOI: 10.3389/fimmu.2013.00074] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 03/05/2013] [Indexed: 11/13/2022] Open
Abstract
Of all the microbial infections relevant to mammals the relationship between parasitic worms and what constitutes and regulates a host protective immune response is perhaps the most complex and evolved. Nippostrongylus brasiliensis is a tissue migrating parasitic roundworm of rodents that exemplifies many of the salient features of parasitic worm infection, including parasite development through sequential larval stages as it migrates through specific tissue sites. Immune competent hosts respond to infection by N. brasiliensis with a rapid and selective development of a profound Th2 immune response that appears able to confer life long protective immunity against reinfection. This review details how the lung can be the site of migrating nematode immune killing and the gut a site of rapid immune mediated clearance of worms. Furthermore it appears that N. brasiliensis induced responses in the lung are sufficient for conferring immunity in lung and gut while infection of the gut only confers immunity in the gut. This review also covers the role of IL-4, STAT6, and the innate cytokines IL-25, IL-33, and thymic stromal lymphopoietin in the generation of CD4-mediated immunity against N. brasiliensis reinfection and discusses what cytokines might be involved in mediated killing or expulsion of helminth parasites.
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Affiliation(s)
- Marina Harvie
- Queensland University of Technology Brisbane, QLD, Australia
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Huston WM, Harvie M, Mittal A, Timms P, Beagley KW. Vaccination to protect against infection of the female reproductive tract. Expert Rev Clin Immunol 2012; 8:81-94. [PMID: 22149343 DOI: 10.1586/eci.11.80] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Infection of the female genital tract can result in serious morbidities and mortalities from reproductive disability, pelvic inflammatory disease and cancer, to impacts on the fetus, such as infant blindness. While therapeutic agents are available, frequent testing and treatment is required to prevent the occurrence of the severe disease sequelae. Hence, sexually transmitted infections remain a major public health burden with ongoing social and economic barriers to prevention and treatment. Unfortunately, while there are two success stories in the development of vaccines to protect against HPV infection of the female reproductive tract, many serious infectious agents impacting on the female reproductive tract still have no vaccines available. Vaccination to prevent infection of the female reproductive tract is an inherently difficult target, with many impacting factors, such as appropriate vaccination strategies/mechanisms to induce a suitable protective response locally in the genital tract, variation in the local immune responses due to the hormonal cycle, selection of vaccine antigen(s) that confers effective protection against multiple variants of a single pathogen (e.g., the different serovars of Chlamydia trachomatis) and timing of the vaccine administration prior to infection exposure. Despite these difficulties, there are numerous ongoing efforts to develop effective vaccines against these infectious agents and it is likely that this important human health field will see further major developments in the next 5 years.
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Affiliation(s)
- Wilhelmina M Huston
- Institute of Health and Biomedical Innovation, 60 Musk Avenue, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
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Howell A, Astley S, Warwick J, Stavrinos P, Sahin S, Ingham S, McBurney H, Eckersley B, Harvie M, Wilson M, Beetles U, Warren R, Hufton A, Sergeant J, Newman W, Buchan I, Cuzick J, Evans DG. Prevention of breast cancer in the context of a national breast screening programme. J Intern Med 2012; 271:321-30. [PMID: 22292490 DOI: 10.1111/j.1365-2796.2012.02525.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Breast cancer is not only increasing in the west but also particularly rapidly in eastern countries where traditionally the incidence has been low. The rise in incidence is mainly related to changes in reproductive patterns and lifestyle. These trends could potentially be reversed by defining women at greatest risk and offering appropriate preventive measures. A model for this approach was the establishment of Family History Clinics (FHCs), which have resulted in improved survival in younger women at high risk. New predictive models of risk that include reproductive and lifestyle factors, mammographic density and measurement of risk-associated single nucleotide polymorphisms (SNPs) may give more precise information concerning risk and enable better targeting for mammographic screening programmes and of preventive measures. Endocrine prevention using anti-oestrogens and aromatase inhibitors is effective, and observational studies suggest lifestyle modification may also be effective. However, referral to FHCs is opportunistic and predominantly includes younger women. A better approach for identifying older women at risk may be to use national breast screening programmes. Here were described pilot studies to assess whether the routine assessment of breast cancer risk is feasible within a population-based screening programme, whether the feedback and advice on risk-reducing interventions would be welcomed and taken up, and to consider whether the screening interval should be modified according to breast cancer risk.
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Affiliation(s)
- A Howell
- Genesis Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, UK.
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Harvie M, Wright C, Pegington M, Mitchell E, Evans DG, Jebb S, Clarke R, Goodacre R, Dunn W, Mattson M, Howell A. P3-09-02: Intermittent Dietary Carbohydrate Restriction Enables Weight Loss and Reduces Breast Cancer Risk Biomarkers. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-09-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Energy restriction is a potential strategy for breast cancer prevention but is difficult to achieve and maintain. We found that intermittent energy restriction (2 days strict dieting week) is comparable to the standard approach of moderate daily restriction for weight loss and marginally better for improving insulin sensitivity, but no easier to follow1. In this follow on study we wished to test whether 2 novel intermittent low carbohydrate/low energy diets were feasible and easier to follow than a standard daily energy restriction. Design: Randomised comparison of 3 dietary types over 4 months in 115 overweight or obese (mean body mass index 31.0 [±5.3 SD] kg/m2) women at increased risk of breast cancer (lifetime risk > 1 in 6).
Diets:
1. A restricted low carbohydrate diet (RLCD): 650 kcal and <50g carbohydrate / day for 2 days per week
2. Ad lib low carbohydrate diet (ALCD): <50g / day for 2 days per week with other food types (e.g. protein) ad lib
3. A standard daily restricted Mediterranean diet (DRMD): ∼ 1500kcal/day for 7 days per week
Methods: Weight, anthropometrics, blood markers for breast cancer; insulin resistance, oxidative stress markers, leptin, adiponectin, lipids, inflammatory markers IGF-1 were assessed at baseline, 1, 3 and 4 months.
Results: 88/114 completed the study (77%, drop outs 6 RLCD, 8 ALCD 12 DRMD). Last observation carried forward analyses show both intermittent low carbohydrate diets were superior to standard daily restriction for reducing weight and body fat: mean (95% confidence interval [CI]) change in body fat for RLCD was −4.3 (−5.6 to −3.0) kg, for ALCD −4.1 (−5.2 to −3.1) kg vs. −2.4 (−3.4 to −1.2) kg for DRMD (P value for difference between groups = 0.02). The intermittent groups had greater improvement in insulin resistance: mean (95% CI) change for RLCD was −22 (−35 to −11) %, ALCD −14 (−27 to −5%) % vs. −4 (−16 to 9) % for DRMD (P = 0.02). Other biomarkers are being assayed currently.
Conclusion: Greater weight loss, fewer drop outs and greater reductions in insulin resistance with the novel intermittent low carbohydrate diets indicate that these are alternative approaches for energy restriction for potentially reducing risk of breast cancer and other diseases.
Reference:
1Harvie MN, Pegington M, Mattson MP, Frystyk J, Dillon B, Evans G et al. The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women. Int.J Obes (Lond) 35; 714–27, 2011. This study is funded by the Genesis Breast Cancer Prevention Appeal: www.genesisuk.org
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-09-02.
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Affiliation(s)
- M Harvie
- 1University Hospital of South Manchester, Manchester, United Kingdom; MRC Human Nutrition Research Group, Cambridge, United Kingdom; University of Manchester, Manchester, United Kingdom; National Institute of Aging, Baltimore
| | - C Wright
- 1University Hospital of South Manchester, Manchester, United Kingdom; MRC Human Nutrition Research Group, Cambridge, United Kingdom; University of Manchester, Manchester, United Kingdom; National Institute of Aging, Baltimore
| | - M Pegington
- 1University Hospital of South Manchester, Manchester, United Kingdom; MRC Human Nutrition Research Group, Cambridge, United Kingdom; University of Manchester, Manchester, United Kingdom; National Institute of Aging, Baltimore
| | - E Mitchell
- 1University Hospital of South Manchester, Manchester, United Kingdom; MRC Human Nutrition Research Group, Cambridge, United Kingdom; University of Manchester, Manchester, United Kingdom; National Institute of Aging, Baltimore
| | - DG Evans
- 1University Hospital of South Manchester, Manchester, United Kingdom; MRC Human Nutrition Research Group, Cambridge, United Kingdom; University of Manchester, Manchester, United Kingdom; National Institute of Aging, Baltimore
| | - S Jebb
- 1University Hospital of South Manchester, Manchester, United Kingdom; MRC Human Nutrition Research Group, Cambridge, United Kingdom; University of Manchester, Manchester, United Kingdom; National Institute of Aging, Baltimore
| | - R Clarke
- 1University Hospital of South Manchester, Manchester, United Kingdom; MRC Human Nutrition Research Group, Cambridge, United Kingdom; University of Manchester, Manchester, United Kingdom; National Institute of Aging, Baltimore
| | - R Goodacre
- 1University Hospital of South Manchester, Manchester, United Kingdom; MRC Human Nutrition Research Group, Cambridge, United Kingdom; University of Manchester, Manchester, United Kingdom; National Institute of Aging, Baltimore
| | - W Dunn
- 1University Hospital of South Manchester, Manchester, United Kingdom; MRC Human Nutrition Research Group, Cambridge, United Kingdom; University of Manchester, Manchester, United Kingdom; National Institute of Aging, Baltimore
| | - M Mattson
- 1University Hospital of South Manchester, Manchester, United Kingdom; MRC Human Nutrition Research Group, Cambridge, United Kingdom; University of Manchester, Manchester, United Kingdom; National Institute of Aging, Baltimore
| | - A Howell
- 1University Hospital of South Manchester, Manchester, United Kingdom; MRC Human Nutrition Research Group, Cambridge, United Kingdom; University of Manchester, Manchester, United Kingdom; National Institute of Aging, Baltimore
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Evans DGR, Astley S, Stavrinos P, Sahin S, Ingham S, McBurney H, Eckersley B, Wilson M, Beetles U, Harvie M, Warren R, Sergeant J, Hufton A, Warwick J, Newman W, Buchan I, Cuzick J, Howell A. P4-11-07: Feasibility and Acceptability of Offering Breast Cancer Risk Estimation in the Context of the UK National Health Service Breast Cancer Screening Programme: A New Paradigm for Cancer Prevention. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-11-07] [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: 11/16/2022]
Abstract
Abstract
Background: Currently there are no real attempts internationally to tailor breast screening programmes to individual risk Methods: We have assessed the feasibility of collecting breast cancer risk information during routine mammographic screening in the National Health Service Breast Screening Programme (NHSBSP) in England, in order to consider, ultimately, adapting the screening interval to risk of breast cancer and introducing preventive strategies in women at high risk. The study Predicting Risk Of Cancer At Screening (PROCAS) aims to recruit 60,000 women over 3 years. Results: 26,000 women (June 8th 2011) have so far given consent to join the study. Thirty six percent of the first 20,000 women in nineteen screening sites in Manchester consented to enter the study and completed a risk factor questionnaire. The median 10 year breast cancer risk was 2.65%, with 926 (9.26%) of the first 10,000 women having a 10 year risk of ≥5% and 92 (0.92%) having a 10 year risk of ≥8% (Tyrer-Cuzick), IQR:1.35. 832 (8.32%) women had a mammographic density of 60% or greater (Visual Analogue Scale). We collected saliva samples from 1019 women for genetic analysis and will extend this to 18% of participants. Of those who agreed to participate in the study, 94% indicated that they wished to know their breast cancer risk. Women with a 10-year risk of ≥8%, and women with a 10-year risk of ≥5% and mammographic density ≥60% were invited to attend or be telephoned to be counselled. To date 138 have accepted with 135, so far, having received risk counselling. Nineteen percent of the high-risk women identified subsequently decided to enter a randomised breast cancer prevention study with either a dietary or drug intervention (IBIS2, anastrazole vs placebo). Results from the first 1,000 women who provided DNA samples suggest that the risk information from the 18 validated SNPS may enhance existing risk models. Conclusion: This study demonstrates that it is feasible to determine individual breast cancer risk and offer women appropriate risk-reducing interventions within the context of a population-based mammographic screening programme.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-07.
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Affiliation(s)
- DGR Evans
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - S Astley
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - P Stavrinos
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - S Sahin
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - S Ingham
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - H McBurney
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - B Eckersley
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - M Wilson
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - U Beetles
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - M Harvie
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - R Warren
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - J Sergeant
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - A Hufton
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - J Warwick
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - W Newman
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - I Buchan
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - J Cuzick
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
| | - A Howell
- 1University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Central Manchester Foundation Trust, Manchester, United Kingdom; Queen Mary University London, London, United Kingdom
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Harvie M, Pegington M, Bundred N, Campbell A, Wolstenholme J, Adams J, Speed S, Morris J, Howell A. P4-12-01: The Breast-Activity and Healthy Eating after Diagnosis (B-AHEAD) Study – A Randomised Comparison of Weight Control Programmes during Adjuvant Treatment. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-12-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Excess weight at diagnosis and weight gain during treatment are linked to increased mortality from breast cancer. Since 60% of breast cancer patients are overweight at diagnosis and 75% gain weight during treatment, weight control should improve outcome but the optimal intervention is unknown.
Aim: To compare 3 programmes for weight control after surgery for primary breast cancer.
Methods: We have recruited a randomised trial of 2 diet and exercise weight control interventions (1. a community based supervised group programme, 2. a mail and phone programme) compared to standard written advice (control). We are comparing the relative effects of the 3 programmes on body weight and composition (by dual energy x-ray absorptiometry), cardiovascular risk parameters (lipids, blood pressure), a marker of breast cancer prognosis (insulin resistance), fitness and quality of life over the first year after diagnosis.
In total 409 women have been randomised (45% of eligible women) and 21 women have left the trial (5.1%), 357 have completed the 6 month assessments, all are due to complete the trial in December 2011.
Results:
Weight and body fat results at 6 months indicate that the low cost mail and phone programme is equal to the supervised programme and both are significantly superior to written advice, but not in patients receiving chemotherapy.
The high uptake and adherence to the trial shows interest and motivation of a significant number of cancer patients to make positive changes to lifestyle at the time of diagnosis. The final trial results will be presented at the December meeting. This abstract presents independent research commissioned by the National Institute for Health Research under the Research for Patient Benefit programme. The views expressed here are those of the authors and not necessarily those of the funding organisations.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-12-01.
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Affiliation(s)
- M Harvie
- 1Univeristy Hospital of South Manchester, Manchester, United Kingdom; University of Dundee, United Kingdom; University of Oxford, United Kingdom; University of Manchester, United Kingdom; University Hospital of South Manchester, United Kingdom
| | - M Pegington
- 1Univeristy Hospital of South Manchester, Manchester, United Kingdom; University of Dundee, United Kingdom; University of Oxford, United Kingdom; University of Manchester, United Kingdom; University Hospital of South Manchester, United Kingdom
| | - N Bundred
- 1Univeristy Hospital of South Manchester, Manchester, United Kingdom; University of Dundee, United Kingdom; University of Oxford, United Kingdom; University of Manchester, United Kingdom; University Hospital of South Manchester, United Kingdom
| | - A Campbell
- 1Univeristy Hospital of South Manchester, Manchester, United Kingdom; University of Dundee, United Kingdom; University of Oxford, United Kingdom; University of Manchester, United Kingdom; University Hospital of South Manchester, United Kingdom
| | - J Wolstenholme
- 1Univeristy Hospital of South Manchester, Manchester, United Kingdom; University of Dundee, United Kingdom; University of Oxford, United Kingdom; University of Manchester, United Kingdom; University Hospital of South Manchester, United Kingdom
| | - J Adams
- 1Univeristy Hospital of South Manchester, Manchester, United Kingdom; University of Dundee, United Kingdom; University of Oxford, United Kingdom; University of Manchester, United Kingdom; University Hospital of South Manchester, United Kingdom
| | - S Speed
- 1Univeristy Hospital of South Manchester, Manchester, United Kingdom; University of Dundee, United Kingdom; University of Oxford, United Kingdom; University of Manchester, United Kingdom; University Hospital of South Manchester, United Kingdom
| | - J Morris
- 1Univeristy Hospital of South Manchester, Manchester, United Kingdom; University of Dundee, United Kingdom; University of Oxford, United Kingdom; University of Manchester, United Kingdom; University Hospital of South Manchester, United Kingdom
| | - A Howell
- 1Univeristy Hospital of South Manchester, Manchester, United Kingdom; University of Dundee, United Kingdom; University of Oxford, United Kingdom; University of Manchester, United Kingdom; University Hospital of South Manchester, United Kingdom
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Sestak I, Harvie M, Howell A, Forbes JF, Dowsett M, Cuzick JM. Weight change associated with anastrozole and tamoxifen treatment in postmenopausal women with breast cancer or at high risk of developing it. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.165] [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
165 Background: Weight gain is commonly reported by patients with breast cancer. Aromatase inhibitors are being tested in the preventive setting in high risk women and it is important to evaluate the association between treatment and weight change as this may effect the patient’s decision to continue to take the drug. Methods: Weight change in postmenopausal women from three large clinical trials (ATAC, IBIS-I, IBIS-II) investigating endocrine treatment for the treatment and prevention of breast cancer have been analysed. The objective of this retrospective study was to assess the effects of anastrozole and tamoxifen on weight change in postmenopausal women. Results: In the ATAC trial, a mean increase of 1.4 kg was observed after 12 months of follow-up and no statistically significant differences between treatment arms (anastrozole vs. tamoxifen) were found. The majority of women kept their weight stable and only 11.2% gained more than 5 kg within this time period. Significant baseline predictors for gaining more than 5 kg of weight after 12 months of follow-up were being younger than 60 years old at entry, smoking at entry, and mastectomy. Results for the two prevention studies IBIS-I and IBIS-II were quite similar. In the IBIS-II trial, the overall mean weight change after 12 months of follow-up was 0.5 kg. In the IBIS-I study women gained an average of 0.9 kg within the first 12 months of follow up. In both studies no differences between treatment and placebo (IBIS-I: tamoxifen vs. placebo; IBIS-II: anastrozole vs. placebo) were observed. Overall, women in the adjuvant setting gained more than 5 kg of weight (11.2%) after 12 months of follow up compared to those in the preventive setting (5.3% IBIS-I, 5.7% IBIS-II), but similar overall weight gain was seen after 60 months of follow up in both settings (5.7% IBIS-I vs. 6.1% ATAC). Conclusions: All three trials have demonstrated that weight gain occurs primarily within the first 12 months of active treatment and are similar to those on placebo. Weight stabilises after 12 months of follow up and major weight gain was rare in all trials, and unrelated to treatment.
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Affiliation(s)
- I. Sestak
- Queen Mary, University of London, London, United Kingdom; Nightingale and Genesis Prevention Centre Wythenshawe Hospital, Manchester, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Australian New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle, Australia; The Royal Marsden Hospital, London, United Kingdom; EMS, Wolfson Institute of Preventive Medicine, London, United Kingdom
| | - M. Harvie
- Queen Mary, University of London, London, United Kingdom; Nightingale and Genesis Prevention Centre Wythenshawe Hospital, Manchester, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Australian New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle, Australia; The Royal Marsden Hospital, London, United Kingdom; EMS, Wolfson Institute of Preventive Medicine, London, United Kingdom
| | - A. Howell
- Queen Mary, University of London, London, United Kingdom; Nightingale and Genesis Prevention Centre Wythenshawe Hospital, Manchester, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Australian New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle, Australia; The Royal Marsden Hospital, London, United Kingdom; EMS, Wolfson Institute of Preventive Medicine, London, United Kingdom
| | - J. F. Forbes
- Queen Mary, University of London, London, United Kingdom; Nightingale and Genesis Prevention Centre Wythenshawe Hospital, Manchester, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Australian New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle, Australia; The Royal Marsden Hospital, London, United Kingdom; EMS, Wolfson Institute of Preventive Medicine, London, United Kingdom
| | - M. Dowsett
- Queen Mary, University of London, London, United Kingdom; Nightingale and Genesis Prevention Centre Wythenshawe Hospital, Manchester, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Australian New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle, Australia; The Royal Marsden Hospital, London, United Kingdom; EMS, Wolfson Institute of Preventive Medicine, London, United Kingdom
| | - J. M. Cuzick
- Queen Mary, University of London, London, United Kingdom; Nightingale and Genesis Prevention Centre Wythenshawe Hospital, Manchester, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Australian New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle, Australia; The Royal Marsden Hospital, London, United Kingdom; EMS, Wolfson Institute of Preventive Medicine, London, United Kingdom
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Keith T, Llewellyn R, Harvie M, Roncaroli F, Weatherall MW. A report of the natural history of leptomeningeal gliomatosis. J Clin Neurosci 2011; 18:582-5. [PMID: 21316246 DOI: 10.1016/j.jocn.2010.07.144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 06/13/2010] [Accepted: 07/24/2010] [Indexed: 11/19/2022]
Abstract
Primary leptomeningeal gliomatosis (PLG) is a rare condition, with fewer than 50 patients reported. Our report illustrates the natural history of PLG in full, from the prodromal phase of subacute meningitis to the final stages characterised by extensive nerve root infiltration, cranial nerve palsies and widespread peripheral neurogenic muscle wasting. We provide correlative neuroimaging with serial MRI, and present the first published positron emission tomography imaging of this condition. We emphasise the importance of considering PLG in the differential diagnosis of chronic aseptic meningitis, the difficulties of making the diagnosis ante mortem, and the utility and potential limitations of early meningeal biopsy in this condition.
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Affiliation(s)
- T Keith
- Department of Medicine, Ealing Hospital, London, UK
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24
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Noon E, Singh S, Cuzick J, Spector TD, Williams FMK, Frost ML, Howell A, Harvie M, Eastell R, Coleman RE, Fogelman I, Blake GM. Significant differences in UK and US female bone density reference ranges. Osteoporos Int 2010; 21:1871-80. [PMID: 20063090 PMCID: PMC3605787 DOI: 10.1007/s00198-009-1153-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 11/24/2009] [Indexed: 11/25/2022]
Abstract
UNLABELLED In the United Kingdom (UK), T- and Z-scores are usually calculated using reference ranges derived from United States (US) populations. In the UK arm of a recent randomised trial (International Breast Cancer Intervention Study II (IBIS-II)), substantially, fewer women than expected were recruited into the osteopenic (-2.5<T-score<-1.0) and osteoporotic (T-score<-2.5) arms of the study. The comparison with data from two independent studies showed that UK women aged >45 years with a typical body mass index of 28 kg m(-2) have spine and hip bone mineral density (BMD) 0.6 standard deviation higher than their US counterparts. INTRODUCTION Dual energy X-ray absorptiometry (DXA) is widely used for the diagnosis of osteoporosis and to investigate the effect of pharmacological treatments on BMD. In both routine and research settings, it is important that DXA results are correctly interpreted. METHODS T- and Z-scores for the first 650 UK Caucasian women enrolled in the IBIS-II study were compared with data from two independent studies of unrelated, unselected UK Caucasian women: (1) 2,382 women aged 18 to 79 recruited to the Twins UK Adult Twin Registry; (2) 431 women aged 21 to 84 with no risk factors for osteoporosis recruited at Guy's Hospital. All DXA measurements were performed on Hologic densitometers. Subjects were divided into six age bands, and T- and Z-scores were calculated using the manufacturer's US reference range for the spine and the National Health and Nutrition Examination Survey III reference range for the femoral neck and total hip. RESULTS The overall mean Z-scores for the IBIS-II, Twin, and Guy's groups were: spine: +0.61, +0.29, +0.33; femoral neck: +0.42, +0.36, +0.45; total hip: +0.65, +0.38, +0.39 (all p<0.001 compared with the expected value of 0). The mean body weight of subjects in the three studies was 74.4, 65.5, and 65.4 kg, respectively. Analysis revealed a highly significant relationship between Z-score and weight at each BMD site with a slope of 0.03 kg(-1). CONCLUSIONS In general, US spine and hip reference ranges are not suitable for the calculation of Z-scores in UK women. For some research study designs, the differences may significantly influence the pattern of subject recruitment.
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Affiliation(s)
- E Noon
- Osteoporosis Research Unit, Division of Imaging Sciences, King's College London, London, UK
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25
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Harvie M, Pegington M, Cuzick J, Frystyk J, Flyvbjerg A, Jebb S, Mattson M, Howell A. Effect of intermittent versus continuous energy restriction on weight loss and breast cancer risk biomarkers. Breast Cancer Res 2010. [PMCID: PMC2875590 DOI: 10.1186/bcr2525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Harvie M, Chapman M, Cuzick J, Flyvbjerg A, Jebb S, Mattson M, Howell A. The effect of intermittent versus continuous energy restriction on biomarkers of breast cancer risk. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-506] [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: 11/16/2022]
Abstract
Abstract
Abstract #506
Excess energy, whether it is the form of high energy diets or low energy expenditure (sedentary lifestyle), is a risk factor for breast cancer. Observational studies show that continuous energy restriction (CER) and exercise reduce risk, particularly of postmenopausal breast cancer. Animal data indicate that intermittent energy restriction (IER) may be superior or at least as effective as continuous energy restriction in preventing or reducing the growth rate of mammary tumours. IER may also be more acceptable than CER which has been difficult to implement.
 We have tested the effectiveness and acceptability of IER and have performed a randomised trial of IER (n=53) versus CER (n=54) in overweight or obese premenopausal women. Energy restriction was 25% in both arms. IER subjects had approximately 550 kcal on 2 days per week and add lib food on other days; CER subjects had approximately 1500 kcal / day over 7 days. Nineteen women (18 %) withdrew from the study before 6 months (IER = 12, CER = 7, main reasons: stress = 4, pregnancy = 3, change in employment = 3, couldn't stick to diet = 3).
 Change in weight and biomarkers for last observation carried forward are reported.
 At 6 months. Both IER and CER are effective for loss of weight -7.9 vs. - 6.7% P = 0.26 and waist circumference -6.3 vs. -5% P = 0.13, and for lowering serum levels of leptin -43.3 vs. -39.8% P = 0.53; C – reactive protein -14.8 vs.-20.3% P = 0.15 and free androgen index -9.8 vs.-14.4% P = 0.90. Both IER and CER increased circulating levels of sex hormone binding globulin + 18.1 vs. 10.8% P = 0.51, and plasma adiponectin +11 vs. +1% P = 0.09. IER is better at lowering insulin resistance at 6 months than CER -29.6 vs. -15.3 % P <0.05.
 These data indicate that 2 days IER gives similar results to CER with respect to weight loss and many of the risk parameters measured and may be an alternative approach to continuous energy restriction. The superior reductions in insulin resistance with IER which may be related to periods of very low calorie intake (approximately 70% restriction). We are waiting data of the effects of IER vs. CER on the IGF-1 axis and oxidative stress. Future studies will investigate the mechanism of IER, its optimal duration and its influence on mammary cell function.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 506.
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Affiliation(s)
- M Harvie
- 1 South Manchester University Hospitals Trust, Manchester, United Kingdom
| | - M Chapman
- 1 South Manchester University Hospitals Trust, Manchester, United Kingdom
| | - J Cuzick
- 2 CRUK Department of Epidemiology and Statistics, Wolfson Institute, London, United Kingdom
| | - A Flyvbjerg
- 3 Medical Research Laboratories, Aarhus University, Aarhus, Denmark
| | - S Jebb
- 4 MRC Human Nutrition Research Group, Cambridge, United Kingdom
| | - M Mattson
- 5 Laboratory of Neurosciences, National Institute on Aging Intramural Research Program, Baltimore, MD
| | - A Howell
- 1 South Manchester University Hospitals Trust, Manchester, United Kingdom
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Harvie M, Chapman M, Cuzick J, Flyvbjerg A, Hopwood P, Jebb S, Parfitt G, Howell A. The effect of intermittent versus chronic energy restriction on breast cancer risk biomarkers in premenopausal women: a randomised pilot trial. Breast Cancer Res 2008. [PMCID: PMC3300756 DOI: 10.1186/bcr1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Howell A, Chapman M, Harvie M. S34. Metabolic aspects of cancer prevention: Intermittent is at least as effective as continuous calorie restriction in women at risk of breast cancer. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70226-x] [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: 10/22/2022] Open
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29
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Ong K, Sims A, Harvie M, Clarke R, Howell A. O-29 Effect of dietary energy restriction on gene expression in normal breast and subcutaneous adipose tissues of overweight women at increased breast cancer risk. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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30
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La Flamme AC, Harvie M, Kenwright D, Cameron K, Rawlence N, Low YS, McKenzie S. Chronic exposure to schistosome eggs reduces serum cholesterol but has no effect on atherosclerotic lesion development. Parasite Immunol 2007; 29:259-66. [PMID: 17430549 DOI: 10.1111/j.1365-3024.2007.00942.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Previous studies have shown that people infected with schistosomiasis have lower levels of serum cholesterol than uninfected controls. To better understand the impact of this parasitic infection on serum cholesterol levels and on atherosclerotic lesion development induced by hypercholesterolemia, apolipoprotein E (ApoE)-deficient mice were chronically exposed to the eggs of Schistosoma mansoni over a period of 16 weeks. Total serum cholesterol and low-density lipoprotein (LDL) were reduced in egg-exposed ApoE-deficient mice fed a diet high in cholesterol compared to unexposed controls. However, exposure to eggs had no effect on atherosclerotic lesion size or progression in ApoE-deficient mice. Macrophages isolated from egg-exposed mice had an enhanced ability to take up LDL but not acetylated LDL (acLDL). This study suggests that schistosome eggs alone may alter serum lipid profiles through enhancing LDL uptake by macrophages, but these changes do not ultimately affect atherosclerotic lesion development.
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Affiliation(s)
- A C La Flamme
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand.
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31
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Abstract
The arrival of eggs in the liver during Schistosoma mansoni infection initiates a protective granulomatous response; however, as the infection progresses, this response results in chronic liver fibrosis. To better understand the impact of schistosomiasis on liver function, we used a proteomic approach to identify proteins whose expression was significantly altered in schistosome-infected mice 8 weeks postinfection. Identification of differentially expressed proteins by mass fingerprinting revealed that schistosome infection markedly reduced the abundance of proteins associated with several normal liver functions (i.e., citric acid cycle, fatty acid cycle, and urea cycle), while proteins associated with stress responses, acute phase reactants, and structural components were all significantly more abundant. The expression patterns of several immunity-related proteins (peroxiredoxin 1, arginase 1, and galectin 1) suggested that different protein forms are associated with schistosome infection. These findings indicate that acute schistosomiasis has a significant impact on specific liver functions and, moreover, that the alterations in specific protein isoforms and upregulation of unique proteins may be valuable as new markers of disease.
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Affiliation(s)
- Marina Harvie
- School of Biological Sciences, Victoria University of Wellington, P.O. Box 600, Wellington, New Zealand
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32
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Harvie M, Chapman M, Cuzick J, Flyvbjerg A, Hopwood P, Jebb S, Parfitt G, Howell A. Effect of intermittent versus chronic energy restriction on breast cancer risk biomarkers in premenopausal women: a randomised pilot trial. Breast Cancer Res 2006. [PMCID: PMC3300276 DOI: 10.1186/bcr1584] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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33
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Weir C, McNeill A, Hook S, Harvie M, La Flamme AC, Le Gros G, Bäckström BT. Critical role of preproenkephalin in experimental autoimmune encephalomyelitis. J Neuroimmunol 2006; 179:18-25. [PMID: 16904193 DOI: 10.1016/j.jneuroim.2006.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 06/23/2006] [Accepted: 06/23/2006] [Indexed: 10/24/2022]
Abstract
Experimental autoimmune encephalomyelitis (EAE) is an organ-specific autoimmune disease model used to investigate mechanisms involved in the activation of self-reactive T cells. Preproenkephalin (PPNK) is the gene that encodes the protein proenkephalin A that has been detected in the brain, adrenal cells and cells of the immune system. In this paper, whether PPNK plays a role in the development of EAE was investigated. PPNK-deficient and wild-type mice were immunized with the MOG(35-55) peptide and the development of EAE observed. Our results show that PPNK-deficient mice developed less severe clinical signs of disease than wild-type mice, and with lower incidence. MOG(35-55)-specific T cells from PPNK-deficient and wild-type mice produced IFNgamma and TNFalpha but no IL-4 or IL-10, indicative of a Th1 phenotype. However, the numbers of MOG(35-55)-specific IFNgamma-producing cells from immunized PPNK-deficient mice were largely reduced at early stages of disease. Interestingly, there was no difference in clinical signs or infiltrating mononuclear cells in the CNS between wild-type and PPNK-deficient mice at the later stage of disease. Our results suggest that PPNK accelerates the generation of autoimmune IFNgamma-producing T cells and MOG(35-55)-induced EAE.
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Affiliation(s)
- Catherine Weir
- Malaghan Institute of Medical Research, Wellington South, New Zealand
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La Flamme AC, Harvie M, McNeill A, Goldsack L, Tierney JB, Bäckström BT. Fcgamma receptor-ligating complexes improve the course of experimental autoimmune encephalomyelitis by enhancing basal Th2 responses. Immunol Cell Biol 2006; 84:522-9. [PMID: 16869936 DOI: 10.1111/j.1440-1711.2006.01464.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
IL-12p40 and macrophages are essential for the induction of disease in the mouse model of multiple sclerosis, experimental autoimmune encephalomyelitis. In this paper, we show that treatment of mice with opsonized erythrocytes, which have been shown to ligate Fcgamma receptors on macrophages and alter their cytokine profile, significantly delayed the onset of experimental autoimmune encephalomyelitis. This protection correlated to the induction of Th2 responses by autoreactive T cells, enhanced basal systemic responses and a significant downregulation of IL-12p40 and nitric oxide synthase-2, but not IFN-gamma expression. IL-4 was essential for the protection by opsonized erythrocytes as the effects of treatment were eliminated in IL-4-deficient mice. Together these studies suggest that the ligation of Fcgamma receptors can modify the development of autoimmune disease by altering macrophage activation and enhancing Th2 responses.
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Affiliation(s)
- Anne C La Flamme
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand.
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35
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Abstract
Excess adiposity over the pre- and postmenopausal years is linked to risk of postmenopausal breast cancer. Weight loss could potentially reduce risk amongst those with excess weight via beneficial effects on the hormonal (decreased circulating levels of oestradiol, testosterone, insulin) and secretory profiles of adipocytes (decreased production of leptin, tumour necrosis factor-alpha, interleukin 6 and increased production of adiponectin). Only modest reductions in adipose tissue are achieved and sustained with current weight loss programmes, which makes strategies to mitigate the adverse metabolic effect of adiposity a priority for cancer prevention. The adverse hormonal and secretory effects of adipose tissue are influenced substantially by acute changes in energy balance prior to changes in adiposity. Human and animal studies have shown dietary energy restriction to bring about favourable changes in circulating levels of insulin, leptin, sex hormone binding globulin, insulin-like growth factor-1, oestradiol, testosterone, reactive oxygen species, and the production and secretion of locally acting adipokines and inflammatory cytokines, that is, increased adiponectin and decreased interleukin-6. Achieving and sustaining energy restriction remains a difficult challenge. Intermittent energy restriction is a potential strategy for promoting periods of energy restriction on a long-term basis. Animal and human data suggest that intermittent energy restriction may have cancer preventative effects beyond that of chronic energy restriction and weight loss. Intermittent energy restriction may be a potential strategy for the primary prevention of breast cancer.
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Affiliation(s)
- M Harvie
- CRUK University Department of Medical Oncology, Christie Hospital, Manchester, UK.
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36
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Howell A, Sims A, Harvie M, Ong KR, Evans G, Clarke R. The future of breast cancer prevention. Breast Cancer Res 2005. [PMCID: PMC4233473 DOI: 10.1186/bcr1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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37
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Abstract
The incidences of schistosomiasis and multiple sclerosis (MS) are mutually exclusive worldwide suggesting that schistosomiasis may offer protection against the induction of the immune-mediated disease, MS. Recent studies using the mouse model of MS, experimental autoimmune encephalomyelitis, support a direct suppression of the onset of MS by chronic Schistosoma mansoni infection. Self-reactive Th1 but not Th2 responses develop in infected mice immunized with myelin oligodendrocyte glycoprotein albeit at reduced levels indicating that the induction of auto-reactive T cells is not abolished nor phenotypically altered. CNS infiltration by inflammatory cells, particularly macrophages, is significantly reduced in S. mansoni-infected, immunized mice compared to uninfected, immunized mice. Because activated macrophages are crucial to the induction of clinical disease, these findings support the hypothesis that differences in macrophage activation may contribute to the reduced incidence and delayed progression of experimental autoimmune encephalomyelitis during schistosomiasis.
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Affiliation(s)
- Anne Camille La Flamme
- School of Biological Sciences, Victoria University of Wellington, P.O. Box 600, Wellington, New Zealand.
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38
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Abstract
The specific effect of central rather than general obesity on breast cancer risk is not clear. This review examines the relationship between waist and waist-hip ratio (WHR) and risk of breast cancer in pre- and post-menopausal women using all available cohort and case-control data. The databases of the Cochrane Library, Medline, Cancer Lit and Embase were searched until October 2002. Relevant cohort and case-control studies with separate analyses in pre- and/or post-menopausal women were included. Random effects meta-analyses were carried out, subgrouped by pre- or post-menopausal status and cohort or case-control design. Sensitivity analyses were also performed. Five cohort studies with 72,1705 person years of observation (453 pre-menopausal and 2684 post-menopausal cases), and three case-control studies comprising 276 pre-menopausal cases with 758 pre-menopausal controls and 390 post-menopausal cases with 1071 post-menopausal controls were included. Pooled results from cohort studies using the most adjusted data [but without adjustment for weight or body mass index (BMI)] suggest a 39% lower risk of breast cancer in post-menopausal women with the smallest waist (compared with the largest) and a 24% lower risk in women with the smallest WHR. In pre-menopausal women, however, pooled results suggest that measurement of waist or WHR have little effect on risk of breast cancer. Adjustment for BMI abolished the relationship between waist or WHR and risk of post-menopausal breast cancer, but introduced such a relationship amongst pre-menopausal women. The relationship between a smaller measurement of waist or WHR and lower risk of post-menopausal breast cancer appears to result from the associated correlation with BMI. Amongst pre-menopausal women, central (not general) obesity may be specifically associated with an increased risk of breast cancer.
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Affiliation(s)
- M Harvie
- University Departments of Medical Oncology, South Manchester University Hospitals, Manchester, UK.
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39
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Ainslie PN, Abbas K, Campbell IT, Frayn KN, Harvie M, Keegan MA, MacLaren DPM, Macdonald IA, Paramesh K, Reilly T. Metabolic and appetite responses to prolonged walking under three isoenergetic diets. J Appl Physiol (1985) 2002; 92:2061-70. [PMID: 11960958 DOI: 10.1152/japplphysiol.01049.2001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/22/2022] Open
Abstract
The effects of three isoenergetic diets on metabolic and appetite responses to prolonged intermittent walking were investigated. Eight men undertook three 450-min walks at intensities varying between 25-30 and 50-55% of maximal O2 uptake. In a balanced design, the subjects were given breakfast, snacks, and lunch containing total carbohydrate (CHO), protein (P), and fat (F) in the following amounts (g/70 kg body mass): mixed diet, 302 CHO, 50 P, 84 F; high-CHO diet, 438 CHO, 46 P, 35 F; high-fat diet, 63 CHO, 44 P, 196 F. Substrate balance was calculated by indirect calorimetry over the 450-min exercise period. Blood samples were taken before exercise and every 45 min during the exercise period. The high-fat diet resulted in a negative total CHO balance (-140 +/- 1 g) and a lower negative fat balance (-110 +/- 33 g) than the other two diets (P < 0.05). Plasma glucagon, nonesterified fatty acids, glycerol, and 3-hydroxybutyrate were higher with the high-fat diet (P < 0.05 vs. high CHO), whereas plasma insulin was lower after high fat (P < 0.05 vs. mixed and high CHO). Subjective ratings of fatigue and appetite showed no differences between the three trials. Although diet influenced the degree of total CHO and fat oxidation, fat was the main source of energy in all trials.
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Affiliation(s)
- P N Ainslie
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, L3 2ET, United Kingdom.
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