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Cameron EG, Nahmou M, Toth AB, Heo L, Tanasa B, Dalal R, Yan W, Nallagatla P, Xia X, Hay S, Knasel C, Stiles TL, Douglas C, Atkins M, Sun C, Ashouri M, Bian M, Chang KC, Russano K, Shah S, Woodworth MB, Galvao J, Nair RV, Kapiloff MS, Goldberg JL. A molecular switch for neuroprotective astrocyte reactivity. Nature 2024; 626:574-582. [PMID: 38086421 DOI: 10.1038/s41586-023-06935-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
The intrinsic mechanisms that regulate neurotoxic versus neuroprotective astrocyte phenotypes and their effects on central nervous system degeneration and repair remain poorly understood. Here we show that injured white matter astrocytes differentiate into two distinct C3-positive and C3-negative reactive populations, previously simplified as neurotoxic (A1) and neuroprotective (A2)1,2, which can be further subdivided into unique subpopulations defined by proliferation and differential gene expression signatures. We find the balance of neurotoxic versus neuroprotective astrocytes is regulated by discrete pools of compartmented cyclic adenosine monophosphate derived from soluble adenylyl cyclase and show that proliferating neuroprotective astrocytes inhibit microglial activation and downstream neurotoxic astrocyte differentiation to promote retinal ganglion cell survival. Finally, we report a new, therapeutically tractable viral vector to specifically target optic nerve head astrocytes and show that raising nuclear or depleting cytoplasmic cyclic AMP in reactive astrocytes inhibits deleterious microglial or macrophage cell activation and promotes retinal ganglion cell survival after optic nerve injury. Thus, soluble adenylyl cyclase and compartmented, nuclear- and cytoplasmic-localized cyclic adenosine monophosphate in reactive astrocytes act as a molecular switch for neuroprotective astrocyte reactivity that can be targeted to inhibit microglial activation and neurotoxic astrocyte differentiation to therapeutic effect. These data expand on and define new reactive astrocyte subtypes and represent a step towards the development of gliotherapeutics for the treatment of glaucoma and other optic neuropathies.
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Affiliation(s)
- Evan G Cameron
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Michael Nahmou
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Anna B Toth
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Lyong Heo
- Stanford Center for Genomics and Personalized Medicine, Stanford University, Palo Alto, CA, USA
| | - Bogdan Tanasa
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Roopa Dalal
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Wenjun Yan
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Pratima Nallagatla
- Stanford Center for Genomics and Personalized Medicine, Stanford University, Palo Alto, CA, USA
| | - Xin Xia
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sarah Hay
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Cara Knasel
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | - Melissa Atkins
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Catalina Sun
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Masoumeh Ashouri
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Minjuan Bian
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kun-Che Chang
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kristina Russano
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sahil Shah
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
- University of California, San Diego, La Jolla, CA, USA
| | - Mollie B Woodworth
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Joana Galvao
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ramesh V Nair
- Stanford Center for Genomics and Personalized Medicine, Stanford University, Palo Alto, CA, USA
| | - Michael S Kapiloff
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jeffrey L Goldberg
- Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA.
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Kowalczyk W, Romanelli L, Atkins M, Hillen H, Bravo González-Blas C, Jacobs J, Xie J, Soheily S, Verboven E, Moya IM, Verhulst S, de Waegeneer M, Sansores-Garcia L, van Huffel L, Johnson RL, van Grunsven LA, Aerts S, Halder G. Hippo signaling instructs ectopic but not normal organ growth. Science 2022; 378:eabg3679. [DOI: 10.1126/science.abg3679] [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: 11/18/2022]
Abstract
The Hippo signaling pathway is widely considered a master regulator of organ growth because of the prominent overgrowth phenotypes caused by experimental manipulation of its activity. Contrary to this model, we show here that removing Hippo transcriptional output did not impair the ability of the mouse liver and
Drosophila
eyes to grow to their normal size. Moreover, the transcriptional activity of the Hippo pathway effectors Yap/Taz/Yki did not correlate with cell proliferation, and hyperactivation of these effectors induced gene expression programs that did not recapitulate normal development. Concordantly, a functional screen in
Drosophila
identified several Hippo pathway target genes that were required for ectopic overgrowth but not normal growth. Thus, Hippo signaling does not instruct normal growth, and the Hippo-induced overgrowth phenotypes are caused by the activation of abnormal genetic programs.
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Affiliation(s)
- W. Kowalczyk
- VIB Center for Cancer Biology and KU Leuven Department of Oncology, KU Leuven, Leuven, Belgium
| | - L. Romanelli
- VIB Center for Cancer Biology and KU Leuven Department of Oncology, KU Leuven, Leuven, Belgium
| | - M. Atkins
- VIB Center for Cancer Biology and KU Leuven Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Biological Sciences, Sam Houston State University, Huntsville, TX, USA
| | - H. Hillen
- VIB Center for Cancer Biology and KU Leuven Department of Oncology, KU Leuven, Leuven, Belgium
| | - C. Bravo González-Blas
- VIB Center for Brain and Disease Research and KU Leuven Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - J. Jacobs
- VIB Center for Brain and Disease Research and KU Leuven Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - J. Xie
- VIB Center for Cancer Biology and KU Leuven Department of Oncology, KU Leuven, Leuven, Belgium
| | - S. Soheily
- VIB Center for Cancer Biology and KU Leuven Department of Oncology, KU Leuven, Leuven, Belgium
| | - E. Verboven
- VIB Center for Cancer Biology and KU Leuven Department of Oncology, KU Leuven, Leuven, Belgium
| | - I. M. Moya
- VIB Center for Cancer Biology and KU Leuven Department of Oncology, KU Leuven, Leuven, Belgium
- Facultad de Ingeniería y Ciencias Aplicadas, Universidad de Las Américas, Quito, Ecuador
| | - S. Verhulst
- Department for Cell Biology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussel-Jette, Belgium
| | - M. de Waegeneer
- VIB Center for Brain and Disease Research and KU Leuven Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - L. Sansores-Garcia
- VIB Center for Cancer Biology and KU Leuven Department of Oncology, KU Leuven, Leuven, Belgium
| | - L. van Huffel
- VIB Center for Cancer Biology and KU Leuven Department of Oncology, KU Leuven, Leuven, Belgium
| | - R. L. Johnson
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L. A. van Grunsven
- Department for Cell Biology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussel-Jette, Belgium
| | - S. Aerts
- VIB Center for Brain and Disease Research and KU Leuven Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - G. Halder
- VIB Center for Cancer Biology and KU Leuven Department of Oncology, KU Leuven, Leuven, Belgium
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Beykin G, Stell L, Halim MS, Nuñez M, Popova L, Nguyen BT, Groth SL, Dennis A, Li Z, Atkins M, Khavari T, Wang SY, Chang R, Fisher AC, Sepah YJ, Goldberg JL. Corrigendum to Phase 1b Randomized Controlled Study of Short Course Topical Recombinant Human Nerve Growth Factor (rhNGF) for Neuroenhancement in Glaucoma: Safety, Tolerability, and Efficacy Measure Outcomes. Am J Ophthalmol 2022;234:223-234. Am J Ophthalmol 2022; 242:254. [PMID: 35977854 DOI: 10.1016/j.ajo.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gala Beykin
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Laurel Stell
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Muhammad Sohail Halim
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Mariana Nuñez
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Lilia Popova
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Bac T Nguyen
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Sylvia L Groth
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Amy Dennis
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Zhongqiu Li
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Melissa Atkins
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Tom Khavari
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Sophia Y Wang
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Robert Chang
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Ann C Fisher
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Yasir J Sepah
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| | - Jeffrey L Goldberg
- The Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
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4
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Shah SH, Schiapparelli LM, Ma Y, Yokota S, Atkins M, Xia X, Cameron EG, Huang T, Saturday S, Sun CB, Knasel C, Blackshaw S, Yates Iii JR, Cline HT, Goldberg JL. Quantitative transportomics identifies Kif5a as a major regulator of neurodegeneration. eLife 2022; 11:68148. [PMID: 35259089 PMCID: PMC8947766 DOI: 10.7554/elife.68148] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 03/05/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
Many neurons in the adult central nervous system, including retinal ganglion cells (RGCs), degenerate and die after injury. Early axon protein and organelle trafficking failure is a key component in many neurodegenerative disorders yet changes to axoplasmic transport in disease models have not been quantified. We analyzed early changes in the protein ‘transportome’ from RGC somas to their axons after optic nerve injury and identified transport failure of an anterograde motor protein Kif5a early in RGC degeneration. We demonstrated that manipulating Kif5a expression affects anterograde mitochondrial trafficking in RGCs and characterized axon transport in Kif5a knockout mice to identify proteins whose axon localization was Kif5a-dependent. Finally, we found that knockout of Kif5a in RGCs resulted in progressive RGC degeneration in the absence of injury. Together with expression data localizing Kif5a to human RGCs, these data identify Kif5a transport failure as a cause of RGC neurodegeneration and point to a mechanism for future therapeutics.
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Affiliation(s)
- Sahil H Shah
- Byers Eye Institute and Spencer Center for Vision Research, Stanford University, Palo Alto, United States
| | | | - Yuanhui Ma
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, United States
| | - Satoshi Yokota
- Byers Eye Institute and Spencer Center for Vision Research, Stanford University, Palo Alto, United States
| | - Melissa Atkins
- Byers Eye Institute and Spencer Center for Vision Research, Stanford University, Palo Alto, United States
| | - Xin Xia
- Byers Eye Institute and Spencer Center for Vision Research, Stanford University, Palo Alto, United States
| | - Evan G Cameron
- Byers Eye Institute and Spencer Center for Vision Research, Stanford University, Palo Alto, United States
| | - Thanh Huang
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Sarah Saturday
- Neuroscience Department, The Scripps Research Institute, La Jolla, United States
| | - Catalin B Sun
- Byers Eye Institute and Spencer Center for Vision Research, Stanford University, Palo Alto, United States
| | - Cara Knasel
- Byers Eye Institute and Spencer Center for Vision Research, Stanford University, Palo Alto, United States
| | - Seth Blackshaw
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States
| | - John R Yates Iii
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, United States
| | - Hollis T Cline
- Neuroscience Department, The Scripps Research Institute, La Jolla, United States
| | - Jeffrey L Goldberg
- Byers Eye Institute and Spencer Center for Vision Research, Stanford University, Palo Alto, United States
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5
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Beykin G, Stell L, Halim MS, Nuñez M, Popova L, Nguyen BT, Groth SL, Dennis A, Li Z, Atkins M, Khavari T, Wang SY, Chang R, Fisher AC, Sepah YJ, Goldberg JL. Phase 1b Randomized Controlled Study of Short Course Topical Recombinant Human Nerve Growth Factor (rhNGF) for Neuroenhancement in Glaucoma: Safety, Tolerability, and Efficacy Measure Outcomes. Am J Ophthalmol 2022; 234:223-234. [PMID: 34780798 PMCID: PMC8821405 DOI: 10.1016/j.ajo.2021.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE No approved therapies directly target retinal ganglion cells (RGCs) for neuroprotection or neuroenhancement in glaucoma. Recombinant human nerve growth factor (rhNGF) has been shown to promote RGC survival and function in animal models of optic neuropathy. Here we evaluate the safety, tolerability, and efficacy of short-term, high-dose rhNGF eye drops versus placebo in a cohort of glaucoma patients. DESIGN This was a prospective, phase 1b, single-center, randomized, double-masked, vehicle-controlled, parallel-group study. METHODS This study was designed to assess safety and tolerability as well as short-term neuroenhancement of structure and function (clinicaltrials.gov NCT02855450). A total of 60 open-angle glaucoma patients were randomized 40:20 to receive either 180 μg/mL rhNGF or vehicle control eye drops in both eyes, 3 times daily for 8 weeks, with a 24-week post-treatment follow-up. One eye was officially selected as the study eye, although both eyes were studied and dosed. Primary endpoints were safety, as assessed by adverse events, and tolerability, as assessed by patient-reported outcomes. Secondary outcome measures included best corrected visual acuity (BCVA), Humphrey visual field, electroretinograpy (ERG), and optical coherence tomography (OCT) of retinal nerve fiber layer (RNFL) thickness at baseline, after 8 weeks of treatment, and at 4 and 24 weeks after treatment (12 and 32 weeks total). RESULTS Of the 60 randomized patients, 23 were female (38%) and the average age was 66.1 years. Through week 32, there were no treatment-related serious adverse events, including no unexpectedly severe progression of optic neuropathy, no adverse events affecting ocular function or pressure, and no drug-related systemic toxicity. Topical high-dose rhNGF was tolerated well, with a low level of symptom burden mainly eliciting periocular ache (in 52% of treated group and 5% of placebo group) and only 3 patients (7.5%) discontinuing treatment because of discomfort, of whom 1 patient (2.5%) prematurely withdrew from the study. There were no statistically significant differences in global indices of Humphrey visual field and no meaningful differences in total, quadrant, or clock-hour mean RNFL thickness between the groups, although both of these function and structure measures showed nonsignificant trends toward significance in favor of rhNGF. Real-world participant data was used to generate an estimate of cohort size needed to power subsequent studies. CONCLUSIONS Use of rhNGF is safe and tolerable in a topical 180-μg/mL formulation. Although no statistically significant short-term neuroenhancement was detected in this trial, given the strong effects of NGF in preclinical models and the trends detected in this study, analysis for efficacy in a neuroprotection trial is warranted. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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6
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Rumfola E, He B, Atkins M, McGowan CM, Ireland JL. Approaches to endocrinopathic laminitis in the field: Results of a survey of veterinary practitioners in North America. J Equine Vet Sci 2021; 110:103856. [PMID: 34958881 DOI: 10.1016/j.jevs.2021.103856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
Endocrinopathic laminitis is the most common cause of laminitis in the field. Insulin has recently been implicated as a key factor in development of endocrinopathic laminitis; however, it is unclear whether diagnostic and treatment approaches reflect insights derived from recent research. This study sought to evaluate North American veterinary practitioners' approach to endocrinopathic laminitis in the field. Demographic information, approach to diagnosis, management, and prognosis of endocrinopathic laminitis, as well as factors influencing changes in approach to laminitis were collected. To compare regional differences in approach to laminitis, results were compared to a recently published study from the United Kingdom. Findings of the present study suggest that North American practitioners have changed their approach to laminitis to more readily incorporate diagnostic testing for endocrine disease.
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Affiliation(s)
- E Rumfola
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States 70803
| | - Banse He
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States 70803.
| | - M Atkins
- Institute of Infection, Veterinary and Ecological Sciences, Department of Equine Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, CH64 7TE, United Kingdom
| | - C M McGowan
- Institute of Infection, Veterinary and Ecological Sciences, Department of Equine Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, CH64 7TE, United Kingdom
| | - J L Ireland
- Institute of Infection, Veterinary and Ecological Sciences, Department of Equine Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, CH64 7TE, United Kingdom
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7
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Xia X, Atkins M, Dalal R, Kuzmenko O, Chang KC, Sun CB, Benatti CA, Rak DJ, Nahmou M, Kunzevitzky NJ, Goldberg JL. Magnetic Human Corneal Endothelial Cell Transplant: Delivery, Retention, and Short-Term Efficacy. Invest Ophthalmol Vis Sci 2019; 60:2438-2448. [PMID: 31158276 PMCID: PMC6546151 DOI: 10.1167/iovs.18-26001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Corneal endothelial dysfunction leads to corneal edema, pain, and vision loss. Adequate animal models are needed to study the safety and efficacy of novel cell therapies as an alternative to corneal transplantation. Methods Primary human corneal endothelial cells (HCECs) were isolated from cadaveric donor corneas, expanded in vitro, transduced to express green fluorescent protein (GFP), loaded with superparamagnetic nanoparticles, and injected into the anterior chamber of adult rabbits immediately after endothelial cell or Descemet's membrane stripping. The same volume of balanced salt solution plus (BSS+) was injected in control eyes. We compared different models for inducing corneal edema in rabbits, and examined the ability of transplanted HCECs to reduce corneal edema over time by measuring central corneal thickness and tracking corneal clarity. GFP-positive donor cells were tracked in vivo using optical coherence tomography (OCT) fluorescence angiography module, and the transplanted cells were confirmed by human nuclei immunostaining. Results Magnetic HCECs integrated onto the recipient corneas with intact Descemet's membrane, and donor identity was confirmed by GFP expression and immunostaining for human nuclei marker. Donor HCECs formed a monolayer on the posterior corneal surface and expressed HCEC functional markers of tight junction formation. No GFP-positive cells were observed in the trabecular meshwork or on the iris, and intraocular pressure remained stable through the length of the study. Conclusions Our results demonstrate magnetic cell-based therapy efficiently delivers HCECs to restore corneal transparency without detectable toxicity or adverse effect on intraocular pressure. Magnetic delivery of HCECs may enhance corneal function and should be explored further for human therapies.
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Affiliation(s)
- Xin Xia
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Melissa Atkins
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Roopa Dalal
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Olga Kuzmenko
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Kun-Che Chang
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Catalina B Sun
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - C Andres Benatti
- Shiley Eye Center, University of California, San Diego, La Jolla, California, United States
| | - Dillon J Rak
- Shiley Eye Center, University of California, San Diego, La Jolla, California, United States
| | - Michael Nahmou
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Noelia J Kunzevitzky
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States.,Shiley Eye Center, University of California, San Diego, La Jolla, California, United States.,Emmecell, Menlo Park, California, United States
| | - Jeffrey L Goldberg
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States.,Shiley Eye Center, University of California, San Diego, La Jolla, California, United States
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8
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Gramlich L, Martin L, Atkins M, Gillam M, Sheppard C, Buhler S, Basualdo Hammond C, Nelson G. SUN-LB320: The Impact of Enhanced Recovery after Surgery on Nutrition Care. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30643-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: 10/18/2022]
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9
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Sznol M, Ferrucci P, Hogg D, Atkins M, Wolter P, Guidoboni M, Lebbe C, Kirkwood J, Schachter J, Daniels G, Hassel J, Cebon J, Gerritsen W, Atkinson V, Thomas L, McCaffrey J, Power D, Jiang J, Hodi F, Wolchok J. Safety profile of nivolumab (NIVO) and ipilimumab (IPI) combination therapy in patients (pts) with advanced melanoma (MEL). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw379.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Beloukas A, King S, Childs K, Papadimitropoulos A, Hopkins M, Atkins M, Agarwal K, Nelson M, Geretti A. Detection of the NS3 Q80K polymorphism by Sanger and deep sequencing in hepatitis C virus genotype 1a strains in the UK. Clin Microbiol Infect 2015; 21:1033-9. [DOI: 10.1016/j.cmi.2015.07.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/14/2015] [Accepted: 07/19/2015] [Indexed: 01/27/2023]
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11
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Kabir MS, Clements MO, Atkins M, Kimmitt PT. Application of RT-Bst to enhance detection of pathogenic viruses of the respiratory tract. Br J Biomed Sci 2015; 72:128-34. [PMID: 26510269 DOI: 10.1080/09674845.2015.11666809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Inefficiency of RT-PCR can be associated with the suboptimal process of reverse transcription as only 40-80% of RNA is converted to cDNA. We employed a novel method, RT-Bst, to enrich the concentration of cDNA for subsequent multiplex PCR detection of selected RNA viruses. The RT-Bst method amplifies cDNA through reverse transcription of viral RNA using reverse transcriptase and amplification of cDNA using Bst DNA polymerase. Viral RNA was extracted from 25 nasopharyngeal samples for detection of influenza A, B and C; parainfluenza 1-4; human coronaviruses 229E and OC43; respiratory syncytial virus (RSV) and rhinovirus. Both multiplex one-step RT-PCR and RT-Bst PCR were used to compare their performances for detection of virus sequences. These findings were compared with routine laboratory detection. When using RT-Bst PCR, 28% of samples yielded a viral pathogen compared to 20% with RT-PCR and 12% using routine diagnostic tests. RT-Bst PCR was shown to have particular utility in the detection of RSV RNA as this was present in 20% of the samples studied compared to 8% when using RT-PCR. For one patient, RT-Bst PCR was able to detect RSV five days earlier than conventional hospital diagnostic testing. RT-Bst and RT-Bst PCR can be used as alternative approaches to reverse transcription and one-step RT-PCR, respectively, for sequence-independent amplification of RNA virus sequences and a larger scale analysis of this new diagnostic approach is warranted.
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King S, Adjei-Asante K, Appiah L, Adinku D, Beloukas A, Atkins M, Sarfo SF, Chadwick D, Phillips RO, Geretti AM. Antibody screening tests variably overestimate the prevalence of hepatitis C virus infection among HIV-infected adults in Ghana. J Viral Hepat 2015; 22:461-8. [PMID: 25394987 DOI: 10.1111/jvh.12354] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/17/2014] [Indexed: 12/18/2022]
Abstract
HIV coinfection with HCV has been poorly studied in sub-Saharan Africa, and the reliability of available seroprevalence estimates remains uncertain. The study aim was to determine HCV RNA prevalence in HIV-infected subjects receiving care in Kumasi, Ghana, and relate the findings to HCV antibody detection. From a population of 1520 HIV-infected adults, all HBsAg-positive subjects (n = 236) and a random subset of HBsAg-negative subject (n = 172) were screened for HCV RNA using pooled plasma; positive samples were genotyped by core and NS5B sequencing. HCV antibodies were detected by three commercial screening assays and confirmed by the line immunoassay. HCV RNA was detected in 4/408 subjects (1.0%, 95% confidence interval 0.0-1.9%), comprising 3/236 (1.3%; 0.0-2.8%) HBsAg-positive and 1/172 (0.6%; 0.0-1.8%) HBsAg-negative subjects. HCV RNA-positive subjects showed reactivity in all three antibody screening assays. Among HCV RNA-negative subjects, 5/67 (7.5%), 5/67 (7.5%) and 19/67 (28.4%) showed antibody reactivity by each screening assay, respectively, including two (3.0%) with reactivity by all three assays. Only one sample (1.5%) had confirmed antibody reactivity by line immunoassay indicating past HCV infection. HCV-positive subjects (three males, two females) were aged 30-46 years, by questionnaire-based interview reported surgical procedures and blood transfusion as risk factors for infection. HCV genotypes were 2 (subtypes 2j, 2l, 2k/unassigned) and 1 (subtype unassigned). Without further testing, HCV antibody screening assays variably overestimated HCV prevalence among HIV-infected subjects in Ghana. These findings inform the interpretation of previous seroprevalence estimates based upon screening assays alone.
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Affiliation(s)
- S King
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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Rayment M, Doku E, Thornton A, Pearn M, Sudhanva M, Jones R, Nardone A, Roberts P, Tenant-Flowers M, Anderson J, Sullivan AK, Atkins M. Automatic oral fluid-based HIV testing in HIV screening programmes: automatic for the people. HIV Med 2014; 14 Suppl 3:49-52. [PMID: 24033905 DOI: 10.1111/hiv.12063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES UK guidelines recommend routine HIV testing in general clinical settings when the local HIV prevalence is > 0.2%. During pilot programmes evaluating the guidelines, we used laboratory-based testing of oral fluid from patients accepting tests. Samples (n = 3721) were tested manually using the Bio-Rad Genscreen Ultra HIV Ag-Ab test (Bio-Rad Laboratories Ltd, Hemel Hempstead, UK). This was a methodologically robust method, but handling of samples was labour intensive. We performed a validation study to ascertain whether automation of oral fluid HIV testing using the fourth-generation HIV test on the Abbott Architect (Abbott Diagnostics, Maidenhead, UK) platform was possible. METHODS Oral fluid was collected from 143 patients (56 known HIV-positive volunteers and 87 others having contemporaneous HIV serological tests) using the Oracol+ device (Malvern Medicals, Worcester, UK). Samples were tested concurrently: manually using the Genscreen Ultra test and automatically on the Abbott Architect. RESULTS For oral fluid, the level of agreement of results between the platforms was 100%. All results agreed with HIV serology. The use of the Oracol+ device produced high-quality samples. Subsequent field use of the test has shown a specificity of 99.97% after nearly 3000 tests. CONCLUSIONS Laboratory-based HIV testing of oral fluid requires less training of local staff, with fewer demands on clinical time and space than near-patient testing. It is acceptable to patients. The validation exercise and subsequent clinical experience support automation, with test performance preserved. Automation reduces laboratory workload and speeds up the release of results. Automated oral fluid testing is thus a viable option for large-scale HIV screening programmes.
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Affiliation(s)
- M Rayment
- Directorate of HIV/GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust
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Rayment M, Rae C, Ghooloo F, Doku E, Hardie J, Finlay S, Gidwani S, Atkins M, Roberts P, Sullivan AK. Routine HIV testing in the emergency department: tough lessons in sustainability. HIV Med 2014; 14 Suppl 3:6-9. [PMID: 24033895 DOI: 10.1111/hiv.12069] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Routine HIV testing in nonspecialist settings has been shown to be acceptable to patients and staff in pilot studies. The question of how to embed routine HIV testing, and make it sustainable, remains to be answered. METHODS We established a service of routine HIV testing in an emergency department (ED) in London, delivered by ED staff as part of routine clinical care. All patients aged 16 to 65 years were offered an HIV test (latterly the upper age limit was removed). Meetings were held weekly and two outcome measures examined: test offer rate (coverage) and test uptake. Sustainability methodology (process mapping; plan-do-study-act (PDSA) cycles) was applied to maximize these outcome measures. RESULTS Over 30 months, 44,582 eligible patients attended the ED. The mean proportion offered an HIV test was 14%, varying from 6% to 54% per month over the testing period. The mean proportion accepting a test was 63% (range 33-100%). A total of 4327 HIV tests have been performed. Thirteen patients have been diagnosed with HIV infection (0.30%). PDSA cycles having the most positive and sustained effects on the outcome measures include the expansion to offer blood-based HIV tests in addition to the original oral fluid tests, and the engagement of ED nursing staff in the programme. CONCLUSIONS HIV testing can be delivered in the ED, but constant innovation and attention have been required to maintain it over 30 months. Patient uptake remains high, suggesting acceptability, but time will be required before true embedding in routine clinical practice is achieved.
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Affiliation(s)
- M Rayment
- Directorate of HIV/GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust
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Turnbull N, Hawkins D, Atkins M, Francis N, Roberts N. Persistent erythema multiforme associated with Epstein-Barr virus infection. Clin Exp Dermatol 2013; 39:154-7. [PMID: 24313260 DOI: 10.1111/ced.12243] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2013] [Indexed: 11/30/2022]
Abstract
Erythema multiforme (EM) is a common, self-limiting condition. Recurrent EM is a well-recognised variant, often associated with herpes simplex virus infection. It is frequently managed with prophylactic aciclovir. Anecdotal reports suggest that recurrent EM may be associated with the use of corticosteroids. Persistent EM, however, is a rare variant, with few cases reported in the literature. It has a protracted course often with atypical and inflammatory lesions. It has been associated with occult viral infections, particularly Epstein-Barr Virus (EBV), as well as inflammatory bowel disease and malignancy. We report a case of EM associated with EBV infection.
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Affiliation(s)
- N Turnbull
- Department of Dermatology, Chelsea and Westminster Hospital, London, UK
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Bashford J, Nelson M, Bower M, Atkins M. JC -- a forgotten foe or a foe to be forgotten? HIV Med 2013; 14:326. [PMID: 23551323 DOI: 10.1111/hiv.12018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jewett M, Finelli A, Kollmannsberger C, Wood L, Legere L, Basiuk J, Canil C, Heng D, Reaume N, Tanguay S, Atkins M, Bjarnason G, Dancey J, Evans M, Fleshner N, Haider M, Kapoor A, Uzzo R, Maskens D, Soulieres D, Yousef G, Basappa N, Bendali N, Black P, Blais N, Cagiannos I, Care M, Chow R, Chung H, Czaykowski P, Derosa D, Durrant K, Ellard S, Farquharson G, Filion-Brulotte C, Gingerich J, Godbout L, Grant R, Hamilton W, Kassouf W, Kurban G, Lane K, Lattouf J, Lau D, Leveridge M, McCarthy J, Moore R, North S, O'brien P, Pituskin E, Racine P, Rendon R, So A, Sridhar S, Stubbs K, Su Z, Taylor L, Udall T, Venner P, Vogel W, Yap S, Yau P, Cooper M, Giroux N, Miron D, Mosher D, Ross K, Willacy J. Management of kidney cancer: canadian kidney cancer forum consensus update 2011. Can Urol Assoc J 2012; 6:16-22. [PMID: 22396361 DOI: 10.5489/cuaj.11273] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Jackson AG, Kløverpris HN, Handley A, Hayes P, Gilmour J, Atkins M, Walker B, Ackland J, Sullivan M, Goulder P. A first-in-man, double blind, placebo controlled study of the candidate therapeutic vaccine Opal-HIV-Gag(c) in HIV infected patients receiving HAART. Retrovirology 2012. [PMCID: PMC3441710 DOI: 10.1186/1742-4690-9-s2-o54] [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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Kløverpris H, Jackson A, Handley A, Hayes P, Gilmour J, Atkins M, Walker B, Ackland J, Sullivan M, Goulder P. Immune response after vaccination of HIV infected individuals receiving HAART with overlapping gag peptides pulsed on autologous cells. Retrovirology 2012. [PMCID: PMC3441579 DOI: 10.1186/1742-4690-9-s2-p115] [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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Atkins M, Glasser FP, Kindness A. Phase Relations and Solubility Modelling in the Cao- SiO2- Al2O3- MgO- SO3-H2O System: For Application To Blended Cementss. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-212-387] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTCement blends are likely to form a large fraction of the materials in the near field of radioactive repositories. Being chemically reactive and slightly soluble, their effect on near field chemistry will be very marked. Predictions of nuclide migration in this zone will therefore depend in part on accurate modelling of cement chemistry.The models being developed require the establishment of correct phase relations in the Cao- SiO2- Al2O3- MgO- SO3-H2O system (the major cement components). More than 40 compatibility experiments were carried out to determine these relationships. Purified cement hydrates were shaken continuously in CO2- free water, for 10 weeks. The results from these experiments together with data from the literature, enabled us to construct a better validated phase relations scheme than has hitherto been possible.Interpretational problems were encountered. Thus, mixtures containing Ca(OH)2, gave rise to the precipitation of metastable phases. This is due to special dissolution/ precipitation equilibria obtaining at early age, allowing ‘AFm type’ (4CaO.Al2O3.SO3.12H2O) phases to form, where C3AH6 (3CaO.Al2O3.6H2O) and AFt (6CaO.Al2O3.3SO3.32H2O) are thermodynamically favoured.
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Teague A, Rossi M, Gilmour C, Watson L, Atkins M, McOwan A. Use of two HIV-POCT tests to identify false reactives. Int J STD AIDS 2009; 20:808-9. [PMID: 19854884 DOI: 10.1258/ijsa.2009.009346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Tan LKK, Gilleece Y, Mandalia S, Murungi A, Grover D, Fisher M, Atkins M, Nelson M. Reduced glomerular filtration rate but sustained virologic response in HIV/hepatitis B co-infected individuals on long-term tenofovir. J Viral Hepat 2009; 16:471-8. [PMID: 19457140 DOI: 10.1111/j.1365-2893.2009.01084.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Reports have described a decrease in glomerular filtration rate (eGFR) associated with tenofovir disoproxil fumarate (TDF) use in HIV positive individuals. However, no study has examined renal function over a prolonged period in HIV/hepatitis B virus (HBV) co-infected patients. We assessed the long-term durability and toxicity of TDF in a cohort of 39 e antigen (eAg) positive co-infected patients commenced on TDF 245 mg daily either in addition to or as part of standard antiretroviral therapy. Immunological and virological parameters were followed to 260 weeks, with the median follow-up period being 251 weeks (range 69-290 weeks). eGFR was calculated using the Modification in Diet in Renal Disease equation. On treatment at 260 weeks, 88% (14/16) had HIV viral load <50 copies/mL, median CD4 count rose from 318 to 532 cells/mm(3), median alanine aminotransferase (ALT) fell from 61 IU/L to 42 IU/L, with 35% (7/20) having a normal ALT, median HBV DNA fell from 69 x 10(6) copies/mL to 500 copies/mL, with 75% (12/16) having an undetectable HBV DNA level and 55% (6/11) becoming eAg negative. Of those with detectable HBV DNA, none had TDF resistance mutations. The eGFR declined by 22.19 mL/min/1.73 mm(2) from baseline (P = 0.023) over this period, which was unaffected by protease inhibitor use, baseline CD4 count, ALT or HBV DNA level. Three patients discontinued TDF therapy due to renal dysfunction. In conclusion, TDF has sustained efficacy but is associated with a significant decline in eGFR. Further larger studies are required to clarify this observation.
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Affiliation(s)
- L K K Tan
- Department of HIV Medicine, Chelsea and Westminster Hospital, London, UK.
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24
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Choueiri TK, Regan M, Oh W, Clement J, Amato A, McDermott D, Cho D, Atkins M, Signoretti S. Prognostic and predictive values of carbonic anhydrase IX (CAIX) and pathologic features in patients with metastatic clear cell renal cell carcinoma receiving targeted therapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16067 Background: Tumor Carbonic Anhydrase IX (CAIX) expression and histologic features can predict outcome in patients with metastatic renal cell carcinoma (mRCC) treated with immunotherapy. We sought to investigate the prognostic and predictive utility of such features in patients receiving VEGF-targeted therapy. Methods: We identified 118 patients with mRCC initiating first- line VEGF-targeted therapy including 94 with clinical data, clear cell histology and available tissue. Tumors were evaluated for specific histologic features and for CAIX expression by immunohistochemistry using the MN75 antibody. The relationship between these pathology findings and tumor shrinkage and other treatment outcomes was assessed. Results: Higher tumor clear cell component was independently associated with greater tumor shrinkage (p=0.02), response (p=0.02) and treatment duration (p=0.02). Patients with high vs. low tumor CAIX expression had mean tumor shrinkages of -12% vs. -5%, respectively (p=.38). There was heterogeneity in tumor responsiveness to sunitinib or sorafenib according to CAIX status (p=0.055 for interaction): mean shrinkage was -17% vs. -25% (mean difference +8%, 95% CI -14% to +31%) for sunitinib-treated patients with high vs. low tumor CAIX expression compared to -13% vs. +9% (mean difference -22%, 95% CI -42% to -1%) for sorafenib-treated patients. Conclusions: Patients with higher clear cell component in their tumors are likely to experience superior clinical benefit from VEGF-targeted therapy. Although CAIX expression was not found to be of prognostic value in patients with clear cell mRCC treated with VEGF-targeted therapy, it may be a predictive biomarker for response to sorafenib treatment. [Table: see text]
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Affiliation(s)
- T. K. Choueiri
- Dana- Faber Cancer Institute, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - M. Regan
- Dana- Faber Cancer Institute, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - W. Oh
- Dana- Faber Cancer Institute, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - J. Clement
- Dana- Faber Cancer Institute, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - A. Amato
- Dana- Faber Cancer Institute, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - D. McDermott
- Dana- Faber Cancer Institute, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - D. Cho
- Dana- Faber Cancer Institute, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - M. Atkins
- Dana- Faber Cancer Institute, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - S. Signoretti
- Dana- Faber Cancer Institute, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA
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Xu WM, Cui YT, Wang L, Yang H, Liang ZQ, Li XM, Zhang SL, Qiao FY, Campbell F, Chang CN, Gardner S, Atkins M. Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study. J Viral Hepat 2009; 16:94-103. [PMID: 19175878 DOI: 10.1111/j.1365-2893.2008.01056.x] [Citation(s) in RCA: 269] [Impact Index Per Article: 17.9] [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: 12/11/2022]
Abstract
This randomized, double-blind, placebo-controlled study evaluated whether lamivudine given during late pregnancy can reduce hepatitis B virus (HBV) perinatal transmission in highly viraemic mothers. Mothers were randomized to either lamivudine 100 mg or placebo from week 32 of gestation to week 4 postpartum. At birth, infants received recombinant HBV vaccine with or without HBIg and were followed until week 52. One hundred and fifty mothers, with a gestational age of 26-30 weeks and serum HBV DNA >1000 MEq/mL (bDNA assay), were treated. A total of 141 infants received immunoprophylaxis at birth. In lamivudine-treated mothers, 56 infants received vaccine + HBIg (lamivudine + vaccine + HBIg) and 26 infants received vaccine (lamivudine + vaccine). In placebo-treated mothers, 59 infants received vaccine + HBIg (placebo + vaccine + HBIg). At week 52, in the primary analyses where missing data was counted as failures, infants in the lamivudine + vaccine + HBIg group had a significant decrease in incidence of HBsAg seropositivity (10/56, 18%vs 23/59, 39%; P = 0.014) and in detectable HBV DNA (11/56, 20%vs 27/59, 46%; P = 0.003) compared to infants in the placebo + vaccine + HBIg group. Sensitivity analyses to evaluate the impact of missing data at week 52 resulting from a high dropout rate (13% in the lamivudine + vaccine + HBIg group and 31% in the placebo + vaccine + HBIg group) remained consistent with the primary analysis in that lower transmission rates were still observed in the infants of lamivudine-treated mothers, but the differences were not statistically significant. No safety concerns were noted in the lamivudine-treated mothers or their infants. Results of this study suggest that lamivudine reduced HBV transmission from highly viraemic mothers to their infants who received passive/active immunization.
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Affiliation(s)
- W-M Xu
- Shanghai Infectious Disease Hospital, Shanghai, China.
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26
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Palmer GM, Atkins M, Anderson BJ, Smith KR, Culnane TJ, McNally CM, Perkins EJ, Chalkiadis GA, Hunt RW. I.V. acetaminophen pharmacokinetics in neonates after multiple doses. Br J Anaesth 2008; 101:523-30. [PMID: 18628265 DOI: 10.1093/bja/aen208] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pharmacokinetics of an i.v. prodrug of acetaminophen (propacetamol) in neonates after repeat dosing are reported, with scant data for i.v. acetaminophen formulation. METHODS Neonates from an intensive care unit received 6-hourly prn i.v. acetaminophen dosed according to postmenstrual age (PMA): 28-32 weeks, 10 mg kg(-1); 32-36 weeks, 12.5 mg kg(-1); and > or =36 weeks, 15 mg kg(-1). A maximum of five blood samples for assay and liver function tests (LFTs) were collected. A one-compartment linear disposition model (zero-order input; first-order elimination) was used to describe time-concentration profiles using population modelling (NONMEM). RESULTS Fifty neonates, median (range) PMA 38.6 (32-45) weeks, mean (SD) weight 2.9 (0.7) kg, received a mean of 15 doses over a median 4 days with 189 serum acetaminophen and 231 LFT measurements. Standardized population parameter estimates for a term neonate were clearance (CL) 5.24 (CV 30.5%) litre h(-1) 70 kg(-1) and volume of distribution (V) 76 (29.6%) litre 70 kg(-1). CL increased with PMA from 4.4 litre h(-1) 70 kg(-1) at 34 weeks to 6.3 litre h(-1) 70 kg(-1) at 46 weeks. The presence of unconjugated hyperbilirubinaemia was associated with reduced CL: 150 micromol litre(-1) associated with 40% CL reduction. Acetaminophen concentrations between 10 and 23 mg litre(-1) at steady state are predicted after 15 mg kg(-1) 6-hourly for a neonate of PMA 40 weeks. Hepatic enzyme analysis of daily samples changed significantly for one patient whose alanine aminotransferase concentration tripled. CONCLUSIONS The parameter estimates are similar to those described for propacetamol. There was no evidence of hepatotoxicity. Unconjugated hyperbilirubinaemia impacts upon CL, dictating dose reduction.
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Affiliation(s)
- G M Palmer
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, VIC 3052, Australia.
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Wang J, Ozzard A, Nathan M, Atkins M, Nelson M, Gazzard B, Bower M. The significance of Epstein-Barr virus detected in the cerebrospinal fluid of people with HIV infection. HIV Med 2007; 8:306-11. [PMID: 17561877 DOI: 10.1111/j.1468-1293.2007.00475.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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
INTRODUCTION Epstein-Barr virus (EBV) is detected in the cerebrospinal fluid (CSF) in people with HIV infection who develop primary cerebral lymphoma (PCL). However, EBV may also be detected in the CSF of patients without PCL, and here the significance is uncertain. METHODS Ninety-eight HIV-positive patients had lumbar punctures performed and polymerase chain reaction (PCR) for EBV was undertaken on the CSF. Thirty-eight patients had non-Hodgkin's lymphoma (NHL), including four with PCL. Sixty patients had a CSF examination for other indications. The clinicopathological details, symptoms, diagnosis, CSF and neuroimaging findings and therapy at time of CSF were recorded and correlated with CSF EBV PCR results. RESULTS EBV was detected in the CSF in three of four patients (75%) with PCL, one of three (33%) with systemic lymphoma and meningeal involvement, and four of 31 (13%) with systemic lymphoma and no meningeal disease. Seven of 60 patients (12%) without lymphoma were CSF EBV-positive. There were no differences in immunological, clinical, biochemical or radiological parameters between patients with and without EBV in the CSF. After a median follow-up time of 30 weeks (maximum 102 weeks), none of the seven CSF EBV-positive patients has developed PCL. CONCLUSION EBV was detected in up to 12% of patients with neurological symptoms but without lymphoma. A positive result did not correlate with more advanced immunosuppression or a particular neurological diagnosis. Patients with EBV in their CSF did not appear to be at increased risk of developing PCL in the short term.
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Affiliation(s)
- J Wang
- Department of Oncology and HIV Medicine, Chelsea and Westminster Hospital, London, UK
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Atkins M. Cost to the NHS of Roche oncology treatments. J R Soc Med 2007. [DOI: 10.1258/jrsm.100.7.303] [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: 11/18/2022] Open
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Bower M, Powles T, Williams S, Newsom-Davis T, Atkins M, Stebbing J, Montoto S, Nelson M, Webb A, Kelleher P. Rituximab induces long-term remissions in patients with HIV-associated multicentric Castleman's disease. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8049] [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
8049 Background: HIV associated multicentric Castlemans (MCD) is rare lympohproliferative disorder and most treatment options to date, have proved largely unsuccessful. This study investigated the efficacy of the anti CD20 monoclonal antibody rituximab in patients with this disease. Methods: Between 2003 and 2006, patients with histological proven HIV related MCD received a course of 4 infusions of rituximab 375mg/m2 at weekly intervals. Results: Twenty one consecutive patients (18 male) were recruited into this study and the median follow-up is 12 months (range 1–49). The median age was 37 years and all patients were either on highly active antiretroviral therapy (HAART) (62%) or started HAART at the time of MCD diagnosis (38%). The median CD4 cell count at MCD diagnosis was 275/mm3 (range 77–725). One died within 2 weeks of starting rituximab (not evaluable); 20 evaluable patients all achieved clinical remission of symptoms and 71% achieved a radiological response according to RECIST criteria. Rituximab lead to a significant fall in anaemia, thrombocytopenia, CRP, ESR, serum HHV8 viral load and IL-10. Rituximab caused transitory fall in the CD19 count, but had no effect on the CD4, CD8 and NK cell counts or plasma HIV viral load. The disease free survival at 2 years is 79% (95%CI: 49–100%) and overall survival is 95% (95%CI: 86–100%). Two patients have relapsed after 1.6 & 2.8 years and were successfully retreated with rituximab therapy. Conclusions: Rituximab therapy results in a sustained clinical, radiological and biochemical remission in patients with HIV related MCD. No significant financial relationships to disclose.
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Affiliation(s)
- M. Bower
- Chelsea and Westminster Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Royal Sussex County Hospital, Brighton, United Kingdom
| | - T. Powles
- Chelsea and Westminster Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Royal Sussex County Hospital, Brighton, United Kingdom
| | - S. Williams
- Chelsea and Westminster Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Royal Sussex County Hospital, Brighton, United Kingdom
| | - T. Newsom-Davis
- Chelsea and Westminster Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Royal Sussex County Hospital, Brighton, United Kingdom
| | - M. Atkins
- Chelsea and Westminster Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Royal Sussex County Hospital, Brighton, United Kingdom
| | - J. Stebbing
- Chelsea and Westminster Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Royal Sussex County Hospital, Brighton, United Kingdom
| | - S. Montoto
- Chelsea and Westminster Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Royal Sussex County Hospital, Brighton, United Kingdom
| | - M. Nelson
- Chelsea and Westminster Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Royal Sussex County Hospital, Brighton, United Kingdom
| | - A. Webb
- Chelsea and Westminster Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Royal Sussex County Hospital, Brighton, United Kingdom
| | - P. Kelleher
- Chelsea and Westminster Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Royal Sussex County Hospital, Brighton, United Kingdom
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Negin BP, Panka D, Wang W, Tawa N, Mullen J, Tahan S, Mandato L, Polivy A, Mier J, Atkins M. Effect of melanoma on immune function in regional lymph nodes (LN). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.8000] [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
8000 Background: Metastatic melanoma is associated with various measures of systemic and local immune suppression. We hypothesized that immune suppression in the regional LN basin exists and may facilitate melanoma progression. Methods: We collected portions of regional LNs from tumor uninvolved sentinel LNs (USLN) (remote from primary melanoma removal) and from macroscopically involved nodes (TILN) from therapeutic node dissections in successive melanoma patients. Lymphocytes were extracted, stained using surface and internal antibodies to T cell receptor zeta chain (TCRζ), T regulatory cells (CD4+CD25+ Fox 3p+) (Tregs) and tumor associated myeloid cells (CD11b+ CD14- CD15+) (TAMC), and analyzed via flow cytometer. Results from USLN specimens were compared with TILN. Results: 30 LNs (14 USLN/16 TILN) from 30 patients were evaluated. Median age of patients was 48 years (range 30–83); 20 were male. USLN patients were stage IB (12) or IIA (2); TILN patients were stage IIIB (5), IIIC (5), and IV (6). 7 patients with TILN and none with USLN have progressed. TILN had significantly less TCRζ chain expression than SLN (62% vs. 85%; p = 0.0001). This amounts to a localized decrease of 23% of TCRζ expression (95% CI 13%; 34%). No significant relationship between lymph node involvement and Treg or TAMC was documented. Conclusion: Regional LN involvement with melanoma is associated with a significant reduction in lymphocyte TCRζ expression indicating immune suppression. The mechanism for this is uncertain, but does not appear to be related to changes in Tregs or TAMC (arginase producing cells). We plan to further investigate TCRζ expression in microscopically involved SLNs and SLNs removed at time of primary excision to see if immune changes precede macroscopic tumor involvement. Supported by Harvard Skin SPORE Project 5 and Immune Monitoring Core P50CA93683–01 No significant financial relationships to disclose.
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Affiliation(s)
- B. P. Negin
- Cutaneous Oncology Program; Beth Israel Deaconess Medical Center, Boston, MA
| | - D. Panka
- Cutaneous Oncology Program; Beth Israel Deaconess Medical Center, Boston, MA
| | - W. Wang
- Cutaneous Oncology Program; Beth Israel Deaconess Medical Center, Boston, MA
| | - N. Tawa
- Cutaneous Oncology Program; Beth Israel Deaconess Medical Center, Boston, MA
| | - J. Mullen
- Cutaneous Oncology Program; Beth Israel Deaconess Medical Center, Boston, MA
| | - S. Tahan
- Cutaneous Oncology Program; Beth Israel Deaconess Medical Center, Boston, MA
| | - L. Mandato
- Cutaneous Oncology Program; Beth Israel Deaconess Medical Center, Boston, MA
| | - A. Polivy
- Cutaneous Oncology Program; Beth Israel Deaconess Medical Center, Boston, MA
| | - J. Mier
- Cutaneous Oncology Program; Beth Israel Deaconess Medical Center, Boston, MA
| | - M. Atkins
- Cutaneous Oncology Program; Beth Israel Deaconess Medical Center, Boston, MA
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31
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Bolam SG, Rees HL, Somerfield P, Smith R, Clarke KR, Warwick RM, Atkins M, Garnacho E. Ecological consequences of dredged material disposal in the marine environment: a holistic assessment of activities around the England and Wales coastline. Mar Pollut Bull 2006; 52:415-26. [PMID: 16256147 DOI: 10.1016/j.marpolbul.2005.09.028] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Accepted: 09/14/2005] [Indexed: 05/05/2023]
Abstract
This study provides a holistic perspective on the ecological effects of dredged material disposal, both intertidally and subtidally. A number of numerical techniques (univariate, distributional, multivariate and meta-analysis) were used to assess impacts at 18 different disposal sites. The analyses revealed that ecological effects associated with dredged material disposal were dependent on the numerical techniques used, and that impacts were disposal-site specific. Disposal-site communities were generally faunistically impoverished to varying degrees, and impacts following intertidal placement were comparable to those of subtidal placement. We conclude that any assessment of the consequences of dredged material disposal to the coastal environment must take account of site-specific variation in prevailing hydrographic regimes and in ecological status, along with information on the disposal activity itself (mode, timing, quantity, frequency and type of material). As would be expected, variability in the latter presents a significant challenge in attempts to generalise about environmental and ecological impacts.
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Affiliation(s)
- S G Bolam
- Centre for Environment, Fisheries and Aquaculture Science, Burnham-on-Crouch, Essex, UK.
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Linnebjerg H, Kothare PA, Skrivanek Z, de la Peña A, Atkins M, Ernest CS, Trautmann ME. Exenatide: effect of injection time on postprandial glucose in patients with Type 2 diabetes. Diabet Med 2006; 23:240-5. [PMID: 16492205 DOI: 10.1111/j.1464-5491.2006.01800.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Exenatide is an incretin mimetic whose effect on glycaemic control in patients with Type 2 diabetes is currently under investigation. This study assessed the effect of injection time relative to a standardized meal on postprandial pharmacodynamics of exenatide in patients with Type 2 diabetes. METHODS Eighteen patients participated in this single-centre, open-label, placebo-controlled, randomized, six-way crossover study. Patients received subcutaneous injections of either placebo (-15 min) or 10 microg of exenatide at -60, -15, 0, +30 or +60 min relative to a standardized breakfast meal on six consecutive days. Serial blood samples were assayed for plasma glucose and insulin concentrations. RESULTS For all exenatide treatments, incremental postprandial glucose area under the postprandial plasma glucose curve from zero to 6 h (AUC0-6 h) was significantly reduced compared with placebo. When exenatide was administered before (-60, -15 min) or with the meal (0 min), peak postprandial glucose concentrations were significantly decreased (P < 0.0001 for all treatments) compared with placebo. Post-meal exenatide administration (+30, P < 0.05; +60 min, P = 0.21) resulted in smaller peak glucose reductions and in some patients transient low plasma glucose concentrations were reported. Peak plasma insulin concentrations in the pre-meal treatments were significantly lower than placebo (P < 0.05 for all treatments), while post-meal dosing groups exhibited a trend towards higher insulin peaks compared with placebo. The most common adverse events related to exenatide were headache, nausea, dyspepsia and vomiting, and were generally of mild-to-moderate intensity. CONCLUSIONS In this study, all exenatide treatments demonstrated reductions in postprandial plasma glucose excursions compared with placebo. Pre-meal and with meal administration of exenatide produced greater reduction of postprandial glucose excursions compared with post-meal administration. These data support flexible dosing of exenatide at any time within 60 min before a meal.
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Affiliation(s)
- H Linnebjerg
- Eli Lilly and Company Limited, Lilly Research Centre, Erl Wood Manor, UK.
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Kirov R, Khalid N, Tredget J, Kennedy A, Atkins M. ECT in depression. Br J Psychiatry 2005; 187:487-8; author reply 488. [PMID: 16308917 DOI: 10.1192/bjp.187.5.487-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ernstoff M, Carrillo C, Urba W, Flaherty L, Clark J, Dutcher J, Margolin K, Atkins M, Sosman JA. A Cytokine Working Group (CWG) 3-arm phase II trial of gp100 (209–2M) peptide + high dose (HD) Interleukin-2 (IL-2) in HLA-A2+ (A2+) advanced melanoma patients (pts). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Ernstoff
- Vanderbilt Univ Med Ctr, Nashville, TN; Earle A Chiles Research Institute, Portland, OR; Dartmouth Hitchcock Medcl Ctr, Lebanon, NH; Wayne State Univ, Detroit, MI; Loyola Univ Medcl Ctr, Maywood, IL; Our Lady of Mercy Medcl Ctr, Bronx, NY; City of Hope Medcl Ctr, Duarte, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA
| | - C. Carrillo
- Vanderbilt Univ Med Ctr, Nashville, TN; Earle A Chiles Research Institute, Portland, OR; Dartmouth Hitchcock Medcl Ctr, Lebanon, NH; Wayne State Univ, Detroit, MI; Loyola Univ Medcl Ctr, Maywood, IL; Our Lady of Mercy Medcl Ctr, Bronx, NY; City of Hope Medcl Ctr, Duarte, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA
| | - W. Urba
- Vanderbilt Univ Med Ctr, Nashville, TN; Earle A Chiles Research Institute, Portland, OR; Dartmouth Hitchcock Medcl Ctr, Lebanon, NH; Wayne State Univ, Detroit, MI; Loyola Univ Medcl Ctr, Maywood, IL; Our Lady of Mercy Medcl Ctr, Bronx, NY; City of Hope Medcl Ctr, Duarte, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA
| | - L. Flaherty
- Vanderbilt Univ Med Ctr, Nashville, TN; Earle A Chiles Research Institute, Portland, OR; Dartmouth Hitchcock Medcl Ctr, Lebanon, NH; Wayne State Univ, Detroit, MI; Loyola Univ Medcl Ctr, Maywood, IL; Our Lady of Mercy Medcl Ctr, Bronx, NY; City of Hope Medcl Ctr, Duarte, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA
| | - J. Clark
- Vanderbilt Univ Med Ctr, Nashville, TN; Earle A Chiles Research Institute, Portland, OR; Dartmouth Hitchcock Medcl Ctr, Lebanon, NH; Wayne State Univ, Detroit, MI; Loyola Univ Medcl Ctr, Maywood, IL; Our Lady of Mercy Medcl Ctr, Bronx, NY; City of Hope Medcl Ctr, Duarte, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA
| | - J. Dutcher
- Vanderbilt Univ Med Ctr, Nashville, TN; Earle A Chiles Research Institute, Portland, OR; Dartmouth Hitchcock Medcl Ctr, Lebanon, NH; Wayne State Univ, Detroit, MI; Loyola Univ Medcl Ctr, Maywood, IL; Our Lady of Mercy Medcl Ctr, Bronx, NY; City of Hope Medcl Ctr, Duarte, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA
| | - K. Margolin
- Vanderbilt Univ Med Ctr, Nashville, TN; Earle A Chiles Research Institute, Portland, OR; Dartmouth Hitchcock Medcl Ctr, Lebanon, NH; Wayne State Univ, Detroit, MI; Loyola Univ Medcl Ctr, Maywood, IL; Our Lady of Mercy Medcl Ctr, Bronx, NY; City of Hope Medcl Ctr, Duarte, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA
| | - M. Atkins
- Vanderbilt Univ Med Ctr, Nashville, TN; Earle A Chiles Research Institute, Portland, OR; Dartmouth Hitchcock Medcl Ctr, Lebanon, NH; Wayne State Univ, Detroit, MI; Loyola Univ Medcl Ctr, Maywood, IL; Our Lady of Mercy Medcl Ctr, Bronx, NY; City of Hope Medcl Ctr, Duarte, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA
| | - J. A. Sosman
- Vanderbilt Univ Med Ctr, Nashville, TN; Earle A Chiles Research Institute, Portland, OR; Dartmouth Hitchcock Medcl Ctr, Lebanon, NH; Wayne State Univ, Detroit, MI; Loyola Univ Medcl Ctr, Maywood, IL; Our Lady of Mercy Medcl Ctr, Bronx, NY; City of Hope Medcl Ctr, Duarte, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA
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O’Day S, Atkins M, Weber J, Thompson J, Anderson C, Gonzalez R, Lutzky J, Amatruda T, Hersh E, Boasberg P. A phase II multi-center trial of maintenance biotherapy (MBT) after induction concurrent biochemotherapy (BCT) for patients (Pts) with metastatic melanoma (MM). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. O’Day
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - M. Atkins
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - J. Weber
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - J. Thompson
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - C. Anderson
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - R. Gonzalez
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - J. Lutzky
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - T. Amatruda
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - E. Hersh
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - P. Boasberg
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
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Browne R, Asboe D, Gilleece Y, Atkins M, Mandalia S, Gazzard B, Nelson M. Increased numbers of acute hepatitis C infections in HIV positive homosexual men; is sexual transmission feeding the increase? Sex Transm Infect 2004; 80:326-7. [PMID: 15295139 PMCID: PMC1744861 DOI: 10.1136/sti.2003.008532] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Stebbing J, Atkins M, Newsom-Davis T, Gazzard B, Bower M. Hepatitis B reactivation during combination chemotherapy for AIDS-related lymphoma is uncommon and does not adversely affect outcome. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. Stebbing
- Imperial College School of Science, Medicine & Technology, London, United Kingdom
| | - M. Atkins
- Imperial College School of Science, Medicine & Technology, London, United Kingdom
| | - T. Newsom-Davis
- Imperial College School of Science, Medicine & Technology, London, United Kingdom
| | - B. Gazzard
- Imperial College School of Science, Medicine & Technology, London, United Kingdom
| | - M. Bower
- Imperial College School of Science, Medicine & Technology, London, United Kingdom
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Carloss E, Regan M, Upton M, Youmans A, McDermott D, Polivy A, Atkins M. Concordance of local pathology interpretation (LR) with central pathology review (CR) in primary tumor specimens from patients with renal cancer (RCC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. Carloss
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - M. Regan
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - M. Upton
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - A. Youmans
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - D. McDermott
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - A. Polivy
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA
| | - M. Atkins
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA
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Atkins M, McDermott D, Regan M, Stanbridge E, Upton M, Youmans A, Febbo P, Lechpammer M, Signoretti S. Carbonic Anhydrase IX (CAIX) expression predicts for renal cell cancer (RCC) patient response and survival to IL-2 therapy. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Atkins
- Beth Israel Deaconess Medical Center, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of California Irvine, Irvine, CA
| | - D. McDermott
- Beth Israel Deaconess Medical Center, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of California Irvine, Irvine, CA
| | - M. Regan
- Beth Israel Deaconess Medical Center, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of California Irvine, Irvine, CA
| | - E. Stanbridge
- Beth Israel Deaconess Medical Center, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of California Irvine, Irvine, CA
| | - M. Upton
- Beth Israel Deaconess Medical Center, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of California Irvine, Irvine, CA
| | - A. Youmans
- Beth Israel Deaconess Medical Center, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of California Irvine, Irvine, CA
| | - P. Febbo
- Beth Israel Deaconess Medical Center, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of California Irvine, Irvine, CA
| | - M. Lechpammer
- Beth Israel Deaconess Medical Center, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of California Irvine, Irvine, CA
| | - S. Signoretti
- Beth Israel Deaconess Medical Center, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; University of California Irvine, Irvine, CA
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40
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Famoyin C, Byrnes C, Roberts S, Gollob J, Atkins M, Mier J, Ko YJ, Gautam S, McDemott D. A randomized phase II study of thalidomide with or without erythropoietin (EPO) in metastatic renal cell carcinoma (RCC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. Famoyin
- Beth Israel Deaconess Medical Center, Boston, MA
| | - C. Byrnes
- Beth Israel Deaconess Medical Center, Boston, MA
| | - S. Roberts
- Beth Israel Deaconess Medical Center, Boston, MA
| | - J. Gollob
- Beth Israel Deaconess Medical Center, Boston, MA
| | - M. Atkins
- Beth Israel Deaconess Medical Center, Boston, MA
| | - J. Mier
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Y.-J. Ko
- Beth Israel Deaconess Medical Center, Boston, MA
| | - S. Gautam
- Beth Israel Deaconess Medical Center, Boston, MA
| | - D. McDemott
- Beth Israel Deaconess Medical Center, Boston, MA
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Nelson M, Portsmouth S, Stebbing J, Atkins M, Barr A, Matthews G, Pillay D, Fisher M, Bower M, Gazzard B. An open-label study of tenofovir in HIV-1 and Hepatitis B virus co-infected individuals. AIDS 2003; 17:F7-10. [PMID: 12478090 DOI: 10.1097/00002030-200301030-00002] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.1] [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: 01/14/2023]
Abstract
BACKGROUND Tenofovir is a novel nucleotide analogue recommended for use in HIV-1 infected treatment-experienced patients. Recent data suggest an effect on Hepatitis B virus (HBV) replication. We therefore investigated the use of tenofovir in HIV-1 and HBV co-infected individuals. METHODS Twenty HIV-1/HBV co-infected patients with a median of 108 weeks lamivudine experience (range, 0-270 weeks) received tenofovir 245 mg daily in addition to or as part of their combination antiretroviral therapy. Their immunologic parameters and HIV-1 RNA and HBV DNA viral loads were followed over a period of 52 weeks. In addition, their HBV DNA polymerase was sequenced at baseline to measure the frequency of YMDD mutations that are associated with lamivudine resistance. FINDINGS A significant decrease in HBV DNA viral load (4 x log ) and alanine aminotransferase levels was observed. There were no significant overall differences between the lamivudine-experienced (n = 15) and -naive (n = 5) individuals and tenofovir was well tolerated. Five patients (25%) underwent HBe antigen seroconversion during the study period. Out of the 15 lamivudine-experienced individuals, 10 had YMDD mutations and one had YIDD mutations in HBV DNA. INTERPRETATION These results indicate that 52 weeks of tenofovir in addition to antiretroviral therapy is active against HBV, and it appears to overcome lamivudine resistance.
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Affiliation(s)
- M Nelson
- Chelsea and Westminster Hospital, London, UK
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Tomkins JP, Luo M, Fang GC, Main D, Goicoechea JL, Atkins M, Frisch DA, Page RE, Guzmán-Novoa E, Yu Y, Hunt G, Wing RA. New genomic resources for the honey bee(Apis mellifera L.): development of a deep-coverage BAC library and a preliminary STC database. Genet Mol Res 2002; 1:306-16. [PMID: 14963821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
We have constructed a bacterial artificial chromosome (BAC) library for a European honey bee strain using the cloning enzyme HindIII in order to develop resources for structural genomics research. The library contains 36,864 clones (ninety-six 384-well plates). A random sampling of 247 clones indicated an average insert size of 113 kb (range = 27 to 213 kb) and 2% empty vectors. Based on an estimated genome size of 270 Mb, this library provides approximately 15 haploid genome equivalents, allowing >99% probability of recovering any specific sequence of interest. High-density colony filters were gridded robotically using a Genetix Q-BOT in a 4 x 4 double-spotted array on 22.5-cm2 filters. Screening of the library with four mapped honey bee genomic clones and two bee cDNA probes identified an average of 21 positive signals per probe, with a range of 7-38 positive signals per probe. An additional screening was performed with nine aphid gene fragments and one Drosophila gene fragment resulting in seven of the nine aphid probes and the Drosophila probe producing positive signals with a range of 1 to 122 positive signals per probe (average of 45). To evaluate the utility of the library for sequence tagged connector analysis, 1152 BAC clones were end sequenced in both forward and reverse directions, giving a total of 2061 successful reads of high quality. End sequences were queried against SWISS-PROT, insect genomic sequence GSS, insect EST, and insect transposable element databases. Results in spreadsheet format from these searches are publicly available at the Clemson University Genomics Institute (CUGI) website in a searchable format (http://www.genome.clemson.edu/projects/stc/bee/AM__Ba/).
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Affiliation(s)
- J P Tomkins
- Clemson University Genomics Institute, Room 100 Jordan Hall, Clemson, SC 29634, USA.
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Dutcher JP, Logan T, Gordon M, Sosman J, Weiss G, Margolin K, Plasse T, Mier J, Lotze M, Clark J, Atkins M. Phase II trial of interleukin 2, interferon α, and 5-fluorouracil in metastatic renal cell cancer. Urol Oncol 2002. [DOI: 10.1016/s1078-1439(01)00163-6] [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: 11/16/2022]
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Abstract
In March 1992, the Royal College of Surgeons issued Guidelines for Day Case Surgery. Patients with a body mass index (BMI) > 30 were deemed unsuitable for operations to be performed as a day case. Since these guidelines were issued, many changes have occurred. Two years ago we successfully increased the BMI limit for patients undergoing general anaesthesia in our day surgery unit from 30 to 34. The success of this led us to question the current validity of the Royal College of Surgeons guidelines. A postal questionnaire was conducted surveying current practice in day surgical units within the UK. We achieved a 96% response rate. The results demonstrated a range of acceptable BMI values, with 85% of units anaesthetising patients with a BMI > 30. We conclude that many day case units routinely anaesthetise patients with BMI values > 30. Therefore, the current guidelines, which were issued 9 years ago, are no longer being adhered to nationally.
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Affiliation(s)
- M Atkins
- Day Case Unit, Clayton Hospital, Wakefield, UK.
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Wolraich ML, Greenhill LL, Pelham W, Swanson J, Wilens T, Palumbo D, Atkins M, McBurnett K, Bukstein O, August G. Randomized, controlled trial of oros methylphenidate once a day in children with attention-deficit/hyperactivity disorder. Pediatrics 2001; 108:883-92. [PMID: 11581440 DOI: 10.1542/peds.108.4.883] [Citation(s) in RCA: 398] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE A new once-a-day methylphenidate (MPH) formulation, Concerta (methylphenidate HCl) extended-release tablets (OROS MPH), has been developed. This study was conducted to determine the safety and efficacy of OROS MPH in a multicenter, randomized, clinical trial. METHODS Children with attention-deficit/hyperactivity disorder (ADHD; n = 282), all subtypes, ages 6 to 12 years, were randomized to placebo (n = 90), immediate-release methylphenidate (IR MPH) 3 times a day (tid; dosed every 4 hours; n = 97), or OROS MPH once a day (qd; n = 95) in a double-blind, 28-day trial. Outcomes in multiple domains were assessed, and data were analyzed using analysis of variance and Kaplan Meier product limit estimates for time to study cessation. The primary time point for analysis was the last available patient visit using last observation carried forward. RESULTS Children in the OROS and IR MPH groups showed significantly greater reductions in core ADHD symptoms than did children on placebo. This was true both at the end of week 1 and at the end of treatment on the basis of mean teacher and parent IOWA Conners ratings. IR MPH tid and OROS MPH qd did not differ significantly on any direct comparisons. Forty-eight percent of the placebo group discontinued early compared with 14% and 16% in the IR MPH and OROS MPH groups, respectively. CONCLUSIONS For the treatment of core ADHD symptoms, OROS MPH dosed qd and IR MPH dosed tid were superior to placebo and were not significantly different from each other.attention-deficit/hyperactivity disorder, methylphenidate, OROS, Concerta.
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Affiliation(s)
- M L Wolraich
- Vanderbilt University, Nashville, Tennessee, USA.
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46
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Affiliation(s)
- B Cohen
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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47
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Dubois RW, Swetter SM, Atkins M, McMasters K, Halbert R, Miller SJ, Shiell R, Kirkwood J. Developing indications for the use of sentinel lymph node biopsy and adjuvant high-dose interferon alfa-2b in melanoma. Arch Dermatol 2001; 137:1217-24. [PMID: 11559220 DOI: 10.1001/archderm.137.9.1217] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To convene a multidisciplinary panel of dermatologists, surgical oncologists, and medical oncologists to formally review available data on the sentinel lymph node (SLN) biopsy procedure and high-dose adjuvant interferon alfa-2b therapy for patients with melanoma and to rate the "appropriateness," "inappropriateness," or "uncertainty" of the procedure and therapy to guide clinical decision making in practice. PARTICIPANTS The panel comprised 13 specialists (4 dermatologists, 4 oncologists, and 5 surgeons) from geographically diverse areas who practiced in community-based settings (n = 8) and academic institutions (n = 5). Participants were chosen based on recommendations from the relevant specialty organizations. EVIDENCE A formal literature review was conducted by investigators at Protocare Sciences Inc, Santa Monica, Calif, on the risks and benefits of performing an SLN biopsy in patients with stage I or II melanoma and adjuvant interferon alfa-2b therapy in patients with stage II or III disease. The MEDLINE database was searched from 1966 through July 2000, and supplemental information was obtained from various cancer societies and cancer research groups. Panel participants were queried on additional sources of relevant information. Unpublished, presented data were included in abstract form on 1 recently closed clinical trial. CONSENSUS PROCESS The RAND/UCLA Appropriateness Method was used to review and rate multiple clinical scenarios for the use of SLN biopsy and interferon alfa-2b therapy. The consensus method did not force agreement. CONCLUSIONS The panel rated 104 clinical scenarios and concluded that the SLN biopsy procedure was appropriate for primary melanomas deeper than 1.0 mm and for tumors 1 mm or less when histologic ulceration was present and/or classified as Clark level 4 or higher. The SLN biopsy was deemed inappropriate for nonulcerated Clark level 2 or 3 melanomas 0.75 mm or less in depth and uncertain in tumors 0.76 to 1.0 mm deep unless they were ulcerated or Clark level 4 or higher. Interferon alfa-2b therapy was deemed appropriate for patients with regional nodal and/or in-transit metastasis and for node-negative patients with primary melanomas deeper than 4 mm. The panel considered the use of interferon alfa-2b therapy uncertain in patients with ulcerated intermediate primary tumors (2.01-4.0 mm in depth) and inappropriate for node-negative patients with nonulcerated tumors less than 4.0 mm deep. Specialty-specific ratings were conducted as well.
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Affiliation(s)
- R W Dubois
- Protocare Sciences Inc, Santa Monica, USA.
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Buzaid AC, Atkins M. Practical guidelines for the management of biochemotherapy-related toxicity in melanoma. Clin Cancer Res 2001; 7:2611-9. [PMID: 11555571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The combination of cisplatin-based chemotherapy with interleukin 2 (IL-2) and IFN-alpha, referred to as biochemotherapy or chemoimmunotherapy, has shown promising antitumor activity in patients with metastatic melanoma. Phase II studies have reported overall response rates ranging from 40 to 60%, with durable complete remissions in approximately 10% of the patients. Toxicity, however, is often severe and can be life-threatening if the healthcare team is not familiar with toxicity management. In this report, we briefly describe the clinical results of the most effective biochemotherapy regimens and provide a detailed description and management of the most common toxic effects, with emphasis on the concurrent biochemotherapy program initially developed at M. D. Anderson Cancer Center and currently being tested in a slightly modified version in two large-scale Intergroup Phase III trials.
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Affiliation(s)
- A C Buzaid
- Oncology Center, Hospital Sirio-Libanes, Sao Paulo, SP 01308-050, Brazil.
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Flaherty LE, Atkins M, Sosman J, Weiss G, Clark JI, Margolin K, Dutcher J, Gordon MS, Lotze M, Mier J, Sorokin P, Fisher RI, Appel C, Du W. Outpatient biochemotherapy with interleukin-2 and interferon alfa-2b in patients with metastatic malignant melanoma: results of two phase II cytokine working group trials. J Clin Oncol 2001; 19:3194-202. [PMID: 11432886 DOI: 10.1200/jco.2001.19.13.3194] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [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: 11/20/2022] Open
Abstract
PURPOSE The Cytokine Working Group performed a randomized phase II trial of two outpatient biochemotherapy regimens to identify an outpatient regimen with high antitumor activity and less toxicity than inpatient regimens which might be compared with chemotherapy or inpatient biochemotherapy regimens in future phase III trials. PATIENTS AND METHODS Eighty-one patients with metastatic malignant melanoma received dacarbazine 250 mg/m(2)/d intravenously (IV) and cisplatin 25 mg/m(2)/d IV on days 1, 2, and 3, plus interferon (IFN) alfa-2b 5 mU/m(2) subcutaneously (SC) on days 6, 8, 10, 13, and 15, given every 28 days. Interleukin-2 (IL-2) was given daily on days 6 to 10 and 13 to 15. In group 1, IV IL-2 was given at 18.0 MU/m(2), and in group 2, SC IL-2 was given at 5.0 mU/m(2). RESULTS In group 1 (IV IL-2), there were five complete responses (CRs) and 11 partial responses (PRs) among 44 patients (objective response rate [ORR], 36%; 95% confidence interval [CI], 22% to 51%). In group 2 (SC IL-2), there was one CR and five PRs among the 36 patients (ORR, 17%; 95% CI, 4% to 29%). The median survival was 10.7 months in group 1 and 7.3 months in group 2. Eleven patients in group 1 and four patients in group 2 remain alive as of the last follow-up. Toxicities in both groups were similar. No patient required hospitalization for neutropenic fever. CONCLUSION Biochemotherapy has activity in these outpatient regimens with acceptable toxicity. The antitumor activity observed with the IV IL-2 regimen seems similar to that of inpatient biochemotherapy regimens. If inpatient biochemotherapy regimens develop an established role in the management of melanoma, future phase III trial comparisons with this outpatient IV IL-2 regimen would be appropriate.
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Affiliation(s)
- L E Flaherty
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
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Naoumov NV, Lopes AR, Burra P, Caccamo L, Iemmolo RM, de Man RA, Bassendine M, O'Grady JG, Portmann BC, Anschuetz G, Barrett CA, Williams R, Atkins M. Randomized trial of lamivudine versus hepatitis B immunoglobulin for long-term prophylaxis of hepatitis B recurrence after liver transplantation. J Hepatol 2001; 34:888-94. [PMID: 11451173 DOI: 10.1016/s0168-8278(01)00039-3] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND/AIMS The long-term prophylaxis of hepatitis B after liver transplantation requires further optimization. In a randomized trial we investigated a regimen where the initially given hepatitis B immunoglobulin (HBIg) is replaced by long-term lamivudine treatment. METHODS Twenty-four liver transplant recipients (all HBsAg-positive/HBV DNA-negative before transplantation), who had received HBIg for at least 6 months without HBV recurrence, were randomized to receive lamivudine (n = 12) or HBIg (n = 12) for 52 weeks. The efficacy criteria involved seronegativity for HBsAg and undetectable HBsAg/ HBcAg in the liver. RESULTS Twenty-one of 24 patients completed the study without hepatitis B virus (HBV) recurrence (11 on HBIg, ten on lamivudine), while three patients became HBsAg-positive. Amongst those without HBV recurrence HBV DNA was detectable only by polymerase chain reaction, intermittently in serum and lymphocytes, and in liver specimens from six of eight patients receiving HBIg and five of seven receiving lamivudine. YMDD variant was found in four cases with no viral antigen expression. Eight patients continued lamivudine after the study and during an additional 6-22 months remained HBsAg-negative with normal graft function. CONCLUSIONS Substitution of HBIg with lamivudine is effective for prevention of HBV recurrence in low-risk liver transplant recipients and offers a convenient and cost-effective alternative for long-term HBV prophylaxis.
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Affiliation(s)
- N V Naoumov
- Institute of Hepatology, University College London and UCL Hospitals, UK.
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