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Ratcliffe S, Meyer EM, Walker CE, Knight M, McNair HM, Matson PG, Iglesias-Rodriguez D, Brzezinski M, Langer G, Sadekov A, Greaves M, Brownlee C, Curnow P, Taylor AR, Wheeler GL. Characterization of the molecular mechanisms of silicon uptake in coccolithophores. Environ Microbiol 2023; 25:315-330. [PMID: 36397254 PMCID: PMC10098502 DOI: 10.1111/1462-2920.16280] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022]
Abstract
Coccolithophores are an important group of calcifying marine phytoplankton. Although coccolithophores are not silicified, some species exhibit a requirement for Si in the calcification process. These species also possess a novel protein (SITL) that resembles the SIT family of Si transporters found in diatoms. However, the nature of Si transport in coccolithophores is not yet known, making it difficult to determine the wider role of Si in coccolithophore biology. Here, we show that coccolithophore SITLs act as Na+ -coupled Si transporters when expressed in heterologous systems and exhibit similar characteristics to diatom SITs. We find that CbSITL from Coccolithus braarudii is transcriptionally regulated by Si availability and is expressed in environmental coccolithophore populations. However, the Si requirement of C. braarudii and other coccolithophores is very low, with transport rates of exogenous Si below the level of detection in sensitive assays of Si transport. As coccoliths contain only low levels of Si, we propose that Si acts to support the calcification process, rather than forming a structural component of the coccolith itself. Si is therefore acting as a micronutrient in coccolithophores and natural populations are only likely to experience Si limitation in circumstances where dissolved silicon (DSi) is depleted to extreme levels.
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Affiliation(s)
| | - Erin M Meyer
- Department of Biology and Marine Biology, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Charlotte E Walker
- Marine Biological Association, The Laboratory, Citadel Hill, Plymouth, UK
| | - Michael Knight
- School of Ocean and Earth Science, University of Southampton, Southampton, UK
| | - Heather M McNair
- Department of Ecology Evolution and Marine Biology and the Marine Science Institute, University of California, Santa Barbara, California, USA
- Graduate School of Oceanography, University of Rhode Island, Narragansett, Rhode Island, USA
| | - Paul G Matson
- Department of Ecology Evolution and Marine Biology and the Marine Science Institute, University of California, Santa Barbara, California, USA
- Environmental Sciences Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee, USA
| | - Debora Iglesias-Rodriguez
- Department of Ecology Evolution and Marine Biology and the Marine Science Institute, University of California, Santa Barbara, California, USA
| | - Mark Brzezinski
- Department of Ecology Evolution and Marine Biology and the Marine Science Institute, University of California, Santa Barbara, California, USA
- Graduate School of Oceanography, University of Rhode Island, Narragansett, Rhode Island, USA
- Environmental Sciences Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee, USA
| | - Gerald Langer
- Marine Biological Association, The Laboratory, Citadel Hill, Plymouth, UK
| | - Aleksey Sadekov
- ARC Centre of Excellence for Coral Reef Studies, Ocean Graduate School, University of Western Australia, Crawley, Western Australia, Australia
| | - Mervyn Greaves
- The Godwin Laboratory for Palaeoclimate Research, Department of Earth Sciences, University of Cambridge, Cambridge, UK
| | - Colin Brownlee
- Marine Biological Association, The Laboratory, Citadel Hill, Plymouth, UK
| | - Paul Curnow
- School of Biochemistry, University of Bristol, Bristol, UK
| | - Alison R Taylor
- Department of Biology and Marine Biology, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Glen L Wheeler
- Marine Biological Association, The Laboratory, Citadel Hill, Plymouth, UK
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Zarkogiannis SD, Fernandez V, Greaves M, Mortyn PG, Kontakiotis G, Antonarakou A. X-ray tomographic data of planktonic foraminifera species Globigerina bulloides from the Eastern Tropical Atlantic across Termination II. GigaByte 2020; 2020:gigabyte5. [PMID: 36824589 PMCID: PMC9632000 DOI: 10.46471/gigabyte.5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/25/2020] [Indexed: 11/09/2022] Open
Abstract
Increased planktonic foraminifera shell weights were recorded during the course of Termination II at a tropical site off the shore of the Mauritanian coast. In order to investigate these increased shell mass values, a series of physicochemical analyses were performed, including X-ray computed tomography (CT). The data are given here. Furthermore, the relevant CT setup, scanning, reconstruction, and visualization methods are explained and the acquired datasets are given, together with 3D volumes and models of the scanned specimens.
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Affiliation(s)
- Stergios D. Zarkogiannis
- Faculty of Geology & Geoenvironment, Department of Historical Geology-Paleontology, School of Earth Sciences, National & Kapodistrian University of Athens, Greece, Corresponding author. E-mail:
| | | | - Mervyn Greaves
- Department of Earth Sciences, University of Cambridge, Cambridge, UK
| | - P. Graham Mortyn
- Institute of Environmental Science and Technology (ICTA), Universitat Autònoma de Barcelona, Spain,Department of Geography, Universitat Autònoma de Barcelona, Spain
| | - George Kontakiotis
- Faculty of Geology & Geoenvironment, Department of Historical Geology-Paleontology, School of Earth Sciences, National & Kapodistrian University of Athens, Greece
| | - Assimina Antonarakou
- Faculty of Geology & Geoenvironment, Department of Historical Geology-Paleontology, School of Earth Sciences, National & Kapodistrian University of Athens, Greece
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Punjabi A, Hewitt K, Balata H, Sinnott N, Lyons J, Crosbie P, Gee C, Duerden R, Greaves M, Booton R, Sharman A, Evison M. Implementation and outcomes of the RAPID programme: addressing the front end of the lung cancer pathway in Manchester. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30080-5] [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: 10/25/2022]
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Zarkogiannis SD, Antonarakou A, Tripati A, Kontakiotis G, Mortyn PG, Drinia H, Greaves M. Influence of surface ocean density on planktonic foraminifera calcification. Sci Rep 2019; 9:533. [PMID: 30679608 PMCID: PMC6346091 DOI: 10.1038/s41598-018-36935-7] [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] [Received: 05/16/2018] [Accepted: 11/27/2018] [Indexed: 12/01/2022] Open
Abstract
This study provides evidence that ambient seawater density influences calcification and may account for the observed planktonic foraminifera shell mass increase during glacial times. Volumes of weighed fossil Globigerina bulloides shells were accurately determined using X-ray Computer Tomography and were combined with water density reconstructions from Mg/Ca and δ18O measurements to estimate the buoyancy force exerted on each shell. After assessment of dissolution effects, the resulting relationship between shell mass and buoyancy suggests that heavier shells would need to be precipitated in glacial climates in order for these organisms to remain at their optimum living depth, and counterbalance the increased buoyant force of a denser, glacial ocean. Furthermore, the reanalysis of bibliographic data allowed the determination of a relationship between G. bulloides shell mass and ocean density, which introduces implications of a negative feedback mechanism for the uptake of atmospheric CO2 by the oceans.
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Affiliation(s)
- Stergios D Zarkogiannis
- National & Kapodistrian University of Athens, School of Earth Sciences, Faculty of Geology & Geoenvironment, Department of Historical Geology - Paleontology, Athens, Greece.
| | - Assimina Antonarakou
- National & Kapodistrian University of Athens, School of Earth Sciences, Faculty of Geology & Geoenvironment, Department of Historical Geology - Paleontology, Athens, Greece
| | - Aradhna Tripati
- Department of Earth, Planetary, and Space Sciences, Department of Atmospheric and Oceanic Sciences, Institute of the Environment and Sustainability, California Nanosystems Institute, University of California, Los Angeles, CA, USA.,European Institute of Marine Sciences (IUEM) Université de Brest, UMR 6538, Domaines Océaniques, Rue Dumont D'Urville, and IFREMER, Plouzané, France
| | - George Kontakiotis
- National & Kapodistrian University of Athens, School of Earth Sciences, Faculty of Geology & Geoenvironment, Department of Historical Geology - Paleontology, Athens, Greece
| | - P Graham Mortyn
- Institute of Environmental Science and Technology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Geography, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hara Drinia
- National & Kapodistrian University of Athens, School of Earth Sciences, Faculty of Geology & Geoenvironment, Department of Historical Geology - Paleontology, Athens, Greece
| | - Mervyn Greaves
- Department of Earth Sciences, University of Cambridge, Cambridge, UK
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Balata H, Hayton C, Barber P, Duerden R, Evison M, Greaves M, Howells J, Irion K, Karunaratne D, Leonard C, Mellor S, Newton T, Sawyer R, Sharman A, Smith E, Taylor B, Walsham A, Whittaker J, Chaudhuri N, Booton R, Crosbie P. Prevalence of incidental interstitial lung disease in the Manchester lung cancer screening pilot. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30103-5] [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: 10/27/2022]
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Balata H, Blandin Knight S, Barber P, Colligan D, Crosbie EJ, Duerden R, Elton P, Evison M, Greaves M, Howells J, Irion K, Karunaratne D, Kirwan M, Macnab A, Mellor S, Miller C, Newton T, Novasio J, Sawyer R, Sharman A, Slevin K, Smith E, Taylor B, Taylor S, Tonge J, Walsham A, Waplington S, Whittaker J, Booton R, Crosbie PAJ. Targeted lung cancer screening selects individuals at high risk of cardiovascular disease. Lung Cancer 2018; 124:148-153. [PMID: 30268454 DOI: 10.1016/j.lungcan.2018.08.006] [Citation(s) in RCA: 15] [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] [Received: 05/09/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is a major cause of morbidity and mortality in populations eligible for lung cancer screening. The aim of this study was to determine whether a brief CV risk assessment, delivered as part of a targeted community-based lung cancer screening programme, was effective in identifying individuals at high risk who might benefit from primary prevention. METHODS The Manchester Lung Screening Pilot consisted of annual low dose CT (LDCT) over 2 screening rounds, targeted at individuals in deprived areas at high risk of lung cancer (age 55-74 and 6-year risk ≥1.51%, using PLCOM2012 risk model). All participants of the second screening round were eligible to take part in the study. Ten-year CV risk was estimated using QRISK2 in participants without CVD and compared to age (±5 years) and sex matched Health Survey for England (HSE) controls; high risk was defined as QRISK2 score ≥10%. Coronary artery calcification (CAC) was assessed on LDCT scans and compared to QRISK2 score. RESULTS Seventy-seven percent (n=920/1,194) of screening attendees were included in the analysis; mean age 65.6 ± 5.4 and 50.4% female. QRISK2 and lung cancer risk (PLCOM2012) scores were correlated (r = 0.26, p < 0.001). Median QRISK2 score was 21.1% (IQR 14.9-29.6) in those without established CVD (77.6%, n = 714/920), double that of HSE controls (10.3%, IQR 6.6-16.2; n = 714) (p < 0.001). QRISK2 score was significantly higher in those with CAC (p < 0.001). Screening attendees were 10-fold more likely to be classified high risk (OR 10.2 [95% CI 7.3-14.0]). One third (33.7%, n = 310/920) of all study participants were high risk but not receiving statin therapy for primary CVD prevention. DISCUSSION Opportunistic CVD risk assessment within a targeted lung cancer screening programme is feasible and is likely to identify a very large number of individuals suitable for primary prevention.
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Affiliation(s)
- H Balata
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - S Blandin Knight
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - P Barber
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - D Colligan
- Manchester Health and Care Commissioning, Manchester, UK
| | - E J Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R Duerden
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - P Elton
- Greater Manchester Health & Social Care Partnership, Manchester, UK
| | - M Evison
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - M Greaves
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - J Howells
- Department of Radiology, Royal Preston Hospital, Preston, UK
| | - K Irion
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - D Karunaratne
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Kirwan
- Thoracic Oncology Research Hub (TORCH), Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - A Macnab
- Department of Cardiology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - S Mellor
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | - C Miller
- Department of Cardiology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - T Newton
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | - J Novasio
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - R Sawyer
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - A Sharman
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - K Slevin
- Thoracic Oncology Research Hub (TORCH), Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - E Smith
- Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - B Taylor
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - S Taylor
- Manchester Health and Care Commissioning, Manchester, UK
| | - J Tonge
- Manchester Health and Care Commissioning, Manchester, UK
| | - A Walsham
- Department of Radiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - S Waplington
- Manchester Health and Care Commissioning, Manchester, UK
| | - J Whittaker
- Department of Radiology, Stockport NHS Foundation Trust, Stockport, UK
| | - R Booton
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - P A J Crosbie
- Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Kluft C, Preston FE, Malia RG, Bertina RM, Wijngaards G, Greaves M, Verheijen JH, Dooijewaard G. Stanozolol-Induced Changes in Fibrinolysis and Coagulation in Healthy Adults. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661049] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe effects of orally-administered stanozolol, 5 mg b. d. on fibrinolysis, coagulation and on various haematological and biochemical parameters have been studied in 16 healthy adults, 8 males and 8 females. Statistically significant enhancement of extrinsic (tissue-type) plasminogen activator activity was detected in all subjects studied. This was associated with significant increases in plasma plasminogen and a concomitant reduction in histidine-rich glycoprotein. There were no changes in plasma urokinase activity. Changes in the coagulation system included significant reduction in plasma fibrinogen and elevation of protein C and anti thrombin III. Changes in plasma lipids included significant reduction of HDL cholesterol associated with an increase in LDL triglycerides. No change occurred in total cholesterol. There were no major differences between the sexes, nor were there serious side effects.The effects of stanozolol on extrinsic (tissue-type) plasminogen activator activity, “free” plasminogen, protein C and antithrombin III, argue strongly in favour of its therapeutic potential.
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Affiliation(s)
- C Kluft
- The Gaubius Institute, Health Research Division TNO, Leiden, The Netherlands
| | - F E Preston
- The University Department of Haematology, Royal Hallamshire Hospital, Sheffield, U. K
| | - R G Malia
- The University Department of Haematology, Royal Hallamshire Hospital, Sheffield, U. K
| | - R M Bertina
- The Haemostasis and Thrombosis Research Unit, Leiden University Hospital, Leiden, The Netherlands
| | - G Wijngaards
- The Gaubius Institute, Health Research Division TNO, Leiden, The Netherlands
| | - M Greaves
- The University Department of Haematology, Royal Hallamshire Hospital, Sheffield, U. K
| | - J H Verheijen
- The Gaubius Institute, Health Research Division TNO, Leiden, The Netherlands
| | - G Dooijewaard
- The Gaubius Institute, Health Research Division TNO, Leiden, The Netherlands
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Greer IA, Greaves M, Madhok R, McLoughlin K, Porter N, Lowe GDO, Preston FE, Forbes CD. Effect of Stanozolol on Factors VIII and IX and Serum Aminotransferases in Haemophilia. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe treatment of haemophilia has been dramatically improved since the introduction of factor VIII and IX concentrates, however these concentrates have brought new problems such as hepatitis and A.I.D.S. An oral agent which could raise endogenous levels of factor VIII and IX would be of great benefit. Danazol, an anabolic steroid, has recently been shown to increase levels of factors VIII and IX in haemophilia. We therefore studied the effect of stanozolol, a closely related anabolic steroid, in 15 patients with haemophilia A or Christmas disease over a 2-4 week period. There was no consistent change in factor VIIIc or factor IX, and fibrinolysis was significantly enhanced. No effect was apparent on the incidence of spontaneous bleeds. However serum aminotransferases which were abnormal in 11 of the 15 patients at the start of the study fell significantly with stanozolol therapy. This raises the interesting possibility that anabolic steroids may be beneficial in patients with chronic liver diseases.
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Affiliation(s)
- I A Greer
- The University Dept. of Medicine, Royal Infirmary, Glasgow, UK
| | - M Greaves
- The Dept. of Haematology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
- The University Dept. of Medicine, Royal Infirmary, Glasgow, UK
| | - R Madhok
- The University Dept. of Medicine, Royal Infirmary, Glasgow, UK
| | - K McLoughlin
- The University Dept. of Medicine, Royal Infirmary, Glasgow, UK
| | - N Porter
- The University Dept. of Medicine, Royal Infirmary, Glasgow, UK
| | - G D O Lowe
- The University Dept. of Medicine, Royal Infirmary, Glasgow, UK
| | - F E Preston
- The Dept. of Haematology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
- The University Dept. of Medicine, Royal Infirmary, Glasgow, UK
| | - C D Forbes
- The University Dept. of Medicine, Royal Infirmary, Glasgow, UK
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Jennings I, Kitchen S, Woods TA, Preston FE, Greaves M. Potentially Clinically Important Inaccuracies in Testing for the Lupus Anticoagulant: an Analysis of Results from three Surveys of the UK National External Quality Assessment Scheme (NEQAS) for Blood Coagulation. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1656080] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe identification of the presence of antiphospholipid in plasma is recognised to be of diagnostic and prognostic importance in subjects with thrombotic disease, recurrent miscarriage or collagen vascular disorders. A number of coagulation assays are currently employed for the detection of lupus anticoagulant (LA), many of which are influenced by reagent dependent and methodological variables.In the present study lyophilised plasma samples from three subjects with “strong”, “weak” and “absent” LA were tested in 220 centres. The most commonly used tests for LA were Activated Partial Thromboplastin Time (APTT), Dilute Russell Viper Venom Time (DRVVT) and Kaolin Clotting Time (KCT). Median DRVVT ratios were 1.75, 1.17 and 1.10 for the three samples. The presence of a strong LA was not detected by 4% of laboratories. The correct diagnosis was made by 94% of users of DRVVT and 85% of users of KCT. A weak LA was not detected by over half of centres. Correction was observed on addition of plasma and also in platelet neutralisation. The correct diagnosis was made by 37% of users of DRVVT and 27% of users of KCT. Lupus Anticoagulant was falsely considered to be present in a Factor IX deficient plasma by approximately one quarter of laboratories. Amongst users of DRVVT and KCT absence of LA in this sample was correctly reported by 73% and 69% of centres respectively.The accuracy of testing for LA in the present study is suboptimal and this is likely to have important clinical consequences. There is clearly a need for greater conformity in the selection and performance of LA tests to facilitate accurate diagnosis of this important group of disorders.
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Affiliation(s)
- I Jennings
- (on behalf of the UK National External Quality Assessments Scheme for Blood Coagilation)
| | - S Kitchen
- (on behalf of the UK National External Quality Assessments Scheme for Blood Coagilation)
| | - T A.L Woods
- (on behalf of the UK National External Quality Assessments Scheme for Blood Coagilation)
| | - F E Preston
- (on behalf of the UK National External Quality Assessments Scheme for Blood Coagilation)
| | - M Greaves
- The Department of Medicine and Therapeutics, Aberdeen University, UK
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Abstract
SummaryTo improve the management and therapeutic control of inpatients on anticoagulant drugs, combined prescription and monitoring charts have been developed for both heparin and warfarin which incorporate clinical guidelines. These have been introduced throughout a 700-bedded acute teaching hospital via a structured program of change management.We have demonstrated improvements in the quality of anticoagulant control (assessed with a custom-written computer program), adherence to clinical guidelines and quality of monitoring and prescribing of anticoagulants in inpatients.The percentage time spent under-anticoagulated with heparin (activated partial thromboplastin time ratio <1.5) fell from 32.7% to 18.5% (p<0.0001), whereas there was no change in percentage time over-anticoagulated (5.1% vs. 5.8%; p = ns). The percentage time spent under-anticoagulated with warfarin was unaltered (26.3% vs. 29.8%; p = ns) but the percentage time spent over-anticoagulated (International Normalised Ratio >4.5) was halved from 5.4% to 2.7% (p<0.001).We conclude that the introduction of the charts led to significant improvements in anticoagulant control.
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Affiliation(s)
- W S Phillips
- The Department of Cardiology, Royal Hallamshire Hospital Sheffield, UK
| | - J Smith
- The Department of Cardiology, Royal Hallamshire Hospital Sheffield, UK
| | - M Greaves
- The Department of Cardiology, Royal Hallamshire Hospital Sheffield, UK
| | - F E Preston
- The Department of Cardiology, Royal Hallamshire Hospital Sheffield, UK
| | - K S Channer
- The Department of Cardiology, Royal Hallamshire Hospital Sheffield, UK
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Abstract
SummaryWe have examined the in vitro effects of DN 9693 (piperidinylimidazo-quinazolinone) on various aspects of platelet reactivity. Our results are consistent with its known function as a phosphodiesterase inhibitor in that it increased platelet cyclic AMP, particularly in conjunction with an adenylate cyclase stimulator, and exerted a profound inhibitory effect on platelet aggregation responses to a variety of agonists. DN 9693 also inhibited ristocetin-induced platelet agglutination (RIPA). We therefore examined its effect on ristocetin co-factor assays and on the binding of a monoclonal antibody (McAb) to platelet membrane glycoprotein lb (GPIb). The drug inhibited the binding of the monoclonal antibody in a dose-dependent manner. This suggests an effect of the drug on the platelet surface membrane with reduced expression of GPIb. Our results indicate that in addition to its anticipated inhibitory effect on platelet aggregation, DN 9693 may also inhibit platelet adhesion.
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Affiliation(s)
- C Jackson
- The Department of Haematology, Royal Hallamshire Hospital, Sheffield, UK
| | - J Ball
- The Department of Haematology, Royal Hallamshire Hospital, Sheffield, UK
| | - J Peel
- The Department of Haematology, Royal Hallamshire Hospital, Sheffield, UK
| | - J Lawry
- The Department of Virology, University Medical School, Sheffield, UK
| | - M Greaves
- The Department of Haematology, Royal Hallamshire Hospital, Sheffield, UK
| | - F E Preston
- The Department of Haematology, Royal Hallamshire Hospital, Sheffield, UK
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Affiliation(s)
- J P Tullett
- Department of Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield
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Morrison ER, Campbell DM, Haites NE, Wilson BJ, Watson MS, Greaves M, Vickers MA, Miedzybrodzka ZH. Prothrombotic Genotypes Are not Associated with Pre-eclampsia and Gestational Hypertension: Results from a Large Population-based Study and Systematic Review. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613083] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryDNA samples collected as part of a large population-based casecontrol study were genotyped to examine the associations of five prothrombotic gene polymorphisms with pre-eclampsia (PE) and gestational hypertension (GH). The polymorphisms studied were: G1691A in Factor V (Factor V Leiden; FVL), prothrombin G20210A, methylenetetrahydrofolate reductase (MTHFR) C677T, plasminogen activator inhibitor-1 4G/5G and the platelet collagen receptor α2β1 C807T. A group of 404 women who developed PE were retrospectively compared with 303 women with GH and 164 control women. The frequency of genotypes did not differ significantly between cases of PE or GH and controls for any of the five polymorphisms studied. We conclude that these prothrombotic genotypes are not associated with the development of PE or GH in our population. The systematic review supports our conclusion, for all but cases of severe disease, which appear to be associated with FVL and, to a lesser extent, MTHFR C677T. There is little value in antenatal screening for prothrombotic polymorphisms to predict the development of pre-eclampsia or gestational hypertension.
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Iglesias-Rodriguez MD, Jones BM, Blanco-Ameijeiras S, Greaves M, Huete-Ortega M, Lebrato M. Physiological responses of coccolithophores to abrupt exposure of naturally low pH deep seawater. PLoS One 2017; 12:e0181713. [PMID: 28750008 PMCID: PMC5531516 DOI: 10.1371/journal.pone.0181713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 07/06/2017] [Indexed: 11/18/2022] Open
Abstract
Upwelling is the process by which deep, cold, relatively high-CO2, nutrient-rich seawater rises to the sunlit surface of the ocean. This seasonal process has fueled geoengineering initiatives to fertilize the surface ocean with deep seawater to enhance productivity and thus promote the drawdown of CO2. Coccolithophores, which inhabit many upwelling regions naturally 'fertilized' by deep seawater, have been investigated in the laboratory in the context of ocean acidification to determine the extent to which nutrients and CO2 impact their physiology, but few data exist in the field except from mesocosms. Here, we used the Porcupine Abyssal Plain (north Atlantic Ocean) Observatory to retrieve seawater from depths with elevated CO2 and nutrients, mimicking geoengineering approaches. We tested the effects of abrupt natural deep seawater fertilization on the physiology and biogeochemistry of two strains of Emiliania huxleyi of known physiology. None of the strains tested underwent cell divisions when incubated in waters obtained from <1,000 m (pH = 7.99-8.08; CO2 = 373-485 p.p.m; 1.5-12 μM nitrate). However, growth was promoted in both strains when cells were incubated in seawater from ~1,000 m (pH = 7.9; CO2 ~560 p.p.m.; 14-17 μM nitrate) and ~4,800 m (pH = 7.9; CO2 ~600 p.p.m.; 21 μM nitrate). Emiliania huxleyi strain CCMP 88E showed no differences in growth rate or in cellular content or production rates of particulate organic (POC) and inorganic (PIC) carbon and cellular particulate organic nitrogen (PON) between treatments using water from 1,000 m and 4,800 m. However, despite the N:P ratio of seawater being comparable in water from ~1,000 and ~4,800 m, the PON production rates were three times lower in one incubation using water from ~1,000 m compared to values observed in water from ~4,800 m. Thus, the POC:PON ratios were threefold higher in cells that were incubated in ~1,000 m seawater. The heavily calcified strain NZEH exhibited lower growth rates and PIC production rates when incubated in water from ~4,800 m compared to ~1,000 m, while cellular PIC, POC and PON were higher in water from 4,800 m. Calcite Sr/Ca ratios increased with depth despite constant seawater Sr/Ca, indicating that upwelling changes coccolith geochemistry. Our study provides the first experimental and field trial of a geoengineering approach to test how deep seawater impacts coccolithophore physiological and biogeochemical properties. Given that coccolithophore growth was only stimulated using waters obtained from >1,000 m, artificial upwelling using shallower waters may not be a suitable approach for promoting carbon sequestration for some locations and assemblages, and should therefore be investigated on a site-by-site basis.
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Affiliation(s)
- Maria Debora Iglesias-Rodriguez
- Department of Ecology, Evolution and Marine Biology, University of California Santa Barbara, Santa Barbara, CA, United States of America.,Ocean and Earth Science, National Oceanography Centre, University of Southampton, Southampton, United Kingdom
| | - Bethan M Jones
- Ocean and Earth Science, National Oceanography Centre, University of Southampton, Southampton, United Kingdom.,Department of Botany and Plant Pathology, Oregon State University, Corvallis, OR, United States of America
| | - Sonia Blanco-Ameijeiras
- Department F.-A. Forel for Environmental and Aquatic Sciences, University of Geneva, 66 Boulevard Carl-Vogt, CH, Geneva, Switzerland
| | - Mervyn Greaves
- Department of Earth Sciences, University of Cambridge, Downing St, Cambridge, United Kingdom
| | - Maria Huete-Ortega
- Department of Chemical and Biological Engineering, University of Sheffield, Mappin Street, Sheffield United Kingdom.,Departamento de Ecología y Biología Animal, Universidad de Vigo, Vigo, Spain
| | - Mario Lebrato
- Department of Geosciences, Christian-Albrechts-University Kiel (CAU), Christian-Albrechts-Platz 4, Kiel, Germany.,Department of Marine Ecology, GEOMAR, Düsternbrooker Weg 20, Kiel, Germany
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18
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Lote H, Spiteri I, Ermini L, Vatsiou A, Roy A, McDonald A, Maka N, Balsitis M, Bose N, Simbolo M, Mafficini A, Lampis A, Hahne JC, Trevisani F, Eltahir Z, Mentrasti G, Findlay C, Kalkman EAJ, Punta M, Werner B, Lise S, Aktipis A, Maley C, Greaves M, Braconi C, White J, Fassan M, Scarpa A, Sottoriva A, Valeri N. Carbon dating cancer: defining the chronology of metastatic progression in colorectal cancer. Ann Oncol 2017; 28:1243-1249. [PMID: 28327965 PMCID: PMC5452067 DOI: 10.1093/annonc/mdx074] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Patients often ask oncologists how long a cancer has been present before causing symptoms or spreading to other organs. The evolutionary trajectory of cancers can be defined using phylogenetic approaches but lack of chronological references makes dating the exact onset of tumours very challenging. Patients and methods Here, we describe the case of a colorectal cancer (CRC) patient presenting with synchronous lung metastasis and metachronous thyroid, chest wall and urinary tract metastases over the course of 5 years. The chest wall metastasis was caused by needle tract seeding, implying a known time of onset. Using whole genome sequencing data from primary and metastatic sites we inferred the complete chronology of the cancer by exploiting the time of needle tract seeding as an in vivo 'stopwatch'. This approach allowed us to follow the progression of the disease back in time, dating each ancestral node of the phylogenetic tree in the past history of the tumour. We used a Bayesian phylogenomic approach, which accounts for possible dynamic changes in mutational rate, to reconstruct the phylogenetic tree and effectively 'carbon date' the malignant progression. Results The primary colon cancer emerged between 5 and 8 years before the clinical diagnosis. The primary tumour metastasized to the lung and the thyroid within a year from its onset. The thyroid lesion presented as a tumour-to-tumour deposit within a benign Hurthle adenoma. Despite rapid metastatic progression from the primary tumour, the patient showed an indolent disease course. Primary cancer and metastases were microsatellite stable and displayed low chromosomal instability. Neo-antigen analysis suggested minimal immunogenicity. Conclusion Our data provide the first in vivo experimental evidence documenting the timing of metastatic progression in CRC and suggest that genomic instability might be more important than the metastatic potential of the primary cancer in dictating CRC fate.
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Affiliation(s)
- H. Lote
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton
- Gastrointestinal Cancers and Lymphoma Unit, The Royal Marsden NHS Trust, Sutton
| | - I. Spiteri
- Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - L. Ermini
- Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - A. Vatsiou
- Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - A. Roy
- Department of Oncology, Crosshouse Hospital, Crosshouse, Kilmarnock
| | - A. McDonald
- Beatson West of Scotland Cancer Centre, Glasgow
| | - N. Maka
- Department of Pathology, Southern General Hospital, Glasgow
| | - M. Balsitis
- Department of Pathology, Crosshouse Hospital, Crosshouse, Kilmarnock, UK
| | - N. Bose
- Department of Oncology, Crosshouse Hospital, Crosshouse, Kilmarnock
| | - M. Simbolo
- Department of Pathology and Diagnostics, ARC-NET Research Centre University of Verona, Verona, Italy
| | - A. Mafficini
- Department of Pathology and Diagnostics, ARC-NET Research Centre University of Verona, Verona, Italy
| | - A. Lampis
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton
| | - J. C. Hahne
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton
| | - F. Trevisani
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton
| | - Z. Eltahir
- Gastrointestinal Cancers and Lymphoma Unit, The Royal Marsden NHS Trust, Sutton
| | - G. Mentrasti
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton
| | - C. Findlay
- Beatson West of Scotland Cancer Centre, Glasgow
| | | | - M. Punta
- Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - B. Werner
- Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - S. Lise
- Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - A. Aktipis
- Centre for Evolution and Cancer, The Institute of Cancer Research, London
- Center for Evolution and Cancer, University of California San Francisco, San Francisco
- Department of Psychology
| | - C. Maley
- Centre for Evolution and Cancer, The Institute of Cancer Research, London
- Center for Evolution and Cancer, University of California San Francisco, San Francisco
- Biodesign Institute, Arizona State University, Tempe, USA
| | - M. Greaves
- Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - C. Braconi
- Gastrointestinal Cancers and Lymphoma Unit, The Royal Marsden NHS Trust, Sutton
- Division of Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - J. White
- Beatson West of Scotland Cancer Centre, Glasgow
| | - M. Fassan
- Department of Pathology and Diagnostics, ARC-NET Research Centre University of Verona, Verona, Italy
- Department of Medicine, Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
| | - A. Scarpa
- Department of Pathology and Diagnostics, ARC-NET Research Centre University of Verona, Verona, Italy
| | - A. Sottoriva
- Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - N. Valeri
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton
- Gastrointestinal Cancers and Lymphoma Unit, The Royal Marsden NHS Trust, Sutton
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Vijayakrishnan J, Kumar R, Henrion MYR, Moorman AV, Rachakonda PS, Hosen I, da Silva Filho MI, Holroyd A, Dobbins SE, Koehler R, Thomsen H, Irving JA, Allan JM, Lightfoot T, Roman E, Kinsey SE, Sheridan E, Thompson PD, Hoffmann P, Nöthen MM, Heilmann-Heimbach S, Jöckel KH, Greaves M, Harrison CJ, Bartram CR, Schrappe M, Stanulla M, Hemminki K, Houlston RS. A genome-wide association study identifies risk loci for childhood acute lymphoblastic leukemia at 10q26.13 and 12q23.1. Leukemia 2017; 31:573-579. [PMID: 27694927 PMCID: PMC5336191 DOI: 10.1038/leu.2016.271] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/26/2016] [Accepted: 09/06/2016] [Indexed: 02/08/2023]
Abstract
Genome-wide association studies (GWASs) have shown that common genetic variation contributes to the heritable risk of childhood acute lymphoblastic leukemia (ALL). To identify new susceptibility loci for the largest subtype of ALL, B-cell precursor ALL (BCP-ALL), we conducted a meta-analysis of two GWASs with imputation using 1000 Genomes and UK10K Project data as reference (totaling 1658 cases and 7224 controls). After genotyping an additional 2525 cases and 3575 controls, we identify new susceptibility loci for BCP-ALL mapping to 10q26.13 (rs35837782, LHPP, P=1.38 × 10-11) and 12q23.1 (rs4762284, ELK3, P=8.41 × 10-9). We also provide confirmatory evidence for the existence of independent risk loci at 9p21.3, but show that the association marked by rs77728904 can be accounted for by linkage disequilibrium with the rare high-impact CDKN2A p.Ala148Thr variant rs3731249. Our data provide further insights into genetic susceptibility to ALL and its biology.
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Affiliation(s)
- J Vijayakrishnan
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - R Kumar
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - M Y R Henrion
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - A V Moorman
- Leukemia Research Group, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - P S Rachakonda
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - I Hosen
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - M I da Silva Filho
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - A Holroyd
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - S E Dobbins
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - R Koehler
- Department of Human Genetics, Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - H Thomsen
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - J A Irving
- Leukemia Research Group, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - J M Allan
- Leukemia Research Group, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - T Lightfoot
- Department of Health Sciences, Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - E Roman
- Department of Health Sciences, Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - S E Kinsey
- Department of Paediatric and Adolescent Haematology and Oncology, Leeds General Infirmary, Leeds, UK
| | - E Sheridan
- Medical Genetics Research Group, Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, Leeds, UK
| | - P D Thompson
- Paediatric and Familial Cancer Research Group, Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - P Hoffmann
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Biomedicine, Human Genomics Research Group, University Hospital Basel, Basel, Switzerland
| | - M M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | | | - K H Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - M Greaves
- Haemato-Oncology Research Unit, Division of Molecular Pathology, Institute of Cancer Research, Sutton, UK
| | - C J Harrison
- Leukemia Research Group, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - C R Bartram
- Department of Human Genetics, Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - M Schrappe
- General Paediatrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Stanulla
- Department of Paediatric Haematology and Oncology, Hannover Medical School, Hannover, Germany
| | - K Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - R S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
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20
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Greaves M. So you want to publish your research in the Journal of Thrombosis and Haemostasis? J Thromb Haemost 2017; 15:405-410. [PMID: 27966273 DOI: 10.1111/jth.13585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M Greaves
- University of Aberdeen, Aberdeen, UK
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21
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Pockley A, Davenport P, Paul F, Greaves M, Preston F. The use of high gradient magnetic separation for the preparation of leucocyte- and platelet-free red cell suspensions. Clin Hemorheol Microcirc 2016. [DOI: 10.3233/ch-1986-6503] [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: 11/15/2022]
Affiliation(s)
- A.G. Pockley
- Department of Haematology, Royal Hallamshire Hospital, Sheffield, England
| | - P. Davenport
- Department of Haematology, Royal Hallamshire Hospital, Sheffield, England
| | - F. Paul
- Department of Physics and Haematology, Southampton University, Southampton, England
| | - M. Greaves
- Department of Haematology, Royal Hallamshire Hospital, Sheffield, England
| | - F.E. Preston
- Department of Haematology, Royal Hallamshire Hospital, Sheffield, England
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22
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Affiliation(s)
- M Greaves
- Royal Hallamshire Hospital, Sheffield, UK
| | - FE Preston
- Royal Hallamshire Hospital, Sheffield, UK
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23
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Affiliation(s)
- K Pongpairoj
- Department of Cutaneous Allergy, St. John's Institute of Dermatology, St Thomas` Hospital, London, UK
| | - M Saha
- Dermatology Clinic, Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK
| | - M Greaves
- Department of Cutaneous Allergy, St. John's Institute of Dermatology, St Thomas` Hospital, London, UK
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24
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McClymont EL, Elmore AC, Kender S, Leng MJ, Greaves M, Elderfield H. Pliocene-Pleistocene evolution of sea surface and intermediate water temperatures from the southwest Pacific. Paleoceanography 2016; 31:895-913. [PMID: 27478302 PMCID: PMC4950126 DOI: 10.1002/2016pa002954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/31/2016] [Accepted: 06/07/2016] [Indexed: 06/06/2023]
Abstract
Over the last 5 million years, the global climate system has evolved toward a colder mean state, marked by large-amplitude oscillations in continental ice volume. Equatorward expansion of polar waters and strengthening temperature gradients have been detected. However, the response of the mid latitudes and high latitudes of the Southern Hemisphere is not well documented, despite the potential importance for climate feedbacks including sea ice distribution and low-high latitude heat transport. Here we reconstruct the Pliocene-Pleistocene history of both sea surface and Antarctic Intermediate Water (AAIW) temperatures on orbital time scales from Deep Sea Drilling Project Site 593 in the Tasman Sea, southwest Pacific. We confirm overall Pliocene-Pleistocene cooling trends in both the surface ocean and AAIW, although the patterns are complex. The Pliocene is warmer than modern, but our data suggest an equatorward displacement of the subtropical front relative to present and a poleward displacement of the subantarctic front of the Antarctic Circumpolar Current (ACC). Two main intervals of cooling, from ~3 Ma and ~1.5 Ma, are coeval with cooling and ice sheet expansion noted elsewhere and suggest that equatorward expansion of polar water masses also characterized the southwest Pacific through the Pliocene-Pleistocene. However, the observed trends in sea surface temperature and AAIW temperature are not identical despite an underlying link to the ACC, and intervals of unusual surface ocean warmth (~2 Ma) and large-amplitude variability in AAIW temperatures (from ~1 Ma) highlight complex interactions between equatorward displacements of fronts associated with the ACC and/or varying poleward heat transport from the subtropics.
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Affiliation(s)
| | | | - Sev Kender
- Centre for Environmental Geochemistry, School of Geography University of Nottingham Nottingham UK; British Geological Survey Nottingham UK
| | - Melanie J Leng
- Centre for Environmental Geochemistry, School of Geography University of Nottingham Nottingham UK; British Geological Survey Nottingham UK
| | - Mervyn Greaves
- Department of Earth Sciences University of Cambridge Cambridge UK
| | - Henry Elderfield
- Department of Earth Sciences University of Cambridge Cambridge UK; Deceased 19 April 2016
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25
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Olaiya A, Lurie B, Watt B, McDonald L, Greaves M, Watson HG. An observational study of direct oral anticoagulant awareness indicating inadequate recognition with potential for patient harm. J Thromb Haemost 2016; 14:987-90. [PMID: 26865203 DOI: 10.1111/jth.13288] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/26/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED Essentials Ignorance of direct oral anticoagulants' effects on coagulation tests may be a safety issue. An electronic questionnaire was sent to prescribers in NHS Grampian with 143 respondents. We found widespread evidence of inappropriate interpretation of the clinical scenarios given. The study suggests potential for patient harm due to lack of knowledge and education is required. SUMMARY Background Lack of awareness of the nature of the direct oral anticoagulants (DOACs) combined with the poor correlation between routine coagulation test prolongation and the activity of these drugs represents a potential for patient harm. Objectives To establish the level of awareness of the different DOACs, and to assess whether prescribers were able to recognize the state of anticoagulation in a hypothetical patient. Methods and results An electronic questionnaire was sent by email to prescribers in our health board. Among 143 respondents, we found significant differences in awareness of the currently licensed drugs. Of the respondents, 88%, 80% and 50%, respectively, recognized rivaroxaban, dabigatran, and apixaban. When provided with a routine clinical situation, only 13.5%, 17.5% and 16.8%, respectively, recognized that the hypothetical patient was anticoagulated, and only 55-58% recognized that it was unsafe to proceed with an invasive procedure. Conclusion These results indicate a significant risk for patient harm related to lack of knowledge about this new group of frequently used drugs, and indicate that additional education and training on this subject are required.
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Affiliation(s)
- A Olaiya
- Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - B Lurie
- Department of Clinical Effectiveness, Aberdeen Royal Infirmary, Aberdeen, UK
| | - B Watt
- Department of Clinical Effectiveness, Aberdeen Royal Infirmary, Aberdeen, UK
| | - L McDonald
- Department of Pharmacy, Aberdeen Royal Infirmary, Aberdeen, UK
| | - M Greaves
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - H G Watson
- Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, UK
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26
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Piccirillo S, Colman S, Potter N, van Delft F, Lillis S, Carnicer M, Kearney L, Watts C, Greaves M. OP14GENETIC AND FUNCTIONAL DIVERSITY OF PROPAGATING CELLS IN GLIOBLASTOMA. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov283.14] [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: 11/14/2022] Open
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27
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Alpar D, Wren D, Ermini L, Mansur MB, van Delft FW, Bateman CM, Titley I, Kearney L, Szczepanski T, Gonzalez D, Ford AM, Potter NE, Greaves M. Clonal origins of ETV6-RUNX1⁺ acute lymphoblastic leukemia: studies in monozygotic twins. Leukemia 2014; 29:839-46. [PMID: 25388957 DOI: 10.1038/leu.2014.322] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/10/2014] [Indexed: 01/20/2023]
Abstract
Studies on twins with concordant acute lymphoblastic leukemia (ALL) have revealed that ETV6-RUNX1 gene fusion is a common, prenatal genetic event with other driver aberrations occurring subclonally and probably postnatally. The fetal cell type that is transformed by ETV6-RUNX1 is not identified by such studies or by the analysis of early B-cell lineage phenotype of derived progeny. Ongoing, clonal immunoglobulin (IG) and cross-lineage T-cell receptor (TCR) gene rearrangements are features of B-cell precursor leukemia and commence at the pro-B-cell stage of normal B-cell lineage development. We reasoned that shared clonal rearrangements of IG or TCR genes by concordant ALL in twins would be informative about the fetal cell type in which clonal advantage is elicited by ETV6-RUNX1. Five pairs of twins were analyzed for all varieties of IG and TCR gene rearrangements. All pairs showed identical incomplete or complete variable-diversity-joining junctions coupled with substantial, subclonal and divergent rearrangements. This pattern was endorsed by single-cell genetic scrutiny in one twin pair. Our data suggest that the pre-leukemic initiating function of ETV6-RUNX1 fusion is associated with clonal expansion early in the fetal B-cell lineage.
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Affiliation(s)
- D Alpar
- 1] Centre for Evolution and Cancer, The Institute of Cancer Research-London, London, UK [2] Department of Pathology, University of Pecs, Pecs, Hungary
| | - D Wren
- Haemato-Oncology Research Unit, Division of Molecular Pathology, The Institute of Cancer Research-London, London, UK
| | - L Ermini
- Centre for Geogenetics, Natural History Museum of Denmark, University of Copenhagen, Copenhagen K, Denmark
| | - M B Mansur
- 1] Centre for Evolution and Cancer, The Institute of Cancer Research-London, London, UK [2] Pediatric Hematology-Oncology Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - F W van Delft
- Centre for Evolution and Cancer, The Institute of Cancer Research-London, London, UK
| | - C M Bateman
- Centre for Evolution and Cancer, The Institute of Cancer Research-London, London, UK
| | - I Titley
- Centre for Evolution and Cancer, The Institute of Cancer Research-London, London, UK
| | - L Kearney
- Centre for Evolution and Cancer, The Institute of Cancer Research-London, London, UK
| | - T Szczepanski
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, Katowice, Poland
| | - D Gonzalez
- Haemato-Oncology Research Unit, Division of Molecular Pathology, The Institute of Cancer Research-London, London, UK
| | - A M Ford
- Centre for Evolution and Cancer, The Institute of Cancer Research-London, London, UK
| | - N E Potter
- Centre for Evolution and Cancer, The Institute of Cancer Research-London, London, UK
| | - M Greaves
- Centre for Evolution and Cancer, The Institute of Cancer Research-London, London, UK
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28
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Watts C, Piccirillo S, Kearney L, Potter N, van Delft F, Coleman S, Lillis S, Carnicer MJ, Greaves M. CB-18 * INTERROGATION OF SUB-CLONAL GENETIC DIVERSITY OF HUMAN GBM REVEALS GENETIC HETEROGENEITY IN TUMOUR-PROPAGATING CELLS, WHICH DISPLAY VARIABLE COMPETITIVE CAPACITY FOR TUMOUR PROPAGATION IN VIVO. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou241.17] [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: 11/13/2022] Open
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29
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Affiliation(s)
- M Greaves
- College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
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30
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Greaves M. It's not about sex. J Thromb Haemost 2014; 12:593-4. [PMID: 24628770 DOI: 10.1111/jth.12558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M Greaves
- College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
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Nangalia J, Massie CE, Baxter EJ, Nice FL, Gundem G, Wedge DC, Avezov E, Li J, Kollmann K, Kent DG, Aziz A, Godfrey AL, Hinton J, Martincorena I, Van Loo P, Jones AV, Guglielmelli P, Tarpey P, Harding HP, Fitzpatrick JD, Goudie CT, Ortmann CA, Loughran SJ, Raine K, Jones DR, Butler AP, Teague JW, O'Meara S, McLaren S, Bianchi M, Silber Y, Dimitropoulou D, Bloxham D, Mudie L, Maddison M, Robinson B, Keohane C, Maclean C, Hill K, Orchard K, Tauro S, Du MQ, Greaves M, Bowen D, Huntly BJP, Harrison CN, Cross NCP, Ron D, Vannucchi AM, Papaemmanuil E, Campbell PJ, Green AR. Somatic CALR mutations in myeloproliferative neoplasms with nonmutated JAK2. N Engl J Med 2013; 369:2391-2405. [PMID: 24325359 PMCID: PMC3966280 DOI: 10.1056/nejmoa1312542] [Citation(s) in RCA: 1333] [Impact Index Per Article: 121.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Somatic mutations in the Janus kinase 2 gene (JAK2) occur in many myeloproliferative neoplasms, but the molecular pathogenesis of myeloproliferative neoplasms with nonmutated JAK2 is obscure, and the diagnosis of these neoplasms remains a challenge. METHODS We performed exome sequencing of samples obtained from 151 patients with myeloproliferative neoplasms. The mutation status of the gene encoding calreticulin (CALR) was assessed in an additional 1345 hematologic cancers, 1517 other cancers, and 550 controls. We established phylogenetic trees using hematopoietic colonies. We assessed calreticulin subcellular localization using immunofluorescence and flow cytometry. RESULTS Exome sequencing identified 1498 mutations in 151 patients, with medians of 6.5, 6.5, and 13.0 mutations per patient in samples of polycythemia vera, essential thrombocythemia, and myelofibrosis, respectively. Somatic CALR mutations were found in 70 to 84% of samples of myeloproliferative neoplasms with nonmutated JAK2, in 8% of myelodysplasia samples, in occasional samples of other myeloid cancers, and in none of the other cancers. A total of 148 CALR mutations were identified with 19 distinct variants. Mutations were located in exon 9 and generated a +1 base-pair frameshift, which would result in a mutant protein with a novel C-terminal. Mutant calreticulin was observed in the endoplasmic reticulum without increased cell-surface or Golgi accumulation. Patients with myeloproliferative neoplasms carrying CALR mutations presented with higher platelet counts and lower hemoglobin levels than patients with mutated JAK2. Mutation of CALR was detected in hematopoietic stem and progenitor cells. Clonal analyses showed CALR mutations in the earliest phylogenetic node, a finding consistent with its role as an initiating mutation in some patients. CONCLUSIONS Somatic mutations in the endoplasmic reticulum chaperone CALR were found in a majority of patients with myeloproliferative neoplasms with nonmutated JAK2. (Funded by the Kay Kendall Leukaemia Fund and others.).
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Chaudhuri N, Duck A, Greaves M, Leonard CT. S13 Sole use of forced vital capacity as per national institute of health and care excellence criteria disadvantage 2 in 5 people with idiopathic pulmonary fibrosis. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.19] [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: 11/03/2022]
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Wright A, Helm J, Spencer L, Leonard C, Bishop P, Greaves M, Chaudhuri N. S12 Interstitial lung disease multidisciplinary discussion: six years of data from a tertiary service. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.18] [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: 11/04/2022]
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Abstract
Shedding of cytoplasm from circulating megakaryocytes (MKs) within the pulmonary vasculature suggests the lungs are an important site for normal platelet production. Fetal lungs receive only a minor fraction of the circulating blood volume. The placenta may act as a site for intrauterine platelet formation. Isolation of MKs from fetal vessels within the placenta has not been previously reported. Immediately after delivery, 3 human placentae were subjected to forward and retrograde perfusion across the placental capillary bed on the fetal side. MKs in perfusates were harvested by 'whole blood filtration' and identified by morphological and immunochemical methods. All perfusates yielded MKs. Qualitatively MKs with copious cytoplasm were more commonly found in perfusates collected from fetal arteries compared with those from fetal veins. This is consistent with filtration of MKs and fragmentation of their cytoplasm within the placental microcirculation to produce platelets. Perfusion of human placentae followed by filtration of perfusates is a useful technique for harvesting fetal MKs and permitting further elucidation of their physiological role.
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Affiliation(s)
- M J Woods
- Department of Medical Physics and Clinical Engineering, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
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Elderfield H, Ferretti P, Greaves M, Crowhurst S, McCave IN, Hodell D, Piotrowski AM. Evolution of Ocean Temperature and Ice Volume Through the Mid-Pleistocene Climate Transition. Science 2012; 337:704-9. [DOI: 10.1126/science.1221294] [Citation(s) in RCA: 530] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Irwin RB, Newton T, Peebles C, Borg A, Clark D, Miller C, Abidin N, Greaves M, Schmitt M. Incidental extra-cardiac findings on clinical CMR. Eur Heart J Cardiovasc Imaging 2012; 14:158-66. [DOI: 10.1093/ehjci/jes133] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Enciso-Mora V, Hosking FJ, Sheridan E, Kinsey SE, Lightfoot T, Roman E, Irving JAE, Tomlinson IPM, Allan JM, Taylor M, Greaves M, Houlston RS. Common genetic variation contributes significantly to the risk of childhood B-cell precursor acute lymphoblastic leukemia. Leukemia 2012; 26:2212-5. [PMID: 22456626 DOI: 10.1038/leu.2012.89] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Recent genome-wide association studies (GWAS) have provided the first unambiguous evidence that common genetic variation influences the risk of childhood B-cell precursor acute lymphoblastic leukemia (BCP-ALL), identifying risk single-nucleotide polymorphisms (SNPs) localizing to 7p12.2, 9p21.3, 10q21.2 and 14q11.2. The testing of SNPs individually for an association in GWA studies necessitates the imposition of a very stringent P-value to address the issue of multiple testing. While this reduces false positives, real associations may be missed and therefore any estimate of the total heritability will be negatively biased. Using GWAS data on 823 BCP-ALL cases by considering all typed SNPs simultaneously, we have calculated that 24% of the total variation in BCP-ALL risk is accounted for common genetic variation (95% confidence interval 6-42%). Our findings provide support for a polygenic basis for susceptibility to BCP-ALL and have wider implications for future searches for novel disease-causing risk variants.
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Affiliation(s)
- V Enciso-Mora
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, UK
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Irwin RB, Newton T, Peebles C, Borg A, Clark D, Miller C, Abidin N, Greaves M, Schmitt M. 121 Incidental extra-cardiac findings on clinical cmr; a comparison of 3 haste techniques. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mansur MB, Ford AM, van Delft FW, Gonzalez D, Emerenciano M, Maia RC, Greaves M, Pombo-de-Oliveira MS. Occurrence of identical NOTCH1 mutation in non-twinned sisters with T-cell acute lymphoblastic leukemia. Leukemia 2011; 25:1368-70. [PMID: 21556011 DOI: 10.1038/leu.2011.96] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Bach S, Bombinski T, Daniels M, Gross D, Hogg T, Martin T, McMurray D, Naber E, Perez N, Schulman A, Tucker S, Andera‐Cato S, Arnold A, Blumberg A, Bord M, Feiertag A, Greaves M, Her A, Kennedy E, Orozco C, Rice C, Rodgers A, Sauer A, Schubert J, Tubbs C, Wray T, Vogt G, Shrestha L, Hillard C. Of Mice and MAGL (Monoacylglycerol Lipase). FASEB J 2011. [DOI: 10.1096/fasebj.25.1_supplement.lb158] [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: 11/11/2022]
Affiliation(s)
- S. Bach
- Brown Deer High SchoolMilwaukeeWI
| | | | | | - D. Gross
- Brown Deer High SchoolMilwaukeeWI
| | - T. Hogg
- Brown Deer High SchoolMilwaukeeWI
| | | | | | - E. Naber
- Brown Deer High SchoolMilwaukeeWI
| | - N. Perez
- Brown Deer High SchoolMilwaukeeWI
| | | | | | | | | | | | - M. Bord
- Brown Deer High SchoolMilwaukeeWI
| | | | | | - A. Her
- Brown Deer High SchoolMilwaukeeWI
| | | | | | - C. Rice
- Brown Deer High SchoolMilwaukeeWI
| | | | - A. Sauer
- Brown Deer High SchoolMilwaukeeWI
| | | | - C. Tubbs
- Brown Deer High SchoolMilwaukeeWI
| | - T. Wray
- Brown Deer High SchoolMilwaukeeWI
| | - G. Vogt
- Brown Deer High SchoolMilwaukeeWI
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Collins PW, Baglin TP, Dang R, Evans G, Greaves M, Laffan M, Pasi KJ, Rose P, Stanworth S, Toh CH, Gower J. Non-malignant haematology research in the UK: looking forward to new opportunities. Br J Haematol 2010. [DOI: 10.1111/j.1365-2141.2010.08407.x] [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: 11/26/2022]
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Collins PW, Baglin TP, Dang R, Evans G, Greaves M, Laffan M, Pasi KJ, Rose P, Stanworth S, Toh CH, Gower J. announcement: Non-malignant haematology research in the UK: looking forward to new opportunities. Br J Haematol 2010; 150:732-6. [DOI: 10.1111/j.1365-2141.2010.08384.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: 11/29/2022]
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Greaves M, Neilson J. Session 22: Prevention of Maternal Death in Early Pregnancy. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.22] [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: 11/13/2022] Open
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Greaves M, Lane DA. Rewards for commitment and success. J Thromb Haemost 2010; 8:1. [PMID: 20167043 DOI: 10.1111/j.1538-7836.2009.03707.x] [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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Lawlor F, Black A, Greaves M. Prednicarbate 0.25% ointment in the treatment of atopic dermatitis: A vehicle-controlled double-blind study. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639509086850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Collins P, Ford I, Greaves M, Macaulay E, Brittenden J. Surgical revascularisation in patients with severe limb ischaemia induces a pro-thrombotic state. Platelets 2009; 17:311-7. [PMID: 16928603 DOI: 10.1080/09537100600746540] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Platelet and coagulation activation are implicated in the increased incidence of ischaemic events seen in patients with peripheral arterial disease. This study aimed to assess the effect of surgical revascularisation on platelet aggregation and coagulation in patients with severe limb ischaemia (SLI). Twenty-two patients had blood samples taken: prior to surgery, on reperfusion, 2, 24 and 48 h post-surgery. Platelet aggregation through COX-mediated and thrombin receptor activator peptide (TRAP)-stimulated GPIIb/IIIa pathways was measured by the Ultegra point of care system. Thrombin-antithrombin III Complex (TAT) and D-dimer were measured by ELISA. COX-mediated aggregation increased significantly at reperfusion and remained elevated at 24 h [median increase from baseline of 9% (range -16 to 33%) P = 0.011]. TRAP-stimulated aggregation increased significantly at reperfusion and remained elevated at 2 h post-surgery [median increase 18% (range -71 to 45%); P = 0.007]. TAT levels were significantly elevated from reperfusion and remained so at 48 h (P < 0.003), whereas D-dimer only increased at 24 h (P = 0.014). For the first time, we have demonstrated that in patients with SLI, platelet aggregation is increased following surgery and there is a mismatch in the balance between the coagulation and fibrinolytic pathways despite the use of aspirin and heparin. Thus in the early post-operative these patients exhibit a pro-thrombotic state.
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Affiliation(s)
- P Collins
- Department of Vascular Surgery, University of Aberdeen, Scotland, UK
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Abstract
Chronic urticaria is defined as the presence of urticaria (hives) for at least 6 weeks with the assumption that it occurs daily or close to it. If we eliminate physical urticarias and urticarial vasculitis from consideration, the remainder can be divided into autoimmune chronic urticaria (45%) and idiopathic chronic urticaria (55%). The autoimmune subgroup is associated with the IgG anti-IgE receptor alpha subunit in 35-40% of patients and IgG anti-IgE in an additional 5-10%. These autoantibodies have been shown to activate blood basophils and cutaneous mast cells in vitro with augmentation of basophil activation by complement and release of C5a, in particular. Binding methods (immunoblot and ELISA) yield positives in many autoimmune diseases as well as occasional normal subjects or patients with other forms of urticaria but most such sera are non-functional. Activation of basophils or mast cells causing histamine release is quite specific for chronic urticaria and defines the autoimmune subgroup. Although pathogenicity is not formally proven, the antibodies cause wealing upon intradermal injection, and removal of the autoantibody leads to remission. A cellular infiltrate is seen to be characterized by mast cell degranulation and infiltration of CD4+ T lymphocytes, monocytes, neutrophils, eosinophils, and basophils. The intensity of the infiltrate and clinical severity of the disease (including accompanying angio-oedema) is more severe in the autoimmune subpopulation. This latter group also has a higher evidence of human leucocyte antigen DR alleles associated with autoimmunity and a 25% incidence of antithyroid antibodies with diagnosed hypothyroidism in some. Hypo-responsiveness of patients' basophils to anti-IgE and hyperresponsiveness to serum defines another subpopulation (at least 50%) that overlaps the idiopathic and autoimmune subgroups. Hypo-responsiveness to anti-IgE has been shown to be associated with elevated levels of cytoplasmic phosphatases that inhibit degranulation. Reversal of the abnormality is seen with disease remission. Further work will be needed to distinguish whether this is a cause or a consequence of persistent urticaria and to further assess the relationship (or lack thereof) of altered responsiveness (decreased or increased) with the presence or absence of activating autoantibodies.
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Affiliation(s)
- A P Kaplan
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC, USA.
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