1
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Graaf G, Kitchens K, Sweeney M, Thomas KC. Behavioral Health Services Outcomes That Matter Most to Caregivers of Children, Youth, and Young Adults with Mental Health Needs. Int J Environ Res Public Health 2024; 21:172. [PMID: 38397663 PMCID: PMC10887955 DOI: 10.3390/ijerph21020172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/14/2024] [Accepted: 01/17/2024] [Indexed: 02/25/2024]
Abstract
This project documents the service outcomes that caregivers value most. A diverse group of caregivers, representing six regions of the United States, participated in two rounds of virtual one-hour focus groups. In round 1, participants identified what they hoped to gain from using behavioral health services for themselves, their families, and their child and discussed what made services a positive experience for them. They then reported their top-three most-hoped-for outcomes. In round 2, groups validated and refined summary findings from round 1. Caregivers prioritized service quality outcomes, primarily. They expressed a desire for an accessible, respectful, and supportive treatment environment, underpinned by well-trained and culturally responsive professionals. Caregivers also desire seamless cross-sector provider collaboration and care transitions, which integrate the insights and preferences of families and children themselves to craft a customized care plan. Priority outcomes not related to service quality included hoping to gain increased knowledge, resources, and tools and techniques to support the mental health needs of their children, to see their children improve their daily functioning and for their child develop more effective interpersonal communication skills. Caregivers also reported hoping to experience less stigma related to the mental health needs of their children and to achieve personal fulfillment for themselves and their children. Research, policies, and mental health services should prioritize and be designed to address the outcomes that matter to youth and families.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Katherine Kitchens
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Millie Sweeney
- Family-Run Executive Director Leadership Association (FREDLA), Elliot City, MD 21042, USA
| | - Kathleen C. Thomas
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599, USA
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2
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Herbell K, McNamara P, Cresswell C, Price M, Sweeney M, Bellonci C. Are we practicing what we preach? Family partnership in therapeutic residential care for children and youth. Resid Treat Child Youth 2023; 41:2-23. [PMID: 38186636 PMCID: PMC10766376 DOI: 10.1080/0886571x.2023.2217530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
This study presents a tiered conceptualization of family partnership developed by the Family-Run Executive Director Leadership Association (FREDLA) with examples of strategies from the literature. This sub-study was part of an overarching systematic review project that aimed to review the literature on family partnership in relation to youth outcomes. The tiers of family partnership include family involvement (i.e., family's inclusion in their child's care); family engagement (i.e., collaboration between TRC and families); family-driven (i.e., families as full partners). This review included thirty studies (n=23 family involvement, n=7 family engagement, n=0 family-driven). The most common family involvement methods were family therapy and family visits to the program, primarily delivered face-to-face. The most common family engagement method was activities, therapies, and skill building occurring at the home with family present. Methods of measuring family partnership primarily included the use of administrative data. Implications for research and practice include the provision of research that evaluates the effects of family partnership on outcomes important in the TRC setting and the development of research-practice and family-research collaborations to increase the uptake of effective family partnering methods.
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Affiliation(s)
- Kayla Herbell
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Patricia McNamara
- Department of Social Work Centre for Health Services and Clinical Research, The University of Melbourne
| | | | - Matt Price
- School of Social Work, University of Kentucky
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3
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Conaty J, Smith B, Sweeney M. 188 A REVIEW OF THE REABLEMENT PROGRAM WHICH INCLUDES THERAPY ASSISTANTS WITHIN THE AMBULATORY HUB. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.161] [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: 11/14/2022] Open
Abstract
Abstract
Background
The Ambulatory Hub for the older person commenced in May 2021 in line with the Enhanced Community Care Implementation Guidance documents. From a client and carer perspective, the hub provides a single point of access and a co-ordinated approach to the client's care needs with a focus on frailty. The Reablement service is provided alongside the Hub team providing a specialist Occupational Therapy and Physiotherapy geriatric assessment. Depending on the outcome of the assessment and needs identified, the client can avail of the Reablement program. Each patient will have an individualised therapy program which is carried out by the therapy assistants in the client’s home. The Reablement program aims to provide care in line with the “Right Care, Right Place, Right Team, Right Time” ethos.
Methods
The charts of 20 clients who completed the Reablement program were reviewed. The data collected included the number of visits by the Occupational Therapist, Physiotherapist and therapy assistants. Feedback from the client and their family was sought and documented.
Results
The results showed that clients received on average 4 Occupational Therapy and 4 Physiotherapy sessions each. The therapy assistants provided on average 15 visits per client to support the implementation of specialist programs developed by the therapy team. The feedback from clients and family was very positive and the following feedback was received “A program like this is a great initiative”, “ It Improved my confidence”, “I’m able to cook my meals for myself again”
Conclusion
The Reablement program with the support of therapy assistants has led to a patient centred service and co-ordinated approach to the care of the client with increased client compliance. A similar service was not available in the community previously. The Reablement program has reduced the need for inpatient reablement beds which was previously the pathway of care for these clients in the community.
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Affiliation(s)
| | - B Smith
- Ambulatory Hub , Cavan, Ireland
| | - M Sweeney
- Cavan General Hospital , Cavan, Ireland
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4
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Sweeney M, Thomas I, OReilly A, Duggan J, Conaty J, Smith B, Enaeney AM, Tackney L, Hopkins C, O'Reilly R. 85 QUALITY IMPROVEMENT INITIATIVE TO ASSESS FRAILTY AWARENESS AND USE CLINICAL FRAILTY SCALE AMONGST STAFF IN ACUTE AND PRIMARY CARE SITES. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.069] [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: 11/13/2022] Open
Abstract
Abstract
Background
Frailty describes a condition characterized by decreased physiological reserve and a decreased resistance to stressors, leading to an increased vulnerability to adverse outcomes. Identification of frailty can generate greater complexity in treatment choices, care planning, and costs of care.
Methods
30 inpatient, Emergency Department and Ambulatory Hub charts were audited to assess the presence of the word Frailty. The use of the Clinical Frailty Scale or alternative frailty scale was also audited. A staff survey was completed across four sites, a total of 115 staff were surveyed.
Results
Awareness of frailty across all services is very good ranging from 92% to 100%. The use and awareness of the Clinical Frailty Scale varied with 41% Emergency department and 12% of acute staff respectively but only 25% Emergency Department and 12% of acute staff feeling competent to complete the scale. Conversely, there was a 73% awareness of the Clinical Frailty Scale amongst primary care staff, 33% feeling competent in it's use. The Ambulatory Hub had 100% awareness of the scale with 54% of staff feeling competent.
The chart audit showed that 20% of charts in the Emergency Department identified frailty, all by the Frailty Intervention Team. 26% of the inpatient charts identified Frailty by the Frailty Intervention Team's notes and from one visiting consultant. Frailty was identified and measured using the Clinical Frailty Scale in all cases of the Ambulatory Hub notes.
Conclusion
By identifying frailty at the first point of contact, targeted specialist interventions and services can be planned for the service user. Frailty identification on the acute site was mainly linked to the Frailty Intervention Team with the Ambulatory Hub leading out on frailty identification and measurement in the community. Future initiatives aim to increase frailty identification and awareness in acute and primary care sites.
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Affiliation(s)
- M Sweeney
- Cavan General Hospital , Cavan, Ireland
| | | | - A OReilly
- Cavan General Hospital , Cavan, Ireland
| | - J Duggan
- Cavan General Hospital , Cavan, Ireland
| | | | - B Smith
- Ambulatory Hub , Cavan, Ireland
| | | | - L Tackney
- Cavan General Hospital , Cavan, Ireland
| | - C Hopkins
- Cavan General Hospital , Cavan, Ireland
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Fu L, Gilham D, Stotz S, Sarsons C, Rakai B, Tsujikawa L, Wasiak S, Johansson J, Sweeney M, Wong N, Kulikowski E. Apabetalone, a BET inhibitor, attenuates inflammation induced by viral RNA mimetic and reduces SARS-CoV-2 spike protein binding regardless of variants. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1696] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Hyperinflammatory responses to SARS-CoV-2 can cause myocarditis and cardiac dysfunction including congestive heart failure [1]. SARS-CoV-2 RNA induces type I interferon (IFN-I), activating IFN regulatory factors (IRFs) and downstream IFN stimulated genes (ISGs) to initiate inflammatory processes. SARS-CoV-2 variants may develop immune escape, undercutting benefits of vaccinations. These challenges highlight the need of variant-independent therapies to improve COVID-19 outcomes. Apabetalone is an epigenetic BD2-selective BET inhibitor in phase 3 trials for cardiovascular disease [2]. Apabetalone has the potential to treat COVID-19. It counters inflammatory signals caused by cytokine storm (CS), preventing cardiac dysfunction associated with severe COVID-19 symptoms in cardiac organoids [3]. It also downregulates angiotensin-converting enzyme 2 (ACE2) expression, the main host cell receptor for SARS-CoV-2 spike protein thus impeding propagation of wild-type SARS-CoV-2 [3,4].
Purpose
1) Evaluate apabetalone's effect on inflammatory processes induced by viral-RNA mimetic in human lung cells; 2) Assess apabetalone's ability to prevent binding of the highly contagious delta variant spike protein to human lung cells.
Methods
Inflammatory gene expression was examined by real-time PCR in apabetalone treated human bronchial epithelial cells (Calu-3) stimulated with poly I:C, a well-accepted viral RNA mimetic that elicits inflammatory signals similar to SARS-CoV-2 RNA [5]. Binding of SARS-CoV-2 delta or wild-type spike protein to apabetalone treated Calu-3 cells was determined by flow cytometry.
Results
In Calu-3 cells, apabetalone dose-dependently downregulated poly I:C induced transcription of key COVID-19 associated cytokines (IL6, CXCL10, CCL2) to a similar extent as baricitinib (up to 86%, p<0.0001), an anti-inflammatory agent in emergency use for COVID-19 treatment. Moreover, apabetalone but not baricitinib diminished IL1B mRNA levels (up to 66%, p<0.0001). Apabetalone and baricitinib opposed poly I:C induced expression of IFNB1 (an IFN-I), IRF1 and IRF9 (upstream regulators) as well as IFIT1 and IFIT2 (downstream ISGs that regulate CXCL10 expression; up to 90%, p<0.0001). Clinically relevant doses of apabetalone did not alter expression of anti-viral IFITM2, an ISG that blocks SARS-CoV-2, particularly omicron, endosomal entry [6]. Therefore, apabetalone counters the expression of inflammatory factors with roles in CS and IFN-I signaling in response to poly I:C. Additionally, apabetalone reduced delta and wild-type spike protein binding to unstimulated Calu-3 cells (up to 72%, p<0.0001).
Conclusions
Apabetalone's dual anti-viral and anti-inflammatory mechanism positions it as a variant-independent COVID-19 therapeutic. Together with an established safety profile from >2000 treatment-years with apabetalone, the data provide rationale for an ongoing clinical trial (NCT04894266) which includes analysis of cardiac damage.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Resverlogix Corp
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Affiliation(s)
- L Fu
- Resverlogix Corp. , Calgary , Canada
| | - D Gilham
- Resverlogix Corp. , Calgary , Canada
| | - S Stotz
- Resverlogix Corp. , Calgary , Canada
| | - C Sarsons
- Resverlogix Corp. , Calgary , Canada
| | - B Rakai
- Resverlogix Corp. , Calgary , Canada
| | | | - S Wasiak
- Resverlogix Corp. , Calgary , Canada
| | | | - M Sweeney
- Resverlogix Corp. , Calgary , Canada
| | - N Wong
- Resverlogix Corp. , Calgary , Canada
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6
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Ahmed A, de Buitleir C, Elsheik N, Sweeney M. Very Long-Chain Acyl-CoA Dehydrogenase Deficiency Presenting as Rhabdomyolysis. Ir Med J 2022; 115:565. [PMID: 35532898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Presentation A 20 year old female attended the Emergency Department by ambulance following a collapse at a concert. On arrival she was complaining of generalised muscular pain. She had not eaten for over 12 hours and had been dancing for approximately 6 hours. The patient was known to have Very-long-chain acyl-CoA dehydrogenase deficiency (VLCAD). She had a normal exam, and normal vital signs. Diagnosis A diagnosis of rhabdomyolysis was made after her creatinine kinase (CK) was found to be >100000 units/litre (Normal range < 170U/L). Her urine was dark brown with urinalysis positive for blood. Treatment The patient was admitted to the high dependency unit, where she was treated with intravenous fluids. Her urine output and renal function were closely monitored. She made a full recovery and was discharged home four days later. Conclusion (VLCAD) is an inherited, autosomal recessive, metabolic disorder caused by mutations in the ACADVL gene. Management includes treatment of manifestation, primary prevention of manifestation, and prevention of secondary complications.
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Affiliation(s)
- A Ahmed
- Emergency Department, Sligo university Hospital, Sligo, Ireland
| | - C de Buitleir
- Emergency Department, Sligo university Hospital, Sligo, Ireland
| | - N Elsheik
- Emergency Department, Sligo university Hospital, Sligo, Ireland
| | - M Sweeney
- Emergency Department, Sligo university Hospital, Sligo, Ireland
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7
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Pullmann MD, Dorsey S, Duong MT, Lyon AR, Muse I, Corbin CM, Davis CJ, Thorp K, Sweeney M, Lewis CC, Powell BJ. Expect the Unexpected: A Qualitative Study of the Ripple Effects of Children's Mental Health Services Implementation Efforts. Implement Res Pract 2022; 3:10.1177/26334895221120797. [PMID: 36504561 PMCID: PMC9731268 DOI: 10.1177/26334895221120797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Strategies to implement evidence-based interventions (EBIs) in children's mental health services have complex direct and indirect causal impacts on multiple outcomes. Ripple effects are outcomes caused by EBI implementation efforts that are unplanned, unanticipated, and/or more salient to stakeholders other than researchers and implementers. The purpose of the current paper is to provide a compilation of possible ripple effects associated with EBI implementation strategies in children's mental health services, to be used for implementation planning, research, and quality improvement. Methods Participants were identified via expert nomination and snowball sampling. Online surveys were completed by 81 participants, each representing one of five roles: providers of mental health services to children or youth, researchers, policy makers, caregivers, and youth. A partially directed conventional content analysis with consensus decision making was used to code ripple effects. Results Four hundred and four unique responses were coded into 66 ripple effects and 14 categories. Categories include general knowledge, skills, attitudes, and confidence about using EBIs; general job-related ripple effects; EBI treatment adherence, fidelity, and alignment; gaming the system; equity and stigma; shifting roles, role clarity, and task shifting; economic costs and benefits; EBI treatment availability, access, participation, attendance, barriers, and facilitators; clinical process and treatment quality; client engagement, therapeutic alliance, and client satisfaction; clinical organization structure, relationships in the organization, process, and functioning; youth client and caregiver outcomes; and use of EBI strategies and insights in one's own life. Conclusions This research advances the field by providing children's mental health implementers, researchers, funders, policy makers, and consumers with a menu of potential ripple effects. It can be a practical tool to ensure compliance with guidance from Quality Improvement/Quality Assurance, Complexity Science, and Diffusion of Innovation Theory. Future phases will match potential ripple effects with salient children's mental health implementation strategies for each participant role.
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Affiliation(s)
- Michael D. Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of
Medicine, School Mental Health Assessment, Research, and Training Center,
Seattle, WA, USA
- Michael Pullmann, University of Washington
School of Medicine, Department of Psychiatry and Behavioral Sciences, School
Mental Health Assessment, Research, and Training Center, 6200 NE 74th Street,
Suite 110, Seattle, WA 98115-6560, USA.
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Mylien T. Duong
- Education, Research, and Impact Committee for Children, Seattle, WA,
USA
| | - Aaron R. Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of
Medicine, School Mental Health Assessment, Research, and Training Center,
Seattle, WA, USA
| | - Ian Muse
- Department of Psychiatry and Behavioral Sciences, University of Washington School of
Medicine, School Mental Health Assessment, Research, and Training Center,
Seattle, WA, USA
| | - Cathy M. Corbin
- Department of Psychiatry and Behavioral Sciences, University of Washington School of
Medicine, School Mental Health Assessment, Research, and Training Center,
Seattle, WA, USA
| | - Chayna J. Davis
- Department of Psychiatry and Behavioral Sciences, University of Washington School of
Medicine, School Mental Health Assessment, Research, and Training Center,
Seattle, WA, USA
| | | | - Millie Sweeney
- Family-Run Executive Director Leadership Association (FREDLA),
Columbia, MD, USA
| | - Cara C. Lewis
- Kaiser Permanente Washington Health
Research Institute, Seattle, WA, USA
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington
University, St. Louis, MO, USA
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8
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Gilham D, Smith AL, Fu L, Moore DY, Muralidharan A, Reid SPM, Stotz SC, Johansson JO, Sweeney M, Wong NCW, El-Gamal D, Kulikowski E. Bromodomain and extraterminal (BET) protein inhibitor, apabetalone, reduces ACE2 expression and attenuates SARS-CoV-2 infection in vitro. Eur Heart J 2021. [PMCID: PMC8767620 DOI: 10.1093/eurheartj/ehab724.3267] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/Introduction SARS-CoV-2 causes life threatening COVID-19 complications including acute coronary syndrome, venous thromboembolism, hyperinflammation and damage in multiple tissues. The SARS-CoV-2 “spike protein” binds cell surface receptors including angiotensin-converting enzyme 2 (ACE2) for entry into host cells to initiate infection. Host cell dipeptidyl peptidase-4 (DPP4 / CD26) is implicated as a cofactor in uptake. Recent evidence indicates expression of factors involved in SARS-CoV-2 uptake into host cells is regulated by BET proteins, epigenetic readers modulating gene expression. Apabetalone, the most clinically advanced BET inhibitor (BETi), is in phase 3 trials for cardiovascular disease (CVD) (a,b). In cultured human cardiomyocytes, apabetalone suppressed infection with SARS-CoV-2 and prevented dysfunction of cardiac organoids induced by the cytokine-storm that arises in patients with severe symptoms (c). However, anti-viral properties of apabetalone in other cell types are not known. Purpose To examine effects of apabetalone on SARS-CoV-2 infection in cell culture via downregulated expression of cell surface receptors involved in viral entry. Cell systems used mimic initial sites of infection in the lung as well as cell types contributing to complications in late stages of infection. Methods Gene expression was measured by real-time PCR, protein levels by immunoblot or flow cytometry, and binding of recombinant SARS-CoV-2 spike protein by flow cytometry. Infection with SARS-CoV-2 was determined in a BSL3 facility. Infectivity was quantified by determining levels of viral spike protein amongst total cells via imaging on an Operetta CLS. Results In Calu-3, a human bronchial epithelial cell line, apabetalone dose-dependently downregulated ACE2 gene expression (up to 98%), reduced ACE2 protein levels (up to 84%) and diminished binding of SARS-CoV-2 spike protein (up to 77%, p<0.001 for all parameters). Further, apabetalone abolished infection of Calu-3 cells with live SARS-CoV-2, which was comparable to other antiviral agents. Apabetalone-driven ACE2 downregulation was also observed in extrapulmonary cell types including HepG2, Huh-7 or primary hepatocytes (up to 90%, p<0.001 for all cell types), and Vero E6, a monkey kidney epithelial cell line (up to 38%, p<0.05). DPP4/CD26, a potential cofactor for SARS-CoV-2 uptake, was also downregulated by apabetalone in Calu-3 cells (mRNA ∼65% and protein ∼40%, p<0.001), which may be synergistic with ACE2 reductions to impede SARS-CoV-2 infection. Conclusions Apabetalone, an investigational drug for CVD, reduced cell surface receptors (ACE2 and DPP4) involved in SARS-CoV-2 uptake into host cells and dramatically attenuated SARS-CoV-2 infection/propagation in vitro. Our results suggest apabetalone can mitigate SARS-CoV-2 replication in multiple organs, which together with an established safety profile supports clinical evaluation of apabetalone to treat Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): COVID-19 Rapid Response Grant from the College of Medicine at the University of Nebraska Medical Center (to DE and SPMR), and by University of Nebraska Medical Center start-up funds (to DE).
Graphical Abstract ![]()
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Affiliation(s)
- D Gilham
- Resverlogix Corp., Calgary, Canada
| | - A L Smith
- University of Nebraska Medical Center, Eppley Institute for Research in Cancer and Allied Diseases, Omaha, United States of America
| | - L Fu
- Resverlogix Corp., Calgary, Canada
| | - D Y Moore
- University of Nebraska Medical Center, Eppley Institute for Research in Cancer and Allied Diseases, Omaha, United States of America
| | - A Muralidharan
- University of Nebraska Medical Center, Department of Pathology and Microbiology, Omaha, United States of America
| | - S P M Reid
- University of Nebraska Medical Center, Department of Pathology and Microbiology, Omaha, United States of America
| | | | - J O Johansson
- Resverlogix Inc., San Francisco, United States of America
| | - M Sweeney
- Resverlogix Inc., San Francisco, United States of America
| | | | - D El-Gamal
- University of Nebraska Medical Center, Eppley Institute for Research in Cancer and Allied Diseases, Omaha, United States of America
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9
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Toth PP, Schwartz GG, Nicholls SJ, Halliday C, Ginsberg HN, Johansson JO, Kalantar-Zadeh K, Kulikowski E, Lebioda K, Wong N, Sweeney M, Ray KK. Reduction in the risk of MACE with apabetalone in patients with recent acute coronary syndrome and diabetes according to NAFLD fibrosis score: exploratory analysis of the BETonMACE trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2536] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Both major adverse cardiovascular events (MACE) and non-alcoholic fatty-liver disease (NAFLD) are highly prevalent in patients with high BMI and long-standing type 2 diabetes (T2DM). NAFLD is characterized by an augmented hepatic inflammation and fat deposition and is strongly associated with metabolic syndrome. Patients with NAFLD are at an increased risk of cardiovascular (CV) events, and MACE is the leading cause of death for patients with NAFLD. Apabetalone (APB) is a novel selective inhibitor of bromodomain and extra-terminal (BET) proteins, epigenetic regulators of gene expression. In the Phase 3 BETonMACE trial treatment of 2,425 T2DM patients post ACS with APB, resulted in hazard ratios (HR) of 0.82 (p=0.11) for the primary endpoint of ischemic MACE (CV death, non-fatal MI or stroke) and 0.59 (p=0.03) for the secondary endpoint of heart failure hospitalization (HFH) vs placebo (PBO). Transient elevations of alanine aminotransferase greater than 5xULN occurred in 3.3% of APB treated patients.
Purpose
In this exploratory post hoc analysis of BETonMACE we evaluated risk modification for a composite of MACE+HFH by APB based on the Angulo NAFLD fibrosis score (FS) using 6 variables (age, BMI, hyperglycemia/diabetes, AST/ALT ratio, platelet count, and albumin). The NAFLD FS categorizes individuals into groups that correlate with differing levels of fibrosis in biopsy studies: (FS F0-F2, no significant fibrosis; FS ID, indeterminant; and FS F3-F4, significant fibrosis).
Methods
Baseline characteristics and blood measurements were used to determine NAFLD FS at baseline. The incidence of MACE+HHF was compared between treatment groups.
Results
Based on FS, there were 618 pts were classified as FS F0-F2 (n=328 APB, n=290 PBO), 1,440 pts were classified as FS ID (n=708 APB, n=732 PBO) and 289 pts were classified as FS F3-F4 (n=144 APB, n=145). MACE+HHF in the PBO group was higher in FS ID and FS F3-F4 compared to FS F0-F2 (17.2% vs 15.0% vs 9.7%) and therefore the former two groups were combined into an elevated risk FS+ group. FS+ pts were older (63 vs 56), had longer duration of T2DM (9.0 vs 7.3 yrs), and higher BMI (30.8 vs 28.6) compared to FS- pts. Overall, APB was associated with fewer MACE+HHF (HR 0.78, 95% CI 0.60–1.01, p=0.06) compared to PBO in the FS+ pts with adjustment for age, duration of T2DM and BMI.
Conclusions
Patients with T2DM and ACS may share common risk factors with patients with NAFLD. Apabetalone appears to exert a favorable effect on MACE in patients with risk factors for NAFLD. Whether apabetalone has a modulatory effect on the development and progression of NAFLD is an important question requiring further investigation.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Resverlogix Corp.
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Affiliation(s)
- P P Toth
- CGH Medical Center, Sterling, United States of America
| | - G G Schwartz
- University of Colorado, School of Medicine Division of Cardiology, Aurora, United States of America
| | - S J Nicholls
- Monash Centre of Cardiovascular Research & Education in Therapeutics, Melbourne, Australia
| | | | - H N Ginsberg
- Columbia University, Irving Institute for Clinical and Translational Research, New York, United States of America
| | | | - K Kalantar-Zadeh
- University of California at Irvine, Division of Nephrology and Hypertension, Irvine, United States of America
| | | | | | - N Wong
- Resverlogix Corp., Calgary, Canada
| | | | - K K Ray
- Imperial College London, Imperial Centre for Cardiovascular Disease Prevention, London, United Kingdom
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10
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Ray K, Nicholls S, Buhr K, Ginsberg H, Kalantar-Zadeh K, Johansson J, Kulikowski E, Toth P, Wong N, Sweeney M, Schwartz G. Apabetalone, a selective BET protein inhibitor, reduces ischemic cardiovascular events and hospitalization for heart failure in patients with acute coronary syndrome and type 2 diabetes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1425] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Despite established treatments, patients with type 2 diabetes mellitus (T2DM) and acute coronary syndrome (ACS) are at higher risk of ischemic cardiovascular (CV) events and hospitalization for heart failure (HHF) compared to those without T2DM. LDL-C lowering or use of GLP-1 agonists predominantly affects ischemic CV events, with little effect on HHF. Conversely, treatment with SGLT-2 inhibitors reduces HHF, with less effect on ischemic CV events. Preclinical studies indicate that bromodomain and extra-terminal (BET) proteins coordinate gene transcription for pathways that promote atherothrombotic events as well as heart failure. We assessed the clinical effect of apabetalone (APB), a novel BET protein inhibitor, on a composite of non-fatal ischemic CV events, HHF, and CV death in a post hoc analysis of the BETonMACE trial
Methods
BETonMACE was a double-blind, placebo-controlled phase 3 study in patients with T2DM and recent acute coronary syndrome receiving standard of care risk factor management. In 13 countries, 2425 patients were enrolled. We conducted a time-to-event analysis for first adjudicated CV death or non-fatal MI, stroke, or HHF using a log-rank test and Cox proportional hazards model.
Results
At baseline median age was 62 years, 25.6% were female, 87.6% white, and use of high intensity statin, ACE inhibitors/ angiotensin II blockers, dual antiplatelet therapy and beta blocker were 90, 88, 92 and 91% respectively. A total of 312 subjects had an endpoint event, with 139 (11.5%) patients in the ABP group and 173 (14.3%) among PBO (HR 0.78, 95% CI 0.63–0.98, p=0.03, Figure). At 26 months, the absolute risk reduction was 3.2% and number needed to treat was 31. Numerically favorable HRs were observed for each component endpoint except for stroke (Table).
Conclusion
This present analysis suggests that BET inhibition with APB may be a novel pathway through which to reduce both HHF and ischemic CV events in high risk patients with T2DM thus impacting broader clinical outcomes with potentially large benefits for patients and healthcare systems.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Resverlogix Corp
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Affiliation(s)
- K.K Ray
- Imperial College London, London, United Kingdom
| | - S.J Nicholls
- Monash University, Cardiovascular Research Centre, Melbourne, Australia
| | - K.A Buhr
- University of Wisconsin-Madison, Madison, United States of America
| | - H.N Ginsberg
- Columbia University, New York, United States of America
| | - K Kalantar-Zadeh
- University of California at Irvine, Irvine, United States of America
| | - J.O Johansson
- Resverlogix Inc, San Francisco, United States of America
| | - E Kulikowski
- Resverlogix Inc, San Francisco, United States of America
| | - P.P Toth
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - N Wong
- Resverlogix Inc, San Francisco, United States of America
| | - M Sweeney
- Resverlogix Inc, San Francisco, United States of America
| | - G.G Schwartz
- University of Colorado, Division of Cardiology, Aurora, United States of America
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Ray KK, Nicholls SJ, Sweeney M, Johansson J, Wong N, Kulikowski E, Toth P, Ginsberg H, Kalantar-Zadeh K, Schwartz GG. P4608BET-inhibition with Apabetalone in Post-ACS Patients with Diabetes: Design and Baseline Characteristics of the BETonMACE trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0991] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes (DM) is associated with increased risk of macro/microvascular disease and cognitive decline. Inflammation and vascular calcification may be contributing factors. Bromodomain and extraterminal (BET) proteins coordinate gene transcription and modify the transcriptional response to hyperglycemia, and inflammation. Apabetalone competitively and selectively inhibits binding between BET proteins and acetyl-lysine marks on histone tails: normalizing transcriptional profiles to physiological levels; reducing in vitro alkaline phosphatase (ALP) transcription and in vivo plasma ALP in a dose-dependent manner. Phase 2 trials with apabetalone show improved renal function in the chronic kidney disease (CKD) subgroups. Furthermore, treatment showed a 55% reduction in CVD events with more pronounced benefit among patients with DM, low HDL-cholesterol (HDL-C) and high sensitivity C-reactive protein (hsCRP).
Methods
The double-blind, placebo controlled phase 3 BETonMACE trial is testing the hypothesis that apabetalone 100 mg b.i.d., added to standard care, reduces major adverse cardiovascular events (MACE: CV death, non-fatal myocardial infarction or stroke) in patients with DM, acute coronary syndrome (ACS) within the preceding 7–90 days, low HDL-C (<40 mg/dL in men; <45 mg/dL in women), and estimated glomerular filtration rate (eGFR) >30 mL/min/1.7m2. The trial will continue until at least 250 MACE, providing 80% power to detect a 30% reduction. Secondary endpoints include changes in eGFR in patients with baseline eGFR 30 to <60 mL/min/1.7m2, inflammatory markers, lipids, and ALP. In addition the Montreal Cognition Assessment (MoCA) test was performed in patients ≥70 years of age at baseline and annually.
Results
Enrollment of 2425 patients across 13 countries and 195 centers is now complete. Baseline characteristics [median (IQR)] include LDL-C 65.0 (36) mg/dL, HDL-C 33.0 (7) mg/dL, HbA1c 7.3 (2.3) %, hsCRP 2.8 (4.9) mg/L, mean blood pressure 129/76 mmHg, and CKD in 266 patients (10.8%). Background care was based on guideline recommendations. Diabetes medications include metformin (79%), insulin (36%), sulfonylureas (28%), DPP4 inhibitors (11%), SGLT2 inhibitors (9.7%) and GLP1 receptor agonists (0.3%). The CKD subpopulation vs. total population differed significantly from the whole population with regard to age (71 vs. 62 y. o.), male sex (58% vs. 75%), history of hypertension (46% vs. 88%), history of stroke (1.5% vs. 7.5%), and current smokers (6.1% vs. 13%). In the 70 year and older (n=466, 19%) population 54% (n=243) showed a baseline MoCA score 25 and lower suggesting cognitive impairment.
Summary
The BETonMACE trial is testing the hypothesis that selective BET-inhibition with apabetalone, added to established, evidence-based treatment, reduces MACE in high-risk patients with DM, recent ACS, and low HDL-C. The study will also assess apabetalone's effect on renal function and cognition.
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Affiliation(s)
- K K Ray
- Imperial College London, London, United Kingdom
| | - S J Nicholls
- Monash University, Monash Cardiovascular Research Centre, Melbourne, Australia
| | - M Sweeney
- Resverlogix Inc., San Francisco, United States of America
| | - J Johansson
- Resverlogix Inc., San Francisco, United States of America
| | - N Wong
- Resverlogix Inc., San Francisco, United States of America
| | - E Kulikowski
- Resverlogix Inc., San Francisco, United States of America
| | - P Toth
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | - H Ginsberg
- Columbia University, New York, United States of America
| | - K Kalantar-Zadeh
- University of California at Irvine, Irvine, United States of America
| | - G G Schwartz
- University of Colorado School of Medicine, Cardiology, Aurora, United States of America
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12
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Kulikowski E, Tsujikawa LM, Gilham D, Rakai B, Halliday C, Stotz SC, Sarsons C, Fu L, Daze E, Wasiak S, Studer D, Rinker KD, Sweeney M, Johansson JO, Wong NCW. P5509Apabetalone (RVX-208) inhibits key drivers of vascular inflammation, calcification, and plaque vulnerability through a BET-dependent epigenetic mechanism. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0459] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Apabetalone (RVX-208) is an orally available small molecule bromodomain & extraterminal (BET) protein inhibitor that targets the second bromodomain (BD2) of BET proteins. Apabetalone returns dysregulated BET-dependent transcription toward normal physiological levels. In phase 2 trials, apabetalone treatment reduced the incidence of major adverse cardiac events by 44% in CVD patients and by 57% in diabetic CVD patients. Previous studies have highlighted apabetalone's positive impact on vascular calcification (VC) and inflammation (VI) marker expression in vitro, as well as its ability to lower serum alkaline phosphatase (ALP) levels, and improve atherosclerotic plaque stability parameters in treated patients. In CVD, elevated inflammatory mediators and cell surface adhesion molecules drive VI, resulting in leukocyte adhesion, infiltration, uptake of oxLDL, and ultimately plaque formation. Here we show in vitro that THP-1 monocyte adhesion to human aortic endothelial cells (HAECs) increases with TNFα stimulation and is attenuated by apabetalone treatment, with fewer monocytes attaching to HAECs under flow conditions. This functional outcome is attributed to apabetalone's reduction of key endothelial adhesion genes, VCAM-1 (50%, p=0.0001) and SELE (37%, p=9x10–5). Apabetalone also prevents TNFα induction of endothelial recruitment genes (MCP-1; 75%, p=0.0002) and genes involved in plaque rupture (IL8; 24%, p=2x10–5). Basal HAEC ALP expression, a potential contributor to endothelial dysfunction and VC, also decreases with apabetalone treatment (70%, p=0.005). Induction of VI genes by TNFα is BET-dependent as degradation of BET proteins by MZ-1 prevents an increase in transcripts in response to TNFα treatment. Ingenuity® Pathway Analysis (IPA®), GSEA, and GO analysis of HAEC gene expression data predicts apabetalone inhibition of pro-atherogenic pathways, gene sets, and upstream regulators induced by TNFα. These include cytokine and chemokine, Toll-Like Receptor (TLR), NFkβ, Interferon and TNFα signaling. In addition, IPA® disease and biological function analysis predicts inhibition of immune cell activation and recruitment by apabetalone. Plasma proteomics (SOMAscan®) and IPA® analysis from apabetalone-treated CVD patients in ASSERT and ASSURE phase 2 trials indicate that apabetalone inhibits pro-atherogenic upstream regulators (IL-6 and IFNy), canonical pathways, and diseases and functions. Serum ALP also decreases dose dependently with apabetalone treatment (ASSERT). Epigenetic inhibition of VI and VC driven atherogenesis likely contributes to the reduction in MACE observed in phase 2 apabetalone treated patients. The ongoing phase 3 post-acute coronary syndrome (ACS) clinical trial in T2DM patients, BETonMACE, is currently testing this hypothesis.
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Affiliation(s)
| | | | - D Gilham
- Resverlogix Corp, Calgary, Canada
| | - B Rakai
- Resverlogix Corp, Calgary, Canada
| | | | | | | | - L Fu
- Resverlogix Corp, Calgary, Canada
| | - E Daze
- Resverlogix Corp, Calgary, Canada
| | - S Wasiak
- Resverlogix Corp, Calgary, Canada
| | - D Studer
- University of Calgary, Department of Chemical and Petroleum Engineering, Calgary, Canada
| | - K D Rinker
- University of Calgary, Department of Chemical and Petroleum Engineering, Calgary, Canada
| | - M Sweeney
- Resverlogix Inc., San Francisco, United States of America
| | - J O Johansson
- Resverlogix Inc., San Francisco, United States of America
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Tsujikawa L, Kulikowski E, Rakai B, Fu L, Das S, Halliday C, Sarsons C, Daze E, Wasiak S, Gilham D, Johansson J, Sweeney M, Wong CW N. Apabetalone (Rvx-208) Attenuates Inflammatory Milieu Underlying Adhesion Of Monocytes To Endothelial Cells In Type 2 Diabetes Mellitus With Cardiovascular Disease Patients. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.775] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Schuld M, Perez J, Anderson C, Bhatia R, Ehlers M, Leger K, Lentz H, Marsh S, Haralson B, Puls A, Sheikh S, Smith A, Spellecy M, Sweeney M, Ya A, Antony E. ABCD: The Language of Replication Protein A (RPA). FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.lb210] [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)
| | | | | | - R. Bhatia
- Ronald Reagan High SchoolMilwaukeeWI
| | - M. Ehlers
- Ronald Reagan High SchoolMilwaukeeWI
| | - K. Leger
- Ronald Reagan High SchoolMilwaukeeWI
| | - H. Lentz
- Ronald Reagan High SchoolMilwaukeeWI
| | - S. Marsh
- Ronald Reagan High SchoolMilwaukeeWI
| | | | - A. Puls
- Ronald Reagan High SchoolMilwaukeeWI
| | - S. Sheikh
- Ronald Reagan High SchoolMilwaukeeWI
| | - A. Smith
- Ronald Reagan High SchoolMilwaukeeWI
| | | | | | - A. Ya
- Ronald Reagan High SchoolMilwaukeeWI
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15
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Crockett C, Fairmichael C, Keane J, Sweeney M, Taylor A, Shum L. Radical Bladder Treatment and Outcomes in the Northern Ireland Cancer Centre. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2017.12.004] [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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16
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Suetterlin K, Sud R, Burge J, McCall S, Fialho D, Haworth A, Sweeney M, Houlden H, Schorge S, Matthews E, Hanna M, Mannikko R. Large scale validation of functional expression of ClC-1 variants in genetic counselling of myotonia congenital. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.260] [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: 11/24/2022]
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17
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Kulikowski E, Wasiak S, Tsujikawa L, Gilham D, Halliday C, Rakai B, Jahagirdar R, Kalantar-Zadeh K, Sweeney M, Johansson J, Wong N, Robson R. P6483Apabetalone (RVX-208) impacts key biomarkers and pathways associated with cardiovascular disease in patients with severe renal impairment. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6483] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Nicholls S, Kulikowski E, Halliday C, Lebioda K, Johansson J, Sweeney M, Kalantar-Zadeh K. P1769Lowering the neutrophil to lymphocyte ratio by the BET inhibitor, apabetalone: potential implications for cardiovascular events in high risk patients. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1769] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Boat TF, Land ML, Leslie LK, Hoagwood KE, Hawkins-Walsh E, McCabe MA, Fraser MW, de Saxe Zerden L, Lombardi BM, Fritz GK, Frogner BK, Hawkins JD, Sweeney M. Workforce Development to Enhance the Cognitive, Affective, and Behavioral Health of Children and Youth: Opportunities and Barriers in Child Health Care Training. NAM Perspect 2016. [DOI: 10.31478/201611b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Wong N, Kulikowski E, Wasiak S, Gilham D, Calosing C, Laura T, Halliday C, Johansson J, Sweeney M. Apabetalone (RVX-208) decreases atherogenic, thrombotic and inflammatory mediators in vitro and in plasma of patients with cardiovascular disease (CVD). Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Hensman Moss D, Poulter M, Beck J, Polke J, Campbell T, Adamson G, Hehir J, Mudanohwo E, McColgan P, Wild E, Haworth A, Sweeney M, Houlden H, Mead S, Tabrizi S. K11 C9orf72 Expansions Are The Most Common Genetic Cause Of Huntington's Disease Phenocopy Presentations In A Uk Cohort. J Neurol Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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Dordea AC, Sweeney M, Taggart J, Lartey J, Wessel H, Robson SC, Taggart MJ. Differential vasodilation of human placental and myometrial arteries related to myofilament Ca(2+)-desensitization and the expression of Hsp20 but not MYPT1. Mol Hum Reprod 2013; 19:727-36. [PMID: 23775458 DOI: 10.1093/molehr/gat045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Endothelial-dependent regulation of vascular tone occurs in part via protein kinase G1α-mediated changes in smooth muscle myofilament sensitivity to Ca(2+). Tissue-specific differences in PKG-dependent relaxation have been attributed to altered expression of myofilament-associated proteins that are substrates for PKG binding. These include the alternative splicing of the myosin targeting subunit (MYPT1) of myosin light chain phosphatase to yield leucine zipper positive (LZ(+)) and negative (LZ(-)) isovariants, with the former being required for PKG-mediated relaxation, and/or altered expressions of telokin, vasodilator-stimulated phosphoprotein (VASP) or heat shock protein Hsp20. During human pregnancy the uterine and placental circulations remain distinct entities and, as such, their mechanisms of vascular tone regulation may differ. Indeed, the sensitivity of myometrial arteries to endothelial-dependent agonists has been suggested to be greater than that of placental arteries. We tested the hypothesis that this was related to tissue-specific changes in PKG-mediated myofilament Ca(2+)-desensitization and/or the expressions of PKG-interacting myofilament-associated proteins. Permeabilized human placental and myometrial arteries were constricted with maximal activating Ca(2+) (pCa 4.5), or sub-maximal Ca(2+) (pCa 6.7) and the thrombane mimetic U46619, and exposed to 8-Br-cGMP. In each case, relaxation was significantly greater in myometrial arteries (e.g. relaxation in pCa 4.5 to 8-Br-cGMP was 49 ± 9.7%, n = 7) than placental arteries (relaxation of 23 ± 6.6%, n = 6, P < 0.05). MYPT1 protein levels, or MYPT1 LZ(+)/LZ(-) mRNA ratios, were similar for both artery types. Of other proteins examined, only Hsp20 expression was significantly elevated in myometrial arteries than placental arteries. These results demonstrate that the reduced human placental artery relaxation to PKG stimulation lies partly at the level of myofilament (de)activation and may be related to a lower expression of Hsp20 than in myometrial arteries.
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Affiliation(s)
- A C Dordea
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
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23
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Johnson P, Halpern R, Becker L, Sweeney M, Dworkin R. The Use of Opioids in Patients with Postherpetic Neuralgia (PHN) Treated with Gabapentin (P04.169). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.169] [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: 11/15/2022] Open
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24
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Rauck R, Irving G, Wallace M, Vanhove G, Sweeney M. Integrated Analysis of Efficacy and Safety of a Once-Daily Gastroretentive Formulation of Gabapentin in Patients with Postherpetic Neuralgia (P04.161). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.161] [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: 11/15/2022] Open
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25
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Backonja MM, Wallace M, Freeman R, Sweeney M. Effect of a Once-Daily Gastroretentive Formulation of Gabapentin on the Neuropathic Pain Scale Score in Patients with Postherpetic Neuralgia (P04.160). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.160] [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: 11/15/2022] Open
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26
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Johnson P, Becker L, Halpern R, Sweeney M, Dworkin R. Use of opioid analgesics in patients with postherpetic neuralgia (PHN) first treated with gabapentin or pregabalin. The Journal of Pain 2012. [DOI: 10.1016/j.jpain.2012.01.293] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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27
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Chen C, Cowles V, Sweeney M. 2.248 GASTRORETENTIVE EXTENDED-RELEASE FORMULATIONS IMPROVE THE PHARMACOKINETICS AND PHARMACODYNAMICS OF LEVODOPA IN PATIENTS WITH PARKINSON'S DISEASE. Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70572-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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28
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Blank S, Borges C, Kowalski A, Sebiyam S, Sweeney M. O1-S11.04 Targeting the use of HIV RNA screening to maximise yield and minimise cost: NYC Health Department STD Clinics, 2008-2010. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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29
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Pathela P, Braunstein S, Schillinger J, Shepard C, Sweeney M, Blank S. LBO-1.5 Men who have sex with men (MSM) have a 140-fold risk for HIV and syphilis compared with other men in New York City. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050119.5] [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: 11/03/2022]
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30
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Stolyarov I, Illarioshkin S, Chen C, Hou S, Cowles V, Sweeney M. P2.202 Levodopa pharmacokinetics following administration of novel gastric retentive extended-release formulations compared to a reference extended-release tablet in Parkinson's disease patients. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70553-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Sweeney M, Watts J, Portis E, Lucas M, Nutsch R, Meeuwse D, Bade D, Oliver V, Morck DW, Shinabarger D, Poppe S, Peterson M, Sweeney D, Knechtel M, Zurenko G. Identification of Porphyromonas levii isolated from clinical cases of bovine interdigital necrobacillosis by 16S rRNA sequencing. Vet Ther 2009; 10:E1-E10. [PMID: 20425726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Laboratories use pigmentation, antibiotic susceptibility, and biochemical tests to identify anaerobic organisms that play a role in bovine interdigital necrobacillosis (bovine foot rot). In this study, 16S rRNA gene sequencing was used to identify strains to the species level that were originally classified as Prevotella or Porphyromonas spp by conventional phenotype assessment methods. Of 264 qualified strains from ceftiofur clinical trials, 241 isolates were definitively identified by 16S rRNA sequencing as Porphyromonas levii. Similarly, of 275 qualified strains from tulathromycin clinical trials, 156 isolates were definitively identified by 16S rRNA sequencing as P. levii. The predominance of P. levii in this study supports the role of this organism as an associative agent of bovine foot rot and may have implications for routine laboratory diagnosis.
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Affiliation(s)
- M Sweeney
- Pfizer Animal Health, Kalamazoo, MI 49007, USA
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32
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Sweeney M, Wareing M, Mills TA, Baker PN, Taggart MJ. Characterisation of tone oscillations in placental and myometrial arteries from normal pregnancies and those complicated by pre-eclampsia and growth restriction. Placenta 2008; 29:356-65. [PMID: 18336903 DOI: 10.1016/j.placenta.2008.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [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] [Received: 11/30/2006] [Revised: 01/18/2008] [Accepted: 01/23/2008] [Indexed: 11/29/2022]
Abstract
Agonist-induced tone oscillations (rhythmic contractions and relaxations) occur in vascular beds to allow acute regulation of volume flow and thus the delivery of oxygen and nutrients to the tissue. Mechanisms responsible for the control of human placental vasomotor tone and blood flow are poorly characterized. This study aimed to characterise thromboxane-induced tone oscillations in human placental and myometrial arteries. Chorionic plate and myometrial arteries obtained from biopsies at term were mounted for isometric tension measurement. Tone oscillations were observed in chorionic arteries only when exposed to sub-maximal (<1 microM) concentrations of U46619. Slow (mean+/-SEM) frequency (2.6+/-0.5 per hour), large amplitude (39+/-7% of peak contraction) tone oscillations were elicited by 0.03 microM U46619 (n=18). In the presence of the nitric oxide synthase (NOS) inhibitor l-NNA (100 microM) the amplitude was significantly reduced (40+/-13% to 18+/-8%, P<0.05, n=6), frequency was unaltered and the bradykinin-dependent vasodilator response was reduced (68+/-13% to 40+/-19%, P<0.05, n=6). Myometrial arteries exposed to 1 microM U46619 developed tone oscillations within 10 min, which increased in amplitude over 30min occurring at relatively constant frequency. The mean amplitude of oscillations at 30 min (31+/-7%, n=16) was similar to that in chorionic arteries but the occurrence more frequent (42.8+/-9.7 per hour, P<0.001). Inhibition of NOS did not alter tone oscillations in myometrial arteries. Tone oscillations in chorionic arteries from pre-eclamptic and growth restricted (FGR) pregnancies were reduced in amplitude whereas those in myometrial arteries had increased frequency. Inhibition of NOS further reduced oscillation amplitude in chorionic arteries from FGR pregnancies. The alterations may contribute to the vasculopathology of these conditions, or, may represent compensatory mechanisms to maintain a matching of materno-placental blood flow.
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Affiliation(s)
- M Sweeney
- Institute of Cellular Medicine, School of Surgical & Reproductive Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
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Turner S, Sweeney M, Kennedy C, Macpherson L. The oral health of people with intellectual disability participating in the UK Special Olympics. J Intellect Disabil Res 2008; 52:29-36. [PMID: 18173570 DOI: 10.1111/j.1365-2788.2007.00971.x] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Research on the dental health of people with intellectual disability has consistently reported more untreated dental disease, more extractions and fewer fillings than in the general population. This paper describes the oral health of participants at the 2005 Glasgow Special Olympics (SO), relating this to the general population studied in the 1998 UK Adult Dental Health Survey (ADHS) and to participants' age and region of residence. METHODS Consenting SO participants were offered oral examinations which followed the standardized SO protocol plus an innovative soft tissue examination. Urgency of any treatment required was noted and reported to participants and carers. Three measures of good dental health--having 21 or more natural teeth, absence of fillings and having no obvious untreated decay--were compared across age groups, regions and with the general population. Logistic regression was used to control for age differences between regions. RESULTS In total, 1021 oral examinations were completed. Older SO participants were more likely to have fewer than 21 teeth and to have fillings, untreated decay, gum inflammation and heavy plaque levels. In all, 28% of SO participants had 21 or more teeth, no fillings and no obvious decay. Those from the north, midlands and south regions of England had significantly more chance of good dental health so defined compared with participants from Scotland [ORs 1.67 (1.09, 2.67), 1.69 (1.12, 2.54), 1.99 (1.26, 3.16), respectively]. Compared with the general population surveyed in the 1998 ADHS study, SO participants were more likely to be free from fillings and obvious untreated decay, but fewer had 21 or more natural teeth among older age groups. Nine per cent were found to have soft tissue problems, and one in four of these required follow-up. Gum inflammation was common. Overall, 5% of participants were judged to require urgent treatment for dental or soft tissue problems and 40% to require non-urgent treatment. This rose to 9% and 66% respectively among those aged 35 years and over. DISCUSSION The low prevalence of untreated decay and fillings among SO participants compared with the general population may be due to their being well supported by family and carers. The study identifies the vulnerability of the older participants to dental problems, and this may indicate greater difficulty maintaining surveillance as individuals age or informal carers become less able or available. Regional variations are similar to those found in the general population. The implications for the organization of care for this group are discussed.
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Affiliation(s)
- S Turner
- Dental Health Services Research Unit, University of Dundee, MacKenzie Building, Dundee, UK.
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Schneider SA, van de Warrenburg BPC, Hughes TD, Davis M, Sweeney M, Wood N, Quinn NP, Bhatia KP. Phenotypic homogeneity of the Huntington disease-like presentation in a SCA17 family. Neurology 2006; 67:1701-3. [PMID: 17101913 DOI: 10.1212/01.wnl.0000242740.01273.00] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We describe clinical and genetic analysis of a family with spinocerebellar ataxia 17 (SCA17) presenting with a Huntington disease-like (HDL) syndrome. Clinically diagnosed, HD is genetically heterogeneous. Differential diagnosis includes SCA17. However, SCA17 HDL presentation has been observed only sporadically or in solitary individuals within a family. HDL phenotypic homogeneity in SCA17 has not been described. SCA17 can present with a HDL syndrome in multiple family members.
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Affiliation(s)
- S A Schneider
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, UK
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Abstract
The authors present four cases from two unrelated families with young-onset predominant cervical dystonia with a dramatic sustained response to levodopa. Onset age was 12 years (range 9 to 15). Additional symptoms included postural hand tremor and laryngeal dystonia. Genetic testing for GTP cyclohydrolase I, tyrosine hydroxylase, and sepiapterin reductase was negative. These cases may represent new forms of dopa-responsive dystonia. Levodopa is advisable in all patients with young-onset cervical dystonia.
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Affiliation(s)
- S A Schneider
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, UK
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Sweeney M, Jones CJP, Greenwood SL, Baker PN, Taggart MJ. Ultrastructural features of smooth muscle and endothelial cells of isolated isobaric human placental and maternal arteries. Placenta 2005; 27:635-47. [PMID: 16029888 DOI: 10.1016/j.placenta.2005.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Revised: 05/13/2005] [Accepted: 05/14/2005] [Indexed: 11/18/2022]
Abstract
The ability of a blood vessel to develop tone is dependent upon morphological parameters of the smooth muscle cells (SMC), including density, relationship with the endothelium and subcellular distribution of myofilaments and intracellular organelles. Consequently, wall ultrastructure of isolated human placental chorionic plate arteries (n=12), fixed when pressurised to mimic their in vivo geometry, was examined qualitatively using electron microscopy, and compared with maternal arteries (omental, n=10, myometrial, n=6). Arteries from women with uncomplicated pregnancy were tested for contractile viability before fixing, with some vessels post-fixed in osmium-ferricyanide for sarcoplasmic reticulum (SR) identification. In contrast to maternal arteries, placental arteries had no internal elastic lamina but exhibited considerable extracellular matrix separating circularly orientated SMC. Human SMC contained tightly packed arrays of myofilaments running parallel to the plasma membrane, enveloping cellular organelles. Synthetic SMC, with few myofilaments and much rough SR, were observed in placental arteries only. SR in SMC from maternal arteries was located centrally, often encircling mitochondria, and also near the plasma membrane associated with caveolae. Positive SR staining was rarely observed in SMC of placental arteries. This study highlights ultrastructural differences between placental and maternal arteries that may underlie specialised mechanisms of regulating vascular tone in the placenta.
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MESH Headings
- Adult
- Chorion/blood supply
- Chorion/physiology
- Electromyography/methods
- Endothelium, Vascular/physiology
- Endothelium, Vascular/ultrastructure
- Female
- Humans
- Microscopy, Electron, Transmission
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/physiology
- Muscle, Smooth, Vascular/ultrastructure
- Myometrium/blood supply
- Myometrium/physiology
- Omentum/blood supply
- Omentum/physiology
- Placental Circulation/drug effects
- Placental Circulation/physiology
- Pregnancy
- Pressure
- Sarcoplasmic Reticulum/ultrastructure
- Umbilical Arteries/physiology
- Umbilical Arteries/ultrastructure
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Affiliation(s)
- M Sweeney
- Maternal and Fetal Health Research Centre, Division of Human Development, University of Manchester, 1st Floor St. Mary's Hospital, Whitworth Park, Manchester M13 0JH, UK.
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Fowler CJ, Miller JR, Sharief MK, Hussain IF, Stecher VJ, Sweeney M. A double blind, randomised study of sildenafil citrate for erectile dysfunction in men with multiple sclerosis. J Neurol Neurosurg Psychiatry 2005; 76:700-5. [PMID: 15834030 PMCID: PMC1739638 DOI: 10.1136/jnnp.2004.038695] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [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: 11/03/2022]
Abstract
OBJECTIVE Identifying and effectively treating erectile dysfunction (ED) can result in an improvement of the quality of life (QoL) in men with multiple sclerosis (MS). METHODS This randomised, double blind (DB), placebo controlled, flexible dose study with an open label extension (OLE) assessed efficacy, QoL, and safety of sildenafil citrate in men with MS and ED. Overall, 217 men received sildenafil (25-100 mg; n = 104) or placebo (n = 113) for 12 weeks. Efficacy was assessed by the International Index of Erectile Function (IIEF) questionnaire that includes questions on achieving (Q3) and maintaining (Q4) an erection as well as a global efficacy question (GEQ). QoL was also assessed. RESULTS After 12 weeks, patients receiving sildenafil had higher mean scores for IIEF Q3 and Q4 compared with those receiving placebo (p<0.0001), and 89% (92/103) reported improved erections compared with 24% (27/112) of patients receiving placebo (p<0.0001). At the end of the OLE phase, 95% of men reported improved erections. Patients receiving placebo during the DB phase showed a nearly fourfold increase in improved erections (97% v 26%). Men receiving sildenafil also showed improvements in five of the eight general QoL questions compared with men receiving placebo (p<0.05). The total mean score for the QoL questionnaire improved by 43% for the sildenafil group versus 13% for the placebo group (p<0.0001). Treatment related AEs were predominantly mild in nature, and no patient discontinued due to an AE. CONCLUSION Sildenafil treatment for ED in men with MS was effective and well tolerated, and resulted in significant improvements in both general and disease specific QoL variables.
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Affiliation(s)
- C J Fowler
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Mailbox 71, Queen Square, London WC1N 3BG, UK.
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Abstract
BACKGROUND AND AIMS While upregulation of divalent metal transporter 1 (DMT1) and iron regulated gene 1 (IREG1) within duodenal enterocytes is reported in patients with hereditary haemochromatosis (HH), these findings are controversial. Furthermore, the effect of HFE, the gene mutated in HH, on expression of these molecules is unclear. This study examines duodenal expression of these three molecules in HH patients (prior to and following phlebotomy), in patients with iron deficiency (ID), and in controls. METHODS DMT1, IREG1, and HFE mRNA were measured in duodenal tissue of C282Y homozygous HH patients, in ID patients negative for the C282Y mutation with a serum ferritin concentration less than 20 microg/l, and in controls negative for C282Y and H63D mutations with normal iron indices, using real time polymerase chain reaction. RESULTS DMT1 and IREG1 mRNA levels were not significantly different in non-phlebotomised (untreated) HH patients compared with controls. DMT1 expression was significantly increased in HH patients who had undergone phlebotomy therapy (treated) and in patients with ID compared with controls. IREG1 was significantly increased in ID patients relative to controls, and while IREG1 expression was 1.8-fold greater in treated HH patients, this was not statistically significant. HFE mRNA expression was not significantly different in any of the groups investigated relative to controls. CONCLUSIONS These findings demonstrate that untreated HH patients do not have increased duodenal DMT1 and IREG mRNA, but rather phlebotomy increases expression of these molecules, reflecting the effect of phlebotomy induced erythropoiesis. Finally, HFE appears to play a minor role in the regulation of iron absorption by the duodenal enterocyte.
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Affiliation(s)
- T Kelleher
- Centre for Liver Disease, Mater Misericordiae University Hospital, Dublin, Ireland
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Montorsi F, Althof SE, Sweeney M, Menchini-Fabris F, Sasso F, Giuliano F. Treatment satisfaction in patients with erectile dysfunction switching from prostaglandin E1 intracavernosal injection therapy to oral sildenafil citrate. Int J Impot Res 2003; 15:444-9. [PMID: 14671665 DOI: 10.1038/sj.ijir.3901049] [Citation(s) in RCA: 16] [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: 11/09/2022]
Abstract
Treatment satisfaction, subanalysed by demographic variables, was evaluated in patients switching from successful intracavernosal prostaglandin E(1) (PGE(1)) therapy to oral sildenafil citrate. The validated Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire was administered at the end of PGE(1) therapy and after 12 weeks of sildenafil treatment in a multicentre, open-label study. Men with erectile dysfunction (n=176) who were switched from stable PGE(1) therapy to sildenafil (25-100 mg) were equally satisfied with onset of action, duration of action, and confidence in ability to engage in sexual activity, but expressed greater overall treatment satisfaction with sildenafil (P<0.01), better ease of use (P<0.001), naturalness of erectile process (P<0.001), and intention to continue treatment (P<0.001). Partners (n=32) were overall more satisfied with sildenafil (P<0.05), and their responses correlated with patient satisfaction (r=0.68). Compared with PGE(1) injection, these data suggest that patients may be less likely to discontinue taking sildenafil treatment for their erectile dysfunction.
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Affiliation(s)
- F Montorsi
- Department of Urology, Universita' Vita Salute San Raffaele, Milan, Italy.
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Sweeney M. Measurement of the GTPase activity of signal-transducing G-proteins in neuronal membranes. Methods Mol Biol 2003; 41:51-61. [PMID: 7655567 DOI: 10.1385/0-89603-298-1:51] [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] [Indexed: 01/26/2023]
Affiliation(s)
- M Sweeney
- Department of Physiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Padma-Nathan H, Stecher VJ, Sweeney M, Orazem J, Tseng LJ, Deriesthal H. Minimal time to successful intercourse after sildenafil citrate: results of a randomized, double-blind, placebo-controlled trial. Urology 2003; 62:400-3. [PMID: 12946731 DOI: 10.1016/s0090-4295(03)00567-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine the minimal time to successful intercourse after taking sildenafil citrate for erectile dysfunction (ED). METHODS Male patients with ED (mean age 60 years; mean ED duration 7.0 years) who were successfully treated with sildenafil (100 mg) for 2 months or longer were randomized to sildenafil (n = 115) or placebo (n = 113) for 4 weeks of double-blind treatment. Using a stopwatch, patients recorded the time needed to obtain an erection hard enough for sexual intercourse after taking the study drug at least 2 hours after eating. RESULTS Within 14 and 20 minutes of sildenafil dosing, 35% and 51% of sildenafil-treated patients, respectively, versus 22% and 30% of placebo-treated patients, respectively, had an erection that led to successful intercourse (P <0.05 for both). The median time to erection leading to successful intercourse after sildenafil dosing was 36 minutes compared with 141 minutes for placebo. CONCLUSIONS In this study, slightly more than one half of a population of prior sildenafil responders achieved an erection that led to successful sexual intercourse within 20 minutes of sildenafil administration, suggesting that the onset of action of sildenafil can be less than 30 minutes in men with ED.
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Affiliation(s)
- H Padma-Nathan
- Department of Urology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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Feng B, Yao P, Li Y, Devlin C, Zhang D, Harding H, Sweeney M, Rong J, Kuriakose G, Fisher E, Marks A, Ron D, Tabas I. 2WS11-1 Signal transduction pathways in free cholesterol-loaded macrophages: Cell biological insight into the progression of atherosclerosis. ATHEROSCLEROSIS SUPP 2003. [DOI: 10.1016/s1567-5688(03)90425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
OBJECTIVES The aim of this study was to estimate the amount of mercury released into both air and saliva from fresh and aged, abraded amalgam discs and then investigate neurotoxic effects of inorganic mercury upon sensory neuronal cultures. METHODS An air-tight chamber was constructed to allow the combined estimation of mercury species released from amalgam pellets. The level released into air and saliva from both freshly packed and aged-abraded amalgam pellets was assessed. Dorsal root ganglia cultures from male CBA mice were exposed to 1 and 10 microM mercuric chloride concentrations. The effects of this were assessed by means of morphology, adhesion, size and immunocytochemistry. RESULTS The mercury released into air from dry fresh amalgam was low and less than the recommended industrial exposure limit for mercury. However, covering the discs with saliva reduced air-mercury levels by 46-56% and there was a statistically significant difference in the air-mercury levels recorded (p=0.013-0.048). The mercury released into air from dry abraded amalgam was shown to be above the recommended industrial limit. Coating the abraded amalgam discs with saliva reduced the mercury by 66-72% with the levels recorded being significantly lower (p<0.001). The level of total mercury within the saliva was found to be highly variable. Little change was noted in the neuronal cultures treated with 1 microM mercuric chloride. However, the cultures exposed to high level (10 microM) mercuric chloride showed cells that became rounded and clumped together indicating pathological change. CONCLUSIONS Amalgam placement appears to present minimal mercury exposure risk. To reduce the amount of mercury released into air, however, amalgam should be polished in a moist atmosphere with high volume aspiration. The neurotoxic effect of mercury appears to be related to concentration, as only in the cultures treated with 10 microM mercuric chloride showed striking qualitative and quantitative cellular changes.
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Affiliation(s)
- M Sweeney
- Hard Tissue Research Group, Glasgow Dental Hospital and School, University of Glasgow, 378 Sauchiehall Street, Scotland Glasgow G2 3JZ, UK
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McDaniel SS, Platoshyn O, Yu Y, Sweeney M, Miriel VA, Golovina VA, Krick S, Lapp BR, Wang JY, Yuan JX. Anorexic effect of K+ channel blockade in mesenteric arterial smooth muscle and intestinal epithelial cells. J Appl Physiol (1985) 2001; 91:2322-33. [PMID: 11641377 DOI: 10.1152/jappl.2001.91.5.2322] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [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] [Indexed: 11/22/2022] Open
Abstract
Activity of voltage-gated K+ (Kv) channels controls membrane potential (E(m)). Membrane depolarization due to blockade of K+ channels in mesenteric artery smooth muscle cells (MASMC) should increase cytoplasmic free Ca2+ concentration ([Ca2+]cyt) and cause vasoconstriction, which may subsequently reduce the mesenteric blood flow and inhibit the transportation of absorbed nutrients to the liver and adipose tissue. In this study, we characterized and compared the electrophysiological properties and molecular identities of Kv channels and examined the role of Kv channel function in regulating E(m) in MASMC and intestinal epithelial cells (IEC). MASMC and IEC functionally expressed multiple Kv channel alpha- and beta-subunits (Kv1.1, Kv1.2, Kv1.3, Kv1.4, Kv1.5, Kv2.1, Kv4.3, and Kv9.3, as well as Kvbeta1.1, Kvbeta2.1, and Kvbeta3), but only MASMC expressed voltage-dependent Ca2+ channels. The current density and the activation and inactivation kinetics of whole cell Kv currents were similar in MASMC and IEC. Extracellular application of 4-aminopyridine (4-AP), a Kv-channel blocker, reduced whole cell Kv currents and caused E(m) depolarization in both MASMC and IEC. The 4-AP-induced E(m) depolarization increased [Ca2+]cyt in MASMC and caused mesenteric vasoconstriction. Furthermore, ingestion of 4-AP significantly reduced the weight gain in rats. These results suggest that MASMC and IEC express multiple Kv channel alpha- and beta-subunits. The function of these Kv channels plays an important role in controlling E(m). The membrane depolarization-mediated increase in [Ca2+]cyt in MASMC and mesenteric vasoconstriction may inhibit transportation of absorbed nutrients via mesenteric circulation and limit weight gain.
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Affiliation(s)
- S S McDaniel
- Department of Medicine, University of California School of Medicine, San Diego, California 92103, USA
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Abstract
AIMS/HYPOTHESIS Ninety percent of all men with diabetes have Type II (non-insulin-dependent) diabetes mellitus, and erectile dysfunction (ED) is common in this patient group. This study evaluated the effects of sildenafil on men with erectile dysfunction and Type II diabetes and compared the results with glycated haemoglobin concentrations and chronic diabetic complications. METHODS Patients (mean age, 59 years) in this double-blind, placebo-controlled trial were randomised to sildenafil (25-100 mg; n = 110) or matching placebo (n = 109) for 12 weeks. Primary criteria for efficacy included questions 3 (achieving an erection) and 4 (maintaining an erection) from the International Index of Erectile Function (IIEF, score range, 0-5). Secondary outcome measures included a global efficacy question (GEQ), patient event logs, a life satisfaction checklist, and the remaining IIEF questions. RESULTS After 12 weeks, the mean scores for questions 3 and 4 had improved significantly in patients receiving sildenafil (3.42 +/- 0.23 and 3.35 +/- 0.24) compared with placebo (1.86 +/- 0.22 and 1.84 +/- 0.23; p < 0.0001). Similarly, the GEQ score was higher in the sildenafil (64.6 %) than the placebo group (10.5 %). Even when correlating efficacy with glycated haemoglobin concentrations ( < or = 8.3 % or > 8.3 %, the median concentration found in this study) or the number of diabetic complications (0 or > or = 1), the mean scores for the GEQ and questions 3 and 4 from the IIEF remained higher for all the sildenafil groups compared with the placebo groups (p < 0.0001). CONCLUSION/INTERPRETATION Sildenafil was well-tolerated and effective in improving erectile dysfunction in men with Type II diabetes, even in patients with poor glycaemic control and chronic complications.
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Affiliation(s)
- A J Boulton
- University of Manchester, Manchester, United Kingdom.
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Keller MB, Ryan ND, Strober M, Klein RG, Kutcher SP, Birmaher B, Hagino OR, Koplewicz H, Carlson GA, Clarke GN, Emslie GJ, Feinberg D, Geller B, Kusumakar V, Papatheodorou G, Sack WH, Sweeney M, Wagner KD, Weller EB, Winters NC, Oakes R, McCafferty JP. Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 2001; 40:762-72. [PMID: 11437014 DOI: 10.1097/00004583-200107000-00010] [Citation(s) in RCA: 440] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare paroxetine with placebo and imipramine with placebo for the treatment of adolescent depression. METHOD After a 7- to 14-day screening period, 275 adolescents with major depression began 8 weeks of double-blind paroxetine (20-40 mg), imipramine (gradual upward titration to 200-300 mg), or placebo. The two primary outcome measures were endpoint response (Hamilton Rating Scale for Depression [HAM-D] score < or = 8 or > or = 50% reduction in baseline HAM-D) and change from baseline HAM-D score. Other depression-related variables were (1) HAM-D depressed mood item; (2) depression item of the Schedule for Affective Disorders and Schizophrenia for Adolescents-Lifetime version (K-SADS-L); (3) Clinical Global Impression (CGI) improvement scores of 1 or 2; (4) nine-item depression subscale of K-SADS-L; and (5) mean CGI improvement scores. RESULTS Paroxetine demonstrated significantly greater improvement compared with placebo in HAM-D total score < or = 8, HAM-D depressed mood item, K-SADS-L depressed mood item, and CGI score of 1 or 2. The response to imipramine was not significantly different from placebo for any measure. Neither paroxetine nor imipramine differed significantly from placebo on parent- or self-rating measures. Withdrawal rates for adverse effects were 9.7% and 6.9% for paroxetine and placebo, respectively. Of 31.5% of subjects stopping imipramine therapy because of adverse effects, nearly one third did so because of adverse cardiovascular effects. CONCLUSIONS Paroxetine is generally well tolerated and effective for major depression in adolescents.
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Affiliation(s)
- M B Keller
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI 02906, USA
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McDaniel SS, Platoshyn O, Wang J, Yu Y, Sweeney M, Krick S, Rubin LJ, Yuan JX. Capacitative Ca(2+) entry in agonist-induced pulmonary vasoconstriction. Am J Physiol Lung Cell Mol Physiol 2001; 280:L870-80. [PMID: 11290510 DOI: 10.1152/ajplung.2001.280.5.l870] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [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] [Indexed: 11/22/2022] Open
Abstract
Agonist-induced increases in cytosolic Ca(2+) concentration ([Ca(2+)](cyt)) in pulmonary artery (PA) smooth muscle cells (SMCs) consist of a transient Ca(2+) release from intracellular stores followed by a sustained Ca(2+) influx. Depletion of intracellular Ca(2+) stores triggers capacitative Ca(2+) entry (CCE), which contributes to the sustained increase in [Ca(2+)](cyt) and the refilling of Ca(2+) into the stores. In isolated PAs superfused with Ca(2+)-free solution, phenylephrine induced a transient contraction, apparently by a rise in [Ca(2+)](cyt) due to Ca(2+) release from the intracellular stores. The transient contraction lasted for 3-4 min until the Ca(2+) store was depleted. Restoration of extracellular Ca(2+) in the presence of phentolamine produced a contraction potentially due to a rise in [Ca(2+)](cyt) via CCE. The store-operated Ca(2+) channel blocker Ni(2+) reduced the store depletion-activated Ca(2+) currents, decreased CCE, and inhibited the CCE-mediated contraction. In single PASMCs, we identified, using RT-PCR, five transient receptor potential gene transcripts. These results suggest that CCE, potentially through transient receptor potential-encoded Ca(2+) channels, plays an important role in agonist-mediated PA contraction.
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Affiliation(s)
- S S McDaniel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California School of Medicine, San Diego, California 92103, USA
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Abstract
Intracellular K+ plays an important role in controlling the cytoplasmic ion homeostasis for maintaining cell volume and inhibiting apoptotic enzymes in the cytosol and nucleus. Cytoplasmic K+ concentration is mainly regulated by K+ uptake via Na+-K+-ATPase and K+ efflux through K+ channels in the plasma membrane. Carbonyl cyanide p-trifluoromethoxyphenylhydrazone (FCCP), a protonophore that dissipates the H+ gradient across the inner membrane of mitochondria, induces apoptosis in many cell types. In rat and human pulmonary artery smooth muscle cells (PASMC), FCCP opened the large-conductance, voltage- and Ca2+-sensitive KK+ (maxi-K) channels, increased K+ currents through maxi-K channels [I(K(Ca))], and induced apoptosis. Tetraethylammonia (1 mM) and iberiotoxin (100 nM) decreased I(K(Ca)) by blocking the sarcolemmal maxi-K channels and inhibited the FCCP-induced apoptosis in PASMC cultured in media containing serum and growth factors. Furthermore, inhibition of K+ efflux by raising extracellular K+ concentration from 5 to 40 mM also attenuated PASMC apoptosis induced by FCCP and the K+ ionophore valinomycin. These results suggest that FCCP-mediated apoptosis in PASMC is partially due to an increase of maxi-K channel activity. The resultant K+ loss through opened maxi-K channels may serve as a trigger for cell shrinkage and caspase activation, which are major characteristics of apoptosis in pulmonary vascular smooth muscle cells.
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Affiliation(s)
- S Krick
- Division of Pulmonary and Critical Care Medicine, UCSD Medical Center, 200 W. Arbor Dr., San Diego, CA 92103-8382, USA
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Golovina VA, Platoshyn O, Bailey CL, Wang J, Limsuwan A, Sweeney M, Rubin LJ, Yuan JX. Upregulated TRP and enhanced capacitative Ca(2+) entry in human pulmonary artery myocytes during proliferation. Am J Physiol Heart Circ Physiol 2001; 280:H746-55. [PMID: 11158974 DOI: 10.1152/ajpheart.2001.280.2.h746] [Citation(s) in RCA: 284] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A rise in cytosolic Ca(2+) concentration ([Ca(2+)](cyt)) due to Ca(2+) release from intracellular Ca(2+) stores and Ca(2+) influx through plasmalemmal Ca(2+) channels plays a critical role in mitogen-mediated cell growth. Depletion of intracellular Ca(2+) stores triggers capacitative Ca(2+) entry (CCE), a mechanism involved in maintaining Ca(2+) influx and refilling intracellular Ca(2+) stores. Transient receptor potential (TRP) genes have been demonstrated to encode the store-operated Ca(2+) channels that are activated by Ca(2+) store depletion. In this study, we examined whether CCE, activity of store-operated Ca(2+) channels, and human TRP1 (hTRP1) expression are essential in human pulmonary arterial smooth muscle cell (PASMC) proliferation. Chelation of extracellular Ca(2+) and depletion of intracellularly stored Ca(2+) inhibited PASMC growth in media containing serum and growth factors. Resting [Ca(2+)](cyt) as well as the increases in [Ca(2+)](cyt) due to Ca(2+) release and CCE were all significantly greater in proliferating PASMC than in growth-arrested cells. Consistently, whole cell inward currents activated by depletion of intracellular Ca(2+) stores and the mRNA level of hTRP1 were much greater in proliferating PASMC than in growth-arrested cells. These results suggest that elevated [Ca(2+)](cyt) and intracellularly stored [Ca(2+)] play an important role in pulmonary vascular smooth muscle cell growth. CCE, potentially via hTRP1-encoded Ca(2+)-permeable channels, may be an important mechanism required to maintain the elevated [Ca(2+)](cyt) and stored [Ca(2+)] in human PASMC during proliferation.
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MESH Headings
- Blood Proteins/pharmacology
- Calcium/metabolism
- Calcium Channel Blockers/pharmacology
- Calcium Channels/genetics
- Calcium Channels/metabolism
- Calcium Channels, L-Type/metabolism
- Cell Division/drug effects
- Cell Division/physiology
- Cells, Cultured
- Gene Expression/physiology
- Humans
- Hypertension, Pulmonary/metabolism
- Imidazoles/pharmacology
- Indoles/pharmacology
- Membrane Potentials/physiology
- Muscle Fibers, Skeletal/cytology
- Muscle Fibers, Skeletal/metabolism
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/metabolism
- Nickel/pharmacology
- Nifedipine/pharmacology
- Patch-Clamp Techniques
- Pulmonary Artery/cytology
- Pulmonary Artery/metabolism
- RNA, Messenger/analysis
- TRPC Cation Channels
- Up-Regulation/drug effects
- Up-Regulation/physiology
- Vasodilator Agents/pharmacology
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Affiliation(s)
- V A Golovina
- Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
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Lamas GA, Lee K, Sweeney M, Leon A, Yee R, Ellenbogen K, Greer S, Wilber D, Silverman R, Marinchak R, Bernstein R, Mittleman RS, Lieberman EH, Sullivan C, Zorn L, Flaker G, Schron E, Orav EJ, Goldman L. The mode selection trial (MOST) in sinus node dysfunction: design, rationale, and baseline characteristics of the first 1000 patients. Am Heart J 2000; 140:541-51. [PMID: 11011325 DOI: 10.1067/mhj.2000.109652] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.6] [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: 11/22/2022]
Abstract
BACKGROUND More than 200,000 permanent pacemakers will be implanted in the United States in 2000 at a cost of more than $2 billion. Sick sinus syndrome (SSS) will likely account for approximately half of all cases necessitating implantation. Pacemaker technology permits the selection of ventricular (single-chamber) or dual-chamber devices. However, clinical and outcomes data are inadequate to support a clear recommendation that one or the other type of device be used. METHODS The Mode Selection Trial (MOST) is a single-blind study supported by the National Heart, Lung, and Blood Institute designed to enroll 2000 patients with SSS. All patients will receive a DDDR pacemaker programmed to VVIR or DDDR before implantation. The average time of follow-up will be 3 years. MOST has a >90% power to detect a 25% reduction in the primary end point-nonfatal stroke or total (all cause) mortality-in the DDDR-treated group. Secondary end points will include health-related quality of life and cost effectiveness, atrial fibrillation, and development of pacemaker syndrome. Prespecified subgroups for analysis will include women and the elderly. Enrollment was completed in October 1999, with a total of 2010 patients. RESULTS The median age of the first 1000 enrolled patients is 74 years, with 25% of patients 80 years or older. Women comprise 49%, and 17% are nonwhite, predominantly black (13%). Before pacemaker implantation, 22% of patients reported a history of congestive heart failure, 11% coronary angioplasty, and 25% coronary bypass surgery. Supraventricular tachycardia including atrial fibrillation was present in 53% of patients. A prior stroke was reported by 12%. Antiarrhythmic therapy was in use in 18% of patients. CONCLUSIONS MOST will fill the clinical need for carefully designed prospective studies to define the benefits of dual-chamber versus single-chamber ventricular pacing in patients with SSS. The MOST population is typical of the overall pacemaker population in the United States. Thus the final results of MOST should be clinically generalizable.
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Affiliation(s)
- G A Lamas
- Division of Cardiology, Mount Sinai Medical Center, and the University of Miami School of Medicine, Miami Beach, USA.
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