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Pillinger NL, Koh CE, Ansari N, Munoz PA, McNamara SG, Steffens D. Preoperative cardiopulmonary exercise testing improves risk assessment of morbidity and length of stay following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Anaesth Intensive Care 2022; 50:447-456. [PMID: 35923075 DOI: 10.1177/0310057x211064904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are the standard treatment for selected patients with peritoneal malignancy. The optimal means of assessing risk prior to these complex operations is not known. This study explored the associations between preoperative cardiopulmonary exercise testing (CPET) variables and postoperative outcomes following elective CRS and HIPEC. This study included patients who underwent routine preoperative CPET prior to elective CRS and HIPEC at Royal Prince Alfred Hospital in Sydney between July 2017 and July 2020. CPET was performed using a cycle ergometer and measured peak oxygen uptake (VO2 peak) and anaerobic threshold (AT). Outcomes included in-hospital morbidity, length of intensive care unit (ICU) stay and hospital stay. The associations between preoperative CPET variables and postoperative morbidity were assessed using univariate and multivariate analyses. A total of 129 patients were included. Mean age was 56 years (standard deviation (SD) 12.5 years), and colorectal cancer was the most common indication for CRS and HIPEC. The overall complication rate was 69%, and two (1.6%) patients died in hospital. Patients who did not develop any postoperative complication had slightly higher preoperative AT and VO2 peak and shorter length of hospital stay. Data in this study support the role of CPET prior to CRS and HIPEC as an adjunct to improve risk assessment.
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Affiliation(s)
- Neil L Pillinger
- Department of Anaesthetics, 2205Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Cherry Ep Koh
- Sydney Medical School, The University of Sydney, Sydney, Australia.,Department of Colorectal Surgery, 2205Royal Prince Alfred Hospital, Sydney, Australia.,Surgical Outcome Resource Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Nabila Ansari
- Department of Colorectal Surgery, 2205Royal Prince Alfred Hospital, Sydney, Australia.,Surgical Outcome Resource Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Phillip A Munoz
- Department of Respiratory and Sleep Medicine, 2205Royal Prince Alfred Hospital, Sydney, Australia
| | - Stephen G McNamara
- Department of Respiratory and Sleep Medicine, 2205Royal Prince Alfred Hospital, Sydney, Australia
| | - Daniel Steffens
- Sydney Medical School, The University of Sydney, Sydney, Australia.,Surgical Outcome Resource Centre, Royal Prince Alfred Hospital, Sydney, Australia
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2
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Dennis M, Howpage S, McGill M, Dutta S, Koay Y, Lal LN, Lal S, Wu T, Ugander M, Wang A, Munoz PA, Wong J, Constantino MI, O'Sullivan J, Twigg SM, Puranik R. Myocardial fibrosis in type 2 diabetes is associated with functional and metabolomic parameters. Int J Cardiol 2022; 363:179-184. [PMID: 35724800 DOI: 10.1016/j.ijcard.2022.06.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/30/2022] [Accepted: 06/15/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Mark Dennis
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Department of Aged Care, LifeHouse Hospital, Sydney, Australia.
| | - Sashie Howpage
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Margaret McGill
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Yen Koay
- Heart Research Institute, Sydney, Australia
| | - Lisa Nguyen Lal
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sean Lal
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ted Wu
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Martin Ugander
- Sydney Medical School, University of Sydney, Sydney, Australia; Kolling Institute, Royal North Shore Hospital, and Charles Perkins Centre, University of Sydney, Sydney, Australia; Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Alexandra Wang
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; University of New South, Wales
| | - Phillip A Munoz
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jencia Wong
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Maria I Constantino
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - John O'Sullivan
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Heart Research Institute, Sydney, Australia
| | - Stephen M Twigg
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rajesh Puranik
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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Tran DL, Kamaladasa Y, Munoz PA, Kotchetkova I, D'Souza M, Celermajer DS, Maiorana A, Cordina R. Estimating exercise intensity using heart rate in adolescents and adults with congenital heart disease: Are established methods valid? International Journal of Cardiology Congenital Heart Disease 2022. [DOI: 10.1016/j.ijcchd.2022.100362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Steffens D, Young J, Beckenkamp PR, Ratcliffe J, Rubie F, Ansari N, Pillinger N, Koh C, Munoz PA, Solomon M. Feasibility and acceptability of a preoperative exercise program for patients undergoing major cancer surgery: results from a pilot randomized controlled trial. Pilot Feasibility Stud 2021; 7:27. [PMID: 33441181 PMCID: PMC7805142 DOI: 10.1186/s40814-021-00765-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 01/03/2021] [Indexed: 12/11/2022] Open
Abstract
Objective To establish the feasibility and acceptability of a preoperative exercise program, and to obtain pilot data on the likely difference in key surgical outcomes to inform the sample size calculation for a full-scale trial. Design Pilot randomized controlled trial. Setting Royal Prince Alfred Hospital, Sydney, Australia. Subjects We included patients undergoing elective pelvic exenteration or cytoreductive surgery aged 18 to 80 years, who presented to the participating gastrointestinal surgeon at least 2 weeks prior to surgery. Patients presenting cognitive impairment, co-morbidity preventing participation in exercise, inadequate English language, currently participating in an exercise program or unable to attend the exercise program sessions were excluded. Methods Participants were randomized to a 2–6 weeks preoperative, face-to-face, individualised exercise program or to usual care. Feasibility was assessed with consent rates to the study, and for the intervention group, retention and adherence rates to the preoperative exercise program. Acceptability of the exercise program was assessed with a semi-structured questionnaire exploring the advice received and the amount, duration and intensity of the exercise program. In addition, postoperative complication rates (Clavien-Dindo), length of hospital stay and self-reported measures of health-related quality of life (SF-36v2) were collected at baseline, day before surgery and in-hospital up to discharge from hospital. Results Of 122 patients screened, 26 (21%) were eligible and 22 (85%) accepted to participate in the trial and were randomized to the intervention (11; 50%) or control group (11; 50%). The median age of the include participants was 63 years. Adherence to the preoperative exercise sessions was 92.7%, with all participants either satisfied (33%) or extremely satisfied (67%) with the overall design of the preoperative exercise program. No significant differences in outcomes were found between groups. Conclusions The results of our pilot trial demonstrate that a preoperative exercise program is feasible and acceptable to patients undergoing major abdominal cancer surgery. There is an urgent need for a definite trial investigating the effectiveness of a preoperative exercise program on postoperative outcomes in patients undergoing major abdominal cancer surgery. This could potentially reduce postoperative complication rates, length of hospital stay and subsequently overall health care costs. Trial registration ACTRN12617001129370. Registered on August 1, 2017, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373396&showOriginal=true&isReview=true Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00765-8.
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Affiliation(s)
- Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, Camperdown, New South Wales, 2050, Australia. .,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Building 89, Leval 9, Missenden Road, Camperdown, New South Wales, 2006, Australia.
| | - Jane Young
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, Camperdown, New South Wales, 2050, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Building 89, Leval 9, Missenden Road, Camperdown, New South Wales, 2006, Australia.,Institiute of Academic Surgery (IAS), Royal Prince Alfred Hospital, 145-147 Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - Paula R Beckenkamp
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Lidcombe, New South Wales, 2141, Australia
| | - James Ratcliffe
- Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2006, Australia
| | - Freya Rubie
- Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2006, Australia
| | - Nabila Ansari
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - Neil Pillinger
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Building 89, Leval 9, Missenden Road, Camperdown, New South Wales, 2006, Australia.,Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2006, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - Phillip A Munoz
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Lidcombe, New South Wales, 2141, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2006, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, Camperdown, New South Wales, 2050, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Building 89, Leval 9, Missenden Road, Camperdown, New South Wales, 2006, Australia.,Institiute of Academic Surgery (IAS), Royal Prince Alfred Hospital, 145-147 Missenden Road, Camperdown, New South Wales, 2050, Australia
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Barberan-Garcia A, Munoz PA, Gimeno-Santos E, Burgos F, Torralba Y, Gistau C, Roca J, Rodriguez DA. Training-induced changes on quadriceps muscle oxygenation measured by near-infrared spectroscopy in healthy subjects and in chronic obstructive pulmonary disease patients. Clin Physiol Funct Imaging 2019; 39:284-290. [PMID: 31012529 DOI: 10.1111/cpf.12572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 04/15/2019] [Indexed: 12/23/2022]
Abstract
AIM We hypothesize that training-induced changes in muscle oxygen saturation (StO2 ) assessed by near-infrared spectroscopy (NIRS) during constant work rate cycling exercise (CWRE) may be a useful marker of the effects of training at 'vastus medialis' of the quadriceps in patients with chronic obstructive pulmonary disease (COPD). METHODS Incremental exercise [peak oxygen uptake (VO2 )] and CWRE at 70% pretraining peak VO2 , before and after 8-w training, were done in 10 healthy age-matched subjects (H) [80% men, 65(11) years, FEV1 105(14)%] and 16 COPD patients [94% men, 70(5) years, FEV1 46(11) %] encompassing the entire spectrum of disease severity, recruited in the outpatient clinics. NIRS was used to assess StO2 in the 'vastus medialis' of the left quadriceps. RESULTS Pretraining CWRE decreased StO2 (P<0·05) and generated marked StO2 rebound (P<0·001) after unloading in the two groups. After training, VO2 peak increased in H [253(204) ml min-1 ] (P<0·01) and in COPD [180(183) ml·min-1 ] (P = 0·01) and blood lactate fell [-4·4 (2·7) and -1·6(2·3) mmol·m-1 ] (P<0·05 each). Training generated a further fall in StO2 during CWRE [-10(12)% and -10(10)%, P<0·05] and increased StO2 rebound after unloading [8(7)% and 5(9)%, P<0·05] in both groups. CONCLUSION Endurance training further decreased StO2 during CWRE, similarly in both groups, likely due to training-induced enhancement of muscle O2 transfer and utilization. Training-induced StO2 fall during CWRE may be useful individual marker for non-invasive assessment of enhanced muscle aerobic post-training function.
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Affiliation(s)
- Anael Barberan-Garcia
- Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Phillip A Munoz
- Respiratory Investigation Unit, Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Elena Gimeno-Santos
- Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Felip Burgos
- Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Yolanda Torralba
- Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Concepción Gistau
- Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Josep Roca
- Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Diego A Rodriguez
- Pulmonology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), CIBERES (ISCIII), Barcelona, Spain
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6
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O'Meagher S, Seneviratne M, Skilton MR, Munoz PA, Robinson PJ, Malitz N, Tanous DJ, Celermajer DS, Puranik R. Right Ventricular Mass is Associated with Exercise Capacity in Adults with Repaired Tetralogy of Fallot. Pediatr Cardiol 2015; 36:1225-31. [PMID: 25795311 DOI: 10.1007/s00246-015-1150-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/29/2014] [Accepted: 03/13/2015] [Indexed: 11/25/2022]
Abstract
The relationship between exercise capacity and right ventricular (RV) structure and function in adult repaired tetralogy of Fallot (TOF) is poorly understood. We therefore aimed to examine the relationships between cardiac MRI and cardiopulmonary exercise test variables in adult repaired TOF patients. In particular, we sought to determine the role of RV mass in determining exercise capacity. Eighty-two adult repaired TOF patients (age at evaluation 26 ± 10 years; mean age at repair 2.5 ± 2.8 years; 23.3 ± 7.9 years since repair; 53 males) (including nine patients with tetralogy-type pulmonary atresia with ventricular septal defect) were prospectively recruited to undergo cardiac MRI and cardiopulmonary exercise testing. As expected, these repaired TOF patients had RV dilatation (indexed RV end-diastolic volume: 153 ± 43.9 mL/m(2)), moderate-severe pulmonary regurgitation (pulmonary regurgitant fraction: 33 ± 14 %) and preserved left (LV ejection fraction: 59 ± 8 %) and RV systolic function (RV ejection fraction: 51 ± 7 %). Exercise capacity was near-normal (peak work: 88 ± 17 % predicted; peak oxygen consumption: 84 ± 17 % predicted). Peak work exhibited a significant positive correlation with RV mass in univariate analysis (r = 0.45, p < 0.001) and (independent of other cardiac MRI variables) in multivariate analyses. For each 10 g higher RV mass, peak work was 8 W higher. Peak work exhibits a significant positive correlation with RV mass, independent of other cardiac MRI variables. RV mass measured on cardiac MRI may provide a novel marker of clinical progress in adult patients with repaired TOF.
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Affiliation(s)
- Shamus O'Meagher
- Faculty of Medicine, The University of Sydney, Sydney, Australia,
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7
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Dale MT, McKeough ZJ, Munoz PA, Corte P, Bye PTP, Alison JA. Physical activity in people with asbestos related pleural disease and dust-related interstitial lung disease: An observational study. Chron Respir Dis 2015; 12:291-8. [PMID: 26048393 DOI: 10.1177/1479972315587518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 11/15/2022] Open
Abstract
This study aimed to measure the levels of physical activity (PA) in people with dust-related pleural and interstitial lung diseases and to compare these levels of PA to a healthy population. There is limited data on PA in this patient population and no previous studies have compared PA in people with dust-related respiratory diseases to a healthy control group. Participants with a diagnosis of a dust-related respiratory disease including asbestosis and asbestos related pleural disease (ARPD) and a healthy age- and gender-matched population wore the SenseWear(®) Pro3 armband for 9 days. Six-minute walk distance, Medical Outcomes Study 36-item short-form health survey and the Hospital Anxiety and Depression Scale were also measured. Fifty participants were recruited and 46 completed the study; 22 with ARPD, 10 with dust-related interstitial lung disease (ILD) and 14 healthy age-matched participants. The mean (standard deviation) steps/day were 6097 (1939) steps/day for dust-related ILD, 9150 (3392) steps/day for ARPD and 10,630 (3465) steps/day for healthy participants. Compared with the healthy participants, dust-related ILD participants were significantly less active as measured by steps/day ((mean difference 4533 steps/day (95% confidence interval (CI): 1888-7178)) and energy expenditure, ((mean difference 512 calories (95% CI: 196-827)) and spent significantly less time engaging in moderate, vigorous or very vigorous activities (i.e. >3 metabolic equivalents; mean difference 1.2 hours/day (95% CI: 0.4-2.0)). There were no differences in levels of PA between healthy participants and those with ARPD. PA was reduced in people with dust-related ILD but not those with ARPD when compared with healthy age and gender-matched individuals.
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Affiliation(s)
- Marita T Dale
- Clinical and Rehabilitation Sciences, The University of Sydney, NSW, Australia Physiotherapy Department, St Vincent's Hospital, NSW, Australia
| | - Zoe J McKeough
- Clinical and Rehabilitation Sciences, The University of Sydney, NSW, Australia
| | - Phillip A Munoz
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, NSW, Australia
| | - Peter Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, NSW, Australia
| | - Peter T P Bye
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, NSW, Australia Sydney Medical School, The University of Sydney, NSW, Australia
| | - Jennifer A Alison
- Clinical and Rehabilitation Sciences, The University of Sydney, NSW, Australia Physiotherapy Department, Royal Prince Alfred Hospital, NSW Australia
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Dale MT, McKeough ZJ, Munoz PA, Corte P, Bye PTP, Alison JA. Exercise training for asbestos-related and other dust-related respiratory diseases: a randomised controlled trial. BMC Pulm Med 2014; 14:180. [PMID: 25407957 PMCID: PMC4247671 DOI: 10.1186/1471-2466-14-180] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 10/17/2014] [Indexed: 11/17/2022] Open
Abstract
Background The study aimed to determine the short and long-term effects of exercise training on exercise capacity and health-related quality of life (HRQoL) compared to usual care in people with dust-related pleural and interstitial respiratory diseases. No previous studies have specifically evaluated exercise training in this patient population. Methods Participants with a diagnosis of a dust-related respiratory disease including asbestosis and asbestos related pleural disease were recruited and randomised to an eight-week exercise training group (EG) or a control group (CG) of usual care. Six-minute walk distance (6MWD), St George’s Respiratory Questionnaire (SGRQ) and Chronic Respiratory Disease Questionnaire (CRQ) were measured at baseline, eight weeks and 26 weeks by an assessor blinded to group allocation. Results Thirty-three of 35 male participants completed the study. Sixty-nine percent of participants had asbestos related pleural disease. At eight weeks, compared to the CG, the EG showed a significantly increased 6MWD (mean difference (95%CI)) 53 metres (32 to 74), improved SGRQ total score, -7 points (-13 to -1) and increased CRQ total score, 6.4 points (2.1 to 10.7). At 26 weeks significant between-group differences were maintained in 6MWD, 45 metres (17 to 73) and CRQ total score, 13.1 points (5.2 to 20.9). Conclusion Exercise training improved short and long-term exercise capacity and HRQoL in people with dust-related pleural and interstitial respiratory diseases. Clinical trial registration number ANZCTR12608000147381. Date trial registered: 27.03.2008.
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Affiliation(s)
- Marita T Dale
- Clinical and Rehabilitation Sciences, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.
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Sharma T, Lau EM, Choudhary P, Torzillo PJ, Munoz PA, Simmons LR, Naeije R, Celermajer DS. Dobutamine stress for evaluation of right ventricular reserve in pulmonary arterial hypertension. Eur Respir J 2014; 45:700-8. [DOI: 10.1183/09031936.00089914] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Right ventricular contractile response to pharmacological stress in pulmonary arterial hypertension (PAH) has not been characterised. We evaluated right ventricular contractile reserve in adults with PAH using dobutamine stress echocardiography.16 PAH patients and 18 age-matched controls underwent low-dose dobutamine stress echocardiography. Contractile reserve was assessed by the change (Δ; peak stress minus rest value) in tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (S′). A subgroup of 13 PAH patients underwent treadmill cardiopulmonary exercise testing for peak oxygen uptake (V′O2peak).At rest, TAPSE and S′ were reduced in the PAH group compared with controls (1.7±0.4 versus 2.4±0.2 cm and 9.7±2.6 versus 12.5±1.2 cm·s−1, respectively; p<0.05). Contractile reserve was markedly attenuated in PAH compared to controls (ΔTAPSE 0.1±0.2 versus 0.6±0.3 cm and ΔS′ 4.6±2.8 versus 11.2±3.6 cm·s−1; p<0.0001). In the sub-group of PAH patients with preserved right ventricular systolic function at rest, contractile reserve remained depressed compared to controls. V′O2peak was significantly correlated with ΔS′ (r=0.87, p=0.0003) and change in stroke volume (r=0.59, p=0.03).Dobutamine stress can reveal sub-clinical reduction in right ventricular contractile reserve in patients with PAH. A correlation with exercise capacity suggests potential clinical value beyond resting measurements.
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O'Meagher S, Munoz PA, Muthurangu V, Robinson PJ, Malitz N, Tanous DJ, Celermajer DS, Puranik R. Mechanisms of maintained exercise capacity in adults with repaired tetralogy of Fallot. Int J Cardiol 2014; 177:178-81. [PMID: 25499372 DOI: 10.1016/j.ijcard.2014.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/21/2014] [Accepted: 09/15/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND The mechanisms whereby cardiac output is augmented with exercise in adult repaired tetralogy of Fallot (TOF) are poorly characterised. METHODS 16 repaired TOF patients (25 ± 7 years of age) and 8 age and sex matched controls (25 ± 4 years of age) underwent cardiopulmonary exercise testing and then real-time cardiac MRI (1.5 T) at rest and whilst exercising within the scanner, aiming for 30% heart rate reserve (Level 1) and 60% heart rate reserve (Level 2), using a custom-built MRI compatible foot pedal device. RESULTS At rest, TOF patients had severely dilated RVs (indexed RV end-diastolic volume: 149 ± 37 mL/m(2)), moderate-severe PR (regurgitant fraction 35 ± 12%), normal RV fractional area change (FAC) (52 ± 7%) and very mildly impaired exercise capacity (83 ± 15% of predicted maximal work rate). Heart rate and RV FAC increased significantly in TOF patients (75 ± 10 vs 123 ± 17 beats per minute, p<0.001; 44 ± 7 vs 51 ± 10%, p=0.025), and similarly in control subjects (70 ± 11 vs 127 ± 12 beats per minute, p<0.001; 49 ± 7 vs 61 ± 9%, p=0.003), when rest was compared to Level 2. PR fraction decreased significantly but only modestly, from rest to Level 2 in TOF patients (37 ± 15 to 31 ± 15%, p=0.002). Pulmonary artery net forward flow was maintained and did not significantly increase from rest to Level 2 in TOF patients (70 ± 19 vs 69 ± 12 mL/beat, p=0.854) or controls (93 ± 9 vs 95 ± 21 mL/beat, p=0.648). CONCLUSIONS During exercise in repaired TOF subjects with dilated RV and free PR, increased total RV output per minute was facilitated by an increase in heart rate, an increase in RV FAC and a decrease in PR fraction.
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Affiliation(s)
- Shamus O'Meagher
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia.
| | - Phillip A Munoz
- Royal Prince Alfred Hospital, Department of Respiratory and Sleep Medicine, Sydney, Australia.
| | - Vivek Muthurangu
- UCL Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, London, United Kingdom; Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
| | - Peter J Robinson
- Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia; Westmead Hospital, Department of Cardiology, Sydney, Australia.
| | | | - David J Tanous
- Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia; Westmead Hospital, Department of Cardiology, Sydney, Australia.
| | - David S Celermajer
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia.
| | - Rajesh Puranik
- The University of Sydney, Faculty of Medicine, Sydney, Australia; Royal Prince Alfred Hospital, Department of Cardiology, Sydney, Australia.
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Dale MT, McKeough ZJ, Munoz PA, Corte P, Bye PTP, Alison JA. Functional exercise capacity and health-related quality of life in people with asbestos related pleural disease: an observational study. BMC Pulm Med 2013; 13:1. [PMID: 23305075 PMCID: PMC3585749 DOI: 10.1186/1471-2466-13-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional exercise capacity in people with asbestos related pleural disease (ARPD) is unknown and there are no data on health-related quality of life (HRQoL). The primary aims were to determine whether functional exercise capacity and HRQoL were reduced in people with ARPD. The secondary aim was to determine whether functional exercise capacity was related to peak exercise capacity, HRQoL, physical activity or respiratory function. METHODS In participants with ARPD, exercise capacity was measured by the six-minute walk test (6MWT) and incremental cycle test (ICT); HRQoL by the St George's Respiratory Questionnaire and physical activity by an activity monitor worn for one week. Participants also underwent lung function testing. RESULTS 25 males completed the study with a mean (SD) age of 71 (6) years, FVC 82 (19)% predicted, FEV1/FVC 66 (11)%, TLC 80 (19)% predicted and DLCO 59 (13)% predicted. Participants had reduced exercise capacity demonstrated by six-minute walk distance (6MWD) of 76 (11)% predicted and peak work rate of 71 (21)% predicted. HRQoL was also reduced. The 6MWD correlated with peak work rate (r=0.58, p=0.002), St George's Respiratory Questionnaire Total score (r=-0.57, p=0.003), metabolic equivalents from the activity monitor (r=0.45, p<0.05), and FVC % predicted (r=0.52, p<0.01). CONCLUSIONS People with ARPD have reduced exercise capacity and HRQoL. The 6MWT may be a useful surrogate measure of peak exercise capacity and physical activity levels in the absence of cardiopulmonary exercise testing and activity monitors. TRIAL REGISTRATION ANZCTR12608000147381.
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Affiliation(s)
- Marita T Dale
- Discipline of Physiotherapy (Rm0166) Faculty of Health Sciences, The University of Sydney, 75 East St Lidcombe, 2141, Sydney, NSW, Australia.
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O'Meagher S, Munoz PA, Alison JA, Young IH, Tanous DJ, Celermajer DS, Puranik R. Exercise capacity and stroke volume are preserved late after tetralogy repair, despite severe right ventricular dilatation. Heart 2012; 98:1595-9. [DOI: 10.1136/heartjnl-2012-302147] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Blanco I, Gimeno E, Munoz PA, Pizarro S, Gistau C, Rodriguez-Roisin R, Roca J, Barberà JA. Hemodynamic and gas exchange effects of sildenafil in patients with chronic obstructive pulmonary disease and pulmonary hypertension. Am J Respir Crit Care Med 2009; 181:270-8. [PMID: 19875684 DOI: 10.1164/rccm.200907-0988oc] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
RATIONALE Sildenafil, a phosphodiesterase-5 inhibitor, could be useful for treating pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD). However, vasodilators may inhibit hypoxic pulmonary vasoconstriction and impair gas exchange in this condition. OBJECTIVES To assess the acute hemodynamic and gas exchange effects of sildenafil in patients with COPD-associated PH. METHODS We conducted a randomized, dose comparison trial in 20 patients with COPD-associated PH. Eleven patients were assigned to 20 mg, and 9 patients to 40 mg, of sildenafil. Pulmonary hemodynamics and gas exchange, including ventilation-perfusion (V(A)/Q) relationships, were assessed at rest and during constant-work rate exercise, before and 1 hour after sildenafil administration. MEASUREMENTS AND MAIN RESULTS Both sildenafil doses reduced the mean pulmonary arterial pressure (PAP) at rest and during exercise, without differences between them. Overall, PAP decreased -6 mm Hg (95% confidence interval [95% CI], -7 to -4) at rest and -11 mm Hg (95% CI, -14 to -8) during exercise. After sildenafil, Pa(O(2)) decreased -6 mm Hg (95% CI, -8 to -4) at rest because of increased perfusion in units with low V(A)/Q ratio, without differences between doses. No change in Pa(O(2)) (95% CI, -3 to 0.2 mm Hg) or V(A)/Q relationships occurred during exercise after sildenafil. Changes induced by sildenafil in Pa(O(2)) and V(A)/Q distributions at rest correlated with their respective values at baseline. CONCLUSIONS In patients with COPD-associated PH, sildenafil improves pulmonary hemodynamics at rest and during exercise. This effect is accompanied by the inhibition of hypoxic vasoconstriction, which impairs arterial oxygenation at rest. The use of sildenafil in COPD should be done cautiously and under close monitoring of blood gases. Clinical trial registered with www.clinicaltrials.gov (NCT00491803).
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Affiliation(s)
- Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona
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Abstract
Spontaneous idiotype shift of anti-DNA antibodies in systemic lupus erythematosus was shown to be associated with changes in the clinical manifestations of the disease. Characterization of two anti-DNA antibody preparations from the same lupus patient showed that lupus nephritis was associated with antibodies showing higher specific antigen-binding activity and avidity to DNA and presenting more cationic quality upon isoelectric focusing and Western blot analysis than the ones found in patients without renal involvement. Lupus cerebritis was associated with anti-DNA antibodies with different idiotypic characteristics not shared by anti-DNA antibodies present in lupus nephritis. Lupus cerebritis anti-DNA antibodies had less specific antigen-binding activity and avidity to DNA and did not show cationic quality. Idiotypic and immunochemical changes of anti-DNA antibodies in lupus may be associated with various clinical manifestations.
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Affiliation(s)
- R Suenaga
- Department of Medicine, University of Kansas Medical Center, Kansas City 66103
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15
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Abstract
Monoclonal antibodies were generated against transferrin purified from chick embryo extract by fusing spleen cells from BALB/c mice immunized against embryonic transferrin, with myeloma cells. Antibodies produced by the selected hybridoma clones were all type IgG. Twelve clones were selected for secretion of antibodies to the embryo extract-derived transferrin, and three clones were studied extensively. Immunoblotting was used to demonstrate antibody binding to several avian transferrin proteins derived from adult chicken serum, adult chicken peripheral nerves, and ovotransferrin. Screening and detailed epitope analysis were accomplished by solid-phase immunoassay. The results indicated that two clones, 2G9.1 and 2B11.1, recognized the embryonic and egg antigens in preference to the adult proteins. However, a third clone, 6H2.1, recognized the nerve-derived transferrin preferentially to both the embryonic and adult serum antigens. None of the clones recognized the serum-derived transferrin in preference to the other antigens. These results indicate that embryonic epitope(s) are conserved in the nerve- but not the serum-derived transferrin. They also show that the neural antigen has site(s) distinct from the embryonic proteins. No changes in displacement curves were observed after these proteins were digested with neuraminidase, indicating that the epitope differences discovered are not intimately related to sialic acid residues on the various transferrins.
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Affiliation(s)
- B W Festoff
- Neurobiology Research Laboratory, Veterans Administration Medical Center, Kansas City, Missouri 64128
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Suenaga R, Munoz PA, Bright SW, Abdou NI. Spontaneous shift of anti-DNA antibody idiotypes in systemic lupus erythematosus. J Immunol 1988; 140:3508-14. [PMID: 2834439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Spontaneous shift in Id expression of polyclonal anti-DNA antibodies in a patient, BS, with SLE was investigated. BS had active lupus nephritis in 1982 and developed central nervous system lupus in 1986 without evidence of active nephritis. Two rabbit polyclonal anti-Id (BS-82 and BS-86 R-anti-Id) were raised against affinity-purified anti-DNA antibodies prepared from 1982 serum (BS-82) and 1986 serum (BS-86), respectively. In addition, murine monoclonal anti-Id was prepared against BS-82 Id. Direct binding assays showed that all three anti-Id had preferential binding to the immunizing anti-DNA antibodies (the homologous Id) and poor binding to anti-DNA antibodies prepared from the different dated sample of BS. This was confirmed by inhibition assays of binding of anti-Id to the homologous Id by various Id. Moreover, inhibition assays of binding of various Id to DNA by the R-anti-Id showed that the R-anti-Id was the most effective inhibitor for the homologous Id. Testing for Id expression in serial (1982 to 1986) serum samples of BS with the R-anti-Id as probes showed that BS-82 Id declined and was undetectable after October, 1984, whereas BS-86 Id was first detectable in July, 1985, and increased by June, 1986. These results clearly demonstrate spontaneous shifts in Id expression of human anti-DNA antibodies. The phenomenon of Id shift should be considered in any future strategy for the diagnosis and therapy of human autoimmune disease by anti-Id.
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Affiliation(s)
- R Suenaga
- Department of Medicine, University of Kansas Medical Center, Kansas City 66103
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Suenaga R, Munoz PA, Bright SW, Abdou NI. Spontaneous shift of anti-DNA antibody idiotypes in systemic lupus erythematosus. The Journal of Immunology 1988. [DOI: 10.4049/jimmunol.140.10.3508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Spontaneous shift in Id expression of polyclonal anti-DNA antibodies in a patient, BS, with SLE was investigated. BS had active lupus nephritis in 1982 and developed central nervous system lupus in 1986 without evidence of active nephritis. Two rabbit polyclonal anti-Id (BS-82 and BS-86 R-anti-Id) were raised against affinity-purified anti-DNA antibodies prepared from 1982 serum (BS-82) and 1986 serum (BS-86), respectively. In addition, murine monoclonal anti-Id was prepared against BS-82 Id. Direct binding assays showed that all three anti-Id had preferential binding to the immunizing anti-DNA antibodies (the homologous Id) and poor binding to anti-DNA antibodies prepared from the different dated sample of BS. This was confirmed by inhibition assays of binding of anti-Id to the homologous Id by various Id. Moreover, inhibition assays of binding of various Id to DNA by the R-anti-Id showed that the R-anti-Id was the most effective inhibitor for the homologous Id. Testing for Id expression in serial (1982 to 1986) serum samples of BS with the R-anti-Id as probes showed that BS-82 Id declined and was undetectable after October, 1984, whereas BS-86 Id was first detectable in July, 1985, and increased by June, 1986. These results clearly demonstrate spontaneous shifts in Id expression of human anti-DNA antibodies. The phenomenon of Id shift should be considered in any future strategy for the diagnosis and therapy of human autoimmune disease by anti-Id.
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Affiliation(s)
- R Suenaga
- Department of Medicine, University of Kansas Medical Center, Kansas City 66103
| | - P A Munoz
- Department of Medicine, University of Kansas Medical Center, Kansas City 66103
| | - S W Bright
- Department of Medicine, University of Kansas Medical Center, Kansas City 66103
| | - N I Abdou
- Department of Medicine, University of Kansas Medical Center, Kansas City 66103
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Väänänen K, Morris DC, Munoz PA, Parvinen EK. Immunohistochemical study of alkaline phosphatase in growth plate cartilage, bone, and fetal calf isolated chondrocytes using monoclonal antibodies. Acta Histochem 1987; 82:211-7. [PMID: 3128049 DOI: 10.1016/s0065-1281(87)80032-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [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: 01/04/2023]
Abstract
Monoclonal antibodies prepared against alkaline phosphatase of matrix vesicles from fetal bovine growth plate cartilage were used to study the distribution of alkaline phosphatase in bovine bone and cartilage. Primary chondrocyte cultures from bovine growth plate cartilage were prepared and expression of this antigen was followed during 3 d long cultured period. Same monoclonal anti-alkaline phosphatase antibodies recognized both osteoblasts in metaphyseal bone as well as proliferating and hypertrophic chondrocytes in growth plate cartilage. Extracellular reaction was observed in lower areas of growth plate cartilage after hyaluronidase digestion of tissue sections. In isolated growth plate chondrocytes strong membrane associated reaction as well as weaker intracytoplasmic reaction were noticed and especially in large hypertrophic cells membrane reaction was clustered showing "capping-like" phenomenon. These results indicates the high similarity of alkaline phosphatase in bone and cartilage and its uneven distribution in chondrocyte plasma membrane.
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Affiliation(s)
- K Väänänen
- Department of Pathology, University of Oulu, Finland
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Oppliger I, Vaananen HK, Munoz PA, Hsu HH, Morris DC, Anderson HC. Development and cross-reactive properties of monoclonal antibodies to bovine matrix vesicle alkaline phosphatase. Bone 1986; 7:373-8. [PMID: 3539156 DOI: 10.1016/8756-3282(86)90258-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Alkaline phosphatase (ALPase), concentrated in the membranes of matrix vesicles, is believed to play a role in initial calcification. To further purify, characterize, and identify this enzyme in tissue, a monoclonal antibody was developed against the ALPase of isolated fetal calf matrix vesicles. Splenic lymphocytes derived from mice immunized with Sepharose 6B-purified fetal calf matrix vesicle ALPase were fused with mouse plasmacytoma cells (line X63-Ag-8.653) using standard hybridoma technology. Hyperimmune sera and hybridoma culture supernatants were screened for the presence of specific antibody using a newly developed double-immunosorbent assay in which putative antibody is added to microtiter plate wells precoated with affinity-purified rabbit antimouse immunoglobulin. After incubation and washing, partially purified fetal calf matrix vesicle ALPase is added to each well. The enzyme adheres only to wells that contain specific anti-ALPase antibody. These wells are identified by adding the enzyme substrate p-nitrophenyl phosphate and reading the wells in a plate-reading spectrophotometer at 405 nm. A hybridoma-producing specific antibody was subsequently cloned and grown as ascities-producing tumors in pristane-primed mice. Ouchterlony analysis indicated that the cell line secretes an immunoglobulin of IgG1 class. This antibody reacts specifically with ALPase derived from calf matrix vesicles and cross-reacts with ALPase of bovine kidney, liver, and placental origin and human bone but does not cross-react with bovine intestinal ALPase or ALPase derived from matrix vesicles isolated from rachitic rat growth plate cartilage.
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Hsu HH, Munoz PA, Barr J, Oppliger I, Morris DC, Vaananen HK, Tarkenton N, Anderson HC. Purification and partial characterization of alkaline phosphatase of matrix vesicles from fetal bovine epiphyseal cartilage. Purification by monoclonal antibody affinity chromatography. J Biol Chem 1985; 260:1826-31. [PMID: 3968087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Alkaline phosphatase of matrix vesicles isolated from fetal bovine epiphyseal cartilage was purified to apparent homogeneity using monoclonal antibody affinity chromatography. The enzyme from the butanol extract of matrix vesicles bound specifically to the immobilized antibody-Sepharose in the presence of 2% Tween 20 whereas the major portion of nonspecific protein was removed by this single step. Of various agents tested, 0.6 M 2-amino-2-methyl-1-propanol, pH 10.2, was the most effective in eluting 80-100% of the enzyme initially applied. Both Tween 20 and 2-amino-2-methyl-1-propanol associated with the eluted enzyme were effectively removed by the sequential application of DEAE-cellulose and Sepharose CL-6B chromatography. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of the enzyme preparation treated with sodium dodecyl sulfate and mercaptoethanol showed the presence of a dominant band (using silver staining) corresponding to a molecular weight of 81,000. This molecular weight was nearer reported values for rat liver (Ohkubo, A., Langerman, N., and Kaplan, M. M. (1974) J. Biol Chem. 249, 7174-7180) and porcine kidney (Cathala, G., Brunel, C., Chapplet-Tordo, D., and Lazdunski, M. (1975) J. Biol. Chem. 250, 6040-6045) alkaline phosphatase, than to previously reported values for chicken (Cyboron, G. W., and Wuthier, R. E. (1981) J. Biol. Chem. 256, 7262-7268) and fetal calf (Fortuna, R., Anderson, H. C., Carty, R. P., and Sajdera, S. W. (1980) Calcif. Tissue Int. 30, 217-225) cartilage matrix vesicle alkaline phosphatase. The purified alkaline phosphatase was activated by micromolar Mg2+. The amino acid composition of cartilage alkaline phosphatase was found to be similar to that previously described for porcine kidney (Wachsmuth, E. D., and Hiwada, K. (1974) Biochem. J. 141, 273-282). Double immunoprecipitation data indicated that monoclonal antibody against cartilage alkaline phosphatase cross-reacted with fetal bovine liver or kidney enzyme but failed to react with calf intestinal or rat cartilage enzyme. Thus these observations suggest that alkaline phosphatase of matrix vesicles from calcifying epiphyseal cartilage is a liver-kidney-bone isozyme.
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Taylor DW, Munoz PA, Kim KJ, Evans CB, Asofsky R. Plasmodium yoelii: comparison of indirect immunofluorescence and radioimmunoassay for detecting monoclonal antibodies to malaria. Exp Parasitol 1982; 53:362-70. [PMID: 6177548 DOI: 10.1016/0014-4894(82)90079-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Taylor DW, Kim KJ, Munoz PA, Evans CB, Asofsky R. Monoclonal antibodies to stage-specific, species-specific, and cross-reactive antigens of the rodent malarial parasite, Plasmodium yoelii. Infect Immun 1981; 32:563-70. [PMID: 6166558 PMCID: PMC351484 DOI: 10.1128/iai.32.2.563-570.1981] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Eighteen hybridoma cell lines were used to study species-specific, stage-specific, and serological cross-reactive antigens of the rodent malarial parasite, Plasmodium yoelii. Specificity and location of plasmodial antigens were determined by indirect fluorescent-antibody analysis. Results showed that a minimum of 12 distinct plasmodial antigens could be distinguished by the 18 hybridomas. Antigens were found on the surface or within the cytoplasm of the parasite, but not on the surface of erythrocytes from infected animals. The majority (11 of 12) of antigens were present in all erythrocytic stages of the parasite, but one was stage-specific for merozoites. Additional studies showed that 6 of 18 of the monoclonal antibodies identified species-specific antigens, 2 of 18 recognized antigens confined to related rodent malarial parasites (Plasmodium berghei, Plasmodium vinckei, and Plasmodium chabaudi), whereas 8 of 18 detected cross-reactive antigens common to rodent, primate (Plasmodium knowlesi, Plasmodium falciparum), and avian (Plasmodium gallinaceum) malarias.
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Abstract
A rare, osteoclastoma-like giant cell tumor developed in the macronodular cirrhotic liver of an 87-year-old man. Histogenetically, the tumor was considered to be of reticuloendothelial cell (Kupffer cell) origin. A brief review of the literature concerning the extraosseous giant cell tumors is included in this report.
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Abstract
A rare, osteoclastoma-like giant cell tumor developed in the macronodular cirrhotic liver of an 87-year-old man. Histogenetically, the tumor was considered to be of reticuloendothelial cell (Kupffer cell) origin. A brief review of the literature concerning the extraosseous giant cell tumors is included in this report.
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