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Razvi Y, Ioannou A, Patel RK, Chacko L, Karia N, Riefolo M, Porcari A, Rauf MU, Starr N, Ganesananthan S, Blakeney I, Kaza N, Filisetti S, Bolhuis RE, Rowczenio D, Gilbertson J, Hutt D, Mahmood S, Lachmann HJ, Wechalekar AD, Kotecha T, Knight DS, Coghlan JG, Petrie A, Whelan CJ, Venneri L, Martinez-Naharro A, Hawkins P, Fontana M, Gillmore JD. Deep phenotyping of p.(V142I)-associated variant transthyretin amyloid cardiomyopathy: Distinct from wild-type transthyretin amyloidosis? Eur J Heart Fail 2024; 26:383-393. [PMID: 37953725 DOI: 10.1002/ejhf.3088] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/26/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023] Open
Abstract
AIMS Transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure. A total of 3-4% of individuals of African descent carry a TTR gene mutation encoding the p.(V142I) variant, a powerful risk factor for development of variant ATTR-CM (ATTRv-CM); this equates to 1.6 million carriers in the United States. We undertook deep phenotyping of p.(V142I)-ATTRv-CM and comparison with wild-type ATTR-CM (ATTRwt-CM). METHODS AND RESULTS A retrospective study of 413 patients with p.(V142I) ATTRv-CM who attended the UK National Amyloidosis Centre (NAC) was conducted. Patients underwent evaluation at time of diagnosis, including clinical, echocardiography, and biomarker analysis; a subgroup had cardiac magnetic resonance (CMR) imaging. A total of 413 patients with ATTRwt-CM, matched for independent predictors of prognosis (age, NAC Stage, decade of first presentation), were used as a comparator group. At time of diagnosis, patients with ATTRv-CM had significant functional impairment by New York Heart Association classification (NHYA class ≥ III; 38%) and 6-min walk test distance (median 276 m). Median 5-year survival in ATTRv-CM patients was 31 versus 59 months in matched patients with ATTRwt-CM (p < 0.001). Patients with ATTRv-CM had significant impairment of functional parameters by echocardiography including biventricular impairment, high burden of regurgitant valvular disease and low cardiac output. Multivariable analysis revealed the prognostic importance of right ventricular dysfunction. CMR and histological analysis revealed myocyte atrophy and widespread myocardial infiltration in ATTRv-CM. CONCLUSION p.(V142I)-ATTRv-CM has an aggressive phenotype characterized by myocyte loss and widespread myocardial infiltration which may account for frequent biventricular failure and poor prognosis in this ATTR-CM genotypic subgroup.
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Affiliation(s)
- Yousuf Razvi
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Adam Ioannou
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Rishi K Patel
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Liza Chacko
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | | | - Mattia Riefolo
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Aldostefano Porcari
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Muhammad Umaid Rauf
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Neasa Starr
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | | | - Iona Blakeney
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | | | - Stefano Filisetti
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Roos Eline Bolhuis
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Dorota Rowczenio
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Janet Gilbertson
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - David Hutt
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Shameem Mahmood
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Helen J Lachmann
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | | | | | | | - Aviva Petrie
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Carol J Whelan
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Lucia Venneri
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Phillip Hawkins
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, Division of Medicine, University College London, London, UK
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2
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Patel R, Ioannou A, Razvi Y, Chacko L, Venneri L, Martinez-Naharro A, Masi A, Lachmann H, Wechalekar A, Petrie A, Whelan C, Hawkins P, Gillmore J, Fontana M. Size matters - redefining sex differences among patients with transthyretin amyloid cardiomyopathy – have we been wrong all along? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1760] [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: 11/14/2022] Open
Abstract
Abstract
Background
Transthyretin amyloid cardiomyopathy (ATTR-CM) is most often diagnosed in men (1–5). The few available studies suggest affected women have a more favourable cardiac phenotype (5–8), but remain unclear regarding differences in outcomes.
Objectives and methods
To characterise sex differences among consecutive patients with non-hereditary and two prevalent forms of hereditary ATTR-CM diagnosed over a 20-year period at our specialist centre through analysis of deep phenotyping at presentation, changes on serial echocardiography and overall prognosis.
Results
In total, 1732 patients were studied, comprising: 1095 with wild-type (wt)ATTR-CM; 206 with T60A-hATTR-CM; and 431 with V122I-hATTR-CM. Female prevalence was greater in T60A-hATTR-CM (29.6%) and V122I-hATTR-CM (27.8%) compared to wtATTR-CM (6%). At presentation, females were 3.3 years older than males (81.9 vs 77.8 years for wtATTR-CM; 68.7 vs 65.1 years for T60A-hATTR-CM; 77.1 vs 74.9 years for V122I-hATTR-CM). At diagnosis, non-indexed measures of wall thickness were significantly greater in males (interventricular septum in diastole (IVSd) of 17.13mm in males & 16.15mm in females; p<0.001). When indexed for body surface area (BSA), we observed that the mean indexed IVSd was fairly constant in males throughout the study period, but in females, had a tendency to decrease over the same study period. Furthermore, BSA significantly influenced measures of disease severity. When indexed for BSA, overall structural and functional phenotype was similar between sexes; the few observed significant differences including indexed IVSd (9.62mm/m2 in females & 8.88mm/m2 in males; p<0.001), indexed left ventricular (LV) end-diastolic volume (35.07ml/m2 in females & 41.05ml/m2 in males; p<0.001) and indexed LV end-systolic volume (17.95ml/m2 in females & 21.74ml/m2 in males; p<0.001) suggested a mildly worse phenotype in females. No significant differences were observed in disease progression on serial echocardiography and mortality across the overall population (p=0.459) and when divided by genotype (p=0.730 for wtATTR-CM; p=0.161 for T60A-hATTR-CM; p=0.056 for V122I-hATTR-CM).
Conclusion
This study of a well-characterized large cohort of ATTR-CM patients, contrary to previous dogmas, did not demonstrate overall differences between sexes in either clinical phenotype, when indexed, or with respect to disease progression and prognosis. The analysis highlighted the deficiencies in using non-indexed values which can not only lead to the inaccurate perception of a milder clinical phenotype in women compared to men, but has been shown to result in female patients presenting at an older age and with a worse phenotype compared to men. These findings indicate the need for revision of existing clinical guidelines regarding awareness and diagnosis of ATTR-CM in women, and modification of clinical trials which currently use single non-indexed threshold for wall thickness as key inclusion criterion.
Funding Acknowledgement
Type of funding sources: Foundation.
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Affiliation(s)
- R Patel
- Royal Free Hospital , London , United Kingdom
| | - A Ioannou
- Royal Free Hospital , London , United Kingdom
| | - Y Razvi
- Royal Free Hospital , London , United Kingdom
| | - L Chacko
- Royal Free Hospital , London , United Kingdom
| | - L Venneri
- Royal Free Hospital , London , United Kingdom
| | | | - A Masi
- Royal Free Hospital , London , United Kingdom
| | - H Lachmann
- Royal Free Hospital , London , United Kingdom
| | | | - A Petrie
- University College London, Eastman Dental Institute , London , United Kingdom
| | - C Whelan
- Royal Free Hospital , London , United Kingdom
| | - P Hawkins
- Royal Free Hospital , London , United Kingdom
| | - J Gillmore
- Royal Free Hospital , London , United Kingdom
| | - M Fontana
- Royal Free Hospital , London , United Kingdom
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3
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Razvi Y, Patel R, Ioannou A, Rauf MU, Masi A, Porcari A, Blakeney I, Kaza N, Lachmann H, Whelan C, Venneri L, Martinez-Naharro A, Hawkins P, Fontana M, Gillmore JD. Cardiac transplantation in transthyretin amyloid cardiomyopathy: outcomes from three decades of tertiary centre experience. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1784] [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
Transthyretin cardiac amyloidosis (ATTR-CM) is a progressive and fatal cardiomyopathy. Treatment options in patients with advanced heart failure are limited to cardiac transplantation (CT). Despite small case series demonstrating comparable outcomes with CT between patients with ATTR-CM and non-amyloid cardiomyopathies, ATTR-CM is considered to be an absolute contraindication to CT in some centres. This is in part due to a perceived risk of amyloid recurrence in the cardiac allograft. We report outcomes of patients with ATTR-CM assessed at our centre whom underwent CT over the past thirty years.
Methods
We retrospectively evaluated all ATTR-CM patients assessed at the UK National Amyloidosis Centre between 1990 and 2020 who underwent CT. Pre-transplantation disease and patient characteristics were determined and outcomes were compared with our large cohort of non-transplanted ATTR-CM patients. Censor date was 11th January 2022.
Results
Eleven (9 male, 2 female) patients with ATTR-CM underwent CT including 8 with wild-type ATTR-CM and 3 with variant ATTR-CM (ATTRv). Median age at CT was 60.3 years and median follow up post-CT was 65.7 months. Median (range) NT-proBNP concentration pre-transplant was 4478ng/L (1057–8778ng/L), median (range) left ventricular ejection fraction (LVEF) was 39% (27–56%) and mean (IQR) interventricular septal (IVSD) was 18 mm (15.9–20.1 mm). 8 patients were NYHA functional class III, the 3 remaining patients were class II.
One, three, and five-year survival was 100%, 89% and 86%, respectively and the longest surviving patient was censored >19 years post CT. Survival is at least comparable to UK and US CT outcome registry data for all non-amyloid patients undergoing CT. No patients had recurrence of amyloid in the cardiac allograft as assessed by endomyocardial biopsy and/or Tc-DPD scintigraphy. Two patients were commenced on Patisiran for amyloid polyneuropathy at 211 and 5 months post-CT. Graft rejection requiring treatment was observed in 2 patients, and successfully treated with intravenous steroids. Renal impairment was common, with 6 patients being left with chronic kidney disease.
Three patients died, including one with ATTRv-CM from complications of leptomeningeal amyloidosis. Survival among the cohort of patients who underwent CT was significantly longer than UK patients with ATTR-CM generally (P≤0.006), regardless of NAC ATTR disease stage and including those diagnosed under 65 years of age (P=0.028). (Figure 1) All surviving patients were NYHA functional class I at time of censor.
Conclusion
Our data indicates that cardiac transplantation is well tolerated, restores functional capacity, and prolongs survival in ATTR-CM with little risk of recurrence of amyloid in the cardiac allograft. We believe that our data argues strongly for ATTR-CM to be routinely included in the list of indications for cardiac transplantation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Razvi
- University College London , London , United Kingdom
| | - R Patel
- University College London , London , United Kingdom
| | - A Ioannou
- University College London , London , United Kingdom
| | - M U Rauf
- University College London , London , United Kingdom
| | - A Masi
- University College London , London , United Kingdom
| | - A Porcari
- University College London , London , United Kingdom
| | - I Blakeney
- University College London , London , United Kingdom
| | - N Kaza
- Imperial College London , London , United Kingdom
| | - H Lachmann
- University College London , London , United Kingdom
| | - C Whelan
- University College London , London , United Kingdom
| | - L Venneri
- University College London , London , United Kingdom
| | | | - P Hawkins
- University College London , London , United Kingdom
| | - M Fontana
- University College London , London , United Kingdom
| | - J D Gillmore
- University College London , London , United Kingdom
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4
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Patel R, Martinez-Naharro A, Kotecha T, Karia N, Ioannou A, Petrie A, Chacko L, Razvi Y, Lachmann H, Venneri L, Kellman P, Gillmore J, Hawkins P, Wechalekar A, Fontana M. Progression, regression and redefining the treatment response – cardiac magnetic resonance with T1 and extracellular volume mapping in cardiac light-chain amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.297] [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
The presence and severity of cardiac involvement in AL amyloidosis is the main driver of prognosis [1]; patients with symptomatic heart failure frequently die within 6 months [1] but median survival has nearly doubled over the past decade, mainly due to significant improvements in chemotherapy. The haematological response to chemotherapy is principally evaluated with serial measurements of serum-free light-chains (FLC) [2]. The cardiac response to chemotherapy is assessed through changes in serum concentrations of brain natriuretic peptides (including NT-proBNP) and echocardiographic parameters [3–5]. Neither are able to directly measure cardiac amyloid burden. Cardiovascular magnetic resonance (CMR) with extra-cellular volume (ECV) mapping can measure the extent cardiac amyloid infiltration [6].
Aims
We investigated the ability of CMR to: 1) measure changes in response to chemotherapy; 2) assess the correlation between haematological response (HMR) and changes in cardiac amyloid; 3) assess the association between changes in cardiac amyloid and prognosis over and above existing predictors.
Methods
In total, 176 patients with cardiac light-chain amyloidosis treated with chemotherapy were assessed with FLC, NT-proBNP and CMR with ECV mapping at baseline (before chemotherapy), 6-months, 12-months & 24-months after commencing chemotherapy. Haematological response was categorized by reductions in FLC as: complete response (CR), very good partial response (VGPR), partial response (PR) or no response (NR). CMR response was categorized by changes in ECV as: progression (≥0.05 increase), stable (<0.05 change) or regression (≥0.05 decrease).
Results
A progressive increase in patients achieving either CR or VGPR was observed at each time point (61% of patients at 6-months, 71% at 12-months and 80% at 24-months). At 6-months, CMR regression was observed in 3% (all had either CR or VGPR) and progression in 32% (61% had either PR or NR; 39% had either CR or VGPR). At 1-year, CMR regression was observed in 22% (all had either CR or VGPR); progression in 22% (63% had either PR or NR; 37% had either CR or VGPR). At 2-years, CMR regression was observed in 38% (all had CR/VGPR); progression in 14% (80% had either PR or NR; 20% had either CR or VGPR). During follow-up (40±15 months), 36 (25%) patients died. CMR response at 6-months predicted death (progression HR 3.821; 95% CI 1.950–7.487; p<0.001) and remained independently associated with prognosis after adjusting for haematological response, NT-proBNP and longitudinal strain on echocardiography (p<0.01).
Conclusions
CMR demonstrates that cardiac amyloid deposits frequently regress following chemotherapy, but only in patients who achieve CR or VGPR, highlighting the need for deep haematological response. Changes in amyloid burden (ECV) predict outcomes after adjusting for known predictors, showing the crucial role of CMR in redefining treatment response.
Funding Acknowledgement
Type of funding sources: Foundation.
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Affiliation(s)
- R Patel
- Royal Free Hospital , London , United Kingdom
| | | | - T Kotecha
- Royal Free Hospital , London , United Kingdom
| | - N Karia
- Royal Free Hospital , London , United Kingdom
| | - A Ioannou
- Royal Free Hospital , London , United Kingdom
| | - A Petrie
- University College London, Eastman Dental Institute , London , United Kingdom
| | - L Chacko
- Royal Free Hospital , London , United Kingdom
| | - Y Razvi
- Royal Free Hospital , London , United Kingdom
| | - H Lachmann
- Royal Free Hospital , London , United Kingdom
| | - L Venneri
- Royal Free Hospital , London , United Kingdom
| | - P Kellman
- National Heart Lung and Blood Institute, National Institutes of Health , Bethesda , United States of America
| | - J Gillmore
- Royal Free Hospital , London , United Kingdom
| | - P Hawkins
- Royal Free Hospital , London , United Kingdom
| | | | - M Fontana
- Royal Free Hospital , London , United Kingdom
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5
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Barneda D, Stephens L, Hawkins P. ARFs get the BioID treatment: what have we been missing? EMBO J 2022; 41:e112181. [PMID: 35929178 PMCID: PMC9433933 DOI: 10.15252/embj.2022112181] [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] [Received: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/09/2022] Open
Abstract
Li et al present the results of a proximity-interaction screen in mammalian cells for the effector proteins of 25 members of the Arf family of small GTPases. This study has generated an important resource for those working in several areas of cell biology and provided an initial characterisation of two new cellular roles for some of the least well studied members of this family, the regulation of PLD1 by ARL11/14 in phagocytosis, and the regulation of PI4KB by ARL5A/5B in the Golgi.
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6
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Bandera F, Martone R, Chacko L, Ganesananthan S, Gilbertson JA, Ponticos M, Petrie A, Cappelli F, Guazzi M, Potena L, Rapezzi C, Leone O, Hawkins P, Gillmore JD, Fontana M. Clinical importance of left atrial infiltration in cardiac transthyretin amyloidosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
INTRODUCTION
The clinical significance of left atrial (LA) involvement in ATTR amyloidosis cardiomyopathy (ATTR-CM) has not been characterized. The aims of this study were to characterize: (1)LA pathology in explanted ATTR-CM hearts; (2)LA mechanics using echocardiographic speckle-tracking in a large cohort of ATTR-CM patients; (3)to study the association with mortality.
METHODS AND RESULTS
Congo red staining and immunohistochemistry was performed to assess the presence, type and extent of amyloid and associated changes in 5 explanted ATTR-CM atria. Echo speckle-tracking was used to assess LA reservoir, conduit, contractile function and stiffness in 906 ATTR-CM patients (551 wt-ATTR-CM;93 T60A-ATTR-CM;241 V122I-ATTR-CM;21 other).
There was extensive ATTR amyloid infiltration in the 5 atria with loss of normal architecture, vessels remodelling, capillary disruption and subendocardial fibrosis. Echo speckle-tracking in 906 ATTR-CM patients demonstrated increased atrial stiffness [median(25th-75th quartile) 1.83(1.15-2.92)] that remained independently associated with prognosis, after adjusting for known predictors (lnLA stiff:HR = 1.26,CI 1.07-1.57;p = 0.009). There was substantial impairment of the three phasic functional atrial components [reservoir 8.86(5.94-12.97)%; conduit 6.5(4.53-9.28)%; contraction function 4.0(2.29-6.56)%]. Atrial contraction was absent in 21.6% of patients whose ECG showed sinus rhythm (SR)-"atrial electro-mechanical dissociation"(AEMD). AEMD was associated with poorer prognosis compared to SR patients with effective mechanical contraction (p < 0.0001). AEMD conferred a similar prognosis to patients in AF.
CONCLUSION
The phenotype of ATTR-CM includes significant infiltration of the atrial walls with progressive loss of atrial function and increased stiffness, which is a strong independent predictor of mortality. AEMD emerged as a distinctive phenotype identifying patients in SR with poor prognosis.
Abstract Figure.
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Affiliation(s)
- F Bandera
- IRCCS Polyclinic San Donato, Department of University Cardiology, Milan, Italy
| | - R Martone
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - L Chacko
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Ganesananthan
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - JA Gilbertson
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Ponticos
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - A Petrie
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - F Cappelli
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
| | - M Guazzi
- IRCCS Polyclinic San Donato, Department of University Cardiology, Milan, Italy
| | - L Potena
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - C Rapezzi
- University Hospital of Ferrara, Ferrara, Italy
| | - O Leone
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - P Hawkins
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - JD Gillmore
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
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7
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Iacono A, Pompa A, De Marchis F, Panfili E, Greco FA, Coletti A, Orabona C, Volpi C, Belladonna ML, Mondanelli G, Albini E, Vacca C, Gargaro M, Fallarino F, Bianchi R, De Marcos Lousa C, Mazza EM, Bicciato S, Proietti E, Milano F, Martelli MP, Iamandii IM, Graupera Garcia-Mila M, Llena Sopena J, Hawkins P, Suire S, Okkenhaug K, Stark AK, Grassi F, Bellucci M, Puccetti P, Santambrogio L, Macchiarulo A, Grohmann U, Pallotta MT. Class IA PI3Ks regulate subcellular and functional dynamics of IDO1. EMBO Rep 2020; 21:e49756. [PMID: 33159421 DOI: 10.15252/embr.201949756] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 11/27/2019] [Revised: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022] Open
Abstract
Knowledge of a protein's spatial dynamics at the subcellular level is key to understanding its function(s), interactions, and associated intracellular events. Indoleamine 2,3-dioxygenase 1 (IDO1) is a cytosolic enzyme that controls immune responses via tryptophan metabolism, mainly through its enzymic activity. When phosphorylated, however, IDO1 acts as a signaling molecule in plasmacytoid dendritic cells (pDCs), thus activating genomic effects, ultimately leading to long-lasting immunosuppression. Whether the two activities-namely, the catalytic and signaling functions-are spatially segregated has been unclear. We found that, under conditions favoring signaling rather than catabolic events, IDO1 shifts from the cytosol to early endosomes. The event requires interaction with class IA phosphoinositide 3-kinases (PI3Ks), which become activated, resulting in full expression of the immunoregulatory phenotype in vivo in pDCs as resulting from IDO1-dependent signaling events. Thus, IDO1's spatial dynamics meet the needs for short-acting as well as durable mechanisms of immune suppression, both under acute and chronic inflammatory conditions. These data expand the theoretical basis for an IDO1-centered therapy in inflammation and autoimmunity.
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Affiliation(s)
- Alberta Iacono
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Andrea Pompa
- Department of Biomolecular Sciences, University Carlo Bo, Urbino, Italy.,Institute of Biosciences and Bioresources, National Research Council of Italy, Perugia, Italy
| | - Francesca De Marchis
- Institute of Biosciences and Bioresources, National Research Council of Italy, Perugia, Italy
| | - Eleonora Panfili
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Francesco A Greco
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - Alice Coletti
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - Ciriana Orabona
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Claudia Volpi
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Maria L Belladonna
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | - Elisa Albini
- Department of Experimental Medicine, University of Perugia, Perugia, Italy.,Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - Carmine Vacca
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Marco Gargaro
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | - Roberta Bianchi
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Carine De Marcos Lousa
- Centre for Biomedical Sciences, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK.,Center for Plant Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | | | - Silvio Bicciato
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Proietti
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | | | - Ioana M Iamandii
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | - Judith Llena Sopena
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain
| | | | | | - Klaus Okkenhaug
- Department of Pathology, University of Cambridge, Cambridge, UK
| | | | - Fabio Grassi
- Institute for Research in Biomedicine, Bellinzona, Switzerland
| | - Michele Bellucci
- Institute of Biosciences and Bioresources, National Research Council of Italy, Perugia, Italy
| | - Paolo Puccetti
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Laura Santambrogio
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Antonio Macchiarulo
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - Ursula Grohmann
- Department of Experimental Medicine, University of Perugia, Perugia, Italy.,Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maria T Pallotta
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
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8
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Chacko L, Martinez-Naharro A, Kotecha T, Martone R, Hutt D, Lane T, Knight D, Moon J, Kellman P, Hawkins P, Gillmore J, Fontana M. Regression of cardiac amyloid deposits with novel therapeutics: reaching new frontiers in cardiac ATTR amyloidosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac involvement is the main driver of outcome in ATTR amyloidosis. Advances in therapeutics hold potential in transforming the course of the disease but the impact on cardiac amyloid load is unknown. The aim of this study was to evaluate the impact of patisiran, a new double stranded RNA based gene silencing therapy and a stabilizer, diflunisal, on cardiac amyloid load as measured by CMR and T1 mapping, in patients with ATTR amyloidosis.
Methods and results
Thirty-two patients with hereditary cardiac amyloidosis were studied. Sixteen patients received treatment with patisiran, and sixteen control subjects did not receive any disease modifying treatment. Patients were assessed with echocardiogram, CMR, NT-proBNP and six-minute walk time measurements at baseline and at 1 year (Mean interval 11.45±3.08 months in treatment group, mean interval 12.82±5.06 months in the control group). CMR analysis comprised LV volumes, T1 mapping to measure the extracellular volume (ECV) occupied by amyloid, T2 mapping and late gadolinium enhancement imaging. At 1-year follow-up, there was a substantial reduction in cardiac amyloid burden, in keeping with cardiac amyloid regression in 45% of patients on treatment. Overall the treatment group showed a reduction in ECV at 1 year follow up compared to an increase in ECV at 1 year in the control group (−1.37%, 95% CI: −3.43 to 0.68% versus 5.02%, 95% CI: 2.86% to 7.18% respectively, p<0.001). The treatment group also showed an improvement in change in 6MWT at 1 year follow up compared to 6MWT at 1 year in the control group (−8.12 meters, 95% CI: −50.8 to 34.6 meters in the treatment group versus −132.27 meters, 95% CI: −216 to −48.6 meters in the control group, p=0.002). The treatment group showed a reduction in BNP at 1 year follow up compared to an increase in the control group (−567.87, 95% CI: −1288.90 to 153.15 in the treatment group versus 2004, 95% CI: 12.82 to 3995.45 in the control group, p<0.001). There was no significant difference from baseline and 1-year data between the control and treatment groups for the difference in echocardiographic parameters, native T1, T2. There was a significant reduction in the percentage of injected dose by 99Tc-DPD scintigraphy in treated patients at 1 year compared to baseline.
Conclusions
These findings provide the first compelling evidence of substantial cardiac amyloid regression in ATTR amyloidosis, as well as the potential for CMR to be used to track response in treated patients with ATTR cardiac amyloidosis. Combination therapy with transthyretin knock down and stabilizing agents may well be synergistic given enhanced stoichiometry of stabilizers in the face of much reduced plasma transthyretin concentration.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Chacko
- University College Hospital, London, United Kingdom
| | | | - T Kotecha
- University College Hospital, London, United Kingdom
| | - R Martone
- Careggi University Hospital, Florence, Italy
| | - D Hutt
- University College Hospital, London, United Kingdom
| | - T Lane
- University College Hospital, London, United Kingdom
| | - D Knight
- University College Hospital, London, United Kingdom
| | - J Moon
- Barts Heart Centre, London, United Kingdom
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - P Hawkins
- University College Hospital, London, United Kingdom
| | - J Gillmore
- University College Hospital, London, United Kingdom
| | - M Fontana
- University College Hospital, London, United Kingdom
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9
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Cohen O, Ismail A, Manwani R, Ravichandran S, Foard D, Mahmood S, Sachchithanantham S, Martinez-Naharro A, Fontana M, Lachmann H, Hawkins P, Gillmore J, Whelan C, Wechalekar A. Global longitudinal strain predicts survival and response in patients with systemic AL amyloidosis. analysis of 915 patients from the ALchemy prospective trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac involvement determines prognosis in systemic AL amyloidosis. The extent is assessed by biomarker-based staging systems. This a prospective report of a large cohort of patients assessing the utility of changes in longitudinal function by 2D strain (GLS%), impairment - a hallmark of amyloidosis.
Purpose
To evaluate the prognostic role of GLS% and other echocardiographic parameters in systemic AL amyloidosis.
Methods
915 newly diagnosed patients seen at the UK National Amyloidosis Centre (February 2010–August 2017) were included. All patients underwent 6-monthly comprehensive assessments inclusive of echocardiogram. The European modification of the Mayo 2004 staging was used with Mayo stage III patients stratified into IIIa (NT-proBNP <8500ng/L) and IIIb (NT-proBNP ≥8500ng/L).
Results
653/915 (71.4%) patients had cardiac involvement. Mayo stage 1, 2, 3a and 3b in 144 (15.7%), 302 (33.0%) 344 (37.6%) and 125 (13.7%) respectively. The median NT-proBNP was 2228ng/L and TNT was 0.54ng/ml. The GLS% significantly worsened with increasing Mayo stage (p<0.0001 between GLS% for each Mayo stage). Poorer baseline GLS% associated with significantly worse OS and stratified patients into three groups: GLS% <−12.8%: OS 69.1 months; GLS% −12.8% to −9%: OS 54.5 months; GLS% >−9%: OS 45.3 months (p<0.0001). On univariate analysis, 11/14 parameters predicted survival (LV wall thickness, LV ejection fraction, systolic velocities of the septal (s'sep) and lateral mitral annulus (s' lat), mitral annulus movement at the lateral corner (e' lat), transmitral early peak flow velocity (E) divided by tissue Doppler mitral annular motion velocity (e') – E/e' and mitral annular plane systolic excursion (MAPSE)). Baseline GLS% >−17% was independent of Mayo stage in predicting survival [Mayo II: Hazard ratio (HR) 2.10 (95% CI: 1.12–3.92) p=0.02, Mayo III: HR 3.94 (95% CI: 2.13–7.32) p<0.0001, Mayo IV: HR 7.49 (95% CI: 3.94–14.21) p<0.0001, GLS <17%: HR 2.14 (95% CI: 1.59–2.88) p<0.0001]. At 12 months, only patients in a haematological complete response (CR) had significant improvement in overall GLS% (p=0.02) as well as baso-lateral (p=0.0004) and baso-septal (p=0.0001) GLS% and MAPSE (p=0.002). The OS was significantly better in patients who achieved a minimum absolute improvement in GLS% of 1.5% improvement (not reached in those with improved GLS% vs. 72 mo in those without) (p=0.034)).
Conclusion
These data show that baseline GLS% is an independent predictor of survival in AL amyloidosis. GLS% is the first functional marker that is independent of the Mayo staging in predicting outcomes and should be incorporated in prognostic staging for patients with AL amyloidosis. GLS% shows improvement in patients who achieve a complete haematologic response to treatment and improvement in GLS% of 1.5% is associated with improved outcomes. An absolute improvement in GLS% should be considered as a criterion for cardiac response in AL amyloidosis.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- O Cohen
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - A Ismail
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - R Manwani
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - S Ravichandran
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - D Foard
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - S Mahmood
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - S Sachchithanantham
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - A Martinez-Naharro
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - M Fontana
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - H Lachmann
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - P Hawkins
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - J Gillmore
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - C Whelan
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
| | - A.D Wechalekar
- National Amyloidosis Centre, Royal Free Hospital, Greater London, United Kingdom
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10
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Khalique Z, Ferreira PF, Scott AD, Nielles-Vallespin S, Martinez-Naharro A, Fontana M, Hawkins P, Firmin DN, Pennell DJ. Diffusion Tensor Cardiovascular Magnetic Resonance in Cardiac Amyloidosis. Circ Cardiovasc Imaging 2020; 13:e009901. [PMID: 32408830 DOI: 10.1161/circimaging.119.009901] [Citation(s) in RCA: 25] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Cardiac amyloidosis (CA) is a disease of interstitial myocardial infiltration, usually by light chains or transthyretin. We used diffusion tensor cardiovascular magnetic resonance (DT-CMR) to noninvasively assess the effects of amyloid infiltration on the cardiac microstructure. Methods DT-CMR was performed at diastole and systole in 20 CA, 11 hypertrophic cardiomyopathy, and 10 control subjects with calculation of mean diffusivity, fractional anisotropy, and sheetlet orientation (secondary eigenvector angle). Results Mean diffusivity was elevated and fractional anisotropy reduced in CA compared with both controls and hypertrophic cardiomyopathy (P<0.001). In CA, mean diffusivity was correlated with extracellular volume (r=0.68, P=0.004), and fractional anisotropy was inversely correlated with circumferential strain (r=-0.65, P=0.02). In CA, diastolic secondary eigenvector angle was elevated, and secondary eigenvector angle mobility was reduced compared with controls (both P<0.001). Diastolic secondary eigenvector angle was correlated with amyloid burden measured by extracellular volume in transthyretin, but not light chain amyloidosis. Conclusions DT-CMR can characterize the microstructural effects of amyloid infiltration and is a contrast-free method to identify the location and extent of the expanded disorganized myocardium. The diffusion biomarkers mean diffusivity and fractional anisotropy effectively discriminate CA from hypertrophic cardiomyopathy. DT-CMR demonstrated that failure of sheetlet relaxation in diastole correlated with extracellular volume in transthyretin, but not light chain amyloidosis. This indicates that different mechanisms may be responsible for impaired contractility in CA, with an amyloid burden effect in transthyretin, but an idiosyncratic effect in light chain amyloidosis. Consequently, DT-CMR offers a contrast-free tool to identify novel pathophysiology, improve diagnostics, and monitor disease through noninvasive microstructural assessment.
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Affiliation(s)
- Zohya Khalique
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital Sydney Street, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.)
| | - Pedro F Ferreira
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital Sydney Street, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.)
| | - Andrew D Scott
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital Sydney Street, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.)
| | - Sonia Nielles-Vallespin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital Sydney Street, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.)
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London Royal Free Hospital, United Kingdom (A.M.-N., M.F., P.H.)
| | - Marianna Fontana
- National Amyloidosis Centre, University College London Royal Free Hospital, United Kingdom (A.M.-N., M.F., P.H.)
| | - Phillip Hawkins
- National Amyloidosis Centre, University College London Royal Free Hospital, United Kingdom (A.M.-N., M.F., P.H.)
| | - David N Firmin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital Sydney Street, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.)
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital Sydney Street, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.)
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11
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Chacko L, Kotecha T, Martinez-Naharro A, Brown J, Knight D, Steriotis A, Little C, Moon J, Gilmore J, Hawkins P, Rakhit R, Patel N, Xue H, Kellman P, Fontana M. 1171Myocardial perfusion mapping in cardiac amyloidosis - exploring the spectrum from infiltration to ischaemia. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac involvement is the main driver of outcome in systemic amyloidosis, but the relationship between amyloid deposits and outcomes is not well understood. The simple explanation of physical, mechanical replacement of the interstitium by amyloid seems insufficient. Preliminary studies support the hypothesis that myocardial ischaemia could contribute to cell damage.
Purpose
(1) To assess myocardial ischaemia in cardiac amyloidosis. (2) To compare patients with cardiac amyloidosis to patients assessed on invasive coronary angiography (ICA) to have normal coronary physiology (NCP), microvascular dysfunction (MVD) and triple vessel coronary disease (3VD). (3) To assess correlation of perfusion mapping to markers of disease severity and prognosis.
Methods
86 patients and 20 healthy volunteers (HV) underwent CMR at 1.5T (Siemens) with standard cine, PSIR-LGE, T1, T2, Extracellular Volume (ECV) mapping and adenosine stress with myocardial blood flow (MBF) mapping. Thirty-eight patients also underwent ICA with 3 vessel assessment of Index of Microcirculatory Resistance and Fractional Flow Reserve: 7 had cardiac amyloidosis, 8 had NCP, 15 had MVD and 8 had 3VD.
Results
Cardiac amyloidosis patients had severe reduction in stress MBF and myocardial perfusion reserve (MPR) (1.22ml/g/min±0.70 and 1.62±0.63) compared to HV (3.21ml/g/min±0.64, p<0.001 and 4.17±0.78, p<0.001), NCP (2.66±0.56, p<0.001 and 2.51±0.43, p=0.036) and MVD (2.10±0.31, p<0.001 and 2.29±0.87, p=0.014) with the degree of reduction being similar only to patients with 3VD (1.44±0.54, p=1.000 and 1.64±0.68, p=1.000) (Figure 1). Rest MBF was also lower in amyloidosis than HV. Cardiac amyloidosis stress MBF and MPR inversely correlated with amyloid burden (ECV, r=−0.715, p<0.001, transmurality of LGE, p<0.01), systolic dysfunction (EF, r=0.405, p<0.01), and blood biomarkers (NT-proBNP (r=−0.678, p<0.001) and Troponin T (r=−0.628, p<0.001)). There was a correlation between stress MBF and native T1 (r=−0.588, p<0.001) but not T2 (p=0.591). Stress MBF and MPR were early disease markers, being elevated in patients with early cardiac amyloid infiltration (raised ECV, no LGE, P<0.01 vs HV).
Conclusion
Myocardial ischaemia is common in cardiac amyloidosis – with stress MBF and MPR similar to that of patients with 3VD. The reduction correlates with the degree of amyloid infiltration and markers of adverse prognosis, highlighting the potential role of myocardial ischaemia as a key mechanism in the pathophysiology of cardiac amyloidosis.
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Affiliation(s)
- L Chacko
- University College Hospital, London, United Kingdom
| | - T Kotecha
- University College Hospital, London, United Kingdom
| | | | - J Brown
- University College Hospital, London, United Kingdom
| | - D Knight
- University College Hospital, London, United Kingdom
| | - A Steriotis
- University College Hospital, London, United Kingdom
| | - C Little
- University College Hospital, London, United Kingdom
| | - J Moon
- University College Hospital, London, United Kingdom
| | - J Gilmore
- University College Hospital, London, United Kingdom
| | - P Hawkins
- University College Hospital, London, United Kingdom
| | - R Rakhit
- University College Hospital, London, United Kingdom
| | - N Patel
- University College Hospital, London, United Kingdom
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - M Fontana
- University College Hospital, London, United Kingdom
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12
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Dyke B, Gordon C, Hawkins P, Tosounidou S. 9. Successful use of IL-6 pathway blockade to treat autoinflammation occurring in the context of a novel TNFRS1A gene mutation. Rheumatol Adv Pract 2019. [PMCID: PMC6761470 DOI: 10.1093/rap/rkz023.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Autoinflammatory fever syndromes are rare and present significant diagnostic and treatment challenges. We present a case which illustrates some key concepts regarding the diagnosis and treatment of a patient with an autoinflammatory disorder, and also touches on the management of active autoinflammation in pregnancy. Case description A 29-year-old woman with a recently identified autoinflammatory disorder was referred to the local rheumatology service in September 2018. She reported having been symptomatic of fever, rashes and arthralgia since the age of 10, and TNF receptor 1 associated periodic syndrome (TRAPS) was suspected on the basis of an N71 deletion on axon 2 of the TNFRS1A gene when tested by a national reference centre 9 months previously. At the time of presentation she was 25 weeks into her sixth pregnancy, the first with a new partner. She reported significant pregnancy morbidity having given birth to a daughter with multiple congenital abnormalities who unfortunately died two days after birth. She suffered 4 subsequent miscarriages at 5-7 weeks gestation with the same partner and underwent extensive genetic testing. At her initial review in the obstetric clinic, she was already receiving low-molecular-weight heparin with aspirin. Colchicine 1 mg tds, did not confer significant symptomatic benefit. One month later, with careful counselling about pregnancy exposure to this biological treatment, IL-1 receptor antagonist (anakinra) therapy was instituted but discontinued after three weeks for generalised rash, as well as lack of efficacy manifesting in raised inflammatory markers. Infection was excluded during a subsequent hospital admission, and prednisolone treatment resulted in significant improvement in clinical course and acute phase response. The patient gave birth to a healthy infant at 37 weeks’ gestation. In the postpartum period, a recurrence of symptoms was observed. IL-6 receptor antagonist (tocilizumab) treatment was commenced at 12 weeks postpartum but discontinued owing to reports of sore throat, cough, headache and fever on the day of the injection. The patient had also discontinued prednisolone on the day of the injection and tocilizumab was rechallenged with good symptomatic response, normalisation of inflammatory markers, and successful reduction in prednisolone dose. Discussion This case highlights some interesting points with relation to the treatment of autoinflammatory disorders refractory to IL-1 pathway blockade, and also, of the management of flares of autoinflammation during pregnancy. Firstly, this lady failed to respond to IL-1 receptor antagonist anakinra which has been associated with efficacy in several reports for individuals with TRAPS, and has supplanted TNF blockade with agents such as etanercept for this condition. Only a handful of case reports describe successful IL-6 inhibitor administration for this condition, and this merits further study. This patient’s flare of autoinflammation was treated in the post-partum period, but the demographic characteristics of the autoinflammatory diseases are such that people of child-bearing age may be required to receive treatment in order to prevent pregnancy morbidity as a result of uncontrolled inflammation. IL-6 blockade has not to date been associated with adverse pregnancy outcomes, although this data requires extension and validation. 2 cases of renal agenesis have been reported in children born to mothers with anakinra, but the very small numbers of exposed parents warrants further examination of this observation and the careful study of ongoing pharmacovigilance data to explore this observation. Secondly, success with IL-6 inhibition has been reported in a series of patients with familial Mediterranean fever, the most common autoinflammatory disorder, but this treatment does not feature in the most recent European guidelines for this condition. IL-6 inhibition is well-established in the treatment of adult-onset Still’s disease (AoSD) however, and this lady’s presentation shares important features with that condition. The existence of TNF-receptor 1 mutations has been reported in patients with AoSD, and it may be that this patient’s presentation is more akin to adult-onset Still’s disease and that her TNF receptor mutation is an incidental finding. Key learning points This report adds to the handful cases in which IL-6 blockade has been used successfully to treat the autoinflammatory manifestations of suspected TNF receptor 1 associated periodic syndrome (TRAPS) after the failure of IL-1 receptor blockade with anakinra. Careful history and examination are required to differentiate between potentially overlapping symptoms of drug reaction, autoinflammation, and infection in patients with systemic autoinflammatory disorders (SAIDs). Once a history consistent with autoinflammatory flare was established, cautiously rechallenging with an IL-6 pathway inhibitor ensured this effective treatment was not discounted due to concerns over a drug reaction. With a degree of commonality between the more common conditions in the SAID family, a detailed examination of the clinical phenotype is essential to the interpretation of genetic tests used for the diagnosis of TRAPS and related disorders. Uncontrolled inflammatory disease is associated with pregnancy morbidity and very limited information is available about the short and long-term safety of treatments for autoinflammatory diseases in general. Current guidelines do not recommend the use of IL-6 inhibitor therapy in pregnancy. Conflict of interest The authors declare no conflicts of interest.
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Affiliation(s)
- Bernard Dyke
- Institute of Inflammation and Ageing, City Hospital, Birmingham, United Kingdom
| | - Caroline Gordon
- Institute of Inflammation and Ageing, City Hospital, Birmingham, United Kingdom
| | - Phillip Hawkins
- National Amyloidosis Centre, Royal Free Hospital, London, United Kingdom
| | - Sofia Tosounidou
- Institute of Inflammation and Ageing, City Hospital, Birmingham, United Kingdom
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13
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Chacko LA, Kotecha T, Martinez A, Brown J, Little C, Knight D, Patel N, Hawkins P, Gillmore J, Moon J, Steriotis A, Kellman P, Xue H, Fontana M. 319Myocardial perfusion mapping in cardiac amyloidosis: transformation from a disease of solely infiltration to myocardial ischaemia. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez102] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L A Chacko
- University College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - T Kotecha
- University College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Martinez
- University College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J Brown
- University College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C Little
- University College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - D Knight
- University College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - N Patel
- University College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - P Hawkins
- University College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J Gillmore
- University College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J Moon
- University College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Steriotis
- University College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- University College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- University College Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- University College Hospital, London, United Kingdom of Great Britain & Northern Ireland
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14
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Martinez Naharro A, Kotecha T, Gonzalez-Lopez E, Corovic A, Anderson S, Chacko L, Brown J, Knight DS, Baksi AJ, Moon JC, Kellman P, Garcia-Pavia P, Gillmore J, Hawkins P, Fontana M. 549High prevalence of intracardiac thrombi in cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez125] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Martinez Naharro
- University College London, CMR Unit at Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - T Kotecha
- University College London, CMR Unit at Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - E Gonzalez-Lopez
- University Hospital Puerta de Hierro Majadahonda, Department of Cardiology, Madrid, Spain
| | - A Corovic
- University College London, CMR Unit at Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Anderson
- University College London, CMR Unit at Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - L Chacko
- University College London, CMR Unit at Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J Brown
- University College London, CMR Unit at Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - D S Knight
- University College London, CMR Unit at Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A J Baksi
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, United States of America
| | - P Garcia-Pavia
- University Hospital Puerta de Hierro Majadahonda, Department of Cardiology, Madrid, Spain
| | - J Gillmore
- University College London, CMR Unit at Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - P Hawkins
- University College London, CMR Unit at Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- University College London, CMR Unit at Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
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15
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Koohy H, Bolland DJ, Matheson LS, Schoenfelder S, Stellato C, Dimond A, Várnai C, Chovanec P, Chessa T, Denizot J, Manzano Garcia R, Wingett SW, Freire-Pritchett P, Nagano T, Hawkins P, Stephens L, Elderkin S, Spivakov M, Fraser P, Corcoran AE, Varga-Weisz PD. Genome organization and chromatin analysis identify transcriptional downregulation of insulin-like growth factor signaling as a hallmark of aging in developing B cells. Genome Biol 2018; 19:126. [PMID: 30180872 PMCID: PMC6124017 DOI: 10.1186/s13059-018-1489-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/20/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Aging is characterized by loss of function of the adaptive immune system, but the underlying causes are poorly understood. To assess the molecular effects of aging on B cell development, we profiled gene expression and chromatin features genome-wide, including histone modifications and chromosome conformation, in bone marrow pro-B and pre-B cells from young and aged mice. RESULTS Our analysis reveals that the expression levels of most genes are generally preserved in B cell precursors isolated from aged compared with young mice. Nonetheless, age-specific expression changes are observed at numerous genes, including microRNA encoding genes. Importantly, these changes are underpinned by multi-layered alterations in chromatin structure, including chromatin accessibility, histone modifications, long-range promoter interactions, and nuclear compartmentalization. Previous work has shown that differentiation is linked to changes in promoter-regulatory element interactions. We find that aging in B cell precursors is accompanied by rewiring of such interactions. We identify transcriptional downregulation of components of the insulin-like growth factor signaling pathway, in particular downregulation of Irs1 and upregulation of Let-7 microRNA expression, as a signature of the aged phenotype. These changes in expression are associated with specific alterations in H3K27me3 occupancy, suggesting that Polycomb-mediated repression plays a role in precursor B cell aging. CONCLUSIONS Changes in chromatin and 3D genome organization play an important role in shaping the altered gene expression profile of aged precursor B cells. Components of the insulin-like growth factor signaling pathways are key targets of epigenetic regulation in aging in bone marrow B cell precursors.
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Affiliation(s)
- Hashem Koohy
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
- Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Daniel J Bolland
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
- Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Cambridge, UK
| | - Louise S Matheson
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
- Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Cambridge, UK
| | | | | | - Andrew Dimond
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
| | - Csilla Várnai
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
| | - Peter Chovanec
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
- Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Cambridge, UK
| | | | - Jeremy Denizot
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
- Present address: Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, F-, 63000, Clermont-Ferrand, France
| | | | - Steven W Wingett
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
- Bioinformatics, Babraham Institute, Cambridge, UK
| | - Paula Freire-Pritchett
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
- Division of Cell Biology, Medical Research Council Laboratory of Molecular Biology, Cambridge, CB2 0QH, UK
| | - Takashi Nagano
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
| | | | | | - Sarah Elderkin
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
| | - Mikhail Spivakov
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
- Functional Gene Control Group, MRC London Institute of Medical Sciences (LMS), Du Cane Road, London, W12 0NN, UK
| | - Peter Fraser
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK
- Department of Biological Science, Florida State University, Tallahassee, FL, USA
| | - Anne E Corcoran
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK.
- Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Cambridge, UK.
| | - Patrick D Varga-Weisz
- Nuclear Dynamics Programme, Babraham Institute, Cambridge, UK.
- School of Biological Sciences, University of Essex, Colchester, UK.
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16
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Sharpley FA, Manwani R, Mahmood S, Sachchithanantham S, Lachmann H, Gilmore J, Whelan C, Hawkins P, Wechalekar A. Real world outcomes of pomalidomide for treatment of relapsed light chain amyloidosis. Br J Haematol 2018; 183:557-563. [PMID: 30095161 DOI: 10.1111/bjh.15541] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/19/2018] [Indexed: 11/28/2022]
Abstract
Pomalidomide is a next-generation immunomodulatory agent with activity in relapsed light chain (AL) amyloidosis, but real world outcomes are lacking. We report the experience of the UK National Amyloidosis Centre. All patients with AL amyloidosis treated with pomalidomide between 2009 and 2017 were included. Data was collected on treatment toxicity and clonal response. Survival was calculated by the Kaplan-Meier method and outcomes reported on an intent-to-treat (ITT) basis. A total of 29 patients treated with pomalidomide were identified. Haematological responses at 3 months were: complete response (CR) nil, very good partial response (VGPR) 10 (35%), partial response (PR) 9 (31%), stable or progressive disease 7 (24%), unevaluable 3 (10%). On an ITT basis (n = 28), responses at 6 months were: CR- nil, VGPR-11 (39%), PR-2 (7%) and the remaining patients were non-responders 15 (53%). Median overall survival was 27 months (95% confidence interval 15·7-38·1 months). Median progression free survival (PFS) was 15 months (95% confidence interval 6·24-23·77). In conclusion, pomalidomide has activity in patients with relapsed AL amyloidosis. Responses are rapid and early responses may be predictive of a sustained overall response. Deep responses (VGPR or better) are seen in only a third of all patients and combination therapy needs to be explored.
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Affiliation(s)
- Faye A Sharpley
- National Amyloidosis Centre, University College London, London, UK
| | - Richa Manwani
- National Amyloidosis Centre, University College London, London, UK
| | - Shameem Mahmood
- National Amyloidosis Centre, University College London, London, UK
| | | | - Helen Lachmann
- National Amyloidosis Centre, University College London, London, UK
| | - Julian Gilmore
- National Amyloidosis Centre, University College London, London, UK
| | - Carol Whelan
- National Amyloidosis Centre, University College London, London, UK
| | - Phillip Hawkins
- National Amyloidosis Centre, University College London, London, UK
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17
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Boldrini M, Baggiano A, Naharro AM, Kotecha T, Rezk T, Fayed H, Knight D, Moon J, Kellman P, Gillmore J, Hawkins P, Fontana M. 1161Accuracy of non contrast magnetic resonance for clinical diagnosis of cardiac amyloidosis - a 868 patient prospective study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Boldrini
- University College London, UCL CMR Department, National Amyloidosis Center, Royal Free Hospital, London, United Kingdom
| | | | - A M Naharro
- University College London, UCL CMR Department, National Amyloidosis Center, Royal Free Hospital, London, United Kingdom
| | - T Kotecha
- University College London, UCL CMR Department, National Amyloidosis Center, Royal Free Hospital, London, United Kingdom
| | - T Rezk
- University College London, National Amyloidosis Center, London, United Kingdom
| | - H Fayed
- University College London, UCL CMR Department, National Amyloidosis Center, Royal Free Hospital, London, United Kingdom
| | - D Knight
- University College London, UCL CMR Department, National Amyloidosis Center, Royal Free Hospital, London, United Kingdom
| | - J Moon
- Barts Health NHS Trust, London, United Kingdom
| | - P Kellman
- National Institute of Health (Home), Washington, United States of America
| | - J Gillmore
- University College London, National Amyloidosis Center, London, United Kingdom
| | - P Hawkins
- University College London, National Amyloidosis Center, London, United Kingdom
| | - M Fontana
- University College London, UCL CMR Department, National Amyloidosis Center, Royal Free Hospital, London, United Kingdom
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18
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Bader R, Mannucci PMM, Tripodi A, Hirsh J, Keller F, Solleder EM, Hawkins P, Peng M, Pelzer H, Teijidor LM, Ramirez IF, Kolde HJ. Multicentric Evaluation of a New PT Reagent Based on Recombinant Human Tissue Factor and Synthetic Phospholipids. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1642433] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryA new PT reagent based on recombinant human tissue factor and synthetic phospholipids (phosphatidyl choline and phosphatidyl serine) with defined fatty acid side chains was calibrated against BCT/253 and CRM 149R. A small but consistent bias in the International Sensitivity Index (ISI) value was obtained using either the human or rabbit brain reference material. ISI values were around 1.0 or slightly lower depending on the respective instrument. Mixing studies with factor deficient plasmas showed a high factor sensitivity especially for factor VII as compared to commercial rabbit brain or human placenta thromboplastin. In an international field trial the reagent was tested using fully or semi automated Electra™ coagulometers in 4 different laboratories. Results with normal samples were in excellent agreement among the different laboratories. Mean values were 10.9, 10.9, 11.0, 11,7 s with a range of 9.5 to 12.5 s. Results of males and females were not different. In patients with liver disease very similar PT activities were found as compared to sensitive rabbit brain or human placental thromboplastins. In normals and patients with oral anticoagulation INR values correlated very well against BCT (r = 0.98, regression line y =-0.07 + 0.9 x). The distribution of samples was linear over the whole range. In the comparison against sensitive rabbit brain thromboplastin or human placental thromboplastin similar correlations were found. In a few cases higher INR values were observed for the recombinant reagent especially in patients with intensive treatment. Factor assays in those patients showed at least the strong reduction of one vitamin Independent coagulation factor. Over all the linearity was better against the rabbit brain reagent than against the human placental reagent which is slightly less factor VII sensitive as shown in mixing studies with normal and factor VII deficient plasma. Precision studies in the 4 laboratories showed excellent reproducibility of lyophilised controls or local patient plasma pools for all reagents with a better performance of the recombinant reagent. C. V. values from day to day ranged from 1.3% to 5% for normal and abnormal controls.These results show that the recombinant PT reagent, especially in conjunction with a precise automated instrument, may improve the results of PT testing and thus may lead to better patient care.
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Affiliation(s)
- R Bader
- The IRCCS Maggiore Hospital and University, Policlinico Centro Hemophilia, Milano, Italy
| | - P M M Mannucci
- The IRCCS Maggiore Hospital and University, Policlinico Centro Hemophilia, Milano, Italy
| | - A Tripodi
- The IRCCS Maggiore Hospital and University, Policlinico Centro Hemophilia, Milano, Italy
| | - J Hirsh
- The Hamilton Civic Hospitals Research Centre, Hamilton, Ontario, Canada
| | - F Keller
- The Medizinische Universitätsklinik, Zentrallabor, Würzburg, Germany
| | - E M Solleder
- The Medizinische Universitätsklinik, Zentrallabor, Würzburg, Germany
| | - P Hawkins
- The Baxter Diagnostics, R & D, Miami, Florida, USA
| | - M Peng
- The Baxter Diagnostics, R & D, Miami, Florida, USA
| | - H Pelzer
- The Baxter Diagnostics, R & D, Miami, Florida, USA
| | - L M Teijidor
- The Baxter Diagnostics, R & D, Miami, Florida, USA
| | - I F Ramirez
- The Baxter Deutschland GmbH, Haemostase Europa, Unterschleißheim/München, Germany
| | - H-J Kolde
- The Baxter Deutschland GmbH, Haemostase Europa, Unterschleißheim/München, Germany
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19
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Alharbi A, Boguslavskiy AE, Austin D, Thiré N, Wood D, Hawkins P, McGrath F, Johnson AS, Lopez-Quintas I, Schmidt B, Légaré F, Marangos JP, Le AT, Bhardwaj R. Author Correction: Femtosecond Laser Mass Spectrometry and High Harmonic Spectroscopy of Xylene Isomers. Sci Rep 2018; 8:7536. [PMID: 29743528 PMCID: PMC5943455 DOI: 10.1038/s41598-018-25623-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Abdullah Alharbi
- Department of Physics, Advanced Research Complex, University of Ottawa, 25 Templeton Street, Ottawa, K1N6N5, Ontario, Canada.,King Abdulaziz City for Science and Technology (KACST), P.O. Box 6086, Riyadh, 11442, Saudi Arabia
| | - Andrey E Boguslavskiy
- Department of Physics, Advanced Research Complex, University of Ottawa, 25 Templeton Street, Ottawa, K1N6N5, Ontario, Canada
| | - Dane Austin
- Blackett Laboratory, Imperial College London, London, UK
| | - Nicolas Thiré
- INRS-EMT, Advanced Laser Light Source, 1650 Lionel-Boulet Bvd, Varennes, J3X1S2, Canada
| | - D Wood
- Blackett Laboratory, Imperial College London, London, UK
| | - P Hawkins
- Blackett Laboratory, Imperial College London, London, UK
| | | | - A S Johnson
- Blackett Laboratory, Imperial College London, London, UK
| | - I Lopez-Quintas
- Instituto de Química Física Rocasolano, IQFR-CSIC, Serrano 119, 28006, Madrid, Spain
| | - Bruno Schmidt
- INRS-EMT, Advanced Laser Light Source, 1650 Lionel-Boulet Bvd, Varennes, J3X1S2, Canada
| | - Francois Légaré
- INRS-EMT, Advanced Laser Light Source, 1650 Lionel-Boulet Bvd, Varennes, J3X1S2, Canada
| | - J P Marangos
- Blackett Laboratory, Imperial College London, London, UK.
| | - Anh-Thu Le
- J. R. Macdonald Laboratory, Physics Department, Kansas State University, Manhattan, Kansas, 66506-2604, USA.
| | - Ravi Bhardwaj
- Department of Physics, Advanced Research Complex, University of Ottawa, 25 Templeton Street, Ottawa, K1N6N5, Ontario, Canada.
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20
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Hawkins P. Therapeutic advances in hereditary ATTR amyloidosis. Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30292-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Alharbi A, Boguslavskiy AE, Austin D, Thiré N, Wood D, Hawkins P, McGrath F, Johnson AS, Lopez-Quintas I, Schmidt B, Légaré F, Marangos JP, Le AT, Bhardwaj R. Femtosecond Laser Mass Spectrometry and High Harmonic Spectroscopy of Xylene Isomers. Sci Rep 2018; 8:3789. [PMID: 29491420 PMCID: PMC5830629 DOI: 10.1038/s41598-018-22055-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/12/2018] [Indexed: 11/09/2022] Open
Abstract
Structural isomers, molecules having the same chemical formula but with atoms bonded in different order, are hard to identify using conventional spectroscopy and mass spectrometry. They exhibit virtually indistinguishable mass spectra when ionized by electrons. Laser mass spectrometry based on photoionization of the isomers has emerged as a promising alternative but requires shaped ultrafast laser pulses. Here we use transform limited femtosecond pulses to distinguish the isomers using two methods. First, we probe doubly charged parent ions with circularly polarized light. We show that the yield of doubly charged ortho-xylene decreases while para-xylene increases over a range of laser intensities when the laser polarization is changed from linear to circular. Second, we probe high harmonic generation from randomly oriented isomer molecules subjected to an intense laser field. We show that the yield of high-order harmonics varies with the positioning of the methyl group in xylene isomers (ortho-, para- and meta-) and is due to differences in the strength of tunnel ionization and the overlap between the angular peaks of ionization and photo-recombination.
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Affiliation(s)
- Abdullah Alharbi
- Department of Physics, Advanced Research Complex, University of Ottawa, 25 Templeton Street, Ottawa, K1N6N5, Ontario, Canada.,King Abdulaziz City for Science and Technology (KACST), P.O. Box 6086, Riyadh, 11442, Saudi Arabia
| | - Andrey E Boguslavskiy
- Department of Physics, Advanced Research Complex, University of Ottawa, 25 Templeton Street, Ottawa, K1N6N5, Ontario, Canada
| | - Dane Austin
- Blackett Laboratory, Imperial College London, London, UK
| | - Nicolas Thiré
- INRS-EMT, Advanced Laser Light Source, 1650 Lionel-Boulet Bvd, Varennes, J3X1S2, Canada
| | - D Wood
- Blackett Laboratory, Imperial College London, London, UK
| | - P Hawkins
- Blackett Laboratory, Imperial College London, London, UK
| | | | - A S Johnson
- Blackett Laboratory, Imperial College London, London, UK
| | - I Lopez-Quintas
- Instituto de Química Física Rocasolano, IQFR-CSIC, Serrano 119, 28006, Madrid, Spain
| | - Bruno Schmidt
- INRS-EMT, Advanced Laser Light Source, 1650 Lionel-Boulet Bvd, Varennes, J3X1S2, Canada
| | - Francois Légaré
- INRS-EMT, Advanced Laser Light Source, 1650 Lionel-Boulet Bvd, Varennes, J3X1S2, Canada
| | - J P Marangos
- Blackett Laboratory, Imperial College London, London, UK.
| | - Anh-Thu Le
- J. R. Macdonald Laboratory, Physics Department, Kansas State University, Manhattan, Kansas, 66506-2604, USA.
| | - Ravi Bhardwaj
- Department of Physics, Advanced Research Complex, University of Ottawa, 25 Templeton Street, Ottawa, K1N6N5, Ontario, Canada.
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22
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Orlacchio A, Ranieri M, Brave M, Arciuch VA, Forde T, De Martino D, Anderson KE, Hawkins P, Di Cristofano A. SGK1 Is a Critical Component of an AKT-Independent Pathway Essential for PI3K-Mediated Tumor Development and Maintenance. Cancer Res 2017; 77:6914-6926. [PMID: 29055016 DOI: 10.1158/0008-5472.can-17-2105] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/12/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023]
Abstract
Activation of the PI3K-AKT signaling cascade is a common critical event during malignant transformation. In this study, we used thyroid gland epithelial cells and a series of genetically engineered mouse strains as model systems to demonstrate that, although necessary, AKT activation is not sufficient for PI3K-driven transformation. Instead, transformation requires the activity of the PDK1-regulated AGC family of protein kinases. In particular, SGK1 was found to be essential for proliferation and survival of thyroid cancer cells harboring PI3K-activating mutations. Notably, cotargeting SGK1 and AKT resulted in significantly higher growth suppression than inhibiting either PI3K or AKT alone. Overall, these findings underscore the clinical relevance of AKT-independent pathways in tumors driven by genetic lesions targeting the PI3K cascade. Cancer Res; 77(24); 6914-26. ©2017 AACR.
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Affiliation(s)
- Arturo Orlacchio
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York
| | - Michela Ranieri
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York
| | - Martina Brave
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York
| | - Valeria Antico Arciuch
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York
| | - Toni Forde
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York
| | - Daniela De Martino
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York
| | - Karen E Anderson
- Inositide Laboratory, Babraham Institute, Babraham, Cambridge, United Kingdom
| | - Phillip Hawkins
- Inositide Laboratory, Babraham Institute, Babraham, Cambridge, United Kingdom
| | - Antonio Di Cristofano
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York.
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23
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Storan ER, O' Gorman SM, Hawkins P, Aalto L, Murphy A, Markham T. Alpha-1-antitrypsin deficiency-related panniculitis: two cases with diverse clinical courses. Clin Exp Dermatol 2017; 42:520-522. [PMID: 28512995 DOI: 10.1111/ced.13102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 11/30/2022]
Abstract
Alpha-1-antitrypsin deficiency (AATD)-related panniculitis is an extremely rare and underdiagnosed entity, and there is a paucity of data on its treatment. We report two cases of AATD-related panniculitis. The first was a 24-year-old woman with known AATD who presented with painful leg ulcers refractory to treatment with corticosteroids and colchicine. She had a good response to α1-antitrypsin infusions but required dose adjustment due to flares in disease activity. The second case was a 38-year-old woman who presented with painful nodules on the legs refractory to corticosteroid therapy. Laboratory investigations revealed severe AATD. She had an excellent response to colchicine therapy. In both these cases of AATD, panniculitis was the first clinical manifestation of the disease. AATD-related panniculitis may have none of the typical clinical clues for AATD, such as a family history, cirrhosis or emphysema. Early identification may help prevent these complications from developing.
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Affiliation(s)
- E R Storan
- Department of Dermatology, Galway University Hospital, Galway, Ireland
| | - S M O' Gorman
- Department of Dermatology, Galway University Hospital, Galway, Ireland
| | - P Hawkins
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - L Aalto
- Department of Pathology, Galway University Hospital, Galway, Ireland
| | - A Murphy
- Department of Dermatology, Galway University Hospital, Galway, Ireland
| | - T Markham
- Department of Dermatology, Galway University Hospital, Galway, Ireland
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24
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da Silva Filho MI, Försti A, Weinhold N, Meziane I, Campo C, Huhn S, Nickel J, Hoffmann P, Nöthen MM, Jöckel KH, Landi S, Mitchell JS, Johnson D, Morgan GJ, Houlston R, Goldschmidt H, Jauch A, Milani P, Merlini G, Rowcieno D, Hawkins P, Hegenbart U, Palladini G, Wechalekar A, Schönland SO, Hemminki K. Genome-wide association study of immunoglobulin light chain amyloidosis in three patient cohorts: comparison with myeloma. Leukemia 2016; 31:1735-1742. [PMID: 28025584 DOI: 10.1038/leu.2016.387] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/28/2016] [Accepted: 11/30/2016] [Indexed: 01/27/2023]
Abstract
Immunoglobulin light chain (AL) amyloidosis is characterized by tissue deposition of amyloid fibers derived from immunoglobulin light chain. AL amyloidosis and multiple myeloma (MM) originate from monoclonal gammopathy of undetermined significance. We wanted to characterize germline susceptibility to AL amyloidosis using a genome-wide association study (GWAS) on 1229 AL amyloidosis patients from Germany, UK and Italy, and 7526 healthy local controls. For comparison with MM, recent GWAS data on 3790 cases were used. For AL amyloidosis, single nucleotide polymorphisms (SNPs) at 10 loci showed evidence of an association at P<10-5 with homogeneity of results from the 3 sample sets; some of these were previously documented to influence MM risk, including the SNP at the IRF4 binding site. In AL amyloidosis, rs9344 at the splice site of cyclin D1, promoting translocation (11;14), reached the highest significance, P=7.80 × 10-11; the SNP was only marginally significant in MM. SNP rs79419269 close to gene SMARCD3 involved in chromatin remodeling was also significant (P=5.2 × 10-8). These data provide evidence for common genetic susceptibility to AL amyloidosis and MM. Cyclin D1 is a more prominent driver in AL amyloidosis than in MM, but the links to aggregation of light chains need to be demonstrated.
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Affiliation(s)
- M I da Silva Filho
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, Malmo, Sweden
| | - N Weinhold
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.,Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - I Meziane
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Campo
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S Huhn
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - J Nickel
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - P Hoffmann
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Biomedicine, University of Basel, Basel, Switzerland
| | - M M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life and Brain Research Center, University of Bonn, Bonn, Germany
| | - K-H Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Germany
| | - S Landi
- Department of Biology, University of Pisa, Pisa, Italy
| | - J S Mitchell
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Surrey, UK
| | - D Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, Surrey, UK
| | - G J Morgan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - R Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Surrey, UK.,Division of Molecular Pathology, The Institute of Cancer Research, Surrey, UK
| | - H Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.,National Centre of Tumor Diseases, Heidelberg, Germany
| | - A Jauch
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - P Milani
- Department of Molecular Medicine, Amyloidosis Research and Treatment Center, Foundation 'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo', University of Pavia, Pavia, Italy
| | - G Merlini
- Department of Molecular Medicine, Amyloidosis Research and Treatment Center, Foundation 'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo', University of Pavia, Pavia, Italy
| | - D Rowcieno
- National Amyloidosis Centre, University College London Medical School, London UK
| | - P Hawkins
- National Amyloidosis Centre, University College London Medical School, London UK
| | - U Hegenbart
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - G Palladini
- Department of Molecular Medicine, Amyloidosis Research and Treatment Center, Foundation 'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo', University of Pavia, Pavia, Italy
| | - A Wechalekar
- National Amyloidosis Centre, University College London Medical School, London UK
| | - S O Schönland
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - K Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, Malmo, Sweden
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25
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Omoyinmi E, Standing A, Keylock A, Rowczenio D, Melo Gomes S, Cullup T, Jenkins L, Gilmour K, Eleftheriou D, Lachmann H, Hawkins P, Klein N, Brogan P. SAT0010 A Targeted Next-Generation Sequencing Gene Panel for Autoinflammation. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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26
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Frej AD, Clark J, Le Roy CI, Lilla S, Thomason PA, Otto GP, Churchill G, Insall RH, Claus SP, Hawkins P, Stephens L, Williams RSB. The Inositol-3-Phosphate Synthase Biosynthetic Enzyme Has Distinct Catalytic and Metabolic Roles. Mol Cell Biol 2016; 36:1464-79. [PMID: 26951199 PMCID: PMC4859692 DOI: 10.1128/mcb.00039-16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/19/2016] [Accepted: 03/03/2016] [Indexed: 12/24/2022] Open
Abstract
Inositol levels, maintained by the biosynthetic enzyme inositol-3-phosphate synthase (Ino1), are altered in a range of disorders, including bipolar disorder and Alzheimer's disease. To date, most inositol studies have focused on the molecular and cellular effects of inositol depletion without considering Ino1 levels. Here we employ a simple eukaryote, Dictyostelium discoideum, to demonstrate distinct effects of loss of Ino1 and inositol depletion. We show that loss of Ino1 results in an inositol auxotrophy that can be rescued only partially by exogenous inositol. Removal of inositol supplementation from the ino1(-) mutant resulted in a rapid 56% reduction in inositol levels, triggering the induction of autophagy, reduced cytokinesis, and substrate adhesion. Inositol depletion also caused a dramatic generalized decrease in phosphoinositide levels that was rescued by inositol supplementation. However, loss of Ino1 triggered broad metabolic changes consistent with the induction of a catabolic state that was not rescued by inositol supplementation. These data suggest a metabolic role for Ino1 that is independent of inositol biosynthesis. To characterize this role, an Ino1 binding partner containing SEL1L1 domains (Q54IX5) and having homology to mammalian macromolecular complex adaptor proteins was identified. Our findings therefore identify a new role for Ino1, independent of inositol biosynthesis, with broad effects on cell metabolism.
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Affiliation(s)
- Anna D Frej
- Centre for Biomedical Sciences, School of Biological Sciences, Royal Holloway University of London, Egham, Surrey, United Kingdom
| | - Jonathan Clark
- The Babraham Institute, Cambridge, Cambridgeshire, United Kingdom
| | - Caroline I Le Roy
- Department of Food and Nutritional Sciences, The University of Reading, Reading, Berkshire, United Kingdom
| | - Sergio Lilla
- Cancer Research UK Beatson Institute, Bearsden, Glasgow, United Kingdom
| | - Peter A Thomason
- Cancer Research UK Beatson Institute, Bearsden, Glasgow, United Kingdom
| | - Grant P Otto
- Centre for Biomedical Sciences, School of Biological Sciences, Royal Holloway University of London, Egham, Surrey, United Kingdom
| | - Grant Churchill
- Department of Pharmacology, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Robert H Insall
- Cancer Research UK Beatson Institute, Bearsden, Glasgow, United Kingdom
| | - Sandrine P Claus
- Department of Food and Nutritional Sciences, The University of Reading, Reading, Berkshire, United Kingdom
| | - Phillip Hawkins
- The Babraham Institute, Cambridge, Cambridgeshire, United Kingdom
| | - Len Stephens
- The Babraham Institute, Cambridge, Cambridgeshire, United Kingdom
| | - Robin S B Williams
- Centre for Biomedical Sciences, School of Biological Sciences, Royal Holloway University of London, Egham, Surrey, United Kingdom
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27
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Kuegler A, Schatz S, Vander Beeken S, Jiang D, Rück A, De Geest B, Hawkins P, Scharffetter-Kochanek K, Anca S. 736 β 2 integrin-dependent activation of NOX2 oxidase in wound macrophages is required for physiological wound healing. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Pepper R, Hutchinson M, Henderson S, Rowczenio D, Hawkins P, Lachmann H. Calprotectin (S100A8/A9) in Familial Mediterranean Fever. Pediatr Rheumatol Online J 2015. [PMCID: PMC4599818 DOI: 10.1186/1546-0096-13-s1-p120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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29
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Donnelly O, Youngstein T, Pepper R, Rowczenio D, Hawkins P, Lachmann H. Adult PFAPA - a single centre experience. Pediatr Rheumatol Online J 2015. [PMCID: PMC4599769 DOI: 10.1186/1546-0096-13-s1-p176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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30
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Gomes SM, Arostegui J, Omoyinmi E, Standing A, Klein N, Lachmann H, Hawkins P, Brogan P. Whole Exome Sequencing reveals a NLRP3 mutation in exon 5 in a patient with CINCA. Pediatr Rheumatol Online J 2015. [PMCID: PMC4597063 DOI: 10.1186/1546-0096-13-s1-p45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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31
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Rowczenio D, Iancu D, Trojer H, Gilbertson J, Gillmore J, Wechalekar A, Tekman M, Stanescu H, Kleta R, Lane T, Hawkins P, Lachmann H. Deletion in MEFV resulting in the loss of p.M694 residue as the cause of autosomal dominant familial Mediterranean fever in North Western European Caucasians - a case series and genetic exploration. Pediatr Rheumatol Online J 2015. [PMCID: PMC4596970 DOI: 10.1186/1546-0096-13-s1-o42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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32
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Rowczenio D, Gomes SM, Aróstegui J, Omoyinmi E, Gonzalez-Roca E, Standing A, Eleftheriou D, Klein N, Brogan P, Lachmann H, Hawkins P. Late onset of the cryopyrin-associated periodic syndrome (CAPS) associated with low level of somatic mosaicism in six patients. Pediatr Rheumatol Online J 2015. [PMCID: PMC4597082 DOI: 10.1186/1546-0096-13-s1-p37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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33
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Rowczenio D, Trojer H, Baginska A, Gillmore J, Wechalekar A, Hawkins P, Lachmann H. Clinical symptoms and molecular investigations in 13 patients with Schnitzler syndrome identified at the single UK centre. Pediatr Rheumatol Online J 2015. [PMCID: PMC4596996 DOI: 10.1186/1546-0096-13-s1-p38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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34
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Kiselev VY, Juvin V, Malek M, Luscombe N, Hawkins P, Le Novère N, Stephens L. Perturbations of PIP3 signalling trigger a global remodelling of mRNA landscape and reveal a transcriptional feedback loop. Nucleic Acids Res 2015; 43:9663-79. [PMID: 26464442 PMCID: PMC4787766 DOI: 10.1093/nar/gkv1015] [Citation(s) in RCA: 16] [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: 07/29/2015] [Accepted: 09/24/2015] [Indexed: 01/10/2023] Open
Abstract
PIP3 is synthesized by the Class I PI3Ks and regulates complex cell responses, such as growth and migration. Signals that drive long-term reshaping of cell phenotypes are difficult to resolve because of complex feedback networks that operate over extended times. PIP3-dependent modulation of mRNA accumulation is clearly important in this process but is poorly understood. We have quantified the genome-wide mRNA-landscape of non-transformed, breast epithelium-derived MCF10a cells and its response to acute regulation by EGF, in the presence or absence of a PI3Kα inhibitor, compare it to chronic activation of PI3K signalling by cancer-relevant mutations (isogenic cells expressing an oncomutant PI3Kα allele or lacking the PIP3-phosphatase/tumour-suppressor, PTEN). Our results show that whilst many mRNAs are changed by long-term genetic perturbation of PIP3 signalling ('butterfly effect'), a much smaller number do so in a coherent fashion with the different PIP3 perturbations. This suggests a subset of more directly regulated mRNAs. We show that mRNAs respond differently to given aspects of PIP3 regulation. Some PIP3-sensitive mRNAs encode PI3K pathway components, thus suggesting a transcriptional feedback loop. We identify the transcription factor binding motifs SRF and PRDM1 as important regulators of PIP3-sensitive mRNAs involved in cell movement.
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Affiliation(s)
| | - Veronique Juvin
- Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | - Mouhannad Malek
- Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | | | - Phillip Hawkins
- Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | - Nicolas Le Novère
- Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK EMBL-European Bioinformatics Institute, Hinxton, CB10 1SD, UK
| | - Len Stephens
- Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
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35
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Standing A, Eleftheriou D, Paisan-Ruiz C, Rowcenzio D, Hong Y, Omoyinmi E, Woo P, Hawkins P, Lachmann H, Klein N, Brogan P. 8th International Congress of Familial Mediterranean Fever and Systemic Autoinflammatory Diseases. Pediatr Rheumatol Online J 2015; 13 Suppl 1:O1-P211. [PMID: 26424586 PMCID: PMC4597419 DOI: 10.1186/1546-0096-13-s1-o1] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- A Standing
- UCL Institute of Child Health, IIIP, London, UK
| | | | | | - D Rowcenzio
- UCL Royal Free Hospital, National Amyloidosis Centre, London, UK
| | - Y Hong
- UCL Institute of Child Health, IIIP, London, UK
| | - E Omoyinmi
- UCL Institute of Child Health, IIIP, London, UK
| | - P Woo
- University College London, London, UK
| | - P Hawkins
- UCL Royal Free Hospital, National Amyloidosis Centre, London, UK
| | - H Lachmann
- UCL Royal Free Hospital, National Amyloidosis Centre, London, UK
| | - N Klein
- UCL Institute of Child Health, IIIP, London, UK
| | - P Brogan
- UCL Institute of Child Health, IIIP, London, UK
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36
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Kuemmerle-Deschner J, Hoffman H, Hawkins P, van der Poll T, Walker U, Speziale A, Tilson H. SAT0524 Evaluation of Long-Term Safety and Effectiveness of Canakinumab Therapy in Patients with Cryopyrin-Associated Periodic Syndrome: Results from Beta-Confident Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2224] [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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37
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Werner RA, Maya Y, Yamane T, Rischpler C, Fukushima K, Chen X, Lapa C, Herrmann K, Higuchi T, Thorn S, Stacy M, Purcell B, Doviak H, Shuman J, Perez E, Burdick J, Spinale F, Sinusas A, Treibel T, Bandula S, Fontana M, White S, Gilbertson J, Punwani S, Gillmore J, Hawkins P, Taylor S, Moon J, Caobelli F, Wollenweber T, Kuehn C, Bavendiek U, Schuetze C, Geworski L, Bauersachs J, Haverich A, Bengel F, Barysheva N, Merkulova I, Shabanova M, Gaman S, Veselova T, Shariya M, Kelion AD, Pakkal M, Chowdhury F, Nagaraj N, Birchall J, Dixon K, Banya W, Mccann G, Gershlick A, Rischpler C, Dirschinger R, Nicolosi S, Kossmann H, Meinicke A, Hanus F, Goetze K, Laugwitz K, Schwaiger M, Nekolla S, Rischpler C, Dirschinger R, Nicolosi S, Kossmann H, Meinicke A, Hanus F, Goetze K, Laugwitz K, Schwaiger M, Nekolla S. Moderated Poster Session 4: Monday 4 May 2015, 15:30-16:30 * Room: Moderated Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev050] [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: 11/15/2022] Open
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38
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Sidhu M, Gulati A, Hawkins P, Cooper S. P70 Improved Lung Cancer Referral Rates And Early Diagnosis In A District General Hospital. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.211] [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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39
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Carr A, Pelayo A, Gilmore J, Hawkins P, Reilly M. P51 Neuropathy phenotype in hereditary transthyretin amyloidosis. Neuromuscul Disord 2014. [DOI: 10.1016/s0960-8966(14)70067-7] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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40
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Bybee AK, Lachmann H, Omoyinmi E, Nedjai B, Woo P, Lane T, Savic S, Hawkins P, McDermott M. PW02-031 - Genetic and clinical manifestations of CAPS. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952365 DOI: 10.1186/1546-0096-11-s1-a172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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41
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Drewe E, Negm O, Abduljabbar W, Hawkins P, Fairclough L, Todd I, Tighe P. OR13-005 – Investigation of clinical and laboratory significance of TNFRSF1A intron by reverse-phase protein microarray. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952581 DOI: 10.1186/1546-0096-11-s1-a267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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42
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McColgan P, Viegas S, Gandhi S, Sheikh F, Pinney J, Fontana M, Rowczenio D, Shah S, Jaumuktane Z, Holton J, Schott J, Werring D, Hawkins P, Reilly MM. WEIGHT LOSS, ENCEPHALOPATHY, URINARY DIFFICULTIES AND NUMB FEET IN A NIGERIAN MAN. J Neurol Neurosurg Psychiatry 2013. [DOI: 10.1136/jnnp-2013-306573.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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43
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Angulo I, Vadas O, Garçon F, Banham-Hall E, Plagnol V, Leahy TR, Baxendale H, Coulter T, Curtis J, Wu C, Blake-Palmer K, Perisic O, Smyth D, Maes M, Fiddler C, Juss J, Cilliers D, Markelj G, Chandra A, Farmer G, Kielkowska A, Clark J, Kracker S, Debré M, Picard C, Pellier I, Jabado N, Morris JA, Barcenas-Morales G, Fischer A, Stephens L, Hawkins P, Barrett JC, Abinun M, Clatworthy M, Durandy A, Doffinger R, Chilvers ER, Cant AJ, Kumararatne D, Okkenhaug K, Williams RL, Condliffe A, Nejentsev S. Phosphoinositide 3-kinase δ gene mutation predisposes to respiratory infection and airway damage. Science 2013; 342:866-71. [PMID: 24136356 DOI: 10.1126/science.1243292] [Citation(s) in RCA: 431] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Genetic mutations cause primary immunodeficiencies (PIDs) that predispose to infections. Here, we describe activated PI3K-δ syndrome (APDS), a PID associated with a dominant gain-of-function mutation in which lysine replaced glutamic acid at residue 1021 (E1021K) in the p110δ protein, the catalytic subunit of phosphoinositide 3-kinase δ (PI3Kδ), encoded by the PIK3CD gene. We found E1021K in 17 patients from seven unrelated families, but not among 3346 healthy subjects. APDS was characterized by recurrent respiratory infections, progressive airway damage, lymphopenia, increased circulating transitional B cells, increased immunoglobulin M, and reduced immunoglobulin G2 levels in serum and impaired vaccine responses. The E1021K mutation enhanced membrane association and kinase activity of p110δ. Patient-derived lymphocytes had increased levels of phosphatidylinositol 3,4,5-trisphosphate and phosphorylated AKT protein and were prone to activation-induced cell death. Selective p110δ inhibitors IC87114 and GS-1101 reduced the activity of the mutant enzyme in vitro, which suggested a therapeutic approach for patients with APDS.
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Affiliation(s)
- Ivan Angulo
- Department of Medicine, University of Cambridge, Cambridge, UK
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44
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Affiliation(s)
- Len Stephens
- The Babraham Institute, Cambridge, United Kingdom.
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45
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Kuemmerle-Deschner J, Hawkins P, Hoffman H, van der Poll T, Walker U, Tilson H. THU0392 Beta-confident-registry: Efficacy and safety of canakinumab in cryopyrin associated periodic syndrome - 18 month follow-up. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2357] [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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46
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Karrar S, Shiwen X, Nikotorowicz-Buniak J, Abraham DJ, Denton C, Stratton R, Bayley R, Kite KA, Clay E, Smith JP, Kitas GD, Buckley C, Young SP, Ye L, Zhang L, Goodall J, Gaston H, Xu H, Lutalo PM, Zhao Y, Meng Choong L, Sangle S, Spencer J, D'Cruz D, Rysnik OJ, McHugh K, Bowness P, Rump-Goodrich L, Mattey D, Kehoe O, Middleton J, Cartwright A, Schmutz C, Askari A, Middleton J, Gardner DH, Jeffery LE, Raza K, Sansom DM, Clay E, Bayley R, Fitzpatrick M, Wallace G, Young S, Shaw J, Hatano H, Cauli A, Giles JL, McHugh K, Mathieu A, Bowness P, Kollnberger S, Webster S, Ellis L, O'Brien LM, Fitzmaurice TJ, Gaston H, Goodall J, Nazeer Moideen A, Evans L, Osgood L, Williams A, Jones S, Thomas C, O'Donnell V, Nowell M, Ouboussad L, Savic S, Dickie LJ, Hintze J, Wong CH, Cook GP, Buch M, Emery P, McDermott MF, Hardcastle SA, Gregson CL, Deere K, Davey Smith G, Dieppe P, Tobias JH, Dennison E, Edwards M, Bennett J, Coggon D, Palmer K, Cooper C, McWilliams D, Young A, Kiely PD, Walsh D, Taylor HJ, Harding I, Hutchinson J, Nelson I, Blom A, Tobias J, Clark E, Parker J, Bukhari M, McWilliams D, Jayakumar K, Young A, Kiely P, Walsh D, Diffin J, Lunt M, Marshall T, Chipping J, Symmons D, Verstappen S, Taylor HJ, Harding I, Hutchinson J, Nelson I, Tobias J, Clark E, Bluett J, Bowes J, Ho P, McHugh N, Buden D, Fitzgerald O, Barton A, Glossop JR, Nixon NB, Emes RD, Dawes PT, Farrell WE, Mattey DL, Scott IC, Steer S, Seegobin S, Hinks AM, Eyre S, Morgan A, Wilson AG, Hocking L, Wordsworth P, Barton A, Worthington J, Cope A, Lewis CM, Guerra S, Ahmed BA, Denton C, Abraham D, Fonseca C, Robinson J, Taylor J, Haroon Rashid L, Flynn E, Eyre S, Worthington J, Barton A, Isaacs J, Bowes J, Wilson AG, Barrett JH, Morgan A, Kingston B, Ahmed M, Kirwan JR, Marshall R, Chapman K, Pearson R, Heycock C, Kelly C, Rynne M, Saravanan V, Hamilton J, Saeed A, Coughlan R, Carey JJ, Farah Z, Matthews W, Bell C, Petford S, Tibbetts LM, Douglas KMJ, Holden W, Ledingham J, Fletcher M, Winfield R, Price Z, Mackay K, Dixon C, Oppong R, Jowett S, Nicholls E, Whitehurst D, Hill S, Hammond A, Hay E, Dziedzic K, Righetti C, Lebmeier M, Manning VL, Hurley M, Scott DL, Choy E, Bearne L, Nikiphorou E, Morris S, James D, Kiely P, Walsh D, Young A, Wong EC, Long J, Fletcher A, Fletcher M, Holmes S, Hockey P, Abbas M, Chattopadhyay C, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, Robson J, Kiran A, Maskell J, Arden N, Hutchings A, Emin A, Culliford D, Dasgupta B, Hamilton W, Luqmani R, Jethwa H, Rowczenio D, Trojer H, Russell T, Loeffler J, Hawkins P, Lachmann H, Verma I, Syngle A, Krishan P, Garg N, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, McGowan SP, Gerrard DT, Chinoy H, Ollier WE, Cooper RG, Lamb JA, Taborda L, Correia Azevedo P, Isenberg D, Leyland KM, Kiran A, Judge A, Hunter D, Hart D, Javaid MK, Arden N, Cooper C, Edwards MH, Litwic AE, Jameson KA, Deeg D, Cooper C, Dennison E, Edwards MH, Jameson KA, Cushnaghan J, Aihie Sayer A, Deeg D, Cooper C, Dennison E, Jagannath D, Parsons C, Cushnaghan J, Cooper C, Edwards MH, Dennison E, Stoppiello L, Mapp P, Ashraf S, Wilson D, Hill R, Scammell B, Walsh D, Wenham C, Shore P, Hodgson R, Grainger A, Aaron J, Hordon L, Conaghan P, Bar-Ziv Y, Beer Y, Ran Y, Benedict S, Halperin N, Drexler M, Mor A, Segal G, Lahad A, Haim A, Rath U, Morgensteren DM, Salai M, Elbaz A, Vasishta VG, Derrett-Smith E, Hoyles R, Khan K, Abraham DJ, Denton C, Ezeonyeji A, Takhar G, Denton C, Ong V, Loughrey L, Bissell LA, Hensor E, Abignano G, Redmond A, Buch M, Del Galdo F, Hall FC, Malaviya A, Nisar M, Baker S, Furlong A, Mitchell A, Godfrey AL, Ruddlesden M, Hadjinicolaou A, Hughes M, Moore T, O'Leary N, Tracey A, Ennis H, Dinsdale G, Roberts C, Herrick A, Denton CP, Guillevin L, Hunsche E, Rosenberg D, Schwierin B, Scott M, Krieg T, Anderson M, Hall FC, Herrick A, McHugh N, Matucci-Cerinic M, Alade R, Khan K, Xu S, Denton C, Ong V, Nihtyanova S, Ong V, Denton CP, Clark KE, Tam FWK, Unwin R, Khan K, Abraham DJ, Denton C, Stratton RJ, Nihtyanova S, Schreiber B, Ong V, Denton CP, Seng Edwin Lim C, Dasgupta B, Corsiero E, Sutcliffe N, Wardemann H, Pitzalis C, Bombardieri M, Tahir H, Donnelly S, Greenwood M, Smith TO, Easton V, Bacon H, Jerman E, Armon K, Poland F, Macgregor A, van der Heijde D, Sieper J, Elewaut D, Pangan AL, Nguyen D, Badenhorst C, Kirby S, White D, Harrison A, Garcia JA, Stebbings S, MacKay JW, Aboelmagd S, Gaffney K, van der Heijde D, Deodhar A, Braun J, Mack M, Hsu B, Gathany T, Han C, Inman RD, Cooper-Moss N, Packham J, Strauss V, Freeston JE, Coates L, Nam J, Moverley AR, Helliwell P, Hensor E, Wakefield R, Emery P, Conaghan P, Mease P, Fleischmann R, Wollenhaupt J, Deodhar A, Kielar D, Woltering F, Stach C, Hoepken B, Arledge T, van der Heijde D, Gladman D, Fleischmann R, Coteur G, Woltering F, Mease P, Kavanaugh A, Gladman D, van der Heijde D, Purcaru O, Mease P, McInnes I, Kavanaugh A, Gottlieb AB, Puig L, Rahman P, Ritchlin C, Li S, Wang Y, Mendelsohn A, Doyle M, Tillett W, Jadon D, Shaddick G, Cavill C, Robinson G, Sengupta R, Korendowych E, de Vries C, McHugh N, Thomas RC, Shuto T, Busquets-Perez N, Marzo-Ortega H, McGonagle D, Tillett W, Richards G, Cavill C, Sengupta R, Shuto T, Marzo-Ortega H, Thomas RC, Bingham S, Coates L, Emery P, John Hamlin P, Adshead R, Cambridge S, Donnelly S, Tahir H, Suppiah P, Cullinan M, Nolan A, Thompson WM, Stebbings S, Mathieson HR, Mackie SL, Bryer D, Buch M, Emery P, Marzo-Ortega H, Krutikov M, Gray L, Bruce E, Ho P, Marzo-Ortega H, Busquets-Perez N, Thomas RC, Gaffney K, Keat A, Innes W, Pandit R, Kay L, Lapshina S, Myasoutova L, Erdes S, Wallis D, Waldron N, McHugh N, Korendowych E, Thorne I, Harris C, Keat A, Garg N, Syngle A, Vohra K, Khinchi D, Verma I, Kaur L, Jones A, Harrison N, Harris D, Jones T, Rees J, Bennett A, Fazal S, Tugnet N, Barkham N, Basu N, McClean A, Harper L, Amft EN, Dhaun N, Luqmani RA, Little MA, Jayne DR, Flossmann O, McLaren J, Kumar V, Reid DM, Macfarlane GJ, Jones G, Yates M, Watts RA, Igali L, Mukhtyar C, Macgregor A, Robson J, Doll H, Yew S, Flossmann O, Suppiah R, Harper L, Hoglund P, Jayne D, Mukhtyar C, Westman K, Luqmani R, Win Maw W, Patil P, Williams M, Adizie T, Christidis D, Borg F, Dasgupta B, Robertson A, Croft AP, Smith S, Carr S, Youssouf S, Salama A, Pusey C, Harper L, Morgan M. Basic Science * 208. Stem Cell Factor Expression is Increased in the Skin of Patients with Systemic Sclerosis and Promotes Proliferation and Migration of Fibroblasts in vitro. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Abstract
A novel oxygen (O(2)) and/or carbon dioxide (CO(2))-sensitive transducer for the measurement of both gaseous O(2) and CO(2) over the concentration ranges of O(2), 0-100% and CO(2), 0-10% has been described employing a solution of 10.6 muM fluorescein (FL) and 190 muM potassium hydroxide in a solvent mixtures of 1:1 (v/v) N,N'-diethylaniline (DEA) and N,N-dimethylformamide. Increasing O(2) concentrations cause the absorbance of the solution at a wavelength of 400 nm to increase owing to a contact charge transfer reaction existing between O(2) and DEA molecules, and increasing CO(2) concentrations produce a non-linear fall in absorbance at 520 nm as the colour of FL changes from its orange dianion form to the colourless neutral, lactonic form. Both processes are independent of each other and reversible. The response to changes in O(2) concentrations is in good agreement with Beer-Lambert's law and the response to changes in CO(2) concentrations in non-linear. A fibre optic sensing system based on this solvent-dye solution has been set up for continuous and reversible determination of both gaseous O(2) and CO(2). Possible applications include environmental and physiological monitoring of O(2) over the ranges of 0-100% and CO(2), 0-10%.
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Affiliation(s)
- M F Choi
- Faculty of Applied Sciences, University of the West of England, Coldharbour Lane, Frenchay, Bristol BS16 1QY, U.K
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Sado DM, Flett AS, Banypersad S, White S, Hughes D, Mehta A, Murphy E, Lachmann R, Hawkins P, Hausenloy D, McKenna W, Taylor A, Elliott P, Moon JC. 092 Interstitial expansion in health and disease—an equilibrium contrast CMR study. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Standing A, Eleftheriou D, Omoyinmi E, Chieng A, Klein N, Lachmann H, Hawkins P, Gilmour K, Brogan P. A Novel Mutation in the X-Linked Inhibitor of Apoptosis Protein Causing a Multi-System Autoinflammatory Disorder. ACTA ACUST UNITED AC 2012. [DOI: 10.5455/apr.012920120432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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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Kuemmerle-Deschner J, Rothenbacher D, Walker U, Tilson H, Hoffman H, Hawkins P. β-Confident-registry: aiming to be largest-ever studied cohort of cryopyrin-associated periodic syndromes (CAPS) patients. Study design and baseline characteristics. Pediatr Rheumatol Online J 2011. [PMCID: PMC3194513 DOI: 10.1186/1546-0096-9-s1-p16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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