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Robison R, Brendle M, Moore C, Cross H, Helm L, Darling S, Thayer S, Thielking P, Shannon S. Ketamine-Assisted Group Psychotherapy for Frontline Healthcare Workers with COVID-19-Related Burnout and PTSD: A Case Series of Effectiveness/Safety for 10 Participants. J Psychoactive Drugs 2024; 56:23-32. [PMID: 36862829 DOI: 10.1080/02791072.2023.2186285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 03/04/2023]
Abstract
This study reports on 10 frontline healthcare workers, employed during the COVID-19 pandemic and experiencing symptoms of burnout and PTSD, treated with group ketamine-assisted psychotherapy (KAP) in a private outpatient clinic setting. Participants attended 6 sessions once weekly. These included 1 preparation session, 3 ketamine sessions (2 sublingual, 1 intramuscular), 2 integration sessions. Measures of PTSD (PCL-5), depression (PHQ-9), and anxiety (GAD-7) were administered at baseline and post-treatment. During ketamine sessions, the Emotional Breakthrough Inventory (EBI) and the 30-item Mystical Experience Questionnaire (MEQ-30) were recorded. Participant feedback was gathered 1-month post-treatment. We observed improvements in participants' average PCL-5 (59% reduction), PHQ-9 (58% reduction), and GAD-7 (36% reduction) scores from pre- to post-treatment. At post-treatment, 100% of participants screened negative for PTSD, 90% had minimal/mild depression or clinically significant improvement, and 60% had minimal/mild anxiety or clinically significant improvement. MEQ and EBI scores had large variations among participants at each ketamine session. Ketamine was well tolerated, and no significant adverse events were reported. Participant feedback corroborated findings of improvements observed in mental health symptoms. We found immediate improvements treating 10 frontline healthcare workers experiencing burnout, PTSD, depression, and anxiety using weekly group KAP and integration.
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Affiliation(s)
- Reid Robison
- Numinus Wellness, Draper, UT, USA
- University of Utah School of Medicine, SL, UT, USA
| | - Madeline Brendle
- Numinus Wellness, Draper, UT, USA
- Department of Pharmacotherapy, University of Utah College of Pharmacy, SLC, UT, USA
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Raison CL, Sanacora G, Woolley J, Heinzerling K, Dunlop BW, Brown RT, Kakar R, Hassman M, Trivedi RP, Robison R, Gukasyan N, Nayak SM, Hu X, O’Donnell KC, Kelmendi B, Sloshower J, Penn AD, Bradley E, Kelly DF, Mletzko T, Nicholas CR, Hutson PR, Tarpley G, Utzinger M, Lenoch K, Warchol K, Gapasin T, Davis MC, Nelson-Douthit C, Wilson S, Brown C, Linton W, Ross S, Griffiths RR. Single-Dose Psilocybin Treatment for Major Depressive Disorder: A Randomized Clinical Trial. JAMA 2023; 330:843-853. [PMID: 37651119 PMCID: PMC10472268 DOI: 10.1001/jama.2023.14530] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/13/2023] [Indexed: 09/01/2023]
Abstract
Importance Psilocybin shows promise as a treatment for major depressive disorder (MDD). Objective To evaluate the magnitude, timing, and durability of antidepressant effects and safety of a single dose of psilocybin in patients with MDD. Design, Setting, and Participants In this phase 2 trial conducted between December 2019 and June 2022 at 11 research sites in the US, participants were randomized in a 1:1 ratio to receive a single dose of psilocybin vs niacin placebo administered with psychological support. Participants were adults aged 21 to 65 years with a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of MDD of at least 60 days' duration and moderate or greater symptom severity. Exclusion criteria included history of psychosis or mania, active substance use disorder, and active suicidal ideation with intent. Participants taking psychotropic agents who otherwise met inclusion/exclusion criteria were eligible following medication taper. Primary and secondary outcomes and adverse events (AEs) were assessed at baseline (conducted within 7 days before dosing) and at 2, 8, 15, 29, and 43 days after dosing. Interventions Interventions were a 25-mg dose of synthetic psilocybin or a 100-mg dose of niacin in identical-appearing capsules, each administered with psychological support. Main Outcomes and Measures The primary outcome was change in central rater-assessed Montgomery-Asberg Depression Rating Scale (MADRS) score (range, 0-60; higher scores indicate more severe depression) from baseline to day 43. The key secondary outcome measure was change in MADRS score from baseline to day 8. Other secondary outcomes were change in Sheehan Disability Scale score from baseline to day 43 and MADRS-defined sustained response and remission. Participants, study site personnel, study sponsor, outcome assessors (raters), and statisticians were blinded to treatment assignment. Results A total of 104 participants (mean [SD] age, 41.1 [11.3] years; 52 [50%] women) were randomized (51 to the psilocybin group and 53 to the niacin group). Psilocybin treatment was associated with significantly reduced MADRS scores compared with niacin from baseline to day 43 (mean difference,-12.3 [95% CI, -17.5 to -7.2]; P <.001) and from baseline to day 8 (mean difference, -12.0 [95% CI, -16.6 to -7.4]; P < .001). Psilocybin treatment was also associated with significantly reduced Sheehan Disability Scale scores compared with niacin (mean difference, -2.31 [95% CI, 3.50-1.11]; P < .001) from baseline to day 43. More participants receiving psilocybin had sustained response (but not remission) than those receiving niacin. There were no serious treatment-emergent AEs; however, psilocybin treatment was associated with a higher rate of overall AEs and a higher rate of severe AEs. Conclusions and Relevance Psilocybin treatment was associated with a clinically significant sustained reduction in depressive symptoms and functional disability, without serious adverse events. These findings add to increasing evidence that psilocybin-when administered with psychological support-may hold promise as a novel intervention for MDD. Trial Registration ClinicalTrials.gov Identifier: NCT03866174.
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Affiliation(s)
| | - Gerard Sanacora
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut
| | - Joshua Woolley
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | - Boadie W. Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Randall T. Brown
- Department of Family Medicine & Community Health, University of Wisconsin School of Medicine & Public Health, Madison
| | - Rishi Kakar
- Center for Psychedelic Research, Segal Trials, Lauderhill, Florida
| | | | | | - Reid Robison
- Numinus Wellness, Draper, Utah
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | - Natalie Gukasyan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sandeep M. Nayak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xiaojue Hu
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, New York, New York
| | - Kelley C. O’Donnell
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, New York, New York
| | - Benjamin Kelmendi
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut
| | - Jordan Sloshower
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut
| | - Andrew D. Penn
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
- School of Nursing, University of California San Francisco
| | - Ellen Bradley
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | - Tanja Mletzko
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Christopher R. Nicholas
- Department of Family Medicine & Community Health, University of Wisconsin School of Medicine & Public Health, Madison
| | - Paul R. Hutson
- Pharmacy Practice & Translational Research Division, School of Pharmacy, University of Wisconsin-Madison
| | | | | | | | | | | | | | | | | | | | | | - Stephen Ross
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, New York, New York
| | - Roland R. Griffiths
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Keeler JL, Treasure J, Himmerich H, Brendle M, Moore C, Robison R. Case report: Intramuscular ketamine or intranasal esketamine as a treatment in four patients with major depressive disorder and comorbid anorexia nervosa. Front Psychiatry 2023; 14:1181447. [PMID: 37255674 PMCID: PMC10225569 DOI: 10.3389/fpsyt.2023.1181447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/18/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction A comorbid diagnosis of a depressive disorder is a negative prognostic factor for individuals with AN, and novel treatments are needed to target depressive symptoms in this population. One emerging promising treatment for depressive disorders is ketamine, although there is less research investigating the use of ketamine for alleviating depression in people with AN. Case report This study reports on four patients with a lifetime diagnosis of AN and a comorbid diagnosis of major depressive disorder who received either intramuscular ketamine (n = 2) or intranasal esketamine (n = 2) treatment from a private psychiatric clinic. Depressive symptomatology (PHQ-9) was measured prior to (es)ketamine administration on every dosing session and adverse effects were recorded during and after dosing. All patients reported a subjective decrease in depression, although only those administered intranasal esketamine showed a reduction in PHQ-9 depression scores over time. Number of doses ranged from 3 to 23. All patients tolerated treatment well and no serious adverse effects emerged, however nausea/vomiting was experienced by one patient on one dosing session. Weight remained stable in all cases, although notably across all patients, weight at the beginning of treatment was within a "healthy" range. Discussion These findings suggest that (es)ketamine may reduce depressive symptoms in people with major depressive disorder and a comorbid diagnosis of AN. Future feasibility and pilot trials are warranted in order to elicit robust data on efficacy, acceptability, safety and tolerability.
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Affiliation(s)
- Johanna Louise Keeler
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, United Kingdom
| | - Hubertus Himmerich
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, United Kingdom
| | - Madeline Brendle
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, United States
- Numinus Wellness, Draper, UT, United States
| | | | - Reid Robison
- Numinus Wellness, Draper, UT, United States
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States
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Brendle M, Ragnhildstveit A, Slayton M, Smart L, Cunningham S, Zimmerman MH, Seli P, Gaffrey MS, Averill LA, Robison R. Registered clinical trials investigating ketamine and esketamine for treatment-resistant depression: A systematic review. JPS 2023. [DOI: 10.1556/2054.2022.00234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AbstractBackground and AimsKetamine and esketamine have garnered interest in both psychiatric research and clinical practice for treatment-resistant depression (TRD). In this review, we examined registered trials investigating the therapeutic use of ketamine or esketamine for TRD, with the aim of characterizing emerging trends and knowledge gaps.MethodsThe ClinicalTrials.gov electronic registry and results database was queried from inception to February 5, 2022, adhering to elements of the PRISMA guideline, we evaluated trial eligibility in the qualitative synthesis. Data regarding study design, drug regimens, and measures were subsequently abstracted and descriptively analyzed.ResultsThe search returned 86 records, of which 56 trials were included in the final review. The number of trials investigating ketamine and esketamine for TRD increased since 2008, with higher peaks observed in 2015 (n = 9) and 2021 (n = 9). Most trials were Phase 2 (13, 23.2%) or Phase 3 (11, 19.6%), gathering preliminary data on efficacy and/or further data on safety and efficacy with variant dosing and pharmacological approaches. By and large, trials examined ketamine and esketamine as individual versus combination treatments (45% and 25%, respectively). The Montgomery-Asberg Depression Rating Scale (MADRS) was most commonly used to assess clinical outcomes (75%).ConclusionsThere are increasingly large-scale and late-phase trials of esketamine over ketamine for TRD, coupled with efforts to centralize evidence on these medications. Yet several trials do not assess patient characteristics that may affect treatment response, such as age, sex, and race. By understanding these design limitations, scientists and clinicians can avoid research waste and funding bodies can judiciously direct support towards high priority research.
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Affiliation(s)
- Madeline Brendle
- Integrated Research Literacy Group, Draper, UT, USA
- Department of Pharmacotherapy, University of Utah College of Pharmacy, SLC, UT, USA
- Numinus Wellness, Draper, UT, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Anya Ragnhildstveit
- Integrated Research Literacy Group, Draper, UT, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Department of Pyschiatry, University of Cambridge, Cambridge, England, UK
| | - Matthew Slayton
- Integrated Research Literacy Group, Draper, UT, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Leo Smart
- Integrated Research Literacy Group, Draper, UT, USA
- Numinus Wellness, Draper, UT, USA
- Department of Neuroscience, Bates College, Lewiston, ME, USA
| | | | | | - Paul Seli
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | | | - Lynnette Astrid Averill
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs, National Center for PTSD – Clinical Neuroscience Division, West Haven, CT, USA
| | - Reid Robison
- Numinus Wellness, Draper, UT, USA
- Department of Psychiatry, University of Utah School of Medicine, UT, USA
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Ragnhildstveit A, Kaiyo M, Snyder MB, Jackson LK, Lopez A, Mayo C, Miranda AC, August RJ, Seli P, Robison R, Averill LA. Cannabis-assisted psychotherapy for complex dissociative posttraumatic stress disorder: A case report. Front Psychiatry 2023; 14:1051542. [PMID: 36846226 PMCID: PMC9947284 DOI: 10.3389/fpsyt.2023.1051542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND A dissociative subtype of posttraumatic stress disorder, known as "D-PTSD", has been included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. In addition to meeting criteria for PTSD, patients endorse prominent dissociative symptoms, namely depersonalization and derealization, or detachment from one's self and surroundings. At present, this population is supported by a highly heterogeneous and undeveloped literature. Targeted interventions are therefore lacking, and those indicated for PTSD are limited by poor efficacy, delayed onset of action, and low patient engagement. Here, we introduce cannabis-assisted psychotherapy (CAP) as a novel treatment for D-PTSD, drawing parallels to psychedelic therapy. CASE PRESENTATION A 28-year-old female presented with complex D-PTSD. In a naturalistic setting, she underwent 10 sessions of CAP, scheduled twice monthly over 5 months, coupled with integrative cognitive behavioral therapy. An autonomic and relational approach to CAP was leveraged, specifically psychedelic somatic interactional psychotherapy. Acute effects included oceanic boundlessness, ego dissolution, and emotional breakthrough. From baseline to post-treatment, the patient showed a 98.5% reduction in pathological dissociation, as measured by the Multidimensional Inventory of Dissociation, no longer meeting criteria for D-PTSD. This was accompanied by decreased cognitive distractibility and emotional suffering, as well as increased psychosocial functioning. Anecdotally, the patient has sustained improvements for over 2 years to date. CONCLUSIONS There is urgency to identify treatments for D-PTSD. The present case, while inherently limited, underscores the potential of CAP as a therapeutic option, leading to robust and sustained improvement. Subjective effects were comparable to those produced by classic and non-classic psychedelics, such as psilocybin and ketamine. Further research is warranted to explore, establish, and optimize CAP in D-PTSD, and to characterize its role in the pharmacological landscape.
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Affiliation(s)
- Anya Ragnhildstveit
- Integrated Research Literacy Group, Draper, UT, United States.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Miriam Kaiyo
- Integrated Research Literacy Group, Draper, UT, United States.,Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, United States
| | | | | | - Alex Lopez
- Integrated Research Literacy Group, Draper, UT, United States
| | - Chasity Mayo
- Integrated Research Literacy Group, Draper, UT, United States
| | - Alyssa Claire Miranda
- Integrated Research Literacy Group, Draper, UT, United States.,Consciousness and Transformative Studies, National University, San Diego, CA, United States
| | - River Jude August
- Integrated Research Literacy Group, Draper, UT, United States.,Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, United States
| | - Paul Seli
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Reid Robison
- Numinus Wellness, Draper, UT, United States.,Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Lynnette Astrid Averill
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Department of Veterans Affairs, Clinical Neuroscience Division, National Center for PTSD, West Haven, CT, United States
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Brendle M, Robison R, Malone DC. Cost-effectiveness of esketamine nasal spray compared to intravenous ketamine for patients with treatment-resistant depression in the US utilizing clinical trial efficacy and real-world effectiveness estimates. J Affect Disord 2022; 319:388-396. [PMID: 36162672 DOI: 10.1016/j.jad.2022.09.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 08/30/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to estimate the cost-effectiveness of esketamine nasal spray relative to intravenous ketamine for patients with treatment-resistant depression (TRD) in the US. METHODS We used a Markov model with a 1-month cycle length, and we estimated quality-adjusted life years (QALYs), costs (2020 USD), and incremental cost-effectiveness ratios (ICER) of esketamine relative to ketamine over a 3-year time horizon, from both the healthcare sector and patient perspectives. We ran the model using efficacy estimates from both clinical trial and real-world effectiveness (RWE) data. One-way and probabilistic sensitivity analyses (PSAs) were performed to evaluate the robustness of findings. RESULTS Over a 3-year time horizon, the use of esketamine yielded 1.98 QALYs (RWE/clinical trial efficacy), and the use of ketamine yielded 2.03 QALYs (clinical trial efficacy) or 1.99 QALYs (RWE). Esketamine was dominated by ketamine using the healthcare perspective. ICERs were above $150,000/QALY threshold with the patient perspective. Under the healthcare perspective, PSA showed there are no scenarios where esketamine was cost-effective compared to ketamine. With the patient's perspective, the probability that esketamine was cost-effective compared to ketamine was 0.0055 (clinical trial efficacy) and 0.35 (RWE). LIMITATIONS The data utilized for efficacy have limitations. The time horizon may fail to capture longer-term costs and benefits. CONCLUSIONS In this decision analytic model evaluating esketamine versus ketamine for TRD, we found esketamine unlikely to be cost-effective under a healthcare sector perspective. Under a patient perspective, esketamine had similar effectiveness and was less costly than ketamine due to insurance coverage.
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Affiliation(s)
- Madeline Brendle
- Department of Pharmacotherapy, University of Utah College of Pharmacy, UT, USA; Numinus Wellness, UT, USA.
| | - Reid Robison
- Numinus Wellness, UT, USA; University of Utah School of Medicine, UT, USA
| | - Daniel C Malone
- Department of Pharmacotherapy, University of Utah College of Pharmacy, UT, USA
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Brendle M, Ahuja S, Valle MD, Moore C, Thielking P, Malone DC, Robison R. Safety and effectiveness of intranasal esketamine for treatment-resistant depression: a real-world retrospective study. J Comp Eff Res 2022; 11:1323-1336. [PMID: 36331048 DOI: 10.2217/cer-2022-0149] [Citation(s) in RCA: 4] [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] [Indexed: 11/06/2022] Open
Abstract
Aim: There is limited real-world evidence for patients with treatment-resistant depression (TRD) receiving esketamine nasal spray. Methods: This retrospective cohort study used data collected from a psychiatric clinic's EHR system. Results: A total of 171 TRD patients received esketamine July 2019-June 2021. This predominantly female, white population had several mental health comorbidities and high exposure to psychiatric medications. We observed significant reductions (p < 0.001) in average PHQ-9 and GAD-7 scores from baseline (PHQ-9: mean: 16.7; SD: 5.8; GAD-7: mean: 12.0; SD: 5.8) to last available treatment (PHQ-9: mean: 12.0; SD: 6.4; GAD-7: mean: 8.7; SD: 5.6). There were no reports of serious adverse events. Conclusion: This study found a significant disease burden for patients with TRD. Esketamine appears to be well tolerated and effective in improving depression and anxiety.
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Affiliation(s)
- Madeline Brendle
- Department of Pharmacotherapy, University of Utah College of Pharmacy, UT 84112, USA.,Numinus Wellness, UT 84020, USA
| | | | | | | | | | - Daniel C Malone
- Department of Pharmacotherapy, University of Utah College of Pharmacy, UT 84112, USA
| | - Reid Robison
- Numinus Wellness, UT 84020, USA.,University of Utah School of Medicine, UT 84132, USA
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Ahuja S, Brendle M, Smart L, Moore C, Thielking P, Robison R. Real-world depression, anxiety and safety outcomes of intramuscular ketamine treatment: a retrospective descriptive cohort study. BMC Psychiatry 2022; 22:634. [PMID: 36192794 PMCID: PMC9528178 DOI: 10.1186/s12888-022-04268-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/20/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Ketamine has emerged as a promising pharmacotherapy for depression and other mental illnesses, and the intramuscular (IM) administration of ketamine is now offered at many North American outpatient psychiatric clinics. However, a characterization of the outpatient population receiving IM ketamine treatment and an evaluation of the real-world depression, anxiety, and safety outcomes of long-term psychiatric IM ketamine treatment has not been reported. This study aimed to evaluate the clinical characteristics, treatment patterns, clinical outcomes, and adverse events of patients receiving IM ketamine treatment. METHODS Patient data from the electronic health records of a private outpatient psychiatric clinic network in the United States were collected and analyzed retrospectively. Adults with any psychiatric diagnosis who received ketamine treatment only by IM administration from January 2018 to June 2021 were included. A total of 452 patients were included in the cohort. RESULTS Patients receiving IM ketamine treatment had a mean of 2.8 (SD 1.4) psychiatric diagnoses. 420 (93%) patients had a diagnosis of major depressive disorder, 243 (54%) patients had a diagnosis of generalized anxiety disorder, and 126 (28%) patients had a diagnosis of post-traumatic stress disorder. Patients received a median of 4 (range 1-48) IM ketamine treatments. Median depression scores (PHQ-9) improved 38% from 16.0 (IQR 11.3-21.8) at baseline to 10.0 (IQR 6.0-15.0) at last treatment (p < .001). Median anxiety scores (GAD-7) improved 50% from 14.0 (IQR 8.0-17.0) at baseline to 7.0 (IQR 4.3-11.8) at last treatment (p < .001). With maintenance ketamine treatments, average improvements in depression (PHQ-9) and anxiety (GAD-7) scores of at least 4.7 and 4.9 points were maintained for over 7 months. An adverse event occurred during 59 of 2532 treatments (2.3%). CONCLUSIONS IM ketamine is being utilized to treat psychiatric outpatients with multiple mental illnesses not limited to depression. Average depression and anxiety levels significantly improve throughout IM ketamine treatment and do not regress to baseline during patients' maintenance treatment phase. Prospective studies are recommended to confirm the long-term effectiveness and safety of IM ketamine.
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Affiliation(s)
| | - Madeline Brendle
- Cedar Psychiatry, Springville, UT USA ,grid.223827.e0000 0001 2193 0096Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT USA
| | - Leo Smart
- Cedar Psychiatry, Springville, UT USA
| | - Claire Moore
- Cedar Psychiatry, Springville, UT USA ,Numinus Wellness, Vancouver, British Columbia Canada
| | - Paul Thielking
- Cedar Psychiatry, Springville, UT USA ,Numinus Wellness, Vancouver, British Columbia Canada ,grid.223827.e0000 0001 2193 0096University of Utah School of Medicine, DraperSalt Lake City, UT 721 E 12200 S, 84020 USA
| | - Reid Robison
- Cedar Psychiatry, Springville, UT, USA. .,Numinus Wellness, Vancouver, British Columbia, Canada. .,University of Utah School of Medicine, DraperSalt Lake City, UT, 721 E 12200 S, 84020, USA.
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Robison R, Lafrance A, Brendle M, Smith M, Moore C, Ahuja S, Richards S, Hawkins N, Strahan E. A case series of group-based ketamine-assisted psychotherapy for patients in residential treatment for eating disorders with comorbid depression and anxiety disorders. J Eat Disord 2022; 10:65. [PMID: 35524316 PMCID: PMC9077943 DOI: 10.1186/s40337-022-00588-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/29/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Depression and anxiety outcome measures, safety/tolerability, patient satisfaction, and ease of implementation of group-based ketamine-assisted psychotherapy (G-KAP) delivered to patients in intensive residential eating disorder (ED) treatment were assessed. CASE PRESENTATION This study reports on five participants with a diagnosis of an ED and comorbid mood and anxiety disorders who received weekly intramuscular ketamine injections in a group setting over 4 weeks. Measures of anxiety (GAD-7) and depression (PHQ-9) were administered pre-dose, 4-h post-dose, and 24-h post dose. Four of the 5 participants experienced clinically significant improvements on the PHQ-9 score (i.e., change greater than 5) while 2 of the 5 participants experienced clinically significant improvements on the GAD-7 score (i.e., change greater than 4) from pre-dose to 24-h post-dose after the last ketamine session. Dosing sessions were well tolerated, and no serious adverse events were reported. Clinical observations and participant reports corroborated improvements in depression and anxiety symptoms, good tolerability of ketamine treatment, and practical implementation of the G-KAP protocol in a residential ED treatment center. CONCLUSIONS This study suggests the potential utility of G-KAP as an adjunct to intensive, specialized ED treatment. Overall, this novel, cross-diagnostic intervention warrants future research to further explore its appropriateness in a treatment setting.
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Affiliation(s)
- Reid Robison
- Center for Change, Orem, UT, USA. .,Novamind Inc., Draper, UT, USA. .,Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | | | - Madeline Brendle
- Novamind Inc., Draper, UT, USA.,Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | | | | | | | | | | | - Erin Strahan
- Wilfrid Laurier University, Brantford, ON, Canada
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10
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Ragnhildstveit A, Slayton M, Jackson LK, Brendle M, Ahuja S, Holle W, Moore C, Sollars K, Seli P, Robison R. Ketamine as a Novel Psychopharmacotherapy for Eating Disorders: Evidence and Future Directions. Brain Sci 2022; 12:brainsci12030382. [PMID: 35326338 PMCID: PMC8963252 DOI: 10.3390/brainsci12030382] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023] Open
Abstract
Eating disorders (EDs) are serious, life-threatening psychiatric conditions associated with physical and psychosocial impairment, as well as high morbidity and mortality. Given the chronic refractory nature of EDs and the paucity of evidence-based treatments, there is a pressing need to identify novel approaches for this population. The noncompetitive N-methyl-D-aspartate receptor (NMDAr) antagonist, ketamine, has recently been approved for treatment-resistant depression, exerting rapid and robust antidepressant effects. It is now being investigated for several new indications, including obsessive–compulsive, post-traumatic, and substance use disorder, and shows transdiagnostic potential for EDs, particularly among clinical nonresponders. Hence, the aim of this review is to examine contemporary findings on the treatment of EDs with ketamine, whether used as a primary, adjunctive, or combination psychopharmacotherapy. Avenues for future research are also discussed. Overall, results are encouraging and point to therapeutic value; however, are limited to case series and reports on anorexia nervosa. Further empirical research is thus needed to explore ketamine efficacy across ED subgroups, establish safety profiles and optimize dosing, and develop theory-driven, targeted treatment strategies at the individual patient level.
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Affiliation(s)
- Anya Ragnhildstveit
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA; (M.S.); (P.S.)
- Integrated Research Literacy Group, Draper, UT 84020, USA; (L.K.J.); (M.B.); (W.H.)
- Correspondence: ; Tel.: +1-(801)-448-3331
| | - Matthew Slayton
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA; (M.S.); (P.S.)
- Integrated Research Literacy Group, Draper, UT 84020, USA; (L.K.J.); (M.B.); (W.H.)
| | - Laura Kate Jackson
- Integrated Research Literacy Group, Draper, UT 84020, USA; (L.K.J.); (M.B.); (W.H.)
- Novamind, Draper, UT 84020, USA; (S.A.); (C.M.); (K.S.); (R.R.)
| | - Madeline Brendle
- Integrated Research Literacy Group, Draper, UT 84020, USA; (L.K.J.); (M.B.); (W.H.)
- Novamind, Draper, UT 84020, USA; (S.A.); (C.M.); (K.S.); (R.R.)
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT 84112, USA
| | - Sachin Ahuja
- Novamind, Draper, UT 84020, USA; (S.A.); (C.M.); (K.S.); (R.R.)
| | - Willis Holle
- Integrated Research Literacy Group, Draper, UT 84020, USA; (L.K.J.); (M.B.); (W.H.)
| | - Claire Moore
- Novamind, Draper, UT 84020, USA; (S.A.); (C.M.); (K.S.); (R.R.)
| | - Kellie Sollars
- Novamind, Draper, UT 84020, USA; (S.A.); (C.M.); (K.S.); (R.R.)
| | - Paul Seli
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA; (M.S.); (P.S.)
| | - Reid Robison
- Novamind, Draper, UT 84020, USA; (S.A.); (C.M.); (K.S.); (R.R.)
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84108, USA
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11
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Miller DB, Robison R, Piccolo SR. Toward a methodology for evaluating DNA variants in nuclear families. PLoS One 2021; 16:e0258375. [PMID: 34624066 PMCID: PMC8500447 DOI: 10.1371/journal.pone.0258375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/27/2021] [Indexed: 11/22/2022] Open
Abstract
The genetic underpinnings of most pediatric-cancer cases are unknown. Population-based studies use large sample sizes but have accounted for only a small proportion of the estimated heritability of pediatric cancers. Pedigree-based studies are infeasible for most human populations. One alternative is to collect genetic data from a single nuclear family and use inheritance patterns within the family to filter candidate variants. This approach can be applied to common and rare variants, including those that are private to a given family or to an affected individual. We evaluated this approach using genetic data from three nuclear families with 5, 4, and 7 children, respectively. Only one child in each nuclear family had been diagnosed with cancer, and neither parent had been affected. Diagnoses for the affected children were benign low-grade astrocytoma, Wilms tumor (stage 2), and Burkitt’s lymphoma, respectively. We used whole-genome sequencing to profile normal cells from each family member and a linked-read technology for genomic phasing. For initial variant filtering, we used global minor allele frequencies, deleteriousness scores, and functional-impact annotations. Next, we used genetic variation in the unaffected siblings as a guide to filter the remaining variants. As a way to evaluate our ability to detect variant(s) that may be relevant to disease status, the corresponding author blinded the primary author to affected status; the primary author then assigned a risk score to each child. Based on this evidence, the primary author predicted which child had been affected in each family. The primary author’s prediction was correct for the child who had been diagnosed with a Wilms tumor; the child with Burkitt’s lymphoma had the second-highest risk score among the seven children in that family. This study demonstrates a methodology for filtering and evaluating candidate genomic variants and genes within nuclear families that may merit further exploration.
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Affiliation(s)
- Dustin B. Miller
- Department of Biology, Brigham Young University, Provo, UT, United States of America
| | - Reid Robison
- Department of Biology, Brigham Young University, Provo, UT, United States of America
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States of America
| | - Stephen R. Piccolo
- Department of Biology, Brigham Young University, Provo, UT, United States of America
- * E-mail:
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12
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Meena GG, Wall TA, Stott MA, Brown O, Robison R, Hawkins AR, Schmidt H. 7X multiplexed, optofluidic detection of nucleic acids for antibiotic-resistance bacterial screening. Opt Express 2020; 28:33019-33027. [PMID: 33114971 PMCID: PMC7679188 DOI: 10.1364/oe.402311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Rapid and accurate diagnosis of bacterial infections resistant to multiple antibiotics requires development of new bio-sensors for differentiated detection of multiple targets. This work demonstrates 7x multiplexed detection for antibiotic-resistance bacterial screening on an optofluidic platform. We utilize spectrally multiplexed multi-spot excitation for simultaneous detection of nucleic acid strands corresponding to bacterial targets and resistance genes. This is enabled by multi-mode interference (MMI) waveguides integrated in an optofluidic device. We employ a combinatorial three-color labeling scheme for the nucleic acid assays to scale up their multiplexing capability to seven different nucleic acids, representing three species and four resistance genes.
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Affiliation(s)
- G. G. Meena
- School of Engineering, University of California, Santa Cruz, 1156 High Street, Santa Cruz, California 95064, USA
| | - T. A. Wall
- Electrical and Computer Engineering Department, Brigham Young University, Provo, Utah 84602, USA
| | - M. A. Stott
- Electrical and Computer Engineering Department, Brigham Young University, Provo, Utah 84602, USA
| | - O. Brown
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah 84602, USA
| | - R. Robison
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah 84602, USA
| | - A. R. Hawkins
- Electrical and Computer Engineering Department, Brigham Young University, Provo, Utah 84602, USA
| | - H. Schmidt
- School of Engineering, University of California, Santa Cruz, 1156 High Street, Santa Cruz, California 95064, USA
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13
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Meyers C, Kass R, Goldenberg D, Milici J, Alam S, Robison R. Ethanol and isopropanol inactivation of human coronavirus on hard surfaces. J Hosp Infect 2020; 107:45-49. [PMID: 32991941 PMCID: PMC7521917 DOI: 10.1016/j.jhin.2020.09.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has greatly increased the frequency of disinfecting surfaces in public places, causing a strain on the ability to obtain disinfectant solutions. An alternative is to use plain alcohols (EtOH and IPA) or sodium hypochlorite (SH). AIM To determine the efficacy of various concentrations of EtOH, IPA and SH on a human coronavirus (HCoV) dried on to surfaces using short contact times. METHODS High concentrations of infectious HCoV were dried on to porcelain and ceramic tiles, then treated with various concentrations of the alcohols for contact times of 15 s, 30 s and 1 min. Three concentrations of SH were also tested. Reductions in titres were measured using the tissue culture infectious dose 50 assay. FINDINGS Concentrations of EtOH and IPA from 62% to 80% were very efficient at inactivating high concentrations of HCoV dried on to tile surfaces, even with a 15-s contact time. Concentrations of 95% dehydrated the virus, allowing infectious virus to survive. The dilutions of SH recommended by the Centers for Disease Control and Prevention (1/10 and 1/50) were efficient at inactivating high concentrations of HCoV dried on to tile surfaces, whereas a 1/100 dilution had substantially lower activity. CONCLUSIONS Multiple concentrations of EtOH, IPA and SH efficiently inactivated infectious HCoV on hard surfaces, typical of those found in public places. Often no remaining infectious HCoV could be detected.
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Affiliation(s)
- C Meyers
- Department of Microbiology and Immunology, Pennsylvania State College of Medicine, Hershey, PA, USA.
| | - R Kass
- Department of Surgical Oncology, Pennsylvania State College of Medicine, Hershey, PA, USA
| | - D Goldenberg
- Department of Otolaryngology, Pennsylvania State College of Medicine, Hershey, PA, USA
| | - J Milici
- Department of Microbiology and Immunology, Pennsylvania State College of Medicine, Hershey, PA, USA
| | - S Alam
- Department of Microbiology and Immunology, Pennsylvania State College of Medicine, Hershey, PA, USA
| | - R Robison
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT, USA
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14
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Paine I, Posey JE, Grochowski CM, Jhangiani SN, Rosenheck S, Kleyner R, Marmorale T, Yoon M, Wang K, Robison R, Cappuccio G, Pinelli M, Magli A, Coban Akdemir Z, Hui J, Yeung WL, Wong BKY, Ortega L, Bekheirnia MR, Bierhals T, Hempel M, Johannsen J, Santer R, Aktas D, Alikasifoglu M, Bozdogan S, Aydin H, Karaca E, Bayram Y, Ityel H, Dorschner M, White JJ, Wilichowski E, Wortmann SB, Casella EB, Kitajima JP, Kok F, Monteiro F, Muzny DM, Bamshad M, Gibbs RA, Sutton VR, Van Esch H, Brunetti-Pierri N, Hildebrandt F, Brautbar A, Van den Veyver IB, Glass I, Lessel D, Lyon GJ, Lupski JR. Paralog Studies Augment Gene Discovery: DDX and DHX Genes. Am J Hum Genet 2019; 105:302-316. [PMID: 31256877 PMCID: PMC6698803 DOI: 10.1016/j.ajhg.2019.06.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/31/2019] [Indexed: 12/24/2022] Open
Abstract
Members of a paralogous gene family in which variation in one gene is known to cause disease are eight times more likely to also be associated with human disease. Recent studies have elucidated DHX30 and DDX3X as genes for which pathogenic variant alleles are involved in neurodevelopmental disorders. We hypothesized that variants in paralogous genes encoding members of the DExD/H-box RNA helicase superfamily might also underlie developmental delay and/or intellectual disability (DD and/or ID) disease phenotypes. Here we describe 15 unrelated individuals who have DD and/or ID, central nervous system (CNS) dysfunction, vertebral anomalies, and dysmorphic features and were found to have probably damaging variants in DExD/H-box RNA helicase genes. In addition, these individuals exhibit a variety of other tissue and organ system involvement including ocular, outer ear, hearing, cardiac, and kidney tissues. Five individuals with homozygous (one), compound-heterozygous (two), or de novo (two) missense variants in DHX37 were identified by exome sequencing. We identified ten total individuals with missense variants in three other DDX/DHX paralogs: DHX16 (four individuals), DDX54 (three individuals), and DHX34 (three individuals). Most identified variants are rare, predicted to be damaging, and occur at conserved amino acid residues. Taken together, these 15 individuals implicate the DExD/H-box helicases in both dominantly and recessively inherited neurodevelopmental phenotypes and highlight the potential for more than one disease mechanism underlying these disorders.
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Affiliation(s)
- Ingrid Paine
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jennifer E Posey
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Shalini N Jhangiani
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sarah Rosenheck
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, NY 11724, USA
| | - Robert Kleyner
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, NY 11724, USA
| | - Taylor Marmorale
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, NY 11724, USA
| | - Margaret Yoon
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, NY 11724, USA
| | - Kai Wang
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Reid Robison
- Utah Foundation for Biomedical Research, Salt Lake City, UT 84107, USA
| | - Gerarda Cappuccio
- Department of Translational Medicine, University of Naples "Federico II," 80131 Napoli, Italy; Telethon Institute of Genetics and Medicine, 80078 Pozzuoli, Italy
| | - Michele Pinelli
- Department of Translational Medicine, University of Naples "Federico II," 80131 Napoli, Italy; Telethon Institute of Genetics and Medicine, 80078 Pozzuoli, Italy
| | - Adriano Magli
- Department of Pediatric Ophthalmology, University of Salerno, 84081 Baronissi SA, Italy
| | - Zeynep Coban Akdemir
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Joannie Hui
- Department of Pediatrics, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wai Lan Yeung
- Department of Pediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - Bibiana K Y Wong
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA; The Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Lucia Ortega
- Medical Genetics Department, Cook Children's Hospital, Fort Worth, TX 76104, USA
| | - Mir Reza Bekheirnia
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Department of Pediatrics, Section of Pediatric Renal, Baylor College of Medicine, Houston, TX 77030, USA; Department of Genetics, Texas Children's Hospital, Houston, TX 76104, USA
| | - Tatjana Bierhals
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Maja Hempel
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jessika Johannsen
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - René Santer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Dilek Aktas
- DAMAGEN Genetic Diagnostic Center, 06690 Ankara, Turkey
| | | | - Sevcan Bozdogan
- Department of Medical Genetics, Cukurova University Faculty of Medicine, 01330 Adana, Turkey
| | - Hatip Aydin
- Department of Medical Genetics, Medical Faculty of Namik Kemal University, Tekirdag 59100, Turkey
| | - Ender Karaca
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Yavuz Bayram
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Hadas Ityel
- Division of Nephrology, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Michael Dorschner
- Center for Precision Diagnostics, University of Washington, Seattle, WA 98195, USA
| | - Janson J White
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Ekkehard Wilichowski
- Department of Pediatrics and Pediatric Neurology, Georg-August-Universität Göttingen, 37075 Göttingen, Germany
| | - Saskia B Wortmann
- Institute of Human Genetics, Technical University München, 81675 Munich, Germany; Institute of Human Genetics, Helmholtz Zentrum Munchen, 85764 Neuherberg, Germany; University Children's Hospital, Paracelsus Medical University, 5020 Salsburg, Austria
| | - Erasmo B Casella
- Children's Institute, Hospital das Clinicas, University of Sao Paulo, 05405-000 Sao Paulo, Brazil
| | | | - Fernando Kok
- Mendelics Genomic Analysis, 04013-000 Sao Paulo, Brazil; Department of Neurology, University of Sao Paulo School of Medicine, 01246-903 Sao Paulo, Brazil
| | | | - Donna M Muzny
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Michael Bamshad
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA; Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA; Division of Genetic Medicine, University of Washington, Seattle, WA 98195, USA
| | - Richard A Gibbs
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - V Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Hilde Van Esch
- Center for Human Genetics, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Nicola Brunetti-Pierri
- Department of Translational Medicine, University of Naples "Federico II," 80131 Napoli, Italy; Telethon Institute of Genetics and Medicine, 80078 Pozzuoli, Italy
| | - Friedhelm Hildebrandt
- Division of Nephrology, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Ariel Brautbar
- Medical Genetics Department, Cook Children's Hospital, Fort Worth, TX 76104, USA
| | - Ignatia B Van den Veyver
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA; The Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Ian Glass
- Division of Genetic Medicine, University of Washington, Seattle, WA 98195, USA
| | - Davor Lessel
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Gholson J Lyon
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, NY 11724, USA; Utah Foundation for Biomedical Research, Salt Lake City, UT 84107, USA; Institute for Basic Research in Developmental Disabilities, Staten Island, NY 10314, USA
| | - James R Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Children's Hospital, Houston, TX 77030, USA.
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15
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Kleyner R, Malcolmson J, Tegay D, Ward K, Maughan A, Maughan G, Nelson L, Wang K, Robison R, Lyon GJ. KBG syndrome involving a single-nucleotide duplication in ANKRD11. Cold Spring Harb Mol Case Stud 2017; 2:a001131. [PMID: 27900361 PMCID: PMC5111005 DOI: 10.1101/mcs.a001131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
KBG syndrome is a rare autosomal dominant genetic condition characterized by neurological involvement and distinct facial, hand, and skeletal features. More than 70 cases have been reported; however, it is likely that KBG syndrome is underdiagnosed because of lack of comprehensive characterization of the heterogeneous phenotypic features. We describe the clinical manifestations in a male currently 13 years of age, who exhibited symptoms including epilepsy, severe developmental delay, distinct facial features, and hand anomalies, without a positive genetic diagnosis. Subsequent exome sequencing identified a novel de novo heterozygous single base pair duplication (c.6015dupA) in ANKRD11, which was validated by Sanger sequencing. This single-nucleotide duplication is predicted to lead to a premature stop codon and loss of function in ANKRD11, thereby implicating it as contributing to the proband's symptoms and yielding a molecular diagnosis of KBG syndrome. Before molecular diagnosis, this syndrome was not recognized in the proband, as several key features of the disorder were mild and were not recognized by clinicians, further supporting the concept of variable expressivity in many disorders. Although a diagnosis of cerebral folate deficiency has also been given, its significance for the proband's condition remains uncertain.
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Affiliation(s)
- Robert Kleyner
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA
| | - Janet Malcolmson
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA;; Genetic Counseling Graduate Program, Long Island University (LIU), Brookville, New York 11548, USA
| | - David Tegay
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA
| | - Kenneth Ward
- Affiliated Genetics, Inc., Salt Lake City, Utah 84109, USA
| | | | - Glenn Maughan
- KBG Syndrome Foundation, West Jordan, Utah 84088, USA
| | - Lesa Nelson
- Affiliated Genetics, Inc., Salt Lake City, Utah 84109, USA
| | - Kai Wang
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, California 90089, USA;; Department of Psychiatry & Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA;; Utah Foundation for Biomedical Research, Salt Lake City, Utah 84107, USA
| | - Reid Robison
- Utah Foundation for Biomedical Research, Salt Lake City, Utah 84107, USA
| | - Gholson J Lyon
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA;; Utah Foundation for Biomedical Research, Salt Lake City, Utah 84107, USA
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16
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Malcolmson J, Kleyner R, Tegay D, Adams W, Ward K, Coppinger J, Nelson L, Meisler MH, Wang K, Robison R, Lyon GJ. SCN8A mutation in a child presenting with seizures and developmental delays. Cold Spring Harb Mol Case Stud 2017; 2:a001073. [PMID: 27900360 PMCID: PMC5111007 DOI: 10.1101/mcs.a001073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The SCN8A gene encodes the sodium voltage-gated channel alpha subunit 8. Mutations in this gene have been associated with early infantile epileptic encephalopathy type 13. With the use of whole-exome sequencing, a de novo missense mutation in SCN8A was identified in a 4-yr-old female who initially exhibited symptoms of epilepsy at the age of 5 mo that progressed to a severe condition with very little movement, including being unable to sit or walk on her own.
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Affiliation(s)
- Janet Malcolmson
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA;; Genetic Counseling Graduate Program, Long Island University (LIU), Brookville, New York 11548, USA
| | - Robert Kleyner
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA
| | - David Tegay
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA
| | - Whit Adams
- Utah Foundation for Biomedical Research, Salt Lake City, Utah 84107, USA
| | - Kenneth Ward
- Affiliated Genetics, Salt Lake City, Utah 84109, USA
| | | | - Lesa Nelson
- Affiliated Genetics, Salt Lake City, Utah 84109, USA
| | - Miriam H Meisler
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan 48109-5618, USA
| | - Kai Wang
- Utah Foundation for Biomedical Research, Salt Lake City, Utah 84107, USA;; Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, California 90089, USA;; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA
| | - Reid Robison
- Utah Foundation for Biomedical Research, Salt Lake City, Utah 84107, USA
| | - Gholson J Lyon
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA;; Utah Foundation for Biomedical Research, Salt Lake City, Utah 84107, USA
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17
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Fang H, Wu Y, Yang H, Yoon M, Jiménez-Barrón LT, Mittelman D, Robison R, Wang K, Lyon GJ. Whole genome sequencing of one complex pedigree illustrates challenges with genomic medicine. BMC Med Genomics 2017; 10:10. [PMID: 28228131 PMCID: PMC5322674 DOI: 10.1186/s12920-017-0246-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/14/2017] [Indexed: 12/18/2022] Open
Abstract
Background Human Phenotype Ontology (HPO) has risen as a useful tool for precision medicine by providing a standardized vocabulary of phenotypic abnormalities to describe presentations of human pathologies; however, there have been relatively few reports combining whole genome sequencing (WGS) and HPO, especially in the context of structural variants. Methods We illustrate an integrative analysis of WGS and HPO using an extended pedigree, which involves Prader–Willi Syndrome (PWS), hereditary hemochromatosis (HH), and dysautonomia-like symptoms. A comprehensive WGS pipeline was used to ensure reliable detection of genomic variants. Beyond variant filtering, we pursued phenotypic prioritization of candidate genes using Phenolyzer. Results Regarding PWS, WGS confirmed a 5.5 Mb de novo deletion of the parental allele at 15q11.2 to 15q13.1. Phenolyzer successfully returned the diagnosis of PWS, and pinpointed clinically relevant genes in the deletion. Further, Phenolyzer revealed how each of the genes is linked with the phenotypes represented by HPO terms. For HH, WGS identified a known disease variant (p.C282Y) in HFE of an affected female. Analysis of HPO terms alone fails to provide a correct diagnosis, but Phenolyzer successfully revealed the phenotype-genotype relationship using a disease-centric approach. Finally, Phenolyzer also revealed the complexity behind dysautonomia-like symptoms, and seven variants that might be associated with the phenotypes were identified by manual filtering based on a dominant inheritance model. Conclusions The integration of WGS and HPO can inform comprehensive molecular diagnosis for patients, eliminate false positives and reveal novel insights into undiagnosed diseases. Due to extreme heterogeneity and insufficient knowledge of human diseases, it is also important that phenotypic and genomic data are standardized and shared simultaneously. Electronic supplementary material The online version of this article (doi:10.1186/s12920-017-0246-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Han Fang
- Stanley Institute for Cognitive Genomics, One Bungtown Road, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA.,Stony Brook University, 100 Nicolls Rd, Stony Brook, NY, USA.,Simons Center for Quantitative Biology, One Bungtown Road, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Yiyang Wu
- Stanley Institute for Cognitive Genomics, One Bungtown Road, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA.,Stony Brook University, 100 Nicolls Rd, Stony Brook, NY, USA
| | - Hui Yang
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, CA, USA.,Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
| | - Margaret Yoon
- Stanley Institute for Cognitive Genomics, One Bungtown Road, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Laura T Jiménez-Barrón
- Stanley Institute for Cognitive Genomics, One Bungtown Road, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA.,Centro de Ciencias Genomicas, Universidad Nacional Autonoma de Mexico, Cuernavaca, Morelos, MX, Mexico
| | | | - Reid Robison
- Tute, Genomics Inc., 150 S 100 W, Provo, UT, USA.,Utah Foundation for Biomedical Research, Salt Lake City, UT, USA
| | - Kai Wang
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, CA, USA.,Department of Psychiatry, University of Southern California, Los Angeles, CA, USA.,Division of Bioinformatics, Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.,Present Address: Department of Biomedical Informatics and Institute for Genomic Medicine, Columbia University Medical Center, New York, 10032, NY, USA
| | - Gholson J Lyon
- Stanley Institute for Cognitive Genomics, One Bungtown Road, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA. .,Stony Brook University, 100 Nicolls Rd, Stony Brook, NY, USA. .,Utah Foundation for Biomedical Research, Salt Lake City, UT, USA.
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O’Rawe J, Wu Y, Dörfel M, Rope A, Au P, Parboosingh J, Moon S, Kousi M, Kosma K, Smith C, Tzetis M, Schuette J, Hufnagel R, Prada C, Martinez F, Orellana C, Crain J, Caro-Llopis A, Oltra S, Monfort S, Jiménez-Barrón L, Swensen J, Ellingwood S, Smith R, Fang H, Ospina S, Stegmann S, Den Hollander N, Mittelman D, Highnam G, Robison R, Yang E, Faivre L, Roubertie A, Rivière JB, Monaghan K, Wang K, Davis E, Katsanis N, Kalscheuer V, Wang E, Metcalfe K, Kleefstra T, Innes A, Kitsiou-Tzeli S, Rosello M, Keegan C, Lyon G. TAF1 Variants Are Associated with Dysmorphic Features, Intellectual Disability, and Neurological Manifestations. Am J Hum Genet 2015; 97:922-32. [PMID: 26637982 PMCID: PMC4678794 DOI: 10.1016/j.ajhg.2015.11.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/05/2015] [Indexed: 11/30/2022] Open
Abstract
We describe an X-linked genetic syndrome associated with mutations in TAF1 and manifesting with global developmental delay, intellectual disability (ID), characteristic facial dysmorphology, generalized hypotonia, and variable neurologic features, all in male individuals. Simultaneous studies using diverse strategies led to the identification of nine families with overlapping clinical presentations and affected by de novo or maternally inherited single-nucleotide changes. Two additional families harboring large duplications involving TAF1 were also found to share phenotypic overlap with the probands harboring single-nucleotide changes, but they also demonstrated a severe neurodegeneration phenotype. Functional analysis with RNA-seq for one of the families suggested that the phenotype is associated with downregulation of a set of genes notably enriched with genes regulated by E-box proteins. In addition, knockdown and mutant studies of this gene in zebrafish have shown a quantifiable, albeit small, effect on a neuronal phenotype. Our results suggest that mutations in TAF1 play a critical role in the development of this X-linked ID syndrome.
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Plowman EK, Tabor LC, Robison R, Gaziano J, Dion C, Watts SA, Vu T, Gooch C. Discriminant ability of the Eating Assessment Tool-10 to detect aspiration in individuals with amyotrophic lateral sclerosis. Neurogastroenterol Motil 2015. [PMID: 26510823 DOI: 10.1111/nmo.12700.] [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] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia is prevalent in individuals with amyotrophic lateral sclerosis (ALS) leading to malnutrition, aspiration pneumonia, and death. These factors necessitate early detection of at-risk patients to prolong maintenance of safe oral intake and pulmonary function. This study aimed to evaluate the discriminant ability of the Eating Assessment Tool (EAT-10) to identify ALS patients with unsafe airway protection during swallowing. METHODS Seventy ALS patients completed the EAT-10 survey and underwent a standardized videofluoroscopic evaluation of swallowing. Two blinded raters determined airway safety using the Penetration Aspiration Scale (PAS). A between groups anova (safe vs penetrators vs aspirators) was conducted and sensitivity, specificity, area under the curve (AUC), and likelihood ratios calculated. KEY RESULTS Mean EAT-10 scores for safe swallowers, penetrators, and aspirators (SEM) were: 4.28 (0.79) vs 7.10 (1.79) vs 20.50 (3.19), respectively, with significant differences noted for aspirators vs safe swallowers and aspirators vs penetrators (p < 0.001). The EAT-10 demonstrated good discriminant ability to accurately identify ALS penetrator/aspirators (PAS ≥3) with a cut off score of 3 (AUC: 0.77, sensitivity: 88%, specificity: 57%). The EAT-10 demonstrated excellent accuracy at identifying aspirators (PAS ≥6) utilizing a cut off score of 8 (AUC: 0.88, sensitivity: 86%, specificity: 72%, likelihood ratio: 3.1, negative predictive value: 95.5%). CONCLUSIONS & INFERENCES The EAT-10 differentiated safe vs unsafe swallowing in ALS patients. This patient self-report scale could represent a quick and meaningful aide to dysphagia screening in busy ALS clinics for the identification and referral of dysphagic patients for further instrumental evaluation.
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Affiliation(s)
- E K Plowman
- Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, FL, USA.,Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | - L C Tabor
- Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, FL, USA.,Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | - R Robison
- Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, FL, USA.,Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | - J Gaziano
- Joy McCann Center for Swallowing Disorders, University of South Florida, Tampa, FL, USA
| | - C Dion
- Department of Policy and Services Research Data Center, University of South Florida, Tampa, FL, USA
| | - S A Watts
- Joy McCann Center for Swallowing Disorders, University of South Florida, Tampa, FL, USA
| | - T Vu
- Department of Neurology, University of South Florida, Tampa, FL, USA
| | - C Gooch
- Department of Neurology, University of South Florida, Tampa, FL, USA
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O’Rawe JA, Fang H, Rynearson S, Robison R, Kiruluta ES, Higgins G, Eilbeck K, Reese MG, Lyon GJ. Integrating precision medicine in the study and clinical treatment of a severely mentally ill person. PeerJ 2013; 1:e177. [PMID: 24109560 PMCID: PMC3792182 DOI: 10.7717/peerj.177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/16/2013] [Indexed: 01/02/2023] Open
Abstract
Background. In recent years, there has been an explosion in the number of technical and medical diagnostic platforms being developed. This has greatly improved our ability to more accurately, and more comprehensively, explore and characterize human biological systems on the individual level. Large quantities of biomedical data are now being generated and archived in many separate research and clinical activities, but there exists a paucity of studies that integrate the areas of clinical neuropsychiatry, personal genomics and brain-machine interfaces. Methods. A single person with severe mental illness was implanted with the Medtronic Reclaim(®) Deep Brain Stimulation (DBS) Therapy device for Obsessive Compulsive Disorder (OCD), targeting his nucleus accumbens/anterior limb of the internal capsule. Programming of the device and psychiatric assessments occurred in an outpatient setting for over two years. His genome was sequenced and variants were detected in the Illumina Whole Genome Sequencing Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory. Results. We report here the detailed phenotypic characterization, clinical-grade whole genome sequencing (WGS), and two-year outcome of a man with severe OCD treated with DBS. Since implantation, this man has reported steady improvement, highlighted by a steady decline in his Yale-Brown Obsessive Compulsive Scale (YBOCS) score from ∼38 to a score of ∼25. A rechargeable Activa RC neurostimulator battery has been of major benefit in terms of facilitating a degree of stability and control over the stimulation. His psychiatric symptoms reliably worsen within hours of the battery becoming depleted, thus providing confirmatory evidence for the efficacy of DBS for OCD in this person. WGS revealed that he is a heterozygote for the p.Val66Met variant in BDNF, encoding a member of the nerve growth factor family, and which has been found to predispose carriers to various psychiatric illnesses. He carries the p.Glu429Ala allele in methylenetetrahydrofolate reductase (MTHFR) and the p.Asp7Asn allele in ChAT, encoding choline O-acetyltransferase, with both alleles having been shown to confer an elevated susceptibility to psychoses. We have found thousands of other variants in his genome, including pharmacogenetic and copy number variants. This information has been archived and offered to this person alongside the clinical sequencing data, so that he and others can re-analyze his genome for years to come. Conclusions. To our knowledge, this is the first study in the clinical neurosciences that integrates detailed neuropsychiatric phenotyping, deep brain stimulation for OCD and clinical-grade WGS with management of genetic results in the medical treatment of one person with severe mental illness. We offer this as an example of precision medicine in neuropsychiatry including brain-implantable devices and genomics-guided preventive health care.
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Affiliation(s)
- Jason A. O’Rawe
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, NY, USA
- Stony Brook University, Stony Brook, NY, USA
| | - Han Fang
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, NY, USA
- Stony Brook University, Stony Brook, NY, USA
| | - Shawn Rynearson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Reid Robison
- Utah Foundation for Biomedical Research, Salt Lake City, UT, USA
| | | | | | - Karen Eilbeck
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | | | - Gholson J. Lyon
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, NY, USA
- Stony Brook University, Stony Brook, NY, USA
- Utah Foundation for Biomedical Research, Salt Lake City, UT, USA
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Nagasawa D, Sun M, Trang A, Yew A, Ooi Y, Robison R, Zada G, Yang I. Systematic Analysis of Diagnostic Molecular Markers for Intracranial Germ Cell Tumors. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Elia J, Glessner JT, Wang K, Takahashi N, Shtir CJ, Hadley D, Sleiman PMA, Zhang H, Kim CE, Robison R, Lyon GJ, Flory JH, Bradfield JP, Imielinski M, Hou C, Frackelton EC, Chiavacci RM, Sakurai T, Rabin C, Middleton FA, Thomas KA, Garris M, Mentch F, Freitag CM, Steinhausen HC, Todorov AA, Reif A, Rothenberger A, Franke B, Mick EO, Roeyers H, Buitelaar J, Lesch KP, Banaschewski T, Ebstein RP, Mulas F, Oades RD, Sergeant J, Sonuga-Barke E, Renner TJ, Romanos M, Romanos J, Warnke A, Walitza S, Meyer J, Pálmason H, Seitz C, Loo SK, Smalley SL, Biederman J, Kent L, Asherson P, Anney RJL, Gaynor JW, Shaw P, Devoto M, White PS, Grant SFA, Buxbaum JD, Rapoport JL, Williams NM, Nelson SF, Faraone SV, Hakonarson H. Genome-wide copy number variation study associates metabotropic glutamate receptor gene networks with attention deficit hyperactivity disorder. Nat Genet 2011; 44:78-84. [PMID: 22138692 PMCID: PMC4310555 DOI: 10.1038/ng.1013] [Citation(s) in RCA: 302] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 10/28/2011] [Indexed: 12/11/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common, heritable neuropsychiatric disorder of unknown etiology. We performed a whole-genome copy number variation (CNV) study on 1,013 cases with ADHD and 4,105 healthy children of European ancestry using 550,000 SNPs. We evaluated statistically significant findings in multiple independent cohorts, with a total of 2,493 cases with ADHD and 9,222 controls of European ancestry, using matched platforms. CNVs affecting metabotropic glutamate receptor genes were enriched across all cohorts (P = 2.1 × 10(-9)). We saw GRM5 (encoding glutamate receptor, metabotropic 5) deletions in ten cases and one control (P = 1.36 × 10(-6)). We saw GRM7 deletions in six cases, and we saw GRM8 deletions in eight cases and no controls. GRM1 was duplicated in eight cases. We experimentally validated the observed variants using quantitative RT-PCR. A gene network analysis showed that genes interacting with the genes in the GRM family are enriched for CNVs in ∼10% of the cases (P = 4.38 × 10(-10)) after correction for occurrence in the controls. We identified rare recurrent CNVs affecting glutamatergic neurotransmission genes that were overrepresented in multiple ADHD cohorts.
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Affiliation(s)
- Josephine Elia
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Rope A, Wang K, Evjenth R, Xing J, Johnston J, Swensen J, Johnson W, Moore B, Huff C, Bird L, Carey J, Opitz J, Stevens C, Jiang T, Schank C, Fain H, Robison R, Dalley B, Chin S, South S, Pysher T, Jorde L, Hakonarson H, Lillehaug J, Biesecker L, Yandell M, Arnesen T, Lyon G. Using VAAST to Identify an X-linked Disorder Resulting in Lethality in Male Infants Due to N-Terminal Acetyltransferase Deficiency. Am J Hum Genet 2011. [DOI: 10.1016/j.ajhg.2011.07.008] [Citation(s) in RCA: 5] [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: 11/16/2022] Open
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Allen-Brady K, Cai G, Cannon D, Robison R, McMahon WM, Coon H, Buxbaum JD. No evidence for IL1RAPL1 involvement in selected high-risk autism pedigrees from the AGRE data set. Autism Res 2011; 4:293-6. [PMID: 21491612 DOI: 10.1002/aur.195] [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] [Received: 07/12/2010] [Accepted: 03/13/2011] [Indexed: 11/06/2022]
Abstract
Finding predisposition genes for Autism Spectrum Disorder (ASD) has proven challenging, and new methods are needed to aid the process. Using pedigree structure as a strategy to identify ASD predisposition genes, we previously performed a genome-wide linkage scan of 86 selected families from the Autism Resource Exchange (AGRE) that appeared to inherit ASD in a dominant manner. We identified a suggestive linkage peak on chromosome Xp22.11-p21.2 that encompasses the IL1RAPL1 gene, a strong candidate gene for ASD. In this follow-up study, we sequenced the coding regions of the IL1RAPL1 gene in 14 male cases representing one case from each pedigree that showed at least nominal linkage evidence on per pedigree basis to the chromosome X region. We observed no deleterious mutations or deletions in the IL1RAPL1 gene in these 14 ASD cases. A SNP was identified in exon 2 in five cases and a variant of unknown significance was identified in intron 6 in a single case. In conclusion, coding changes of the IL1RAPL1 gene do not appear to be associated with ASD in selected AGRE families with linkage evidence to the chromosome Xp22.11-p21.2 region.
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Affiliation(s)
- Kristina Allen-Brady
- Utah ASD Research Project, Department of Psychiatry, University of Utah, Salt Lake City, Utah 84108, USA.
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Rope AF, Wang K, Evjenth R, Xing J, Johnston JJ, Swensen JJ, Johnson WE, Moore B, Huff CD, Bird LM, Carey JC, Opitz JM, Stevens CA, Schank C, Fain HD, Robison R, Dalley B, Chin S, South ST, Pysher TJ, Jorde LB, Hakonarson H, Lillehaug JR, Biesecker LG, Yandell M, Arnesen T, Lyon GJ. Massively parallel sequencing identifies a previously unrecognized X-linked disorder resulting in lethality in male infants owing to amino-terminal acetyltransferase deficiency. Genome Biol 2011. [PMCID: PMC3439021 DOI: 10.1186/gb-2011-12-s1-p13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Alan F Rope
- Department of Pediatrics (Medical Genetics), University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kai Wang
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, PA , USA,Present address: Zilkha Neurogenetic Institute, Department of Psychiatry and Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rune Evjenth
- Department of Molecular Biology, University of Bergen, N-5020 Bergen, Norway
| | - Jinchuan Xing
- Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Jennifer J Johnston
- Genetic Disease Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeffrey J Swensen
- Department of Pathology, University of Utah, Salt Lake City, UT, USA,ARUP Laboratories, Salt Lake City, Utah, USA
| | - W Evan Johnson
- Department of Statistics, Brigham Young University, Provo, Utah, USA
| | - Barry Moore
- Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Chad D Huff
- Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Lynne M Bird
- Rady Children’s Hospital and University of California, San Diego, Department of Pediatrics, San Diego, CA, USA
| | - John C Carey
- Department of Pediatrics (Medical Genetics), University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John M Opitz
- Department of Pediatrics (Medical Genetics), University of Utah School of Medicine, Salt Lake City, UT, USA,Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT, USA,Department of Pathology, University of Utah, Salt Lake City, UT, USA,Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Cathy A Stevens
- Department of Pediatrics, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - Christa Schank
- Department of Statistics, Brigham Young University, Provo, Utah, USA
| | | | - Reid Robison
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Brian Dalley
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Steven Chin
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Sarah T South
- Department of Pediatrics (Medical Genetics), University of Utah School of Medicine, Salt Lake City, UT, USA,ARUP Laboratories, Salt Lake City, Utah, USA
| | - Theodore J Pysher
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Lynn B Jorde
- Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, PA , USA
| | - Johan R Lillehaug
- Department of Molecular Biology, University of Bergen, N-5020 Bergen, Norway
| | - Leslie G Biesecker
- Genetic Disease Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Yandell
- Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Thomas Arnesen
- Department of Molecular Biology, University of Bergen, N-5020 Bergen, Norway,Department of Surgery, Haukeland University Hospital, N-5021 Bergen, Norway
| | - Gholson J Lyon
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA,New York University Child Study Center, New York, NY, USA,Present address: Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, PA , USA
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Allen-Brady K, Robison R, Cannon D, Varvil T, Villalobos M, Pingree C, Leppert MF, Miller J, McMahon WM, Coon H. Genome-wide linkage in Utah autism pedigrees. Mol Psychiatry 2010; 15:1006-15. [PMID: 19455147 PMCID: PMC4023913 DOI: 10.1038/mp.2009.42] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 03/25/2009] [Accepted: 04/13/2009] [Indexed: 01/04/2023]
Abstract
Genetic studies of autism over the past decade suggest a complex landscape of multiple genes. In the face of this heterogeneity, studies that include large extended pedigrees may offer valuable insights, as the relatively few susceptibility genes within single large families may be more easily discerned. This genome-wide screen of 70 families includes 20 large extended pedigrees of 6-9 generations, 6 moderate-sized families of 4-5 generations and 44 smaller families of 2-3 generations. The Center for Inherited Disease Research (CIDR) provided genotyping using the Illumina Linkage Panel 12, a 6K single-nucleotide polymorphism (SNP) platform. Results from 192 subjects with an autism spectrum disorder (ASD) and 461 of their relatives revealed genome-wide significance on chromosome 15q, with three possibly distinct peaks: 15q13.1-q14 (heterogeneity LOD (HLOD)=4.09 at 29 459 872 bp); 15q14-q21.1 (HLOD=3.59 at 36 837 208 bp); and 15q21.1-q22.2 (HLOD=5.31 at 55 629 733 bp). Two of these peaks replicate earlier findings. There were additional suggestive results on chromosomes 2p25.3-p24.1 (HLOD=1.87), 7q31.31-q32.3 (HLOD=1.97) and 13q12.11-q12.3 (HLOD=1.93). Affected subjects in families supporting the linkage peaks found in this study did not reveal strong evidence for distinct phenotypic subgroups.
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Affiliation(s)
- K Allen-Brady
- Utah Autism Research Project, Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA
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Allen-Brady K, Cannon D, Robison R, McMahon WM, Coon H. A unified theory of autism revisited: linkage evidence points to chromosome X using a high-risk subset of AGRE families. Autism Res 2010; 3:47-52. [PMID: 20437600 DOI: 10.1002/aur.119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Zhao et al. [2007] in their "Unified Theory of Autism" hypothesized that incidence of autism in males could be explained by essentially two types of family structures: majority of autism cases are from low-risk autism families with de novo mutations, and a minority of cases are from high-risk multiplex families, where risk to male offspring approximates 50% consistent with a dominant model and high penetrance. Using the Autism Genetic Resource Exchange (AGRE) data set, Zhao et al. identified 86 high-risk families with likely dominant transmission. As genotype data are now available for many members of the AGRE resource, the objective of this manuscript was to determine if dominant linkage evidence for an autism predisposition gene exists in these 86 high-risk families. HumanHap550K Illumina SNP data were available for 92% of 455 total family members in these 86 high-risk families. We performed a linkage analysis using a pruned subset of markers where markers in high linkage disequilibrium were removed. We observed a single suggestive peak (maximum LOD 2.01, maximum HLOD 2.08) under a dominant model on chromosome Xp22.11-p21.2 that encompasses the IL1RAPL1 gene. Mutations or deletions in IL1RAPL1 have been previously reported in three families with autism. In our study, 11 families contributed nominally (P<0.05, HLOD>0.588) to the chromosome X peak. These results demonstrate that identification of a more homogeneous subset of autism cases, which was based on family structure in this study, may help to identify, localize and further our understanding of autism predisposition genes.
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Affiliation(s)
- Kristina Allen-Brady
- Department of Psychiatry, Utah Autism Research Project, University of Utah, Salt Lake City, Utah, 84108, USA.
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Fell HB, Robison R. The development and phosphatase activity in vivo and in vitro of the mandibular skeletal tissue of the embryonic fowl. Biochem J 2006; 24:1905-21. [PMID: 16744546 PMCID: PMC1254811 DOI: 10.1042/bj0241905] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- H B Fell
- The Strangeways Research Laboratory, Cambridge, and the Biochemical Department, Lister Institute, London
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Affiliation(s)
- R Robison
- The Biochemical Department, the Lister Institute, London
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Affiliation(s)
- C M Jephcott
- The Biochemical Department, The Lister Institute, London
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Affiliation(s)
- H B Fell
- The Strangeways Research Laboratory, Cambridge, and the Biochemical Department, The Lister Institute, London
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32
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Affiliation(s)
- M G Macfarlane
- The Biochemical Department, The Lister Institute, London
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33
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Affiliation(s)
- A Harden
- The Biochemical Department, Lister Institute
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34
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Martland M, Robison R. Possible Significance of Hexosephosphoric Esters in Ossification: Part VI. Phosphoric Esters in Blood-Plasma. Biochem J 2006; 20:847-55. [PMID: 16743725 PMCID: PMC1251788 DOI: 10.1042/bj0200847] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M Martland
- The Biochemical Department, The Lister Institute, London
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35
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Martland M, Robison R. The Possible Significance of Hexosephosphoric Esters in Ossification: Part VII. The Bone Phosphatase. Biochem J 2006; 21:665-74. [PMID: 16743883 PMCID: PMC1251964 DOI: 10.1042/bj0210665] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M Martland
- The Biochemical Department, the Lister Institute, London
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36
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Affiliation(s)
- A Harden
- The Biochemical Department, Lister Institute
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39
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Tankó B, Robison R. The hydrolysis of hexosediphosphoric ester by bone phosphatase: (a) The participation of phosphohexokinase; (b) the isolation of pure fructose-1-phosphate. Biochem J 2006; 29:961-72. [PMID: 16745750 PMCID: PMC1266576 DOI: 10.1042/bj0290961] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- B Tankó
- The Biochemical Department, The Lister Institute, London
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40
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Affiliation(s)
- R Robison
- The Biochemical Department, the Lister Institute, London
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41
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Affiliation(s)
- W T Morgan
- The Biochemical Department, Lister Institute, London
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43
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Affiliation(s)
- M Martland
- The Biochemical Department, Lister Institute, London
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44
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Affiliation(s)
- M Macleod
- The Biochemical Department, Lister Institute, London
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45
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Affiliation(s)
- R Robison
- The Biochemical Department, the Lister Institute, London
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46
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Goodwin HW, Robison R. The Possible Significance of Hexosephosphoric Esters in Ossification. Part IV. The Phosphoric Esters of the Blood: Preliminary Communication. Biochem J 2006; 18:1161-2. [PMID: 16743347 PMCID: PMC1259497 DOI: 10.1042/bj0181161] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- H W Goodwin
- The Biochemical Department of the Lister Institute
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47
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Kay HD, Robison R. The Possible Significance of Hexosephosphoric Esters in Ossification. Part III: The Action of the Bone Enzyme on the Organic Phosphorus Compounds in Blood. Biochem J 2006; 18:755-64. [PMID: 16743454 PMCID: PMC1263972 DOI: 10.1042/bj0180755] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- H D Kay
- The Biochemical Department, Lister Institute
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48
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Affiliation(s)
- R Robison
- The Departments of Biochemistry and Experimental Pathology, Lister Institute, London
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49
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50
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Affiliation(s)
- R Robison
- The Biochemical Department of the Lister Institute
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