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Nespoux J, Monaghan MLT, Jones NK, Stewart K, Denby L, Czopek A, Mullins JJ, Menzies RI, Baker AH, Bailey MA. P2X7 receptor knockout does not alter renal function or prevent angiotensin II-induced kidney injury in F344 rats. Sci Rep 2024; 14:9573. [PMID: 38670993 PMCID: PMC11053004 DOI: 10.1038/s41598-024-59635-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
P2X7 receptors mediate immune and endothelial cell responses to extracellular ATP. Acute pharmacological blockade increases renal blood flow and filtration rate, suggesting that receptor activation promotes tonic vasoconstriction. P2X7 expression is increased in kidney disease and blockade/knockout is renoprotective. We generated a P2X7 knockout rat on F344 background, hypothesising enhanced renal blood flow and protection from angiotensin-II-induced renal injury. CRISPR/Cas9 introduced an early stop codon into exon 2 of P2rx7, abolishing P2X7 protein in kidney and reducing P2rx7 mRNA abundance by ~ 60% in bone-marrow derived macrophages. The M1 polarisation response to lipopolysaccharide was unaffected but P2X7 receptor knockout suppressed ATP-induced IL-1β release. In male knockout rats, acetylcholine-induced dilation of the renal artery ex vivo was diminished but not the response to nitroprusside. Renal function in male and female knockout rats was not different from wild-type. Finally, in male rats infused with angiotensin-II for 6 weeks, P2X7 knockout did not reduce albuminuria, tubular injury, renal macrophage accrual, and renal perivascular fibrosis. Contrary to our hypothesis, global P2X7 knockout had no impact on in vivo renal hemodynamics. Our study does not indicate a major role for P2X7 receptor activation in renal vascular injury.
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Affiliation(s)
- Josselin Nespoux
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Marie-Louise T Monaghan
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Natalie K Jones
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Kevin Stewart
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Laura Denby
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Alicja Czopek
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - John J Mullins
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Robert I Menzies
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Andrew H Baker
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Matthew A Bailey
- Edinburgh Kidney, British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.
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2
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ElBeck Z, Hossain MB, Siga H, Oskolkov N, Karlsson F, Lindgren J, Walentinsson A, Koppenhöfer D, Jarvis R, Bürli R, Jamier T, Franssen E, Firth M, Degasperi A, Bendtsen C, Menzies RI, Streckfuss-Bömeke K, Kohlhaas M, Nickel AG, Lund LH, Maack C, Végvári Á, Betsholtz C. Epigenetic modulators link mitochondrial redox homeostasis to cardiac function in a sex-dependent manner. Nat Commun 2024; 15:2358. [PMID: 38509128 PMCID: PMC10954618 DOI: 10.1038/s41467-024-46384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
While excessive production of reactive oxygen species (ROS) is a characteristic hallmark of numerous diseases, clinical approaches that ameliorate oxidative stress have been unsuccessful. Here, utilizing multi-omics, we demonstrate that in cardiomyocytes, mitochondrial isocitrate dehydrogenase (IDH2) constitutes a major antioxidative defense mechanism. Paradoxically reduced expression of IDH2 associated with ventricular eccentric hypertrophy is counterbalanced by an increase in the enzyme activity. We unveil redox-dependent sex dimorphism, and extensive mutual regulation of the antioxidative activities of IDH2 and NRF2 by a feedforward network that involves 2-oxoglutarate and L-2-hydroxyglutarate and mediated in part through unconventional hydroxy-methylation of cytosine residues present in introns. Consequently, conditional targeting of ROS in a murine model of heart failure improves cardiac function in sex- and phenotype-dependent manners. Together, these insights may explain why previous attempts to treat heart failure with antioxidants have been unsuccessful and open new approaches to personalizing and, thereby, improving such treatment.
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Affiliation(s)
- Zaher ElBeck
- Department of Medicine Huddinge, Karolinska Institutet, Campus Flemingsberg, 141 57, Huddinge, Sweden.
- Departmenty of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.
| | - Mohammad Bakhtiar Hossain
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Humam Siga
- Department of Medicine Huddinge, Karolinska Institutet, Campus Flemingsberg, 141 57, Huddinge, Sweden
| | - Nikolay Oskolkov
- Department of Biology, National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Lund University, Lund, Sweden
| | - Fredrik Karlsson
- Data Sciences and Quantitative Biology, Discovery Sciences, R&D, AstraZeneca, Gothenburg, Sweden
| | - Julia Lindgren
- Translational Genomics, Centre for Genomics Research, Discovery Sciences, R&D, AstraZeneca, Gothenburg, Sweden
| | - Anna Walentinsson
- Translational Science & Experimental Medicine, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Dominique Koppenhöfer
- Department of Medicine Huddinge, Karolinska Institutet, Campus Flemingsberg, 141 57, Huddinge, Sweden
| | - Rebecca Jarvis
- Neuroscience, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Roland Bürli
- Neuroscience, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Tanguy Jamier
- Neuroscience, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Elske Franssen
- Neuroscience, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Mike Firth
- Data Sciences and Quantitative Biology, Discovery Sciences, R&D, AstraZeneca, Gothenburg, Sweden
| | - Andrea Degasperi
- Data Sciences and Quantitative Biology, Discovery Sciences, R&D, AstraZeneca, Gothenburg, Sweden
- Early Cancer Institute, University of Cambridge, Cambridge, United Kingdom
| | - Claus Bendtsen
- Data Sciences and Quantitative Biology, Discovery Sciences, R&D, AstraZeneca, Gothenburg, Sweden
| | - Robert I Menzies
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Katrin Streckfuss-Bömeke
- Institute of Pharmacology and Toxicology, University of Würzburg, Würzburg, Germany
- Clinic for Cardiology and Pneumology, Georg-August University Göttingen and DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Department of Translational Research, Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Michael Kohlhaas
- Department of Translational Research, Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Alexander G Nickel
- Department of Translational Research, Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Lars H Lund
- Department of Medicine Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Christoph Maack
- Department of Translational Research, Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Ákos Végvári
- Division of Chemistry I, Department of Medical Biochemistry & Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Christer Betsholtz
- Department of Medicine Huddinge, Karolinska Institutet, Campus Flemingsberg, 141 57, Huddinge, Sweden
- Departmenty of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
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Raina MacIntyre C, Kevin Yin J, Felter C, Menzies RI, Thommes E, Largeron N, Moa AM, Trent M, Costantino V, Choi S, Alvarez FP. Estimated health and economic impact of using high-dose influenza vaccine on respiratory and circulatory plus respiratory hospitalizations of older adults in Australia. Vaccine X 2023; 15:100365. [PMID: 37609557 PMCID: PMC10440578 DOI: 10.1016/j.jvacx.2023.100365] [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] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
Background Standard dose influenza vaccine provides moderate protection from infection, but with lower effectiveness among the elderly. High dose and adjuvanted vaccines (HD-TIV and aTIV) were developed to address this. This study aims to estimate the incremental health and economic impact of using HD-TIV (high dose trivalent vaccine) instead of aTIV (adjuvanted trivalent vaccine) on respiratory and circulatory plus respiratory hospitalizations of older people (≥65 years) in Australia. Methods This is a modelling study comparing predicted hospitalization outcomes in people receiving HD-TIV or aTIV during an average influenza season in Australia. Hospitalization records of Australian adults ≥65 years of age from 01 April to 30 November during 15 influenza seasons (2002-2017 excluding 2009, which was a pandemic) were extracted from the Australian Institute of Health and Welfare [AIHW] and used to calculate hospitalisation rates during an average season. Relative vaccine effectiveness data for aTIV and HD-TIV were used to estimate morbidity burden related to influenza. Results Between 2002 and 2017, the average respiratory hospitalization rate among older people during influenza season (April-November) was 3,445/100,000 population-seasons, with an average cost of AU$ 7,175 per admission. The average circulatory plus respiratory hospitalization rate among older Australian people during that time was 10,393/100,000 population-seasons, with an average cost of AU$ 7829 per admission. For older Australians, HD-TIV may avert an additional 6,315-9,410 respiratory admissions each year, with an incremental healthcare cost saving of AU$ 15.9-38.2 million per year compared to aTIV. Similar results were also noted for circulatory plus respiratory hospitalizations. Conclusions From the modelled estimations, HD-TIV was associated with less economic burden and fewer respiratory, and circulatory plus respiratory hospitalizations than aTIV for older Australians.
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Affiliation(s)
| | - J. Kevin Yin
- Medical Department, Greater China, Sanofi Vaccines, Beijing, China
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Edward Thommes
- New Products and Innovation, Sanofi, Toronto, Ontario, Canada
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON, Canada
| | | | - Aye M. Moa
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mallory Trent
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Seulki Choi
- Market Access, Sanofi, Sydney, NSW, Australia
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Veenit V, Heerspink HJL, Ahlström C, Greasley PJ, Skritic S, van Zuydam N, Kohan DE, Hansen PBL, Menzies RI. The sodium glucose co-transporter 2 inhibitor dapagliflozin ameliorates the fluid-retaining effect of the endothelin A receptor antagonist zibotentan. Nephrol Dial Transplant 2023; 38:2289-2297. [PMID: 37102226 PMCID: PMC10539223 DOI: 10.1093/ndt/gfad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Endothelin A receptor antagonists (ETARA) slow chronic kidney disease (CKD) progression but their use is limited due to fluid retention and associated clinical risks. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) cause osmotic diuresis and improve clinical outcomes in CKD and heart failure. We hypothesized that co-administration of the SGLT2i dapagliflozin with the ETARA zibotentan would mitigate the fluid retention risk using hematocrit (Hct) and bodyweight as proxies for fluid retention. METHODS Experiments were performed in 4% salt fed WKY rats. First, we determined the effect of zibotentan (30, 100 or 300 mg/kg/day) on Hct and bodyweight. Second, we assessed the effect of zibotentan (30 or 100 mg/kg/day) alone or in combination with dapagliflozin (3 mg/kg/day) on Hct and bodyweight. RESULTS Hct at Day 7 was lower in zibotentan versus vehicle groups [zibotentan 30 mg/kg/day, 43% (standard error 1); 100 mg/kg/day, 42% (1); and 300 mg/kg/day, 42% (1); vs vehicle, 46% (1); P < .05], while bodyweight was numerically higher in all zibotentan groups compared with vehicle. Combining zibotentan with dapagliflozin for 7 days prevented the change in Hct [zibotentan 100 mg/kg/day and dapagliflozin, 45% (1); vs vehicle 46% (1); P = .44] and prevented the zibotentan-driven increase in bodyweight (zibotentan 100 mg/kg/day + dapagliflozin 3 mg/kg/day = -3.65 g baseline corrected bodyweight change; P = .15). CONCLUSIONS Combining ETARA with SGLT2i prevents ETARA-induced fluid retention, supporting clinical studies to assess the efficacy and safety of combining zibotentan and dapagliflozin in individuals with CKD.
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Affiliation(s)
- Vandana Veenit
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christine Ahlström
- DMPK, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Peter J Greasley
- Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Stanko Skritic
- Innovation Strategies & External Liaison, Pharmaceutical Technologies & Development, AstraZeneca, Gothenburg, Sweden; Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Natalie van Zuydam
- Biostatistics Sweden, Data Science and Quantitative Biology, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Donald E Kohan
- Division of Nephrology, University of Utah Health, Salt Lake City, UT, USA
| | - Pernille B L Hansen
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Robert I Menzies
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
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5
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Buvall L, Menzies RI, Williams J, Woollard KJ, Kumar C, Granqvist AB, Fritsch M, Feliers D, Reznichenko A, Gianni D, Petrovski S, Bendtsen C, Bohlooly-Y M, Haefliger C, Danielson RF, Hansen PBL. Selecting the right therapeutic target for kidney disease. Front Pharmacol 2022; 13:971065. [DOI: 10.3389/fphar.2022.971065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Kidney disease is a complex disease with several different etiologies and underlying associated pathophysiology. This is reflected by the lack of effective treatment therapies in chronic kidney disease (CKD) that stop disease progression. However, novel strategies, recent scientific breakthroughs, and technological advances have revealed new possibilities for finding novel disease drivers in CKD. This review describes some of the latest advances in the field and brings them together in a more holistic framework as applied to identification and validation of disease drivers in CKD. It uses high-resolution ‘patient-centric’ omics data sets, advanced in silico tools (systems biology, connectivity mapping, and machine learning) and ‘state-of-the-art‘ experimental systems (complex 3D systems in vitro, CRISPR gene editing, and various model biological systems in vivo). Application of such a framework is expected to increase the likelihood of successful identification of novel drug candidates based on strong human target validation and a better scientific understanding of underlying mechanisms.
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6
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Nespoux J, Monaghan MT, Jones NK, Denby L, Czopek A, Mullins JJ, Menzies RI, Baker AH, Bailey MA. Sex Difference in Renal Artery Contractility in a Novel CRISPR/Cas9‐Generated P2X7 Knockout Rat. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r5740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Josselin Nespoux
- British Heart Foundation Centre for Cardiovascular Science, The University of EdinburghEdinburghUnited Kingdom
| | - Marie‐Louise T. Monaghan
- British Heart Foundation Centre for Cardiovascular ScienceBritish Heart Foundation Centre for Cardiovascular Science, The University of EdinburghEdinburghUnited Kingdom
| | - Natalie K. Jones
- British Heart Foundation Centre for Cardiovascular ScienceBritish Heart Foundation Centre for Cardiovascular Science, The University of EdinburghEdinburghUnited Kingdom
| | - Laura Denby
- British Heart Foundation Centre for Cardiovascular ScienceBritish Heart Foundation Centre for Cardiovascular Science, The University of EdinburghEdinburghUnited Kingdom
| | - Alicja Czopek
- British Heart Foundation Centre for Cardiovascular ScienceBritish Heart Foundation Centre for Cardiovascular Science, The University of EdinburghEdinburghUnited Kingdom
| | - John J. Mullins
- British Heart Foundation Centre for Cardiovascular ScienceBritish Heart Foundation Centre for Cardiovascular Science, The University of EdinburghEdinburghUnited Kingdom
| | - Robert I. Menzies
- British Heart Foundation Centre for Cardiovascular ScienceBritish Heart Foundation Centre for Cardiovascular Science, The University of EdinburghEdinburghUnited Kingdom
| | - Andrew H. Baker
- British Heart Foundation Centre for Cardiovascular ScienceBritish Heart Foundation Centre for Cardiovascular Science, The University of EdinburghEdinburghUnited Kingdom
| | - Matthew A. Bailey
- British Heart Foundation Centre for Cardiovascular ScienceBritish Heart Foundation Centre for Cardiovascular Science, The University of EdinburghEdinburghUnited Kingdom
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7
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Moa AM, Menzies RI, Yin JK, MacIntyre CR. Modelling the influenza disease burden in people aged 50-64 and ≥65 years in Australia. Influenza Other Respir Viruses 2021; 16:132-141. [PMID: 34586749 PMCID: PMC8692809 DOI: 10.1111/irv.12902] [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] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Estimation of influenza disease burden is necessary to monitor the impact of intervention programmes. This study aims to estimate the attributable fraction of respiratory and circulatory disease due to influenza among Australian adults 50–64 and ≥65 years of age. Methods A semi‐parametric generalised‐additive model was used to estimate annual and average rate of influenza‐attributable hospitalisation and death per 100,000 population under the principal diagnosis of influenza/pneumonia, respiratory, circulatory and myocardial infarction (MI) from 2001 through 2017. Results Over the study period, seasonal influenza accounted for an estimated annual average respiratory hospitalisation rate of 78.9 (95%CI: 76.3, 81.4) and 287.5 (95%CI: 279.8, 295.3) per 100,000 population in adults aged 50–64 and ≥65 years, respectively. The corresponding respiratory mortality rates were 0.9 (95%CI: 0.7, 1.2) and 18.2 (95%CI: 16.9, 19.4) per 100,000 population. The 2017 season had the highest influenza‐attributable respiratory hospitalisations in both age groups, and respiratory complications were estimated approximately 2.5 times higher than the average annual estimate in adults aged ≥65 years in 2017. For mortality, on average, influenza attributed 1,080 circulatory and 361 MI deaths in adults aged ≥65 years per year. Influenza accounted for 1% and 2.8% of total MI deaths in adults aged 50–64 and ≥65 years, respectively. Conclusion Rates of cardiorespiratory morbidity and mortality were high in older adults, whilst the younger age group contributed a lower disease burden. Extension of influenza vaccination programme beyond the targeted population could be an alternative strategy to reduce the burden of influenza.
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Affiliation(s)
- Aye M Moa
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Robert I Menzies
- Medical, Sanofi Pasteur Australia and New Zealand, Sydney, New South Wales, Australia
| | - J Kevin Yin
- Medical Department of Global Influenza Franchise, Sanofi Pasteur, Singapore.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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8
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Jones NK, Stewart K, Czopek A, Menzies RI, Thomson A, Moran CM, Cairns C, Conway BR, Denby L, Livingstone DEW, Wiseman J, Hadoke PW, Webb DJ, Dhaun N, Dear JW, Mullins JJ, Bailey MA. Endothelin-1 Mediates the Systemic and Renal Hemodynamic Effects of GPR81 Activation. Hypertension 2020; 75:1213-1222. [PMID: 32200679 PMCID: PMC7176350 DOI: 10.1161/hypertensionaha.119.14308] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 02/07/2023]
Abstract
Supplemental Digital Content is available in the text. GPR81 (G-protein-coupled receptor 81) is highly expressed in adipocytes, and activation by the endogenous ligand lactate inhibits lipolysis. GPR81 is also expressed in the heart, liver, and kidney, but roles in nonadipose tissues are poorly defined. GPR81 agonists, developed to improve blood lipid profile, might also provide insights into GPR81 physiology. Here, we assessed the blood pressure and renal hemodynamic responses to the GPR81 agonist, AZ′5538. In male wild-type mice, intravenous AZ′5538 infusion caused a rapid and sustained increase in systolic and diastolic blood pressure. Renal artery blood flow, intrarenal tissue perfusion, and glomerular filtration rate were all significantly reduced. AZ′5538 had no effect on blood pressure or renal hemodynamics in Gpr81−/− mice. Gpr81 mRNA was expressed in renal artery vascular smooth muscle, in the afferent arteriole, in glomerular and medullary perivascular cells, and in pericyte-like cells isolated from kidney. Intravenous AZ′5538 increased plasma ET-1 (endothelin 1), and pretreatment with BQ123 (endothelin-A receptor antagonist) prevented the pressor effects of GPR81 activation, whereas BQ788 (endothelin-B receptor antagonist) did not. Renal ischemia-reperfusion injury, which increases renal extracellular lactate, increased the renal expression of genes encoding ET-1, KIM-1 (Kidney Injury Molecule 1), collagen type 1-α1, TNF-α (tumor necrosis factor-α), and F4/80 in wild-type mice but not in Gpr81−/− mice. In summary, activation of GPR81 in vascular smooth muscle and perivascular cells regulates renal hemodynamics, mediated by release of the potent vasoconstrictor ET-1. This suggests that lactate may be a paracrine regulator of renal blood flow, particularly relevant when extracellular lactate is high as occurs during ischemic renal disease.
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Affiliation(s)
- Natalie K Jones
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - Kevin Stewart
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - Alicja Czopek
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - Robert I Menzies
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - Adrian Thomson
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - Carmel M Moran
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - Carolynn Cairns
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - Bryan R Conway
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - Laura Denby
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - Dawn E W Livingstone
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - John Wiseman
- Discovery Sciences, IMED Biotech Unit, AstraZeneca R&D Gothenburg, Sweden (J.W.)
| | - Patrick W Hadoke
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - David J Webb
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - Neeraj Dhaun
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - James W Dear
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - John J Mullins
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
| | - Matthew A Bailey
- From the University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Scotland, United Kingdom (N.K.J., K.S., A.C., R.I.M., A.T., C.M.M., C.C., B.R.C., L.D., D.E.W.L., P.W.H., D.J.W., N.D., J.W.D., J.J.M., M.A.B.)
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9
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Alfazema N, Barrier M, de Procé SM, Menzies RI, Carter R, Stewart K, Diaz AG, Moyon B, Webster Z, Bellamy COC, Arends MJ, Stimson RH, Morton NM, Aitman TJ, Coan PM. Camk2n1 Is a Negative Regulator of Blood Pressure, Left Ventricular Mass, Insulin Sensitivity, and Promotes Adiposity. Hypertension 2019; 74:687-696. [PMID: 31327268 PMCID: PMC6686962 DOI: 10.1161/hypertensionaha.118.12409] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 12/13/2022]
Abstract
Supplemental Digital Content is available in the text. Metabolic syndrome is a cause of coronary artery disease and type 2 diabetes mellitus. Camk2n1 resides in genomic loci for blood pressure, left ventricle mass, and type 2 diabetes mellitus, and in the spontaneously hypertensive rat model of metabolic syndrome, Camk2n1 expression is cis-regulated in left ventricle and fat and positively correlates with adiposity. Therefore, we knocked out Camk2n1 in spontaneously hypertensive rat to investigate its role in metabolic syndrome. Compared with spontaneously hypertensive rat, Camk2n1−/− rats had reduced cardiorenal CaMKII (Ca2+/calmodulin-dependent kinase II) activity, lower blood pressure, enhanced nitric oxide bioavailability, and reduced left ventricle mass associated with altered hypertrophic networks. Camk2n1 deficiency reduced insulin resistance, visceral fat, and adipogenic capacity through the altered cell cycle and complement pathways, independent of CaMKII. In human visceral fat, CAMK2N1 expression correlated with adiposity and genomic variants that increase CAMK2N1 expression associated with increased risk of coronary artery disease and type 2 diabetes mellitus. Camk2n1 regulates multiple networks that control metabolic syndrome traits and merits further investigation as a therapeutic target in humans.
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Affiliation(s)
- Neza Alfazema
- From the MRC Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom (N.A., M.B., S.M.d.P., T.J.A., P.M.C.)
| | - Marjorie Barrier
- From the MRC Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom (N.A., M.B., S.M.d.P., T.J.A., P.M.C.)
| | - Sophie Marion de Procé
- From the MRC Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom (N.A., M.B., S.M.d.P., T.J.A., P.M.C.)
| | - Robert I Menzies
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (R.I.M., R.C., K.S., R.H.S., N.M.M.)
| | - Roderick Carter
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (R.I.M., R.C., K.S., R.H.S., N.M.M.)
| | - Kevin Stewart
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (R.I.M., R.C., K.S., R.H.S., N.M.M.)
| | - Ana Garcia Diaz
- MRC London Institute of Medical Sciences, Imperial College London, United Kingdom (A.G.D., B.M., Z.W.)
| | - Ben Moyon
- MRC London Institute of Medical Sciences, Imperial College London, United Kingdom (A.G.D., B.M., Z.W.)
| | - Zoe Webster
- MRC London Institute of Medical Sciences, Imperial College London, United Kingdom (A.G.D., B.M., Z.W.)
| | - Christopher O C Bellamy
- Division of Pathology, Centre for Comparative Pathology, Edinburgh CRUK Cancer Centre, United Kingdom (C.O.C.B., M.J.A.)
| | - Mark J Arends
- Division of Pathology, Centre for Comparative Pathology, Edinburgh CRUK Cancer Centre, United Kingdom (C.O.C.B., M.J.A.)
| | - Roland H Stimson
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (R.I.M., R.C., K.S., R.H.S., N.M.M.)
| | - Nicholas M Morton
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (R.I.M., R.C., K.S., R.H.S., N.M.M.)
| | - Timothy J Aitman
- From the MRC Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom (N.A., M.B., S.M.d.P., T.J.A., P.M.C.)
| | - Philip M Coan
- From the MRC Institute of Genetics and Molecular Medicine, Edinburgh, United Kingdom (N.A., M.B., S.M.d.P., T.J.A., P.M.C.)
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10
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Craigie E, Menzies RI, Larsen CK, Jacquillet G, Carrel M, Wildman SS, Loffing J, Leipziger J, Shirley DG, Bailey MA, Unwin RJ. The renal and blood pressure response to low sodium diet in P2X4 receptor knockout mice. Physiol Rep 2018; 6:e13899. [PMID: 30350402 PMCID: PMC6198136 DOI: 10.14814/phy2.13899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 01/02/2023] Open
Abstract
In the kidney, purinergic (P2) receptor-mediated ATP signaling has been shown to be an important local regulator of epithelial sodium transport. Appropriate sodium regulation is crucial for blood pressure (BP) control and disturbances in sodium balance can lead to hypo- or hypertension. Links have already been established between P2 receptor signaling and the development of hypertension, attributed mainly to vascular and/or inflammatory effects. A transgenic mouse model with deletion of the P2X4 receptor (P2X4-/- ) is known to have hypertension, which is thought to reflect endothelial dysfunction and impaired nitric oxide (NO) release. However, renal function in this model has not been characterized; moreover, studies in vitro have shown that the P2X4 receptor can regulate renal epithelial Na+ channel (ENaC) activity. Therefore, in the present study we investigated renal function and sodium handling in P2X4-/- mice, focusing on ENaC-mediated Na+ reabsorption. We confirmed an elevated BP in P2X4-/- mice compared with wild-type mice, but found that ENaC-mediated Na+ reabsorption is no different from wild-type and does not contribute to the raised BP observed in the knockout. However, when P2X4-/- mice were placed on a low sodium diet, BP normalized. Plasma aldosterone concentration tended to increase according to sodium restriction status in both genotypes; in contrast to wild-types, P2X4-/- mice did not show an increase in functional ENaC activity. Thus, although the increased BP in P2X4-/- mice has been attributed to endothelial dysfunction and impaired NO release, there is also a sodium-sensitive component.
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Affiliation(s)
- Eilidh Craigie
- Centre for NephrologyUniversity College London Medical SchoolLondonUnited Kingdom
- Institue for AnatomyUniversity of ZürichZürichSwitzerland
| | - Robert I. Menzies
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUnited Kingdom
| | - Casper K. Larsen
- Department of Biomedicine, PhysiologyAarhus UniversityAarhus CDenmark
| | - Grégory Jacquillet
- Centre for NephrologyUniversity College London Medical SchoolLondonUnited Kingdom
| | - Monique Carrel
- Institue for AnatomyUniversity of ZürichZürichSwitzerland
| | - Scott S. Wildman
- Urinary System Physiology UnitMedway School of PharmacyUniversity of KentKentUnited Kingdom
| | | | - Jens Leipziger
- Department of Biomedicine, PhysiologyAarhus UniversityAarhus CDenmark
| | - David G. Shirley
- Centre for NephrologyUniversity College London Medical SchoolLondonUnited Kingdom
| | - Matthew A. Bailey
- British Heart Foundation Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUnited Kingdom
| | - Robert J. Unwin
- Centre for NephrologyUniversity College London Medical SchoolLondonUnited Kingdom
- CVRM iMEDAstraZeneca GothenburgGothenburgSweden
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11
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Menzies RI, Leask J, Royle J, MacIntyre CR. Vaccine myopia: adult vaccination also needs attention. Med J Aust 2018; 206:238-239. [PMID: 28358998 DOI: 10.5694/mja16.00811] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/31/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Jenny Royle
- NHMRC Centre of Research Excellence in Population Health Research, University of NSW, Sydney, NSW
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12
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Abstract
The rat has classically been the species of choice for pharmacological studies and disease modeling, providing a source of high-quality physiological data on cardiovascular and renal pathophysiology over many decades. Recent developments in genome engineering now allow us to capitalize on the wealth of knowledge acquired over the last century. Here, we review rat models of hypertension, diabetic nephropathy, and acute and chronic kidney disease. These models have made important contributions to our understanding of renal diseases and have revealed key genes, such as Ace and P2rx7, involved in renal pathogenic processes. By targeting these genes of interest, researchers are gaining a better understanding of the etiology of renal pathologies, with the promised potential of slowing disease progression or even reversing the damage caused. Some, but not all, of these target genes have proved to be of clinical relevance. However, it is now possible to generate more sophisticated and appropriate disease models in the rat, which can recapitulate key aspects of human renal pathology. These advances will ultimately be used to identify new treatments and therapeutic targets of much greater clinical relevance. Summary: This Review highlights the key role that the rat continues to play in improving our understanding of the etiologies of renal pathologies, and how these insights have opened up new therapeutic avenues.
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Affiliation(s)
- Linda J Mullins
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Bryan R Conway
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Robert I Menzies
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Laura Denby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - John J Mullins
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
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13
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Yin JK, Jayasinghe SH, Charles PG, King C, Chiu CK, Menzies RI, McIntyre PB. Determining the contribution of
Streptococcus pneumoniae
to community‐acquired pneumonia in Australia. Med J Aust 2017; 207:396-400. [DOI: 10.5694/mja16.01102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/01/2017] [Indexed: 11/17/2022]
Affiliation(s)
- J Kevin Yin
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Sanjay H Jayasinghe
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
- University of Sydney, Sydney, NSW
| | | | - Catherine King
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
| | - Clayton K Chiu
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
| | | | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
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14
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Menzies RI, Royle J, MacIntyre CR. Vaccine myopia: adult vaccination also needs attention. Med J Aust 2017; 207:407. [DOI: 10.5694/mja17.00677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 07/17/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Jenny Royle
- University of New South Wales, Sydney, NSW
- NEST Family Wellness Clinic, Melbourne, VIC
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15
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Menzies RI, Zhao X, Mullins LJ, Mullins JJ, Cairns C, Wrobel N, Dunbar DR, Bailey MA, Kenyon CJ. Transcription controls growth, cell kinetics and cholesterol supply to sustain ACTH responses. Endocr Connect 2017; 6:446-457. [PMID: 28720595 PMCID: PMC5574282 DOI: 10.1530/ec-17-0092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 01/29/2023]
Abstract
Chronic ACTH exposure is associated with adrenal hypertrophy and steroidogenesis. The underlying molecular processes in mice have been analysed by microarray, histological and immunohistochemical techniques. Synacthen infused for 2 weeks markedly increased adrenal mass and plasma corticosterone levels. Microarray analysis found greater than 2-fold changes in expression of 928 genes (P < 0.001; 397 up, 531 down). These clustered in pathways involved in signalling, sterol/lipid metabolism, cell proliferation/hypertrophy and apoptosis. Signalling genes included some implicated in adrenal adenomas but also upregulated genes associated with cyclic AMP and downregulated genes associated with aldosterone synthesis. Sterol metabolism genes were those promoting cholesterol supply (Scarb1, Sqle, Apoa1) and disposal (Cyp27a1, Cyp7b1). Oil red O staining showed lipid depletion consistent with reduced expression of genes involved in lipid synthesis. Genes involved in steroidogenesis (Star, Cyp11a1, Cyp11b1) were modestly affected (P < 0.05; <1.3-fold). Increased Ki67, Ccna2, Ccnb2 and Tk1 expression complemented immunohistochemical evidence of a 3-fold change in cell proliferation. Growth arrest genes, Cdkn1a and Cdkn1c, which are known to be active in hypertrophied cells, were increased >4-fold and cross-sectional area of fasciculata cells was 2-fold greater. In contrast, genes associated with apoptosis (eg Casp12, Clu,) were downregulated and apoptotic cells (Tunel staining) were fewer (P < 0.001) and more widely distributed throughout the cortex. In summary, long-term steroidogenesis with ACTH excess is sustained by genes controlling cholesterol supply and adrenal mass. ACTH effects on adrenal morphology and genes controlling cell hypertrophy, proliferation and apoptosis suggest the involvement of different cell types and separate molecular pathways.
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Affiliation(s)
- Robert I Menzies
- The University/BHF Centre for Cardiovascular ScienceUniversity of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - Xin Zhao
- The University/BHF Centre for Cardiovascular ScienceUniversity of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - Linda J Mullins
- The University/BHF Centre for Cardiovascular ScienceUniversity of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - John J Mullins
- The University/BHF Centre for Cardiovascular ScienceUniversity of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - Carolynn Cairns
- The University/BHF Centre for Cardiovascular ScienceUniversity of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - Nicola Wrobel
- The University/BHF Centre for Cardiovascular ScienceUniversity of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - Donald R Dunbar
- The University/BHF Centre for Cardiovascular ScienceUniversity of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - Matthew A Bailey
- The University/BHF Centre for Cardiovascular ScienceUniversity of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - Christopher J Kenyon
- The University/BHF Centre for Cardiovascular ScienceUniversity of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
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16
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Menzies RI, Booth JWR, Mullins JJ, Bailey MA, Tam FWK, Norman JT, Unwin RJ. Hyperglycemia-induced Renal P2X7 Receptor Activation Enhances Diabetes-related Injury. EBioMedicine 2017; 19:73-83. [PMID: 28434946 PMCID: PMC5440600 DOI: 10.1016/j.ebiom.2017.04.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/31/2017] [Accepted: 04/06/2017] [Indexed: 12/22/2022] Open
Abstract
Diabetes is a leading cause of renal disease. Glomerular mesangial expansion and fibrosis are hallmarks of diabetic nephropathy and this is thought to be promoted by infiltration of circulating macrophages. Monocyte chemoattractant protein-1 (MCP-1) has been shown to attract macrophages in kidney diseases. P2X7 receptors (P2X7R) are highly expressed on macrophages and are essential components of pro-inflammatory signaling in multiple tissues. Here we show that in diabetic patients, renal P2X7R expression is associated with severe mesangial expansion, impaired glomerular filtration (≤40ml/min/1.73sq.m.), and increased interstitial fibrosis. P2X7R activation enhanced the release of MCP-1 in human mesangial cells cultured under high glucose conditions. In mice, P2X7R-deficiency prevented glomerular macrophage attraction and collagen IV deposition; however, the more severe interstitial inflammation and fibrosis often seen in human diabetic kidney diseases was not modelled. Finally, we demonstrate that a P2X7R inhibitor (AZ11657312) can reduce renal macrophage accrual following the establishment of hyperglycemia in a model of diabetic nephropathy. Collectively these data suggest that P2X7R activation may contribute to the high prevalence of kidney disease found in diabetics.
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Affiliation(s)
- Robert I Menzies
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.
| | - John W R Booth
- UCL Centre for Nephrology, University College London, London, UK
| | - John J Mullins
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Matthew A Bailey
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Frederick W K Tam
- Imperial College Renal and Transplant Centre, Department of Medicine, Imperial College London, London, UK
| | - Jill T Norman
- UCL Centre for Nephrology, University College London, London, UK
| | - Robert J Unwin
- UCL Centre for Nephrology, University College London, London, UK; Cardiovascular and Metabolic Diseases (CVMD) iMed, AstraZeneca, Gothenburg, Sweden
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17
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Menzies RI, Tam FW, Unwin RJ, Bailey MA. Purinergic signaling in kidney disease. Kidney Int 2016; 91:315-323. [PMID: 27780585 DOI: 10.1016/j.kint.2016.08.029] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/10/2016] [Accepted: 08/15/2016] [Indexed: 02/04/2023]
Abstract
Nucleotides are key subunits for nucleic acids and provide energy for intracellular metabolism. They can also be released from cells to act physiologically as extracellular messengers or pathologically as danger signals. Extracellular nucleotides stimulate membrane receptors in the P2 and P1 family. P2X are ATP-activated cation channels; P2Y and P1 are G-protein coupled receptors activated by ATP, ADP, UTP, and UDP in the case of P2 or adenosine for P1. Renal P2 receptors influence both vascular contractility and tubular function. Renal cells also express ectonucleotidases that rapidly hydrolyze extracellular nucleotides. These enzymes integrate this multireceptor purinergic-signaling complex by determining the nucleotide milieu to titrate receptor activation. Purinergic signaling also regulates immune cell function by modulating the synthesis and release of various cytokines such as IL1-β and IL-18 as part of inflammasome activation. Abnormal or excessive stimulation of this intricate paracrine system can be pro- or anti-inflammatory, and is also linked to necrosis and apoptosis. Kidney tissue injury causes a localized increase in ATP concentration, and sustained activation of P2 receptors can lead to renal glomerular, tubular, and vascular cell damage. Purinergic receptors also regulate the activity and proliferation of fibroblasts, promoting both inflammation and fibrosis in chronic disease. In this short review we summarize some of the recent findings related to purinergic signaling in the kidney. We focus predominantly on the P2X7 receptor, discussing why antagonists have so far disappointed in clinical trials and how advances in our understanding of purinergic signaling might help to reposition these compounds as potential treatments for renal disease.
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Affiliation(s)
- Robert I Menzies
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Frederick W Tam
- Imperial College Renal and Transplant Centre, Department of Medicine, Imperial College London, UK
| | - Robert J Unwin
- Cardiovascular and Metabolic Diseases Biotech Unit, AstraZeneca Gothenburg, Sweden; UCL Centre for Nephrology, University College London, London, UK.
| | - Matthew A Bailey
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland, UK
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18
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Hull BP, Dey A, Beard FH, Menzies RI, Brotherton JM, McIntyre PB. Immunisation coverage annual report, 2013. Commun Dis Intell (2018) 2016; 40:E146-E169. [PMID: 27080022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Brynley P Hull
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and University of Sydney, New South Wales
| | - Aditi Dey
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and University of Sydney, New South Wales
| | - Frank H Beard
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and University of Sydney, New South Wales
| | - Robert I Menzies
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and University of Sydney, New South Wales
| | - Julia M Brotherton
- National HPV Vaccination Program Register, Victorian Cytology Service, East Melbourne, Victoria
| | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and University of Sydney, New South Wales
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19
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Evans LC, Ivy JR, Wyrwoll C, McNairn JA, Menzies RI, Christensen TH, Al-Dujaili EAS, Kenyon CJ, Mullins JJ, Seckl JR, Holmes MC, Bailey MA. Conditional Deletion of Hsd11b2 in the Brain Causes Salt Appetite and Hypertension. Circulation 2016; 133:1360-70. [PMID: 26951843 PMCID: PMC4819772 DOI: 10.1161/circulationaha.115.019341] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/12/2016] [Indexed: 11/30/2022]
Abstract
Supplemental Digital Content is available in the text. Background— The hypertensive syndrome of Apparent Mineralocorticoid Excess is caused by loss-of-function mutations in the gene encoding 11β-hydroxysteroid dehydrogenase type 2 (11βHSD2), allowing inappropriate activation of the mineralocorticoid receptor by endogenous glucocorticoid. Hypertension is attributed to sodium retention in the distal nephron, but 11βHSD2 is also expressed in the brain. However, the central contribution to Apparent Mineralocorticoid Excess and other hypertensive states is often overlooked and is unresolved. We therefore used a Cre-Lox strategy to generate 11βHSD2 brain-specific knockout (Hsd11b2.BKO) mice, measuring blood pressure and salt appetite in adults. Methods and Results— Basal blood pressure, electrolytes, and circulating corticosteroids were unaffected in Hsd11b2.BKO mice. When offered saline to drink, Hsd11b2.BKO mice consumed 3 times more sodium than controls and became hypertensive. Salt appetite was inhibited by spironolactone. Control mice fed the same daily sodium intake remained normotensive, showing the intrinsic salt resistance of the background strain. Dexamethasone suppressed endogenous glucocorticoid and abolished the salt-induced blood pressure differential between genotypes. Salt sensitivity in Hsd11b2.BKO mice was not caused by impaired renal sodium excretion or volume expansion; pressor responses to phenylephrine were enhanced and baroreflexes impaired in these animals. Conclusions— Reduced 11βHSD2 activity in the brain does not intrinsically cause hypertension, but it promotes a hunger for salt and a transition from salt resistance to salt sensitivity. Our data suggest that 11βHSD2-positive neurons integrate salt appetite and the blood pressure response to dietary sodium through a mineralocorticoid receptor–dependent pathway. Therefore, central mineralocorticoid receptor antagonism could increase compliance to low-sodium regimens and help blood pressure management in cardiovascular disease.
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Affiliation(s)
- Louise C Evans
- From British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, United Kingdom (L.C.E., J.R.I., C.W., J.A.M., R.I.M., T.H.C., C.J.K., J.J.M., J.R.S., M.C.H., M.A.B.); and Dietetics, Nutrition and Biological Sciences Department, Queen Margaret University, Edinburgh, United Kingdom (E.A.S.Al-D.). The current address for Dr Evans is Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee; the current address for Dr Wyrwoll is School of Anatomy, Physiology & Human Biology, The University of Western Australia, Crawley, Australia; and the current address for Dr Christensen is Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense
| | - Jessica R Ivy
- From British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, United Kingdom (L.C.E., J.R.I., C.W., J.A.M., R.I.M., T.H.C., C.J.K., J.J.M., J.R.S., M.C.H., M.A.B.); and Dietetics, Nutrition and Biological Sciences Department, Queen Margaret University, Edinburgh, United Kingdom (E.A.S.Al-D.). The current address for Dr Evans is Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee; the current address for Dr Wyrwoll is School of Anatomy, Physiology & Human Biology, The University of Western Australia, Crawley, Australia; and the current address for Dr Christensen is Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense
| | - Caitlin Wyrwoll
- From British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, United Kingdom (L.C.E., J.R.I., C.W., J.A.M., R.I.M., T.H.C., C.J.K., J.J.M., J.R.S., M.C.H., M.A.B.); and Dietetics, Nutrition and Biological Sciences Department, Queen Margaret University, Edinburgh, United Kingdom (E.A.S.Al-D.). The current address for Dr Evans is Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee; the current address for Dr Wyrwoll is School of Anatomy, Physiology & Human Biology, The University of Western Australia, Crawley, Australia; and the current address for Dr Christensen is Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense
| | - Julie A McNairn
- From British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, United Kingdom (L.C.E., J.R.I., C.W., J.A.M., R.I.M., T.H.C., C.J.K., J.J.M., J.R.S., M.C.H., M.A.B.); and Dietetics, Nutrition and Biological Sciences Department, Queen Margaret University, Edinburgh, United Kingdom (E.A.S.Al-D.). The current address for Dr Evans is Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee; the current address for Dr Wyrwoll is School of Anatomy, Physiology & Human Biology, The University of Western Australia, Crawley, Australia; and the current address for Dr Christensen is Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense
| | - Robert I Menzies
- From British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, United Kingdom (L.C.E., J.R.I., C.W., J.A.M., R.I.M., T.H.C., C.J.K., J.J.M., J.R.S., M.C.H., M.A.B.); and Dietetics, Nutrition and Biological Sciences Department, Queen Margaret University, Edinburgh, United Kingdom (E.A.S.Al-D.). The current address for Dr Evans is Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee; the current address for Dr Wyrwoll is School of Anatomy, Physiology & Human Biology, The University of Western Australia, Crawley, Australia; and the current address for Dr Christensen is Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense
| | - Thorbjørn H Christensen
- From British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, United Kingdom (L.C.E., J.R.I., C.W., J.A.M., R.I.M., T.H.C., C.J.K., J.J.M., J.R.S., M.C.H., M.A.B.); and Dietetics, Nutrition and Biological Sciences Department, Queen Margaret University, Edinburgh, United Kingdom (E.A.S.Al-D.). The current address for Dr Evans is Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee; the current address for Dr Wyrwoll is School of Anatomy, Physiology & Human Biology, The University of Western Australia, Crawley, Australia; and the current address for Dr Christensen is Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense
| | - Emad A S Al-Dujaili
- From British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, United Kingdom (L.C.E., J.R.I., C.W., J.A.M., R.I.M., T.H.C., C.J.K., J.J.M., J.R.S., M.C.H., M.A.B.); and Dietetics, Nutrition and Biological Sciences Department, Queen Margaret University, Edinburgh, United Kingdom (E.A.S.Al-D.). The current address for Dr Evans is Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee; the current address for Dr Wyrwoll is School of Anatomy, Physiology & Human Biology, The University of Western Australia, Crawley, Australia; and the current address for Dr Christensen is Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense
| | - Christopher J Kenyon
- From British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, United Kingdom (L.C.E., J.R.I., C.W., J.A.M., R.I.M., T.H.C., C.J.K., J.J.M., J.R.S., M.C.H., M.A.B.); and Dietetics, Nutrition and Biological Sciences Department, Queen Margaret University, Edinburgh, United Kingdom (E.A.S.Al-D.). The current address for Dr Evans is Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee; the current address for Dr Wyrwoll is School of Anatomy, Physiology & Human Biology, The University of Western Australia, Crawley, Australia; and the current address for Dr Christensen is Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense
| | - John J Mullins
- From British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, United Kingdom (L.C.E., J.R.I., C.W., J.A.M., R.I.M., T.H.C., C.J.K., J.J.M., J.R.S., M.C.H., M.A.B.); and Dietetics, Nutrition and Biological Sciences Department, Queen Margaret University, Edinburgh, United Kingdom (E.A.S.Al-D.). The current address for Dr Evans is Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee; the current address for Dr Wyrwoll is School of Anatomy, Physiology & Human Biology, The University of Western Australia, Crawley, Australia; and the current address for Dr Christensen is Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense
| | - Jonathan R Seckl
- From British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, United Kingdom (L.C.E., J.R.I., C.W., J.A.M., R.I.M., T.H.C., C.J.K., J.J.M., J.R.S., M.C.H., M.A.B.); and Dietetics, Nutrition and Biological Sciences Department, Queen Margaret University, Edinburgh, United Kingdom (E.A.S.Al-D.). The current address for Dr Evans is Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee; the current address for Dr Wyrwoll is School of Anatomy, Physiology & Human Biology, The University of Western Australia, Crawley, Australia; and the current address for Dr Christensen is Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense
| | - Megan C Holmes
- From British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, United Kingdom (L.C.E., J.R.I., C.W., J.A.M., R.I.M., T.H.C., C.J.K., J.J.M., J.R.S., M.C.H., M.A.B.); and Dietetics, Nutrition and Biological Sciences Department, Queen Margaret University, Edinburgh, United Kingdom (E.A.S.Al-D.). The current address for Dr Evans is Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee; the current address for Dr Wyrwoll is School of Anatomy, Physiology & Human Biology, The University of Western Australia, Crawley, Australia; and the current address for Dr Christensen is Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense
| | - Matthew A Bailey
- From British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, United Kingdom (L.C.E., J.R.I., C.W., J.A.M., R.I.M., T.H.C., C.J.K., J.J.M., J.R.S., M.C.H., M.A.B.); and Dietetics, Nutrition and Biological Sciences Department, Queen Margaret University, Edinburgh, United Kingdom (E.A.S.Al-D.). The current address for Dr Evans is Department of Physiology, Cardiovascular Center, Medical College of Wisconsin, Milwaukee; the current address for Dr Wyrwoll is School of Anatomy, Physiology & Human Biology, The University of Western Australia, Crawley, Australia; and the current address for Dr Christensen is Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense.
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Menzies RI, Howarth AR, Unwin RJ, Tam FWK, Mullins JJ, Bailey MA. Inhibition of the purinergic P2X7 receptor improves renal perfusion in angiotensin-II-infused rats. Kidney Int 2015; 88:1079-87. [PMID: 26108066 DOI: 10.1038/ki.2015.182] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/19/2015] [Accepted: 04/23/2015] [Indexed: 12/14/2022]
Abstract
Chronic activation of the renin-angiotensin system promotes hypertension, renal microvascular dysfunction, tissue hypoxia, and inflammation. Despite similar hypertension, an injurious response to excess angiotensin II is greater in F344 than in Lewis rats; the latter displaying renoprotection. Here we studied whether p2rx7, encoding the P2X7 receptor (P2X7R), is a candidate gene for the differential susceptibility to vascular dysfunction under high angiotensin II tone. A 14-day infusion of angiotensin II into F344 rats increased blood pressure by about 15 mm Hg without inducing fibrosis or albuminuria. In vivo pressure natriuresis was suppressed, medullary perfusion reduced by half, and the corticomedullary oxygenation gradient disrupted. Selective P2X7R antagonism restored pressure natriuresis, promoting a significant leftward shift in the intercept and increasing the slope. Sodium excretion was increased sixfold and blood pressure normalized. The specific P2X7R antagonist AZ11657312 increased renal medullary perfusion, but only in angiotensin II-treated rats. Tissue oxygenation was improved by P2X7R blockade, particularly in poorly oxygenated regions of the kidney. Thus, activation of P2X7R induces microvascular dysfunction and regional hypoxia when angiotensin II is elevated and these effects may contribute to progression of renal injury induced by chronic angiotensin II.
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Affiliation(s)
- Robert I Menzies
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.,Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | - Amelia R Howarth
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Robert J Unwin
- Cardiovascular and Metabolic Diseases (iMed CVMD) R&D, AstraZeneca, Mölndal, Sweden.,UCL Centre for Nephrology, University College London, London, UK
| | - Frederick W K Tam
- Imperial College Renal and Transplant Centre, Department of Medicine, Imperial College London, London, UK
| | - John J Mullins
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Matthew A Bailey
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
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21
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Menzies RI, Jardine A, McIntyre PB. Pneumonia in Elderly Australians: Reduction in Presumptive Pneumococcal Hospitalizations but No Change in All-Cause Pneumonia Hospitalizations Following 7-Valent Pneumococcal Conjugate Vaccination. Clin Infect Dis 2015; 61:927-33. [PMID: 26066319 DOI: 10.1093/cid/civ429] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/31/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies evaluating long-term trends in hospitalizations coded as pneumonia following introduction of the 7-valent pneumococcal vaccine (PCV7) are sparse, especially in adults. We extended our previous analysis to 6.5 years after the "3 + 0" PCV7 schedule was introduced in Australia in 2005. METHODS We estimated vaccine impact on hospitalizations coded as pneumonia (pneumococcal/lobar, other specified, unspecified, and all-cause) using a multivariate negative binomial regression model of monthly hospitalization rates by age group for the pre-PCV7 (July 1998 to December 2004) and post-PCV7 (January 2005 to June 2011) periods, adjusting for vaccination coverage. Changes in pneumonia hospitalizations were measured as incidence rate ratios. RESULTS A total of 791 000 hospitalizations coded as pneumonia were identified; unspecified causes accounted for >85%. Reductions in pneumonia coded as pneumococcal/lobar were statistically significant in all age groups and greatest in children. Significant reductions in all-cause pneumonia were seen only in children aged <2 years (32%; 95% confidence interval [CI], 28%-37%) and 2-4 years (20%; 95% CI, 14%-27%), with no significant changes in other age groups, including adults aged 65-74 (4%; 95% CI, -3% to 10%), 75-84 (2%; 95% CI, -4% to 9%), and ≥85 years (3%; 95% CI, -3% to 10%). CONCLUSIONS We could not replicate reductions of 23% in all-cause pneumonia 7-9 years post-PCV7 introduction reported for adults aged ≥85 years in the United States. This could be attributable to vaccine program factors, differing proportions of pneumonia due to pneumococci, or data limitations. More data from countries with differing PCV schedules and from the PCV13 era are needed to inform vaccination strategies for elderly adults.
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Affiliation(s)
- Robert I Menzies
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney Sydney Medical School, University of Sydney
| | - Andrew Jardine
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney National Centre for Epidemiology and Population Health, Australian National University, Canberra
| | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney Sydney Medical School, University of Sydney
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22
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Ward KF, Trent M, Hull BP, Quinn HE, Dey A, Menzies RI. Evaluating the implementation of the 13-valent pneumococcal vaccine supplementary dose program in Australian primary health care settings. BMC Health Serv Res 2015; 15:109. [PMID: 25889782 PMCID: PMC4404082 DOI: 10.1186/s12913-015-0738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 02/12/2015] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The availability of new pneumococcal conjugate vaccines covering a broader range of serotypes, has seen many countries introduce these into their national immunisation program. When transitioning from 7-valent to 13-valent pneumococcal conjugate vaccines, Australia is one of a small number of countries that included a supplementary dose of the 13-valent pneumococcal conjugate vaccine to offer protection against additional serotypes to an expanded age group of children. An evaluation of the implementation and uptake of the 13-valent pneumococcal conjugate vaccine supplementary dose was undertaken in two local health districts (LHDs) in New South Wales, Australia. METHODS A self-administered postal survey of immunisation providers in the Northern New South Wales and Mid North Coast LHDs. Trends in vaccine ordering were examined. Coverage was assessed using data from the Australian Childhood Immunisation Register (ACIR). RESULTS Of the 177 surveys sent, 125 were returned (70%). Almost all providers (96%) were aware of the 13vPCV supplementary dose program though took an opportunistic approach to program promotion and parental reminders. Supplementary doses of 13vPCV were ordered for 37% of the eligible cohort, mostly in the program's first six months. Coverage as recorded on the ACIR was 27%, though was lower in older children and those not due for scheduled childhood vaccines. Of the children who received the 13vPCV supplementary dose, 3% received it at the same time as vaccines due at 12-months of age, and 44% at the time of those due at 18-months of age. CONCLUSION Despite the high awareness of the program, reported coverage was lower than that for other PCV supplementary dose programs in Australia and internationally. This may be influenced by providers' largely opportunistic approach to implementation, under-reporting to the ACIR or vaccine uptake. Lessons learned from this evaluation are relevant for future time-limited childhood vaccination programs. Prior to commencement, providers should be informed about the importance of catch-up/supplementary vaccination for their patients and their active role in promoting this. They should also receive program information before parents. An understanding of parental reasons for non-receipt of time-limited childhood vaccines and evaluation of the effect of aligning supplementary (or catch up) vaccination programs with the NIP schedule would be useful to inform future programs.
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Affiliation(s)
- Kirsten F Ward
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia.
| | - Marianne Trent
- North Coast Public Health Unit, 31 Uralba Street, Lismore, NSW, 2480, Australia.
| | - Brynley P Hull
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia.
| | - Helen E Quinn
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia. .,Discipline of Paediatrics and Child Health, University of Sydney, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia.
| | - Aditi Dey
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia. .,Discipline of Paediatrics and Child Health, University of Sydney, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia.
| | - Robert I Menzies
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia. .,Discipline of Paediatrics and Child Health, University of Sydney, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia.
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23
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Menzies RI, Krause VL, McIntyre PB. Impact of pneumococcal polysaccharide vaccine in people aged 65 years or older. Med J Aust 2014; 201:200. [DOI: 10.5694/mja14.00399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/21/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Robert I Menzies
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW
| | - Vicki L Krause
- Centre for Disease Control, Department of Health, Darwin, NT
| | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW
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24
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Menzies RI, Jayasinghe SH, Krause VL, Chiu CK, McIntyre PB. Impact of pneumococcal polysaccharide vaccine in people aged 65 years or older. Med J Aust 2014; 200:112-5. [PMID: 24484116 DOI: 10.5694/mja12.11759] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 12/11/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the impact and effectiveness of the 23-valent polysaccharide pneumococcal vaccine (23vPPV) in ≥ 65-year-old Australians in the context of concurrent 7-valent pneumococcal conjugate vaccine (7vPCV) use in infants. DESIGN, PATIENTS AND SETTING Ecological analysis of trends in invasive pneumococcal disease (IPD) notification rates and vaccine effectiveness estimation using the screening method, using data on Australians aged ≥ 65 years (23vPPV funded) and 50-64 years (23vPPV not funded). INTERVENTION National 23vPPV program for people aged ≥ 65 years and national 7vPCV program for infants, both commencing in 2005. MAIN OUTCOME MEASURES IPD incidence rate ratios, 2002-2004 to 2010-2011, and 23vPPV effectiveness against 23vPPV-type IPD. RESULTS The proportion of people aged ≥ 65 years who were vaccinated within the previous 5 years in jurisdictions excluding Victoria ranged from 41% to 64% over the study period, with no clear trend over time. Incidence rate ratios in the ≥ 65-year age group were 0.11 (95% CI, 0.09-0.14) for 7vPCV serotypes, 1.64 (95% CI, 1.41-1.91) for 23vPPV-non-7vPCV serotypes and 2.07 (95% CI, 1.67-2.57) for non-23vPPV serotypes. The incidence rate ratio for total IPD was 0.65 (95% CI, 0.59-0.71) for people aged ≥ 65 years, and 0.80 (0.71-0.90) for people aged 50-64 years. The estimate of 23vPPV effectiveness was 61.1% (95% CI, 55.1%-66.9%). CONCLUSIONS The greater reduction in IPD among ≥ 65-year-olds compared with 50-64-year-olds did not reach statistical significance. However, vaccine effectiveness was significant. Greater reductions in IPD in ≥ 65-year-olds would be expected from the indirect effects of using 13-valent pneumococcal conjugate vaccine in infants (introduced for Australian infants in 2011) and an increase in 23vPPV coverage.
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Affiliation(s)
- Robert I Menzies
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia.
| | - Sanjay H Jayasinghe
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia
| | - Vicki L Krause
- Centre for Disease Control, Department of Health, Darwin, NT, Australia
| | - Clayton K Chiu
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Peter B McIntyre
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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25
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Menzies RI, Unwin RJ, Dash RK, Beard DA, Cowley AW, Carlson BE, Mullins JJ, Bailey MA. Effect of P2X4 and P2X7 receptor antagonism on the pressure diuresis relationship in rats. Front Physiol 2013; 4:305. [PMID: 24187541 PMCID: PMC3807716 DOI: 10.3389/fphys.2013.00305] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 10/03/2013] [Indexed: 12/31/2022] Open
Abstract
Reduced glomerular filtration, hypertension and renal microvascular injury are hallmarks of chronic kidney disease, which has a global prevalence of ~10%. We have shown previously that the Fischer (F344) rat has lower GFR than the Lewis rat, and is more susceptible to renal injury induced by hypertension. In the early stages this injury is limited to the pre-glomerular vasculature. We hypothesized that poor renal hemodynamic function and vulnerability to vascular injury are causally linked and genetically determined. In the present study, normotensive F344 rats had a blunted pressure diuresis relationship, compared with Lewis rats. A kidney microarray was then interrogated using the Endeavour enrichment tool to rank candidate genes for impaired blood pressure control. Two novel candidate genes, P2rx7 and P2rx4, were identified, having a 7− and 3− fold increased expression in F344 rats. Immunohistochemistry localized P2X4 and P2X7 receptor expression to the endothelium of the pre-glomerular vasculature. Expression of both receptors was also found in the renal tubule; however there was no difference in expression profile between strains. Brilliant Blue G (BBG), a relatively selective P2X7 antagonist suitable for use in vivo, was administered to both rat strains. In Lewis rats, BBG had no effect on blood pressure, but increased renal vascular resistance, consistent with inhibition of some basal vasodilatory tone. In F344 rats BBG caused a significant reduction in blood pressure and a decrease in renal vascular resistance, suggesting that P2X7 receptor activation may enhance vasoconstrictor tone in this rat strain. BBG also reduced the pressure diuresis threshold in F344 rats, but did not alter its slope. These preliminary findings suggest a physiological and potential pathophysiological role for P2X7 in controlling renal and/or systemic vascular function, which could in turn affect susceptibility to hypertension-related kidney damage.
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Affiliation(s)
- Robert I Menzies
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh Edinburgh, UK
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26
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Menzies RI, Zammit-Mangion A, Hollis LM, Lennen RJ, Jansen MA, Webb DJ, Mullins JJ, Dear JW, Sanguinetti G, Bailey MA. An anatomically unbiased approach for analysis of renal BOLD magnetic resonance images. Am J Physiol Renal Physiol 2013; 305:F845-52. [DOI: 10.1152/ajprenal.00113.2013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Oxygenation defects may contribute to renal disease progression, but the chronology of events is difficult to define in vivo without recourse to invasive methodologies. Blood oxygen level-dependent magnetic resonance imaging (BOLD MRI) provides an attractive alternative, but the R2* signal is physiologically complex. Postacquisition data analysis often relies on manual selection of region(s) of interest. This approach excludes from analysis significant quantities of biological information and is subject to selection bias. We present a semiautomated, anatomically unbiased approach to compartmentalize voxels into two quantitatively related clusters. In control F344 rats, low R2* clustering was located predominantly within the cortex and higher R2* clustering within the medulla (70.96 ± 1.48 vs. 79.00 ± 1.50; 3 scans per rat; n = 6; P < 0.01) consistent anatomically with a cortico-medullary oxygen gradient. An intravenous bolus of acetylcholine caused a transient reduction of the R2* signal in both clustered segments ( P < 0.01). This was nitric oxide dependent and temporally distinct from the hemodynamic effects of acetylcholine. Rats were then chronically infused with angiotensin II (60 ng/min) and rescanned 3 days later. Clustering demonstrated a disruption of the cortico-medullary gradient, producing less distinctly segmented mean R2* clusters (71.30 ± 2.00 vs. 72.48 ± 1.27; n = 6; NS). The acetylcholine-induced attenuation of the R2* signal was abolished by chronic angiotensin II infusion, consistent with reduced nitric oxide bioavailability. This global map of oxygenation, defined by clustering individual voxels on the basis of quantitative nearness, might be more robust in defining deficits in renal oxygenation than the absolute magnitude of R2* in small, manually selected regions of interest defined exclusively by anatomical nearness.
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Affiliation(s)
- Robert I. Menzies
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom; and
| | | | - Lyam M. Hollis
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom; and
| | - Ross J. Lennen
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom; and
| | - Maurits A. Jansen
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom; and
| | - David J. Webb
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom; and
| | - John J. Mullins
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom; and
| | - James W. Dear
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom; and
| | - Guido Sanguinetti
- School of Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Matthew A. Bailey
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom; and
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27
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Menzies RI, Markey P, Boyd R, Koehler AP, McIntyre PB. No evidence of increasing Haemophilus influenzae non-b infection in Australian Aboriginal children. Int J Circumpolar Health 2013; 72:20992. [PMID: 23984279 PMCID: PMC3753125 DOI: 10.3402/ijch.v72i0.20992] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND High, or increasing, rates of invasive Haemophilus influenzae (Hi) type a disease have been reported from North American native children from circumpolar regions, raising the question of serotype replacement being driven by vaccination against Hi type b (Hib). Indigenous Australians from remote areas had high rates of invasive Hib disease in the past, comparable to those in North American Indigenous populations. OBJECTIVE Evaluate incidence rates of invasive Hi (overall and by serotype) in Indigenous Australian children over time. DESIGN Descriptive study of Hi incidence rates by serotype, in the Northern Territory (NT) and South Australia (SA) from 2001 to 2011. Comparison of NT data with a study that was conducted in the NT in 1985-1988, before Hib vaccine was introduced. RESULTS The average annual rate of invasive Hi type a (Hia) disease in Indigenous children aged < 5 years was 11/100,000 population. Although the incidence of Hi infection in Indigenous children in 2001-2003 was lower than during 2004-2011, this may be due to changes in surveillance. No other trend over time in individual serotypes or total invasive Hi disease, in Indigenous or non-Indigenous people, was identified. Compared to 1985-1988, rates in 2001-2011 were lower in all serotype groupings, by 98% for Hib, 75% for Hia, 79% for other serotypes and 67% for non-typeable Hi. CONCLUSIONS There is no evidence of increases in invasive disease due to Hia, other specific non-b types, or non-typeable Hi in Australian Indigenous children. These data suggest that the increase in Hia some time after the introduction of Hib vaccine, as seen in the North American Arctic Region, is not common to all populations with high pre-vaccine rates of invasive Hib disease. However, small case numbers and the lack of molecular subtyping and PCR confirmation of pre-vaccine results complicate comparisons with North American epidemiology.
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Affiliation(s)
- Robert I Menzies
- The National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Sydney, New South Wales, Australia.
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Gao Z, Wood JG, Burgess MA, Menzies RI, McIntyre PB, MacIntyre CR. Models of strategies for control of rubella and congenital rubella syndrome—A 40 year experience from Australia. Vaccine 2013. [DOI: 10.1016/j.vaccine.2012.11.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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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Mahajan D, Reid S, Cook J, Macartney K, Menzies RI. NSW annual report describing adverse events following immunisation, 2011. N S W Public Health Bull 2012; 23:187-200. [PMID: 23442996 DOI: 10.1071/nb12081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM This report summarises Australian passive surveillance data for adverse events following immunisation in NSW for 2011. METHODS Analysis of de-identified information on all adverse events following immunisation reported to the Therapeutic Goods Administration. RESULTS 449 adverse events following immunisation were reported for vaccines administered in 2011; this is slightly higher than in 2010 (n=439) and the second highest number since 2003. The most commonly reported reactions were injection site reaction, fever, allergic reaction and malaise. A large number of injection site reactions were reported following administration of the 23-valent pneumococcal polysaccharide vaccine in adults aged 65 years and over (97.4/100000 doses) and in children aged less than 7 years following administration of the 13-valent pneumococcal conjugate vaccine (29.4/100000 doses) and combined diphtheria, tetanus, pertussis (acellular) and inactivated poliovirus (quadrivalent)-containing vaccines (47.1/100000 doses). Only 10% of the reported adverse events were categorised as serious. There were two reports of death however both were attributed to causes other than vaccination. CONCLUSION The increased number of reports in 2011 is attributable to the high rates of injection site reactions in children associated with the administration of combined diphtheria, tetanus, pertussis (acellular) and inactivated poliovirus (quadrivalent)-containing vaccines and the 13-valent pneumococcal conjugate vaccine, as well as in adults following receipt of the 23-valent pneumococcal polysaccharide vaccine.
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Affiliation(s)
- Deepika Mahajan
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead.
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Menzies RI, Burgess M, Durrheim DN. Controlling measles in NSW: how are we doing in the context of other countries in the Western Pacific? N S W Public Health Bull 2012; 23:169-170. [PMID: 23442993 DOI: 10.1071/nb12080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Robert I Menzies
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead.
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Abstract
UNLABELLED This annual report, the third in the series, documents trends in immunisation coverage in NSW for children, adolescents and the elderly, to the end of 2011. METHODS Data from the Australian Childhood Immunisation Register, the NSW School Immunisation Program and the NSW Population Health Survey were used to calculate various measures of population coverage. RESULTS During 2011, greater than 90% coverage was maintained for children at 12 and 24 months of age. For children at 5 years of age the improvement seen in 2010 was sustained, with coverage at or near 90%. For adolescents, there was improved coverage for all doses of human papillomavirus vaccine, both doses of hepatitis B vaccine, varicella vaccine and the dose of diphtheria, tetanus and acellular pertussis given to school attendees in Years 7 and 10. Pneumococcal vaccination coverage in the elderly has been steadily rising, although it has remained lower than the influenza coverage estimates. CONCLUSION This report provides trends in immunisation coverage in NSW across the age spectrum. The inclusion of coverage estimates for the pneumococcal conjugate, varicella and meningococcal C vaccines in the official coverage assessments for 'fully immunised' in 2013 is a welcome initiative.
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Affiliation(s)
- Brynley Hull
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead.
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Ashek A, Menzies RI, Mullins LJ, Bellamy COC, Harmar AJ, Kenyon CJ, Flatman PW, Mullins JJ, Bailey MA. Activation of thiazide-sensitive co-transport by angiotensin II in the cyp1a1-Ren2 hypertensive rat. PLoS One 2012; 7:e36311. [PMID: 22558431 PMCID: PMC3338649 DOI: 10.1371/journal.pone.0036311] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 04/02/2012] [Indexed: 12/02/2022] Open
Abstract
Transgenic rats with inducible expression of the mouse Ren2 gene were used to elucidate mechanisms leading to the development of hypertension and renal injury. Ren2 transgene activation was induced by administration of a naturally occurring aryl hydrocarbon, indole-3-carbinol (100 mg/kg/day by gastric gavage). Blood pressure and renal parameters were recorded in both conscious and anesthetized (butabarbital sodium; 120 mg/kg IP) rats at selected time-points during the development of hypertension. Hypertension was evident by the second day of treatment, being preceded by reduced renal sodium excretion due to activation of the thiazide-sensitive sodium-chloride co-transporter. Renal injury was evident after the first day of transgene induction, being initially limited to the pre-glomerular vasculature. Mircoalbuminuria and tubuloinsterstitial injury developed once hypertension was established. Chronic treatment with either hydrochlorothiazide or an AT1 receptor antagonist normalized sodium reabsorption, significantly blunted hypertension and prevented renal injury. Urinary aldosterone excretion was increased ∼20 fold, but chronic mineralocorticoid receptor antagonism with spironolactone neither restored natriuretic capacity nor prevented hypertension. Spironolactone nevertheless ameliorated vascular damage and prevented albuminuria. This study finds activation of sodium-chloride co-transport to be a key mechanism in angiotensin II-dependent hypertension. Furthermore, renal vascular injury in this setting reflects both barotrauma and pressure-independent pathways associated with direct detrimental effects of angiotensin II and aldosterone.
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Affiliation(s)
- Ali Ashek
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Robert I. Menzies
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Linda J. Mullins
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom
| | | | - Anthony J. Harmar
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Christopher J. Kenyon
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Peter W. Flatman
- Centre for Integrative Physiology, The University of Edinburgh, Edinburgh, United Kingdom
| | - John J. Mullins
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Matthew A. Bailey
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
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Hull B, Dey A, Campbell-Lloyd S, Menzies RI, McIntyre PB. NSW annual immunisation coverage report, 2010. N S W Public Health Bull 2012; 22:179-95. [PMID: 22060056 DOI: 10.1071/nb11021] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED This annual report, the second in the series, documents trends in immunisation coverage in NSW for children, adolescents and the elderly, to the end of 2010. METHODS Data from the Australian Childhood Immunisation Register, the NSW School Immunisation Program and the NSW Population Health Survey were used to calculate various measures of population coverage, coverage for Aboriginal children and vaccination timeliness for all children. RESULTS Over 90% coverage has been reached for children at 12 and 24 months of age. For children at 5 years of age there was an improvement during 2010 in timeliness for vaccines due at 4 years and coverage almost reached 90%. Delayed receipt of vaccines is still an issue for Aboriginal children. For adolescents, there is good coverage for the first and second doses of human papillomavirus vaccine and the dose of diphtheria, tetanus and acellular pertussis. The pneumococcal vaccination rate in the elderly has been steadily rising, although it has remained lower than the influenza coverage estimates. CONCLUSION Completion of the recommended immunisation schedule at the earliest appropriate age should be the next public health goal at both the state and local health district level. Official coverage assessments for 'fully immunised' should include the 7-valent pneumococcal conjugate and meningococcal C vaccines, and wider dissemination should be considered.
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Affiliation(s)
- Brynley Hull
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead.
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Quinn HE, Mahajan D, Hueston L, Campbell P, Menzies RI, Gilbert GL, McIntyre PB. The seroepidemiology of pertussis in NSW: fluctuating immunity profiles related to changes in vaccination schedules. N S W Public Health Bull 2011; 22:224-229. [PMID: 22243639 DOI: 10.1071/nb11023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The pertussis epidemic experienced in NSW in 2008-2009 was likely to be in part due to changes in diagnostic practice since 2007, which amplified disease notifications. We used population-based seroepidemiology as a less biased means of interpreting age-specific pertussis infection patterns in NSW from three serosurveys undertaken in 1997-98 (during an epidemic), 2002 (post-epidemic) and 2007 (inter-epidemic), using a standardised pertussis toxin IgG enzyme-linked immunosorbent assay (ELISA). There was a decrease in the proportion of high anti-pertussis toxin IgG titres (>62.5ELISAUnits/mL) across all age groups in the 2007 serosurvey compared to the previous two serosurveys. In the 2007 serosurvey, the proportion of undetectable (<5ELISAUnits/mL) anti-pertussis toxin IgG titres increased in many age groups. The seroepidemiological profiles of the three serosurveys demonstrate fluctuating immunity profiles related to changes in vaccination schedules.
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Affiliation(s)
- Helen E Quinn
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead.
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35
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Mahajan D, Campbell-Lloyd S, Cook J, Menzies RI. NSW annual report describing adverse events following immunisation, 2010. N S W Public Health Bull 2011; 22:196-208. [PMID: 22060057 DOI: 10.1071/nb11024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM This report summarises Australian passive surveillance data for adverse events following immunisation in NSW for 2010. METHODS Analysis of de-identified information on all adverse events following immunisation reported to the Therapeutic Goods Administration. RESULTS 424 adverse events following immunisation were reported for vaccines administered in 2010; this is 6% lower than 2009 but 24% higher than 2008 and the second highest number since 2003. A total of 274 (65%) adverse events involved seasonal or pandemic influenza vaccines. Reports were predominantly of mild transient events: the most commonly reported reactions were fever, allergic reaction, injection site reaction, malaise and headache. Only 9% of the reported adverse events were serious in nature, including eight reports of febrile convulsions in children following seasonal influenza vaccine. CONCLUSION The large number of reports in 2010 is attributable to the high rates of fever and febrile convulsions in children after vaccination with 2010 seasonal trivalent influenza vaccine, as well as pandemic (H1N1) 2009 influenza vaccine.
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Affiliation(s)
- Deepika Mahajan
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead.
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36
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Street JM, Birkhoff W, Menzies RI, Webb DJ, Bailey MA, Dear JW. Exosomal transmission of functional aquaporin 2 in kidney cortical collecting duct cells. J Physiol 2011; 589:6119-27. [PMID: 22025668 DOI: 10.1113/jphysiol.2011.220277] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Exosomes are vesicles released following fusion of endosomes with the plasma membrane. Urine contains exosomes that are released from the entire length of the nephron and change in composition with kidney disease. Exosomes can shuttle information between non-renal cells via transfer of protein and RNA. In this study murine kidney collecting duct (mCCDC11) cells were used to demonstrate that exosomes can act as a signalling mechanism between cells. First, the release of exosomes by mCCDC11 cells was confirmed by multiple approaches. Following isopynic centrifugation, exosomal proteins flotillin-1 and TSG101 were identified in fractions consistent with exosomes. Electron microscopy demonstrated structures consistent in size and shape with exosomes. Exposure of mCCDC11 cells to the synthetic vasopressin analogue, desmopressin, did not affect exosomal flotillin-1 or TSG101 but increased aquaporin 2 (AQP2) in a dose- and time-dependent manner that was highly correlated with cellular AQP2 (exosomal AQP2 vs. cellular AQP2, Pearson correlation coefficient r = 0.93). To test whether the ratio of exosomal AQP2/flotillin-1 is under physiological control in vivo, rats were treated with desmopressin. The ratio of AQP2/flotillin-1 in the urinary exosome was significantly increased. Inter-cellular signalling by exosomes was demonstrated: exosomes from desmopressin-treated cells stimulated both AQP2 expression and water transport in untreated mCCDc11 cells (water flow across cells: control exosome treatment 52.8 ± 11 μl cm(-2); AQP2-containing exosomes 77.4 ± 4 μl cm(-2), P = 0.05, n = 4). In summary, the amount of AQP2 in exosomes released from collecting duct cells is physiologically regulated and exosomal AQP2 closely reflects cellular expression. Exosomes can transfer functional AQP2 between cells and this represents a novel physiological mechanism for cell-to-cell communication within the kidney.
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Affiliation(s)
- Jonathan M Street
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, UK
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Hull B, Dey A, Mahajan D, Campbell-Lloyd S, Menzies RI, McIntyre PB. NSW Annual Immunisation Coverage Report, 2009. N S W Public Health Bull 2011; 21:210-23. [PMID: 21211474 DOI: 10.1071/nb10045] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This is the first in a series of annual immunisation coverage reports that document trends in NSW for a range of standard measures derived from Australian Childhood Immunisation Register data, including overall coverage at standard age milestones and for individual vaccines. This report includes data up to and including 2009. METHODS Data from the Australian Childhood Immunisation Register, the NSW Health Survey and the NSW School Immunisation Program were used to calculate various measures of population coverage relating to childhood vaccines, adult influenza and pneumococcal vaccines and adolescent vaccination, respectively. RESULTS Immunise Australia Program targets have been reached for children at 12 and 24 months of age but not for children at 5 years of age. Delayed receipt of vaccines is an issue for vaccines recommended for Aboriginal children. Pneumococcal vaccination in the elderly has been steadily rising, although it has remained lower than the influenza coverage estimates. For adolescents, there is better coverage for the first and second doses of human papillomavirus vaccine and the dose of dTpa than for varicella. CONCLUSION This comprehensive analysis provides important baseline data for NSW against which future reports can be compared to monitor progress in improving immunisation coverage. Immunisation at the earliest appropriate age should be a public health goal for countries such as Australia where high levels of vaccine coverage at milestone ages have been achieved.
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Affiliation(s)
- Brynley Hull
- National Centre for Immunisation Research and Surveillance,The Children's Hospital at Westmead.
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Mahajan D, Campbell-Lloyd S, Roomiani I, Menzies RI. NSW Annual Adverse Events Following Immunisation Report, 2009. N S W Public Health Bull 2010; 21:224-233. [PMID: 21211475 DOI: 10.1071/nb10048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM This is the first annual report for NSW of adverse events following immunisation. It summarises Australian passive surveillance data for adverse events following immunisation for NSW for 2009. METHODS Analysis of de-identified information on all adverse events following immunisation reported to the Therapeutic Goods Administration. RESULTS 450 adverse events following immunisation were reported for vaccines administered in 2009; this is 32% higher than 2008 and the highest since 2003. The increase was almost entirely attributed to the commencement of the pandemic (H1N1) 2009 influenza vaccine in September 2009. Only 6% of the reported adverse events were serious in nature and the most commonly reported reactions were allergic reaction, injection site reaction, fever and headache. CONCLUSION Reports of adverse events following immunisation in 2009 were dominated by the pandemic (H1N1) 2009 influenza vaccine. A large proportion of these adverse events were reported directly to the Therapeutic Goods Administration by members of the public. Reports were predominantly mild transient events, similar to those expected from the seasonal flu vaccine.
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Affiliation(s)
- Deepika Mahajan
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead.
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Abstract
Over the past decade the number of recommended and funded vaccines for adolescents has increased, becoming a substantial part of the National Immunisation Program in Australia. In response, NSW has implemented disease-specific vaccination campaigns for both children and adolescents and more recently established a routine high school-based vaccination program to administer vaccines to this often hard to reach group. This paper outlines the history of school-based vaccination in NSW from its commencement in 1971 to coverage from early disease-specific programs, and describes the implementation of the current program of routine vaccination. Substantial coverage has been achieved across the age spectrum 5-17 years, highlighting the effectiveness of the school-based vaccination program in reaching large numbers of adolescents.
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Affiliation(s)
- Kirsten F Ward
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead.
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Jardine A, Deeks SL, Patel MS, Menzies RI, Gilbert GL, McIntyre PB. An evaluation of the Australian National Serosurveillance Program. Commun Dis Intell Q Rep 2010; 34:29-36. [PMID: 20521496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The Australian National Serosurveillance Program (ANSP) was established in 1997 to provide national estimates of population immunity to vaccine preventable diseases and inform immunisation policy in Australia. The 1st round tested opportunistically collected sera from pathology laboratories across Australia, a 2nd round was carried out in 2002, and a 3rd round of testing is currently ongoing using sera from 2007-08. This is the 1st systematic evaluation of the ANSP since its inception. Existing information and outputs from the ANSP were reviewed and used in conjunction with data collected from a survey of the program operators to evaluate the overall utility of the ANSP and the following system attributes; acceptability, stability, simplicity, flexibility, data quality, sensitivity, representativeness and timeliness. So far the ANSP has generated 26 peer-reviewed publications and provided useful data that have influenced and provided an evidence base for immunisation policy in Australia; for example informing mathematical models, which identified the need for the young adult measles-mumps-rubella immunisation campaign. However, difficulties have been encountered with obtaining enough samples for testing in the 3rd round currently being undertaken. This is a concern that has the potential to undermine the representativeness and stability of the system, and other methods of sample collection must be investigated. Serological surveillance is an important component of any comprehensive system for monitoring population immunity to vaccine preventable diseases and evaluating the effectiveness of immunisation programs. However, an effective ongoing program requires strong support to ensure it remains sustainable in an era when laboratory based population health research for the public good is becoming increasingly challenging.
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Affiliation(s)
- Andrew Jardine
- National Centre for Epidemiology and Population Health, Australian National University, Australian Capital Territory.
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Abstract
There are many similarities regarding the health status of Indigenous people in the 4 English-speaking developed countries of North America and the Pacific (United States, Canada, Australia, New Zealand), where they are all now minority populations. Although vaccines have contributed to the reduction or elimination of disease disparities for many infections, Indigenous people continue to have higher morbidity and mortality from many chronic and infectious diseases compared with the general populations in their countries. This review summarizes the available data on the epidemiology of vaccine-preventable diseases in Indigenous populations in these 4 countries in the context of the vaccination strategies used and their impact, with the aim of identifying successful strategies with the potential for wider implementation.
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Affiliation(s)
- Robert I Menzies
- The National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, Australia
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Thomas P, Joseph TL, Menzies RI. Evaluation of a targeted immunisation program for Aboriginal and Torres Strait Islander infants in an urban setting. N S W Public Health Bull 2008; 19:96-99. [PMID: 18638435 DOI: 10.1071/nb07055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A conjugate pneumococcal vaccination program for Aboriginal and Torres Strait Islander children in an urban setting initially achieved poor uptake. A targeted intervention was developed to raise awareness among hospital staff, in general practice and in parents of eligible children. An evaluation of the intervention found moderate levels of increased awareness, use of promotional materials and an increase in vaccination. However, significant structural barriers remained.
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Affiliation(s)
- Paul Thomas
- Centre for Public Health, Sydney West Area Health Service, Australia
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43
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Rank C, Menzies RI. How reliable are Australian Childhood Immunisation Register coverage estimates for indigenous children? An assessment of data quality and coverage. Commun Dis Intell Q Rep 2007; 31:283-287. [PMID: 17974220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Low levels of reporting indigenous status to the Australian Childhood Immunisation Register (ACIR) in the past have resulted in reduced confidence in vaccination coverage data for Aboriginal and Torres Straight Islander children. This study shows that the reporting of indigenous status has improved from 42% of the estimated national cohort of Indigenous children aged 12 to 14 months in 2002 to 95% in 2005. Over that period diphtheria-tetanus-pertussis (DTP) vaccination coverage estimates for Indigenous children increased slightly from 86.0% to 86.9%. Data by state and territory or remoteness are also presented. ACIR vaccination coverage estimates for Indigenous children can now be used with confidence for program planning at the national and jurisdictional level.
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Owen R, Roche PW, Hope K, Yohannes K, Roberts A, Liu C, Stirzaker S, Kong F, Bartlett M, Donovan B, East I, Fitzsimmons G, McDonald A, McIntyre PB, Menzies RI. Australia's notifiable diseases status, 2005: annual report of the National Notifiable Diseases Surveillance System. Commun Dis Intell Q Rep 2007; 31:1-70. [PMID: 17503645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In 2005, 60 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 125,461 cases of communicable diseases to the National Notifiable Diseases Surveillance System: an increase of 10% on the number of notifications in 2004. In 2005, the most frequently notified diseases were sexually transmissible infections (51,557 notifications, 41% of total notifications), gastrointestinal diseases (29,422 notifications, 23%) and bloodborne diseases (19,278 notifications, 15%). There were 17,753 notifications of vaccine preventable diseases; 4,935 notifications of vectorborne diseases; 1,826 notification of other bacterial infections (legionellosis, leprosy, meningococcal infections and tuberculosis) and 687 notifications of zoonotic diseases.
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Affiliation(s)
- Rhonda Owen
- Surveillance Policy and Systems Section, Office of Health Protection, Australian Government Department of Health and Ageing, Canberra ACT.
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45
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Yohannes K, Roche PW, Roberts A, Liu C, Firestone SM, Bartlett M, East I, Hull BP, Kirk MD, Lawrence GL, McDonald A, McIntyre PB, Menzies RI, Quinn HE, Vadjic C. Australia's notifiable diseases status, 2004, annual report of the National Notifiable Diseases Surveillance System. Commun Dis Intell Q Rep 2006; 30:1-79. [PMID: 16639808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
In 2004, 60 diseases and conditions were nationally notifiable in Australia. States and Territories reported a total of 110,929 cases of communicable diseases to the National Notifiable Diseases Surveillance System (NNDSS): an increase of 4 per cent on the number of notifications in 2003. In 2004, the most frequently notified diseases were sexually transmissible infections (46,762 cases; 42% of total notifications), gastrointestinal diseases (25,247 cases; 23% of total notifications) and bloodborne diseases (19,191 cases; 17% of total notifications). There were 13,206 notifications of vaccine preventable diseases, 6,000 notifications of vectorborne diseases, 1,799 notifications of other bacterial infections (includes, legionellosis, leprosy, meningococcal infections and tuberculosis) and 877 notifications of zoonotic diseases.
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Affiliation(s)
- Keflemariam Yohannes
- Surveillance Branch, Office of Health Protection, Australian Government Department of Health and Ageing, Canberra, Australian Capital Territory.
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46
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Abstract
Vaccination programs can act as a paradigm for effective health programs in Indigenous people.
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Lumbers ER, Menzies RI, Gibson KJ, Tyndale-Biscoe CH. Levels of active and inactive reninlike enzymes in plasma and reproductive tract of the pregnant wallaby. Am J Physiol 1994; 266:R1353-8. [PMID: 8184982 DOI: 10.1152/ajpregu.1994.266.4.r1353] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Active and total (acid-activated) levels of a reninlike enzyme (hereafter called renin) were measured in plasma, tissues, and yolk sac fluid of pregnant and postpartum wallabies. Plasma active renin generated angiotensin I (ANG I) from sheep angiotensinogen at 14 +/- 1.3 (SE) ng.ml-1.h-1, whereas acid-activated renin generated ANG I at 33.3 +/- 2.5 ng.ml-1.h-1, i.e., 44.2 +/- 3.7% of renin in plasma was active, and 58 +/- 3.7% was inactive. Inactive renin levels were highest in pregnant animals (P = 0.05). Uterine renin was mainly inactive (95%); levels were 5.1 +/- 1.1 times plasma levels. The levels of renin in nonpregnant uteri were the same as those in pregnant uteri from the same animals. Uterine renin levels did not change with gestation. Pooled acid-activated yolk sac fluid generated ANG I at low rates (0.7 and 1.6 ng.ml-1.h-1); the acid-activated supernatant of a homogenate of pooled fetal membranes generated ANG I at 15 ng.g wet wt-1.h-1. Yolk sac fluid was strikingly different in electrolyte composition from maternal plasma. Its lower osmolality suggests that the membranes separating it from maternal plasma have a low permeability to water. Thus, although eutherian and marsupial mammals diverged 136-164 million years ago, the wallaby, like many eutherian mammals, has inactive renin in blood, in the female reproductive tract, and in fetal membranes.
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Affiliation(s)
- E R Lumbers
- School of Physiology and Pharmacology, University of New South Wales, Sydney, Australia
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Abstract
1. Renal function was studied in chronically catheterized fetal sheep (119-128 days gestation), before and during treatment of the ewe with the angiotensin converting enzyme (ACE) inhibitor, captopril, which crosses the placenta and blocks the fetal renin angiotensin system. 2. An i.v. dose of 15 mg (about 319 micrograms kg-1) of captopril to salt-replete ewes followed by an infusion to the ewe of 6 mg h-1 (about 128 micrograms kg-1 h-1) caused a fall in fetal arterial pressure (P < 0.01), and a rise in fetal renal blood flow (RBF) from 67.9 +/- 5.6 to 84.9 +/- 8.3 ml min-1 (mean +/- s.e. mean) (P < 0.05). Renal vascular resistance and glomerular filtration rate (GFR) fell (P < 0.01); fetal urine flow (P < 0.01); fetal urine flow (P < 0.01) and sodium excretion declined (P < 0.05). 3. Ewes were treated for the next 2 days with 15 mg captopril twice daily. On the 4th day, 15 mg was given to the ewe and fetal renal function studied for 2 h during the infusion of captopril (6 mg h-1) to the ewe. Of the 9 surviving fetuses, 3 were anuric and 3 had low urine flow rates. When 6 micrograms kg-1 h-1 of angiotensin II was infused directly into the fetus RBF fell from 69 +/- 10.1 ml min-1 to 31 +/- 13.9 ml min-1, GFR rose (P < 0.05) and urine flow (P < 0.01) and sodium excretion increased in all fetuses. 4. It is concluded that the small fall in fetal arterial pressure partly contributed to the fall in fetal GFR but in addition, efferent arteriolar tone fell so that the filtration pressure fell further. Thus maintenance of fetal renal function depends on the integrity of the fetal renin angiotensin system. These findings explain why use of ACE inhibitors in human pregnancy is associated with neonatal anuria.
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Affiliation(s)
- E R Lumbers
- School of Physiology and Pharmacology, University of NSW, Kensington, Sydney, Australia
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Tamblyn RM, Menzies RI, Tamblyn RT, Farant JP, Hanley J. The feasibility of using a double blind experimental cross-over design to study interventions for sick building syndrome. J Clin Epidemiol 1992; 45:603-12. [PMID: 1607899 DOI: 10.1016/0895-4356(92)90132-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Methodological problems have limited scientific investigation of the causes of and solutions for sick building syndrome. The feasibility of using an experimental double blind cross-over study to resolve many of these methodological problems was assessed in a pilot study. The experimental intervention was to vary the amount of outdoor air from 10 cubic feet per minute per person (cfmpp) to 20 cfmpp or 50 cfmpp by central manipulation of the building heating, ventilation and air-conditioning (HVAC) system. Over 6 consecutive study weeks, 2 trials of rates were administered in random order. Study subjects and investigators of the study were blinded to intervention sequence. Unblinding, office environment rating and symptom occurrence were measured weekly. Of 305 eligible workers, 254 participated. Problems were encountered in delivering the lowest dose of ventilation due to building leakage. The prevalence of symptoms diminished steadily over the 6 study weeks, time trends which could be controlled by recommended design modifications. Blinding to the intervention was successfully maintained. Weekly non-response did not introduce a response bias but reduced the number of subjects available for analysis by one-third for each trial. We conclude that this design, with certain modifications, is feasible to evaluate many proposed interventions for sick building syndrome.
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Affiliation(s)
- R M Tamblyn
- National Centres of Excellence Network in Respiratory Health, McGill University, Department of Epidemiology and Biostatistics, Montreal, Quebec, Canada
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Lumbers ER, Kingsford NM, Menzies RI, Stevens AD. Acute effects of captopril, an angiotensin-converting enzyme inhibitor, on the pregnant ewe and fetus. Am J Physiol 1992; 262:R754-60. [PMID: 1590470 DOI: 10.1152/ajpregu.1992.262.5.r754] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
After control measurements had been made, 15 chronically catheterized pregnant ewes (gestational age 123-141 days) were given 15 mg of captopril intravenously followed by an infusion of 6 mg/h. These doses blocked the pressor responses of both ewes and fetuses to 5 micrograms of angiotensin I. After captopril, maternal mean arterial pressure fell from 94 +/- 3.5 to 88 +/- 3.6 (SE) mmHg (P less than 0.0001) and pulse interval fell (P = 0.008). Maternal flow to the cotyledons fell from 766 +/- 118 to 525 +/- 77 ml/min (P = 0.002), as did flow to the remainder of the maternal placenta, i.e., the caruncles and their underlying myoendometrium (control flow 188 +/- 35 ml/min, flow 10-15 min after captopril 166 +/- 36.1 ml/min; P = 0.021). Flow to the rest of the myometrium did not change. Fetal arterial pressure fell from 46.9 +/- 1.6 to 44.1 +/- 1.6 mmHg (P less than 0.009), and fetal placental blood flow fell from 639.9 +/- 93.2 to 413.1 +/- 53.9 ml/min (P = 0.025). Flow to the fetal membranes declined also, from 53.2 +/- 6.5 to 35.6 +/- 3.3 ml/min (P less than 0.005). Maternal and fetal renal blood flows and fetal adrenal blood flows were unchanged. Fetal arterial PO2 was initially 19.5 +/- 0.8 mmHg; after captopril, it was 17.7 +/- 0.9 mmHg (P = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- E R Lumbers
- School of Physiology and Pharmacology, University of New South Wales, Kensington, Australia
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