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Puhr S, Welsh JB, Bauza CE, Walker TC. Patients with Type 2 Diabetes and Residual Insulin Secretory Capacity Realize Glycemic Benefits from Real-Time Continuous Glucose Monitoring. J Diabetes Sci Technol 2021; 15:965-967. [PMID: 33855888 PMCID: PMC8258531 DOI: 10.1177/19322968211007880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sarah Puhr
- Dexcom, Inc., San Diego, CA, USA
- Sarah Puhr, Dexcom, Inc., 6340 Sequence Dr., San Diego, CA 92121, USA.
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2
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Gleich S, Gibson N, Puhr S, Walker TC, Caruso D. Centralized Remote Monitoring of Continuous Glucose Monitoring Data at Diabetes Camp Mitigates Hypoglycemia. J Diabetes Sci Technol 2021; 15:962-964. [PMID: 33955245 PMCID: PMC8258530 DOI: 10.1177/19322968211009538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sarah Gleich
- Nevada Diabetes Association, Reno, NV, USA
- Sarah Gleich, BA, Executive Director California/Nevada Diabetes Association, 18 Stewart Street, Reno, NV 89501, USA.
| | | | | | | | - Dan Caruso
- Nevada Diabetes Association, Reno, NV, USA
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Darukhanavala A, Puhr S, Dinunno K, Alfego D, Welsh J, Butler L, Magyar K. Association between attendance at an American diabetes camp and improvements in glycaemic control and treatment satisfaction. Endocrinol Diabetes Metab 2021; 4:e00254. [PMID: 34277978 PMCID: PMC8279631 DOI: 10.1002/edm2.254] [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: 01/23/2021] [Revised: 03/24/2021] [Accepted: 03/27/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Few studies have evaluated glycaemic control using continuous glucose monitoring (CGM) in individuals before and after attendance at a diabetes camp or by comparing control groups at home to control groups at camp. Methods Youth (6–17 years) with T1D and receiving insulin therapy were enrolled at a week‐long diabetes camp. They participated in three clinic visits: at the start of a week at home, by initiating a Dexcom G6 CGM system; at the start of a week at camp, where the home week G6 was removed and a camp week G6 was inserted; and after camp, where the camp week G6 was removed. We administered Problem Areas in Diabetes (PAID) surveys at the second and third visits. Participants with <80% CGM data coverage or who did not complete all PAID surveys were excluded from analysis. We compared glycaemic control and PAID scores between the week at home and week at camp. Results Of 76 enrolled campers, 69 completed the study and 52 had results that qualified for analysis. The mean participant age was 12.5 ± 2.2 years. Camp was associated with significantly improved treatment satisfaction, time in desired glucose range and insulin sensitivity. Time in hyperglycaemia and basal insulin requirements decreased significantly. Conclusions Diabetes camp is associated with significant improvements in diabetes treatment satisfaction and glycaemic control compared to home care.
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Affiliation(s)
- Amy Darukhanavala
- Division of Pediatric Endocrinology UMass Medical Center Worcester MA USA
| | | | - Kyle Dinunno
- The Barton Center for Diabetes Education North Oxford MA USA
| | - David Alfego
- Division of Pediatric Endocrinology UMass Medical Center Worcester MA USA
| | | | - Lynn Butler
- The Barton Center for Diabetes Education North Oxford MA USA
| | - Kendra Magyar
- The Barton Center for Diabetes Education North Oxford MA USA
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Castorino K, Polsky S, O'Malley G, Levister C, Nelson K, Farfan C, Brackett S, Puhr S, Levy CJ. Performance of the Dexcom G6 Continuous Glucose Monitoring System in Pregnant Women with Diabetes. Diabetes Technol Ther 2020; 22:943-947. [PMID: 32324061 PMCID: PMC7757524 DOI: 10.1089/dia.2020.0085] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: The aim of this study was to determine the performance of the Dexcom G6 continuous glucose monitoring (CGM) system across three sensor wear sites in pregnant women with diabetes in the second or third trimesters. Methods: Participants with type 1 (T1D), type 2 (T2D), or gestational (GDM) diabetes mellitus were enrolled at three sites. Each wore two G6 sensors on the abdomen, upper buttock, and/or posterior upper arm for 10 days and underwent a 6-h clinic session between days 3 and 7 of sensor wear, during which YSI reference blood glucose values were obtained every 30 min. No intentional glucose manipulations were performed. Accuracy metrics included the proportion of CGM values that were within ±20% of paired reference values >100 mg/dL or ±20 mg/dL of YSI values ≤100 mg/dL (hereafter referred to as %20/20), as well as the analogous %15/15, %30/30, and %40/40. The mean absolute relative difference (MARD) between CGM-YSI pairs was also calculated. Results: Thirty-two participants with T1D (n = 20), T2D (n = 3), or GDM (n = 9) were enrolled: 19 were in the second trimester and 13 were in the third trimester of pregnancy. Compared with the reference, 92.5% of CGM values were within ±20%/20 mg/dL. The overall MARD and that of sensors worn on the abdomen, upper buttock, and posterior upper arm was 10.3%, 11.5%, 11.2%, and 8.7%, respectively. There were no device-related adverse events. Skin reactions at the insertion sites were absent or minor. Conclusions: The Dexcom G6 CGM system is accurate and safe in pregnant women with diabetes.
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Affiliation(s)
- Kristin Castorino
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
- Address correspondence to: Kristin Castorino, DO, Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA 93105, USA
| | - Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Grenye O'Malley
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Camilla Levister
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kristen Nelson
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Christian Farfan
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Scott Brackett
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sarah Puhr
- Dexcom, Inc., San Diego, California, USA
| | - Carol J. Levy
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Puhr S. Response to Dr. Seibold's Comment on Puhr et al. (DOI: 10.1089/dia.2019.0360). Diabetes Technol Ther 2020; 22:430. [PMID: 31724877 DOI: 10.1089/dia.2019.0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Puhr S, Derdzinski M, Parker AS, Welsh JB, Price DA. Real-World Hypoglycemia Avoidance With a Predictive Low Glucose Alert Does Not Depend on Frequent Screen Views. J Diabetes Sci Technol 2020; 14:83-86. [PMID: 30943780 PMCID: PMC7189147 DOI: 10.1177/1932296819840691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Frequent real-time continuous glucose monitoring (rtCGM) data viewing has been associated with reduced mean glucose and frequent scanning of an intermittently scanned continuous glucose monitoring (isCGM) system has been associated with reduced hypoglycemia for patients with diabetes. However, requiring patients to frequently interact with their glucose monitoring devices to detect actual or impending hypoglycemia is burdensome. We hypothesized that a predictive low glucose alert, which forecasts glucose ≤55 mg/dL within 20 minutes and is included in a new rtCGM system, could mitigate hypoglycemia without requiring frequent device interaction. METHODS We analyzed estimated glucose values (EGVs) from an anonymized convenience sample of 15,000 patients who used Dexcom G6 (Dexcom, Inc, San Diego, CA, USA) and its mobile app for at least 30 days with or without the "Urgent Low Soon" alert (ULS) enabled. Screen view frequency was determined as the frequency with which the trend screen was accessed on the app. Multiple screen views within any 5-minute interval were counted as one. Hypoglycemia exposure for patients in the top and bottom quartiles of screen view frequency (>8.25 and <3.30 per day, respectively) was calculated as the percentage of EGVs below various thresholds. RESULTS Over 93% of users enabled the ULS alert; its use was associated with significantly reduced hypoglycemia <55 and <70 mg/dL, independent of screen view frequency. CONCLUSION Use of the G6 ULS alert may disencumber rtCGM users by promoting significant reductions in hypoglycemia without requiring frequent device interactions.
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Affiliation(s)
- Sarah Puhr
- Dexcom, Inc, San Diego, CA, USA
- Sarah Puhr, PhD, Dexcom, Inc, 6340 Sequence
Dr, San Diego, CA 92121, USA.
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Hirsch IB, Welsh JB, Calhoun P, Puhr S, Walker TC, Price DA. Associations between HbA 1c and continuous glucose monitoring-derived glycaemic variables. Diabet Med 2019; 36:1637-1642. [PMID: 31267573 PMCID: PMC6899839 DOI: 10.1111/dme.14065] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 01/04/2023]
Abstract
AIMS To identify clinically useful associations between HbA1c levels and various continuous glucose monitoring-derived metrics. METHODS We retrospectively analysed end-of-study HbA1c levels and >2 weeks of continuous glucose monitoring data collected from 530 adults with Type 1 diabetes or insulin-requiring Type 2 diabetes during four randomized trials. Each trial lasted ≥24 weeks and provided central laboratory end-of-study HbA1c levels and continuous glucose monitoring data from the preceding 3 months. Participants were assigned to groups based on either HbA1c levels or continuous glucose monitoring-derived glucose values. RESULTS HbA1c was strongly correlated with mean glucose value (r=0.80), time spent with glucose values in the 3.9-10.0 mmol/l range (time in range; r=-0.75) and percentage of glucose values >13.9 mmol/l (r=0.72), but was weakly correlated with the percentage of glucose values <3.9 mmol/l (r=-0.39) or <3.0 mmol/l (r=-0.21). The median percentage of glucose values <3.0 mmol/l was <1.2% (<20 min/day) for all HbA1c -based groups, but the median percentage of values >13.9 mmol/l varied from 2.5% (0.6 h/day) to 27.8% (6.7 h/day) in the lowest and highest HbA1c groups, respectively. More than 90% of participants with either <2% of glucose values >13.9 mmol/l, mean glucose <7.8 mmol/l, or time in range >80% had HbA1c levels ≤53 mmol/mol (≤7.0%). For participants with HbA1c ≥64 mmol/mol (≥8.0%), the median time in range was 44%, with 90% of participants having a time in range of <59%. CONCLUSIONS The associations shown in the present study suggest that continuous glucose monitoring-derived metrics may help guide diabetes therapy intensification efforts in an HbA1c -independent manner.
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Affiliation(s)
- I. B. Hirsch
- University of Washington School of MedicineSeattleWAUSA
| | | | - P. Calhoun
- Dexcom, Inc.San DiegoCAUSA
- Present address:
Jaeb Center for Health ResearchTampaFLUSA
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Abstract
BACKGROUND Those caring for children and adolescents with diabetes often use glucose concentration and trending information in management decisions. Some continuous glucose monitoring (CGM) systems offer real-time sharing and monitoring capabilities through mobile apps carried by the person with diabetes and the caregiver(s), respectively. Few large studies have explored real-world associations between sharing and following, CGM utilization, and glycemic outcomes. METHODS We performed a retrospective evaluation of device usage and glycemic control in 15,000 youth ranging in age from 2 to 18 years by analyzing anonymized data that had been uploaded with a mobile app that provides optional sharing. The presence or absence of a real-time monitor (a "Follower") was established on 15 June 2018. Each day with ≥ 1 uploaded glucose values was counted as a day of device usage. Between-group glucose comparisons were made with two-sided Welch's t tests. RESULTS Overall, 94.8% of the population used the sharing feature and had at least one Follower. The mean numbers of Followers for patients aged 2-5, 6-12, and 13-18 years were 2.8, 2.8, and 2.4, respectively. In all three age categories, the presence of at least one Follower was associated with lower mean glucose values, more glucose values in the 70- to 180-mg/dL range, correspondingly fewer glucose values representing hypoglycemia and hyperglycemia, and significantly more device utilization. CONCLUSION Real-time sharing and following of CGM data are associated with improved device utilization and glycemic parameters. The observed association suggests either more timely interventions or higher levels of engagement among the caregivers or the youth with diabetes. FUNDING Dexcom, Inc.
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Puhr S, Derdzinski M, Welsh JB, Parker AS, Walker T, Price DA. Real-World Hypoglycemia Avoidance with a Continuous Glucose Monitoring System's Predictive Low Glucose Alert. Diabetes Technol Ther 2019; 21:155-158. [PMID: 30896290 PMCID: PMC6477579 DOI: 10.1089/dia.2018.0359] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Programmable and fixed auditory and/or vibratory threshold alerts are essential features of real-time continuous glucose monitoring (rtCGM) systems that provide users time to intervene before the onset of clinical hypoglycemia or hyperglycemia. A sixth-generation rtCGM system from Dexcom, Inc. (G6) includes a new alert that is triggered when an algorithm predicts that an estimated glucose value ≤55 mg/dL will occur within 20 min, allowing users more time to act to avoid hypoglycemia. We examined whether this predictive low glucose alert provided added benefit to traditional low threshold alerts. METHODS We analyzed glucose values from an anonymized sample of 1424 patients who transitioned to G6 from the preceding fifth-generation system (G5) with no predictive alert. Users with the low threshold alert setting of 70 or 80 mg/dL were evaluated separately. Receiver users, those who disabled the predictive low glucose alert, or those with <30 days of data immediately before or after the transition to G6 were excluded. RESULTS Percent time <54, ≤55, <70, and >250 mg/dL fell significantly after the transition to G6, independent of low threshold alert setting. Time in range improved for G6 users with a low threshold alert setting of 70 mg/dL. CONCLUSIONS Advance warning provided by predictive low glucose alerts may further reduce hypoglycemia among rtCGM-experienced users.
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Affiliation(s)
- Sarah Puhr
- Dexcom, Inc., San Diego, California
- Address correspondence to: Sarah Puhr, PhD, Dexcom, Inc., 6340 Sequence Drive, San Diego, CA 92121
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Welsh JB, Gao P, Derdzinski M, Puhr S, Johnson TK, Walker TC, Graham C. Accuracy, Utilization, and Effectiveness Comparisons of Different Continuous Glucose Monitoring Systems. Diabetes Technol Ther 2019; 21:128-132. [PMID: 30681379 PMCID: PMC6434583 DOI: 10.1089/dia.2018.0374] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Accuracy and feature sets of continuous glucose monitoring (CGM) systems may influence device utilization and outcomes. We compared clinical trial accuracy and real-world utilization and effectiveness of two different CGM systems. MATERIALS AND METHODS Separately conducted accuracy studies of a fifth-generation and a sixth-generation CGM system involved 50 and 159 adults, respectively. For between-system performance comparisons, propensity score methods were utilized to balance cohort characteristics. Real-world outcomes were assessed in 10,000 anonymized patients who had switched from the fifth-generation to the sixth-generation system and had used connected mobile devices to upload data from both systems, allowing pairwise comparisons of device utilization and glucose concentration distributions. RESULTS Propensity score-adjusted mean absolute relative differences for the fifth- and sixth-generation systems were 9.0% and 9.9%, and the percentages of values within ±20%/20 mg/dL were 93.1% and 92.5%, respectively. The sixth-generation system, but not the fifth-generation system, met accuracy criteria for interoperable CGM systems. Both systems had high real-world utilization rates (93.8% and 95.3% in the fifth- and sixth-generation systems, respectively). Use of the sixth-generation system was associated with fewer glucose values <55 mg/dL (<3.1 mmol/L) (0.7% vs. 1.1%, P < 0.001) and more values 70-180 mg/dL (3.9-10.0 mmol/L) (57.3% vs. 56.0%, P < 0.001) than the fifth-generation system. CONCLUSIONS CGM performance outcomes can be compared through the propensity score analysis of clinical trial data and pairwise comparisons of real-world data. The systems compared here had nearly equivalent accuracy and utilization rates. Longer term biochemical and psychosocial benefits observed with the fifth-generation system are also expected with the sixth-generation system.
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Affiliation(s)
- John B. Welsh
- Dexcom, Inc., San Diego, California
- Address correspondence to: John B. Welsh, MD, PhD, Dexcom, Inc., 6340 Sequence Drive, San Diego, CA 92121
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Puhr S, Calhoun P, Welsh JB, Walker TC. The Effect of Reduced Self-Monitored Blood Glucose Testing After Adoption of Continuous Glucose Monitoring on Hemoglobin A1c and Time in Range. Diabetes Technol Ther 2018; 20:557-560. [PMID: 30036082 DOI: 10.1089/dia.2018.0134] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The effectiveness of real-time continuous glucose monitoring (rtCGM) in adults with diabetes treated with insulin injections was evaluated in the 24-week DIAMOND clinical trial comparing rtCGM users to a control group using self-monitored blood glucose (SMBG) testing ( Clinicaltrials.gov : NCT02282397). All participants were instructed to use SMBG results for diabetes management decisions; however, SMBG testing frequency varied within the rtCGM group. This brief report evaluated how SMBG frequency changes in the rtCGM group were correlated with glycemic outcomes in the same trial. Baseline and end-of-study hemoglobin A1c (HbA1c) levels, percentages of CGM values in the 70-180 mg/dL target range (time in range [TIR]), mean of daily differences (MODD), and glycemic coefficients of variation (CVs) were compared. The rtCGM group analyzed included 175 participants-99 with type 1 diabetes (T1D) and 76 with type 2 diabetes (T2D). When comparing participants whose SMBG testing frequency decreased by >1/day versus ≤1/day, mean change in HbA1c was similar (-0.9 ± 0.7 percentage points in both groups, P = 0.59), as was change in TIR (+3.9 ± 14.3 vs. +5.7 ± 13.7 percentage points, respectively, P = 0.39). Likewise, when comparing participants in the highest and lowest quartiles of SMBG frequency reduction (≥2.2 vs. ≤0.4 fewer tests/day, respectively), changes in HbA1c (-0.8 ± 0.6 vs. -0.9 ± 0.6 percentage points, respectively, P = 0.52) and TIR (+4.8 ± 13.2 vs. +5.6 ± 12.7 percentage points, respectively, P = 0.98) were similar. The mean (standard deviation [SD]) change in MODD was -8.3 mg/dL (14.8) and -5.5 mg/dL (14.7) for participants who reduced their SMBG frequency by >1 test/day and ≤1 test/day, respectively; the mean (SD) change in CV was -3.6% (5.0) and -1.6% (5.1) for participants who reduced their SMBG frequency by >1 test/day and ≤1 test/day, respectively. These findings suggest that individuals who decrease the frequency of SMBG testing can effectively base some of their diabetes-related treatment decisions on glucose concentrations, trend information, and alarms provided by their rtCGM systems.
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Abstract
Dendritic cells (DCs) are uniquely potent in orchestrating T cell immune response, thus they are indispensable immune sentinels. They originate from progenitors in the bone marrow through hematopoiesis, a highly regulated developmental process involving multiple cellular and molecular events. This review highlights studies of DC development-from the discovery of DCs as glass-adherent antigen presenting cells to the debate and resolution of their origin and lineage map. In particular, we summarize the roles of lineage-specific cytokines, the placement of distinct hematopoietic progenitors within the DC lineage and transcriptional programs governing DC development, which together have allowed us to diagram the current view of DC hematopoiesis. Important open questions and debates on the DC development and relevant models are also discussed.
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Affiliation(s)
- Sarah Puhr
- Columbia University Medical Center, Department of Microbiology and Immunology, New York, NY 10032, USA.
| | - Jaeyop Lee
- Columbia University Medical Center, Department of Microbiology and Immunology, New York, NY 10032, USA.
| | - Ekaterina Zvezdova
- Columbia University Medical Center, Department of Microbiology and Immunology, New York, NY 10032, USA.
| | - Yu J Zhou
- Columbia University Medical Center, Department of Microbiology and Immunology, New York, NY 10032, USA
| | - Kang Liu
- Columbia University Medical Center, Department of Microbiology and Immunology, New York, NY 10032, USA.
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Lee J, Breton G, Aljoufi A, Zhou YJ, Puhr S, Nussenzweig MC, Liu K. Clonal analysis of human dendritic cell progenitor using a stromal cell culture. J Immunol Methods 2015; 425:21-26. [PMID: 26056939 DOI: 10.1016/j.jim.2015.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 01/21/2023]
Abstract
Different dendritic cell (DC) subsets co-exist in humans and coordinate the immune response. Having a short life, DCs must be constantly replenished from their progenitors in the bone marrow through hematopoiesis. Identification of a DC-restricted progenitor in mouse has improved our understanding of how DC lineage diverges from myeloid and lymphoid lineages. However, identification of the DC-restricted progenitor in humans has not been possible because a system that simultaneously nurtures differentiation of human DCs, myeloid and lymphoid cells, is lacking. Here we report a cytokine and stromal cell culture that allows evaluation of CD34(+) progenitor potential to all three DC subsets as well as other myeloid and lymphoid cells, at a single cell level. Using this system, we show that human granulocyte-macrophage progenitors are heterogeneous and contain restricted progenitors to DCs.
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Affiliation(s)
- Jaeyop Lee
- Columbia University Medical Center, Department of Microbiology and Immunology, New York, NY 10032, USA
| | - Gaëlle Breton
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY 10065, USA
| | - Arafat Aljoufi
- Columbia University Medical Center, Department of Microbiology and Immunology, New York, NY 10032, USA
| | - Yu Jerry Zhou
- Columbia University Medical Center, Department of Microbiology and Immunology, New York, NY 10032, USA
| | - Sarah Puhr
- Columbia University Medical Center, Department of Microbiology and Immunology, New York, NY 10032, USA
| | - Michel C Nussenzweig
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY 10065, USA; Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065, USA
| | - Kang Liu
- Columbia University Medical Center, Department of Microbiology and Immunology, New York, NY 10032, USA.
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Breton G, Lee J, Zhou YJ, Schreiber JJ, Keler T, Puhr S, Anandasabapathy N, Schlesinger S, Caskey M, Liu K, Nussenzweig MC. Circulating precursors of human CD1c+ and CD141+ dendritic cells. ACTA ACUST UNITED AC 2015; 212:401-13. [PMID: 25687281 PMCID: PMC4354370 DOI: 10.1084/jem.20141441] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [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] [Indexed: 12/23/2022]
Abstract
Two subsets of conventional dendritic cells (cDCs) with distinct cell surface markers and functions exist in mouse and human. The two subsets of cDCs are specialized antigen-presenting cells that initiate T cell immunity and tolerance. In the mouse, a migratory cDC precursor (pre-CDC) originates from defined progenitors in the bone marrow (BM). Small numbers of short-lived pre-CDCs travel through the blood and replace cDCs in the peripheral organs, maintaining homeostasis of the highly dynamic cDC pool. However, the identity and distribution of the immediate precursor to human cDCs has not been defined. Using a tissue culture system that supports the development of human DCs, we identify a migratory precursor (hpre-CDC) that exists in human cord blood, BM, blood, and peripheral lymphoid organs. hpre-CDCs differ from premonocytes that are restricted to the BM. In contrast to earlier progenitors with greater developmental potential, the hpre-CDC is restricted to producing CD1c(+) and CD141(+) Clec9a(+) cDCs. Studies in human volunteers demonstrate that hpre-CDCs are a dynamic population that increases in response to levels of circulating Flt3L.
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Affiliation(s)
- Gaëlle Breton
- Laboratory of Molecular Immunology, Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065
| | - Jaeyop Lee
- Columbia University Medical Center, Department of Microbiology and Immunology, New York, NY 10032
| | - Yu Jerry Zhou
- Columbia University Medical Center, Department of Microbiology and Immunology, New York, NY 10032
| | | | | | - Sarah Puhr
- Columbia University Medical Center, Department of Microbiology and Immunology, New York, NY 10032
| | - Niroshana Anandasabapathy
- Laboratory of Molecular Immunology, Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065 Department of Dermatology Brigham and Women's Hospital, Boston, MA 02115
| | - Sarah Schlesinger
- Laboratory of Molecular Immunology, Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065
| | - Marina Caskey
- Laboratory of Molecular Immunology, Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065
| | - Kang Liu
- Columbia University Medical Center, Department of Microbiology and Immunology, New York, NY 10032
| | - Michel C Nussenzweig
- Laboratory of Molecular Immunology, Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065 Laboratory of Molecular Immunology, Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065
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Lee J, Breton G, Oliveira TYK, Zhou YJ, Aljoufi A, Puhr S, Cameron MJ, Sékaly RP, Nussenzweig MC, Liu K. Restricted dendritic cell and monocyte progenitors in human cord blood and bone marrow. ACTA ACUST UNITED AC 2015; 212:385-99. [PMID: 25687283 PMCID: PMC4354373 DOI: 10.1084/jem.20141442] [Citation(s) in RCA: 194] [Impact Index Per Article: 21.6] [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] [Indexed: 12/23/2022]
Abstract
Liu, Nussenzweig, and colleagues track the differentiation of human progenitor cells into dendritic cells (DCs). They show that a granulocyte/monocyte/DC progenitor gives rise to a monocyte-DC progenitor that in turn gives rise to both monocytes and a common DC progenitor. The common DC progenitor produces the three major subsets of human DCs. In mice, two restricted dendritic cell (DC) progenitors, macrophage/dendritic progenitors (MDPs) and common dendritic progenitors (CDPs), demonstrate increasing commitment to the DC lineage, as they sequentially lose granulocyte and monocyte potential, respectively. Identifying these progenitors has enabled us to understand the role of DCs and monocytes in immunity and tolerance in mice. In humans, however, restricted monocyte and DC progenitors remain unknown. Progress in studying human DC development has been hampered by lack of an in vitro culture system that recapitulates in vivo DC hematopoiesis. Here we report a culture system that supports development of CD34+ hematopoietic stem cell progenitors into the three major human DC subsets, monocytes, granulocytes, and NK and B cells. Using this culture system, we defined the pathway for human DC development and revealed the sequential origin of human DCs from increasingly restricted progenitors: a human granulocyte-monocyte-DC progenitor (hGMDP) that develops into a human monocyte-dendritic progenitor (hMDP), which in turn develops into monocytes, and a human CDP (hCDP) that is restricted to produce the three major DC subsets. The phenotype of the DC progenitors partially overlaps with granulocyte-macrophage progenitors (GMPs). These progenitors reside in human cord blood and bone marrow but not in the blood or lymphoid tissues.
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Affiliation(s)
- Jaeyop Lee
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY 10032
| | - Gaëlle Breton
- Laboratory of Molecular Immunology and Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065
| | - Thiago Yukio Kikuchi Oliveira
- Laboratory of Molecular Immunology and Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065
| | - Yu Jerry Zhou
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY 10032
| | - Arafat Aljoufi
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY 10032
| | - Sarah Puhr
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY 10032
| | | | | | - Michel C Nussenzweig
- Laboratory of Molecular Immunology and Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065 Laboratory of Molecular Immunology and Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065
| | - Kang Liu
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY 10032
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