1
|
Quinlan JI, Dhaliwal A, Williams FR, Allen SL, Choudhary S, Rowlands A, Breen L, Lavery GG, Lord JM, Elsharkawy AM, Armstrong MJ, Greig CA. Impaired lower limb muscle mass, quality and function in end stage liver disease: A cross-sectional study. Exp Physiol 2023; 108:1066-1079. [PMID: 37166422 PMCID: PMC10988432 DOI: 10.1113/ep091157] [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: 02/03/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Abstract
NEW FINDINGS What is the central question of this study? To what extent does musculoskeletal impairment occur (i.e., muscle mass, quality and function) in patients with end stage liver disease (ESLD) by comparison to a healthy age/sex-matched control group? What is the main finding and its importance? Muscle mass, quality and function are impaired in patients with ESLD (compared to age/sex matched controls). Importantly, greater impairments were seen in lower limb compared to arm and trunk muscle groups. These findings may suggest that there should be greater consideration of muscle health in functionally relevant lower limb muscle groups. ABSTRACT Sarcopenia is associated with reduced quality of life and increased mortality in patients with end stage liver disease (ESLD). Historically, sarcopenia identification in ESLD utilised L3 skeletal muscle index (SMI). There are few data on muscle quality and function within lower limb muscle groups with high functional relevance. The aim of this prospective case-control study was to evaluate the quadriceps muscle in patients with ESLD. Muscle mass and quality were evaluated using MRI (quadriceps anatomical cross sectional area (ACSA), quadriceps volume index, L3 SMI, quadriceps intermuscular adipose tissue (IMAT)), mid-arm muscle circumference (MAMC) and ultrasonography (vastus lateralis (VL) thickness and quadriceps ACSA). Muscle strength/function was assessed by handgrip strength, peak quadriceps isokinetic torque and chair rise time. Thirty-nine patients with ESLD (55 years, 61% male, 48% alcoholic related liver disease (ArLD), 71% Child-Pugh B/C) and 18 age/sex-matched healthy control participants (HC) were studied. Quadriceps mass was significantly reduced in ESLD versus HC (-17%), but L3 SMI and MAMC were unchanged. Quadriceps IMAT percentage was increased in ESLD (+103%). Handgrip strength (-15%), peak isokinetic torque (-29%), and chair rise time (+56%) were impaired in ESLD. Ultrasound measures of VL thickness (r = 0.56, r = 0.57, r = 0.42) and quadriceps ACSA (r = 0.98, r = 0.86, r = 0.67) correlated to MRI quadriceps ACSA, quadriceps volume and L3 SMI, respectively. Quadriceps muscle mass, quality, and function were impaired in patients with ESLD, whereas conventional assessments of muscle (L3 SMI and MAMC) highlighted no differences between ESLD and HC. Full evaluation of lower limb muscle health is essential in ESLD in order to accurately assess sarcopenia and target future interventions.
Collapse
Affiliation(s)
- Jonathan I. Quinlan
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
- School of Sport, Exercise and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
| | - Amritpal Dhaliwal
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
- Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
| | - Felicity R. Williams
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
- Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
- Therapies DepartmentUniversity Hospitals BirminghamBirminghamUK
| | - Sophie L. Allen
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
- School of Sport, Exercise and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
| | | | - Alex Rowlands
- NIHR Leicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreUniversity of Leicester, Leicester General HospitalLeicesterUK
| | - Leigh Breen
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
- School of Sport, Exercise and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
- MRC‐Versus Arthritis Centre for Musculoskeletal Ageing ResearchUniversity of BirminghamBirminghamUK
| | - Gareth G. Lavery
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
- MRC‐Versus Arthritis Centre for Musculoskeletal Ageing ResearchUniversity of BirminghamBirminghamUK
- Department of BiosciencesNottingham Trent UniversityNottinghamUK
| | - Janet M. Lord
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
- Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
- MRC‐Versus Arthritis Centre for Musculoskeletal Ageing ResearchUniversity of BirminghamBirminghamUK
| | - Ahmed M. Elsharkawy
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
- Liver UnitQueen Elizabeth Hospital BirminghamBirminghamUK
| | - Matthew J. Armstrong
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
- Liver UnitQueen Elizabeth Hospital BirminghamBirminghamUK
| | - Carolyn A. Greig
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
- School of Sport, Exercise and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
- MRC‐Versus Arthritis Centre for Musculoskeletal Ageing ResearchUniversity of BirminghamBirminghamUK
| |
Collapse
|
2
|
Allen SL, Elliott BT, Carson BP, Breen L. Improving physiological relevance of cell culture: the possibilities, considerations, and future directions of the ex vivo coculture model. Am J Physiol Cell Physiol 2023; 324:C420-C427. [PMID: 36571441 PMCID: PMC9902212 DOI: 10.1152/ajpcell.00473.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In vitro models provide an important platform for the investigation of cellular growth and atrophy to inform, or extend mechanistic insights from, logistically challenging in vivo trials. Although these models allow for the identification of candidate mechanistic pathways, many models involve supraphysiological dosages, nonphysiological conditions, or experimental changes relating to individual proteins or receptors, all of which limit translation to human trials. To overcome these drawbacks, the use of ex vivo human plasma and serum has been used in cellular models to investigate changes in myotube hypertrophy, cellular protein synthesis, anabolic and catabolic markers in response to differing age, disease states, and nutrient status. However, there are currently no concurrent guidelines outlining the optimal methodology for this model. This review discusses the key methodological considerations surrounding the use of ex vivo plasma and serum with a focus in application to skeletal muscle cell lines (i.e., C2C12, L6, and LHCN-M2) and human primary skeletal muscle cells (HSMCs) as a means to investigate molecular signaling in models of atrophy and hypertrophy, alongside future directions.
Collapse
Affiliation(s)
- Sophie L. Allen
- 1School of Sport Exercise and Rehabilitation Sciences, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom,2NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom
| | - Bradley T. Elliott
- 3Translational Physiology Research Group, School of Life Sciences, University of Westminster, London, United Kingdom
| | - Brian P. Carson
- 4Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland,5Health Research Institute, University of Limerick, Limerick, Ireland
| | - Leigh Breen
- 1School of Sport Exercise and Rehabilitation Sciences, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom,2NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom,6MRC-Versus Arthritis Centre for Musculoskeletal Aging Research, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
3
|
Allen SL, Seabright AP, Quinlan JI, Dhaliwal A, Williams FR, Fine NHF, Hodson DJ, Armstrong MJ, Elsharkaway AM, Greig CA, Lai YC, Lord JM, Lavery GG, Breen L. The Effect of Ex Vivo Human Serum from Liver Disease Patients on Cellular Protein Synthesis and Growth. Cells 2022; 11:cells11071098. [PMID: 35406665 PMCID: PMC8997893 DOI: 10.3390/cells11071098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023] Open
Abstract
Sarcopenia is a common complication affecting liver disease patients, yet the underlying mechanisms remain unclear. We aimed to elucidate the cellular mechanisms that drive sarcopenia progression using an in vitro model of liver disease. C2C12 myotubes were serum and amino acid starved for 1-h and subsequently conditioned with fasted ex vivo serum from four non-cirrhotic non-alcoholic fatty liver disease patients (NAFLD), four decompensated end-stage liver disease patients (ESLD) and four age-matched healthy controls (CON) for 4- or 24-h. After 4-h C2C12 myotubes were treated with an anabolic stimulus (5 mM leucine) for 30-min. Myotube diameter was reduced following treatment with serum from ESLD compared with CON (−45%) and NAFLD (−35%; p < 0.001 for both). A reduction in maximal mitochondrial respiration (24% and 29%, respectively), coupling efficiency (~12%) and mitophagy (~13%) was identified in myotubes conditioned with NAFLD and ESLD serum compared with CON (p < 0.05 for both). Myostatin (43%, p = 0.04) and MuRF-1 (41%, p = 0.03) protein content was elevated in myotubes treated with ESLD serum compared with CON. Here we highlight a novel, experimental platform to further probe changes in circulating markers associated with liver disease that may drive sarcopenia and develop targeted therapeutic interventions.
Collapse
Affiliation(s)
- Sophie L. Allen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (S.L.A.); (A.P.S.); (J.I.Q.); (C.A.G.); (Y.-C.L.)
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
| | - Alex P. Seabright
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (S.L.A.); (A.P.S.); (J.I.Q.); (C.A.G.); (Y.-C.L.)
| | - Jonathan I. Quinlan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (S.L.A.); (A.P.S.); (J.I.Q.); (C.A.G.); (Y.-C.L.)
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
| | - Amritpal Dhaliwal
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Liver Unit, Queen Elizabeth Hospital Birmingham, Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Felicity R. Williams
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Liver Unit, Queen Elizabeth Hospital Birmingham, Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Nicholas H. F. Fine
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK; (N.H.F.F.); (D.J.H.)
| | - David J. Hodson
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK; (N.H.F.F.); (D.J.H.)
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TT, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), NIHR Oxford Biomedical Research Centre, Churchill Hosptial, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 7LE, UK
| | - Matthew J. Armstrong
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- Liver Unit, Queen Elizabeth Hospital Birmingham, Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Ahmed M. Elsharkaway
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- Liver Unit, Queen Elizabeth Hospital Birmingham, Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Carolyn A. Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (S.L.A.); (A.P.S.); (J.I.Q.); (C.A.G.); (Y.-C.L.)
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Yu-Chiang Lai
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (S.L.A.); (A.P.S.); (J.I.Q.); (C.A.G.); (Y.-C.L.)
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK; (N.H.F.F.); (D.J.H.)
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Janet M. Lord
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Gareth G. Lavery
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- Department of Biosciences, Nottingham Trent University, Nottingham NG1 8NS, UK
| | - Leigh Breen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (S.L.A.); (A.P.S.); (J.I.Q.); (C.A.G.); (Y.-C.L.)
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham B15 2TT, UK
- Correspondence:
| |
Collapse
|
4
|
Quinlan JI, Dhaliwal A, Williams F, Allen SL, Breen L, Greig CA, Lord JM, Armstrong MJ, Elsharkawy AM. Feasibility, Efficacy, and Safety of Percutaneous Muscle Biopsies in Patients With Chronic Liver Disease. Front Physiol 2022; 12:817152. [PMID: 35242045 PMCID: PMC8886882 DOI: 10.3389/fphys.2021.817152] [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: 11/17/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Sarcopenia is present in many chronic disease states including decompensated end stage liver disease (ESLD) and non-cirrhotic non-alcoholic fatty liver disease (NAFLD). Sarcopenia in ESLD can negatively impact quality of life and increase mortality. Despite this, very little is understood about the mechanisms of sarcopenia in these conditions. One key reason for this is the reluctance to undertake percutaneous muscle biopsies due to the perceived increased risks. ESLD can induce thrombocytopaenia and coagulopathy which significantly increases the risk of bleeding. In addition, patients with either NAFLD or ESLD often have co-morbidities that would require additional care and risk assessment. Thus, the aim of this study was to establish an effective and safe protocol for the implementation of percutaneous muscle biopsies in patients with NAFLD and ESLD. METHODS A total of 47 patients with ESLD and 9 patients with non-cirrhotic NAFLD were recruited from the Liver Unit, Queen Elizabeth Hospital (Birmingham, United Kingdom). A total of 71 percutaneous vastus lateralis biopsies were attempted over two study visits. A vigorous safety screening occurred prior to and during each visit and a strict protocol was followed to mitigate against complications and risk. RESULTS A total of 85% of patients consented to the muscle biopsy at either visit (48/56). A total of 9% of consented biopsies could not occur due to medical considerations, including high international normalised ratio (INR) (n = 3) and the use of aspirin (n = 4). Muscle tissue was obtained from 90% of attempts, with a mean average yield (wet weight tissue) of 98.1 ± 52.9 mg. CONCLUSION Percutaneous muscle biopsies are both feasible and yield sufficient tissue in an ESLD population. The procedure is effective for obtaining muscle tissue whilst also safe, with only one adverse event. This study provides evidence for the successful use of muscle biopsies in this population, even in consideration of disease specific complications, medications, and comorbidities.
Collapse
Affiliation(s)
- Jonathan I Quinlan
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Amritpal Dhaliwal
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Felicity Williams
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Sophie L Allen
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Leigh Breen
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Carolyn A Greig
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Janet M Lord
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Matthew J Armstrong
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom.,Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Ahmed M Elsharkawy
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom.,Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| |
Collapse
|
5
|
Dhaliwal A, Williams FR, Quinlan JI, Allen SL, Greig C, Filer A, Raza K, Ghosh S, Lavery GG, Newsome PN, Choudhary S, Breen L, Armstrong MJ, Elsharkawy AM, Lord JM. Evaluation of the mechanisms of sarcopenia in chronic inflammatory disease: protocol for a prospective cohort study. Skelet Muscle 2021; 11:27. [PMID: 34895316 PMCID: PMC8665319 DOI: 10.1186/s13395-021-00282-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 11/19/2021] [Indexed: 02/12/2023] Open
Abstract
Background Several chronic inflammatory diseases co-exist with and accelerate sarcopenia (reduction in muscle strength, function and mass) and negatively impact on both morbidity and mortality. There is currently limited research on the extent of sarcopenia in such conditions, how to accurately assess it and whether there are generic or disease-specific mechanisms driving sarcopenia. Therefore, this study aims to identify potential mechanisms driving sarcopenia within chronic inflammatory disease via a multi-modal approach; in an attempt to help define potential interventions for future use. Methods This prospective cohort study will consist of a multi-modal assessment of sarcopenia and its underlying mechanisms. Recruitment will target three chronic inflammatory diseases: chronic liver disease (CLD) (n=50), with a subset of NAFLD (n=20), inflammatory bowel disease (IBD) (n=50) and rheumatoid arthritis (RA) (n=50) both before and after therapeutic intervention. In addition, 20 age and sex matched healthy individuals will be recruited for comparison. Participants will undergo 4 assessment visits at weeks 0, 2, 12 and 24. Visits will consist of the following assessments: blood tests, anthropometrics, functional assessment, quadriceps muscle imaging, actigraphy, quality of life questionnaires, food diary collection and muscle biopsy of the vastus lateralis (at weeks 2 and 24 only). In addition, stool and urine samples will be collected for future microbiome and metabolomics analysis. Discussion This is the first study to use a multi-modal assessment model to phenotype sarcopenia in these chronic inflammatory diseases. We hope to identify generic as well as disease-specific mechanisms driving sarcopenia. We appreciate that these cohorts do require separate standards of care treatments which limit comparison between groups. Ethics and dissemination The study is approved by the Health Research Authority - West Midlands Solihull Research Ethics Service Committee Authority (REC reference: 18/WM/0167). Recruitment commenced in January 2019 and will continue until July 2021. The study was halted in March 2020 and again in January 2021 with the COVID-19 pandemic. The findings will be disseminated through peer-reviewed publications and conference presentations. All data will be stored on a secure server. Trial registration ClinicalTrials.gov Identifier: NCT04734496
Collapse
Affiliation(s)
- Amritpal Dhaliwal
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,University of Hospitals of Birmingham NHS Trust, Birmingham, UK.,NIHR Biomedical Research Centre (BRC), University Hospitals Birmingham and University of Birmingham, Birmingham, UK
| | - Felicity R Williams
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,University of Hospitals of Birmingham NHS Trust, Birmingham, UK.,NIHR Biomedical Research Centre (BRC), University Hospitals Birmingham and University of Birmingham, Birmingham, UK
| | - Jonathan I Quinlan
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Biomedical Research Centre (BRC), University Hospitals Birmingham and University of Birmingham, Birmingham, UK.,School of Sport, Exercise and Rehabilitation Science, University of Birmingham, Birmingham, UK
| | - Sophie L Allen
- NIHR Biomedical Research Centre (BRC), University Hospitals Birmingham and University of Birmingham, Birmingham, UK.,School of Sport, Exercise and Rehabilitation Science, University of Birmingham, Birmingham, UK
| | - Carolyn Greig
- NIHR Biomedical Research Centre (BRC), University Hospitals Birmingham and University of Birmingham, Birmingham, UK.,School of Sport, Exercise and Rehabilitation Science, University of Birmingham, Birmingham, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Research, University of Birmingham, Birmingham, UK
| | - Andrew Filer
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,University of Hospitals of Birmingham NHS Trust, Birmingham, UK
| | - Karim Raza
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Subrata Ghosh
- University of Hospitals of Birmingham NHS Trust, Birmingham, UK.,NIHR Biomedical Research Centre (BRC), University Hospitals Birmingham and University of Birmingham, Birmingham, UK
| | - Gareth G Lavery
- NIHR Biomedical Research Centre (BRC), University Hospitals Birmingham and University of Birmingham, Birmingham, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Research, University of Birmingham, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Philip N Newsome
- University of Hospitals of Birmingham NHS Trust, Birmingham, UK.,NIHR Biomedical Research Centre (BRC), University Hospitals Birmingham and University of Birmingham, Birmingham, UK
| | - Surabhi Choudhary
- NIHR Biomedical Research Centre (BRC), University Hospitals Birmingham and University of Birmingham, Birmingham, UK
| | - Leigh Breen
- School of Sport, Exercise and Rehabilitation Science, University of Birmingham, Birmingham, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Research, University of Birmingham, Birmingham, UK
| | - Matthew J Armstrong
- University of Hospitals of Birmingham NHS Trust, Birmingham, UK.,NIHR Biomedical Research Centre (BRC), University Hospitals Birmingham and University of Birmingham, Birmingham, UK
| | - Ahmed M Elsharkawy
- University of Hospitals of Birmingham NHS Trust, Birmingham, UK.,NIHR Biomedical Research Centre (BRC), University Hospitals Birmingham and University of Birmingham, Birmingham, UK
| | - Janet M Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK. .,NIHR Biomedical Research Centre (BRC), University Hospitals Birmingham and University of Birmingham, Birmingham, UK.
| |
Collapse
|
6
|
Allen SL, Marshall RN, Edwards SJ, Lord JM, Lavery GG, Breen L. The effect of young and old ex vivo human serum on cellular protein synthesis and growth in an in vitro model of aging. Am J Physiol Cell Physiol 2021; 321:C26-C37. [PMID: 33909501 DOI: 10.1152/ajpcell.00093.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In vitro models of muscle aging are useful for understanding mechanisms of age-related muscle loss and aiding the development of targeted therapies. To investigate mechanisms of age-related muscle loss in vitro utilizing ex vivo human serum, fasted blood samples were obtained from four old (72 ± 1 yr) and four young (26 ± 3 yr) men. Older individuals had elevated levels of plasma CRP, IL-6, HOMA-IR, and lower concentric peak torque and work-per-repetition compared with young participants (P < 0.05). C2C12 myotubes were serum and amino acid starved for 1 h and conditioned with human serum (10%) for 4 h or 24 h. After 4 h, C2C12 cells were treated with 5 mM leucine for 30 min. Muscle protein synthesis (MPS) was determined through the surface sensing of translation (SUnSET) technique and regulatory signaling pathways were measured via Western blot. Myotube diameter was significantly reduced in myotubes treated with serum from old, in comparison to young donors (84%, P < 0.001). MPS was reduced in myotubes treated with old donor serum, compared with young serum before leucine treatment (32%, P < 0.01). MPS and the phosphorylation of Akt, p70S6K, and eEF2 were increased in myotubes treated with young serum in response to leucine treatment, with a blunted response identified in cells treated with old serum (P < 0.05). Muscle protein breakdown signaling pathways did not differ between groups. In summary, we show that myotubes conditioned with serum from older individuals had decreased myotube diameter and MPS compared with younger individuals, potentially driven by low-grade systemic inflammation.
Collapse
Affiliation(s)
- Sophie L Allen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.,National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Ryan N Marshall
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Sophie J Edwards
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Janet M Lord
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Gareth G Lavery
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partner, Birmingham, United Kingdom
| | - Leigh Breen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.,National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
7
|
Morgan PT, Harris DO, Marshall RN, Quinlan JI, Edwards SJ, Allen SL, Breen L. Protein Source and Quality for Skeletal Muscle Anabolism in Young and Older Adults: A Systematic Review and Meta-Analysis. J Nutr 2021; 151:1901-1920. [PMID: 33851213 PMCID: PMC8245874 DOI: 10.1093/jn/nxab055] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/07/2021] [Accepted: 02/11/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is much debate regarding the source/quality of dietary proteins in supporting indices of skeletal muscle anabolism. OBJECTIVE We performed a systematic review and meta-analysis to determine the effect of protein source/quality on acute muscle protein synthesis (MPS) and changes in lean body mass (LBM) and strength, when combined with resistance exercise (RE). METHODS A systematic search of the literature was conducted to identify studies that compared the effects of ≥2 dose-matched, predominantly isolated protein sources of varying "quality." Three separate models were employed as follows: 1) protein feeding alone on MPS, 2) protein feeding combined with a bout of RE on MPS, and 3) protein feeding combined with longer-term resistance exercise training (RET) on LBM and strength. Further subgroup analyses were performed to compare the effects of protein source/quality between young and older adults. A total of 27 studies in young (18-35 y) and older (≥60 y) adults were included. RESULTS Analysis revealed an effect favoring higher-quality protein for postprandial MPS at rest [mean difference (MD): 0.014%/h; 95% CI: 0.006, 0.021; P < 0.001] and following RE (MD: 0.022%/h; 95% CI: 0.014, 0.030; P < 0.00001) in young (model 1: 0.016%/h; 95% CI: -0.004, 0.036; P = 0.12; model 2: 0.030%/h; 95% CI: 0.015, 0.045; P < 0.0001) and older (model 1: 0.012%/h; 95% CI: 0.006, 0.018; P < 0.001; model 2: 0.014%/h; 95% CI: 0.007, 0.021; P < 0.001) adults. However, although higher protein quality was associated with superior strength gains with RET [standardized mean difference (SMD): 0.24 kg; 95% CI: 0.02, 0.45; P = 0.03)], no effect was observed on changes to LBM (SMD: 0.05 kg; 95% CI: -0.16, 0.25; P = 0.65). CONCLUSIONS The current review suggests that protein quality may provide a small but significant impact on indices of muscle protein anabolism in young and older adults. However, further research is warranted to elucidate the importance of protein source/quality on musculoskeletal aging, particularly in situations of low protein intake.
Collapse
Affiliation(s)
- Paul T Morgan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Dane O Harris
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Ryan N Marshall
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Jonathan I Quinlan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK,National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sophie J Edwards
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Sophie L Allen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | | |
Collapse
|
8
|
Victor BS, Allen SL, Holcomb CT, Samuell C, Thorman A. Spectrally resolved polarization angle across the motional Stark effect spectrum. Rev Sci Instrum 2021; 92:043508. [PMID: 34243398 DOI: 10.1063/5.0040543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/13/2021] [Indexed: 06/13/2023]
Abstract
A new diagnostic technique has been developed that couples a spectrometer and an image-intensified camera into the traditional motional Stark effect (MSE) system on DIII-D. The image-intensified camera syncs with the photo-elastic modulators to spectrally resolve the Stokes parameters across the Stark multiplet. Polarization dependent phase shift, likely from a plasma facing mirror, leads to the spectropolarimeter measuring a variation in the polarization angle across the MSE spectrum of ∼8°.
Collapse
Affiliation(s)
- B S Victor
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S L Allen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C T Holcomb
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Samuell
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Thorman
- UK Atomic Energy Authority, Abingdon OX14 3DB, United Kingdom
| |
Collapse
|
9
|
Allen SL, Quinlan JI, Dhaliwal A, Armstrong MJ, Elsharkawy AM, Greig CA, Lord JM, Lavery GG, Breen L. Sarcopenia in chronic liver disease: mechanisms and countermeasures. Am J Physiol Gastrointest Liver Physiol 2021; 320:G241-G257. [PMID: 33236953 PMCID: PMC8609568 DOI: 10.1152/ajpgi.00373.2020] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sarcopenia, a condition of low muscle mass, quality, and strength, is commonly found in patients with cirrhosis and is associated with adverse clinical outcomes including reduction in quality of life, increased mortality, and posttransplant complications. In chronic liver disease (CLD), sarcopenia is most commonly defined through the measurement of the skeletal muscle index of the third lumbar spine. A major contributor to sarcopenia in CLD is the imbalance in muscle protein turnover, which likely occurs due to a decrease in muscle protein synthesis and an elevation in muscle protein breakdown. This imbalance is assumed to arise due to several factors including accelerated starvation, hyperammonemia, amino acid deprivation, chronic inflammation, excessive alcohol intake, and physical inactivity. In particular, hyperammonemia is a key mediator of the liver-gut axis and is known to contribute to mitochondrial dysfunction and an increase in myostatin expression. Currently, the use of nutritional interventions such as late-evening snacks, branched-chain amino acid supplementation, and physical activity have been proposed to help the management and treatment of sarcopenia. However, little evidence exists to comprehensively support their use in clinical settings. Several new pharmacological strategies, including myostatin inhibition and the nutraceutical Urolithin A, have recently been proposed to treat age-related sarcopenia and may also be of use in CLD. This review highlights the potential molecular mechanisms contributing to sarcopenia in CLD alongside a discussion of existing and potential new treatment strategies.
Collapse
Affiliation(s)
- Sophie L. Allen
- 1School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom,2National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Jonathan I. Quinlan
- 1School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom,2National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Amritpal Dhaliwal
- 2National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom,3Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom,4Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Matthew J. Armstrong
- 2National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom,4Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Ahmed M. Elsharkawy
- 2National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom,3Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom,4Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Carolyn A. Greig
- 1School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom,2National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom,5MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Janet M. Lord
- 2National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom,3Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom,5MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Gareth G. Lavery
- 2National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom,6Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom,7Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partner, Birmingham, United Kingdom
| | - Leigh Breen
- 1School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom,2National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom,5MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
10
|
Allen SL, Samuell CM, Meyer WH, Howard J. Laser calibration of the DIII-D coherence imaging system. Rev Sci Instrum 2018; 89:10E110. [PMID: 30399797 DOI: 10.1063/1.5038739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
In this paper, we describe an in situ calibration technique for Coherence Imaging Spectroscopy (CIS) that measures 2-D images of ion flows on DIII-D. A low power CW diode laser that is tuneable in the range 464-468 nm along with a precision wavemeter (10-5 nm resolution) is used to characterize the interferometer phase as a function of wavelength in the region of C iii (465 nm) and He ii (468 nm). The interferometer is stabilized both mechanically and thermally to minimize drift during the calibration. Optical stirring and an integration sphere are used to obtain spatially uniform calibration images. The quality of the calibration data enables a measurement of phase versus wavelength over approximately 10 fringes of the interferometer. These coefficients can also be related to the geometry of the optics and the birefringent crystal of the interferometer. On DIII-D, the integration sphere with the laser light is inserted into the CIS optical system between shots and the laser image and wavelength are automatically recorded, providing a zero velocity reference.
Collapse
Affiliation(s)
- S L Allen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C M Samuell
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - W H Meyer
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Howard
- Australian National Laboratory, Canberra, ACT 0200, Australia
| |
Collapse
|
11
|
Meyer WH, Allen SL, Samuell CM, Fenstermacher ME. Tomographic analysis of tangential viewing cameras (invited). Rev Sci Instrum 2018; 89:10K110. [PMID: 30399959 DOI: 10.1063/1.5038586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
Many tokamaks now use visible light cameras to observe plasma-wall interactions and integrated line emission. The DIII-D coherence imaging spectroscopy diagnostic cameras image interferograms that encode line integrated velocity. By modeling the 2D camera image pixels as line of sight integrals through an axisymmetric discrete grid, it is possible to do tomographic analysis to determine the local plasma line emissivity and parallel velocity. Methods to solve the inverse problem posed by these tangential viewing cameras are presented. The inversion begins with calculation of the sparse response matrix that encompasses all the geometry and diagnostic information and reduces the process of image formation to a sparse matrix-vector multiply. This work includes techniques for determining the detailed geometry of the camera views and methods for handling physical quantities that vary spatially. Additionally, the size of the response matrix has driven the development of capability to distribute the coarse parallel calculation across a heterogeneous cluster of computers on the Energy Sciences Network. Iterative techniques are then used to solve the sparse matrix-vector linear system.
Collapse
Affiliation(s)
- W H Meyer
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S L Allen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C M Samuell
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M E Fenstermacher
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| |
Collapse
|
12
|
Samuell CM, Allen SL, Meyer WH, Isler RC, Briesemeister A, Wilcox RS, Lasnier CJ, Mclean AG, Howard J. Verification of Doppler coherence imaging for 2D ion velocity measurements on DIII-D. Rev Sci Instrum 2018; 89:093502. [PMID: 30278733 DOI: 10.1063/1.5039367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/17/2018] [Indexed: 06/08/2023]
Abstract
Coherence Imaging Spectroscopy (CIS) has emerged as a powerful tool for investigating complex ion phenomena in the boundary of magnetically confined plasma devices. The combination of Fourier-transform interferometry and high-resolution fast-framing cameras has made it possible to make sensitive velocity measurements that are also spatially resolved. However, this sensitivity makes the diagnostic vulnerable to environmental effects including thermal drifts, vibration, and magnetic fields that can influence the velocity measurement. Additionally, the ability to provide an absolute calibration for these geometries can be impacted by differences in the light-collection geometry between the plasma and reference light source, spectral impurities, and the presence of thin-films on in-vessel optics. This paper discusses the mitigation of these effects and demonstration that environmental effects result in less than 0.5 km/s error on the DIII-D CIS systems. A diagnostic comparison is used to demonstrate agreement between CIS and traditional spectroscopy once tomographic artifacts are accounted for.
Collapse
Affiliation(s)
- C M Samuell
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S L Allen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - W H Meyer
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R C Isler
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - A Briesemeister
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - R S Wilcox
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - C J Lasnier
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A G Mclean
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Howard
- Australian National University, Canberra, ACT 0200, Australia
| |
Collapse
|
13
|
Jaervinen AE, Allen SL, Eldon D, Fenstermacher ME, Groth M, Hill DN, Leonard AW, McLean AG, Porter GD, Rognlien TD, Samuell CM, Wang HQ. E×B Flux Driven Detachment Bifurcation in the DIII-D Tokamak. Phys Rev Lett 2018; 121:075001. [PMID: 30169054 DOI: 10.1103/physrevlett.121.075001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/21/2018] [Indexed: 06/08/2023]
Abstract
A bifurcative step transition from low-density, high-temperature, attached divertor conditions to high-density, low-temperature, detached divertor conditions is experimentally observed in DIII-D tokamak plasmas as density is increased. The step transition is only observed in the high confinement mode and only when the B×∇B drift is directed towards the divertor. This work reports for the first time a theoretical explanation and numerical simulations that qualitatively reproduce this bifurcation and its dependence on the toroidal field direction. According to the model, the bifurcation is primarily driven by the interdependence of the E×B-drift fluxes, divertor electric potential structure, and divertor conditions. In the attached conditions, strong potential gradients in the low field side (LFS) divertor drive E×B-drift flux towards the high field side divertor, reinforcing low density, high temperature conditions in the LFS divertor leg. At the onset of detachment, reduction in the potential gradients in the LFS divertor leg reduce the E×B-drift flux as well, such that the divertor plasma evolves nonlinearly to high density, strongly detached conditions. Experimental estimates of the E×B-drift fluxes, based on divertor Thomson scattering measurements, and their dependence on the divertor conditions are qualitatively consistent with the numerical predictions. The implications for divertor power exhaust and detachment control in the next step fusion devices are discussed.
Collapse
Affiliation(s)
- A E Jaervinen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S L Allen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Eldon
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M E Fenstermacher
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Groth
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D N Hill
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A W Leonard
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A G McLean
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - G D Porter
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - T D Rognlien
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C M Samuell
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - H Q Wang
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| |
Collapse
|
14
|
Adams JW, Howe CJ, Andrews AC, Allen SL, Vinnard C. Tuberculosis screening among HIV-infected patients: tuberculin skin test vs. interferon-gamma release assay. AIDS Care 2017; 29:1504-1509. [PMID: 28486818 DOI: 10.1080/09540121.2017.1325438] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
National guidelines recommend screening for latent tuberculosis infection (LTBI) in all HIV-infected patients. Thus, the objective of this study was to measure protocol adherence to national guidelines regarding LTBI screening for HIV-infected patients entering care at an urban primary care clinic specializing in HIV care, identify clinical and other characteristics associated with adherence, and determine whether transitioning from the tuberculin skin test (TST) to the interferon-gamma release assay (IGRA) improved adherence. We conducted a retrospective study using protocol adherence to LTBI screening guidelines within twelve months of entering care at an HIV clinic as the primary outcome. Successful protocol adherence was defined as the placement and reading of a TST, performance of an IGRA, or a note in study clinic records documenting prior testing or treatment for tuberculosis in an outside setting. Multivariable modified Poisson regression models were used in analyses. Overall, 32% (n = 118/372) of patients received LTBI screening within twelve months of entering care. Protocol adherence to LTBI screening guidelines increased from 28% to 37% following the transition from TST to IGRA screening. IGRA screening [adjusted prevalence ratio: 1.45, 95% confidence limits: (1.07, 1.96)], male sex [1.47 (1.05, 2.07)], transfer patient status [1.51 (1.05, 2.18)], and greater than one year of clinic attendance [1.62 (1.06, 2.48)] were independently associated with protocol adherence. Among patients without prior LTBI screening or treatment, patients entering the clinic in 2013 under the IGRA screening protocol were more likely to be screened for LTBI compared to patients entering under the TST screening protocol (34.3% vs. 9.7%, p < 0.001). In conclusion, transitioning from TST to IGRA-based screening improved adherence to screening guidelines. However, further work on improving adherence to LTBI screening guidelines among HIV-infected patients is needed.
Collapse
Affiliation(s)
- J W Adams
- a Department of Epidemiology , Brown University School of Public Health , Providence , USA
| | - C J Howe
- a Department of Epidemiology , Brown University School of Public Health , Providence , USA
| | - A C Andrews
- b Department of Epidemiology , Drexel School of Public Health , Philadelphia , PA , USA
| | - S L Allen
- c Division of Infectious Diseases & HIV Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
| | - C Vinnard
- d Public Health Research Institute, Rutgers , The State University of New Jersey , Newark , NJ , USA
| |
Collapse
|
15
|
Victor BS, Holcomb CT, Allen SL, Meyer WH, Makowski MA, Thorman A. Asymmetries in the motional Stark effect emission on the DIII-D tokamak. Rev Sci Instrum 2016; 87:11E126. [PMID: 27910343 DOI: 10.1063/1.4961560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Spectrometer measurements and filter upgrades to a motional Stark effect polarimeter measuring the outer half-radius of the DIII-D tokamak helped to identify asymmetries in the polarization angle of Stark-split emission. The measured polarization angle of the π components differs and is not orthogonal to the σ component. These differences persist over a range of densities and with low levels of background light. It is suggested that the difference in the polarization angle between components is from a change in the ellipticity of the emitted light across the Stark components coupled with imperfect polarization preservation from an in-vessel mirror.
Collapse
Affiliation(s)
- B S Victor
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C T Holcomb
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S L Allen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - W H Meyer
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M A Makowski
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Thorman
- Plasma Research Laboratory, Australia National University, Canberra ACT 0200, Australia
| |
Collapse
|
16
|
McLean AG, Soukhanovskii VA, Allen SL, Carlstrom TN, LeBlanc BP, Ono M, Stratton BC. Conceptual design of a divertor Thomson scattering diagnostic for NSTX-U. Rev Sci Instrum 2014; 85:11E825. [PMID: 25430390 DOI: 10.1063/1.4894001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A conceptual design for a divertor Thomson scattering (DTS) diagnostic has been developed for the NSTX-U device to operate in parallel with the existing multipoint Thomson scattering system. Higher projected peak heat flux in NSTX-U will necessitate application of advanced magnetics geometries and divertor detachment. Interpretation and modeling of these divertor scenarios will depend heavily on local measurement of electron temperature, Te, and density, ne, which DTS provides in a passive manner. The DTS design for NSTX-U adopts major elements from the successful DIII-D DTS system including 7-channel polychromators measuring Te to 0.5 eV. If implemented on NSTX-U, the divertor TS system would provide an invaluable diagnostic for the boundary program to characterize the edge plasma.
Collapse
Affiliation(s)
- A G McLean
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94550, USA
| | - V A Soukhanovskii
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94550, USA
| | - S L Allen
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94550, USA
| | - T N Carlstrom
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608, USA
| | - B P LeBlanc
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - M Ono
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - B C Stratton
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| |
Collapse
|
17
|
Lasnier CJ, Allen SL, Ellis RE, Fenstermacher ME, McLean AG, Meyer WH, Morris K, Seppala LG, Crabtree K, Van Zeeland MA. Wide-angle ITER-prototype tangential infrared and visible viewing system for DIII-D. Rev Sci Instrum 2014; 85:11D855. [PMID: 25430268 DOI: 10.1063/1.4892897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
An imaging system with a wide-angle tangential view of the full poloidal cross-section of the tokamak in simultaneous infrared and visible light has been installed on DIII-D. The optical train includes three polished stainless steel mirrors in vacuum, which view the tokamak through an aperture in the first mirror, similar to the design concept proposed for ITER. A dichroic beam splitter outside the vacuum separates visible and infrared (IR) light. Spatial calibration is accomplished by warping a CAD-rendered image to align with landmarks in a data image. The IR camera provides scrape-off layer heat flux profile deposition features in diverted and inner-wall-limited plasmas, such as heat flux reduction in pumped radiative divertor shots. Demonstration of the system to date includes observation of fast-ion losses to the outer wall during neutral beam injection, and shows reduced peak wall heat loading with disruption mitigation by injection of a massive gas puff.
Collapse
Affiliation(s)
- C J Lasnier
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - S L Allen
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - R E Ellis
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - M E Fenstermacher
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - A G McLean
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - W H Meyer
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - K Morris
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - L G Seppala
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - K Crabtree
- College of Optics, University of Arizona, Tucson, Arizona 85721, USA
| | - M A Van Zeeland
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608, USA
| |
Collapse
|
18
|
Soukhanovskii VA, McLean AG, Allen SL. Near-infrared spectroscopy for divertor plasma diagnosis and control in DIII-D tokamak. Rev Sci Instrum 2014; 85:11E418. [PMID: 25430325 DOI: 10.1063/1.4891600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
New near infrared (NIR) spectroscopic measurements performed in the DIII-D tokamak divertor plasma suggest new viable diagnostic applications: divertor recycling and low-Z impurity flux measurements, a spectral survey for divertor Thomson scattering (DTS) diagnostic, and Te monitoring for divertor detachment control. A commercial 0.3 m spectrometer coupled to an imaging lens via optical fiber and a InGaAs 1024 pixel array detector enabled deuterium and impurity emission measurements in the range 800-2300 nm. The first full NIR survey identified D, He, B, Li, C, N, O, Ne lines and provided plasma Te, ne estimates from deuterium Paschen and Brackett series intensity and Stark line broadening analysis. The range 1.000-1.060 mm was surveyed in high-density and neon seeded divertor plasmas for spectral background emission studies for λ = 1.064 μm laser-based DTS development. The ratio of adjacent deuterium Paschen-α and Brackett Br9 lines in recombining divertor plasmas is studied for divertor Te monitoring aimed at divertor detachment real-time feedback control.
Collapse
Affiliation(s)
- V A Soukhanovskii
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - A G McLean
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - S L Allen
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| |
Collapse
|
19
|
Weber TR, Allen SL, Howard J. C-III flow measurements with a coherence imaging spectrometer. Rev Sci Instrum 2012; 83:10E102. [PMID: 23126924 DOI: 10.1063/1.4728311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This work describes a coherence imaging spectrometer capable of making spatially resolved CIII flow measurements in the DIII-D lower divertor. The spectrometer exploits a periscope view of the plasma to produce line-of-sight averaged velocity measurements of CIII. From these chord averaged flow measurements, a 2D poloidal cross section of the CIII flow is tomographically reconstructed. Details of the diagnostic setup, acquired data, and data analysis will be presented, along with prospects for future applications.
Collapse
Affiliation(s)
- T R Weber
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | | | | |
Collapse
|
20
|
Lanctot MJ, Holcomb CT, Allen SL, Fenstermacher ME, Luce TC. Pedestal magnetic field measurements using a motional Stark effect polarimeter. Rev Sci Instrum 2012; 83:10E319. [PMID: 23126977 DOI: 10.1063/1.4733342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Temperature-controlled, 0.15 nm interference filters were installed on an edge-viewing system of the motional Stark effect (MSE) polarimeter on the DIII-D tokamak. The upgraded system provides a factor of two reduction in the bandpass compared to the previous design, and linear control of the bandpass, which is unaltered by wavelength tuning. With the new system, there is a reduced dependence of the inferred polarization angle on the filter wavelength calibration. Recent measurements from the calibrated edge-viewing system show increased agreement with other MSE arrays.
Collapse
Affiliation(s)
- M J Lanctot
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA.
| | | | | | | | | |
Collapse
|
21
|
Spector MS, Iossifov I, Kritharis A, He C, Kolitz JE, Lowe SW, Allen SL. Mast-cell leukemia exome sequencing reveals a mutation in the IgE mast-cell receptor β chain and KIT V654A. Leukemia 2011; 26:1422-5. [PMID: 22173243 PMCID: PMC3368985 DOI: 10.1038/leu.2011.354] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
22
|
King JD, Makowski MA, Holcomb CT, Allen SL, Hill DN, La Haye RJ, Turco F, Petty CC, Van Zeeland MA, Rhodes TL, Meyer WH, Geer R, Morse EC. Magnetohydrodynamic interference with the edge pedestal motional Stark effect diagnostic on DIII-D. Rev Sci Instrum 2011; 82:033515. [PMID: 21456744 DOI: 10.1063/1.3568827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Accurate measurement of internal magnetic field direction using motional Stark effect (MSE) polarimetry in the edge pedestal is desired for nearly all tokamak scenario work. A newly installed 500 kHz 32-channel digitizer on the MSE diagnostic of DIII-D allows full spectral information of the polarimeter signal to be recovered for the first time. Fourier analysis of this data has revealed magnetohydrodynamic (MHD) fluctuations in the plasma edge pedestal at ρ ≥ 0.92. By correlating edge localized mode fluctuations seen on lock-in amplifier outputs with MSE spectrograms, it has been shown that edge pedestal tearing mode fluctuations cause interference with MSE second harmonic instrument frequencies. This interference results in unrecoverable errors in the real-time polarization angle measurement that are more than an order of magnitude larger than typical polarimeter uncertainties. These errors can cause as much as a 38% difference in local q. By using a redundant measure of the linear polarization found at the fourth harmonic photo-elastic modulator (PEM) frequency, MHD interference can be avoided. However, because of poorer signal-to-noise the fourth harmonic signal computed polarization angle shows no improvement over the MHD polluted second harmonics. MHD interference could be avoided in future edge pedestal tokamak polarimeters by utilizing PEMs with higher fundamental frequencies and a greater separation between their frequencies.
Collapse
Affiliation(s)
- J D King
- Lawrence Livermore National Laboratory, Livermore, California 94550-9234, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
King JD, Makowski MA, Holcomb CT, Allen SL, Geer R, Meyer WH, Hill DN, Pham D, Morse EC. A digital lock-in upgrade of the motional Stark effect diagnostic on DIII-D. Rev Sci Instrum 2010; 81:10D739. [PMID: 21033930 DOI: 10.1063/1.3496989] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The use of lock-in amplifiers for phase sensitive detection of motional Stark effect (MSE) diagnostic signals is of critical importance to real-time internal current profile measurements in tokamak plasmas. A digital lock-in (DLI) upgrade utilizing field programable gate array firmware has been installed on the MSE system of the DIII-D tokamak for the eventual replacement of largely obsolete analog units. While the new digital system has shown a small reduction in electronic noise over the analog, the main advantages are reduced cost, hardware simplicity, compact size, and phase tracking during plasma operations. DLI recovery of MSE polarization angles was accomplished through use of reference processing to produce only photoelastic modulator (PEM) second harmonic frequencies and electronic signal processing to maximize the fidelity of the recovered signal. A simplified discrete analytical solution was found that accurately describes the new DLI hardware. The DLI algorithm was found to cause a prohibitively large oscillating artifact atop the demodulated signal. The artifact was caused by the accumulator interval not containing an exact integer number of PEM multiplier periods. Successful MSE measurements require the minimization of this oscillating artifact amplitude. The analytical solution was used to select an appropriate accumulator interval that both reduces the artifact and maintains the greatest temporal resolution possible. Sample EFIT equilibria reconstructions and corresponding safety factor profiles showed very close agreement between the analog and digital lock-ins.
Collapse
Affiliation(s)
- J D King
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Howard J, Diallo A, Creese M, Blackwell BD, Allen SL, Ellis RM, Porter GD, Meyer W, Fenstermacher ME, Brooks NH, Van Zeeland ME, Boivin RL. Doppler coherence imaging and tomography of flows in tokamak plasmas (invited). Rev Sci Instrum 2010; 81:10E528. [PMID: 21034056 DOI: 10.1063/1.3492422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This article describes the results of spatial heterodyne Doppler "coherence imaging" of carbon ion flows in the divertor region of the DIII-D tokamak. Spatially encoded interferometric projections of doubly ionized carbon emission at 465 nm have been demodulated and tomographically inverted to obtain the spatial distribution of the carbon ion parallel flow and emissivity. The operating principles of the new instruments are described, and the link between measured properties and line integrals of the flow field are established. An iterative simultaneous arithmetic reconstruction procedure is applied to invert the interferometric phase shift projections, and the reconstructed parallel flow field amplitudes are found to be in reasonable agreement with UEDGE modeling.
Collapse
Affiliation(s)
- J Howard
- Plasma Research Laboratory, The Australian National University, Canberra 0200, Australia.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
The utilization of glucose, amino acids, fatty acids, bicarbonate, purines, and pyrimidines by the Reiter treponeme was studied by using carbon 14-labeled substrates. The distribution of carbon from the substrates into various cell components was determined. Radioactivity from labeled bicarbonate in the cellular protein was restricted to aspartic acid. The Reiter treponeme is capable of synthesizing glycine, serine, alanine, aspartic acid, glutamic acid, proline, and possibly ornithine. Phenylalanine, arginine, lysine, leucine, isoleucine, valine, threonine, and histidine do not appear to be synthesized by this treponeme. The Reiter treponeme cannot synthesize fatty acids, and thymine is not incorporated. Glucose is a major carbon and energy source. Arginine, histidine, serine, threonine, and glutamic acid are degraded by the Reiter treponeme and may serve as energy sources. It was calculated that exogenously supplied amino acids contribute 41 to 54% of the cellular material; fatty acids, 18%; and glucose, 28 to 43%.
Collapse
Affiliation(s)
- S L Allen
- Department of Microbiology, University of Minnesota, Minneapolis, Minnesota 55455
| | | | | |
Collapse
|
26
|
Holcomb CT, Makowski MA, Allen SL, Meyer WH, Van Zeeland MA. Overview of equilibrium reconstruction on DIII-D using new measurements from an expanded motional Stark effect diagnostic. Rev Sci Instrum 2008; 79:10F518. [PMID: 19044663 DOI: 10.1063/1.2955711] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Motional Stark effect (MSE) measurements constrain equilibrium reconstruction of DIII-D tokamak plasmas using the equilibrium code EFIT. In 2007, two new MSE arrays were brought online, bringing the system to three core arrays, two edge arrays, and 64 total channels. We present the first EFIT reconstructions using this expanded system. Safety factor and E(R) profiles produced by fitting to data from the two new arrays and one of the other three agree well with independent measurements. Comparison of the data from the three arrays that view the core shows that one of the older arrays is inconsistent with the other two unless the measured calibration factors for this array are adjusted. The required adjustments depend on the toroidal field and plasma current direction, and on still other uncertain factors that change as the plasma evolves. We discuss possible sources of calibration error for this array.
Collapse
Affiliation(s)
- C T Holcomb
- Lawrence Livermore National Laboratory, 7000 East Ave., Livermore, California 94550, USA
| | | | | | | | | |
Collapse
|
27
|
Makowski MA, Allen SL, Holcomb CT, Lerner S, Morris K, Wong N. Optimization of the optical design of the ITER MSE diagnostic. Rev Sci Instrum 2008; 79:10F519. [PMID: 19044664 DOI: 10.1063/1.2955708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The motional Stark effect (MSE) diagnostic will be essential for the study of advanced scenarios on ITER and its design is currently underway with initial emphasis on the optical design. Optical performance, as measured by photon throughput and minimization of polarization aberrations, will be critical to the success of the diagnostic. Consequently, the initial design work has been focused heavily on this area. In order meet the ITER MSE diagnostic design requirements, two approaches for the measurement are under consideration. The first is based on standard polarimeter techniques to measure the polarization of the emitted light, whereas the second measures the Stark splitting from which absolute value(B) can be inferred, where absolute value(B) is the magnitude of the total magnetic field. The base line design of the optical system is centered on the first approach. Emphasis in this case is placed on minimizing the polarization aberrations of the optical relay system. Motivation for the second method results from concern that the optical properties of the plasma-facing mirror, particularly its diattenuation and retardance, will degrade with plasma exposure. The second approach, while less sensitive to aberrations induced by plasma exposure effects, requires greater optical throughput in order to measure the complete Stark spectrum. We have developed an optimized optical design applicable to both measurement techniques. A summary of the design is presented and design issues are discussed.
Collapse
Affiliation(s)
- M A Makowski
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, USA
| | | | | | | | | | | |
Collapse
|
28
|
Barginear MF, Donahue L, Allen SL, Budman DR, Bradley T, Bhaskaran M, Shapira I. Heparin-induced thrombocytopenia complicating hemodialysis. Clin Appl Thromb Hemost 2007; 14:105-7. [PMID: 18160608 DOI: 10.1177/1076029607304405] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hemodialysis complicated by heparin-induced thrombocytopenia (HIT) is a rare event requiring anticoagulation with direct-thrombin inhibitors. Contaminant calcific uremic arteriolopathy (calciphylaxis) further complicates this situation due to the possibility that warfarin anticoagulation may exacerbate skin necrosis. The authors report a patient with renal failure and calciphylaxis who developed HIT after starting hemodialysis. She was successfully treated with Argatroban.
Collapse
Affiliation(s)
- M F Barginear
- Don Monti Division of Medical Oncology/Division of Hematology, North Shore University Hospital, New York University School of Medicine, New York 11042, USA.
| | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
B cell-type chronic lymphocytic leukemia (B-CLL) is a heterogeneous disease. This is reflected by the very wide-ranging clinical courses that B-CLL patients experience and by the marked variation in laboratory findings between patients. In this chapter, we will review the various clinical and laboratory parameters that divide B-CLL patients into "subgroups," and correlate the parameters that define them. When feasible, we will also link clinical features to the cellular and genetic characteristics recently defined for these leukemic cells. The discussion is limited to parameters that define phenotypes or subgroups that may relate to disease activity and clinical outcome.
Collapse
MESH Headings
- B-Lymphocytes/immunology
- B-Lymphocytes/pathology
- Bone Marrow/pathology
- Chromosome Aberrations
- DNA-Binding Proteins/genetics
- Female
- Gene Expression Profiling
- Humans
- Immunoglobulin Variable Region/genetics
- Immunologic Memory
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/classification
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphocyte Activation
- Male
- Mutation
- Proto-Oncogene Proteins c-bcl-6
- Receptors, Antigen, B-Cell/metabolism
- Signal Transduction
- Telomere/enzymology
- Telomere/genetics
- ZAP-70 Protein-Tyrosine Kinase/genetics
Collapse
Affiliation(s)
- N Chiorazzi
- Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY 11030, USA.
| | | | | |
Collapse
|
30
|
Parnes HL, Cirrincione C, Aisner J, Berry DA, Allen SL, Abrams J, Chuang E, Cooper MR, Perry MC, Duggan DB, Szatrowski TP, Henderson IC, Norton L. Phase III study of cyclophosphamide, doxorubicin, and fluorouracil (CAF) plus leucovorin versus CAF for metastatic breast cancer: Cancer and Leukemia Group B 9140. J Clin Oncol 2003; 21:1819-24. [PMID: 12721259 DOI: 10.1200/jco.2003.05.119] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine whether biochemical modulation with LV (leucovorin) enhances the efficacy of CAF (cyclophosphamide, doxorubicin, and fluorouracil) against metastatic breast cancer. PATIENTS AND METHODS Women with histologically confirmed stage IV breast cancer, Cancer and Leukemia Group B (CALGB) performance status 0 to 2, and no prior chemotherapy for metastatic disease were randomly assigned to receive CAF (cyclophosphamide 500 mg/m2 day 1, doxorubicin 40 mg/m2 day 1, and fluorouracil [FU] 200 mg/m2 intravenous bolus days 1 to 5) with or without LV (LV 200 mg/m2 over 30 minutes days 1 to 5 given 1 hour before FU). RESULTS Two hundred forty-two patients were randomly assigned to treatment; 124 patients had visceral crisis and 40 patients had a CALGB performance status score of 2. The median follow-up was 6 years. The two study arms were similar with regard to serious adverse events; four patients died from treatment-related causes, two patients on each study arm. Predictive variables for time to treatment failure and survival were visceral disease and performance status. The overall response rate was 29% for CAF versus 28% for CAF plus LV. The median time to treatment failure (9 months) and median survival (1.7 years) did not differ by treatment arm. CONCLUSION Modulation of CAF with LV improved neither response rates nor survival among women with metastatic breast cancer, compared with CAF alone. Multivariate analyses confirmed the prognostic importance of performance status and visceral crisis. However, the overall and complete response rates, response durations, time to treatment failure, and survival were the same in the two treatment arms.
Collapse
Affiliation(s)
- H L Parnes
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, 6130 Executive Plaza EPN Room 2100, Rockville MD 20852, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Demiroglu A, Steer EJ, Heath C, Taylor K, Bentley M, Allen SL, Koduru P, Brody JP, Hawson G, Rodwell R, Doody ML, Carnicero F, Reiter A, Goldman JM, Melo JV, Cross NC. The t(8;22) in chronic myeloid leukemia fuses BCR to FGFR1: transforming activity and specific inhibition of FGFR1 fusion proteins. Blood 2001; 98:3778-83. [PMID: 11739186 DOI: 10.1182/blood.v98.13.3778] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.7] [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: 12/21/2022] Open
Abstract
This report describes 2 patients with a clinical and hematologic diagnosis of chronic myeloid leukemia (CML) in chronic phase who had an acquired t(8;22)(p11;q11). Analysis by fluorescence in situ hybridization (FISH) and reverse transcription-polymerase chain reaction (RT-PCR) indicated that both patients were negative for the BCR-ABL fusion, but suggested that the BCR gene was disrupted. Further FISH indicated a breakpoint within fibroblast growth factor receptor 1 (FGFR1), the receptor tyrosine kinase that is known to be disrupted in a distinctive myeloproliferative disorder, most commonly by fusion to ZNF198. RT-PCR confirmed the presence in both cases of an in-frame messenger RNA fusion between BCR exon 4 and FGFR1 exon 9. Expression of BCR-FGFR1 in the factor-dependent cell line Ba/F3 resulted in interleukin 3-independent clones that grew at a comparable rate to cells transformed with ZNF198-FGFR1. The growth of transformed cells was inhibited by the phosphatidylinositol 3-kinase inhibitor LY294002, the farnesyltransferase inhibitors L744832 and manumycin A, the p38 inhibitors SB202190 and SB203580 but not by the MEK inhibitor PD98059. The growth of BaF3/BCR-FGFR1 and BaF3/ZNF198-FGFR1 was not significantly inhibited by treatment with STI571, but was inhibited by SU5402, a compound with inhibitory activity against FGFR1. Inhibition with this compound was associated with decreased phosphorylation of ERK1/2 and BCR-FGFR1 or ZNF198-FGFR1, and was dose dependent with an inhibitory concentration of 50% of approximately 5 microM. As expected, growth of BaF3/BCR-ABL was inhibited by STI571 but not by SU5402. The study demonstrates that the BCR-FGFR1 fusion may occur in patients with apparently typical CML. Patients with constitutively active FGFR1 fusion genes may be amenable to treatment with specific FGFR1 inhibitors.
Collapse
MESH Headings
- Aged
- Amino Acid Sequence
- Base Sequence
- Cell Division
- Chromosomes, Human, Pair 22
- Chromosomes, Human, Pair 8
- Enzyme Inhibitors/pharmacology
- Female
- Fusion Proteins, bcr-abl/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Middle Aged
- Molecular Sequence Data
- Oncogene Proteins/chemistry
- Oncogene Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Phosphoinositide-3 Kinase Inhibitors
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Proto-Oncogene Proteins
- Proto-Oncogene Proteins c-bcr
- Pyrroles/pharmacology
- RNA, Messenger/analysis
- Receptor Protein-Tyrosine Kinases/chemistry
- Receptor Protein-Tyrosine Kinases/genetics
- Receptor, Fibroblast Growth Factor, Type 1
- Receptors, Fibroblast Growth Factor/chemistry
- Receptors, Fibroblast Growth Factor/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Signal Transduction
- Transfection
- Translocation, Genetic
Collapse
Affiliation(s)
- A Demiroglu
- Department of Haematology, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Lichtman SM, Kolitz J, Budman DR, Schulman P, Vinciguerra V, Hoffman M, Mittelman A, Allen SL, Fusco D, Hayes FA. Treatment of aggressive non-Hodgkin's lymphoma in elderly patients with thiotepa, Novantrone (mitoxantrone), vincristine, prednisone (TNOP). Am J Clin Oncol 2001; 24:360-2. [PMID: 11474261 DOI: 10.1097/00000421-200108000-00008] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aging of the population and the increased incidence of non-Hodgkin's lymphoma will result in a large number of elderly patients with this disorder. Newer therapies will be required for this group of patients. This article reports a new therapy for elderly patients with diffuse aggressive non-Hodgkin's lymphoma. Patients were treated with TNOP (thiotepa 20 mg/m(2), mitoxantrone (Novantrone) 10 mg/m(2), vincristine (Oncovin) 1 mg/m(2) all on day 1 and prednisone 60 mg/m(2) on days 1 through 5 of a 21-day course. Twenty-six patients were enrolled on study. The patients' ages ranged from 66 years to 87 years, with a mean age of 75.5 years. Eleven patients had a partial response (42%) and 4 patients had a complete response (15%) for a total response of 57%. Eighty-one percent of patients survived 1 year and 54% survived for 2 years. The median survival was 26 months. Hematologic and nonhematologic toxicity was tolerable. We believe that TNOP is an excellent therapeutic option in this group of elderly patients, particularly in the palliative setting.
Collapse
Affiliation(s)
- S M Lichtman
- Don Monti Division of Medical Oncology, Department of Medicine, North Shore University Hospital--New York University School of Medicine, Manhasset, New York 11030, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
|
34
|
Budman DR, Johnson R, Barile B, Bowsher RR, Vinciguerra V, Allen SL, Kolitz J, Ernest CS, Kreis W, Zervos P, Walling J. Phase I and pharmacokinetic study of LY309887: a specific inhibitor of purine biosynthesis. Cancer Chemother Pharmacol 2001; 47:525-31. [PMID: 11459206 DOI: 10.1007/s002800000272] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [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: 10/27/2022]
Abstract
PURPOSE In this phase I trial in humans the safety and pharmacology of LY309887 on a weekly schedule combined with daily oral 5-mg doses of folic acid were evaluated. BACKGROUND LY309887 is an inhibitor of folate-dependent enzymes involved in de novo purine biosynthesis and has a broad preclinical antitumor activity. In murine systems, combining this agent with exogenous folic acid results in an enhanced therapeutic index. METHODS This study was a single-institution, open-label, clinical trial of dose escalation with toxicity and pharmacokinetic parameters determined. The dose range studied was 0.5-4 mg/m2 per week x6 and then a modified schedule weekly x3 every 6 weeks. RESULTS Dose-limiting toxicities were of delayed onset and associated with hematologic, neurologic, and mucosal effects. Pharmacokinetic parameters revealed dose linearity for AUC and Cmax. Low circulating levels of drug persisted for over 200 h. Urinary excretion accounted for approximately 50% of the parent drug but was highly variable. The urinary excretion was near maximal within 24 h of dosing. CONCLUSIONS The modified dosing schedule allowed repetitive dosing in patients. Further evaluation of the 2 mg/m2 per week x3 every 6 weeks with daily oral folate supplement as a potential phase II dose may be warranted.
Collapse
Affiliation(s)
- D R Budman
- Don Monti Division of Oncology, North Shore University Hospital, New York University School of Medicine, Manhasset 11030, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Damle RN, Fais F, Ghiotto F, Valetto A, Albesiano E, Wasil T, Batliwalla FM, Allen SL, Schulman P, Vinciguerra VP, Rai KR, Gregersen PK, Ferrarini M, Chiorazzi N. Chronic lymphocytic leukemia: a proliferation of B cells at two distinct stages of differentiation. Curr Top Microbiol Immunol 2001; 252:285-92. [PMID: 11125486 DOI: 10.1007/978-3-642-57284-5_29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
MESH Headings
- ADP-ribosyl Cyclase
- ADP-ribosyl Cyclase 1
- Antigens, CD/analysis
- Antigens, Differentiation/analysis
- Antigens, Neoplasm/analysis
- B-Lymphocyte Subsets/pathology
- CD5 Antigens/analysis
- Cell Differentiation
- Cell Division
- Cell Transformation, Neoplastic/pathology
- DNA Replication
- DNA, Neoplasm/genetics
- Embryonal Carcinoma Stem Cells
- Gene Rearrangement, B-Lymphocyte, Heavy Chain
- Genes, Immunoglobulin
- Germinal Center/pathology
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Joining Region/genetics
- Immunoglobulin Variable Region/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphocyte Activation/immunology
- Membrane Glycoproteins
- NAD+ Nucleosidase/analysis
- Neoplastic Stem Cells/pathology
- Telomere/ultrastructure
Collapse
Affiliation(s)
- R N Damle
- North Shore University Hospital-NYU School of Medicine, Manhasset, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Dorman DC, Allen SL, Byczkowski JZ, Claudio L, Fisher JE, Fisher JW, Harry GJ, Li AA, Makris SL, Padilla S, Sultatos LG, Mileson BE. Methods to identify and characterize developmental neurotoxicity for human health risk assessment. III: pharmacokinetic and pharmacodynamic considerations. Environ Health Perspect 2001; 109 Suppl 1:101-11. [PMID: 11250810 PMCID: PMC1240547 DOI: 10.1289/ehp.01109s1101] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
We review pharmacokinetic and pharmacodynamic factors that should be considered in the design and interpretation of developmental neurotoxicity studies. Toxicologic effects on the developing nervous system depend on the delivered dose, exposure duration, and developmental stage at which exposure occurred. Several pharmacokinetic processes (absorption, distribution, metabolism, and excretion) govern chemical disposition within the dam and the nervous system of the offspring. In addition, unique physical features such as the presence or absence of a placental barrier and the gradual development of the blood--brain barrier influence chemical disposition and thus modulate developmental neurotoxicity. Neonatal exposure may depend on maternal pharmacokinetic processes and transfer of the xenobiotic through the milk, although direct exposure may occur through other routes (e.g., inhalation). Measurement of the xenobiotic in milk and evaluation of biomarkers of exposure or effect following exposure can confirm or characterize neonatal exposure. Physiologically based pharmacokinetic and pharmacodynamic models that incorporate these and other determinants can estimate tissue dose and biologic response following in utero or neonatal exposure. These models can characterize dose--response relationships and improve extrapolation of results from animal studies to humans. In addition, pharmacologic data allow an experimenter to determine whether exposure to the test chemical is adequate, whether exposure occurs during critical periods of nervous system development, whether route and duration of exposure are appropriate, and whether developmental neurotoxicity can be differentiated from direct actions of the xenobiotic.
Collapse
Affiliation(s)
- D C Dorman
- Chemical Industry Institute of Toxicology, Research Triangle Park, North Carolina, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Two patients are reported with hemolytic anemia due to red blood cell fragmentation in association with prosthetic heart vales. They were treated with erythropoietin which eliminated the need for packed red blood cell transfusion.
Collapse
Affiliation(s)
- S Hirawat
- Don Monti Division of Medical Oncology, Department of Medicine, North Shore University Hospital-New York University School of Medicine, Manhasset, New York 11030, USA
| | | | | |
Collapse
|
38
|
Patel R, Allen SL, Manahan JM, Wright AJ, Krom RA, Wiesner RH, Persing DH, Cockerill FR, Thompson RL. Natural history of vancomycin-resistant enterococcal colonization in liver and kidney transplant recipients. Liver Transpl 2001; 7:27-31. [PMID: 11150418 DOI: 10.1053/jlts.2001.20784] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
At Mayo Medical Center (Rochester, MN), surveillance rectal (and other-site) cultures have been routinely collected from liver transplant recipients as part of a selective bowel decontamination program. Beginning in 1995, vancomycin-resistant enterococcus (VRE) colonization and infection were identified in Mayo Clinic liver and kidney transplant patients through our surveillance cultures. The purpose of this study is to describe the natural history of VRE colonization in this patient population. Fifty-two patients with VRE colonization (predominantly with a single vanB clone) were identified from September 1995 through December 1997. Five hundred ninety cultures were reviewed for this study (mean, 11.3 cultures/patient). The median time from initial VRE colonization to the last surveillance culture obtained was 306 days (range, 1 to 1,393 days). VRE infection was documented in 6 patients (11.3%). Eighteen patients (35%) met the criteria for clearance of VRE colonization, defined as VRE-negative rectal culture results on at least 3 consecutive occasions greater than 1 week apart. However, VRE was detected on subsequent surveillance cultures from 2 of these patients (11% relapse rate). Of the remaining 34 patients, 16 remained colonized with VRE and 18 did not meet the definition for clearance of VRE colonization because of incomplete follow-up. This study documents that VRE colonization usually persists for months to years in liver and kidney transplant patients.
Collapse
Affiliation(s)
- R Patel
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Allen SL. Genetic nomenclature rules for Tetrahymena thermophila. Methods Cell Biol 1999; 62:561-3. [PMID: 10503218] [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: 02/14/2023]
Affiliation(s)
- S L Allen
- Department of Biology, University of Michigan, Ann Arbor 48109, USA
| |
Collapse
|
40
|
Affiliation(s)
- S L Allen
- Department of Biology, University of Michigan, Ann Arbor 48109, USA
| |
Collapse
|
41
|
Damle RN, Wasil T, Fais F, Ghiotto F, Valetto A, Allen SL, Buchbinder A, Budman D, Dittmar K, Kolitz J, Lichtman SM, Schulman P, Vinciguerra VP, Rai KR, Ferrarini M, Chiorazzi N. Ig V gene mutation status and CD38 expression as novel prognostic indicators in chronic lymphocytic leukemia. Blood 1999; 94:1840-7. [PMID: 10477712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Cellular immunophenotypic studies were performed on a cohort of randomly selected IgM(+) B-chronic lymphocytic leukemia (B-CLL) cases for which Ig V(H) and V(L) gene sequences were available. The cases were categorized based on V gene mutation status and CD38 expression and analyzed for treatment history and survival. The B-CLL cases could be divided into 2 groups. Those patients with unmutated V genes displayed higher percentages of CD38(+) B-CLL cells (>/=30%) than those with mutated V genes that had lower percentages of CD38(+) cells (<30%). Patients in both the unmutated and the >/=30% CD38(+) groups responded poorly to continuous multiregimen chemotherapy (including fludarabine) and had shorter survival. In contrast, the mutated and the <30% CD38(+) groups required minimal or no chemotherapy and had prolonged survival. These observations were true also for those patients who stratified to the Rai intermediate risk category. In the mutated and the <30% CD38(+) groups, males and females were virtually equally distributed, whereas in the unmutated and the >/=30% CD38(+) groups, a marked male predominance was found. Thus, Ig V gene mutation status and the percentages of CD38(+) B-CLL cells appear to be accurate predictors of clinical outcome in B-CLL patients. These parameters, especially CD38 expression that can be analyzed conveniently in most clinical laboratories, should be valuable adjuncts to the present staging systems for predicting the clinical course in individual B-CLL cases. Future evaluations of new therapeutic strategies and drugs should take into account the different natural histories of patients categorized in these manners.
Collapse
MESH Headings
- Antigens, CD/immunology
- B-Lymphocytes/immunology
- CD5 Antigens/genetics
- Cohort Studies
- Female
- Follow-Up Studies
- Genes, Immunoglobulin
- Humans
- Immunoglobulin Light Chains/genetics
- Immunoglobulin Variable Region
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Mutation
- Prognosis
- Survival Analysis
- Time Factors
Collapse
Affiliation(s)
- R N Damle
- Department of Medicine, North Shore University Hospital, Manhasset, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
A rare cause of a spontaneous, life threatening coagulopathy in adults is the development of autoantibodies to factor VIII. We recently had the opportunity to treat seven patients with this disorder. After stabilization, they were given a regimen consisting of prednisone and oral cyclophosphamide. All patients had a complete response to treatment. The median time to response was three weeks. Durable remissions were achieved, making this oral regimen an acceptable treatment for this disorder.
Collapse
Affiliation(s)
- R L Bayer
- Department of Medicine, North Shore University Hospital-New York University School of Medicine, Manhasset 11030, USA
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Fais F, Ghiotto F, Hashimoto S, Sellars B, Valetto A, Allen SL, Schulman P, Vinciguerra VP, Rai K, Rassenti LZ, Kipps TJ, Dighiero G, Schroeder HW, Ferrarini M, Chiorazzi N. Chronic lymphocytic leukemia B cells express restricted sets of mutated and unmutated antigen receptors. J Clin Invest 1998; 102:1515-25. [PMID: 9788964 PMCID: PMC509001 DOI: 10.1172/jci3009] [Citation(s) in RCA: 657] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To better understand the stage(s) of differentiation reached by B-type chronic lymphocytic leukemia (B-CLL) cells and to gain insight into the potential role of antigenic stimulation in the development and diversification of these cells, we analyzed the rearranged VH genes expressed by 83 B-CLL cells (64 IgM+ and 19 non-IgM+). Our results confirm and extend the observations of a bias in the use of certain VH, D, and JH genes among B-CLL cells. In addition, they indicate that the VH genes of approximately 50% of the IgM+ B-CLL cells and approximately 75% of the non-IgM+ B-CLL cells can exhibit somatic mutations. The presence of mutation varies according to the VH family expressed by the B-CLL cell (VH3 expressers displaying more mutation than VH1 and VH4 expressers). In addition, the extent of mutation can be sizeable with approximately 32% of the IgM+ cases and approximately 68% of the non-IgM+ cases differing by > 5% from the most similar germline gene. Approximately 20% of the mutated VH genes display replacement mutations in a pattern consistent with antigen selection. However, CDR3 characteristics (D and JH gene use and association and HCDR3 length, composition, and charge) suggest that selection for distinct B cell receptors (BCR) occurs in many more B-CLL cells. Based on these data, we suggest three prototypic BCR, representing the VH genes most frequently encountered in our study. These data suggest that many B-CLL cells have been previously stimulated, placing them in the "experienced" or "memory" CD5(+) B cell subset.
Collapse
MESH Headings
- Amino Acid Sequence
- B-Lymphocyte Subsets/immunology
- B-Lymphocytes/immunology
- Binding Sites/genetics
- CD5 Antigens
- DNA, Complementary/genetics
- Gene Rearrangement, B-Lymphocyte, Heavy Chain
- Humans
- Immunoglobulin M/biosynthesis
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Molecular Sequence Data
- Mutation
- Reading Frames
- Receptors, Antigen, B-Cell/genetics
- Sequence Analysis, DNA
Collapse
Affiliation(s)
- F Fais
- Department of Medicine, North Shore University Hospital and New York University School of Medicine, Manhasset, New York 11030, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Affiliation(s)
- S L Allen
- Ultrasound Department, National Women's Hospital, Epsom, Auckland, New Zealand
| | | | | | | |
Collapse
|
45
|
Wagner AE, Gaynor JS, Dunlop CI, Allen SL, Demme WC. Monitoring adequacy of ventilation by capnometry during thoracotomy in dogs. J Am Vet Med Assoc 1998; 212:377-9. [PMID: 9470047] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine whether end-tidal partial pressure of carbon dioxide (PETCO2) was a reliable estimate of PaCO2 in dogs undergoing thoracotomy. DESIGN Case series. ANIMALS 18 dogs that underwent thoracotomy. PROCEDURE PaCO2 and PETCO2 were measured shortly after induction of anesthesia, while dogs were breathing spontaneously; 5 minutes prior to initial skin incision, while dogs were receiving intermittent positive-pressure ventilation (IPPV); 5, 30, and 60 minutes after the thoracic cavity was opened, while dogs were receiving IPPV; and after the thoracic cavity was closed and evacuated, when dogs were again breathing spontaneously. For each period, arterial-end-tidal difference in partial pressure of carbon dioxide (PaCO2-PETCO2) was compared with PaCO2-PETCO2 for the preceding period. RESULTS Significant changes in PaCO2-PETCO2 from one period to the next were not detected except when values obtained 5 minutes after the thoracic cavity was opened were compared with values obtained 5 minutes before incision. The PaCO2-PETCO2 was not constant for individual dogs. CLINICAL IMPLICATIONS PETCO2 was not a reliable indicator of adequacy of ventilation during thoracotomy in these dogs, because it differed greatly from PaCO2, and PaCO2-PETCO2 was not consistent.
Collapse
Affiliation(s)
- A E Wagner
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins 80523, USA
| | | | | | | | | |
Collapse
|
46
|
Lee EJ, George SL, Amrein PC, Paciucci PA, Allen SL, Schiffer CA. An evaluation of combinations of diaziquone, etoposide and mitoxantrone in the treatment of adults with relapsed or refractory acute myeloid leukemia: results of 8722, a randomized phase II study conducted by Cancer and Leukemia Group B. Leukemia 1998; 12:139-43. [PMID: 9519774 DOI: 10.1038/sj.leu.2400905] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A phase II trial was conducted to determine which of the three possible two-drug combinations of diaziquone, etoposide and mitoxantrone was associated with the highest response rate in patients with relapsed or refractory acute myeloid leukemia (AML). Of the 167 patients (median age 55) with AML who entered the trial, 123 were in first relapse, 22 were in second relapse and 22 had failed to achieve complete remission (CR). CR rates were 30% for diaziquone and mitoxantrone, and 23% for the other two combinations (mitoxantrone/etoposide and diaziquone/etoposide), NS. Patients in first relapse had higher CR rates (40%) than other patients. Of the 166 patients who actually received treatment, 43 died before having either a CR or persistent leukemia. Non-hematologic toxicity was primarily mucosal with 24% of patients experiencing grade 3 or greater stomatitis on the two diaziquone arms, and 43% on the mitoxantrone/etoposide arm. The combination of diaziquone and mitoxantrone was selected for further testing in patients with AML.
Collapse
Affiliation(s)
- E J Lee
- Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, USA
| | | | | | | | | | | |
Collapse
|
47
|
Serrano D, Monteiro J, Allen SL, Kolitz J, Schulman P, Lichtman SM, Buchbinder A, Vinciguerra VP, Chiorazzi N, Gregersen PK. Clonal expansion within the CD4+CD57+ and CD8+CD57+ T cell subsets in chronic lymphocytic leukemia. The Journal of Immunology 1997. [DOI: 10.4049/jimmunol.158.3.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
The role of T cells in chronic lymphocytic leukemia (CLL) has not been extensively investigated, since the most prominent cellular abnormality in CLL involves the clonal expansion of B cells. In this study we have undertaken a comprehensive analysis of the CD4+ and CD8+ T cell repertoire in a population of CLL patients (n = 19) and age-matched controls (n = 22). The TCR repertoire analysis was performed using a multiplex PCR assay for CDR3 length, an approach that allows for the detection of underlying oligoclonality in complex T cell populations. We established that oligoclonality was substantially more frequent in both the CD4+ and CD8+ T cell populations of CLL patients than in the age-matched controls (p < 0.001). Using three-color FACS analysis with a panel of TCRV segment-specific mAbs, we also established that oligoclonal expansions are predominantly found in the CD57+ subset of both the CD4+ and CD8+ T cell populations. The frequency of the CD57 marker on CD4+ T cells was increased in the setting of CLL (% CD57 = 14.8 +/- 13.0%) compared with that in normal controls (% CD57 = 3.3 +/- 3.0%; p < 0.001). An elevated frequency of CD4+CD57+ T cells was correlated with more advanced disease. Similarly, the most extreme oligoclonal expansions of CD4+CD57+ T cells occurred in CLL patients who had progressed beyond Rai stage 0. These data document profound alterations in the T cell repertoire of CLL patients and point to a role for clonal T cell populations in the pathogenesis of this disease.
Collapse
Affiliation(s)
- D Serrano
- Department of Medicine, North Shore University Hospital/New York University School of Medicine, Manhasset, NY 11030, USA
| | - J Monteiro
- Department of Medicine, North Shore University Hospital/New York University School of Medicine, Manhasset, NY 11030, USA
| | - S L Allen
- Department of Medicine, North Shore University Hospital/New York University School of Medicine, Manhasset, NY 11030, USA
| | - J Kolitz
- Department of Medicine, North Shore University Hospital/New York University School of Medicine, Manhasset, NY 11030, USA
| | - P Schulman
- Department of Medicine, North Shore University Hospital/New York University School of Medicine, Manhasset, NY 11030, USA
| | - S M Lichtman
- Department of Medicine, North Shore University Hospital/New York University School of Medicine, Manhasset, NY 11030, USA
| | - A Buchbinder
- Department of Medicine, North Shore University Hospital/New York University School of Medicine, Manhasset, NY 11030, USA
| | - V P Vinciguerra
- Department of Medicine, North Shore University Hospital/New York University School of Medicine, Manhasset, NY 11030, USA
| | - N Chiorazzi
- Department of Medicine, North Shore University Hospital/New York University School of Medicine, Manhasset, NY 11030, USA
| | - P K Gregersen
- Department of Medicine, North Shore University Hospital/New York University School of Medicine, Manhasset, NY 11030, USA
| |
Collapse
|
48
|
Serrano D, Monteiro J, Allen SL, Kolitz J, Schulman P, Lichtman SM, Buchbinder A, Vinciguerra VP, Chiorazzi N, Gregersen PK. Clonal expansion within the CD4+CD57+ and CD8+CD57+ T cell subsets in chronic lymphocytic leukemia. J Immunol 1997; 158:1482-9. [PMID: 9013995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The role of T cells in chronic lymphocytic leukemia (CLL) has not been extensively investigated, since the most prominent cellular abnormality in CLL involves the clonal expansion of B cells. In this study we have undertaken a comprehensive analysis of the CD4+ and CD8+ T cell repertoire in a population of CLL patients (n = 19) and age-matched controls (n = 22). The TCR repertoire analysis was performed using a multiplex PCR assay for CDR3 length, an approach that allows for the detection of underlying oligoclonality in complex T cell populations. We established that oligoclonality was substantially more frequent in both the CD4+ and CD8+ T cell populations of CLL patients than in the age-matched controls (p < 0.001). Using three-color FACS analysis with a panel of TCRV segment-specific mAbs, we also established that oligoclonal expansions are predominantly found in the CD57+ subset of both the CD4+ and CD8+ T cell populations. The frequency of the CD57 marker on CD4+ T cells was increased in the setting of CLL (% CD57 = 14.8 +/- 13.0%) compared with that in normal controls (% CD57 = 3.3 +/- 3.0%; p < 0.001). An elevated frequency of CD4+CD57+ T cells was correlated with more advanced disease. Similarly, the most extreme oligoclonal expansions of CD4+CD57+ T cells occurred in CLL patients who had progressed beyond Rai stage 0. These data document profound alterations in the T cell repertoire of CLL patients and point to a role for clonal T cell populations in the pathogenesis of this disease.
Collapse
Affiliation(s)
- D Serrano
- Department of Medicine, North Shore University Hospital/New York University School of Medicine, Manhasset, NY 11030, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
We demonstrate a reliable method for mapping conventional loci and obtaining meiotic linkage data for the ciliated protozoan Tetrahymena thermophila. By coupling nullisomic deletion mapping with meiotic linkage mapping, loci known to be located on a particular chromosome or chromosome arm can be tested for recombination. This approach has been used to map three isozyme loci, EstA (Esterase A), EstB (Esterase B), and AcpA (Acid Phosphatase A), with respect to the ChxA locus (cycloheximide resistance) and 11 RAPDs (randomly amplified polymorphic DNAs). To assign isozyme loci to chromosomes, clones of inbred strains C3 or C2 were crossed to inbred strain B nullisomics. EstA, EstB and AcpA were mapped to chromosomes 1R, 3L and 3R, respectively. To test EstA and AcpA for linkage to known RAPD loci on their respective chromosomes, a panel of Round II (genomic exclusion) segregants from a B/C3 heterozygote was used. Using the MAPMAKER program, EstA was assigned to the ChxA linkage group on chromosome 1R, and a detailed map was constructed that includes 10 RAPDs. AcpA (on 3R), while unlinked to all the RAPDs assigned to chromosome 3 by nullisomic mapping, does show linkage to a RAPD not yet assignable to chromosomes by nullisomic mapping.
Collapse
Affiliation(s)
- S L Allen
- Department of Biology, University of Michigan, Ann Arbor 48109-1048, USA.
| | | | | |
Collapse
|
50
|
Fais F, Sellars B, Ghiotto F, Yan XJ, Dono M, Allen SL, Budman D, Dittmar K, Kolitz J, Lichtman SM, Schulman P, Schuster M, Vinciguerra VP, Rai K, Stevenson FK, Gregersen PK, Ferrarini M, Chiorazzi N. Examples of in vivo isotype class switching in IgM+ chronic lymphocytic leukemia B cells. J Clin Invest 1996; 98:1659-66. [PMID: 8833916 PMCID: PMC507600 DOI: 10.1172/jci118961] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) usually involves the expansion of a clone of CD5+ B cells synthesizing IgM antibodies. These B cells appear to be blocked at the antigen receptor-expressing stage of B cell differentiation and are thought not to undergo an isotype class switch to IgG or IgA production. In vivo and in vitro studies suggest, however, that in some instances terminal differentiation and isotype switching can occur. To test the hypothesis that in vivo isotype class switching occurs in IgM+ B-type CLL cells, we analyzed the PBMC of 19 CLL patients for the presence of transcripts encoding the rearranged CLL V(H)DJ(H) associated with either gamma or alpha H chains. The molecular data indicate that approximately 50% of B-CLL patients have amplifications of IgM+ B cells that undergo an isotype class switch. Switching to IgA appears to occur more often than to IgG; also, switching can involve different IgG subclasses in individual patients. In many instances, these CLL-related gamma and alpha transcripts are much more plentiful than those of normal B cells that produce the same isotype. These switched transcripts do not reveal evidence for the accumulation of significant numbers of new V(H) gene mutations. The cellular data indicate that B cells with lesser amounts of surface membrane IgD and higher IgM/IgD ratios are more likely to undergo this switching process. Furthermore, B cells expressing IgG and IgA of the same idiotype or V(H) family and the same CDR3 length as those of the CLL IgM+ clone can be identified in the blood of patients studied using multiparameter immunofluorescence analyses. Collectively, these data suggest that not all members of a B-CLL clone are frozen at the surface membrane Ig-expressing stage of B cell maturation, and that some members can switch to the production of non-IgM isotypes. The occurrence of switching without the accumulation of V gene mutations indicates that the processes of differentiation and diversification are not linked.
Collapse
Affiliation(s)
- F Fais
- Department of Medicine, North Shore University Hospital and Cornell University Medical College, Manhasset, New York 11030, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|