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Hill MD, Gill SS, Le-Niculescu H, MacKie O, Bhagar R, Roseberry K, Murray OK, Dainton HD, Wolf SK, Shekhar A, Kurian SM, Niculescu AB. Precision medicine for psychotic disorders: objective assessment, risk prediction, and pharmacogenomics. Mol Psychiatry 2024:10.1038/s41380-024-02433-8. [PMID: 38326562 DOI: 10.1038/s41380-024-02433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/16/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024]
Abstract
Psychosis occurs inside the brain, but may have external manifestations (peripheral molecular biomarkers, behaviors) that can be objectively and quantitatively measured. Blood biomarkers that track core psychotic manifestations such as hallucinations and delusions could provide a window into the biology of psychosis, as well as help with diagnosis and treatment. We endeavored to identify objective blood gene expression biomarkers for hallucinations and delusions, using a stepwise discovery, prioritization, validation, and testing in independent cohorts design. We were successful in identifying biomarkers that were predictive of high hallucinations and of high delusions states, and of future psychiatric hospitalizations related to them, more so when personalized by gender and diagnosis. Top biomarkers for hallucinations that survived discovery, prioritization, validation and testing include PPP3CB, DLG1, ENPP2, ZEB2, and RTN4. Top biomarkers for delusions include AUTS2, MACROD2, NR4A2, PDE4D, PDP1, and RORA. The top biological pathways uncovered by our work are glutamatergic synapse for hallucinations, as well as Rap1 signaling for delusions. Some of the biomarkers are targets of existing drugs, of potential utility in pharmacogenomics approaches (matching patients to medications, monitoring response to treatment). The top biomarkers gene expression signatures through bioinformatic analyses suggested a prioritization of existing medications such as clozapine and risperidone, as well as of lithium, fluoxetine, valproate, and the nutraceuticals omega-3 fatty acids and magnesium. Finally, we provide an example of how a personalized laboratory report for doctors would look. Overall, our work provides advances for the improved diagnosis and treatment for schizophrenia and other psychotic disorders.
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Affiliation(s)
- M D Hill
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indianapolis VA Medical Center, Indianapolis, IN, USA
| | - S S Gill
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - H Le-Niculescu
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - O MacKie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indianapolis VA Medical Center, Indianapolis, IN, USA
| | - R Bhagar
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - K Roseberry
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - O K Murray
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - H D Dainton
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - S K Wolf
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, Ohio State University Medical Center, Columbus, OH, USA
| | - A Shekhar
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Office of the Dean, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - A B Niculescu
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
- Indianapolis VA Medical Center, Indianapolis, IN, USA.
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
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Gill SS, Namireddy SR. Surgical vs Non-surgical interventions for distal radius fractures: a quantitative analysis of Patient-Rated Wrist Evaluation measures. Acta Orthop Belg 2023; 89:701-708. [PMID: 38205764 DOI: 10.52628/89.4.12408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Trials to assess differences in PRWE (Patient Related Wrist Evaluation) over time, for both surgical and non-surgical interventions post DRFs (distal radius fractures) are rare. The DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire has been shown to be improved by a greater margin in the medium term for surgical interventions, than non surgical interventions. However, a study found that PRWE can be considered superior to the DASH questionnaire for DRFs, due to greater specificity to wrist pain and function. Conflicting data makes it difficult to determine surgical vs non-surgical superiority for DRF's over time with PRWE as a recovery metric. PubMed and Cochrane were searched for randomised controlled trials up to 31.8.23, reporting PRWE over 3, and 12 months. Data was extracted by 2 researchers. The differences in PRWE over time post surgical and non-surgical interventions was assessed using unpaired T testing. 1226 records were screened. 4 studies enrolling 817 participants met the eligibility criteria and were analysed. Significantly lower PRWE in surgical intervention has been identified at the 3 month mark (p<0.001). There was greater significant change in non-surgical intervention between months 3 and 12 (p<0.001). Change in PRWE over time may be a good indicator of functional outcomes in DRFs post surgical or non-surgical interventions. This could inform future clinical trial design and surgical decision-making. Further work is required to design even more user-friendly and digital patient- reported outcomes specifically for DRFs.
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Roseberry K, Le-Niculescu H, Levey DF, Bhagar R, Soe K, Rogers J, Palkowitz S, Pina N, Anastasiadis WA, Gill SS, Kurian SM, Shekhar A, Niculescu AB. Towards precision medicine for anxiety disorders: objective assessment, risk prediction, pharmacogenomics, and repurposed drugs. Mol Psychiatry 2023; 28:2894-2912. [PMID: 36878964 PMCID: PMC10615756 DOI: 10.1038/s41380-023-01998-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/29/2023] [Accepted: 02/10/2023] [Indexed: 03/08/2023]
Abstract
Anxiety disorders are increasingly prevalent, affect people's ability to do things, and decrease quality of life. Due to lack of objective tests, they are underdiagnosed and sub-optimally treated, resulting in adverse life events and/or addictions. We endeavored to discover blood biomarkers for anxiety, using a four-step approach. First, we used a longitudinal within-subject design in individuals with psychiatric disorders to discover blood gene expression changes between self-reported low anxiety and high anxiety states. Second, we prioritized the list of candidate biomarkers with a Convergent Functional Genomics approach using other evidence in the field. Third, we validated our top biomarkers from discovery and prioritization in an independent cohort of psychiatric subjects with clinically severe anxiety. Fourth, we tested these candidate biomarkers for clinical utility, i.e. ability to predict anxiety severity state, and future clinical worsening (hospitalizations with anxiety as a contributory cause), in another independent cohort of psychiatric subjects. We showed increased accuracy of individual biomarkers with a personalized approach, by gender and diagnosis, particularly in women. The biomarkers with the best overall evidence were GAD1, NTRK3, ADRA2A, FZD10, GRK4, and SLC6A4. Finally, we identified which of our biomarkers are targets of existing drugs (such as a valproate, omega-3 fatty acids, fluoxetine, lithium, sertraline, benzodiazepines, and ketamine), and thus can be used to match patients to medications and measure response to treatment. We also used our biomarker gene expression signature to identify drugs that could be repurposed for treating anxiety, such as estradiol, pirenperone, loperamide, and disopyramide. Given the detrimental impact of untreated anxiety, the current lack of objective measures to guide treatment, and the addiction potential of existing benzodiazepines-based anxiety medications, there is a urgent need for more precise and personalized approaches like the one we developed.
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Affiliation(s)
- K Roseberry
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - H Le-Niculescu
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - D F Levey
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Yale School of Medicine, New Haven, CT, USA
| | - R Bhagar
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - K Soe
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - J Rogers
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - S Palkowitz
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indianapolis VA Medical Center, Indianapolis, IN, USA
| | - N Pina
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indianapolis VA Medical Center, Indianapolis, IN, USA
| | - W A Anastasiadis
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indianapolis VA Medical Center, Indianapolis, IN, USA
| | - S S Gill
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - S M Kurian
- Scripps Health and Department of Molecular Medicine, Scripps Research, La Jolla, CA, USA
| | - A Shekhar
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Office of the Dean, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - A B Niculescu
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
- Indianapolis VA Medical Center, Indianapolis, IN, USA.
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Maqsood R, Khan A, Mushtaq MH, Yaqub T, Aslam MA, Rashid HB, Gill SS, Akram R, Rehman A, Chaudhry M. Risk factors for outbreaks caused by variant strain of Newcastle disease on environmentally controlled broiler chicken farms in Lahore, Pakistan. Pol J Vet Sci 2021; 24:497-503. [PMID: 35179843 DOI: 10.24425/pjvs.2021.139974] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Newcastle disease (ND) is a frequently reported disease in poultry among both vaccinated and non-vaccinated flocks in Pakistan. During 2011-2012 poultry industry in Punjab, mainly in Lahore region, faced fatal outbreaks of ND caused by a variant strain. An analytical study was conducted during outbreak period in Lahore region. A total of 114 environmentally controlled farms were selected with the help of convenient sampling method. A questionnaire was designed about the potential risk factors associated with the spread of ND outbreak. The bivariate relationships between ND status and independent variables were investigated by applying the Chi-square and Fisher's exact test. Multivariable logistic model was used to estimate the effect of each studied variable on the outcome by adjusting the other variables in the model. The variables which showed an association with ND outbreaks at commercial poultry farms were improper method for dead birds disposal (OR=4.96; 95% CI 1.63-15.12), use of same feed transporting vehicle at multiple poultry farms (OR=4.92; 95% CI 1.58-15.33), farm to farm distance of less than 1 km (OR=9.32; 95% CI(1.19-73.12), number of sheds at one farm (OR=2.31; 95% CI 0.93-5.69), labor type (OR=2.72; 95% CI 0.83-8.88) and biosecurity (OR= 4.47; 95% CI 0.56-35.66).
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Affiliation(s)
- R Maqsood
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore-Pakistan
- Institute of Continuing Education and Extension, University of Veterinary and Animal Sciences, Lahore-Pakistan
| | - A Khan
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore-Pakistan
| | - M H Mushtaq
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore-Pakistan
| | - T Yaqub
- Institute of Microbiology, University of Veterinary and Animal Sciences, Lahore-Pakistan
| | - M A Aslam
- Office of Research Innovation and Commercialization, University of Veterinary and Animal Sciences, Lahore-Pakistan
| | - H B Rashid
- Department of Veterinary Surgery and Pet Sciences, University of Veterinary and Animal Sciences, Lahore-Pakistan
| | - S S Gill
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore-Pakistan
| | - R Akram
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore-Pakistan
| | - A Rehman
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore-Pakistan
| | - M Chaudhry
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore-Pakistan
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Moran CH, Pietrzyk M, Sarangmat N, Gerard CS, Barua N, Ashida R, Whone A, Szewczyk-Krolikowski K, Mooney L, Gill SS. Clinical Outcome of “Asleep” Deep Brain Stimulation for Parkinson Disease Using Robot-Assisted Delivery and Anatomic Targeting of the Subthalamic Nucleus: A Series of 152 Patients. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa367_s070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Moran C, Sarangmat N, Gerard CS, Barua N, Ashida R, Woolley M, Pietrzyk M, Gill SS. Two Hundred Twenty-Six Consecutive Deep Brain Stimulation Electrodes Placed Using an "Asleep" Technique and the Neuro|MateTM Robot for the Treatment of Movement Disorders. Oper Neurosurg (Hagerstown) 2021; 19:530-538. [PMID: 32629477 DOI: 10.1093/ons/opaa176] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 04/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Robotics in neurosurgery has demonstrated widening indications and rapid growth in recent years. Robotic precision and reproducibility are especially pertinent to the field of functional neurosurgery. Deep brain stimulation (DBS) requires accurate placement of electrodes in order to maximize efficacy and minimize side effects. In addition, asleep techniques demand clear target visualization and immediate on-table verification of accuracy. OBJECTIVE To describe the surgical technique of asleep DBS surgery using the Neuro|MateTM Robot (Renishaw plc, Wotton-under-Edge, United Kingdom) and examine the accuracy of DBS lead placement in the subthalamic nucleus (STN) for the treatment of movement disorders. METHODS A single-center retrospective review of 113 patients who underwent bilateral STN/Zona Incerta electrode placement was performed. Accuracy of implantation was assessed using 5 measurements, Euclidian distance, radial error, depth error, angular error, and shift error. RESULTS A total of 226 planned vs actual electrode placements were analyzed. The mean 3-dimensional vector error calculated for 226 trajectories was 0.78 +/- 0.37 mm. The mean radial displacement off planned trajectory was 0.6 +/- 0.33 mm. The mean depth error, angular error, and shift error was 0.4 +/- 0.35 mm, 0.4 degrees, and 0.3 mm, respectively. CONCLUSION This report details our institution's method for DBS lead placement in patients under general anaesthesia using anatomical targeting without microelectrode recordings or intraoperative test stimulation for the treatment of movement disorders. This is the largest reported dataset of accuracy results in DBS surgery performed asleep. This novel robot-assisted operative technique results in sub-millimeter accuracy in DBS electrode placement.
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Affiliation(s)
- Catherine Moran
- Functional Neurosurgery Group, Clinical Neurosciences, University of Bristol, Bristol, United Kingdom.,Department of Neurosurgery, North Bristol Trust, Westbury-on-Trym, United Kingdom
| | - Nagaraja Sarangmat
- Department of Neurology, North Bristol Trust, Westbury-on-Trym, United Kingdom
| | - Carter S Gerard
- Department of Neurosurgery, North Bristol Trust, Westbury-on-Trym, United Kingdom
| | - Neil Barua
- Department of Neurosurgery, North Bristol Trust, Westbury-on-Trym, United Kingdom
| | - Reiko Ashida
- Department of Neurosurgery, North Bristol Trust, Westbury-on-Trym, United Kingdom
| | - Max Woolley
- Functional Neurosurgery Group, Clinical Neurosciences, University of Bristol, Bristol, United Kingdom.,Neurological Products Division, Renishaw Plc, Wotton-under-Edge, United Kingdom
| | - Mariusz Pietrzyk
- Neurological Products Division, Renishaw Plc, Wotton-under-Edge, United Kingdom
| | - Steven S Gill
- Functional Neurosurgery Group, Clinical Neurosciences, University of Bristol, Bristol, United Kingdom.,Department of Neurosurgery, North Bristol Trust, Westbury-on-Trym, United Kingdom
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Moran CH, Pietrzyk M, Sarangmat N, Gerard CS, Barua N, Ashida R, Whone A, Szewczyk-Krolikowski K, Mooney L, Gill SS. Clinical Outcome of "Asleep" Deep Brain Stimulation for Parkinson Disease Using Robot-Assisted Delivery and Anatomic Targeting of the Subthalamic Nucleus: A Series of 152 Patients. Neurosurgery 2021; 88:165-173. [PMID: 32985669 DOI: 10.1093/neuros/nyaa367] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 06/08/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent advances in methods used for deep brain stimulation (DBS) include subthalamic nucleus electrode implantation in the "asleep" patient without the traditional use of microelectrode recordings or intraoperative test stimulation. OBJECTIVE To examine the clinical outcome of patients who have undergone "asleep" DBS for the treatment of Parkinson disease using robot-assisted electrode delivery. METHODS This is a retrospective review of clinical outcomes of 152 consecutive patients. Their outcomes at 1 yr postimplantation are reported; these include Unified Parkinson's Disease Rating Scale (UPDRS) assessment, Tinetti Mobility Test, Parkinson's Disease Questionnaire (PDQ)-39 quality of life assessment, Mattis Dementia Rating Scale, Beck Depression Inventory, and Beck Anxiety. We also report on a new parietal trajectory for electrode implantation. RESULTS A total of 152 patients underwent assessment at 1 yr. UPDRS III improved from 39 to 20.5 (47%, P < .001). The total UPDRS score improved from 67.6 to 36.4 (46%, P < .001). UPDRS II scores improved from 18.9 to 10.5 (44%, P < .001) and UPDRS IV scores improved from 7.1 to 3.6 (49%, P < .001). There was a significant reduction in levodopa equivalent daily dose after surgery (mean: 35%, P < .001). PDQ-39 summary index improved by a mean of 7.1 points. There was no significant difference found in clinical outcomes between the frontal and parietal approaches. CONCLUSION "Asleep" robot-assisted DBS of the subthalamic nucleus demonstrates comparable outcomes with traditional techniques in the treatment of Parkinson disease.
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Affiliation(s)
- Catherine H Moran
- Department of Neurosurgery, Tallaght University Hospital, Dublin, Ireland
| | - Mariusz Pietrzyk
- Neurological Applications Division, Renishaw PlC, Wooton-under-Edge, United Kinrgdom
| | - Nagaraja Sarangmat
- Department of Neurology, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - Carter S Gerard
- Department of Neurosurgery, Swedish Medical Center, Seattle, Washington
| | - Neil Barua
- Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - Reiko Ashida
- Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - Alan Whone
- Department of Neurology, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | | | - Lucy Mooney
- Department of Neurology, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
| | - Steven S Gill
- Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
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Whone AL, Boca M, Luz M, Woolley M, Mooney L, Dharia S, Broadfoot J, Cronin D, Schroers C, Barua NU, Longpre L, Barclay CL, Boiko C, Johnson GA, Fibiger HC, Harrison R, Lewis O, Pritchard G, Howell M, Irving C, Johnson D, Kinch S, Marshall C, Lawrence AD, Blinder S, Sossi V, Stoessl AJ, Skinner P, Mohr E, Gill SS. Extended Treatment with Glial Cell Line-Derived Neurotrophic Factor in Parkinson's Disease. J Parkinsons Dis 2020; 9:301-313. [PMID: 30829619 PMCID: PMC6597995 DOI: 10.3233/jpd-191576] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Intraputamenal glial cell line-derived neurotrophic factor (GDNF), administered every 4 weeks to patients with moderately advanced Parkinson’s disease, did not show significant clinical improvements against placebo at 40 weeks, although it significantly increased [18F]DOPA uptake throughout the entire putamen. Objective: This open-label extension study explored the effects of continued (prior GDNF patients) or new (prior placebo patients) exposure to GDNF for another 40 weeks. Methods: Using the infusion protocol of the parent study, all patients received GDNF without disclosing prior treatment allocations (GDNF or placebo). The primary outcome was the percentage change from baseline to Week 80 in the OFF state Unified Parkinson’s Disease Rating Scale (UPDRS) motor score. Results: All 41 parent study participants were enrolled. The primary outcome decreased by 26.7±20.7% in patients on GDNF for 80 weeks (GDNF/GDNF; N = 21) and 27.6±23.6% in patients on placebo for 40 weeks followed by GDNF for 40 weeks (placebo/GDNF, N = 20; least squares mean difference: 0.4%, 95% CI: –13.9, 14.6, p = 0.96). Secondary endpoints did not show significant differences between the groups at Week 80 either. Prespecified comparisons between GDNF/GDNF at Week 80 and placebo/GDNF at Week 40 showed significant differences for mean OFF state UPDRS motor (–9.6±6.7 vs. –3.8±4.2 points, p = 0.0108) and activities of daily living score (–6.9±5.5 vs. –1.0±3.7 points, p = 0.0003). No treatment-emergent safety concerns were identified. Conclusions: The aggregate study results, from the parent and open-label extension suggest that future testing with GDNF will likely require an 80- rather than a 40-week randomized treatment period and/or a higher dose.
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Affiliation(s)
- Alan L Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Mihaela Boca
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Matthias Luz
- Med Genesis Therapeutix Inc., Victoria, BC, Canada
| | - Max Woolley
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Lucy Mooney
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Sonali Dharia
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Jack Broadfoot
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - David Cronin
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Christian Schroers
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Neil U Barua
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Lara Longpre
- Med Genesis Therapeutix Inc., Victoria, BC, Canada
| | | | - Chris Boiko
- Med Genesis Therapeutix Inc., Victoria, BC, Canada
| | | | | | - Rob Harrison
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Owen Lewis
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Gemma Pritchard
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Mike Howell
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Charlie Irving
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - David Johnson
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Suk Kinch
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Christopher Marshall
- The Wales Research and Diagnostic Positron Emission Tomography Imaging Centre (PETIC), Cardiff University, Cardiff, UK
| | | | - Stephan Blinder
- Department of Physics and Astronomy, The University of British Columbia, Vancouver, BC, Canada
| | - Vesna Sossi
- Department of Physics and Astronomy, The University of British Columbia, Vancouver, BC, Canada
| | - A Jon Stoessl
- Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Paul Skinner
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Erich Mohr
- Med Genesis Therapeutix Inc., Victoria, BC, Canada
| | - Steven S Gill
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK.,Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
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Whone A, Luz M, Boca M, Woolley M, Mooney L, Dharia S, Broadfoot J, Cronin D, Schroers C, Barua NU, Longpre L, Barclay CL, Boiko C, Johnson GA, Fibiger HC, Harrison R, Lewis O, Pritchard G, Howell M, Irving C, Johnson D, Kinch S, Marshall C, Lawrence AD, Blinder S, Sossi V, Stoessl AJ, Skinner P, Mohr E, Gill SS. Randomized trial of intermittent intraputamenal glial cell line-derived neurotrophic factor in Parkinson's disease. Brain 2020; 142:512-525. [PMID: 30808022 PMCID: PMC6391602 DOI: 10.1093/brain/awz023] [Citation(s) in RCA: 174] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/24/2018] [Accepted: 12/12/2018] [Indexed: 01/12/2023] Open
Abstract
We investigated the effects of glial cell line-derived neurotrophic factor (GDNF) in Parkinson’s disease, using intermittent intraputamenal convection-enhanced delivery via a skull-mounted transcutaneous port as a novel administration paradigm to potentially afford putamen-wide therapeutic delivery. This was a single-centre, randomized, double-blind, placebo-controlled trial. Patients were 35–75 years old, had motor symptoms for 5 or more years, and presented with moderate disease severity in the OFF state [Hoehn and Yahr stage 2–3 and Unified Parkinson’s Disease Rating Scale motor score (part III) (UPDRS-III) between 25 and 45] and motor fluctuations. Drug delivery devices were implanted and putamenal volume coverage was required to exceed a predefined threshold at a test infusion prior to randomization. Six pilot stage patients (randomization 2:1) and 35 primary stage patients (randomization 1:1) received bilateral intraputamenal infusions of GDNF (120 µg per putamen) or placebo every 4 weeks for 40 weeks. Efficacy analyses were based on the intention-to-treat principle and included all patients randomized. The primary outcome was the percentage change from baseline to Week 40 in the OFF state (UPDRS-III). The primary analysis was limited to primary stage patients, while further analyses included all patients from both study stages. The mean OFF state UPDRS motor score decreased by 17.3 ± 17.6% in the active group and 11.8 ± 15.8% in the placebo group (least squares mean difference: −4.9%, 95% CI: −16.9, 7.1, P = 0.41). Secondary endpoints did not show significant differences between the groups either. A post hoc analysis found nine (43%) patients in the active group but no placebo patients with a large clinically important motor improvement (≥10 points) in the OFF state (P = 0.0008). 18F-DOPA PET imaging demonstrated a significantly increased uptake throughout the putamen only in the active group, ranging from 25% (left anterior putamen; P = 0.0009) to 100% (both posterior putamina; P < 0.0001). GDNF appeared to be well tolerated and safe, and no drug-related serious adverse events were reported. The study did not meet its primary endpoint. 18F-DOPA imaging, however, suggested that intermittent convection-enhanced delivery of GDNF produced a putamen-wide tissue engagement effect, overcoming prior delivery limitations. Potential reasons for not proving clinical benefit at 40 weeks are discussed.
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Affiliation(s)
- Alan Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Matthias Luz
- MedGenesis Therapeutix Inc., Victoria, BC, Canada
| | - Mihaela Boca
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Max Woolley
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Lucy Mooney
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Sonali Dharia
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Jack Broadfoot
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - David Cronin
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Christian Schroers
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Neil U Barua
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | - Lara Longpre
- MedGenesis Therapeutix Inc., Victoria, BC, Canada
| | | | - Chris Boiko
- MedGenesis Therapeutix Inc., Victoria, BC, Canada
| | | | | | - Rob Harrison
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Owen Lewis
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Gemma Pritchard
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Mike Howell
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Charlie Irving
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - David Johnson
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Suk Kinch
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Christopher Marshall
- The Wales Research and Diagnostic Positron Emission Tomography Imaging Centre (PETIC), Cardiff University, Cardiff, UK
| | | | - Stephan Blinder
- Department of Physics and Astronomy, The University of British Columbia, Vancouver, BC, Canada
| | - Vesna Sossi
- Department of Physics and Astronomy, The University of British Columbia, Vancouver, BC, Canada
| | - A Jon Stoessl
- Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Paul Skinner
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
| | - Erich Mohr
- MedGenesis Therapeutix Inc., Victoria, BC, Canada
| | - Steven S Gill
- Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
- Renishaw plc, New Mills, Wotton-under-Edge, Gloucestershire, UK
- Correspondence regarding study concept, drug-delivery device and surgical implantation to: Professor Steven S. Gill, FRCS Consultant Neurosurgeon, Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK E-mail: Correspondence regarding trial oversight/execution and study data to: Dr Alan Whone, PhD, FRCP Movement Disorders Group, Bristol Brain Centre, Southmead Hospital, Bristol, BS10 5NB, UK E-mail:
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Asby DJ, Killick-Cole CL, Boulter LJ, Singleton WG, Asby CA, Wyatt MJ, Barua NU, Bienemann AS, Gill SS. Combined use of CDK4/6 and mTOR inhibitors induce synergistic growth arrest of diffuse intrinsic pontine glioma cells via mutual downregulation of mTORC1 activity. Cancer Manag Res 2018; 10:3483-3500. [PMID: 30254491 PMCID: PMC6140749 DOI: 10.2147/cmar.s167095] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Diffuse intrinsic pontine glioma (DIPG) is a lethal type of pediatric brain tumor that is resistant to conventional chemotherapies. Palbociclib is a putative novel DIPG treatment that restricts the proliferation of rapidly dividing cancer cells via selective inhibition of cyclin-dependent kinase (CDK) 4 and CDK6. However, implementing palbociclib as a monotherapy for DIPG is unfeasible, as CDK4/6 inhibitor resistance is commonplace and palbociclib does not readily cross the blood-brain barrier (BBB) or persist in the central nervous system. To inhibit the growth of DIPG cells, we aimed to use palbociclib in combination with the rapamycin analog temsirolimus, which is known to ameliorate resistance to CDK4/6 inhibitors and inhibit BBB efflux. Materials and methods We tested palbociclib and temsirolimus in three patient-derived DIPG cell lines. The expression profiles of key proteins in the CDK4/6 and mammalian target of rapamycin (mTOR) signaling pathways were assessed, respectively, to determine feasibility against DIPG. Moreover, we investigated effects on cell viability and examined in vivo drug toxicity. Results Immunoblot analyses revealed palbociclib and temsirolimus inhibited CDK4/6 and mTOR signaling through canonical perturbation of phosphorylation of the retinoblastoma (RB) and mTOR proteins, respectively; however, we observed noncanonical downregulation of mTOR by palbociclib. We demonstrated that palbociclib and temsirolimus inhibited cell proliferation in all three DIPG cell lines, acting synergistically in combination to further restrict cell growth. Flow cytometric analyses revealed both drugs caused G1 cell cycle arrest, and clonogenic assays showed irreversible effects on cell proliferation. Palbociclib did not elicit neurotoxicity in primary cultures of normal rat hippocampi or when infused into rat brains. Conclusion These data illustrate the in vitro antiproliferative effects of CDK4/6 and mTOR inhibitors in DIPG cells. Direct infusion of palbociclib into the brain, in combination with systemic delivery of temsirolimus, represents a promising new approach to developing a much-needed treatment for DIPG.
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Affiliation(s)
- Daniel J Asby
- Functional Neurosurgery Research Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,
| | - Clare L Killick-Cole
- Functional Neurosurgery Research Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,
| | - Lisa J Boulter
- Functional Neurosurgery Research Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,
| | - William Gb Singleton
- Functional Neurosurgery Research Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK, .,Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Bristol, UK,
| | - Claire A Asby
- Department of Neurology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Marcella J Wyatt
- Functional Neurosurgery Research Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,
| | - Neil U Barua
- Functional Neurosurgery Research Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK, .,Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Bristol, UK,
| | - Alison S Bienemann
- Functional Neurosurgery Research Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,
| | - Steven S Gill
- Functional Neurosurgery Research Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK, .,Department of Neurosurgery, North Bristol NHS Trust, Southmead Hospital, Bristol, UK,
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Singleton WGB, Bienemann AS, Woolley M, Johnson D, Lewis O, Wyatt MJ, Damment SJP, Boulter LJ, Killick-Cole CL, Asby DJ, Gill SS. The distribution, clearance, and brainstem toxicity of panobinostat administered by convection-enhanced delivery. J Neurosurg Pediatr 2018; 22:288-296. [PMID: 29856296 DOI: 10.3171/2018.2.peds17663] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [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: 11/06/2022]
Abstract
OBJECTIVE The pan-histone deacetylase inhibitor panobinostat has preclinical efficacy against diffuse intrinsic pontine glioma (DIPG), and the oral formulation has entered a Phase I clinical trial. However, panobinostat does not cross the blood-brain barrier in humans. Convection-enhanced delivery (CED) is a novel neurosurgical drug delivery technique that bypasses the blood-brain barrier and is of considerable clinical interest in the treatment of DIPG. METHODS The authors investigated the toxicity, distribution, and clearance of a water-soluble formulation of panobinostat (MTX110) in a small- and large-animal model of CED. Juvenile male Wistar rats (n = 24) received panobinostat administered to the pons by CED at increasing concentrations and findings were compared to those in animals that received vehicle alone (n = 12). Clinical observation continued for 2 weeks. Animals were sacrificed at 72 hours or 2 weeks following treatment, and the brains were subjected to neuropathological analysis. A further 8 animals received panobinostat by CED to the striatum and were sacrificed 0, 2, 6, or 24 hours after infusion, and their brains explanted and snap-frozen. Tissue-drug concentration was determined by liquid chromatography tandem mass spectrometry (LC-MS/MS). Large-animal toxicity was investigated using a clinically relevant MRI-guided translational porcine model of CED in which a drug delivery system designed for humans was used. Panobinostat was administered at 30 μM to the ventral pons of 2 juvenile Large White-Landrace cross pigs. The animals were subjected to clinical and neuropathological analysis, and findings were compared to those obtained in controls after either 1 or 2 weeks. Drug distribution was determined by LC-MS/MS in porcine white and gray matter immediately after CED. RESULTS There were no clinical or neuropathological signs of toxicity up to an infused concentration of 30 μM in both small- and large-animal models. The half-life of panobinostat in rat brain after CED was 2.9 hours, and the drug was observed to be distributed in porcine white and gray matter with a volume infusion/distribution ratio of 2 and 3, respectively. CONCLUSIONS CED of water-soluble panobinostat, up to a concentration of 30 μM, was not toxic and was distributed effectively in normal brain. CED of panobinostat warrants clinical investigation in patients with DIPG.
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Affiliation(s)
- William G B Singleton
- 1Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol
| | - Alison S Bienemann
- 1Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol
| | - Max Woolley
- 1Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol.,2Neurological Applications Department, Renishaw PLC, Wotton under Edge, Gloucestershire; and
| | - David Johnson
- 1Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol.,2Neurological Applications Department, Renishaw PLC, Wotton under Edge, Gloucestershire; and
| | - Owen Lewis
- 2Neurological Applications Department, Renishaw PLC, Wotton under Edge, Gloucestershire; and
| | - Marcella J Wyatt
- 1Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol
| | | | - Lisa J Boulter
- 1Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol
| | - Clare L Killick-Cole
- 1Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol
| | - Daniel J Asby
- 1Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol
| | - Steven S Gill
- 1Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol.,2Neurological Applications Department, Renishaw PLC, Wotton under Edge, Gloucestershire; and
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Adnan AK, Alexopoulos A, Alo KM, Alterman RL, Amar A, Andrade P, Arulkumar S, Awad AJ, Baltuch G, Barolat G, Barthélemy EJ, Barua NU, Bennett ME, Bentley N, Bezchlibnyk YB, Bijanki KR, Bingaman W, Boggs JW, Boon P, Brouwer BA, Campos LW, Caparso A, Capozzo A, Chae J, Chang JW, Cheng J, Copenhaver D, Deer TR, Deogaonkar M, Dhar D, Dohmeier K, Dougherty DD, Durand DM, Foote K, Gilligan J, Gill SS, Gonzalez-Martinez J, Greenberg BD, Gross RE, H. Pourfar M, Hamani C, Hayek SM, Holtzheimer PE, Ilfeld BM, Jin H, Joosten B, Jung NY, Kim CH, Kim YG, Klehr M, Koch P, Kohl S, Kopell BH, Kramer D, Krames ES, Krishnan B, Krishna V, Kuhn J, Kyung-soo Hong J, Leonardo K, Leong MS, Li D, Linninger AA, Lipsman N, Liu C, Lozano AM, Mackow M, Malinowski MN, Mayberg HS, Mazzone P, Mehta AI, Mehta V, Mills-Joseph R, Nair D, North RB, Okun M, Patel NK, Patil PG, Pope JE, Poree LR, Prager JP, Raedt R, Rasouli JJ, Rasskazoff S, Rauck R, Reeves K, Rezai AR, Russin J, Sabersky A, Saulino M, Scarnati E, Schu S, Sharma M, Shipley J, Shirvalkar P, Slavin KV, Stanton-Hicks M, Stone S, Stuart WA, Sun B, Tangen K, Tepper SJ, van Kleef M, Vancamp T, Verrills P, Viselli F, Visser-Vandewalle V, Vitale F, Vonck K, Wang T, Wang X, Weiner RL, Widge AS, Wongsarnpigoon A, Y. Mogilner A, Yaeger KA, Yaksh TL, Yin D, Zeljic K, Zhang C, Zhan S. List of Contributors of Volume 2. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.01005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Barua NU, Gill SS. Infusion Therapy for Movement Disorders. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Singleton WGB, Bienemann AS, Wooley M, Johnson D, Lewis O, Wyatt MJ, White LJ, Damment SJP, Killick-Cole C, Asby DJ, Gill SS. TRTH-07. THE DISTRIBUTION, CLEARANCE AND TOXICITY OF PANOBINOSTAT ADMINISTERED TO JUVENILE RAT AND PIG BRAINSTEM BY CONVECTION ENHANCED DELIVERY. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Asby DJ, Bienemann AS, Wright LJ, Killick-Cole C, Singleton WGB, Wyatt MJ, Barua NU, Gill SS. DIPG-42. THE COMBINATION OF THE CDK4/6 INHIBITOR PALBOCICLIB WITH THE RAPALOGUE TEMSIROLIMUS INHIBITS DIPG CELL PROLIFERATION VIA SYNERGISTIC ATTENUATION OF CELL CYCLE REGULATORS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Killick-Cole CL, Singleton WGB, Bienemann AS, Asby DJ, Wyatt MJ, Boulter LJ, Barua NU, Gill SS. Repurposing the anti-epileptic drug sodium valproate as an adjuvant treatment for diffuse intrinsic pontine glioma. PLoS One 2017; 12:e0176855. [PMID: 28542253 PMCID: PMC5444593 DOI: 10.1371/journal.pone.0176855] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 04/18/2017] [Indexed: 11/18/2022] Open
Abstract
Targeting epigenetic changes in diffuse intrinsic pontine glioma (DIPG) may provide a novel treatment option for patients. This report demonstrates that sodium valproate, a histone deacetylase inhibitor (HDACi), can increase the cytotoxicity of carboplatin in an additive and synergistic manner in DIPG cells in vitro. Sodium valproate causes a dose-dependent decrease in DIPG cell viability in three independent ex vivo cell lines. Furthermore, sodium valproate caused an increase in acetylation of histone H3. Changes in cell viability were consistent with an induction of apoptosis in DIPG cells in vitro, determined by flow cytometric analysis of Annexin V staining and assessment of apoptotic markers by western blotting. Subsequently, immunofluorescent staining of neuronal and glial markers was used to determine toxicity in normal rat hippocampal cells. Pre-treatment of cells with sodium valproate enhanced the cytotoxic effects of carboplatin, in three DIPG cell lines tested. These results demonstrate that sodium valproate causes increased histone H3 acetylation indicative of HDAC inhibition, which is inversely correlated with a reduction in cell viability. Cell viability is reduced through an induction of apoptosis in DIPG cells. Sodium valproate potentiates carboplatin cytotoxicity and prompts further work to define the mechanism responsible for the synergy between these two drugs and determine in vivo efficacy. These findings support the use of sodium valproate as an adjuvant treatment for DIPG.
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Affiliation(s)
- Clare L. Killick-Cole
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol, United Kingdom
- * E-mail: (SG); (CKC)
| | - William G. B. Singleton
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol, United Kingdom
- Department of Neurosurgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Alison S. Bienemann
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol, United Kingdom
| | - Daniel J. Asby
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol, United Kingdom
| | - Marcella J. Wyatt
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol, United Kingdom
| | - Lisa J. Boulter
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol, United Kingdom
| | - Neil U. Barua
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol, United Kingdom
- Department of Neurosurgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Steven S. Gill
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol, United Kingdom
- Department of Neurosurgery, North Bristol NHS Trust, Bristol, United Kingdom
- * E-mail: (SG); (CKC)
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Singleton WG, Collins AM, Bienemann AS, Killick-Cole CL, Haynes HR, Asby DJ, Butts CP, Wyatt MJ, Barua NU, Gill SS. Convection enhanced delivery of panobinostat (LBH589)-loaded pluronic nano-micelles prolongs survival in the F98 rat glioma model. Int J Nanomedicine 2017; 12:1385-1399. [PMID: 28260886 PMCID: PMC5327904 DOI: 10.2147/ijn.s125300] [Citation(s) in RCA: 33] [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] [Indexed: 01/26/2023] Open
Abstract
Background The pan-histone deacetylase inhibitor panobinostat is a potential therapy for malignant glioma, but it is water insoluble and does not cross the blood–brain barrier when administered systemically. In this article, we describe the in vitro and in vivo efficacy of a novel water-soluble nano-micellar formulation of panobinostat designed for administration by convection enhanced delivery (CED). Materials and methods The in vitro efficacy of panobinostat-loaded nano-micelles against rat F98, human U87-MG and M059K glioma cells and against patient-derived glioma stem cells was measured using a cell viability assay. Nano-micelle distribution in rat brain was analyzed following acute CED using rhodamine-labeled nano-micelles, and toxicity was assayed using immunofluorescent microscopy and synaptophysin enzyme-linked immunosorbent assay. We compared the survival of the bioluminescent syngenic F98/Fischer344 rat glioblastoma model treated by acute CED of panobinostat-loaded nano-micelles with that of untreated and vehicle-only-treated controls. Results Nano-micellar panobinostat is cytotoxic to rat and human glioma cells in vitro in a dose-dependent manner following short-time exposure to drug. Fluorescent rhodamine-labelled nano-micelles distribute with a volume of infusion/volume of distribution (Vi/Vd) ratio of four and five respectively after administration by CED. Administration was not associated with any toxicity when compared to controls. CED of panobinostat-loaded nano-micelles was associated with significantly improved survival when compared to controls (n=8 per group; log-rank test, P<0.001). One hundred percent of treated animals survived the 60-day experimental period and had tumour response on post-mortem histological examination. Conclusion CED of nano-micellar panobinostat represents a potential novel therapeutic option for malignant glioma and warrants translation into the clinic.
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Affiliation(s)
- W G Singleton
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol; Department of Neurosurgery, North Bristol NHS Trust
| | - A M Collins
- Bristol Centre for Functional Nanomaterials, School of Physics, HH Wills Physics Laboratory
| | - A S Bienemann
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol
| | - C L Killick-Cole
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol
| | - H R Haynes
- Brain Tumour Research Group, School of Clinical Sciences
| | - D J Asby
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol
| | - C P Butts
- School of Chemistry, University of Bristol, Bristol, UK
| | - M J Wyatt
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol
| | - N U Barua
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol; Department of Neurosurgery, North Bristol NHS Trust
| | - S S Gill
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol; Department of Neurosurgery, North Bristol NHS Trust
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Gill SS, Paw R, Doyle P, Shah A, Al-Shakhshir S, Abukhder M. CONSULTUS INTERRUPTUS: UNSCHEDULED INTERACTIONS WITHIN THE EMERGENCY DEPARTMENT. Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206402.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Singleton WG, Barua NU, Morgan J, Bienemann AS, Killick-Cole CL, Asby DJ, Edwards RJ, Lowis SP, Gill SS. NS-21MULTI-CATHETER INTERMITTENT CONVECTION-ENHANCED DELIVERY OF CARBOPLATIN AS A TREATMENT FOR DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG): PRE-CLINICAL RATIONALE AND EARLY CLINICAL EXPERIENCE. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now078.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
BACKGROUND Concerns have been raised about the potential influence of political pressures on drug funding decisions. We evaluated the temporal relationship between cancer drug funding and provincial elections in 9 Canadian provinces. METHODS New indications for cancer drugs between January 2003 and December 2012 were identified, and the dates of official provincial funding dates and election dates between 1 January 2003 and 31 December 2014 were retrieved. The probability of drug funding announcements in the 60-day period preceding a provincial election was evaluated using binomial probability distribution analysis. RESULTS Data from 9 provinces (all Canadian provinces except Quebec) were available. During the period of interest, 69 new indications for 39 individual drugs were identified. Variation in the availability of funding dates was identified. At the time of data collection, 2 provinces did not have data available for all 69 indications. For the 9 provinces, the number of funded indications during the 60-day period preceding an election ranged from 0 to 3; however, no differences in the proportion of indications funded pre-election were identified. Additional analyses also failed to demonstrate any significant associations with the 90-day period before an election, or the 60- and 90-day periods after an election. CONCLUSIONS We observed no clear temporal relationship between provincial election dates and funding decisions in this recent Canadian sample of new indications for cancer drugs.
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Affiliation(s)
- A Srikanthan
- Division of Medical Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, BC
| | - S S Gill
- Department of Medicine, Queen's University, Kingston, ON
| | - K K W Chan
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, and the Canadian Centre for Applied Research in Cancer Control, Toronto, ON
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Singleton WG, Bienemann AS, Killick-Cole CL, Collins AM, Haynes HR, Boulter LJ, Wyatt MJ, Asby DJ, Barua NU, Lowis SP, Gill SS. PCM-17INTRATUMOURAL CONVECTION ENHANCED DELIVERY OF LBH589 (PANOBINOSTAT) LOADED PLURONIC-P407 NANO-MICELLES IS ASSOCIATED WITH ENHANCED SURVIVAL AND ANTI-TUMOUR RESPONSE IN THE ORTHOTOPIC F98/FISCHER 344 RAT GLIOMA MODEL. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now080.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lewis O, Woolley M, Johnson D, Rosser A, Barua NU, Bienemann AS, Gill SS, Evans S. Chronic, intermittent convection-enhanced delivery devices. J Neurosci Methods 2016; 259:47-56. [DOI: 10.1016/j.jneumeth.2015.11.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/28/2015] [Accepted: 11/06/2015] [Indexed: 12/11/2022]
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Affiliation(s)
- Neil U Barua
- Functional Neurosurgery Research Group, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
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Arshad A, Yang B, Bienemann AS, Barua NU, Wyatt MJ, Woolley M, Johnson DE, Edler KJ, Gill SS. Convection-Enhanced Delivery of Carboplatin PLGA Nanoparticles for the Treatment of Glioblastoma. PLoS One 2015; 10:e0132266. [PMID: 26186224 PMCID: PMC4506141 DOI: 10.1371/journal.pone.0132266] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 06/11/2015] [Indexed: 12/01/2022] Open
Abstract
We currently use Convection-Enhanced Delivery (CED) of the platinum-based drug, carboplatin as a novel treatment strategy for high grade glioblastoma in adults and children. Although initial results show promise, carboplatin is not specifically toxic to tumour cells and has been associated with neurotoxicity at high infused concentrations in pre-clinical studies. Our treatment strategy requires intermittent infusions due to rapid clearance of carboplatin from the brain. In this study, carboplatin was encapsulated in lactic acid-glycolic acid copolymer (PLGA) to develop a novel drug delivery system. Neuronal and tumour cytotoxicity were assessed in primary neuronal and glioblastoma cell cultures. Distribution, tissue clearance and toxicity of carboplatin nanoparticles following CED was assessed in rat and porcine models. Carboplatin nanoparticles conferred greater tumour cytotoxicity, reduced neuronal toxicity and prolonged tissue half-life. In conclusion, this drug delivery system has the potential to improve the prognosis for patients with glioblastomas.
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Affiliation(s)
- Azeem Arshad
- Functional Neurosurgery Research Group, School of Clinical Sciences, Bristol University, Bristol, United Kingdom
| | - Bin Yang
- Department of Chemistry, University of Bath, Bath, United Kingdom
| | - Alison S. Bienemann
- Functional Neurosurgery Research Group, School of Clinical Sciences, Bristol University, Bristol, United Kingdom
| | - Neil U. Barua
- Functional Neurosurgery Research Group, School of Clinical Sciences, Bristol University, Bristol, United Kingdom
| | - Marcella J. Wyatt
- Functional Neurosurgery Research Group, School of Clinical Sciences, Bristol University, Bristol, United Kingdom
| | - Max Woolley
- Neurological Applications Division, Renishaw Plc, Gloucestershire, United Kingdom
| | - Dave E. Johnson
- Neurological Applications Division, Renishaw Plc, Gloucestershire, United Kingdom
| | - Karen J. Edler
- Department of Chemistry, University of Bath, Bath, United Kingdom
| | - Steven S. Gill
- Functional Neurosurgery Research Group, School of Clinical Sciences, Bristol University, Bristol, United Kingdom
- * E-mail:
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Barua NU, Hopkins K, Woolley M, O'Sullivan S, Harrison R, Edwards RJ, Bienemann AS, Wyatt MJ, Arshad A, Gill SS. A novel implantable catheter system with transcutaneous port for intermittent convection-enhanced delivery of carboplatin for recurrent glioblastoma. Drug Deliv 2014; 23:167-73. [PMID: 24786643 DOI: 10.3109/10717544.2014.908248] [Citation(s) in RCA: 47] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Inadequate penetration of the blood-brain barrier (BBB) by systemically administered chemotherapies including carboplatin is implicated in their failure to improve prognosis for patients with glioblastoma. Convection-enhanced delivery (CED) of carboplatin has the potential to improve outcomes by facilitating bypass of the BBB. OBJECTIVE We report the first use of an implantable CED system incorporating a novel transcutaneous bone-anchored port (TBAP) for intermittent CED of carboplatin in a patient with recurrent glioblastoma. MATERIALS AND METHODS The CED catheter system was implanted using a robot-assisted surgical method. Catheter targeting accuracy was verified by performing intra-operative O-arm imaging. The TBAP was implanted using a skin-flap dermatome technique modeled on bone-anchored hearing aid surgery. Repeated infusions were performed by attaching a needle administration set to the TBAP. Drug distribution was monitored with serial real-time T2-weighted magnetic resonance imaging (MRI). RESULTS All catheters were implanted to within 1.5 mm of their planned target. Intermittent infusions of carboplatin were performed on three consecutive days and repeated after one month without the need for further surgical intervention. Infused volumes of 27.9 ml per day were well tolerated, with the exception of a single seizure episode. Follow-up MRI at eight weeks demonstrated a significant reduction in the volume of tumor enhancement from 42.6 ml to 24.6 ml, and was associated with stability of the patient's clinical condition. CONCLUSION Reduction in the volume of tumor enhancement indicates that intermittent CED of carboplatin has the potential to improve outcomes in glioblastoma. The novel technology described in this report make intermittent CED infusion regimes an achievable treatment strategy.
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Affiliation(s)
- Neil U Barua
- a Department of Neurosurgery , Frenchay Hospital , Bristol , UK
| | - Kirsten Hopkins
- b Department of Oncology , Bristol Oncology Centre , Bristol , UK
| | - Max Woolley
- c Neurological Applications Division , Renishaw PLC , Gloucs , Wotton-under-Edge , UK , and
| | - Stephen O'Sullivan
- c Neurological Applications Division , Renishaw PLC , Gloucs , Wotton-under-Edge , UK , and
| | - Rob Harrison
- c Neurological Applications Division , Renishaw PLC , Gloucs , Wotton-under-Edge , UK , and
| | | | - Alison S Bienemann
- d Functional Neurosurgery Research Group , University of Bristol , Bristol , UK
| | - Marcella J Wyatt
- d Functional Neurosurgery Research Group , University of Bristol , Bristol , UK
| | - Azeem Arshad
- d Functional Neurosurgery Research Group , University of Bristol , Bristol , UK
| | - Steven S Gill
- a Department of Neurosurgery , Frenchay Hospital , Bristol , UK
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Tsujiuchi T, Natsume A, Motomura K, Kondo G, Ranjit M, Hachisu R, Sugimura I, Tomita S, Takehara I, Woolley M, Barua NU, Gill SS, Bienemann AS, Yamashita Y, Toyokuni S, Wakabayashi T. Preclinical evaluation of an O(6)-methylguanine-DNA methyltransferase-siRNA/liposome complex administered by convection-enhanced delivery to rat and porcine brains. Am J Transl Res 2014; 6:169-178. [PMID: 24489997 PMCID: PMC3902228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 12/31/2013] [Indexed: 06/03/2023]
Abstract
The main determinant of glioblastoma (GBM) resistance to temozolomide (TMZ) is thought to be O(6)-methylguanine-DNA methyltransferase (MGMT), which is a DNA-repair enzyme that removes alkyl groups from the O(6)-position of guanine. Previously, we reported that a MGMT-siRNA/cationic liposome complex exerted a clear synergistic antitumor effect in combination with TMZ. Translation to a clinical setting might be desirable for reinforcing the efficacy of TMZ therapy for GBM. In this study, we aim to evaluate the safety of MGMT-siRNA/cationic liposome complexes and determine whether the convection-enhanced delivery of these complexes is suitable for clinical use by undertaking preclinical testing in laboratory animals. No significant adverse events were observed in rats receiving infusions of MGMT-siRNA/cationic liposome complex directly into the brain with or without TMZ administration. A pig which received the complex administered by CED also showed no evidence of neurological dysfunction or histological abnormalities. However, the complex did not appear to achieve effective distribution by CED in either the rat or the porcine brain tissue. Considering these results together, we concluded that insufficient distribution of cationic liposomes was achieved for tumor treatment by CED.
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Affiliation(s)
- Takashi Tsujiuchi
- Department of Neurosurgery, Nagoya University School of MedicineNagoya, Aichi, Japan
| | - Atsushi Natsume
- Department of Neurosurgery, Nagoya University School of MedicineNagoya, Aichi, Japan
| | - Kazuya Motomura
- Department of Neurosurgery, Nagoya University School of MedicineNagoya, Aichi, Japan
| | - Goro Kondo
- Department of Neurosurgery, Nagoya University School of MedicineNagoya, Aichi, Japan
| | - Melissa Ranjit
- Department of Neurosurgery, Nagoya University School of MedicineNagoya, Aichi, Japan
| | - Rei Hachisu
- Hokkaido System ScienceSapporo, Hokkaido, Japan
| | | | - Shinpei Tomita
- New Drug Development Research CenterEniwa, Hokkaido, Japan
| | - Isao Takehara
- New Drug Development Research CenterEniwa, Hokkaido, Japan
| | - Max Woolley
- Renishaw Advanced MaterialsNew Mills, Wotton-under-Edge, Gloucestershire, GL 12 8JR, United Kingdom
| | - Neil U Barua
- Functional Neurosurgery Research Group, University of BristolUnited Kingdom
| | - Steven S Gill
- Functional Neurosurgery Research Group, University of BristolUnited Kingdom
| | - Alison S Bienemann
- Functional Neurosurgery Research Group, University of BristolUnited Kingdom
| | - Yoriko Yamashita
- Department of Pathology and Biological Responses, Nagoya University School of MedicineNagoya, Japan
| | - Shinya Toyokuni
- Department of Pathology and Biological Responses, Nagoya University School of MedicineNagoya, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University School of MedicineNagoya, Aichi, Japan
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Barua NU, Gill SS, Love S. Convection-enhanced drug delivery to the brain: therapeutic potential and neuropathological considerations. Brain Pathol 2013; 24:117-27. [PMID: 23944716 DOI: 10.1111/bpa.12082] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 08/08/2013] [Indexed: 12/16/2022] Open
Abstract
Convection-enhanced delivery (CED) describes a direct method of drug delivery to the brain through intraparenchymal microcatheters. By establishing a pressure gradient at the tip of the infusion catheter in order to exploit bulk flow through the interstitial spaces of the brain, CED offers a number of advantages over conventional drug delivery methods-bypass of the blood-brain barrier, targeted distribution through large brain volumes and minimization of systemic side effects. Despite showing early promise, CED is yet to fulfill its potential as a mainstream strategy for the treatment of neurological disease. Substantial research effort has been dedicated to optimize the technology for CED and identify the parameters, which govern successful drug distribution. It seems likely that successful clinical translation of CED will depend on suitable catheter technology being used in combination with drugs with optimal physicochemical characteristics, and on neuropathological analysis in appropriate preclinical models. In this review, we consider the factors most likely to influence the success or failure of CED, and review its application to the treatment of high-grade glioma, Parkinson's disease (PD) and Alzheimer's disease (AD).
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Affiliation(s)
- Neil U Barua
- Department of Neurosurgery, Institute of Clinical Neurosciences, School of Clinical Sciences, University of Bristol, Frenchay Hospital, Bristol, UK
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Patel NK, Pavese N, Javed S, Hotton GR, Brooks DJ, Gill SS. Benefits of putaminal GDNF infusion in Parkinson disease are maintained after GDNF cessation. Neurology 2013; 81:1176-8. [PMID: 23946313 DOI: 10.1212/wnl.0b013e3182a55ea5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We previously reported clinical improvement, increase in putamen [(18)F]-dopa uptake on PET imaging, and neuropathologic evidence of sprouting of dopaminergic fibers following chronic intraputaminal delivery of glial cell line-derived neurotrophic factor (GDNF) in idiopathic Parkinson disease (PD).(1-3) We now provide clinical and PET evidence of persistent efficacy lasting for at least 3 years following cessation of GDNF infusion in a patient with PD. This is a single-case observational study, providing Class IV evidence.
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Affiliation(s)
- Nikunj K Patel
- From the Institute of Clinical Neurosciences (N.K.P., S.J., S.S.G.), Frenchay Hospital, Bristol; and Imperial College London (N.P., G.R.H., D.J.B.), Division of Brain Sciences, Hammersmith Hospital, London, UK
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Kenny GD, Bienemann AS, Tagalakis AD, Pugh JA, Welser K, Campbell F, Tabor AB, Hailes HC, Gill SS, Lythgoe MF, McLeod CW, White EA, Hart SL. Multifunctional receptor-targeted nanocomplexes for the delivery of therapeutic nucleic acids to the brain. Biomaterials 2013; 34:9190-200. [PMID: 23948162 DOI: 10.1016/j.biomaterials.2013.07.081] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/23/2013] [Indexed: 01/05/2023]
Abstract
Convection enhanced delivery (CED) is a method of direct injection to the brain that can achieve widespread dispersal of therapeutics, including gene therapies, from a single dose. Non-viral, nanocomplexes are of interest as vectors for gene therapy in the brain, but it is essential that administration should achieve maximal dispersal to minimise the number of injections required. We hypothesised that anionic nanocomplexes administered by CED should disperse more widely in rat brains than cationics of similar size, which bind electrostatically to cell-surface anionic moieties such as proteoglycans, limiting their spread. Anionic, receptor-targeted nanocomplexes (RTN) containing a neurotensin-targeting peptide were prepared with plasmid DNA and compared with cationic RTNs for dispersal and transfection efficiency. Both RTNs were labelled with gadolinium for localisation in the brain by MRI and in brain sections by LA-ICP-MS, as well as with rhodamine fluorophore for detection by fluorescence microscopy. MRI distribution studies confirmed that the anionic RTNs dispersed more widely than cationic RTNs, particularly in the corpus callosum. Gene expression levels from anionic formulations were similar to those of cationic RTNs. Thus, anionic RTN formulations can achieve both widespread dispersal and effective gene expression in brains after administration of a single dose by CED.
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Affiliation(s)
- Gavin D Kenny
- Molecular Immunology Unit, UCL Institute of Child Health, London WC1N 1EH, UK; Centre for Advanced Biomedical Imaging, Department of Medicine and Institute of Child Health, University College London, London WC1E 6DD, UK
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Gill SS, Pease RA, Ashwin CJ, Gill SS, Tait NP. Respiratory-aspirated 35-mm hairpin successfully retrieved with a Teflon® snare system under fluoroscopic guidance via a split endotracheal tube: a useful technique in cases of failed extraction by bronchoscopy and avoiding the need for a thoracotomy. Br J Radiol 2012; 85:e756-9. [PMID: 22919019 DOI: 10.1259/bjr/45761403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Respiratory foreign body aspiration (FBA) is a common global health problem requiring prompt recognition and early treatment to prevent potentially fatal complications. The majority of FBAs are due to organic objects and treatment is usually via either endoscopic or surgical extraction. FBA of a straight hairpin has been described as a unique entity in the literature, occurring most commonly in females, particularly during adolescence. In the process of inserting hairpins, the pins will typically be between the teeth with the head tilted backwards, while tying their hair with both hands. This position increases the risk of aspiration, particularly if there is any sudden coughing or laughing. To our knowledge, this is the first case report of a 35-mm straight metallic hairpin foreign body that has been successfully retrieved by a radiological snare system under fluoroscopic guidance. This was achieved with the use of a split endotracheal tube, and therefore avoided the need for a thoracotomy in an adolescent female patient.
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Affiliation(s)
- S S Gill
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK.
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Barua NU, Miners JS, Bienemann AS, Wyatt MJ, Welser K, Tabor AB, Hailes HC, Love S, Gill SS. Convection-Enhanced Delivery of Neprilysin: A Novel Amyloid-β-Degrading Therapeutic Strategy. ACTA ACUST UNITED AC 2012; 32:43-56. [DOI: 10.3233/jad-2012-120658] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Neil U. Barua
- Functional Neurosurgery Research Group, University of Bristol, Bristol, UK
| | | | | | - Marcella J. Wyatt
- Functional Neurosurgery Research Group, University of Bristol, Bristol, UK
| | | | | | - Helen C. Hailes
- Department of Chemistry, University College London, London, UK
| | - Seth Love
- Dementia Research Group, University of Bristol, Bristol, UK
| | - Steven S. Gill
- Functional Neurosurgery Research Group, University of Bristol, Bristol, UK
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Writer MJ, Kyrtatos PG, Bienemann AS, Pugh JA, Lowe AS, Villegas-Llerena C, Kenny GD, White EA, Gill SS, McLeod CW, Lythgoe MF, Hart SL. Lipid peptide nanocomplexes for gene delivery and magnetic resonance imaging in the brain. J Control Release 2012; 162:340-8. [PMID: 22800579 PMCID: PMC3657147 DOI: 10.1016/j.jconrel.2012.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 06/29/2012] [Accepted: 07/03/2012] [Indexed: 11/16/2022]
Abstract
Gadolinium-labelled nanocomplexes offer prospects for the development of real-time, non-invasive imaging strategies to visualise the location of gene delivery by MRI. In this study, targeted nanoparticle formulations were prepared comprising a cationic liposome (L) containing a Gd-chelated lipid at 10, 15 and 20% by weight of total lipid, a receptor-targeted, DNA-binding peptide (P) and plasmid DNA (D), which electrostatically self-assembled into LPD nanocomplexes. The LPD formulation containing the liposome with 15% Gd-chelated lipid displayed optimal peptide-targeted, transfection efficiency. MRI conspicuity peaked at 4h after incubation of the nanocomplexes with cells, suggesting enhancement by cellular uptake and trafficking. This was supported by time course confocal microscopy analysis of transfections with fluorescently-labelled LPD nanocomplexes. Gd-LPD nanocomplexes delivered to rat brains by convection-enhanced delivery were visible by MRI at 6 h, 24 h and 48 h after administration. Histological brain sections analysed by laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) confirmed that the MRI signal was associated with the distribution of Gd(3+) moieties and differentiated MRI signals due to haemorrhage. The transfected brain cells near the injection site appeared to be mostly microglial. This study shows the potential of Gd-LPD nanocomplexes for simultaneous delivery of contrast agents and genes for real-time monitoring of gene therapy in the brain.
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Affiliation(s)
- Michele J. Writer
- Molecular Immunology Unit, UCL Institute of Child Health, London WC1N 1EH, UK
| | - Panagiotis G. Kyrtatos
- Centre for Advanced Biomedical Imaging, Department of Medicine and UCL Institute of Child Health, University College London, London WC1E 6DD, UK
| | - Alison S. Bienemann
- The Functional Neurosurgery Research Group, Bristol University, Institute of Clinical Neurosciences, Southmead Hospital, Bristol BS16 1LE, UK
| | - John A. Pugh
- Centre For Analytical Sciences, University of Sheffield, Sheffield S10 2TN, UK
| | - Andrew S. Lowe
- Centre for Advanced Biomedical Imaging, Department of Medicine and UCL Institute of Child Health, University College London, London WC1E 6DD, UK
| | | | - Gavin D. Kenny
- Molecular Immunology Unit, UCL Institute of Child Health, London WC1N 1EH, UK
| | - Edward A. White
- The Functional Neurosurgery Research Group, Bristol University, Institute of Clinical Neurosciences, Southmead Hospital, Bristol BS16 1LE, UK
| | - Steven S. Gill
- The Functional Neurosurgery Research Group, Bristol University, Institute of Clinical Neurosciences, Southmead Hospital, Bristol BS16 1LE, UK
| | - Cameron W. McLeod
- Centre For Analytical Sciences, University of Sheffield, Sheffield S10 2TN, UK
| | - Mark F. Lythgoe
- Centre for Advanced Biomedical Imaging, Department of Medicine and UCL Institute of Child Health, University College London, London WC1E 6DD, UK
| | - Stephen L. Hart
- Molecular Immunology Unit, UCL Institute of Child Health, London WC1N 1EH, UK
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Gill SS, Turner D, Tsolakis A, York APE. Controlling soot formation with filtered EGR for diesel and biodiesel fuelled engines. Environ Sci Technol 2012; 46:4215-22. [PMID: 22380527 DOI: 10.1021/es203941n] [Citation(s) in RCA: 9] [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: 05/15/2023]
Abstract
Although exhaust gas recirculation (EGR) is an effective strategy for controlling the levels of nitrogen oxides (NO(X)) emitted from a diesel engine, the full potential of EGR in NO(X)/PM trade-off and engine performance (i.e., fuel economy) has not fully been exploited. Significant work into the cause and control of particulate matter (PM) has been made over the past decade with new cleaner fuels and after-treatment devices emerging to comply with the current and forthcoming emission regulations. In earlier work, we demonstrated that engine operation with oxygenated fuels (e.g., biodiesel) reduces the PM emissions and extends the engine tolerance to EGR before it reaches smoke-limited conditions. The same result has also been reported when high cetane number fuels such as gas-to-liquid (GTL) are used. To further our understanding of the relationship between EGR and PM formation, a diesel particulate filter (DPF) was integrated into the EGR loop to filter the recirculated soot particulates. The control of the soot recirculation penalty through filtered EGR (FEGR) resulted in a 50% engine-out soot reduction, thus showing the possibility of extending the maximum EGR limit or being able to run at the same level of EGR with an improved NO(X)/soot trade-off.
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Affiliation(s)
- S S Gill
- School of Mechanical Engineering, University of Birmingham, Birmingham, UK
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Khan S, Javed S, Mooney L, White P, Plaha P, Whone A, Gill SS. Clinical outcomes from bilateral versus unilateral stimulation of the pedunculopontine nucleus with and without concomitant caudal zona incerta region stimulation in Parkinson's disease. Br J Neurosurg 2012; 26:722-5. [PMID: 22404735 DOI: 10.3109/02688697.2012.659297] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The Pedunculopontine nucleus is a novel target for deep brain stimulation and this may improve postural instability and gait dysfunction in Parkinson's disease. If unilateral Pedunculopontine nucleus stimulation is as efficacious as bilateral stimulation this would lead to less surgical risk. METHODS 5 Parkinson's disease patients with bilateral caudal Zona Incerta region and Pedunculopontine nucleus electrodes were assessed using the motor component of the Unified Parkinson's Disease Rating Scale. Patients were assessed in the on-medication state to determine the optimal combination of stimulation setting for axial symptom control. RESULTS The on-medication composite axial-subscore only showed a statistically significant improvement when bilateral Pedunculopontine nucleus and caudal Zona Incerta region stimulation was used. CONCLUSIONS In the on-medication state bilateral Pedunculopontine nucleus and caudal Zona Incerta region stimulation is required in order to produce a significant change in the motor Unified Parkinson's Disease Rating Scale axial-subscore from baseline.
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Affiliation(s)
- Sadaquate Khan
- Department of Neurosurgery, Institute of Neurosciences, Frenchay Hospital, Bristol
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Abstract
OBJECTIVE To assess the effect of deep brain stimulation (DBS) in the pedunculopontine nucleus (PPN) and caudal zona incerta (cZi)-both separately and in combination-on motor symptoms and regional cerebral blood flow (rCBF) in patients with Parkinson disease (PD). METHODS Four patients with bilateral cZi and PPN DBS electrodes were rated with the Unified Parkinson's Disease Rating Scale motor subscale (UPDRS-III) when taking and withdrawn from medication. A block of 16 [(15)O]-H(2)O PET resting measurements of rCBF were performed in 4 different states with patients withdrawn from medication: 1) no stimulation, 2) cZi stimulation alone, 3) PPN stimulation alone, 4) combined PPN/cZi stimulation. RESULTS When patients were medicated, combined PPN/cZi stimulation produced a statistically significant improvement in UPDRS-III score compared to cZi stimulation alone. In the "off" medication state, the clinical effect of combined stimulation was not significantly different from that induced by cZi stimulation alone. Concomitant PPN/cZi stimulation had a cumulative effect on levels of rCBF, effectively combining subcortical and cortical changes induced by stimulation of either target in isolation. CONCLUSIONS These findings suggest that concomitant low frequency stimulation of PPN and cZi regions induces additive brain activation changes and provides improved control of PD symptoms when medicated. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that concomitant low frequency stimulation of PPN and cZI improves motor symptoms in patients with PD on dopamine replacement. It provides Class III evidence that concomitant low frequency stimulation of PPN and cZi induces additive rCBF changes in motor areas of brain.
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Affiliation(s)
- S Khan
- Department of Neurosurgery, Institute of Neurosciences, Frenchay Hospital, Bristol, UK
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Barua NU, Bienemann AS, Hesketh S, Wyatt MJ, Castrique E, Love S, Gill SS. Intrastriatal convection-enhanced delivery results in widespread perivascular distribution in a pre-clinical model. Fluids Barriers CNS 2012; 9:2. [PMID: 22264361 PMCID: PMC3274474 DOI: 10.1186/2045-8118-9-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 01/20/2012] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Convection-enhanced delivery (CED), a direct method for drug delivery to the brain through intraparenchymal microcatheters, is a promising strategy for intracerebral pharmacological therapy. By establishing a pressure gradient at the tip of the catheter, drugs can be delivered in uniform concentration throughout a large volume of interstitial fluid. However, the variables affecting perivascular distribution of drugs delivered by CED are not fully understood. The aim of this study was to determine whether the perivascular distribution of solutes delivered by CED into the striatum of rats is affected by the molecular weight of the infused agent, by co-infusion of vasodilator, alteration of infusion rates or use of a ramping regime. We also wanted to make a preliminary comparison of the distribution of solutes with that of nanoparticles. METHODS We analysed the perivascular distribution of 4, 10, 20, 70, 150 kDa fluorescein-labelled dextran and fluorescent nanoparticles at 10 min and 3 h following CED into rat striatum. We investigated the effect of local vasodilatation, slow infusion rates and ramping on the perivascular distribution of solutes. Co-localisation with perivascular basement membranes and vascular endothelial cells was identified by immunohistochemistry. The uptake of infusates by perivascular macrophages was quantified using stereological methods. RESULTS Widespread perivascular distribution and macrophage uptake of fluorescein-labelled dextran was visible 10 min after cessation of CED irrespective of molecular weight. However, a significantly higher proportion of perivascular macrophages had taken up 4, 10 and 20 kDa fluorescein-labelled dextran than 150 kDa dextran (p < 0.05, ANOVA). Co-infusion with vasodilator, slow infusion rates and use of a ramping regime did not alter the perivascular distribution. CED of fluorescent nanoparticles indicated that particles co-localise with perivascular basement membranes throughout the striatum but, unlike soluble dextrans, are not taken up by perivascular macrophages after 3 h. CONCLUSIONS This study suggests that widespread perivascular distribution and interaction with perivascular macrophages is likely to be an inevitable consequence of CED of solutes. The potential consequences of perivascular distribution of therapeutic agents, and in particular cytotoxic chemotherapies, delivered by CED must be carefully considered to ensure safe and effective translation to clinical trials.
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Affiliation(s)
- Neil U Barua
- Department of Neurosurgery, Frenchay Hospital, Bristol, BS16 1LE, UK.
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Moorchung N, Batra RB, Mani NS, Gill SS. Clonality assessment of lymphoproliferative lesions using the polymerase chain reaction: an analysis of two methods. INDIAN J PATHOL MICR 2011; 54:330-4. [PMID: 21623084 DOI: 10.4103/0377-4929.81628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Lymphoid malignancies are a heterogeneous group of disorders which may be difficult to differentiate from reactive proliferations even after immunohistochemistry. Polymerase chain reaction (PCR) is believed to be a good adjunct tool for diagnosis. MATERIALS AND METHODS We examined 24 cases of neoplastic and non-neoplastic lymphoproliferative lesions in this study and evaluated the PCR as an additional tool in the confirmation of the diagnosis. Two different PCR methodologies were evaluated. RESULTS In the evaluation of the T-cell PCR, it was seen that the correlation using both the commercial kits and the custom-synthesized primers was highly significant at a P value of <0.05. In the evaluation of the B-cell PCR, it was seen that the correlation using both the commercial kits and the custom-synthesized primers was not significant using either method (P > 0.05). CONCLUSIONS Both the methods showed an excellent concordance for T-cell γ gene rearrangements, However, the same was not seen in the B-cell receptor rearrangements. This may be because of the small sample size or the inability of consensus V primers to recognize complementary DNA sequences in all of the V segments.
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Affiliation(s)
- Nikhil Moorchung
- Department of Pathology, Armed Forces Medical College, Pune, India.
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Daimi SR, Siddiqui AU, Gill SS. Analysis of foramen ovale with special emphasis on pterygoalar bar and pterygoalar foramen. Folia Morphol (Warsz) 2011; 70:149-153. [PMID: 21866524] [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: 05/31/2023]
Abstract
The foramen ovale is of great surgical and diagnostic importance in procedures like percutaneous trigeminal rhizotomy for trigeminal neuralgia, transfacial fine needle aspiration technique in perineural spread of tumour, and electroencephalographic analysis. This study presents the anatomic variations in dimensions, appearance, number of foramen ovale (FO), and presence of pterygoalar bar and pterygoalar foramen. For the present study ninety dry adult human skulls were utilised. Anterioposterior (length) and transverse (width) diameters of FO were measured, and the presence of pterygoalar bar and foramen were observed. The most common shape of FO observed was like a figure 'D'. The ranges of anteroposterior diameter of the right and left FO were 8.5-4.5 mm and 10-3 mm, respectively. The mean length of the right FO was 6.60 mm while that of the left FO was 6.26 mm. The ranges of transverse diameter (width) of both right and left foramen were 2.5-6 mm and 2-5 mm, respectively. The mean transverse diameter of the right FO was 3.70 mm and that of left was 3.34 mm. Bony spur in FO was seen in 6.66% of cases. A complete pterygoalar bar and foramen were observed in seven cases unilaterally, and in one case it was bilateral. Anteroposterior and transverse diameters of right FO were greater than left. Anatomical understanding, including the size, shape of FO, and presence of pterygoalar bar, has immense surgical and diagnostic importance.
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Affiliation(s)
- S R Daimi
- Department of Anatomy, Rural Medical College, Pravara Institute of Medical Sciences, Loni, (Maharashtra State), India
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Abstract
Little is known about endosomal pathway proteins involved in arthropod-borne virus (arbovirus) assembly and cell-to-cell spread in vector mosquitoes. UNC93A and synaptic vesicle-2 (SV2) proteins are involved in intracellular transport in mammals. They show amino acid sequence conservation from mosquitoes to humans, and their transcripts are highly enriched in Aedes aegypti during arbovirus infection. Transient gene silencing of SV2 or UNC93A in mosquitoes infected with the recombinant alphavirus Sindbis MRE16-enhanced green fluorescent protein (SINV; family Togaviridae) resulted in the accumulation of viral positive- and negative-strand RNA, congregation of virus envelope antigen in intracellular networks, and reduced virus dissemination outside of the midgut. Further, UNC93A silencing, but not SV2 silencing, resulted in a 10-fold reduction in viral titres at 4 days post-infection. Together, these data support a role for UNC93A and SV2 in virus assembly or budding. Cis-regulatory elements (CREs) were identified at the 5'-ends of genes from the original data set in which SV2 and UNC93A were identified. Common CREs at the 5'-end genomic regions of a subset of enriched transcripts support the hypothesis that UNC93A transcription may be co-regulated with that of other ion transport and endosomal trafficking proteins.
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Affiliation(s)
- C L Campbell
- Department of Biochemistry and Molecular Biology, Colorado State University, Fort Collins, CO 80523, USA.
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Abstract
106 cases of intracranial tumours were evaluated, out of which 42 cases (39.6%) were histologically confirmed as gliomas. Computerised tomography (CT) imaging characteristics of glioma were studied with respect to morphology and contrast enhancement to find a possible correlation between CT appearance and the grade of malignancy. It was found that there is a range of patterns both before and after intravenous contrast, which allows an assessment of grading of the tumour with a fair degree of reliability.
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Affiliation(s)
- Hariqbal Singh
- Senior Advisor (Radiology), Command Hospital (Western Command) Chandimandir
| | - Vinay Maurya
- Graded Specialist (Radiology), Military Hospital, Jodhpur 342 010
| | - S S Gill
- Classified Specialist (Pathology), Command Hospital (Southern Command), Pune - 411 040
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Khan S, Mooney L, Plaha P, Javed S, White P, Whone AL, Gill SS. Outcomes from stimulation of the caudal zona incerta and pedunculopontine nucleus in patients with Parkinson's disease. Br J Neurosurg 2011; 25:273-80. [PMID: 21344974 DOI: 10.3109/02688697.2010.544790] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Axial symptoms including postural instability, falls and failure of gait initiation are some of the most disabling motor symptoms of Parkinson's disease (PD). We performed bilateral deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) in combination with the caudal zona incerta (cZi) in order to determine their efficacy in alleviating these symptoms. METHODS Seven patients with predominant axial symptoms in both the 'on' and 'off' medication states underwent bilateral cZi and PPN DBS. Motor outcomes were assessed using the motor component of the Unified Parkinson's Disease Rating Scale (UPDRS 3) and a composite axial subscore was derived from items 27, 28, 29 and 30 (arising from chair, posture, gait and postural stability). Quality of life was measured using the PDQ39. Comparisons were made between scores obtained at baseline and those at a mean follow-up of 12 months. RESULTS In both the off and on medication states, a statistically significant improvement in the UPDRS part 3 score was achieved by stimulation of the PPN, cZi and both in combination. In the off medication state, our composite axial subscore of the UPDRS part 3 improved with stimulation of the PPN, cZi and both in combination. The composite axial subscore, in the 'on' medication state, however, only showed a statistically significant improvement when a combination of cZi and PPN stimulation was used. CONCLUSIONS This study provides evidence that a combination of PPN and cZi stimulation can achieve a significant improvement in the hitherto untreatable 'on' medication axial symptoms of PD.
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Affiliation(s)
- Sadaquate Khan
- Department of Neurosurgery, Institute of Neurosciences, Frenchay Hospital, Bristol, UK
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White E, Woolley M, Bienemann A, Johnson DE, Wyatt M, Murray G, Taylor H, Gill SS. A robust MRI-compatible system to facilitate highly accurate stereotactic administration of therapeutic agents to targets within the brain of a large animal model. J Neurosci Methods 2010; 195:78-87. [PMID: 21074564 PMCID: PMC3396852 DOI: 10.1016/j.jneumeth.2010.10.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 10/06/2010] [Accepted: 10/24/2010] [Indexed: 11/21/2022]
Abstract
Achieving accurate intracranial electrode or catheter placement is critical in clinical practice in order to maximise the efficacy of deep brain stimulation and drug delivery respectively as well as to minimise side-effects. We have developed a highly accurate and robust method for MRI-guided, stereotactic delivery of catheters and electrodes to deep target structures in the brain of pigs. This study outlines the development of this equipment and animal model. Specifically this system enables reliable head immobilisation, acquisition of high-resolution MR images, precise co-registration of MRI and stereotactic spaces and overall rigidity to facilitate accurate burr hole-generation and catheter implantation. To demonstrate the utility of this system, in this study a total of twelve catheters were implanted into the putamen of six Large White Landrace pigs. All implants were accurately placed into the putamen. Target accuracy had a mean Euclidean distance of 0.623 mm (standard deviation of 0.33 mm). This method has allowed us to accurately insert fine cannulae, suitable for the administration of therapeutic agents by convection-enhanced delivery (CED), into the brain of pigs. This study provides summary evidence of a robust system for catheter implantation into the brain of a large animal model. We are currently using this stereotactic system, implantation procedure and animal model to develop catheter-based drug delivery systems that will be translated into human clinical trials, as well as to model the distribution of therapeutic agents administered by CED over large volumes of brain.
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Affiliation(s)
- E White
- Department of Neurosurgery, Frenchay Hospital, Bristol, UK
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Thevathasan W, Silburn PA, Brooker H, Coyne TJ, Khan S, Gill SS, Aziz TZ, Brown P. The impact of low-frequency stimulation of the pedunculopontine nucleus region on reaction time in parkinsonism. J Neurol Neurosurg Psychiatry 2010; 81:1099-104. [PMID: 20562469 DOI: 10.1136/jnnp.2009.189324] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Attentional augmentation and enhanced motor function are potential mechanisms by which stimulation of the region of the pedunculopontine nucleus (PPN) may improve gait in parkinsonism. Here, the authors assess the impact of stimulation of this region on attentional and motor aspects of reaction task performance in patients with parkinsonism. METHODS Eleven patients implanted with PPN stimulators underwent computerised assessment of simple, choice and digit vigilance reaction tasks. Patients were assessed 'off medication' during stimulation at different frequencies (0 Hz, 5 Hz, 10 Hz and 'therapeutic' 20-35 Hz). There were two primary endpoints: 'Speed of Reaction' (sum of the mean task reaction times) and 'Accuracy of Reaction' (reflecting omissions and percentage of correct responses). Baseline performance was compared with age- and sex-matched healthy controls. Clinical effects of stimulation were assessed using the Unified Parkinson's Disease Rating Scale and a falls frequency scale. RESULTS Compared with healthy controls, subjects had significant deficits in 'Speed of Reaction' and in all mean task reaction times. 'Accuracy of Reaction' was not different from healthy controls and did not improve with stimulation. 'Speed of Reaction' significantly improved with stimulation at therapeutic frequencies (20-35 Hz). Of the individual tasks, only simple reaction time improved significantly. Simple reaction time distribution analysis revealed a general speeding of responses rather than a selective reduction in outliers. Acute PPN stimulation improved gait and balance but not akinesia scores. Chronic PPN stimulation significantly improved falls frequency. Falls score improvement significantly correlated with changes to simple reaction time with therapeutic stimulation. CONCLUSION The pattern of reaction time improvement with stimulation of the PPN area suggests a benefit on motor performance, rather than augmentation of attention.
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Affiliation(s)
- Wesley Thevathasan
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
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Khan S, Javed S, Park N, Gill SS, Patel NK. A Magnetic Resonance Imaging–Directed Method for Transventricular Targeting of Midline Structures for Deep Brain Stimulation Using Implantable Guide Tubes. Oper Neurosurg (Hagerstown) 2010; 66:234-7; discussion 237. [DOI: 10.1227/01.neu.0000369648.71236.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
The periventricular gray/periaqueductal gray (PVG/PAG) is a target site for deep brain stimulation for chronic pain. The pedunculopontine nucleus (PPN) is a target for the treatment of axial disturbance in Parkinson's disease. Conventionally, a trajectory lateral to the ventricle is used in targeting deep subcortical structures; however, this limits the number of active contacts that can be placed in these midline targets. To maximize the number of contacts within these targets, a trajectory traversing the ventricles may be used; however, this is avoided because lead placement remains unpredictable with problems including ventricular lead migration and hemorrhage. We describe a novel method for accurate and safe transventricular targeting.
METHODS
Magnetic resonance imaging is used for visualizing the target structure. A trajectory traversing the lateral ventricle is planned, avoiding blood vessels. The guide tube is inserted through the ventricle to a position short of the target site and its proximal end is fixed. A stylet is inserted in the guide tube with its distal end at the target site. After intraoperative radiological confirmation of placement, the indwelling stylet is removed and the guide tube acts as a port for delivering the stimulating electrode.
RESULTS
The PVG/PAG matter and the PPN were targeted, taking a transventricular trajectory. We implanted unilateral PVG/PAG matter electrodes in 10 patients and bilateral PPN electrodes in 3 patients. All electrodes were implanted accurately within the desired target with no complications.
CONCLUSION
The use of an implanted guide tube enables the safe and accurate transventricular targeting of the PVG/PAG matter and the PPN.
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Affiliation(s)
- Sadaquate Khan
- Institute of Neurosciences, Frenchay Hospital, Bristol, United Kingdom
| | - Shazia Javed
- Institute of Neurosciences, Frenchay Hospital, Bristol, United Kingdom
| | - Nicholas Park
- Institute of Neurosciences, Frenchay Hospital, Bristol, United Kingdom
| | - Steven S. Gill
- Institute of Neurosciences, Frenchay Hospital, Bristol, United Kingdom
| | - Nikunj K. Patel
- Institute of Neurosciences, Frenchay Hospital, Bristol, United Kingdom
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Timmermann L, Pauls KAM, Wieland K, Jech R, Kurlemann G, Sharma N, Gill SS, Haenggeli CA, Hayflick SJ, Hogarth P, Leenders KL, Limousin P, Malanga CJ, Moro E, Ostrem JL, Revilla FJ, Santens P, Schnitzler A, Tisch S, Valldeoriola F, Vesper J, Volkmann J, Woitalla D, Peker S. Dystonia in neurodegeneration with brain iron accumulation: outcome of bilateral pallidal stimulation. ACTA ACUST UNITED AC 2010; 133:701-12. [PMID: 20207700 PMCID: PMC2842517 DOI: 10.1093/brain/awq022] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Neurodegeneration with brain iron accumulation encompasses a heterogeneous group of rare neurodegenerative disorders that are characterized by iron accumulation in the brain. Severe generalized dystonia is frequently a prominent symptom and can be very disabling, causing gait impairment, difficulty with speech and swallowing, pain and respiratory distress. Several case reports and one case series have been published concerning therapeutic outcome of pallidal deep brain stimulation in dystonia caused by neurodegeneration with brain iron degeneration, reporting mostly favourable outcomes. However, with case studies, there may be a reporting bias towards favourable outcome. Thus, we undertook this multi-centre retrospective study to gather worldwide experiences with bilateral pallidal deep brain stimulation in patients with neurodegeneration with brain iron accumulation. A total of 16 centres contributed 23 patients with confirmed neurodegeneration with brain iron accumulation and bilateral pallidal deep brain stimulation. Patient details including gender, age at onset, age at operation, genetic status, magnetic resonance imaging status, history and clinical findings were requested. Data on severity of dystonia (Burke Fahn Marsden Dystonia Rating Scale-Motor Scale, Barry Albright Dystonia Scale), disability (Burke Fahn Marsden Dystonia Rating Scale-Disability Scale), quality of life (subjective global rating from 1 to 10 obtained retrospectively from patient and caregiver) as well as data on supportive therapy, concurrent pharmacotherapy, stimulation settings, adverse events and side effects were collected. Data were collected once preoperatively and at 2-6 and 9-15 months postoperatively. The primary outcome measure was change in severity of dystonia. The mean improvement in severity of dystonia was 28.5% at 2-6 months and 25.7% at 9-15 months. At 9-15 months postoperatively, 66.7% of patients showed an improvement of 20% or more in severity of dystonia, and 31.3% showed an improvement of 20% or more in disability. Global quality of life ratings showed a median improvement of 83.3% at 9-15 months. Severity of dystonia preoperatively and disease duration predicted improvement in severity of dystonia at 2-6 months; this failed to reach significance at 9-15 months. The study confirms that dystonia in neurodegeneration with brain iron accumulation improves with bilateral pallidal deep brain stimulation, although this improvement is not as great as the benefit reported in patients with primary generalized dystonias or some other secondary dystonias. The patients with more severe dystonia seem to benefit more. A well-controlled, multi-centre prospective study is necessary to enable evidence-based therapeutic decisions and better predict therapeutic outcomes.
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Affiliation(s)
- L Timmermann
- Klinik und Poliklinik für Neurologie, Uniklinik Köln, Kerpener Str. 62, 50924 Köln, Germany.
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Abstract
Congenital dislocation of the subtalar joint is one of the rarest forms of presentation of a calcaneo-valgus foot. We report the second case of this type published; an 18-month female child aged was seen with calcaneo-valgus deformity of left foot since birth. She was walking over the medial malleolus and medial border of foot. Radiographs and 3D CT scan of the left foot confirmed the diagnosis of a congenital subtalar dislocation. Surgical correction was achieved through a posterolateral incision, and the reduced joint was fixed with a k-wires for 6 weeks; the foot was immobilized in below knee cast for another 6 weeks, and an ankle foot orthosis was used for another 3 years. At 3 years post-surgical follow up, the child has a plantigrade foot with no functional impairment. Follow up radiographs and 3D CT scan confirmed the maintenance of well aligned talo-calcaneal joint. This type of dislocation should be considered in the differential diagnosis of calcaneo-valgus foot; a clear understanding of the pathology, a precise operative reduction, and long-term use of orthosis results in a favourable outcome.
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Affiliation(s)
- Raghav Saini
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160 012, India.
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Gill SS, Sebastian MG, Tan SG, Chia KH, Tan BS, Tay KH. Endovascular aortic repair: the experience of two tertiary institutions in Singapore. Singapore Med J 2009; 50:768-771. [PMID: 19710973] [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: 05/28/2023]
Abstract
INTRODUCTION Endovascular aortic repair (EVAR) has gained prominence as a means of treating aortic disease, with lower perioperative morbidity and mortality compared to open surgery. This article aimed to describe the experience of two tertiary hospitals in a Southeast Asian population. METHODS A retrospective review of 100 consecutive patients undergoing EVAR in two hospitals in Singapore was conducted. This included patients undergoing elective as well as emergency repair. RESULTS The mean duration of follow-up was 31.8 months. The mean aneurysm size was 6.3 cm and the mean length of stay was 12.1 days. 64 percent of the patients were of American Society of Anesthesiologists class III or above. The deployment success was 98 percent. Major complications (acute myocardial infarction, pneumonia, cerebrovascular accidents, renal failure, colonic infarction and spinal cord infarction) occurred in 18 patients. Perioperative mortality occurred in six percent of cases. The endoleak rate was 28 percent. Both patients with colonic infarction had a single patent internal iliac artery post-procedure, and end-stage renal failure. CONCLUSION Our results are comparable to published experiences in aortic stenting. Our population possibly had a higher incidence of short common iliac arteries. Revascularisation of internal iliac arteries should be considered for patients with end-stage renal failure and a single patent internal iliac artery.
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Affiliation(s)
- S S Gill
- Department of General Surgery, Singapore General Hospital, Outram Road, Singapore
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Wickremaratchi MM, Majounie E, Morris HR, Williams NM, Lewis H, Gill SS, Khan S, Heywood P, Hardy J, Wiles CM, Singleton AB, Quinn NP. Parkin-related disease clinically diagnosed as a pallido-pyramidal syndrome. Mov Disord 2009; 24:138-40. [PMID: 18942080 DOI: 10.1002/mds.22181] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Gill SS. Gastric Stromal Tumour presenting as Upper Gastrointestinal Bleed. Med J Armed Forces India 2009; 65:197. [PMID: 27408239 DOI: 10.1016/s0377-1237(09)80154-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- S S Gill
- Associate Professor (Department of Pathology), AFMC, Pune
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