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Sheremeta MS, Korchagina MO, Guseinova RM, Schmidt TE, Nizhegorodova KS, Sviridenko NY, Melnichenko GA. [Alemtuzumab-induced Graves' disease]. Probl Endokrinol (Mosk) 2023; 69:51-57. [PMID: 37448247 DOI: 10.14341/probl13238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 07/15/2023]
Abstract
Multiple sclerosis (MS) is a severe chronic autoimmune demyelinating disease of the central nervous system, mediated by Th1/Th17 lymphocytes as well as B lymphocytes, macrophages and other immune cells. Some patients with MS are treated with alemtuzumab, a monoclonal antibody against CD52+ cells, which belongs to the disease-modifying therapies (DMTs). The main effect of alemtuzumab is related to changes in immune recruitment. Alemtuzumab therapy can induce secondary autoimmunity against the background of immune rebalancing. The thyroid gland is generally involved in the autoimmune process. Graves' disease (GD) develops most often, followed by autoimmune thyroiditis.We present a clinical case of a patient with GD developed after alemtuzumab therapy for MS. The patient was referred to a radiologist at the Department of Radionuclide Therapy of Endocrinology Research Centre for radioiodine therapy (RAIT) due to relapse of thyrotoxicosis after anti-thyroid drug therapy for GD. The goal of treatment was achieved in 2 months, thyroid hormone therapy was initiated, against the background of this, there was compensation of thyroid function.
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Affiliation(s)
| | | | | | - T E Schmidt
- I.M. Sechenov First Moscow State Medical University
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2
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Nganou-Makamdop K, Talla A, Sharma AA, Darko S, Ransier A, Laboune F, Chipman JG, Beilman GJ, Hoskuldsson T, Fourati S, Schmidt TE, Arumugam S, Lima NS, Moon D, Callisto S, Schoephoerster J, Tomalka J, Mugyenyi P, Ssali F, Muloma P, Ssengendo P, Leda AR, Cheu RK, Flynn JK, Morou A, Brunet-Ratnasingham E, Rodriguez B, Lederman MM, Kaufmann DE, Klatt NR, Kityo C, Brenchley JM, Schacker TW, Sekaly RP, Douek DC. Translocated microbiome composition determines immunological outcome in treated HIV infection. Cell 2021; 184:3899-3914.e16. [PMID: 34237254 DOI: 10.1016/j.cell.2021.05.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 02/03/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022]
Abstract
The impact of the microbiome on HIV disease is widely acknowledged although the mechanisms downstream of fluctuations in microbial composition remain speculative. We detected rapid, dynamic changes in translocated microbial constituents during two years after cART initiation. An unbiased systems biology approach revealed two distinct pathways driven by changes in the abundance ratio of Serratia to other bacterial genera. Increased CD4 T cell numbers over the first year were associated with high Serratia abundance, pro-inflammatory innate cytokines, and metabolites that drive Th17 gene expression signatures and restoration of mucosal integrity. Subsequently, decreased Serratia abundance and downregulation of innate cytokines allowed re-establishment of systemic T cell homeostasis promoting restoration of Th1 and Th2 gene expression signatures. Analyses of three other geographically distinct cohorts of treated HIV infection established a more generalized principle that changes in diversity and composition of translocated microbial species influence systemic inflammation and consequently CD4 T cell recovery.
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Affiliation(s)
- Krystelle Nganou-Makamdop
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA; Institute of Clinical and Molecular Virology, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Aarthi Talla
- Department of Pathology, Case Western Reserve University, Cleveland, OH 10900, USA; Allen Institute for Immunology, Seattle, WA 98109, USA
| | - Ashish Arunkumar Sharma
- Department of Pathology, Case Western Reserve University, Cleveland, OH 10900, USA; Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Sam Darko
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Amy Ransier
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Farida Laboune
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jeffrey G Chipman
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Gregory J Beilman
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Torfi Hoskuldsson
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Slim Fourati
- Department of Pathology, Case Western Reserve University, Cleveland, OH 10900, USA; Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Thomas E Schmidt
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Sahaana Arumugam
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Noemia S Lima
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Damee Moon
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Samuel Callisto
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - Jeffery Tomalka
- Department of Pathology, Case Western Reserve University, Cleveland, OH 10900, USA; Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | | | | | | | | | - Ana R Leda
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL 33124, USA
| | - Ryan K Cheu
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL 33124, USA
| | - Jacob K Flynn
- Barrier Immunity Section, Laboratory of Viral Diseases, NIAID/NIH, Bethesda, MD 20892, USA
| | - Antigoni Morou
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC H3C 3J7, Canada; Université de Montréal, Montreal, QC H3C 3J7, Canada; Roche Diagnostics GmbH, 82377 Penzberg, Germany
| | - Elsa Brunet-Ratnasingham
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC H3C 3J7, Canada; Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Benigno Rodriguez
- Case Western Reserve University School of Medicine, Cleveland, OH 10900, USA
| | - Michael M Lederman
- Case Western Reserve University School of Medicine, Cleveland, OH 10900, USA
| | - Daniel E Kaufmann
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC H3C 3J7, Canada; Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Nichole R Klatt
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL 33124, USA
| | - Cissy Kityo
- Joint Clinical Research Center, Kampala, Uganda
| | - Jason M Brenchley
- Barrier Immunity Section, Laboratory of Viral Diseases, NIAID/NIH, Bethesda, MD 20892, USA
| | - Timothy W Schacker
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Rafick P Sekaly
- Department of Pathology, Case Western Reserve University, Cleveland, OH 10900, USA; Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA.
| | - Daniel C Douek
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
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3
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Rothenberger M, Nganou-Makamdop K, Kityo C, Ssali F, Chipman JG, Beilman GJ, Hoskuldsson T, Anderson J, Jasurda J, Schmidt TE, Calisto SP, Pearson H, Reimann T, David C, Perkey K, Southern P, Wietgrefe S, Helgeson E, Reilly C, Haase AT, Douek DC, Fletcher CV, Schacker TW. Impact of Integrase Inhibition Compared With Nonnucleoside Inhibition on HIV Reservoirs in Lymphoid Tissues. J Acquir Immune Defic Syndr 2019; 81:355-360. [PMID: 31192893 PMCID: PMC6582649 DOI: 10.1097/qai.0000000000002026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/04/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND HIV is produced in lymphoid tissues (LT) and stored on the follicular dendritic cell network in LT. When antiretroviral therapy is started, plasma viremia decays in 2 phases; the first within days of starting therapy and the second over weeks. Raltegravir (RAL), an integrase inhibitor, has been associated with only a single rapid phase of decay, and we speculated this may be due to higher intracellular concentration (IC) of RAL in LT. We have previously measured suboptimal ICs of antiretroviral therapy agents in LT, which were associated with slower decay of both vRNA+ cells and the follicular dendritic cell network pool. SETTING Outpatient clinic at the Joint Clinical Research Center in Kampala, Uganda. METHODS We compared the rate of decay in LT in people starting RAL with those starting efavirenz (EFV). RESULTS There was no difference in the rate of virus decay in LT. The ratio of the ICs of RAL and EFV in lymph node to the concentration of drug that inhibits 95% of virus in blood was 1 log lower in lymph node for EFV and >3 logs lower for RAL. CONCLUSION These data further highlight the challenges of drug delivery to LT in HIV infection and demonstrate that RAL is not superior to EFV as judged by direct measurements of the source of virus in LT.
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Affiliation(s)
| | | | - Cissy Kityo
- Joint Clinical Research Center, Kampala, Uganda
| | | | | | | | | | - Jodi Anderson
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Jake Jasurda
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | | | | | - Hope Pearson
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Thomas Reimann
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Caitlin David
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Katherine Perkey
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | | | | | - Erika Helgeson
- Biostatistics, University of Minnesota, Minneapolis, MN; and
| | - Cavan Reilly
- Biostatistics, University of Minnesota, Minneapolis, MN; and
| | | | - Daniel C Douek
- Vaccine Research Center, National Institutes of Allergy and Infectious Diseases, NIH, Bethesda, MD
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4
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Khachanova NV, Bakhtiyarova KZ, Boyko AN, Vlasov YV, Davydovskaia MV, Evdoshenko EP, Zakharova MN, Malkova NA, Sivertseva SA, Spirin NN, Stolyarov ID, Schmidt TE, Khabirov FA. [Provision of alemtuzumab safety is one of the main components of pharmacovigilance]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:82-87. [PMID: 30160673 DOI: 10.17116/jnevro201811808282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/17/2022]
Abstract
Modern multiple sclerosis therapy with disease-modifying drugs is characterized by the risks of dangerous infectious complications. In the last 5 years, there have been several reports of severe, sometimes lethal, listeriosis infection in patients treated with alemtuzumab. This article presents a clinical case of lethal listeriosis meningoencephalitis, which developed within 7 days after the completion of the first cycle of alemtuzumab therapy. In January 2018, a meeting of the expert Council was held, at which the clinical recommendations published in 2017 were revised and updated.
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Affiliation(s)
- N V Khachanova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Ya V Vlasov
- Samara State Medical University, Samara, Russia
| | - M V Davydovskaia
- Pirogov Russian National Research Medical University, Moscow, Russia; Scientific and Practical Center for Clinical Research and Medical Technologies Assessment of the Department of Health of the City of Moscow, Moscow, Russia
| | - E P Evdoshenko
- City Center of Multiple Sclerosis and Other Autoimmune Diseases City Clinical Hospital #31, St-Petersburg, Russia; Pavlov Saint-Petersburg State Medical University, St-Petersburg, Russia
| | | | - N A Malkova
- Novosibirsk State Medical University, Novosibirsk, Russia
| | - S A Sivertseva
- Tyumen Regional Multiple Sclerosis Center, Tyumen, Russia
| | - N N Spirin
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - I D Stolyarov
- Bechtereva Institute of Human Brain, St-Petersburg, Russia
| | - T E Schmidt
- Sechenov First Moscow State Medical University, Moscow, Russia
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5
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Schnaith AM, Evans EM, Vogt C, Tinsay AM, Schmidt TE, Tessier KM, Erickson BK. An innovative medical school curriculum to address human papillomavirus vaccine hesitancy. Vaccine 2018; 36:3830-3835. [PMID: 29778518 DOI: 10.1016/j.vaccine.2018.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vaccination rates against Human Papillomavirus (HPV) in the US remain alarmingly low. Physicians can significantly influence a parent's decision to vaccinate their children. However, medical education often lacks training on specific strategies for communicating with vaccine hesitant parents. METHODS We created an innovative curriculum designed to teach medical students how to address HPV vaccine hesitancy. The curriculum consisted of (1) a presentation on the epidemiology, biology, and disease morbidity associated with HPV, (2) a video that teaches specific communication strategies and (3) role-playing simulations. This curriculum was delivered to medical students at two separate sites. Medical students were surveyed before and after completing the educational curriculum. The surveys assessed student comfort talking to HPV vaccine hesitant parents and their likelihood to recommend the HPV vaccine. RESULTS Pre- and post-intervention surveys were completed by 101 of the 132 participants (77% response rate). After the intervention, student awareness of the benefits of the HPV vaccine increased by a mean of 0.82 points (Likert scale 1-5, p < 0.01) and student comfort talking to vaccine hesitant parents increased by a mean of 1.37 points (p < 0.01). Prior to the intervention, students more strongly recommended the HPV vaccine to females compared to males, but this gender disparity was eliminated after the intervention (p < 0.01). Personal vaccination status was independately associated with a higher likelihood of recommending the HPV vaccine both before and after the intervention. CONCLUSION Our innovative curriculum improved medical student comfort level discussing HPV vaccination with hesitant parents and increased the perceived likelihood of recommending HPV vaccination. The intervention is easy to implement, scalable, and requires minimal resources. Educating future providers on this important topic has the potential to improve vaccination rates nationwide and thus should be considered for all medical students.
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Affiliation(s)
- Abigail M Schnaith
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Erica M Evans
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Caleb Vogt
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Andrea M Tinsay
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Thomas E Schmidt
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Katelyn M Tessier
- Masonic Cancer Center Biostatistics Core, University of Minnesota, 717 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Britt K Erickson
- Department of Obstetrics & Gynecology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, United States.
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6
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Kityo C, Makamdop KN, Rothenberger M, Chipman JG, Hoskuldsson T, Beilman GJ, Grzywacz B, Mugyenyi P, Ssali F, Akondy RS, Anderson J, Schmidt TE, Reimann T, Callisto SP, Schoephoerster J, Schuster J, Muloma P, Ssengendo P, Moysi E, Petrovas C, Lanciotti R, Zhang L, Arévalo MT, Rodriguez B, Ross TM, Trautmann L, Sekaly RP, Lederman MM, Koup RA, Ahmed R, Reilly C, Douek DC, Schacker TW. Lymphoid tissue fibrosis is associated with impaired vaccine responses. J Clin Invest 2018; 128:2763-2773. [PMID: 29781814 DOI: 10.1172/jci97377] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 09/26/2017] [Accepted: 04/10/2018] [Indexed: 11/17/2022] Open
Abstract
Vaccine responses vary by geographic location. We have previously described how HIV-associated inflammation leads to fibrosis of secondary lymph nodes (LNs) and T cell depletion. We hypothesized that other infections may cause LN inflammation and fibrosis, in a process similar to that seen in HIV infection, which may lead to T cell depletion and affect vaccine responses. We studied LNs of individuals from Kampala, Uganda, before and after yellow fever vaccination (YFV) and found fibrosis in LNs that was similar to that seen in HIV infection. We found blunted antibody responses to YFV that correlated to the amount of LN fibrosis and loss of T cells, including T follicular helper cells. These data suggest that LN fibrosis is not limited to HIV infection and may be associated with impaired immunologic responses to vaccines. This may have an impact on vaccine development, especially for infectious diseases prevalent in the developing world.
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Affiliation(s)
- Cissy Kityo
- Joint Clinical Research Center, Kampala, Uganda
| | - Krystelle Nganou Makamdop
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | | | | | | | | | - Rama S Akondy
- Emory Vaccine Center, and Department of Microbiology and Immunology, Emory University, Atlanta, Georgia, USA
| | - Jodi Anderson
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | | | | | | | | | | | - Eirini Moysi
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Constantinos Petrovas
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Lin Zhang
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria T Arévalo
- Center for Vaccines and Immunology and Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | | | - Ted M Ross
- Center for Vaccines and Immunology and Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | - Lydie Trautmann
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | | | | | - Richard A Koup
- Immunology Laboratory, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Rafi Ahmed
- Emory Vaccine Center, and Department of Microbiology and Immunology, Emory University, Atlanta, Georgia, USA
| | - Cavan Reilly
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel C Douek
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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7
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Yang AL, Schmidt TE, Stibitz S, Derrick SC, Morris SL, Parra M. A simplified mycobacterial growth inhibition assay (MGIA) using direct infection of mouse splenocytes and the MGIT system. J Microbiol Methods 2016; 131:7-9. [PMID: 27650198 DOI: 10.1016/j.mimet.2016.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 08/29/2016] [Revised: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Abstract
We describe a simplified Mycobacterial Growth Inhibition Assay (MGIA) for pre-clinical assessment of vaccine-mediated protection in mice. The assay is accomplished by directly infecting splenocytes from vaccinated mice with Mycobacterium tuberculosis and quantifying mycobacteria using Mycobacterial Growth Indicator Tubes (MGIT). Vaccine-mediated immunogenicity detected by this assay correlated with protection.
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Affiliation(s)
- Amy L Yang
- Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Thomas E Schmidt
- Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Scott Stibitz
- Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Steven C Derrick
- Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA.
| | - Sheldon L Morris
- Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Marcela Parra
- Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
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8
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Koenig RW, Schmidt TE, Heinen CPG, Wirtz CR, Kretschmer T, Antoniadis G, Pedro MT. Intraoperative high-resolution ultrasound: a new technique in the management of peripheral nerve disorders. J Neurosurg 2011; 114:514-21. [DOI: 10.3171/2010.9.jns10464] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Surgical treatment of nerve lesions in continuity remains difficult, even in the most experienced hands. The regenerative potential of those injuries can be evaluated by intraoperative electrophysiological studies and/or intraneural dissection. The present study examines the value of intraoperative high-frequency ultrasound as an imaging tool for decision making in the management of traumatic nerve lesions in continuity.
Methods
Intraoperative high-frequency ultrasound was applied to 19 traumatic or iatrogenic nerve lesions of differing extents. The information obtained was correlated with intraoperative electrophysiological, microsurgical intraneural dissection, and histopathological findings in resected nerve segments.
Results
The intraoperative application of high-resolution, high-frequency ultrasound enabled morphological examination of nerve lesions in continuity, with good image quality. The assessment of the severity of the underlying nerve injury matched perfectly with the judgment obtained from intraoperative electrophysiological studies. Both intraneural nerve dissection and neuropathological examination of the resected nerve segments confirmed the sonographic findings. In addition, intraoperative ultrasound proved to be very time efficient.
Conclusions
With intraoperative ultrasound, the extent of traumatic peripheral nerve lesions can be examined morphologically for the first time. It is a promising, noninvasive method that seems capable of assessing the type (intraneural/perineural) and grade of nerve fibrosis. Therefore, in combination with intraoperative neurophysiological studies, intraoperative high-resolution ultrasound may represent a major tool for noninvasive assessment of the regenerative potential of a nerve lesion.
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Affiliation(s)
- Ralph W. Koenig
- 1Department of Neurosurgery, University of Ulm/Bezirkskrankenhaus Guenzburg; and
| | - Thomas E. Schmidt
- 1Department of Neurosurgery, University of Ulm/Bezirkskrankenhaus Guenzburg; and
| | | | - Christian R. Wirtz
- 1Department of Neurosurgery, University of Ulm/Bezirkskrankenhaus Guenzburg; and
| | - Thomas Kretschmer
- 2Department of Neurosurgery, Evangelisches Krankenhaus Oldenburg, Germany
| | - Gregor Antoniadis
- 1Department of Neurosurgery, University of Ulm/Bezirkskrankenhaus Guenzburg; and
| | - Maria T. Pedro
- 1Department of Neurosurgery, University of Ulm/Bezirkskrankenhaus Guenzburg; and
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