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Ansari S, Mazaheri T, O'Donnell K, Waite M, Cann A, Abdel-Malek M, Boyle L, Tweedlie L, Scholtz S, Hameed S, Izzi-Engbeaya C, Chahal H, Tan T. Time to unshackle the medical treatment of obesity in the NHS. Clin Med (Lond) 2024:100206. [PMID: 38643826 DOI: 10.1016/j.clinme.2024.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/24/2024] [Indexed: 04/23/2024]
Abstract
Obesity affects 1 in 4 people in the United Kingdom and costs the National Health Service (NHS) ∼£6.5 billion annually. The glucagon-like peptide-1 (GLP-1) receptor analogues, such as once-daily subcutaneous Liraglutide 3.0 mg (Saxenda®) and once-weekly subcutaneous Semaglutide 2.4 mg (Wegovy®), were approved by the National Institute of Clinical Excellence (NICE) as a treatment for obesity and funded by the NHS for 2 years. Our local data shows that Saxenda is effective at reducing bodyweight and glycaemia in people with obesity and diabetes however, the supply issues of GLP-1 receptor analogues has contributed to the unavailability of Saxenda and Wegovy in our service. Our patients are devastated that they cannot access NICE-approved GLP-1 receptor analogues for obesity. The 2-year GLP-1 receptor analogue treatment limit for obesity alongside a lack of funded NHS services and supply issues represent barriers to treatment for people living with obesity who have clear medical indications.
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Affiliation(s)
- Saleem Ansari
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, W2 1NY; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN
| | - Tina Mazaheri
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, W2 1NY
| | - Karen O'Donnell
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, W2 1NY
| | - Matthew Waite
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, W2 1NY
| | - Alexandra Cann
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, W2 1NY
| | - Mariana Abdel-Malek
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, W2 1NY; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN
| | - Luke Boyle
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, W2 1NY; Centre for Obesity, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT
| | - Lucy Tweedlie
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, W2 1NY; Psychological Medicine Department, West London NHS Health Trust, London UB2 4SD
| | - Samantha Scholtz
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, W2 1NY; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN; Psychological Medicine Department, West London NHS Health Trust, London UB2 4SD
| | - Saira Hameed
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, W2 1NY; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN
| | - Chioma Izzi-Engbeaya
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, W2 1NY; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN
| | - Harvinder Chahal
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, W2 1NY
| | - Tricia Tan
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, W2 1NY; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN.
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Ansari S, Khoo B, Tan T. Targeting the incretin system in obesity and type 2 diabetes mellitus. Nat Rev Endocrinol 2024:10.1038/s41574-024-00979-9. [PMID: 38632474 DOI: 10.1038/s41574-024-00979-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/19/2024]
Abstract
Obesity and type 2 diabetes mellitus (T2DM) are widespread, non-communicable diseases that are responsible for considerable levels of morbidity and mortality globally, primarily in the form of cardiovascular disease (CVD). Changes to lifestyle and behaviour have insufficient long-term efficacy in most patients with these diseases; metabolic surgery, although effective, is not practically deliverable on the scale that is required. Over the past two decades, therapies based on incretin hormones, spearheaded by glucagon-like peptide 1 (GLP1) receptor agonists (GLP1RAs), have become the treatment of choice for obesity and T2DM, and clinical evidence now suggests that these agents have benefits for CVD. We review the latest advances in incretin-based pharmacotherapy. These include 'GLP1 plus' agents, which combine the known advantages of GLP1RAs with the activity of additional hormones, such as glucose-dependent insulinotropic peptide, glucagon and amylin, to achieve desired therapeutic goals. Second-generation non-peptidic oral GLP1RAs promise to extend the benefits of GLP1 therapy to those who do not want, or cannot have, subcutaneous injection therapy. We conclude with a discussion of the knowledge gaps that must be addressed before incretin-based therapies can be properly deployed for maximum benefit in the treatment of obesity and T2DM.
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Affiliation(s)
- Saleem Ansari
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Bernard Khoo
- Department of Endocrinology, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Tricia Tan
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
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Kyriacou C, Yang W, Kapur S, Maheetharan S, Pikovsky M, Parker N, Barcroft J, Bobdiwala S, Sur S, Stalder C, Gould D, Ofili-Yebovi D, Day A, Unsworth N, Wilkes EH, Tan T, Bourne T. Ambulatory human chorionic gonadotrophin (hCG) testing: a verification of two hCG point of care devices. Clin Chem Lab Med 2024; 62:664-673. [PMID: 37886834 DOI: 10.1515/cclm-2023-0703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES Quantitative human chorionic gonadotropin (hCG) measurements are used to manage women classified with a pregnancy of unknown location (PUL). Two point of care testing (POCT) devices that quantify hCG are commercially available. We verified the i-STAT 1 (Abbott) and the AQT 90 FLEX (Radiometer) prior to use in PUL triage. METHODS Tests for precision, external quality assurance (EQA), correlation, hook effect and recovery were undertaken alongside a POCT usability assessment during this prospective multi-center verification. RESULTS Coefficients of variation ranged between 4.0 and 5.1 % for the three i-STAT 1 internal quality control (IQC) solutions and between 6.8 and 7.3 % for the two AQT IQC solutions. Symmetric differences in POCT EQA results when compared with laboratory and EQA stock values ranged between 3.2 and 24.5 % for the i-STAT 1 and between 3.3 and 36.9 % for the AQT. Correlation coefficients (i-STAT 1: 0.96, AQT: 0.99) and goodness of fit curves (i-STAT 1: 0.92, AQT: 0.99) were excellent when using suitable whole blood samples. An hCG hook effect was noted with the i-STAT 1 between 572,194 and 799,089 IU/L, lower than the hook effect noted with the AQT, which was between 799,089 and 1,619,309 IU/L. When hematocrit concentration was considered in sample types validated for use with each device, hCG recovery was 108 % with the i-STAT 1 and 98 % with the AQT. The i-STAT 1 scored lower on usability overall (90/130) than the AQT (121/130, p<0.001, Mann-Whitney). CONCLUSIONS Both hCG POCT devices were verified for use in clinical practice. Practical factors must also be considered when choosing which device to use in each unit.
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Affiliation(s)
- Christopher Kyriacou
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Wei Yang
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Shikha Kapur
- Gynaecology Emergency Unit, Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College London, London, UK
| | - Shanuja Maheetharan
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Margaret Pikovsky
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Nina Parker
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Jennifer Barcroft
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shabnam Bobdiwala
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shyamaly Sur
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Catriona Stalder
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Deborah Gould
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Dede Ofili-Yebovi
- Early Pregnancy Assessment Unit, Chelsea and Westminster Hospital, London, UK
| | - Andrea Day
- Early Pregnancy Assessment Unit, West Middlesex University Hospital, London, UK
| | - Nick Unsworth
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Edmund H Wilkes
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Tricia Tan
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Eng PC, Phylactou M, Qayum A, Woods C, Lee H, Aziz S, Moore B, Miras AD, Comninos AN, Tan T, Franks S, Dhillo WS, Abbara A. Obesity-Related Hypogonadism in Women. Endocr Rev 2024; 45:171-189. [PMID: 37559411 PMCID: PMC10911953 DOI: 10.1210/endrev/bnad027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/02/2023] [Accepted: 08/07/2023] [Indexed: 08/11/2023]
Abstract
Obesity-related hypogonadotropic hypogonadism is a well-characterized condition in men (termed male obesity-related secondary hypogonadism; MOSH); however, an equivalent condition has not been as clearly described in women. The prevalence of polycystic ovary syndrome (PCOS) is known to increase with obesity, but PCOS is more typically characterized by increased gonadotropin-releasing hormone (GnRH) (and by proxy luteinizing hormone; LH) pulsatility, rather than by the reduced gonadotropin levels observed in MOSH. Notably, LH levels and LH pulse amplitude are reduced with obesity, both in women with and without PCOS, suggesting that an obesity-related secondary hypogonadism may also exist in women akin to MOSH in men. Herein, we examine the evidence for the existence of a putative non-PCOS "female obesity-related secondary hypogonadism" (FOSH). We précis possible underlying mechanisms for the occurrence of hypogonadism in this context and consider how such mechanisms differ from MOSH in men, and from PCOS in women without obesity. In this review, we consider relevant etiological factors that are altered in obesity and that could impact on GnRH pulsatility to ascertain whether they could contribute to obesity-related secondary hypogonadism including: anti-Müllerian hormone, androgen, insulin, fatty acid, adiponectin, and leptin. More precise phenotyping of hypogonadism in women with obesity could provide further validation for non-PCOS FOSH and preface the ability to define/investigate such a condition.
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Affiliation(s)
- Pei Chia Eng
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, National University of Singapore, Singapore 117549
| | - Maria Phylactou
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Ambreen Qayum
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Casper Woods
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
| | - Hayoung Lee
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
| | - Sara Aziz
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
| | - Benedict Moore
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
| | - Alexander D Miras
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Alexander N Comninos
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Tricia Tan
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Steve Franks
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Ali Abbara
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
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Kyriacou C, Kapur S, Jeyapala S, Parker N, Yang W, Pikovsky M, Bobdiwala S, Barcroft J, Maheetharan S, Sur S, Stalder C, Gould D, Syed S, Tan T, Bourne T. Beta-human chorionic gonadotrophin point of care testing for the management of pregnancy of unknown location. Reprod Biomed Online 2024; 48:103643. [PMID: 38262209 DOI: 10.1016/j.rbmo.2023.103643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 01/25/2024]
Abstract
RESEARCH QUESTION Does a commercially available quantitative beta-human chorionic gonadotrophin (BHCG) point of care testing (POCT) device improve workflow management in early pregnancy by performing comparably to gold standard laboratory methods, and is the performance of a validated pregnancy of unknown location (PUL) triage strategy maintained using POCT BHCG results? DESIGN Women classified with a PUL between 2018 and 2021 at three early pregnancy units were included. The linear relationship of untreated whole-blood POCT and serum laboratory BHCG values was defined using coefficients and regression. Paired serial BHCG values were then incorporated into the validated M6 multinomial logistic regression model to stratify the PUL as at high risk or at low risk of clinical complications. The sensitivity and negative predictive value were assessed. The timings required for equivocal POCT and laboratory care pathways were compared. RESULTS A total of 462 PUL were included. The discrepancy between 571 laboratory and POCT BHCG values was -5.2% (-6.2 IU/l), with a correlation coefficient of 0.96. The 133 PUL with paired 0 and 48 h BHCG values were compared using the M6 model. The sensitivity for high-risk outcomes (96.2%) and negative predictive values (98.5%) was excellent for both. Sample receipt and laboratory processing took 135 min (421 timings), compared with 12 min (91 timings) when using POCT (P < 0.0001). CONCLUSIONS POCT BHCG values correlated well with laboratory testing measurements. The M6 model retained its performance when using POCT BHCG values. Using the model with POCT may improve workflow and patient care without compromising on effective PUL triage.
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Affiliation(s)
- Christopher Kyriacou
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shikha Kapur
- Gynaecology Emergency Unit, Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College London, London, UK
| | - Sobanakumari Jeyapala
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Hillingdon Hospital, London, UK
| | - Nina Parker
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Wei Yang
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Margaret Pikovsky
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shabnam Bobdiwala
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Jennifer Barcroft
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shanuja Maheetharan
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Shyamaly Sur
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Catriona Stalder
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Deborah Gould
- Gynaecology Emergency Unit, Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College London, London, UK
| | - Shabana Syed
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Hillingdon Hospital, London, UK
| | - Tricia Tan
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
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6
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van Tiel J, Tan T, Tee J, Marion T, Öner F, Rutges J. Outcome of traumatic thoracolumbar spine fractures in elderly: A systematic review. Brain Spine 2024; 4:102775. [PMID: 38510601 PMCID: PMC10951749 DOI: 10.1016/j.bas.2024.102775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024]
Abstract
Introduction Adequate guidelines for treatment of people over 65 years, suffering traumatic thoracolumbar spine fractures without neurologic deficit, are currently lacking. Research question The aim of this study was to systematically review the available literature regarding the outcome of conservative and surgical treatment of thoracolumbar spinal trauma in elderly patients. Material and methods A systematic review according the PRISMA guidelines was performed. Pubmed, Web of Science, EMBASE and the Cochrane Central register were searched until June 2021. Risk of bias of the included studies was evaluated. Clinical and radiological results, as well as complications of conservative or surgical treatment were reviewed. Results Six articles were included (one prospective randomized trial, two prospective and three retrospective cohort studies). In these studies conflicting results were observed with regard to pain, radiological results and complications following both conservative and surgical treatment strategies for thoracolumbar spine fractures in elderly. Discussion and conclusion Treatment of thoracolumbar fractures in elderly should focus on early mobilization to reduce complications and hospital stay. This may improve functional outcome and prevent worsening of frailty in this vulnerable group of patients. To elucidate the optimal treatment for elderly patient with thoracolumbar fractures, future research should focus on patient specific treatment rather than the mere difference between outcome of surgical and conservative treatment.
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Affiliation(s)
- J. van Tiel
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - T. Tan
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - J. Tee
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - T.E. Marion
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - F.C. Öner
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J.P.H.J. Rutges
- Department of Orthopedic Surgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Dubash S, Barwick TD, Kozlowski K, Rockall AG, Khan S, Khan S, Yusuf S, Lamarca A, Valle JW, Hubner RA, McNamara MG, Frilling A, Tan T, Wernig F, Todd J, Meeran K, Pratap B, Azeem S, Huiban M, Keat N, Lozano-Kuehne JP, Aboagye EO, Sharma R. Somatostatin Receptor Imaging with [ 18F]FET-βAG-TOCA PET/CT and [ 68Ga]Ga-DOTA-Peptide PET/CT in Patients with Neuroendocrine Tumors: A Prospective, Phase 2 Comparative Study. J Nucl Med 2024; 65:jnumed.123.266601. [PMID: 38331457 PMCID: PMC10924162 DOI: 10.2967/jnumed.123.266601] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 02/10/2024] Open
Abstract
There is a clinical need for 18F-labeled somatostatin analogs for the imaging of neuroendocrine tumors (NET), given the limitations of using [68Ga]Ga-DOTA-peptides, particularly with regard to widespread accessibility. We have shown that [18F]fluoroethyl-triazole-[Tyr3]-octreotate ([18F]FET-βAG-TOCA) has favorable dosimetry and biodistribution. As a step toward clinical implementation, we conducted a prospective, noninferiority study of [18F]FET-βAG-TOCA PET/CT compared with [68Ga]Ga-DOTA- peptide PET/CT in patients with NET. Methods: Forty-five patients with histologically confirmed NET, grades 1 and 2, underwent PET/CT imaging with both [18F]FET-βAG-TOCA and [68Ga]Ga-peptide performed within a 6-mo window (median, 77 d; range, 6-180 d). Whole-body PET/CT was conducted 50 min after injection of 165 MBq of [18F]FET-βAG-TOCA. Tracer uptake was evaluated by comparing SUVmax and tumor-to-background ratios at both lesion and regional levels by 2 unblinded, experienced readers. A randomized, blinded reading of both scans was also then undertaken by 3 experienced readers, and consensus was assessed at a regional level. The ability of both tracers to visualize liver metastases was also assessed. Results: A total of 285 lesions were detected on both imaging modalities. An additional 13 tumor deposits were seen in 8 patients on [18F]FET-βAG-TOCA PET/CT, and [68Ga]Ga-DOTA-peptide PET/CT detected an additional 7 lesions in 5 patients. Excellent correlation in SUVmax was observed between both tracers (r = 0.91; P < 0.001). No difference was observed between median SUVmax across regions, except in the liver, where the median tumor-to-background ratio of [18F]FET-βAG-TOCA was significantly lower than that of [68Ga]Ga-DOTA-peptide (2.5 ± 1.9 vs. 3.5 ± 2.3; P < 0.001). Conclusion: [18F]FET-βAG-TOCA was not inferior to [68Ga]Ga-DOTA-peptide in visualizing NET and may be considered in routine clinical practice given the longer half-life and availability of the cyclotron-produced fluorine radioisotope.
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Affiliation(s)
- Suraiya Dubash
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Tara D Barwick
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Imaging, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kasia Kozlowski
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Andrea G Rockall
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sairah Khan
- Department of Imaging, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sameer Khan
- Department of Imaging, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Siraj Yusuf
- Radiology and Nuclear Medicine Department, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Angela Lamarca
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Juan W Valle
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Richard A Hubner
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Mairéad G McNamara
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Andrea Frilling
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Tricia Tan
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Florian Wernig
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jeannie Todd
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Karim Meeran
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Bhavesh Pratap
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Saleem Azeem
- Invicro-London, Imperial College London, London, United Kingdom; and
| | - Michael Huiban
- Invicro-London, Imperial College London, London, United Kingdom; and
| | - Nicholas Keat
- Invicro-London, Imperial College London, London, United Kingdom; and
| | - Jingky P Lozano-Kuehne
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, University of Newcastle, Newcastle, United Kingdom
| | - Eric O Aboagye
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Rohini Sharma
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom;
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Yang S, Song D, Wang R, Liu M, Tan T, Wang Y, Xie Q, Wang L. Sodium fluoride-induced autophagy of ameloblast-like cells via the p-ULk1/ATG13/LC3B pathway in vitro. Oral Dis 2024. [PMID: 38321366 DOI: 10.1111/odi.14884] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To investigate the effects of sodium fluoride on the ameloblast and reveal the mechanism of dental fluorosis. MATERIALS AND METHODS Mouse ameloblast-like cell line (ALC) cells were treated with various concentrations of NaF, and subjected to Incucyte, fluorescence immunoassay, transmission electron microscopy, reverse transcription quantitative polymerase chain reaction (RT-qPCR), western blot for autophagy examination, alkaline phosphatase and alizarin red staining for mineralization after osteogenic induction. RESULTS NaF exerts a dose-dependent inhibitory effect on ALC cell growth. TEM and fluorescence immunoassay showed that 1.5 mM or higher concentrations of NaF could induce a fusion of lysosome and mitochondria, finally increasing the number of autophagosome. RT-qPCR and western blot showed that the upregulation of autophagy related gene 13 (ATG13), downregulation of phosphorylated Unc-51-like kinase 1 (p-ULK1) were found in NaF-induced autophagy of ALC cells. The knockdown of ATG13 could rescue it as well as the expression of p-ULK1 and LC3B. Besides, alizarin red staining showed that fluoride under these concentrations could promote the mineralization of ALC. CONCLUSIONS The data show that fluoride in higher concentration can induce autophagy via the p-ULk1/ATG13/LC3B pathway of ALCs than lower ones promote mineralization in vitro, which provides insight into the function of NaF in the autophagy and mineralization of ameloblast.
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Affiliation(s)
- S Yang
- Department of Prosthodontics, School and Hospital of Stomatology, Peking University, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - D Song
- Department of Prosthodontics, School and Hospital of Stomatology, Peking University, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - R Wang
- Department of Prosthodontics, School and Hospital of Stomatology, Peking University, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - M Liu
- Department of Prosthodontics, School and Hospital of Stomatology, Peking University, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - T Tan
- Department of Prosthodontics, School and Hospital of Stomatology, Peking University, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Y Wang
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
| | - Q Xie
- Department of Prosthodontics, School and Hospital of Stomatology, Peking University, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - L Wang
- Department of Prosthodontics, School and Hospital of Stomatology, Peking University, Beijing, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Beijing, China
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Hinds CE, Peace E, Chen S, Davies I, El Eid L, Tomas A, Tan T, Minnion J, Jones B, Bloom SR. Abolishing β-arrestin recruitment is necessary for the full metabolic benefits of G protein-biased glucagon-like peptide-1 receptor agonists. Diabetes Obes Metab 2024; 26:65-77. [PMID: 37795639 DOI: 10.1111/dom.15288] [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: 03/23/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 10/06/2023]
Abstract
AIM Earlier studies have shown that peptide glucagon-like peptide-1 receptor (GLP-1R) agonists with reduced β-arrestin recruitment show enhanced anti-hyperglycaemic efficacy through avoidance of GLP-1R desensitization. However, the ligand modifications needed to decrease β-arrestin recruitment usually also reduces GLP-1R affinity, therefore higher doses are needed. Here we aimed to develop new, long-acting, G protein-biased GLP-1R agonists with acute signalling potency comparable with semaglutide, to provide insights into specific experimental and therapeutic scenarios. MATERIALS AND METHODS New GLP-1R agonist peptides were assessed using a variety of in vitro and in vivo assays. RESULTS First, we show that very substantial reductions in β-arrestin recruitment efficacy are required to realize fully the benefits of GLP-1R agonism on blood glucose lowering in mice, with more moderate reductions being less effective. Secondly, our lead compound (SRB107) performs substantially better than semaglutide for effects on blood glucose and weight loss, which may be jointly attributable to its biased agonist action and protracted pharmacokinetics. Thirdly, we show that biased agonist-specific GLP-1R internalization profiles occur at clinically relevant pharmacological concentrations. Finally, we show that SRB107 cAMP signalling is differentially modulated by single and double GLP1R coding variants seen in human populations, with implications for GLP-1R agonist pharmacogenomics. CONCLUSIONS Completely abolishing β-arrestin recruitment improves the anti-hyperglycaemic effects of GLP-1R agonists in mice.
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Affiliation(s)
- Charlotte E Hinds
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Ellie Peace
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Shiqian Chen
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Iona Davies
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Liliane El Eid
- Section of Cell Biology, Imperial College London, London, UK
| | - Alejandra Tomas
- Section of Cell Biology, Imperial College London, London, UK
| | - Tricia Tan
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - James Minnion
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Ben Jones
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
| | - Stephen R Bloom
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK
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10
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Tan T, Junghans C, Varaden D. Empowering community health professionals for effective air pollution information communication. BMC Public Health 2023; 23:2547. [PMID: 38124041 PMCID: PMC10734129 DOI: 10.1186/s12889-023-17462-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Air pollution remains a significant public health risk, particularly in urban areas. Effective communication strategies remain integral to overall protection by encouraging the adoption of personal air pollution exposure reduction behaviours. This study aims to explore how community health professionals can be empowered to communicate air pollution information and advice to the wider community, to encourage the uptake of desired behaviours in the population. METHODS The study adopted a qualitative methodology, where four homogenous Focus Group Discussions (FGDs) were held with a range of community health professionals, including Health Care Professionals, Community Health and Wellbeing Workers (CHWWs) and Social Prescribing Link Workers (SPLW). A classical content analysis was conducted with the Structural Empowerment Theory (SET) and Psychological Empowerment Theory (PET) as guiding concepts. RESULTS Five key themes were identified: from a structural empowerment perspective: [1] resources and support, [2] knowledge. From a psychological empowerment perspective: [3] confidence as advisor, [4] responsibility as advisor, and [5] residents' receptiveness to advice. It was concluded that advice should be risk stratified, clear, easy to follow and provide alternatives. CONCLUSION This study identified ways for community health professionals to be empowered by local councils or other organisations in providing advice on air pollution, through the provision of essential structural support and opportunities to enhance their knowledge and confidence in the subject. Implementing recommendations from this study would not only empower community health professionals to advise on air pollution to the wider community but also increase adherence to health advice.
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Affiliation(s)
- Tricia Tan
- School of Public Health, Imperial College London, London, UK
| | - Cornelia Junghans
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Diana Varaden
- MRC Centre for Environment and Health, Imperial College London, London, UK.
- NIHR-HPRU Environmental Exposures and Health, School of Public Health, Imperial College London, London, UK.
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11
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Kjeldsen SA, Gluud LL, Werge MP, Pedersen JS, Bendtsen F, Alexiadou K, Tan T, Torekov SS, Iepsen EW, Jensen NJ, Richter MM, Goetze JP, Rungby J, Hartmann B, Holst JJ, Holst B, Holt J, Gustafsson F, Madsbad S, Svane MS, Bojsen-Møller KN, Wewer Albrechtsen NJ. Neprilysin activity is increased in metabolic dysfunction-associated steatotic liver disease and normalizes after bariatric surgery or GLP-1 therapy. iScience 2023; 26:108190. [PMID: 37953952 PMCID: PMC10638073 DOI: 10.1016/j.isci.2023.108190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Inhibitors of neprilysin improve glycemia in patients with heart failure and type 2 diabetes (T2D). The effect of weight loss by diet, surgery, or pharmacotherapy on neprilysin activity (NEPa) is unknown. We investigated circulating NEPa and neprilysin protein concentrations in obesity, T2D, metabolic dysfunction-associated steatotic liver disease (MASLD), and following bariatric surgery, or GLP-1-receptor-agonist therapy. NEPa, but not neprilysin protein, was enhanced in obesity, T2D, and MASLD. Notably, MASLD associated with NEPa independently of BMI and HbA1c. NEPa decreased after bariatric surgery with a concurrent increase in OGTT-stimulated GLP-1. Diet-induced weight loss did not affect NEPa, but individuals randomized to 52-week weight maintenance with liraglutide (1.2 mg/day) decreased NEPa, consistent with another study following 6-week liraglutide (3 mg/day). A 90-min GLP-1 infusion did not alter NEPa. Thus, MASLD may drive exaggerated NEPa, and lowered NEPa following bariatric surgery or liraglutide therapy may contribute to the reported improved cardiometabolic effects.
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Affiliation(s)
- Sasha A.S. Kjeldsen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Lise L. Gluud
- Gastro Unit, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Mikkel P. Werge
- Gastro Unit, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Julie S. Pedersen
- Gastro Unit, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Flemming Bendtsen
- Gastro Unit, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kleopatra Alexiadou
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2BX, UK
| | - Tricia Tan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2BX, UK
| | - Signe S. Torekov
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Eva W. Iepsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Nicole J. Jensen
- Department of Endocrinology, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
| | - Michael M. Richter
- Department of Clinical Biochemistry, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
| | - Jens P. Goetze
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jørgen Rungby
- Department of Endocrinology, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jens J. Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Birgitte Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Joachim Holt
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Sten Madsbad
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Hvidovre, 2650 Hvidovre, Denmark
| | - Maria S. Svane
- Gastro Unit, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Hvidovre, 2650 Hvidovre, Denmark
| | - Kirstine N. Bojsen-Møller
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Hvidovre, 2650 Hvidovre, Denmark
| | - Nicolai J. Wewer Albrechtsen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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12
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Eng PC, Forlano R, Tan T, Manousou P, Dhillo WS, Izzi-Engbeaya C. Non-alcoholic fatty liver disease in women - Current knowledge and emerging concepts. JHEP Rep 2023; 5:100835. [PMID: 37771547 PMCID: PMC10522907 DOI: 10.1016/j.jhepr.2023.100835] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 09/30/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a major cause of liver disease worldwide, affecting up to 30% of adults. Progression to non-alcoholic steatohepatitis (NASH) is a key risk factor for cirrhosis, hepatocellular carcinoma and cardiovascular events. Alterations in reproductive hormones are linked to the development and/or progression of NAFLD/NASH in women. Women with polycystic ovary syndrome and those with oestrogen deficiency are at increased risk of NAFLD/NASH, with higher mortality rates in older women compared to men of similar ages. NAFLD/NASH is currently the leading indication for liver transplantation in women without hepatocellular carcinoma. Therefore, a better understanding of NAFLD in women is needed to improve outcomes. In this review, we discuss the hormonal and non-hormonal factors that contribute to NAFLD development and progression in women. Furthermore, we highlight areas of focus for clinical practice and for future research.
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Affiliation(s)
- Pei Chia Eng
- Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Roberta Forlano
- Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Department of Hepatology, Imperial College Healthcare NHS Trust, London, UK
| | - Tricia Tan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Pinelopi Manousou
- Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Department of Hepatology, Imperial College Healthcare NHS Trust, London, UK
| | - Waljit S. Dhillo
- Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Chioma Izzi-Engbeaya
- Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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13
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Bally L, Khoo B, Knop F, Madsbad S, Patti ME, Tan T. Call for prospective studies of continuous glucose monitoring to define the glycaemic response to bariatric surgery. Lancet Diabetes Endocrinol 2023; 11:712-714. [PMID: 37652072 DOI: 10.1016/s2213-8587(23)00228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Bernard Khoo
- Endocrinology, Division of Medicine, University College London, London, UK
| | - Filip Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mary-Elizabeth Patti
- Joslin Diabetes Center, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Tricia Tan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0HS, UK.
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Patel P, Thomas R, Hamady M, Hague J, Raja J, Tan T, Bloom S, Richards T, Weiss CR, Prechtl CG, Smith C, Sasikaran T, Hesketh R, Bourmpaki E, Johnson NA, Fiorentino F, Ahmed AR. EMBIO trial study protocol: left gastric artery embolisation for weight loss in patients living with obesity with a BMI 35-50 kg/m 2. BMJ Open 2023; 13:e072327. [PMID: 37770263 PMCID: PMC10546152 DOI: 10.1136/bmjopen-2023-072327] [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: 01/30/2023] [Accepted: 08/17/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Left gastric artery embolisation (LGAE) is a well-established treatment for major upper gastrointestinal (GI) bleeding when control is not established via upper GI endoscopy and recently has shown promising results for weight loss in small single arm studies. LGAE could be a treatment option in between our current tier-3 and tier-4 services for obesity. EMBIO is a National Institute for Health Research funded trial, a multicentre double-blinded randomised controlled trial between Imperial College National Health Service Trust and University College London Hospital, comparing LGAE versus Placebo procedure. The key aims of the trial is to evaluate LGAE efficacy on weight loss, its mechanism of action, safety profile and obesity-related comorbidities. METHODS AND ANALYSIS 76 participants will be recruited from the existing tier-3 database after providing informed consent. Key inclusion criteria include adults aged 18-70 with a body mass index 35-50 kg/m2 and appropriate anatomy of the left gastric artery and coeliac plexus on CT Angiogram. Key exclusion criteria included previous major abdominal and bariatric surgery, weight >150 kg, type 2 diabetes on any medications other than metformin and the use of weight modifying medications. Participants will undergo mechanistic visits 1 week prior to the intervention and 3, 6 and 12 months postintervention. Informed consent will be received from each participant and they will be randomised in a 1:1 ratio to left gastric artery embolisation and placebo treatment. Blinding strategies include the use of moderate doses of sedation, visual and auditory isolation. All participants will enter a tier-3 weight management programme postintervention. The primary analysis will estimate the difference between the groups in the mean per cent weight loss at 12 months. ETHICS AND DISSEMINATION This trial shall be conducted in full conformity with the 1964 Declaration of Helsinki and all subsequent revisions. Local research ethics approval was granted by London-Central Research Ethics Committee, (Reference 19/LO/0509) on 11 October 2019. The Medicines and Healthcare products Regulatory Agency (MHRA) issued the Letter of No Objection on 8 April 2022 (Reference CI/2022/0008/GB). The trial's development and progress are monitored by an independent trial steering committee and data monitoring and ethics committee. The researchers plan to disseminate results at conferences, in peer- reviewed journals as well as lay media and to patient organisations. TRIAL REGISTRATION NUMBER ISRCTN16158402.
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Affiliation(s)
- Prashant Patel
- Department of Cancer and Surgery, Imperial College London - St Mary's Campus, London, UK
- Department of Interventional Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Robert Thomas
- Department of Interventional Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mohamad Hamady
- Surgery and Cancer, Imperial College London, London, UK
- Interventional Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Julian Hague
- Department of Interventional Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jowad Raja
- Department of Interventional Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tricia Tan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Stephen Bloom
- Clinical Director, North West London Pathology, Head of Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Hospital, London, UK
| | - Toby Richards
- Department of Cancer and Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - Clifford R Weiss
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Claire Smith
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | | | - Richard Hesketh
- Department of Interventional Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Elli Bourmpaki
- Department of Interventional Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Ahmed R Ahmed
- Department of Cancer and Surgery, Imperial College London, London, UK
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15
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Tan T, Zheng Y, Li Y, Zeng Y. [Pharmacogenetic testing improves treatment responses in patients with PLA2R-related membranous nephropathy]. Nan Fang Yi Ke Da Xue Xue Bao 2023; 43:1047-1050. [PMID: 37439180 DOI: 10.12122/j.issn.1673-4254.2023.06.23] [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] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVE To evaluate the value of pharmacogenetic testing for improving the efficacy and safety of treatment with cyclosporine, tacrolimus, and cyclophosphamide (CTX) for PLA2R-related membranous nephropathy and for determing individualized and precise treatment plans for the patients. METHODS A total of 63 patients with PLA2R-related membranous nephropathy hospitalized in the Department of Nephrology at our hospital from January, 2019 to October, 2021 were enrolled in this study. Thirty-three of the patients underwent pharmacogenetic testing before taking the immunosuppressive drugs selected based on the results of genetic screening for sensitive targets, and the other 30 patients were empirically given immunosuppressive drugs according to the guidelines (control group). The clinical efficacy and adverse effects of the immunosuppressive drugs were analyzed for all the patients. The two groups of patients were compared for demographic and biochemical parameters including 24-h urine protein, serum albumin, renal function, and serum anti-phospholipase A2 receptor antibody both before and at 3 months after the beginning of the treatment. RESULTS Among the 33 patients undergoing pharmacogenetic testing, 51.5% showed a GG genotype for cyclosporine, and 61.6% had an AG genotype for tacrolimus; for CTX, 51.5% of the patients showed a homozygous deletion and 63.6% had an AA genotype. After treatment for 3 months, serum anti-phospholipase A2 receptor antibody, 24-h urine protein, and serum albumin levels were significantly improved in pharmacogenetic testing group as compared with the control group (P < 0.05). CONCLUSION Individualized and precise administration of immunosuppressive drugs based on pharmacogenetic testing better controls proteinuria and serum antiphospholipase A2 receptor antibodies and increases serum albumin level in patients with PLA2R-related membranous nephropathy.
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Affiliation(s)
- T Tan
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518000, China
| | - Y Zheng
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518000, China
| | - Y Li
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518000, China
| | - Y Zeng
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518000, China
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Sharma A, Lazarus K, Papadopoulou D, Prabhudev H, Tan T, Meeran K, Choudhury S. Optimising prednisolone or prednisone replacement in adrenal insufficiency. Endocr Connect 2023:EC-23-0097. [PMID: 37289726 PMCID: PMC10388668 DOI: 10.1530/ec-23-0097] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/08/2023] [Indexed: 06/10/2023]
Abstract
CONTEXT Patients with adrenal insufficiency (AI) have higher mortality than the general population, possibly because of excess glucocorticoid exposure at inappropriate times. The cortisol circadian rhythm is difficult to mimic with twice or thrice-daily hydrocortisone. Prednisolone is a once-daily alternative which may improve patient compliance and convenience. OBJECTIVES Prednisolone day curves can be used to accurately down-titrate patients to the minimum effective dose. We aimed to review prednisolone day curves and determine therapeutic ranges at different timepoints after administration. METHODS Between August 2013 and May 2021, 108 prednisolone day curves from 76 individuals receiving prednisolone replacement were analysed. Prednisolone concentrations were determined by ultra-high performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). Spearman's correlation coefficient was used to determine the relationship between 2-, 4- and 6-hour prednisolone levels compared to the validated standard 8-hour prednisolone level (15-25 μg/L). RESULTS The median dose was 4mg prednisolone once daily. There was strong correlation between the 4-hour and 8-hour (R=0.8829, p ≤0.0001), and 6-hour and 8-hour prednisolone levels (R=0.9530, p ≤ 0.0001). Target ranges for prednisolone were 37-62 μg/L at 4-hours, 24-39 μg/L at 6-hours and 15-25 μg/L at 8-hours. Prednisolone doses were successfully reduced in 21 individuals and of these, three were reduced to 2mg once daily. All patients were well upon follow-up. CONCLUSION This is the largest evaluation of oral prednisolone pharmacokinetics in humans. Low dose prednisolone of 2-4mg is safe and effective in most patients with AI. Doses can be titrated with either 4-hour, 6-hour, or 8-hour single timepoint drug levels.
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Affiliation(s)
- Angelica Sharma
- A Sharma, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Katharine Lazarus
- K Lazarus, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Deborah Papadopoulou
- D Papadopoulou, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Hemanth Prabhudev
- H Prabhudev, Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Tricia Tan
- T Tan, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Karim Meeran
- K Meeran, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Sirazum Choudhury
- S Choudhury, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
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Phylactou M, Comninos AN, Salih A, Labib M, Eng PC, Clarke SA, Moore P, Tan T, Cegla J, Dhillo WS, Abbara A. Derivation and comparison of formulae for the adjustment of total calcium. Front Endocrinol (Lausanne) 2023; 14:1070443. [PMID: 37251673 PMCID: PMC10213740 DOI: 10.3389/fendo.2023.1070443] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/18/2023] [Indexed: 05/31/2023] Open
Abstract
Background Free ionized calcium (Ca2+) is the biologically active component of total calcium (TCa) and hence responsible for its biological action. TCa is routinely adjusted for albumin using several formulae (e.g. James, Orell, Payne and Berry) to more closely reflect Ca2+. Here, we derive a novel formula to estimate Ca2+ and compare its performance to established formulae. Methods Cohort for prediction of Ca2+: 2806 serum samples (TCa) taken contemporaneously with blood gas samples (Ca2+) at Imperial College Healthcare NHS Trust were used to derive formulae to estimate Ca2+ using multivariable linear regression. Cohort for prediction of PTH: Performance of novel and existing formulae to predict PTH in 5510 patients was determined by Spearman correlation. Results Ca2+ prediction Cohort: Adjusted calcium (r2 = 0.269) was less strongly associated with Ca2+, than TCa (r2 = 0.314). Prediction of Ca2+ from a newly derived formula incorporating TCa, potassium, albumin, and hematocrit had an improved r2 of 0.327, whereas inclusion of all available parameters increased the r2 further to 0.364. Of the established formulae, James performed best in predicting Ca2+ (r2 = 0.27). PTH prediction cohort: Berry resulted in higher whereas Orell in lower adjusted calcium levels. Prediction of PTH was strongest in the setting of hypercalcemia, with James having the highest Spearman correlation coefficient (+0.496) similar to including all parameters (+0.499). Conclusion Adjustment of calcium for albumin using established formulae does not always outperform unadjusted TCa in the reflection of Ca2+. Further prospective studies are needed to optimise adjustment of TCa and to establish bounds for validity.
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Affiliation(s)
- Maria Phylactou
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Alexander N. Comninos
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Ahmed Salih
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - Marina Labib
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - Pei Chia Eng
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Sophie A. Clarke
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Pope Moore
- Department of Clinical Biochemistry, North West London Pathology, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Tricia Tan
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare National Health Service Trust, London, United Kingdom
- Department of Clinical Biochemistry, North West London Pathology, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Jaimini Cegla
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare National Health Service Trust, London, United Kingdom
- Department of Clinical Biochemistry, North West London Pathology, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Waljit S. Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Ali Abbara
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare National Health Service Trust, London, United Kingdom
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Chockalingam Jnr R, Tang K, Chew K, Abdul Aziz Z, Loh J, Chao V, Tan T, Kerk K, Teo L, Sim D, Sivathasan C. A Retrospective Analysis of Concomitant Alfieri Stitch Mitral Valve Repair in Patients Undergoing Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1283] [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: 04/05/2023] Open
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19
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Tan J, Kerk K, Tay J, Neo C, Tan T, Sivathasan C. Microtrauma - A Common Cause for Driveline Infection. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1570] [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: 04/05/2023] Open
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20
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Avari P, Tang W, Jugnee N, Hersi I, Al-Balah A, Tan T, Frankel A, Oliver N, Reddy M. The Accuracy of Continuous Glucose Sensors in People with Diabetes Undergoing Haemodialysis (ALPHA Study). Diabetes Technol Ther 2023. [PMID: 36961385 DOI: 10.1089/dia.2023.0013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
OBJECTIVES Real-time and intermittently scanned continuous glucose monitoring are increasingly used for glucose monitoring in people with diabetes requiring renal replacement therapy, with limited data reporting their accuracy in this cohort. We evaluated the accuracy of Dexcom G6 and Abbott Freestyle Libre 1 glucose monitoring systems in people with diabetes undergoing haemodialysis. METHODS Participants on haemodialysis with diabetes (on insulin or sulfonylureas) were recruited. Paired sensor glucose from Dexcom G6 and Freestyle Libre 1 were recorded with plasma glucose analysed using the YSI (Yellow Springs Instrument) method at frequent intervals during haemodialysis. Analysis of accuracy metrics included mean absolute relative difference (MARD), Clarke Error Grid (CEG) analysis and proportion of CGM values within 15 and 20% or 15 and 20mg/dL of YSI reference values for blood glucose >100 mg/dL or ≤100 mg/dL, respectively (% 15/15, % 20/20). RESULTS Forty adults (median age 64.7 (60.2-74.4) years) were recruited. Overall MARD for Dexcom G6 was 22.7% (2,656 matched glucose pairs), and 11.3% for Libre 1 (n=2,785). The proportions of readings meeting %15/15 and %20/20 were 29.1% and 45.4% for Dexcom G6, respectively, and 73.5% and 85.6% for Libre 1. CEG analysis showed 98.9% of all values in zones A and B for Dexcom G6 and 99.8% for Libre 1. CONCLUSIONS Our results indicate Freestyle Libre 1 is a reliable tool for glucose monitoring in adults on haemodialysis. Further studies are required to evaluate Dexcom G6 accuracy in people on haemodialysis. Small molecule interferents may affect electrochemical glucose sensors in end-stage kidney disease.
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Affiliation(s)
- Parizad Avari
- Imperial College London, 4615, Department of Metabolism, Digestion and Reproduction, London, United Kingdom of Great Britain and Northern Ireland;
| | - Wenxi Tang
- Imperial College London, 4615, Department of Metabolism, Digestion and Reproduction, London, United Kingdom of Great Britain and Northern Ireland;
| | - Narvada Jugnee
- Imperial College London, 4615, Department of Metabolism, Digestion and Reproduction, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - Ibrahim Hersi
- Imperial College London, 4615, Department of Metabolism, Digestion and Reproduction, London, United Kingdom of Great Britain and Northern Ireland;
| | - Amer Al-Balah
- Imperial College London, 4615, Department of Metabolism, Digestion and Reproduction, London, United Kingdom of Great Britain and Northern Ireland;
| | - Tricia Tan
- Imperial College London, 4615, Department of Metabolism, Digestion and Reproduction, London, United Kingdom of Great Britain and Northern Ireland;
| | - Andrew Frankel
- Imperial College London, 4615, Department of Metabolism, Digestion and Reproduction, London, United Kingdom of Great Britain and Northern Ireland;
| | - Nick Oliver
- Imperial College London, 4615, Department of Metabolism, Digestion and Reproduction, London, United Kingdom of Great Britain and Northern Ireland;
| | - Monika Reddy
- Imperial College London, 4615, Department of Metabolism, Digestion and Reproduction, London, United Kingdom of Great Britain and Northern Ireland;
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21
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Hanson H, Durkie M, Lalloo F, Izatt L, McVeigh TP, Cook JA, Brewer C, Drummond J, Butler S, Cranston T, Casey R, Tan T, Morganstein D, Eccles DM, Tischkowitz M, Turnbull C, Woodward ER, Maher ER. UK recommendations for SDHA germline genetic testing and surveillance in clinical practice. J Med Genet 2023; 60:107-111. [PMID: 35260474 PMCID: PMC9887350 DOI: 10.1136/jmedgenet-2021-108355] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/13/2022] [Indexed: 02/03/2023]
Abstract
SDHA pathogenic germline variants (PGVs) are identified in up to 10% of patients with paraganglioma and phaeochromocytoma and up to 30% with wild-type gastrointestinal stromal tumours. Most SDHA PGV carriers present with an apparently sporadic tumour, but often the pathogenic variant has been inherited from parent who has the variant, but has not developed any clinical features. Studies of SDHA PGV carriers suggest that lifetime penetrance for SDHA-associated tumours is low, particularly when identified outside the context of a family history. Current recommended surveillance for SDHA PGV carriers follows an intensive protocol. With increasing implementation of tumour and germline large panel and whole-genome sequencing, it is likely more SDHA PGV carriers will be identified in patients with tumours not strongly associated with SDHA, or outside the context of a strong family history. This creates a complex situation about what to recommend in clinical practice considering low penetrance for tumour development, surveillance burden and patient anxiety. An expert SDHA working group was formed to discuss and consider this situation. This paper outlines the recommendations from this working group for testing and management of SDHA PGV carriers in clinical practice.
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Affiliation(s)
- Helen Hanson
- South West Thames Regional Genetic Services, St George's University Hospitals NHS Foundation Trust, London, UK
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Miranda Durkie
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, North East and Yorkshire Genomic Laboratory Hub, Sheffield, UK
| | - Fiona Lalloo
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Louise Izatt
- Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Terri P McVeigh
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Jackie A Cook
- Department of Clinical Genetics, Sheffield Children's NHS FoundationTrust, Sheffield, UK
| | - Carole Brewer
- Department of Clinical Genetics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - James Drummond
- East NHS Genomic Laboratory Hub, Cambridge University Hospitals Genomic Laboratory, Cambridge University Hospital Foundation Trust, Cambridge, UK
| | - Samantha Butler
- Molecular Genetics, West Midlands Regional Genetics Laboratory, Birmingham, West Midlands, UK
| | - Treena Cranston
- Oxford Molecular Genetics Laboratory, Churchill Hospital, Oxford, UK
| | - Ruth Casey
- Department of Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Medical Genetics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tricia Tan
- Section of Investigative Medicine, Imperial College London, London, UK
| | | | - Diana M Eccles
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Marc Tischkowitz
- Department of Medical Genetics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Clare Turnbull
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Emma Roisin Woodward
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Clarke SA, Phylactou M, Patel B, Mills EG, Muzi B, Izzi‐Engbeaya C, Choudhury S, Khoo B, Meeran K, Comninos AN, Abbara A, Tan T, Dhillo WS. Letter to the editor of clinical endocrinology: Assessment of adrenal function in patients who survive COVID-19. Clin Endocrinol (Oxf) 2023; 98:270-272. [PMID: 35986449 PMCID: PMC9538615 DOI: 10.1111/cen.14816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Sophie A. Clarke
- Division of Diabetes, Endocrinology and Metabolism, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Department of EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Maria Phylactou
- Division of Diabetes, Endocrinology and Metabolism, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Department of EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Bijal Patel
- Division of Diabetes, Endocrinology and Metabolism, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
| | - Edouard G. Mills
- Division of Diabetes, Endocrinology and Metabolism, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
| | - Beatrice Muzi
- Division of Diabetes, Endocrinology and Metabolism, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
| | - Chioma Izzi‐Engbeaya
- Division of Diabetes, Endocrinology and Metabolism, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Department of EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Sirazum Choudhury
- Division of Diabetes, Endocrinology and Metabolism, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Department of Clinical BiochemistryImperial College Healthcare NHS TrustLondonUK
| | - Bernard Khoo
- Department of Endocrinology, Division of Medicine, Faculty of Medical Sciences, Royal Free CampusUniversity College LondonLondonUK
| | - Karim Meeran
- Division of Diabetes, Endocrinology and Metabolism, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Department of EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Alexander N. Comninos
- Division of Diabetes, Endocrinology and Metabolism, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Department of EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Ali Abbara
- Division of Diabetes, Endocrinology and Metabolism, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Department of EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Tricia Tan
- Division of Diabetes, Endocrinology and Metabolism, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Department of EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Waljit S. Dhillo
- Division of Diabetes, Endocrinology and Metabolism, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Department of EndocrinologyImperial College Healthcare NHS TrustLondonUK
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23
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Brady S, Tan T, O'Flaherty D. Hereditary haemorrhagic telangiectasia and neuraxial anaesthesia in pregnancy: when should magnetic resonance imaging be performed? Anaesth Rep 2023; 11:e12227. [PMID: 37124667 PMCID: PMC10140102 DOI: 10.1002/anr3.12227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2023] [Indexed: 05/02/2023] Open
Affiliation(s)
- S. Brady
- Department of AnaesthesiologyCoombe Women and Infants University HospitalDublinIreland
| | - T. Tan
- Department of AnaesthesiologyCoombe Women and Infants University HospitalDublinIreland
| | - D. O'Flaherty
- Department of AnaesthesiologyCoombe Women and Infants University HospitalDublinIreland
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Wei PJ, Liu J, Tan T, Zhu W, Zhuang J, Guo HM. [Effect analysis of myectomy guided by personalized three-dimensional reconstruction and printing in the treatment of obstructive hypertrophic cardiomyopathy]. Zhonghua Wai Ke Za Zhi 2023; 61:54-60. [PMID: 36603885 DOI: 10.3760/cma.j.cn112139-20220806-00345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: To examine the clinical efficacy of myectomy guided by personalized three-dimensional reconstruction and printing for patients with obstructive hypertrophic cardiomyopathy. Methods: The clinical data of 28 patients with obstructive hypertrophic cardiomyopathy, who underwent septal myectomy guided by personalized three-dimensional reconstruction and printing in the Department of Cardiaovascular Surgery, Guangdong Provincial People's Hospital from May 2020 to December 2021, were retrospectively analyzed. There were 14 males and 14 females, aging (51.1±14.0) years (range: 18 to 72 years). Enhanced cardiac computed tomography images were imported into Mimics software for preoperative three-dimensional reconstruction. The direction of the short axial plane of each segment was marked perpendicularly to the interventricular septum on the long axial plane of the digital cardiac model, then the thickness was measured on each short axial plane. A figurative digital model was used to determine the extent of resection and to visualize mitral valve and papillary muscle abnormalities. Correlation between the length, width, thickness, and volume of the predicted resected myocardium and those of the surgically resected myocardium was assessed by Pearson correlation analysis or Spearman correlation analysis. The accuracy of detecting mitral valve and papillary muscle abnormalities of transthoracic echocardiography and three-dimensional reconstruction was also compared. Results: There was no death or serious complications like permanent pacemaker implantation, re-sternotomy for bleeding, low cardiac output syndrome, stroke, or multiple organ dysfunction syndromes in the whole group. Namely, the obstruction of the left ventricular outflow tract was effectively relieved. The systolic anterior motion of the anterior mitral valve leaflet was absent in all patients after myectomy. The length, width, and thickness of the predicted resected myocardium by three-dimensional reconstruction were significantly positively correlated with the length (R=0.65, 95%CI: 0.37 to 0.82, P<0.01), width (R=0.39, 95%CI: 0.02 to 0.67, P<0.01), and thickness (R=0.82, 95%CI: 0.65 to 0.92, P<0.01) of the surgically resected myocardium, while the relation of the volume of the predicted resected myocardium and the volume of the surgically resected myocardium was a strong positive correlation (R=0.88, 95%CI: 0.76 to 0.94, P<0.01). Importantly, the interventricular septal myocardial thickness measured by preoperative transthoracic echocardiography showed a moderate positive correlation with the volume of surgically resected myocardium (R=0.52, 95%CI: 0.19 to 0.75, P<0.01). During a follow-up of (14.4±6.8) months (range: 3 to 22 months), no death occurred, and 1 patient was readmitted for endocardial radiofrequency ablation due to atrial fibrillation. Conclusion: Personalized three-dimensional reconstruction and printing can not only visualize the intracardiac structure but also guide septal myectomy by predicting the thickness, volume, and extent of resected myocardium to achieve ideal resection.
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Affiliation(s)
- P J Wei
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou 510080, China
| | - J Liu
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou 510080, China
| | - T Tan
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou 510080, China
| | - W Zhu
- Department of Adult Cardiac Ultrasound Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou 510080, China
| | - J Zhuang
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou 510080, China
| | - H M Guo
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou 510080, China
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Ren J, Sun Y, Dai B, Song W, Tan T, Guo L, Cao H, Wu Y, Hu W, Wang Z, Haiping D. Association between Ca2+ Signaling Pathway-Related Gene Polymorphism and Age-Related Hearing Loss in Qingdao Chinese Elderly. RUSS J GENET+ 2022. [DOI: 10.1134/s1022795422100076] [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: 11/07/2022]
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McGlone ER, Ansell TB, Dunsterville C, Song W, Carling D, Tomas A, Bloom SR, Sansom MSP, Tan T, Jones B. Hepatocyte cholesterol content modulates glucagon receptor signalling. Mol Metab 2022; 63:101530. [PMID: 35718339 PMCID: PMC9254120 DOI: 10.1016/j.molmet.2022.101530] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether glucagon receptor (GCGR) actions are modulated by cellular cholesterol levels. METHODS We determined the effects of experimental cholesterol depletion and loading on glucagon-mediated cAMP production, ligand internalisation and glucose production in human hepatoma cells, mouse and human hepatocytes. GCGR interactions with lipid bilayers were explored using coarse-grained molecular dynamic simulations. Glucagon responsiveness was measured in mice fed a high cholesterol diet with or without simvastatin to modulate hepatocyte cholesterol content. RESULTS GCGR cAMP signalling was reduced by higher cholesterol levels across different cellular models. Ex vivo glucagon-induced glucose output from mouse hepatocytes was enhanced by simvastatin treatment. Mice fed a high cholesterol diet had increased hepatic cholesterol and a blunted hyperglycaemic response to glucagon, both of which were partially reversed by simvastatin. Simulations identified likely membrane-exposed cholesterol binding sites on the GCGR, including a site where cholesterol is a putative negative allosteric modulator. CONCLUSIONS Our results indicate that cellular cholesterol content influences glucagon sensitivity and indicate a potential molecular basis for this phenomenon. This could be relevant to the pathogenesis of non-alcoholic fatty liver disease, which is associated with both hepatic cholesterol accumulation and glucagon resistance.
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Affiliation(s)
- Emma Rose McGlone
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, United Kingdom; Department of Surgery and Cancer, Imperial College London, London W12 0NN, United Kingdom.
| | - T Bertie Ansell
- Department of Biochemistry, University of Oxford, Oxford OX1 3QU, United Kingdom.
| | - Cecilia Dunsterville
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, United Kingdom.
| | - Wanling Song
- Department of Biochemistry, University of Oxford, Oxford OX1 3QU, United Kingdom.
| | - David Carling
- Cellular Stress Research Group, MRC London Institute of Medical Sciences, Imperial College London, London W12 0NN, United Kingdom.
| | - Alejandra Tomas
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, United Kingdom.
| | - Stephen R Bloom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, United Kingdom.
| | - Mark S P Sansom
- Department of Biochemistry, University of Oxford, Oxford OX1 3QU, United Kingdom.
| | - Tricia Tan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, United Kingdom.
| | - Ben Jones
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, United Kingdom.
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Patel P, Thomas R, Hamady M, Hague J, Raja J, Tan T, Bloom S, Richards T, Weiss C, Prechtl C, Smith C, Thiagarajah S, Fiorentino F, Markakis H, Ahmed AR. O102 We know about left gastric artery embolisation and will embio provide the next solution to treat obesity? Br J Surg 2022. [DOI: 10.1093/bjs/znac242.102] [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: 11/05/2022]
Abstract
Abstract
Introduction
Left gastric artery embolisation (LGAE) is a minimally invasive procedure which has shown promising results for weight loss in recent studies and could play a key role as a treatment option in-between our current tier-3 and tier-4 services. Imperial College NHS Trust will sponsor the EMBIO trial, the first multi-centre double blinded randomised controlled trial comparing LGAE vs Placebo procedure to evaluate its efficacy on weight loss and obesity related comorbidities over a 12 month follow up period. Here, we perform a systematic review of the existing literature.
Methods
9 studies were reviewed. Studies which investigated weight loss as a % +- Ghrelin % change at 3,6 and 12 months were included as these pre-defined time points correlate with the EMBIO protocol. 6 studies met our inclusion criteria, 5 single arm studies and 1 single blinded RCT.
Results
N=62 patients were included in our analysis. Mean weight loss reported was 8.5%, 8.8% and 10% at 3, 6 and 12 months respectively post LGAE. Ghrelin levels reduced by 36%, 16.2% and 16.5% at 3, 6 and 12 months respectively post LGAE. To date, the only reported adverse events recorded include superficial gastric erosions healed on endoscopy by day 90 and one case of subclinical pancreatitis.
Conclusion
LGAE potentially offers a day case procedure under local anaesthesia and sedation to treat obesity and its metabolic complications. The EMBIO trial will provide level 1 evidence to confirm if LGAE is a viable intervention for obesity and evaluate its safety profile.
Take-home message
Left gastric artery embolisation could be the perfect solution to treat obesity in between existing tier-3 and tier-4 treatments.
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Affiliation(s)
| | | | | | | | - J Raja
- University College Hospital
| | | | | | - T Richards
- University of Western Australia , Perth , Australia
| | - C Weiss
- Johns Hopkins University , Baltimore, Maryland USA
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Takis PG, Vuckovic I, Tan T, Denic A, Lieske JC, Lewis MR, Macura S. NMRpQuant: an automated software for large scale urinary total protein quantification by one-dimensional 1H NMR profiles. Bioinformatics 2022; 38:4437-4439. [PMID: 35861573 PMCID: PMC9477529 DOI: 10.1093/bioinformatics/btac502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/24/2022] [Accepted: 07/06/2022] [Indexed: 12/24/2022] Open
Abstract
SUMMARY 1H nuclear magnetic resonance (NMR) spectroscopy is an established bioanalytical technology for metabolic profiling of biofluids in both clinical and large-scale population screening applications. Recently, urinary protein quantification has been demonstrated using the same 1D 1H NMR experimental data captured for metabolic profiling. Here, we introduce NMRpQuant, a freely available platform that builds on these findings with both novel and further optimized computational NMR approaches for rigorous, automated protein urine quantification. The results are validated by interlaboratory comparisons, demonstrating agreement with clinical/biochemical methodologies, pointing at a ready-to-use tool for routine protein urinalyses. AVAILABILITY AND IMPLEMENTATION NMRpQuant was developed on MATLAB programming environment. Source code and Windows/macOS compiled applications are available at https://github.com/pantakis/NMRpQuant, and working examples are available at https://doi.org/10.6084/m9.figshare.18737189.v1. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
| | - Ivan Vuckovic
- Metabolomics Core, Mayo Clinic, Rochester, MN 55905, USA
| | - Tricia Tan
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, UK,Clinical Biochemistry, Blood Sciences, North West London Pathology, Charing Cross Hospital, London W6 8RF, UK
| | - Aleksandar Denic
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - John C Lieske
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew R Lewis
- Section of Bioanalytical Chemistry, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK,National Phenome Centre, Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, UK
| | - Slobodan Macura
- Metabolomics Core, Mayo Clinic, Rochester, MN 55905, USA,Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
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Mohamed RS, Abuelgasim B, Barker S, Prabhudev H, Martin NM, Meeran K, Williams EL, Darch S, Matthew W, Tan T, Wernig F. Late-night salivary cortisol and cortisone should be the initial screening test for Cushing's syndrome. Endocr Connect 2022; 11:EC-22-0050. [PMID: 35671282 PMCID: PMC9254321 DOI: 10.1530/ec-22-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/07/2022] [Indexed: 11/08/2022]
Abstract
Endogenous Cushing's syndrome (CS) poses considerable diagnostic challenges. Although late-night salivary cortisol (LNSC) is recommended as a first-line screening investigation, it remains the least widely used test in many countries. The combined measurement of LNSC and late-night salivary cortisone (LNS cortisone) has shown to further improve diagnostic accuracy. We present a retrospective study in a tertiary referral centre comparing LNSC, LNS cortisone, overnight dexamethasone suppression test, low-dose dexamethasone suppression test and 24-h urinary free cortisol results of patients investigated for CS. Patients were categorised into those who had CS (21 patients) and those who did not (33 patients). LNSC had a sensitivity of 95% and a specificity of 91%. LNS cortisone had a specificity of 100% and a sensitivity of 86%. With an optimal cut-off for LNS cortisone of >14.5 nmol/L the sensitivity was 95.2%, and the specificity was 100% with an area under the curve of 0.997, for diagnosing CS. Saliva collection is non-invasive and can be carried out at home. We therefore advocate simultaneous measurement of LNSC and LNS cortisone as the first-line screening test to evaluate patients with suspected CS.
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Affiliation(s)
| | - Biyaser Abuelgasim
- Imperial College School of Medicine, Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK
| | - Sally Barker
- Imperial College School of Medicine, Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK
| | - Hemanth Prabhudev
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Niamh M Martin
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Karim Meeran
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Emma L Williams
- Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK
| | - Sarah Darch
- Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK
| | - Whitlock Matthew
- Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK
| | - Tricia Tan
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Florian Wernig
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Correspondence should be addressed to F Wernig:
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Comninos AN, Hansen MS, Courtney A, Choudhury S, Yang L, Mills EG, Phylactou M, Busbridge M, Khir M, Thaventhiran T, Bech P, Tan T, Abbara A, Frost M, Dhillo WS. Acute Effects of Kisspeptin Administration on Bone Metabolism in Healthy Men. J Clin Endocrinol Metab 2022; 107:1529-1540. [PMID: 35244717 PMCID: PMC9113799 DOI: 10.1210/clinem/dgac117] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Indexed: 12/23/2022]
Abstract
CONTEXT Osteoporosis results from disturbances in bone formation and resorption. Recent nonhuman data suggest that the reproductive hormone kisspeptin directly stimulates osteoblast differentiation in vitro and thus could have clinical therapeutic potential. However, the effects of kisspeptin on human bone metabolism are currently unknown. OBJECTIVE To assess the effects of kisspeptin on human bone metabolism in vitro and in vivo. METHODS In vitro study: of Mono- and cocultures of human osteoblasts and osteoclasts treated with kisspeptin. Clinical study: Randomized, placebo-controlled, double-blind, 2-way crossover clinical study in 26 men investigating the effects of acute kisspeptin administration (90 minutes) on human bone metabolism, with blood sampling every 30 minutes to +90 minutes. Cells for the in vitro study were from 12 male blood donors and 8 patients undergoing hip replacement surgery. Twenty-six healthy eugonadal men (age 26.8 ± 5.8 years) were included in the clinical study. The intervention was Kisspeptin (vs placebo) administration. The main outcome measures were changes in bone parameters and turnover markers. RESULTS Incubation with kisspeptin in vitro increased alkaline phosphatase levels in human bone marrow mesenchymal stem cells by 41.1% (P = .0022), and robustly inhibited osteoclastic resorptive activity by up to 53.4% (P < .0001), in a dose-dependent manner. Kisspeptin administration to healthy men increased osteoblast activity, as evidenced by a 20.3% maximal increase in total osteocalcin (P = .021) and 24.3% maximal increase in carboxylated osteocalcin levels (P = .014). CONCLUSION Collectively, these data provide the first human evidence that kisspeptin promotes osteogenic differentiation of osteoblast progenitors and inhibits bone resorption in vitro. Furthermore, kisspeptin acutely increases the bone formation marker osteocalcin but not resorption markers in healthy men, independent of downstream sex steroid levels. Kisspeptin could therefore have clinical therapeutic application in the treatment of osteoporosis.
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Affiliation(s)
- Alexander N Comninos
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Endocrine Bone Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Morten S Hansen
- KMEB Molecular Endocrinology Laboratory, Department of Endocrinology, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
| | - Alan Courtney
- Department of Clinical Biochemistry, Imperial College Healthcare NHS Trust, London, UK
| | - Sirazum Choudhury
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
- Department of Clinical Biochemistry, Imperial College Healthcare NHS Trust, London, UK
| | - Lisa Yang
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Edouard G Mills
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Maria Phylactou
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Mark Busbridge
- Department of Clinical Biochemistry, Imperial College Healthcare NHS Trust, London, UK
| | - Muaza Khir
- Department of Clinical Biochemistry, Imperial College Healthcare NHS Trust, London, UK
| | - Thilipan Thaventhiran
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Paul Bech
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
- Department of Clinical Biochemistry, Imperial College Healthcare NHS Trust, London, UK
| | - Tricia Tan
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
- Department of Clinical Biochemistry, Imperial College Healthcare NHS Trust, London, UK
| | - Ali Abbara
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Morten Frost
- KMEB Molecular Endocrinology Laboratory, Department of Endocrinology, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
- Steno Diabetes Centre, Odense University Hospital, Denmark
| | - Waljit S Dhillo
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Correia GDS, Takis PG, Sands CJ, Kowalka AM, Tan T, Turtle L, Ho A, Semple MG, Openshaw PJM, Baillie JK, Takáts Z, Lewis MR. 1H NMR Signals from Urine Excreted Protein Are a Source of Bias in Probabilistic Quotient Normalization. Anal Chem 2022; 94:6919-6923. [PMID: 35503092 PMCID: PMC9118196 DOI: 10.1021/acs.analchem.2c00466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Normalization to account for variation in urinary dilution is crucial for interpretation of urine metabolic profiles. Probabilistic quotient normalization (PQN) is used routinely in metabolomics but is sensitive to systematic variation shared across a large proportion of the spectral profile (>50%). Where 1H nuclear magnetic resonance (NMR) spectroscopy is employed, the presence of urinary protein can elevate the spectral baseline and substantially impact the resulting profile. Using 1H NMR profile measurements of spot urine samples collected from hospitalized COVID-19 patients in the ISARIC 4C study, we determined that PQN coefficients are significantly correlated with observed protein levels (r2 = 0.423, p < 2.2 × 10-16). This correlation was significantly reduced (r2 = 0.163, p < 2.2 × 10-16) when using a computational method for suppression of macromolecular signals known as small molecule enhancement spectroscopy (SMolESY) for proteinic baseline removal prior to PQN. These results highlight proteinuria as a common yet overlooked source of bias in 1H NMR metabolic profiling studies which can be effectively mitigated using SMolESY or other macromolecular signal suppression methods before estimation of normalization coefficients.
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Affiliation(s)
- Gonçalo D. S. Correia
- Section
of Bioanalytical Chemistry, Division of Systems Medicine, Department
of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
- National
Phenome Centre, Imperial College London, Hammersmith Campus, IRDB Building, London W12 0NN, United Kingdom
- G. D. S. Correia.
| | - Panteleimon G. Takis
- Section
of Bioanalytical Chemistry, Division of Systems Medicine, Department
of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
- National
Phenome Centre, Imperial College London, Hammersmith Campus, IRDB Building, London W12 0NN, United Kingdom
- P. G. Takis.
| | - Caroline J. Sands
- Section
of Bioanalytical Chemistry, Division of Systems Medicine, Department
of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
- National
Phenome Centre, Imperial College London, Hammersmith Campus, IRDB Building, London W12 0NN, United Kingdom
| | - Anna M. Kowalka
- Division
of Diabetes, Endocrinology and Metabolism, Department of Metabolism,
Digestion and Reproduction, Imperial College
London, Du Cane Road, London W12 0NN, United Kingdom
- Clinical
Biochemistry, Blood Sciences, North West London Pathology, Charing Cross Hospital, London W6 8RF, United Kingdom
| | - Tricia Tan
- Division
of Diabetes, Endocrinology and Metabolism, Department of Metabolism,
Digestion and Reproduction, Imperial College
London, Du Cane Road, London W12 0NN, United Kingdom
- Clinical
Biochemistry, Blood Sciences, North West London Pathology, Charing Cross Hospital, London W6 8RF, United Kingdom
| | - Lance Turtle
- NIHR
Health Protection Research Unit in Emerging and Zoonotic Infections,
Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, United Kingdom
| | - Antonia Ho
- MRC-University
of Glasgow Centre for Virus Research, University
of Glasgow, Glasgow G61 1QH, United Kingdom
| | - Malcolm G. Semple
- NIHR
Health Protection Research Unit in Emerging and Zoonotic Infections,
Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 7BE, United Kingdom
- Respiratory
Medicine, Alder Hey Children’s Hospital, Liverpool L12 2AP, United Kingdom
| | - Peter J. M. Openshaw
- Faculty
of Medicine, National Heart and Lung Institute, Imperial College London, London SW3 6LY, United Kingdom
| | - J. Kenneth Baillie
- Roslin
Institute, University of Edinburgh, Edinburgh EH25 9RG, United Kingdom
| | - Zoltán Takáts
- Section
of Bioanalytical Chemistry, Division of Systems Medicine, Department
of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
- National
Phenome Centre, Imperial College London, Hammersmith Campus, IRDB Building, London W12 0NN, United Kingdom
| | - Matthew R. Lewis
- Section
of Bioanalytical Chemistry, Division of Systems Medicine, Department
of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
- National
Phenome Centre, Imperial College London, Hammersmith Campus, IRDB Building, London W12 0NN, United Kingdom
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Ji C, Tan T. W235 A 31-year-old woman with complete androgen insensitivity syndrome. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.440] [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: 11/03/2022]
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Williams ST, Chatzikyriakou P, Carroll PV, McGowan BM, Velusamy A, White G, Obholzer R, Akker S, Tufton N, Casey RT, Maher ER, Park SM, Porteous M, Dyer R, Tan T, Wernig F, Brady AF, Kosicka-Slawinska M, Whitelaw BC, Dorkins H, Lalloo F, Brennan P, Carlow J, Martin R, Mitchell AL, Harrison R, Hawkes L, Newell-Price J, Kelsall A, Igbokwe R, Adlard J, Schirwani S, Davidson R, Morrison PJ, Chung TT, Bowles C, Izatt L. SDHC phaeochromocytoma and paraganglioma: A UK-wide case series. Clin Endocrinol (Oxf) 2022; 96:499-512. [PMID: 34558728 DOI: 10.1111/cen.14594] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/04/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Phaeochromocytomas and paragangliomas (PPGL) are rare, but strongly heritable tumours. Variants in succinate dehydrogenase (SDH) subunits are identified in approximately 25% of cases. However, clinical and genetic information of patients with SDHC variants are underreported. DESIGN This retrospective case series collated data from 18 UK Genetics and Endocrinology departments. PATIENTS Both asymptomatic and disease-affected patients with confirmed SDHC germline variants are included. MEASUREMENTS Clinical data including tumour type and location, surveillance outcomes and interventions, SDHC genetic variant assessment, interpretation, and tumour risk calculation. RESULTS We report 91 SDHC cases, 46 probands and 45 non-probands. Fifty-one cases were disease-affected. Median age at genetic diagnosis was 43 years (range: 11-79). Twenty-four SDHC germline variants were identified including six novel variants. Head and neck paraganglioma (HNPGL, n = 30, 65.2%), extra-adrenal paraganglioma (EAPGL, n = 13, 28.2%) and phaeochromocytomas (PCC) (n = 3, 6.5%) were present. One case had multiple PPGLs. Malignant disease was reported in 19.6% (9/46). Eight cases had non-PPGL SDHC-associated tumours, six gastrointestinal stromal tumours (GIST) and two renal cell cancers (RCC). Cumulative tumour risk (95% CI) at age 60 years was 0.94 (CI: 0.79-0.99) in probands, and 0.16 (CI: 0-0.31) in non-probands, respectively. CONCLUSIONS This study describes the largest cohort of 91 SDHC patients worldwide. We confirm disease-affected SDHC variant cases develop isolated HNPGL disease in nearly 2/3 of patients, EAPGL and PCC in 1/3, with an increased risk of GIST and RCC. One fifth developed malignant disease, requiring comprehensive lifelong tumour screening and surveillance.
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Affiliation(s)
- Sophie T Williams
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department Medical Molecular Genetics, King's College London, Guy's Hospital, London, UK
| | | | - Paul V Carroll
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Barbara M McGowan
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anand Velusamy
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gemma White
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rupert Obholzer
- Department of Ear, Nose, Throat Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Scott Akker
- Department of Endocrinology, St Bartholomew's Hospital, Barts Health NHS Foundation Trust, Cambridge, UK
| | - Nicola Tufton
- Department of Endocrinology, St Bartholomew's Hospital, Barts Health NHS Foundation Trust, Cambridge, UK
| | - Ruth T Casey
- Department of Endocrinology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Soo-Mi Park
- Department of Clinical Genetics, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Mary Porteous
- South East Scotland Genetic Service, Western General Hospital, Edinburgh, Scotland, UK
| | - Rebecca Dyer
- South East Scotland Genetic Service, Western General Hospital, Edinburgh, Scotland, UK
| | - Tricia Tan
- Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Florian Wernig
- Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Angela F Brady
- North West Thames Regional Genetics Service, Northwick Park Hospital, London, UK
| | | | | | - Huw Dorkins
- Department of Clinical Genetics, Leicester Royal Infirmary, Leicester, UK
| | - Fiona Lalloo
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester, UK
| | - Paul Brennan
- Northern Genetics Service, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Joseph Carlow
- Northern Genetics Service, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Richard Martin
- Northern Genetics Service, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Anna L Mitchell
- Department of Endocrinology, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle, UK
| | - Rachel Harrison
- Department of Clinical Genetics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Lara Hawkes
- Department of Clinical Genetics, Churchill Hospital, Oxford, UK
| | - John Newell-Price
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Alan Kelsall
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rebecca Igbokwe
- Department of Clinical Genetics, Birmingham Women's Hospital, Birmingham, UK
| | - Julian Adlard
- Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, UK
| | - Schaida Schirwani
- Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, UK
| | - Rosemarie Davidson
- Department of Clinical Genetics, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Patrick J Morrison
- Department of Medical Genetics, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - Teng-Teng Chung
- Department of Endocrinology, University College London Hospital NHS Foundation Trust, London, UK
| | | | - Louise Izatt
- Department Medical Molecular Genetics, King's College London, Guy's Hospital, London, UK
- Department of Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Clarke SA, Phylactou M, Patel B, Mills EG, Muzi B, Izzi-Engbeaya C, Khoo B, Meeran K, Comninos AN, Abbara A, Tan T, Oliver N, Dhillo WS. Preserved C-peptide in survivors of COVID-19: Post hoc analysis. Diabetes Obes Metab 2022; 24:570-574. [PMID: 34850532 DOI: 10.1111/dom.14608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 01/09/2023]
Affiliation(s)
- Sophie A Clarke
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Maria Phylactou
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Bijal Patel
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Edouard G Mills
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Beatrice Muzi
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Chioma Izzi-Engbeaya
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Bernard Khoo
- Department of Endocrinology, Division of Medicine, Faculty of Medical Sciences, Royal Free Campus, University College London, London, UK
| | - Karim Meeran
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Alexander N Comninos
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Ali Abbara
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Tricia Tan
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Clinical Biochemistry, Imperial College Healthcare NHS Trust, London, UK
| | - Nick Oliver
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Waljit S Dhillo
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Mahendran S, Sekhar P, Malaty M, Khanna S, Amarasekera A, MacIntyre R, Tan T. Association Between Troponin Elevation and Severity of COVID-19 Infection: A Systematic Review and Meta-Analysis. Heart Lung Circ 2022. [PMCID: PMC9345546 DOI: 10.1016/j.hlc.2022.06.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chen H, Bhat A, Goode E, Latumahina A, Farghaian H, Omaimah N, Patel R, Tan T, Burgess D, Gan G. Performance of a Multi-Disciplinary Heart Failure Clinic Model of Care in Western Sydney: A Blacktown Hospital Pilot Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.112] [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: 11/27/2022]
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Khanna S, Wen I, Thakur A, Bhat A, Chen H, Gan G, Tan T. Prognostic Implications of Traditional and Emerging Risk Factor Profiles in Patients With Systemic Sclerosis. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.369] [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: 10/16/2022]
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Nawaz S, Gu K, Fernandez F, Chen H, Bhat A, Gan G, Tan T. Utility of Myocardial Work in Predicting Cardiovascular Outcomes in a Diabetic Population. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.302] [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: 11/27/2022]
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Khanna S, Wen I, Thakur A, Bhat A, Chen H, Gan G, Tan T. Prognostic Impact of Traditional and Emerging Risk Factor Profiles in Patients With Systemic Lupus Erythematosus. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.368] [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: 10/16/2022]
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Zaheen M, Ferdous F, Amarasekera A, Tan T. Mineralocorticoid Receptor Antagonists in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.104] [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: 11/16/2022]
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Ferdous F, Zaheen M, Amarasekera A, Tan T. Catheter Ablation Versus Medical Therapy for Atrial Fibrillation in Patients with Heart Failure with Reduced Ejection Fraction: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.149] [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: 10/16/2022]
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Chen H, Bhat A, Lee C, Fernandez F, Gan G, Negishi K, Tan T. Prognostic Value of Right Ventricular Free Wall Strain in Stable Non-Ischaemic Cardiomyopathy Patients With Reduced Left Ventricular Systolic Function. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.121] [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: 11/17/2022]
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Abbara A, Al-Memar M, Phylactou M, Daniels E, Patel B, Eng PC, Nadir R, Izzi-Engbeaya C, Clarke SA, Mills EG, Hunjan T, Pacuszka E, Yang L, Bech P, Tan T, Comninos AN, Kelsey TW, Kyriacou C, Fourie H, Bourne T, Dhillo WS. Changes in Circulating Kisspeptin Levels During Each Trimester in Women With Antenatal Complications. J Clin Endocrinol Metab 2022; 107:e71-e83. [PMID: 34427658 PMCID: PMC8684464 DOI: 10.1210/clinem/dgab617] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Antenatal complications such as hypertensive disorders of pregnancy (HDP), fetal growth restriction (FGR), gestational diabetes (GDM), and preterm birth (PTB) are associated with placental dysfunction. Kisspeptin has emerged as a putative marker of placental function, but limited data exist describing circulating kisspeptin levels across all 3 trimesters in women with antenatal complications. OBJECTIVE We aimed to assess whether kisspeptin levels are altered in women with antenatal complications. METHODS Women with antenatal complications (n = 105) and those with uncomplicated pregnancies (n = 265) underwent serial ultrasound scans and blood sampling at the Early Pregnancy Assessment Unit at Hammersmith Hospital, UK, at least once during each trimester (March 2014 to March 2017). The women with antenatal complications (HDP [n = 32], FGR [n = 17], GDM [n = 35], PTB [n = 11], and multiple complications [n=10]) provided 373 blood samples and the controls provided 930 samples. Differences in circulating kisspeptin levels were assessed. RESULTS Third-trimester kisspeptin levels were higher than controls in HDP but lower in FGR. The odds of HDP adjusted for gestational age, maternal age, ethnicity, BMI, smoking, and parity were increased by 30% (95% CI, 16%-47%; P < 0.0001), and of FGR were reduced by 28% (95% CI, 4-46%; P = 0.025), for every 1 nmol/L increase in plasma kisspeptin. Multiple of gestation-specific median values of kisspeptin were higher in pregnancies affected by PTB (P = 0.014) and lower in those with GDM (P = 0.020), but not significantly on multivariable analysis. CONCLUSION We delineate changes in circulating kisspeptin levels at different trimesters and evaluate the potential of kisspeptin as a biomarker for antenatal complications.
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Affiliation(s)
- Ali Abbara
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Maya Al-Memar
- Tommy’s National Centre for Miscarriage Research, Queen Charlotte’s and Chelsea Hospital, Imperial College London, Du Cane Road, London, UK
| | - Maria Phylactou
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Elisabeth Daniels
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Bijal Patel
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Pei C Eng
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Rans Nadir
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Chioma Izzi-Engbeaya
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Sophie A Clarke
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Edouard G Mills
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Tia Hunjan
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Ewa Pacuszka
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Lisa Yang
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Paul Bech
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Tricia Tan
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Alexander N Comninos
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
| | - Tom W Kelsey
- School of Computer Science, University of St Andrews, St Andrews, UK
| | - Christopher Kyriacou
- Tommy’s National Centre for Miscarriage Research, Queen Charlotte’s and Chelsea Hospital, Imperial College London, Du Cane Road, London, UK
| | - Hanine Fourie
- Tommy’s National Centre for Miscarriage Research, Queen Charlotte’s and Chelsea Hospital, Imperial College London, Du Cane Road, London, UK
| | - Tom Bourne
- Tommy’s National Centre for Miscarriage Research, Queen Charlotte’s and Chelsea Hospital, Imperial College London, Du Cane Road, London, UK
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
- Correspondence: Prof. Tom Bourne, PhD, Tommy’s National Centre for Miscarriage Research, Queen Charlotte’s and Chelsea Hospital, Imperial College London, Du Cane Road, London, W12 0HS, UK.
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, W12, UK
- Prof. Waljit S. Dhillo, PhD, Department of Investigative Medicine, Imperial College London, 6th Floor, Commonwealth Building, Hammersmith Hospital, Du Cane Road, London, W12 ONN, UK.
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Ioannou A, Isralls S, Tan T, Lefroy D. Thyrotoxic periodic paralysis presenting as a broad complex tachycardia. Br J Hosp Med (Lond) 2021; 82:1-3. [PMID: 34983232 DOI: 10.12968/hmed.2021.0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Adam Ioannou
- Department of Cardiology, Hammersmith Hospital, London, UK
| | - Sharon Isralls
- Department of Cardiology, Hammersmith Hospital, London, UK
| | - Tricia Tan
- Department of Endocrinology, Hammersmith Hospital, London, UK
| | - David Lefroy
- Department of Cardiology, Hammersmith Hospital, London, UK
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Lynch A, Quinn L, Briggs R, Tan T, Thorpe O, Romero-Ortuno R, Byrne T, Cunningham C, Lavin A. 161 THE ROLE OF THE GERIATRIC DAY HOSPITAL DURING THE COVID 19 PANDEMIC. Age Ageing 2021. [PMCID: PMC8690085 DOI: 10.1093/ageing/afab219.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- A Lynch
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Age Related Health Department, Tallaght University Hospital, Dublin, Ireland
| | - L Quinn
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - R Briggs
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - T Tan
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - O Thorpe
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - R Romero-Ortuno
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - T Byrne
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - C Cunningham
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - A Lavin
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland,Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
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Lynch A, Quinn L, Briggs R, Tan T, Thorpe O, Romero-Ortuno R, Byrne T, Cunningham C, Lavin A. 163 EVALUATING THE ROLE OF THE GERIATRIC DAY HOSPITAL IN MEDICATION OPTIMISATION. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.163] [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: 02/25/2023] Open
Abstract
Abstract
Background
The geriatric day hospital (GDH) provides outpatient geriatric medical, nursing and rehabilitation care to older adults. The aim of this study was to assess whether medication optimisation occurs in this setting. We believe the GDH would be an ideal location for mediation optimisation due to the stable community dwelling patients and close follow up by specialised physicians.
Methods
Electronic patient records of the new patients ≥65 years seen in the GDH over a 3-month period were reviewed. Potentially inappropriate prescriptions (PIPs) and potentially prescribing omissions (PPOs) were identified using the STOPP/START prescribing tool on admission to the GDH and again at discharge from the GDH.
Results
One-hundred and sixty-seven patient records were reviewed; mean age 80.8 (SD6.5) years, 62.9% female, median clinical frailty scale score 6 (IQR5–6), mean number of conditions 5.79 (SD3), mean number of medications 7.57 (SD3.7). Patients had a median of 4 (IQR2–7) consultations. The number of patients prescribed at least 1 STOPP-PIP reduced by 10% (42.4% vs 38%; p < 0.001). Vasodilator drugs in patients with orthostatic hypotension were deprescribed most frequently (6.5% vs 3%; p < 0.001). PPOs were reduced by 36% (47.5% vs 30.6%;p < 0.001). The largest improvement was identified in the prescription of vitamin D in patients experiencing falls (17.4% vs 13.8%;p < 0.001). Logistic regression was performed to ascertain the influence of age, gender, falls, dementia, co-morbidity number and medication number on the likelihood of a patient experiencing a PIP or PPO. For every medication prescribed, the odds of experiencing a PIP increased by 11.8% (OR1.187, 95%CI 1.052–1.339). Being female increased the odds of experiencing a PPO by 21.7% (OR2.17, 95%CI 10.53–4.468).
Conclusion
Medication optimisation is key in avoiding side effects from potentially inappropriate medications. The frequency of patient attendances coupled with geriatricians’ expertise makes the GDH an ideal setting for medication optimisation in multi-morbid frail community-dwelling older adults.
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Affiliation(s)
- A Lynch
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Age Related Health Care Department, Tallaght University Hospital , Dublin, Ireland
| | - L Quinn
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - R Briggs
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - T Tan
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - O Thorpe
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - R Romero-Ortuno
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - T Byrne
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - C Cunningham
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
| | - A Lavin
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
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Ramadoss V, Lazarus K, Prevost AT, Tan T, Meeran K, Choudhury S. Improving the Interpretation of Afternoon Cortisol Levels and SSTs to Prevent Misdiagnosis of Adrenal Insufficiency. J Endocr Soc 2021; 5:bvab147. [PMID: 34611573 PMCID: PMC8486915 DOI: 10.1210/jendso/bvab147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adrenal Insufficiency (AI), especially iatrogenic-AI, is a treatable cause of mortality. The difficulty in obtaining 9 am cortisol levels means samples are taken at suboptimal times, including a substantial proportion in the afternoon. Low afternoon cortisol levels often provoke short Synacthen tests (SSTs). It is important that this does not lead to patients misdiagnosed with AI, exposing them to the excess mortality and morbidity of inappropriate steroid replacement therapy. METHODS This retrospective study collected 60 178 cortisol results. Medical records, including subsequent SSTs of initial cortisol results measured after midday were reviewed. RESULTS Receiver operating characteristic analysis (area under the curve: 0.89) on 6531 suitable cortisol values showed that a limit of <201.5 nmol/L achieved a sensitivity and specificity of 95.6% and 72.6%, while a limit of <234 nmol/L had a sensitivity of 100% and a specificity of 59.5%. Out of 670 SSTs, 628 patients passed. Of these, 140 would have otherwise failed if only their 30-min cortisol was assessed without the 60-min value. A 30- and 60-min SST cortisol cutoff of 366.5 nmol/L and 418.5 nmol/L, respectively, can achieve a sensitivity of >95% on the Abbott analyser platform. CONCLUSION An afternoon cortisol >234 nmol/L excludes AI on Abbott analyser platforms. In patients who have an afternoon cortisol <234 nmol/L, including both 30- and 60-min SST cortisol values prevents unnecessary glucocorticoid replacement therapy in 22.3% of individuals in this study. The Abbott analyser SST cortisol cutoffs used to define AI should be 366.5 nmol/L and 418.5 nmol/L at 30 and 60 min, respectively. All patients remained well subsequently with at least 1-year longitudinal follow-up.
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Affiliation(s)
- Vijay Ramadoss
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Katharine Lazarus
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Andrew Toby Prevost
- Nightingale-Saunders Clinical Trials and Epidemiology Unit, King’s College London, London, UK
| | - Tricia Tan
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Clinical Biochemistry, Northwest London Pathology, London, UK
| | - Karim Meeran
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Sirazum Choudhury
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Clinical Biochemistry, Northwest London Pathology, London, UK
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McGlone ER, Manchanda Y, Jones B, Pickford P, Inoue A, Carling D, Bloom SR, Tan T, Tomas A. Receptor Activity-Modifying Protein 2 (RAMP2) alters glucagon receptor trafficking in hepatocytes with functional effects on receptor signalling. Mol Metab 2021; 53:101296. [PMID: 34271220 PMCID: PMC8363841 DOI: 10.1016/j.molmet.2021.101296] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Receptor Activity-Modifying Protein 2 (RAMP2) is a chaperone protein which allosterically binds to and interacts with the glucagon receptor (GCGR). The aims of this study were to investigate the effects of RAMP2 on GCGR trafficking and signalling in the liver, where glucagon (GCG) is important for carbohydrate and lipid metabolism. METHODS Subcellular localisation of GCGR in the presence and absence of RAMP2 was investigated using confocal microscopy, trafficking and radioligand binding assays in human embryonic kidney (HEK293T) and human hepatoma (Huh7) cells. Mouse embryonic fibroblasts (MEFs) lacking the Wiskott-Aldrich Syndrome protein and scar homologue (WASH) complex and the trafficking inhibitor monensin were used to investigate the effect of halted recycling of internalised proteins on GCGR subcellular localisation and signalling in the absence of RAMP2. NanoBiT complementation and cyclic AMP assays were used to study the functional effect of RAMP2 on the recruitment and activation of GCGR signalling mediators. Response to hepatic RAMP2 upregulation in lean and obese adult mice using a bespoke adeno-associated viral vector was also studied. RESULTS GCGR is predominantly localised at the plasma membrane in the absence of RAMP2 and exhibits remarkably slow internalisation in response to agonist stimulation. Rapid intracellular accumulation of GCG-stimulated GCGR in cells lacking the WASH complex or in the presence of monensin indicates that activated GCGR undergoes continuous cycles of internalisation and recycling, despite apparent GCGR plasma membrane localisation up to 40 min post-stimulation. Co-expression of RAMP2 induces GCGR internalisation both basally and in response to agonist stimulation. The intracellular retention of GCGR in the presence of RAMP2 confers a bias away from β-arrestin-2 recruitment coupled with increased activation of Gαs proteins at endosomes. This is associated with increased short-term efficacy for glucagon-stimulated cAMP production, although long-term signalling is dampened by increased receptor lysosomal targeting for degradation. Despite these signalling effects, only a minor disturbance of carbohydrate metabolism was observed in mice with upregulated hepatic RAMP2. CONCLUSIONS By retaining GCGR intracellularly, RAMP2 alters the spatiotemporal pattern of GCGR signalling. Further exploration of the effects of RAMP2 on GCGR in vivo is warranted.
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Affiliation(s)
- Emma Rose McGlone
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Yusman Manchanda
- Section of Cell Biology and Functional Genomics, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Ben Jones
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Phil Pickford
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Asuka Inoue
- Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
| | - David Carling
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Stephen R Bloom
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Tricia Tan
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
| | - Alejandra Tomas
- Section of Cell Biology and Functional Genomics, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
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Wei N, Lamba A, Franciosi S, Law I, Ochoa L, Johnsrude C, Kwok S, Tan T, Dhillon S, Fournier A, Seslar S, Stephenson E, Blaufox A, Cabrera Ortega M, Escudero C, Sanatani S. SUPRAVENTRICULAR TACHYCARDIA IN INFANTS: DOES MEDICATION CHOICE MATTER? Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.068] [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: 10/20/2022] Open
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Abbara A, Al-Memar M, Phylactou M, Kyriacou C, Eng PC, Nadir R, Izzi-Engbeaya C, Clarke SA, Mills EG, Daniels E, Huo L, Pacuszka E, Yang L, Patel B, Tan T, Bech P, Comninos AN, Fourie H, Kelsey TW, Bourne T, Dhillo WS. Performance of plasma kisspeptin as a biomarker for miscarriage improves with gestational age during the first trimester. Fertil Steril 2021; 116:809-819. [PMID: 34053677 PMCID: PMC8445632 DOI: 10.1016/j.fertnstert.2021.04.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 10/25/2020] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the performance of kisspeptin and beta human chorionic gonadotropin (βhCG), both alone and in combination, as biomarkers for miscarriage throughout the first trimester. DESIGN Prospective, nested case-control study. SETTING Tertiary Centre, Queen Charlotte Hospital, London, United Kingdom. PATIENT(S) Adult women who had miscarriages (n = 95, 173 samples) and women with healthy pregnancies (n = 265, 557 samples). INTERVENTION(S) The participants underwent serial ultrasound scans and blood sampling for measurement of plasma kisspeptin and βhCG levels during the first trimester. MAIN OUTCOME MEASURE(S) The ability of plasma kisspeptin and βhCG levels to distinguish pregnancies complicated by miscarriage from healthy pregnancies unaffected by miscarriage. RESULT(S) Gestation-adjusted levels of circulating kisspeptin and βhCG were lower in samples from women with miscarriages than in women with healthy pregnancies by 79% and 70%, respectively. The area under the receiver-operating characteristic curve for identifying miscarriage during the first trimester was 0.874 (95% confidence interval [CI] 0.844-0.904) for kisspeptin, 0.859 (95% CI 0.820-0.899) for βhCG, and 0.916 (95% CI 0.886-0.946) for the sum of the two markers. The performance of kisspeptin in identifying miscarriage improved with increasing length of gestation, whereas that of βhCG worsened. A decision matrix incorporating kisspeptin, βhCG, and gestational age had 83% to 87% accuracy for the prediction of miscarriage. CONCLUSION(S) Plasma kisspeptin is a promising biomarker for miscarriage and provides additional value to βhCG alone, especially during later gestational weeks of the first trimester.
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Affiliation(s)
- Ali Abbara
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Maya Al-Memar
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, United Kingdom
| | - Maria Phylactou
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Christopher Kyriacou
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, United Kingdom
| | - Pei Chia Eng
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Rans Nadir
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Chioma Izzi-Engbeaya
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Sophie A Clarke
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Edouard G Mills
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Elisabeth Daniels
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Lechun Huo
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Ewa Pacuszka
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Lisa Yang
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Bijal Patel
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Tricia Tan
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Paul Bech
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Alexander N Comninos
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Hanine Fourie
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, United Kingdom
| | - Tom W Kelsey
- School of Computer Science, University of St. Andrews, St. Andrews, United Kingdom
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, United Kingdom; Katholieke Universiteit Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom.
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