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Kim AY, Woo W, Saxena A, Tanidir IC, Yao A, Kurniawati Y, Thakur V, Shin YR, Shin JI, Jung JW, Barron DJ. Treatment of hypoplastic left heart syndrome: a systematic review and meta-analysis of randomised controlled trials. Cardiol Young 2024; 34:659-666. [PMID: 37724575 DOI: 10.1017/s1047951123002986] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND This meta-analysis aimed to consolidate existing data from randomised controlled trials on hypoplastic left heart syndrome. METHODS Hypoplastic left heart syndrome specific randomised controlled trials published between January 2005 and September 2021 in MEDLINE, EMBASE, and Cochrane databases were included. Regardless of clinical outcomes, we included all randomised controlled trials about hypoplastic left heart syndrome and categorised them according to their results. Two reviewers independently assessed for eligibility, relevance, and data extraction. The primary outcome was mortality after Norwood surgery. Study quality and heterogeneity were assessed. A random-effects model was used for analysis. RESULTS Of the 33 included randomised controlled trials, 21 compared right ventricle-to-pulmonary artery shunt and modified Blalock-Taussig-Thomas shunt during the Norwood procedure, and 12 regarded medication, surgical strategy, cardiopulmonary bypass tactics, and ICU management. Survival rates up to 1 year were superior in the right ventricle-to-pulmonary artery shunt group; this difference began to disappear at 3 years and remained unchanged until 6 years. The right ventricle-to-pulmonary artery shunt group had a significantly higher reintervention rate from the interstage to the 6-year follow-up period. Right ventricular function was better in the modified Blalock-Taussig-Thomas shunt group 1-3 years after the Norwood procedure, but its superiority diminished in the 6-year follow-up. Randomised controlled trials regarding medical treatment, surgical strategy during cardiopulmonary bypass, and ICU management yielded insignificant results. CONCLUSIONS Although right ventricle-to-pulmonary artery shunt appeared to be superior in the early period, the two shunts applied during the Norwood procedure demonstrated comparable long-term prognosis despite high reintervention rates in right ventricle-to-pulmonary artery shunt due to pulmonary artery stenosis. For medical/perioperative management of hypoplastic left heart syndrome, further randomised controlled trials are needed to deliver specific evidence-based recommendations.
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Affiliation(s)
- A Y Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - W Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - A Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - I C Tanidir
- Department of Pediatric Cardiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - A Yao
- Department of Health Service Promotion, University of Tokyo, Japan
| | - Y Kurniawati
- Department of Pediatric Cardiology, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - V Thakur
- Department of Pediatrics, Labatt Family Heart Center, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Y R Shin
- Department of Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - J I Shin
- Department of Pediatrics, Labatt Family Heart Center, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Severance Underwood Meta-research Center, Institute of Convergence Science, Yonsei University, Seoul, South Korea
| | - J W Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - D J Barron
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Lopez KN, Morris SA, Krishnan A, Jacobs MB, Bhat AH, Chelliah A, Chiu JS, Cuneo BF, Freire G, Hornberger LK, Howley L, Husain N, Ikemba C, Kavanaugh-McHugh A, Kutty S, Lee C, McBrien A, Michelfelder EC, Pinto NM, Schwartz R, Stern KWD, Taylor C, Thakur V, Tworetzky W, Wittlieb-Weber C, Woldu K, Donofrio MT, Peyvandi S. Associations Between Maternal Sociodemographics and Hospital Mortality in Newborns With Prenatally Diagnosed Hypoplastic Left Heart Syndrome. Circulation 2023; 148:283-285. [PMID: 37459407 PMCID: PMC10361626 DOI: 10.1161/circulationaha.123.064476] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Keila N Lopez
- Department of Cardiology, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX (K.N.L., S.A.M.)
| | - Shaine A Morris
- Department of Cardiology, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX (K.N.L., S.A.M.)
| | - Anita Krishnan
- Children's National Heart Institute, Washington, DC (A.K., R.S., M.T.D.)
| | - Marni B Jacobs
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla (M.B.J.)
| | - Aarti H Bhat
- Division of Cardiology, University of Washington, Seattle (A.H.B.)
| | - Anjali Chelliah
- Division of Cardiology, Columbia University, New York, NY (A.C.)
| | - Joanne S Chiu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD (J.S.C., S.K.)
- Division of Cardiology, Department of Pediatrics, Massachusetts General Hospital, Boston (J.S.C.)
| | - Bettina F Cuneo
- Division of Cardiology, The Heart Institute, Children's Hospital of Colorado/University of Colorado, Aurora (B.F.C., L.H.)
| | - Grace Freire
- Johns Hopkins University All Children's Hospital, St. Petersburg, FL (G.F.)
| | - Lisa K Hornberger
- Division of Cardiology, Department of Pediatrics, University of Alberta, EDM, Canada (L.K.H., A.M.)
| | - Lisa Howley
- Division of Cardiology, The Heart Institute, Children's Hospital of Colorado/University of Colorado, Aurora (B.F.C., L.H.)
- Division of Cardiology, The Children's Heart Clinic/Children's Minnesota, Minneapolis (L.H.)
| | - Nazia Husain
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL (N.H.)
| | - Catherine Ikemba
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (C.I., K.W.)
| | - Ann Kavanaugh-McHugh
- Thomas P. Graham Jr Division of Pediatric Cardiology, Monroe Carell Children's Hospital, Nashville, TN (A.K.-M.)
| | - Shelby Kutty
- Division of Cardiology, Johns Hopkins University, Baltimore, MD (J.S.C., S.K.)
- Division of Cardiology, University of Nebraska Medical Center, Omaha (S.K.)
| | - Caroline Lee
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.L.)
| | - Angela McBrien
- Division of Cardiology, Department of Pediatrics, University of Alberta, EDM, Canada (L.K.H., A.M.)
| | - Erik C Michelfelder
- Emory University School of Medicine, Children's Healthcare of Atlanta/Sibley Heart Center, GA (E.C.M.)
| | - Nelangi M Pinto
- Division of Pediatric Cardiology, University of Utah, Salt Lake City (N.M.P.)
| | - Rachel Schwartz
- Children's National Heart Institute, Washington, DC (A.K., R.S., M.T.D.)
- Division of Cardiology, Boston Children's Hospital, MA (R.S., W.T.)
| | - Kenan W D Stern
- Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY (K.W.D.S.)
- Icahn School of Medicine at Mount Sinai, Children's Heart Center, New York, NY (K.W.D.S.)
| | | | - Varsha Thakur
- Division of Cardiology, University of Toronto, ON, Canada (V.T.)
| | - Wayne Tworetzky
- Division of Cardiology, Boston Children's Hospital, MA (R.S., W.T.)
| | | | - Kris Woldu
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (C.I., K.W.)
- Division of Cardiology, Cook Children's Heart Center, Fort Worth, TX (K.W.)
| | - Mary T Donofrio
- Children's National Heart Institute, Washington, DC (A.K., R.S., M.T.D.)
| | - Shabnam Peyvandi
- Division of Cardiology, University of California, San Francisco (S.P.)
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Cohen J, Arya B, Caplan R, Donofrio MT, Ferdman D, Harrington JK, Ho DY, Hogan W, Hornberger LK, Jhaveri S, Killen SAS, Lindblade CL, Michelfelder E, Moon-Grady AJ, Patel S, Quezada E, Ronai C, Sanchez Mejia AA, Schidlow DN, Stiver C, Thakur V, Srivastava S. Congenitally Corrected Transposition of the Great Arteries: Fetal Diagnosis, Associations, and Postnatal Outcome: A Fetal Heart Society Research Collaborative Study. J Am Heart Assoc 2023:e029706. [PMID: 37259984 PMCID: PMC10381988 DOI: 10.1161/jaha.122.029706] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Background Fetal diagnosis of congenitally corrected transposition of the great arteries (ccTGA) has been increasingly reported; however, predictors of clinical outcomes remain underexplored. We undertook a multicenter, retrospective study to investigate natural history, associated anomalies, and outcomes of fetal ccTGA. Methods and Results Fetuses with ccTGA diagnosed from January 2004 to July 2020 within 20 North American programs were included. Fetuses with severe ventricular hypoplasia thought to definitively preclude biventricular repair were excluded. We included 205 fetuses diagnosed with ccTGA at a median gestational age of 23 (interquartile range, 21-27) weeks. Genetic abnormalities were found in 5.9% tested, with extracardiac anomalies in 6.3%. Associated cardiac defects were diagnosed in 161 (78.5%), with atrioventricular block in 23 (11.3%). On serial fetal echocardiogram, 39% demonstrated a functional or anatomic change, most commonly increased tricuspid regurgitation (6.7%) or pulmonary outflow obstruction (11.1%). Of 194 fetuses with follow-up, 26 were terminated, 3 experienced fetal death (2 with atrioventricular block), and 165 were live-born. Of 158 with postnatal data (median follow-up 3.7 years), 10 (6.6%) had death/transplant before 1 year. On univariable analysis, fetal factors associated with fetal death or death/transplant by 1 year included ≥ mild tricuspid regurgitation, pulmonary atresia, aortic obstruction, fetal arrhythmia, and worsening hemodynamics on serial fetal echocardiogram (defined as worse right ventricular function, tricuspid regurgitation, or effusion). Conclusions Associated cardiac lesions and arrhythmias are common in fetal ccTGA, and functional changes commonly occur through gestation. Worse outcomes are associated with fetal tricuspid regurgitation (≥mild), any arrhythmia, pulmonary atresia, aortic obstruction, and worsening hemodynamics on serial echocardiograms. These findings can inform prenatal counseling and perinatal management planning.
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Affiliation(s)
| | | | | | | | | | | | - Deborah Y Ho
- Stanford School of Medicine, Lucile Packard Children's Hospital CA Palo Alto
| | | | | | | | | | | | | | | | - Sheetal Patel
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine Chicago IL
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Pruthi V, Abbasi N, Thakur V, Shinar S, O'Connor A, Silver R, Simpson T, Van Mieghem T. Performance of comprehensive first trimester fetal anatomy assessment. Prenat Diagn 2023. [PMID: 37113105 DOI: 10.1002/pd.6360] [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: 03/08/2023] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Ultrasound assessment of the fetal anatomy and fetal echocardiography are feasible in the first trimester of pregnancy. This study was designed to assess the performance of a comprehensive fetal anatomy assessment in a high-risk population at a tertiary fetal medicine unit. METHODS Retrospective review of high-risk patients undergoing comprehensive fetal anatomy ultrasound assessment between 11 weeks and 13+6 weeks gestation was conducted. Findings of the early anatomy ultrasound scan were compared with the second trimester anatomy scan, and birth outcomes or post-mortem results. RESULTS Early anatomy ultrasounds were performed in 765 patients. Sensitivity of the scan for detecting fetal anomalies compared to the birth outcome was 80.5% (95% CI 73.5 -86.3) and specificity was 93.1% (95%CI 90.6 - 95.2). Positive and negative predictive values were 78.5% (95% CI 71.4 - 84.6) and 93.9 % (95% CI 91.4 - 95.8), respectively. The most missed and the most overdiagnosed abnormalities were ventricular septal defects. The second trimester ultrasound had sensitivity of 69.0% (95% CI 55.5 - 80.5) and specificity of 87.5% (95% CI 84.3 - 90.2). CONCLUSION In a high-risk population, early assessments had similar performance metrics as the second trimester anatomy ultrasound. We advocate for a comprehensive fetal assessment in the care of high-risk pregnancies. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Vagisha Pruthi
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - Nimrah Abbasi
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - Varsha Thakur
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
- Department of Cardiology, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Shiri Shinar
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - Anne O'Connor
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - Rachel Silver
- Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Tasha Simpson
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - Tim Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
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Thakur V, Thakur V, Aguila B, Slepak T, Wang M, Song W, Konai M, Mobashery S, Chang M, Rana AB, Wang D, de Freitas JT, Gultekin SH, Welford SM, Ivan ME, Bedogni B. Targeting extracellular matrix remodeling sensitizes glioblastoma to ionizing radiation. Neurooncol Adv 2022; 4:vdac147. [PMID: 36212741 PMCID: PMC9536293 DOI: 10.1093/noajnl/vdac147] [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] [Indexed: 11/13/2022] Open
Abstract
Background The median survival of Glioblastoma multiforme (GBM) patients is 14+ months due to poor responses to surgery and chemoradiation. Means to counteract radiation resistance are therefore highly desirable. We demonstrate the membrane bound matrix metalloproteinase MT1-MMP promotes resistance of GBM to radiation, and that using a selective and brain permeable MT1-MMP inhibitor, (R)-ND336, improved tumor control can be achieved in preclinical studies. Methods Public microarray and RNA-sequencing data were used to determine MT1-MMP relevance in GBM patient survival. Glioma stem-like neurospheres (GSCs) were used for both in vitro and in vivo assays. An affinity resin coupled with proteomics was used to quantify active MT1-MMP in brain tissue of GBM patients. Short hairpin RNA (shRNA)-mediated knockdown of MT1-MMP and inhibition via the MT1-MMP inhibitor (R)-ND336, were used to assess the role of MT1-MMP in radio-resistance. Results MT1-MMP expression inversely correlated with patient survival. Active MT1-MMP was present in brain tissue of GBM patients but not in normal brain. shRNA- or (R)-ND336-mediated inhibition of MT1-MMP sensitized GSCs to radiation leading to a significant increase in survival of tumor-bearing animals. MT1-MMP depletion reduced invasion via the effector protease MMP2; and increased the cytotoxic response to radiation via induction of replication fork stress and accumulation of double strand breaks (DSBs), making cells more susceptible to genotoxic insult. Conclusions MT1-MMP is pivotal in maintaining replication fork stability. Disruption of MT1-MMP sensitizes cells to radiation and can counteract invasion. (R)-ND336, which efficiently penetrates the brain, is therefore a novel radio-sensitizer in GBM.
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Affiliation(s)
- Varsha Thakur
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine , Miami, Florida
- Sylvester Comprehensive Cancer Center , Miami, Florida
| | - Vijay Thakur
- Department of Radiation Oncology, University of Miami Miller School of Medicine , Miami, Florida
- Sylvester Comprehensive Cancer Center , Miami, Florida
| | - Brittany Aguila
- Department of Radiation Oncology, University of Miami Miller School of Medicine , Miami, Florida
- Sylvester Comprehensive Cancer Center , Miami, Florida
| | - Tatiana Slepak
- Department of Neurological Surgery, University of Miami Miller School of Medicine , Miami, Florida
| | - Man Wang
- Department of Chemistry and Biochemistry, University of Notre Dame , Notre Dame, Indiana
| | - Wei Song
- Department of Chemistry and Biochemistry, University of Notre Dame , Notre Dame, Indiana
| | - Mohini Konai
- Department of Chemistry and Biochemistry, University of Notre Dame , Notre Dame, Indiana
| | - Shahriar Mobashery
- Department of Chemistry and Biochemistry, University of Notre Dame , Notre Dame, Indiana
| | - Mayland Chang
- Department of Chemistry and Biochemistry, University of Notre Dame , Notre Dame, Indiana
| | - Ayush B Rana
- Department of Radiation Oncology, University of Miami Miller School of Medicine , Miami, Florida
- Sylvester Comprehensive Cancer Center , Miami, Florida
| | - Dazhi Wang
- Department of Radiation Oncology, University of Miami Miller School of Medicine , Miami, Florida
- Sylvester Comprehensive Cancer Center , Miami, Florida
| | - Juliano Tiburcio de Freitas
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine , Miami, Florida
- Sylvester Comprehensive Cancer Center , Miami, Florida
| | - Sakir Humayun Gultekin
- Neuropathology, Division of Anatomic Pathology, University of Miami Miller School of Medicine , Miami, Florida
| | - Scott M Welford
- Department of Radiation Oncology, University of Miami Miller School of Medicine , Miami, Florida
- Sylvester Comprehensive Cancer Center , Miami, Florida
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine , Miami, Florida
| | - Barbara Bedogni
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine , Miami, Florida
- Sylvester Comprehensive Cancer Center , Miami, Florida
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Lin Y, Thakur V. How Small Is Too Small? The Challenge of Accurate Prenatal and Postnatal Detection of Coarctation of the Aorta. CJC Pediatr Congenit Heart Dis 2022; 1:163-166. [PMID: 37969930 PMCID: PMC10642105 DOI: 10.1016/j.cjcpc.2022.05.005] [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] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2023]
Affiliation(s)
- Yalin Lin
- Division of Cardiology, Labatt Family Heart Centre, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Varsha Thakur
- Division of Cardiology, Labatt Family Heart Centre, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Pruthi V, Thakur V, Jaeggi E, Rowbottom L, Naguleswaran K, Ryan G, Van Mieghem T. Impact of planned delivery on the perinatal outcome of term fetuses with isolated heart defects. Journal of Obstetrics and Gynaecology Canada 2022; 44:901-907. [DOI: 10.1016/j.jogc.2022.03.022] [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] [Received: 12/04/2021] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
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van Nisselrooij AEL, Moon-Grady AJ, Wacker-Gussmann A, Tomek V, Malčić I, Grzyb A, Pavlova A, Kazamia K, Thakur V, Sinkovskaya E, Harkel ADJT, Haak MC. The aorto-left ventricular tunnel from a fetal perspective: original case series and literature review. Prenat Diagn 2022; 42:267-277. [PMID: 35018638 PMCID: PMC9303731 DOI: 10.1002/pd.6090] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/03/2021] [Revised: 12/16/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022]
Abstract
Introduction Aorto‐left ventricular tunnel (ALVT) accounts for <0.1% of congenital heart defects. Evidence on the prognosis from a fetal perspective is limited. With this retrospective international case series, we provide information on the outcome of fetuses with ALVT. Methods All members of the Association for European Pediatric and Congenital Cardiology's (AEPC) fetal working group and fetal medicine units worldwide were invited for participation. We observed antenatal parameters, neonatal outcome and postnatal follow‐up. Additionally, a systematic search of the literature was performed. Results Twenty fetuses with ALVT were identified in 10 participating centers (2001–2019). Fetal echocardiographic characteristics of ALVT included an increased cardiac–thorax ratio (95%), left ventricular end‐diastolic diameter (90%) and a dysplastic aortic valve (90%). Extracardiac malformations were rare (5%). Eight fetuses died at a median gestational age (GA) of 21 + 6 weeks (range, 19–24): all showed signs of hydrops prior to 24 weeks or at autopsy. All others (60%, 12/2) were live–born (median GA 38 + 4, range 37–40), underwent surgery and were alive at last follow up (median 3.2 years, range 0.1–17). The literature reported 22 ALVT fetuses with similar outcome. Conclusions In the absence of fetal hydrops, ALVT carries a good prognosis. Fetuses who survive to 24 weeks without hydrops are likely to have a good outcome. What's already known about this topic?Aorto‐left ventricular tunnel (ALVT) is an extremely rare diagnosis that may cause congenital heart failure and fetal hydrops, leading to fetal or neonatal death. A few case reports show that after corrective surgery in the neonatal period, cases with ALVT tend to have a good prognosis.
What does this study add?This is the first study that evaluates prenatal characteristics, prognostic parameters and outcome following a prenatal diagnosis of ALVT in a cohort of cases worldwide, including a systematic review of the literature as well. In the absence of fetal hydrops, ALVT carries a good prognosis. Fetuses who survive to 24 weeks without hydrops are likely to have a good outcome.
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Affiliation(s)
- A E L van Nisselrooij
- Department of Fetal Medicine and Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - A J Moon-Grady
- Division of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco, California
| | - A Wacker-Gussmann
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Munich, Germany
| | - V Tomek
- Children's Heart Centre Prague, University Hospital Motol, Prague, Czech Republic
| | - I Malčić
- Department of Child's Cardiology, Zagreb University Hospital, Zagreb, Croatia
| | - A Grzyb
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - A Pavlova
- Department of Cardiology, Ukrainian Children's Cardiac Centre, Kyiv, Ukraine
| | - K Kazamia
- Children's Heart Centre Stockholm-Uppsala, Karolinska University Hospital, Stockholm, Sweden
| | - V Thakur
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - E Sinkovskaya
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - A D J Ten Harkel
- Department of Fetal Medicine and Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - M C Haak
- Department of Fetal Medicine and Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
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Hanumanthu V, Thakur V, Chatterjee D, Vinay K. Periocular cutaneous amyloidosis in multiple myeloma. QJM 2021; 114:603-604. [PMID: 33878191 DOI: 10.1093/qjmed/hcab084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Hanumanthu
- Department of Dermatology, Venereology and Leprology, Sector 12, Chandigarh 160012, Punjab, India
| | - V Thakur
- Department of Dermatology, Venereology and Leprology, Sector 12, Chandigarh 160012, Punjab, India
| | - D Chatterjee
- Department of Histopathology; Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, Punjab, India
| | - K Vinay
- Department of Histopathology; Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, Punjab, India
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Narang T, Kamat D, Thakur V, Lavania M, Singh I, Ahuja M, Dogra S. Equal rates of drug resistance in leprosy cases with relapse and recurrent /chronic type 2 reaction; Time to revise the guidelines for drug resistance testing in leprosy. Clin Exp Dermatol 2021; 47:297-302. [PMID: 34382256 DOI: 10.1111/ced.14884] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/12/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Leprosy relapse/recurrence is a serious concern especially in a leprosy endemic nation like India. It is believed that bacilli persisting even after multi-drug therapy could cause relapse; recently however drug resistance as a cause for recurrences and chronic erythema nodosum leprosum (ENL) has been speculated. Our objective was to study drug resistance patterns in cases of leprosy relapse and chronic/recurrent ENL's. METHODOLOGY This cross-sectional study conducted over a period of 1 year included patients diagnosed as leprosy relapse and those with chronic/recurrent (c/r) ENL. Skin biopsy specimens were subjected to conventional PCR for resistance testing for rifampicin, dapsone and ofloxacin, targeting rpoB, folP and gyrA gene of M.leprae respectively. RESULTS A total of 61 patients (25 smear negative) were included in the study. Of these, 37 were diagnosed as leprosy relapse and 24 had c/r ENL. Drug resistance to at least one drug was identified in 10 (16.4%) cases. Rates of drug resistance were 5.4% (2/37) for dapsone, 10.8% (4/37) for rifampicin and 2.7% (1/37) for ofloxacin amongst cases of relapse where as it was 12.5% (3/24) and 8.3% (2/24) for dapsone and rifampicin respectively amongst those with c/rENL.. Multi drug resistance was seen in 3.3% (2/61) patients. CONCLUSION Drug resistance rate amongst those with c/rENL was almost equaled that of relapse. Smear negative leprosy relapse cases also had resistance to bactericidal drugs. These findings call for modifications in criteria for testing under leprosy drug resistance surveillance and all cases of relapse and those with recalcitrant c/rENL should be tested.
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Affiliation(s)
- T Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - D Kamat
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - V Thakur
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - M Lavania
- Enteric Viruses Group, ICMR-National Institute of Virology, Pune, India
| | - I Singh
- Department of Molecular Biology, Stanley Browne Laboratory, TLM Community Hospital, New Delhi, India
| | - M Ahuja
- Department of Molecular Biology, Stanley Browne Laboratory, TLM Community Hospital, New Delhi, India
| | - S Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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11
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Thakur V, Tiburcio de Freitas J, Li Y, Zhang K, Savadelis A, Bedogni B. MT1-MMP-dependent ECM processing regulates laminB1 stability and mediates replication fork restart. PLoS One 2021; 16:e0253062. [PMID: 34237080 PMCID: PMC8266045 DOI: 10.1371/journal.pone.0253062] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/27/2021] [Indexed: 12/12/2022] Open
Abstract
Radiotherapy remains a mainstay of treatment for a majority of cancer patients. We have previously shown that the membrane bound matrix metalloproteinase MT1-MMP confers radio- and chemotherapy resistance to breast cancer via processing of the ECM and activation of integrinβ1/FAK signaling. Here, we further discovered that the nuclear envelope protein laminB1 is a potential target of integrinβ1/FAK. FAK interacts with laminB1 contributing to its stability. Stable laminB1 is found at replication forks (RFs) where it is likely to allow the proper positioning of RF protection factors, thus preventing RF degradation. Indeed, restoration of laminB1 expression rescues replication fork stalling and collapse that occurs upon MT1-MMP inhibition, and reduces DNA damage in breast cancer cells. Together, these data highlight a novel mechanism of laminB1 stability and replication fork restart via MT1-MMP dependent extracelluar matrix remodeling.
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Affiliation(s)
- Varsha Thakur
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Juliano Tiburcio de Freitas
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Yuan Li
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Keman Zhang
- Department of Biochemistry, Case Western Reserve University, Cleveland, OH, United States of America
| | - Alyssa Savadelis
- Department of Biochemistry, Case Western Reserve University, Cleveland, OH, United States of America
| | - Barbara Bedogni
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL, United States of America
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12
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Fritz C, Stamper M, Valentino S, Ulatowski L, Gupta M, Thakur V, Chung S, DeHann N, Laggner C, Manor D. Abstract 2271: Potential small-molecule inhibitors of the Tiam1 oncogene product. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-2271] [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: 11/16/2022]
Abstract
Abstract
T-cell lymphoma invasion and metastasis-inducing factor (Tiam)1 is an established proto-oncogene that drives cancer cell migration and metastasis. The correlation between Tiam1 integrity and patient survival, epithelial-mesenchymal transition, and angiogenesis, render it as an important prognostic factor in multiple human malignancies. Tiam1 is a guanine nucleotide exchange factor (GEF) that facilitates the activation of the small GTPase Rac1, thereby controlling cytoskeletal organization, cell polarity, motility, and invasion. In light of the clinical relevance of Tiam1 signaling, we investigated the utility of small molecule inhibitors that target Tiam1 as a therapeutic intervention strategy. We used an in silico computational approach to screen 10 million compounds for candidate drugs that bind to a select patch on Tiam1's surface. We then identified 13 compounds that inhibit the migration of Tiam1-expressing A549 cells without affecting overall viability. Our studies open the door for a new targeted therapy approach in Tiam1-relevant cancers.
Citation Format: Claire Fritz, Michaela Stamper, Stephen Valentino, Lynn Ulatowski, Meghana Gupta, Varsha Thakur, Stacey Chung, Nick DeHann, Christian Laggner, Danny Manor. Potential small-molecule inhibitors of the Tiam1 oncogene product [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2271.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Danny Manor
- 1Case Western Reserve University, Cleveland, OH
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13
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Thakur V, Gupta P, Vinay K. Dermoscopic features of post kala azar dermal leishmaniasis. J Eur Acad Dermatol Venereol 2021; 35:e460-e462. [PMID: 33725369 DOI: 10.1111/jdv.17222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/10/2021] [Indexed: 12/14/2022]
Affiliation(s)
- V Thakur
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P Gupta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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14
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Krishnan A, Jacobs MB, Morris SA, Peyvandi S, Bhat AH, Chelliah A, Chiu JS, Cuneo BF, Freire G, Hornberger LK, Howley L, Husain N, Ikemba C, Kavanaugh-McHugh A, Kutty S, Lee C, Lopez KN, McBrien A, Michelfelder EC, Pinto NM, Schwartz R, Stern KWD, Taylor C, Thakur V, Tworetzky W, Wittlieb-Weber C, Woldu K, Donofrio MT. Impact of Socioeconomic Status, Race and Ethnicity, and Geography on Prenatal Detection of Hypoplastic Left Heart Syndrome and Transposition of the Great Arteries. Circulation 2021; 143:2049-2060. [PMID: 33993718 DOI: 10.1161/circulationaha.120.053062] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prenatal detection (PND) has benefits for infants with hypoplastic left heart syndrome (HLHS) and transposition of the great arteries (TGA), but associations between sociodemographic and geographic factors with PND have not been sufficiently explored. This study evaluated whether socioeconomic quartile (SEQ), public insurance, race and ethnicity, rural residence, and distance of residence (distance and driving time from a cardiac surgical center) are associated with the PND or timing of PND, with a secondary aim to analyze differences between the United States and Canada. METHODS In this retrospective cohort study, fetuses and infants <2 months of age with HLHS or TGA admitted between 2012 and 2016 to participating Fetal Heart Society Research Collaborative institutions in the United States and Canada were included. SEQ, rural residence, and distance of residence were derived using maternal census tract from the maternal address at first visit. Subjects were assigned a SEQ z score using the neighborhood summary score or Canadian Chan index and separated into quartiles. Insurance type and self-reported race and ethnicity were obtained from medical charts. We evaluated associations among SEQ, insurance type, race and ethnicity, rural residence, and distance of residence with PND of HLHS and TGA (aggregate and individually) using bivariate analysis with adjusted associations for confounding variables and cluster analysis for centers. RESULTS Data on 1862 subjects (HLHS: n=1171, 92% PND; TGA: n=691, 58% PND) were submitted by 21 centers (19 in the United States). In the United States, lower SEQ was associated with lower PND in HLHS and TGA, with the strongest association in the lower SEQ of pregnancies with fetal TGA (quartile 1, 0.78 [95% CI, 0.64-0.85], quartile 2, 0.77 [95% CI, 0.64-0.93], quartile 3, 0.83 [95% CI, 0.69-1.00], quartile 4, reference). Hispanic ethnicity (relative risk, 0.85 [95% CI, 0.72-0.99]) and rural residence (relative risk, 0.78 [95% CI, 0.64-0.95]) were also associated with lower PND in TGA. Lower SEQ was associated with later PND overall; in the United States, rural residence and public insurance were also associated with later PND. CONCLUSIONS We demonstrate that lower SEQ, Hispanic ethnicity, and rural residence are associated with decreased PND for TGA, with lower SEQ also being associated with decreased PND for HLHS. Future work to increase PND should be considered in these specific populations.
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Affiliation(s)
- Anita Krishnan
- Divisions of Cardiology (A.K., M.T.D.), Children's National Hospital, Washington, DC
| | - Marni B Jacobs
- Biostatistics (M.B.J.), Children's National Hospital, Washington, DC.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego (M.B.J.)
| | - Shaine A Morris
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX (S.A.M., K.N.L.)
| | - Shabnam Peyvandi
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco (S.P.)
| | - Aarti H Bhat
- Division of Cardiology, Seattle Children's Hospital, University of Washington (A.H.B.)
| | - Anjali Chelliah
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York (A.C.)
| | - Joanne S Chiu
- Division of Pediatric Cardiology, Johns Hopkins University, Baltimore, MD (J.S.C., S.K.).,Division of Cardiology, Department of Pediatrics, Massachusetts General Hospital, Boston (J.S.C.)
| | - Bettina F Cuneo
- Division of Cardiology, Children's Hospital of Colorado/University of Colorado, Aurora (B.F.C., L.H.)
| | - Grace Freire
- Division of Cardiology, Johns Hopkins University All Children's Hospital, St. Petersburg, FL (G.F.)
| | - Lisa K Hornberger
- Division of Pediatric Cardiology, University of Alberta, Edmonton, Canada (L.K.H., A.M.)
| | - Lisa Howley
- Division of Cardiology, Children's Hospital of Colorado/University of Colorado, Aurora (B.F.C., L.H.).,Division of Cardiology, The Children's Heart Clinic/Children's Minnesota, Minneapolis (L.H.)
| | - Nazia Husain
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL (N.H.)
| | - Catherine Ikemba
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (C.I., K.W.)
| | - Ann Kavanaugh-McHugh
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN (A.K.-M.)
| | - Shelby Kutty
- Division of Pediatric Cardiology, Johns Hopkins University, Baltimore, MD (J.S.C., S.K.).,University of Nebraska Medical Center, Omaha (S.K.)
| | - Caroline Lee
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (C.L.)
| | - Keila N Lopez
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX (S.A.M., K.N.L.)
| | - Angela McBrien
- Division of Pediatric Cardiology, University of Alberta, Edmonton, Canada (L.K.H., A.M.)
| | - Erik C Michelfelder
- Emory University School of Medicine, Children's Healthcare of Atlanta/Sibley Heart Center, GA (E.C.M.)
| | - Nelangi M Pinto
- Division of Pediatric Cardiology, University of Utah, Salt Lake City (N.M.P.)
| | - Rachel Schwartz
- Division of Cardiology, Boston Children's Hospital, MA (R.S., W.T.).,The George Washington School of Medicine, Washington, DC (R.S.)
| | - Kenan W D Stern
- Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York (K.W.D.S.)
| | - Carolyn Taylor
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston (C.T.)
| | - Varsha Thakur
- Division of Cardiology, University of Toronto, Ontario, Canada (V.T.)
| | - Wayne Tworetzky
- Division of Cardiology, Boston Children's Hospital, MA (R.S., W.T.)
| | - Carol Wittlieb-Weber
- Division of Pediatric Cardiology, University of Rochester, NY (C.W.-W.).,Division of Cardiology, Children's Hospital of Philadelphia, PA (C.W.-W.)
| | - Kris Woldu
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (C.I., K.W.).,Division of Cardiology, Cook Children's Heart Center, Ft. Worth, TX (K.W.)
| | - Mary T Donofrio
- Divisions of Cardiology (A.K., M.T.D.), Children's National Hospital, Washington, DC
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15
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Saito M, Silverman E, Golding F, Guerra V, Hiraki L, Thakur V, Jaeggi E. Effects of Transplacental Dexamethasone Therapy on Fetal Immune-Mediated Complete Heart Block. Fetal Diagn Ther 2021; 48:183-188. [PMID: 33592603 DOI: 10.1159/000513202] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Antibody-mediated complete atrioventricular block (CAVB) is considered irreversible. We sought to examine the effects of transplacental steroids on fetal AV conduction. METHODS Fifty-nine fetuses diagnosed with CAVB at our center from 1996 to 2018 were reviewed. Routine dexamethasone administration to birth was used to limit cardiac inflammatory damage. Restoration of fetal AV conduction was classified as "unexpected" treatment response. RESULTS CAVB resolved in 5/29 (17%) fetuses first treated ≤24-week gestation with 8 mg/day of dexamethasone, when compared with 0/30 (0%) when treatment was initiated later and/or at a starting dose of 4 mg/day (odds ratio 13.69; 95% confidence interval 0.72-260.13; p = 0.024). Treatment response was also associated with a faster ventricular rate at diagnosis (median [range]: 80 [60-97] beats per minute [bpm] vs. 58 [38-92] bpm; p = 0.0036). CAVB reappeared in all 5 responders either prenatally (n = 1) or postnatally before (n = 3) or after (n = 1) the first year of life. When compared with infants with treatment-resistant CAVB (median follow-up 10.3 years), responders (median follow-up 12.3 years) required postnatal pacing less frequent (2/5 [40%] vs. 45/49 [92%]; p = 0.013). CONCLUSIONS In a subgroup of CAVB fetuses, dexamethasone transiently restored AV conduction. This was associated with a lower rate of postnatal pacing when compared with nonresponders.
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Affiliation(s)
- Mika Saito
- Department of Pediatrics, Fetal Cardiac Program, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Earl Silverman
- Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Fraser Golding
- Department of Pediatrics, Fetal Cardiac Program, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Vitor Guerra
- Department of Pediatrics, Fetal Cardiac Program, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Linda Hiraki
- Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Varsha Thakur
- Department of Pediatrics, Fetal Cardiac Program, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Edgar Jaeggi
- Department of Pediatrics, Fetal Cardiac Program, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada,
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16
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Nagarajan P, Thakur V, Rajkumar R. Coping and burden among caregivers of patients with major mental illness. Indian J Soc Psychiatry 2021. [DOI: 10.4103/ijsp.ijsp_160_20] [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: 11/04/2022] Open
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17
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Dubey P, Shrivastava J, Choubey BP, Agrawal A, Thakur V. Neurodevelopmental outcome of healthy term newborn with serum bilirubin >15 mg/dl at one year. J Neonatal Perinatal Med 2020; 14:339-344. [PMID: 33337390 DOI: 10.3233/npm-200511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Neonatal hyperbilirubinemia is a common medical emergency in early neonatal period. Unconjugated bilirubin is neurotoxic and can lead to lifelong neurological sequelae in survivors. OBJECTIVE To find out the association between serum bilirubin and neurodevelopmental outcome at 1 year of age using Development Assessment Scale for Indian Infants (DASII). METHODS A prospective cohort study was conducted in the Department of Pediatrics of a tertiary care institution of Central India between January 2018 and August 2019. Total 108 term healthy neonates, with at least one serum bilirubin value of >15 mg/dl, were included. Subjects were divided into three groups based on the serum bilirubin; group 1: (15-20 mg/dl) -85(78.7%) cases, group 2: (20-25 mg/dl) -17(15.7%), and group 3: (>25 mg/dl) -6(5.5%). Developmental assessment was done using DASII at 3, 6, 9, 12 months of age. RESULTS Out of 108 cases, 101(93.5%) received phototherapy, and 7(6.5%) received double volume exchange transfusion. Severe delay was observed in 5(4.6%) and mild delay in 2(1.9%) cases in the motor domain of DASII at one year. Severe delay in the motor domain was associated with mean TSB of 27.940±2.89 mg/dl and mild delay with mean TSB of 22.75±1.76 mg/dl (p = 0.001). On cluster analysis, delay was observed in locomotion 1 score in 11(13%) cases (p = 0.003) and manipulation score in 6(7.1%) cases in group 1. CONCLUSION Increased serum bilirubin was a significant risk factor for the delayed neurodevelopment in babies with neonatal jaundice. Even a moderate level of bilirubin significantly affects the developmental outcome.
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Affiliation(s)
- P Dubey
- Department of Pediatrics, Gandhi Medical College & Kamla Nehru Hospital, Bhopal, MP, India
| | - J Shrivastava
- Department of Pediatrics, Gandhi Medical College & Kamla Nehru Hospital, Bhopal, MP, India
| | - B P Choubey
- Department of Pediatrics, Gandhi Medical College & Kamla Nehru Hospital, Bhopal, MP, India
| | - A Agrawal
- Department of Pediatrics, Gandhi Medical College & Kamla Nehru Hospital, Bhopal, MP, India
| | - V Thakur
- Department of Pediatrics, Gandhi Medical College & Kamla Nehru Hospital, Bhopal, MP, India
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18
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Pruthi V, Abbasi N, Ryan G, Drake J, Kulkarni AV, Kwan-Wong T, Phillips J, Thakur V, Church P, Diambomba Y, Kelly E, Vermeersch L, Pollard L, Carvalho JCA, Van Mieghem T. Fetal Surgery for Open Spina Bifida in Canada: Initial Results. J Obstet Gynaecol Can 2020; 43:733-739.e1. [PMID: 33227419 DOI: 10.1016/j.jogc.2020.10.014] [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: 07/31/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Fetal myelomeningocele closure results in better infant outcomes than postnatal closure at the cost of potential prematurity and maternal morbidity. Our aim is to describe the setup of a fetal myelomeningocele closure program in Canada and document its outcomes. METHODS We conducted a retrospective review of all open fetal myelomeningocele closure surgeries performed at the Ontario Fetal Centre in its first 3 years of operation (2017-2020). Maternal and fetal baseline characteristics, surgical details, pregnancy outcomes, and infant follow-up until 1 year of age were recorded. RESULTS Twenty-seven women underwent fetal myelomeningocele closure surgery, 10 of whom (37%) resided outside of Ontario. Mean gestational age at surgery was 25.0 ± 0.7 weeks. All surgeries were technically uncomplicated and no fetal deaths occurred. There was a significant negative correlation between increasing experience and skin-to-skin surgical time (R² = 0.36; P = 0.001). Of the 26 patients who have delivered, 4 (15.4%) experienced preterm prelabour rupture of membranes. Mean gestational age at delivery was 34.9±3.0 weeks. All but 1 patient delivered by cesarean. Maternal complications occurred in 9 women (34.6%). There were no maternal deaths, but 3 (11.5%) infant deaths. Of the 14 surviving infants who have reached at least 1 year of age, 5 (35.7%) underwent ventriculo-peritoneal shunting. Of the 9 infants who have not yet reached 1 year of age, 3 (33.3%) underwent endoscopic third ventriculostomy and none underwent shunting. CONCLUSION Fetal open spina bifida closure can be performed in Canada, with results similar to those reported by other international expert centres. Long-term follow-up is ongoing.
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Affiliation(s)
- Vagisha Pruthi
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, ON; Ontario Fetal Centre, Mount Sinai Hospital, Toronto, ON
| | - Nimrah Abbasi
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, ON; Ontario Fetal Centre, Mount Sinai Hospital, Toronto, ON
| | - Greg Ryan
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, ON; Ontario Fetal Centre, Mount Sinai Hospital, Toronto, ON
| | - James Drake
- Ontario Fetal Centre, Mount Sinai Hospital, Toronto, ON; Department of Neurosurgery, Hospital for Sick Children and University of Toronto, Toronto, ON
| | - Abhaya V Kulkarni
- Ontario Fetal Centre, Mount Sinai Hospital, Toronto, ON; Department of Neurosurgery, Hospital for Sick Children and University of Toronto, Toronto, ON
| | - Terence Kwan-Wong
- Division of Plastic Surgery, Hospital for Sick Children, Toronto, ON
| | - John Phillips
- Division of Plastic Surgery, Hospital for Sick Children, Toronto, ON
| | - Varsha Thakur
- Ontario Fetal Centre, Mount Sinai Hospital, Toronto, ON; Department of Cardiology, Hospital for Sick Children and University of Toronto, Toronto, ON
| | - Paige Church
- Department of Paediatrics, Holland-Bloorview, Sunnybrook Health Centre and University of Toronto, Toronto, ON
| | - Yenge Diambomba
- Department of Neonatology, Mount Sinai Hospital and University of Toronto, Toronto, ON
| | - Edmond Kelly
- Department of Neonatology, Mount Sinai Hospital and University of Toronto, Toronto, ON
| | - Leslie Vermeersch
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, ON; Ontario Fetal Centre, Mount Sinai Hospital, Toronto, ON
| | - Lindsay Pollard
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, ON; Ontario Fetal Centre, Mount Sinai Hospital, Toronto, ON
| | - Jose C A Carvalho
- Ontario Fetal Centre, Mount Sinai Hospital, Toronto, ON; Department of Anesthesia and Pain Management, Mount Sinai Hospital and University of Toronto, Toronto, ON; Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, ON
| | - Tim Van Mieghem
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, ON; Ontario Fetal Centre, Mount Sinai Hospital, Toronto, ON.
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19
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Escandon J, Thakur V, Bedogni B. Abstract B27: MT1-MMP targeting in melanoma brain metastasis. Cancer Res 2020. [DOI: 10.1158/1538-7445.mel2019-b27] [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: 11/16/2022]
Abstract
Abstract
Background: Melanoma brain metastases contribute to morbidity and mortality of melanoma, and the treatment is limited due to its accessibility for drugs and also for surgical approaches. Radiotherapy is a widely used approach for disseminated metastatic foci in the brain. However, there is a gap in therapeutics since there are few to no alternatives to melanoma brain metastasis after the radiotherapy dose has been maximized. MT1-MMP is a metalloproteinase that has shown a direct correlation with metastasis and whose inhibition slows down the occurrence of metastasis and tumor growth. By microarray analysis, it has been found that inhibition of MT1-MMP downregulates the expression of DNA-damage response genes.
Objective/Hypothesis: We hypothesize that the inhibition of MT1-MMP in combination with radiotherapy will enhance the tumor cell killing efficacy by means of preventing cells from responding to the DNA damage that is caused by radiation. Further, we hypothesize that the Integrin beta 1 pathway downstream of MT1-MMP is the mediator in the downregulation of DNA-damage response genes.
Methods: We utilized melanoma cell lines, A375, WM-266-4-Luciferase, and K457, in which we introduced shMT1-MMP lentivirus with control shGFP. Cell culture assays compared the response of shMT1-MMP cells and shGFP cells in the presence of radiotherapy and the assays included comet assay, foci of gammaH2AX staining, clonogenic assay, and evaluation of radiotherapy response by Western blot. Furthermore, a nude mouse model was utilized in which WM-266-4-luciferase shMT1-MMP and control shGFP cells were inoculated by stereotactic injection. In vivo imaging system (IVIS) was utilized to follow up the tumors.
Results: Ongoing experiments aim to look at the response of shMT1-MMP cells to radiotherapy compared to shGFP cells by DNA damage evaluation assays (Comet assay, gammaH2AX foci, DNA-damage response proteins by Western blot), downstream signaling of Integrin beta 1 pathway, and the survival of nude mice in shMT1-MMP inoculated tumors and their response to radiotherapy.
Impact: This project has the potential to advance the current treatment of melanoma brain metastasis and also has the potential of advancing the understanding of the DNA-damage response in melanoma.
Citation Format: Julia Escandon, Varsha Thakur, Barbara Bedogni. MT1-MMP targeting in melanoma brain metastasis [abstract]. In: Proceedings of the AACR Special Conference on Melanoma: From Biology to Target; 2019 Jan 15-18; Houston, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(19 Suppl):Abstract nr B27.
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Affiliation(s)
- V Thakur
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - S Kumar
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - A Bishnoi
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
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21
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Gotha L, Pruthi V, Abbasi N, Kulkarni AV, Church P, Drake JM, Carvalho JCA, Diambomba Y, Thakur V, Ryan G, Van Mieghem T. Fetal spina bifida: What we tell the parents. Prenat Diagn 2020; 40:1499-1507. [PMID: 32692418 DOI: 10.1002/pd.5802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/08/2020] [Accepted: 07/19/2020] [Indexed: 12/20/2022]
Abstract
Worldwide, about 150 000 infants are born with spina bifida yearly, making this condition one of the most common fetal central nervous system anomalies compatible with life. Over the last decade, major changes have been introduced in the prenatal diagnosis and management of spina bifida. In this review, we provide a brief summary of the current management of fetal spina bifida and present essential information that should be provided to expecting parents when their fetus has been diagnosed with spina bifida. This information is focused around common parental questions, as encountered in our typical clinical practice, to facilitate knowledge translation.
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Affiliation(s)
- Lara Gotha
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Vagisha Pruthi
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.,Ontario Fetal Centre, Toronto, Canada
| | - Nimrah Abbasi
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.,Ontario Fetal Centre, Toronto, Canada
| | - Abhaya V Kulkarni
- Ontario Fetal Centre, Toronto, Canada.,Division of Neurosurgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paige Church
- Department of Pediatrics, Sunnybrook Health Sciences Centre, Holland-Bloorview Kids Rehabilitation Hospital and University of Toronto, Toronto, Canada
| | - James M Drake
- Ontario Fetal Centre, Toronto, Canada.,Division of Neurosurgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Jose C A Carvalho
- Ontario Fetal Centre, Toronto, Canada.,Department of Anesthesia, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Yenge Diambomba
- Ontario Fetal Centre, Toronto, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Varsha Thakur
- Ontario Fetal Centre, Toronto, Canada.,Department of Cardiology, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Greg Ryan
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.,Ontario Fetal Centre, Toronto, Canada
| | - Tim Van Mieghem
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.,Ontario Fetal Centre, Toronto, Canada
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22
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Marusak C, Thakur V, Li Y, Freitas JT, Zmina PM, Thakur VS, Chang M, Gao M, Tan J, Xiao M, Lu Y, Mills GB, Flaherty K, Frederick DT, Miao B, Sullivan RJ, Moll T, Boland GM, Herlyn M, Zhang G, Bedogni B. Targeting Extracellular Matrix Remodeling Restores BRAF Inhibitor Sensitivity in BRAFi-resistant Melanoma. Clin Cancer Res 2020; 26:6039-6050. [PMID: 32820016 DOI: 10.1158/1078-0432.ccr-19-2773] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 07/07/2020] [Accepted: 08/17/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE The extracellular matrix (ECM) is an intriguing, yet understudied component of therapy resistance. Here, we investigated the role of ECM remodeling by the collagenase, MT1-MMP, in conferring resistance of v-Raf murine sarcoma viral oncogene homolog B1 (BRAF)-mutant melanoma to BRAF inhibitor (BRAFi) therapy. EXPERIMENTAL DESIGN Publicly available RNA-sequencing data and reverse phase protein array were used to determine the relevance of MT1-MMP upregulation in BRAFi-resistant melanoma in patients, patient-derived xenografts, and cell line-derived tumors. Short hairpin RNA (shRNA)-mediated knockdown of MT1-MMP, inhibition via the selective MT1-MMP/MMP2 inhibitor, ND322, or overexpression of MT1-MMP was used to assess the role of MT1-MMP in mediating resistance to BRAFi. RESULTS MT1-MMP was consistently upregulated in posttreatment tumor samples derived from patients upon disease progression and in melanoma xenografts and cell lines that acquired resistance to BRAFi. shRNA- or ND322-mediated inhibition of MT1-MMP synergized with BRAFi leading to resensitization of resistant cells and tumors to BRAFi. The resistant phenotype depends on the ability of cells to cleave the ECM. Resistant cells seeded in MT1-MMP uncleavable matrixes were resensitized to BRAFi similarly to MT1-MMP inhibition. This is due to the inability of cells to activate integrinβ1 (ITGB1)/FAK signaling, as restoration of ITGB1 activity is sufficient to maintain resistance to BRAFi in the context of MT1-MMP inhibition. Finally, the increase in MT1-MMP in BRAFi-resistant cells is TGFβ dependent, as inhibition of TGFβ receptors I/II dampens MT1-MMP overexpression and restores sensitivity to BRAF inhibition. CONCLUSIONS BRAF inhibition results in a selective pressure toward higher expression of MT1-MMP. MT1-MMP is pivotal to an ECM-based signaling pathway that confers resistance to BRAFi therapy.
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Affiliation(s)
- Charles Marusak
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - Varsha Thakur
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - Yuan Li
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - Juliano T Freitas
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - Patrick M Zmina
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - Vijay S Thakur
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida
| | - Mayland Chang
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana
| | - Ming Gao
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana
| | - Jiufeng Tan
- The Wistar Institute, Philadelphia, Pennsylvania
| | - Min Xiao
- The Wistar Institute, Philadelphia, Pennsylvania
| | - Yiling Lu
- Department of Genomic Medicine, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, Texas
| | - Gordon B Mills
- The Knight Cancer Institute, Oregon Health Sciences University, Portland, Oregon
| | - Keith Flaherty
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | | | - Benchun Miao
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Ryan J Sullivan
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Tabea Moll
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Genevieve M Boland
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Gao Zhang
- Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Barbara Bedogni
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida.
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23
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Choudhary R, Ashraf R, Thakur V, Kumaran MS. Teriflunomide-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Clin Exp Dermatol 2020; 46:166-169. [PMID: 32557734 DOI: 10.1111/ced.14339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/02/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Affiliation(s)
- R Choudhary
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Ashraf
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - V Thakur
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - M S Kumaran
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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24
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Namavarian A, Eid A, Goh ESY, Thakur V. A novel DNAH11 variant segregating in a sibship with heterotaxy and implications for genetic counseling. Mol Genet Genomic Med 2020; 8:e1358. [PMID: 32633470 PMCID: PMC7507105 DOI: 10.1002/mgg3.1358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 01/28/2023] Open
Abstract
Background Isomerism or heterotaxy syndrome is the loss of normal asymmetry of the internal thoraco‐abdominal organs in the left‐right axis and is associated with cardiovascular malformations. Mutations within DNAH11 can be associated with primary ciliary dyskinesia and heterotaxy syndromes. Methods We report a family of healthy, nonconsanguinous parents with subsequent pregnancies demonstrating a novel likely pathogenic variant in DNAH11 segregating in a sibship with varied presentations. Result The first affected pregnancy presented with right atrial isomerism. Further DNA testing identified three variants in DNAH11 related to primary ciliary dyskinesia: a maternally inherited heterozygous variant of unknown significance (VUS) c.2772G>A (p.Met924Ile), a maternally inherited novel likely pathogenic variant c.11662C>T (p.Arg3888Cys) as well as a paternally inherited pathogenic c.1648delA variant (p.Arg550GlyfsX16). The second pregnancy inherited the same variants including the pathogenic and likely pathogenic DNAH11 variants and presented with left isomerism and extracardiac abnormalities. Conclusion We present a novel likely pathogenic variant (c.11662C>T) in DNAH11 that has manifested in heterotaxy with variability in phenotypes for subsequent pregnancies of common parents. This report demonstrates that sibship illustrates potential variability in phenotypes associated with the same pathogenic variants within a family and highlights the difficulty in genetic counseling due to the variation in clinical presentation.
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Affiliation(s)
| | - Anas Eid
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elaine Suk-Ying Goh
- Laboratory Medicine and Genetics, Trillium Health Partners, Mississauga, ON, Canada
| | - Varsha Thakur
- Division of Cardiology, Hospital for Sick Children, Toronto, ON, Canada
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25
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Violet PC, Ebenuwa I, Wang Y, Niyyati M, Padayatty S, Head B, Wilkins K, Chung S, Thakur V, Ulatowski L, Atkinson J, Ghelfi M, Smith Smith S, Smith S, Tu H, Bobe G, Liu CY, Herion D, Shamburek R, Manor D, Traber M, Levine MA. SUN-555 Vitamin E Sequestration by Liver Fat in Vitro and in Women with Hepato-Steatosis. J Endocr Soc 2020. [PMCID: PMC7208418 DOI: 10.1210/jendso/bvaa046.1450] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND: The global obesity epidemic has sobering consequences to human health. Especially concerning is obesity-associated hepato-steatosis (HS), a common cause of chronic liver disease in the Americas and Western Europe that precedes non-alcoholic steatohepatitis (NASH). Maintenance of normal body weight is the only current means to prevent HS and NASH. We hypothesized that excess liver fat in obesity-associated HS could act as a pathophysiologic chemical depot for fat-soluble vitamins and alter normal physiology. Because clinical trials with Vitamin E (α-T) have shown that NASH partially responds to this supplement, we selected α-T as a model vitamin to test the sequestration hypothesis. INTERVENTIONS: Under an IND and IRB-approved protocol, two deuterium-labeled α-tocopherols (d3-α-T and d6-α-T) were administered orally and intravenously, respectively, to 10 healthy women and 6 women with HS. Serial blood samples obtained over 72 h were analyzed by LC-MS/MS. In parallel, we performed studies in hepatocytes in cell culture and mouse model. RESULTS: In healthy women who received oral d3- and intravenous d6-α-T, 85% of the initial plasma peak d6-α-T disappeared within 20 minute and reappeared in the plasma peaking between 6-8 h. Compared to healthy subjects, subjects with HS had similar d6-α-T entry rates into liver, but reduced release rates into plasma (p<0.001). Similarly, pharmacokinetics parameters (AUC and Maximum Concentration [Cmax]), were reduced (AUC0-8,p<0.01;Cmax p<0.02) in HS subjects, indicating reduced hepatic d6-α-T output. Consistently, livers of mice fed with a high fat diet (42% fat) had more vitamin E compared to controls diet (5% fat), with both diets having the same α-T content CONCLUSION: These findings suggest the unique role of the liver in vitamin E physiology which is dysregulated by excess liver fat (measured by magnetic resonance spectroscopy). Considered together, the findings imply that obesity-associated HS may produce unrecognized hepatic α-T sequestration, which might subsequently drive liver disease. The data here raise the intriguing possibility that timely α-T supplementation might attenuate progression of HS to NASH, perhaps by correcting an unrecognized fat-induced, localized, hepatic vitamin E deficiency prior to onset of inflammation, hepatitis, and fibrosis. Additionally, our findings raise the possibility that HS may similarly alter hepatic physiology of other fat-soluble vitamins.
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Affiliation(s)
| | - Ifechukwude Ebenuwa
- National Institute on Diabetes & Digestive & Kidney Diseases, Washington, DC, USA
| | - Yu Wang
- National Institutes of Health, Bethesda, MD, USA
| | | | | | - Brian Head
- Linus Pauling Institute, Oregon State University, Corvallis, OR, USA
| | | | - Stacey Chung
- Departments of Pharmacology and Nutrition, School of Medicine, Case Western Reserve University and the Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Varsha Thakur
- Departments of Pharmacology and Nutrition, School of Medicine, Case Western Reserve University and the Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Lynn Ulatowski
- Departments of Pharmacology and Nutrition, School of Medicine, Case Western Reserve University and the Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Jeffery Atkinson
- Department of Chemistry, Brock University, St Catharines, ON, Canada
| | - Mikel Ghelfi
- National Institute on Diabetes & Digestive & Kidney Diseases, Bethesda, MD, USA
| | | | - Sheila Smith
- National Institute on Diabetes & Digestive & Kidney Diseases, Bethesda, MD, USA
| | - Hongbin Tu
- National Institute on Diabetes & Digestive & Kidney Diseases, Bethesda, MD, USA
| | - Gerd Bobe
- Linus Pauling Institute, Oregon State University, Corvallis, OR, USA
| | | | | | - Robert Shamburek
- Cardiovascular Branch, Intramural Research Program, NHLBI, Bethesda, MD, USA
| | - Danny Manor
- Departments of Pharmacology and Nutrition, School of Medicine, Case Western Reserve University and the Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Maret Traber
- Linus Pauling Institute, Oregon State University, Corvallis, OR, USA
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26
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Nagata H, Glick L, Lougheed J, Grattan M, Mondal T, Thakur V, Schwartz SM, Jaeggi E. Prenatal Diagnosis of Transposition of the Great Arteries Reduces Postnatal Mortality: A Population-Based Study. Can J Cardiol 2020; 36:1592-1597. [PMID: 32622839 DOI: 10.1016/j.cjca.2020.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Transposition of the great arteries (TGA) may present as a life-threatening neonatal malformation. Although prenatal detection facilitates the perinatal management, the impact on outcome is controversial. METHODS This study reviewed the differences in prenatal diagnosis of TGA from 2009 to 2014 among the 5 geographic areas in Ontario and compared the management, morbidity, and mortality among neonates with a prenatal (prenatal cohort; n = 70) vs a postnatal (postnatal cohort; n = 76) anomaly diagnosis. Cases were identified from prospective databases of the provincial cardiac tertiary centres and the coroner's office. RESULTS Prenatal TGA detection rates varied significantly among areas (median: 50%; range: 14% to 72%; P = 0.03). Compared with the postnatal cohort, time from birth to tertiary care admission (1.4 vs 10.4 hours, P < 0.001), prostaglandin therapy (0.1 vs 5.3 hours; P < 0.001), balloon atrial septostomy (5.3 vs 14.9 hours; P <0.001), and arterial switch operation (6 vs 9 days, P = 0.002) was significantly shorter in the prenatal cohort. Although other preoperative variables-including the need of ventilation and mechanical support, morbidity score, and lowest pH and preductal oxygen saturations-were comparable, a prenatal diagnosis was associated with improved 1-year survival (odds ratio: 0.108; 95% confidence interval, 0.013-0.88; P = 0.0184). CONCLUSIONS Prenatal diagnosis of TGA significantly shortened time intervals from birth to neonatal care and surgery and was associated with improved survival. The prenatal detection rate of TGA in Ontario was low (50% or less) outside of Metropolitan Toronto, suggesting the need for new strategies to further improve intraprovincial detection rates.
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Affiliation(s)
- Hazumu Nagata
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lauren Glick
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jane Lougheed
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Michael Grattan
- Children's Hospital of Western Ontario, London, Ontario, Canada
| | | | - Varsha Thakur
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Edgar Jaeggi
- The Hospital for Sick Children, Toronto, Ontario, Canada.
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27
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Violet PC, Ebenuwa IC, Wang Y, Niyyati M, Padayatty SJ, Head B, Wilkins K, Chung S, Thakur V, Ulatowski L, Atkinson J, Ghelfi M, Smith S, Tu H, Bobe G, Liu CY, Herion DW, Shamburek RD, Manor D, Traber MG, Levine M. Vitamin E sequestration by liver fat in humans. JCI Insight 2020; 5:133309. [PMID: 31821172 PMCID: PMC7030816 DOI: 10.1172/jci.insight.133309] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 09/10/2019] [Accepted: 11/26/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUNDWe hypothesized that obesity-associated hepatosteatosis is a pathophysiological chemical depot for fat-soluble vitamins and altered normal physiology. Using α-tocopherol (vitamin E) as a model vitamin, pharmacokinetics and kinetics principles were used to determine whether excess liver fat sequestered α-tocopherol in women with obesity-associated hepatosteatosis versus healthy controls.METHODSCustom-synthesized deuterated α-tocopherols (d3- and d6-α-tocopherols) were administered to hospitalized healthy women and women with hepatosteatosis under investigational new drug guidelines. Fluorescently labeled α-tocopherol was custom-synthesized for cell studies.RESULTSIn healthy subjects, 85% of intravenous d6-α-tocopherol disappeared from the circulation within 20 minutes but reappeared within minutes and peaked at 3-4 hours; d3- and d6-α-tocopherols localized to lipoproteins. Lipoprotein redistribution occurred only in vivo within 1 hour, indicating a key role of the liver in uptake and re-release. Compared with healthy subjects who received 2 mg, subjects with hepatosteatosis had similar d6-α-tocopherol entry rates into liver but reduced initial release rates (P < 0.001). Similarly, pharmacokinetics parameters were reduced in hepatosteatosis subjects, indicating reduced hepatic d6-α-tocopherol output. Reductions in kinetics and pharmacokinetics parameters in hepatosteatosis subjects who received 2 mg were echoed by similar reductions in healthy subjects when comparing 5- and 2-mg doses. In vitro, fluorescent-labeled α-tocopherol localized to lipid in fat-loaded hepatocytes, indicating sequestration.CONCLUSIONSThe unique role of the liver in vitamin E physiology is dysregulated by excess liver fat. Obesity-associated hepatosteatosis may produce unrecognized hepatic vitamin E sequestration, which might subsequently drive liver disease. Our findings raise the possibility that hepatosteatosis may similarly alter hepatic physiology of other fat-soluble vitamins.TRIAL REGISTRATIONClinicalTrials.gov, NCT00862433.FUNDINGNational Institute of Diabetes and Digestive and Kidney Diseases and NIH grants DK053213-13, DK067494, and DK081761.
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Affiliation(s)
- Pierre-Christian Violet
- Molecular and Clinical Nutrition Section, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Ifechukwude C. Ebenuwa
- Molecular and Clinical Nutrition Section, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Yu Wang
- Molecular and Clinical Nutrition Section, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Mahtab Niyyati
- Molecular and Clinical Nutrition Section, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Sebastian J. Padayatty
- Molecular and Clinical Nutrition Section, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Brian Head
- Linus Pauling Institute, Oregon State University, Corvallis, Oregon, USA
| | - Kenneth Wilkins
- Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Stacey Chung
- Department of Pharmacology and Department of Nutrition, School of Medicine, Case Western Reserve University and the Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Varsha Thakur
- Department of Pharmacology and Department of Nutrition, School of Medicine, Case Western Reserve University and the Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Lynn Ulatowski
- Department of Pharmacology and Department of Nutrition, School of Medicine, Case Western Reserve University and the Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Jeffrey Atkinson
- Department of Chemistry, Brock University, Saint Catharines, Ontario, Canada
| | - Mikel Ghelfi
- Department of Chemistry, Brock University, Saint Catharines, Ontario, Canada
| | - Sheila Smith
- Molecular and Clinical Nutrition Section, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Hongbin Tu
- Molecular and Clinical Nutrition Section, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Gerd Bobe
- Linus Pauling Institute, Oregon State University, Corvallis, Oregon, USA
| | | | - David W. Herion
- Clinical Research Informatics, Clinical Center, NIH, Bethesda, Maryland, USA
| | - Robert D. Shamburek
- Cardiovascular Branch, Intramural Research Program, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA
| | - Danny Manor
- Department of Pharmacology and Department of Nutrition, School of Medicine, Case Western Reserve University and the Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Maret G. Traber
- Linus Pauling Institute, Oregon State University, Corvallis, Oregon, USA
| | - Mark Levine
- Molecular and Clinical Nutrition Section, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
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28
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Thakur N, Sant R, Nicholls S, McDonald S, Thakur V, Thakur Y. 2892 Minitouch Outpatient Endometrial Ablation for Heavy Menstrual Bleeding - The Way Forward! J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.243] [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: 12/01/2022]
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29
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Manhas M, Mittal S, Sharma AK, Gupta KK, Pathania V, Thakur V. Biological approach in repair of partially inflamed dental pulp using second-generation platelet-rich fibrin and mineral trioxide aggregate as a pulp medicament in primary molars. J Indian Soc Pedod Prev Dent 2019; 37:399-404. [PMID: 31710016 DOI: 10.4103/jisppd.jisppd_133_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The purpose of this study was to evaluate and compare clinically and radiographically PRF, MTA and Ca(OH)2 as a pulp dressing material in primary molars. MATERIAL AND METHODS The study was conducted on 30 children between 6-9 years of age. Pulpotomy was performed using MTA(Gp I), PRF + MTA(Gp II) and PRF +Ca(OH)2(Group III). The teeth were evaluated clinically and radiographically after 1,3 and 6 months and were subjected to statistics analysis. RESULTS After 6 months follow-up the overall success rate was found to be highest in Gp I with success rate of 97% followed by Gp II 95% and Gp III 78.3%. The results were found to be statistically insignificant (P ≤ 0.05). CONCLUSION All materials used in the present study were equally effective as the success rates are statistically insignificant.
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Affiliation(s)
- Maria Manhas
- Department of Pedodontics, Himachal Dental College, Sundar Nagar, Himachal Pradesh, India
| | - Sudhir Mittal
- Department of Pedodontics, Himachal Dental College, Sundar Nagar, Himachal Pradesh, India
| | - A K Sharma
- Department of Pedodontics, Himachal Dental College, Sundar Nagar, Himachal Pradesh, India
| | - K K Gupta
- Department of Pedodontics, Himachal Dental College, Sundar Nagar, Himachal Pradesh, India
| | - V Pathania
- Department of Pedodontics, Himachal Dental College, Sundar Nagar, Himachal Pradesh, India
| | - V Thakur
- Department of Pedodontics, Himachal Dental College, Sundar Nagar, Himachal Pradesh, India
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30
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Awasti S, Vinay K, Thakur V, Kumar R, Holla AP, Sahni K, Parsad D, Kanwar AJ. Comparison of efficacy of cold trypsinization versus warm trypsinization in preparation of autologous non-cultured epidermal cell suspension for treatment of stable vitiligo. J Eur Acad Dermatol Venereol 2019; 33:e237-e239. [PMID: 30768811 DOI: 10.1111/jdv.15502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S Awasti
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - K Vinay
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - V Thakur
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - R Kumar
- Department of Zoology, Panjab University, Chandigarh, 160012, India
| | - A P Holla
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - K Sahni
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - D Parsad
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - A J Kanwar
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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31
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Morgan CT, Mueller B, Thakur V, Guerra V, Jull C, Mertens L, Friedberg M, Golding F, Seed M, Miner SES, Jaeggi ET, Manlhiot C, Nield LE. Improving Prenatal Diagnosis of Coarctation of the Aorta. Can J Cardiol 2018; 35:453-461. [PMID: 30935636 DOI: 10.1016/j.cjca.2018.12.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The purpose of the study was to evaluate the association between fetal echocardiographic measurements and the need for intervention (primary coarctation repair, staged coarctation repair, or catheter intervention) in prenatally diagnosed coarctation of the aorta. METHODS A single-centre retrospective cohort study (2005-2015) of 107 fetuses diagnosed with suspected coarctation of the aorta in the setting of an apex-forming left ventricle and antegrade flow across the mitral and aortic valves. RESULTS Median gestational age at diagnosis was 32 weeks (interquartile range, 23-35 weeks). Fifty-six (52%) did not require any neonatal intervention, 51 patients (48%) underwent a biventricular repair. In univariable analysis, an increase in ascending aorta (AAo) peak Doppler flow velocity (odds ratio [OR], 1.40 [95% confidence interval [CI], 1.05-1.91] per 20 cm/s; P = 0.03) was associated with intervention. No intervention was associated with larger isthmus size (OR, 0.23; P < 0.001), transverse arch diameter (OR, 0.23; P < 0.001), and aortic (OR, 0.72; P = 0.02), mitral (OR, 0.58; P = 0.001), and AAo (OR, 0.53; P < 0.001) z-scores. In multivariable analysis, higher peak AAo Doppler (OR, 2.51 [95% CI, 1.54-4.58] per 20 cm/s; P = 0.001) and younger gestational age at diagnosis (OR, 0.81 [95% CI, 0.70-0.93] per week; P = 0.005) were associated with intervention, whereas a higher AAo z-score (OR, 0.65 [95% CI, 0.43-0.94] per z; P = 0.029) and transverse arch dimension (OR, 0.44 [95% CI, 0.18-0.97]; P = 0.05) decreased the risk of intervention. CONCLUSIONS In prenatally suspected coarctation, the variables associated with intervention comprised smaller AAo and transverse arch size, earlier gestational age at diagnosis, and the additional finding of a higher peak AAo Doppler.
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Affiliation(s)
- Conall T Morgan
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brigitte Mueller
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Varsha Thakur
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vitor Guerra
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Callaghan Jull
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Luc Mertens
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark Friedberg
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fraser Golding
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike Seed
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven E S Miner
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Edgar T Jaeggi
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cedric Manlhiot
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lynne E Nield
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Thakur V, Zhang K, Savadelis A, Zmina P, Aguila B, Welford SM, Abdul-Karim F, Bonk KW, Keri RA, Bedogni B. The membrane tethered matrix metalloproteinase MT1-MMP triggers an outside-in DNA damage response that impacts chemo- and radiotherapy responses of breast cancer. Cancer Lett 2018; 443:115-124. [PMID: 30502358 DOI: 10.1016/j.canlet.2018.11.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 01/18/2023]
Abstract
Breast cancer is the second leading cause of death among women in the US. Targeted therapies exist, however resistance is common and patients resort to chemotherapy. Chemotherapy is also a main treatment for triple negative breast cancer (TNBC) patients; while radiation is delivered to patients with advanced disease to counteract metastasis. Yet, resistance to both chemo- and radiotherapy is still frequent, highlighting a need to provide novel sensitizers. We discovered that MT1-MMP modulates DNA damage responses (DDR) in breast cancer. MT1-MMP expression inversely correlates to chemotherapy response of breast cancer patients. Inhibition of MT1-MMP sensitizes TNBC cells to IR and doxorubicin in vitro, and in vivo in an orthotopic breast cancer model. Specifically, depletion of MT1-MMP causes stalling of replication forks and Double Strand Breaks (DBSs), leading to increased sensitivity to additional genotoxic stresses. These effects are mediated by integrinβ1, as a constitutive active integrinβ1 reverts replication defects and protects cells depleted of MT1-MMP from IR and chemotherapy. These data highlight a novel DNA damage response triggered by MT1-MMP-integrinβ1 and provide a new point of therapeutic targeting that may improve breast cancer patient outcomes.
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Affiliation(s)
- Varsha Thakur
- Department of Biochemistry, Case Western Reserve University, Cleveland, OH, 44106, USA; Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Keman Zhang
- Department of Biochemistry, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Alyssa Savadelis
- Department of Biochemistry, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Patrick Zmina
- Department of Biochemistry, Case Western Reserve University, Cleveland, OH, 44106, USA; Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Brittany Aguila
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Scott M Welford
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Fadi Abdul-Karim
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, OH, 44119, USA
| | - Kristen W Bonk
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Ruth A Keri
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Barbara Bedogni
- Department of Biochemistry, Case Western Reserve University, Cleveland, OH, 44106, USA; Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
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Thakur Y, Thakur V, Karunaratne C, Nicholls S. Minitouch Endometrial Ablation: Review of Outcomes and Resource Usage at Basildon University Hospital. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.396] [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: 10/18/2022]
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Shroff N, Shroff R, Thakur Y, Thakur V, Penketh R, Tas B. Smartphone Speculum: Design, Development and Initial Experience. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.118] [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: 10/18/2022]
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Thakur V, Lu J, Roscilli G, Aurisicchio L, Cappelletti M, Pavoni E, White WL, Bedogni B. The natural compound fucoidan from New Zealand Undaria pinnatifida synergizes with the ERBB inhibitor lapatinib enhancing melanoma growth inhibition. Oncotarget 2017; 8:17887-17896. [PMID: 28060735 PMCID: PMC5392294 DOI: 10.18632/oncotarget.14437] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/13/2016] [Indexed: 12/24/2022] Open
Abstract
Melanoma remains one of the most aggressive and therapy-resistant cancers. Finding new treatments to improve patient outcomes is an ongoing effort. We previously demonstrated that melanoma relies on the activation of ERBB signaling, specifically of the ERBB3/ERBB2 cascade. Here we show that melanoma tumor growth is inhibited by 60% over controls when treated with lapatinib, a clinically approved inhibitor of ERBB2/EGFR. Importantly, tumor growth is further inhibited to 85% when the natural compound fucoidan from New Zealand U. pinnatifida is integrated into the treatment regimen. Fucoidan not only enhances tumor growth inhibition, it counteracts the morbidity associated with prolonged lapatinib treatment. Fucoidan doubles the cell killing capacity of lapatinib. These effects are associated with a further decrease in AKT and NFκB signaling, two key pathways involved in melanoma cell survival. Importantly, the enhancing cell killing effects of fucoidan can be recapitulated by inhibiting ERBB3 by either a specific shRNA or a novel, selective ERBB3 neutralizing antibody, reiterating the key roles played by this receptor in melanoma. We therefore propose the use of lapatinib or specific ERBB inhibitors, in combination with fucoidan as a new treatment of melanoma that potentiates the effects of the inhibitors while protecting from their potential side effects.
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Affiliation(s)
- Varsha Thakur
- Department of Biochemistry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jun Lu
- School of Science, Auckland University of Technology, New Zealand
| | | | | | | | | | | | - Barbara Bedogni
- Department of Biochemistry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Ghani M, Chapiro J, Letzen B, Thakur V, Lin M, Papademetris X, Schernthaner R, Huber S, Geschwind J. Identifying enhancement-based staging markers on baseline MR imaging in patients with colorectal cancer liver metastases undergoing loco-regional tumor therapy. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.621] [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: 11/25/2022] Open
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Abstract
Purpose of Review: Gossypibomas remain a dreaded and unwanted complication of surgical practice. Despite significant interest and numerous guidelines, the number of reported cases remains sparse due to various factors, including potential legal implications. Herein, we review related data from India to ascertain if the problem is better or worse than that reported in world literature. Materials and Methods: A literature search was performed on PubMed and Google Scholar, to collect and analyze all case reports and case reviews regarding the condition in India. Results: On analysis of the results, there were 100 publications reporting a total of 126 events. The average patient age was 38.65 years. Average time to discovery was 1225.62 days. Forty-nine percent of reported cases were discovered within the 1st year. The most common clinical features were pain (73.8%), palpable mass (47.6%), vomiting (35%), abdominal distention (26%), and fever (12.6%). Spontaneous expulsion of the gossypiboma was noted in five cases (3.96%). Transmural migration was seen in 36 cases (28.57%). Conclusions: Despite advancements in surgical approaches and preventive measures, gossypibomas continue to be a cause of significant morbidity. A safe working culture, open communication, teamwork, and an accurate sponge count remain our best defence against this often unpredictable complication of surgery.
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Affiliation(s)
- T Patial
- Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - V Thakur
- Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - N Vijhay Ganesun
- Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - M Sharma
- Department of Forensic Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Thakur Y, Thakur V, Nicholls S. Outpatient Endometrial Ablation (Minitouch) – A Procedure with Minimal Resource Requirements. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.283] [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: 11/24/2022]
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Thakur V, Bedogni B. The membrane tethered matrix metalloproteinase MT1-MMP at the forefront of melanoma cell invasion and metastasis. Pharmacol Res 2016; 111:17-22. [DOI: 10.1016/j.phrs.2016.05.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 01/18/2023]
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Thakur V, Munk N, Mertens L, Nield LE. Does prenatal diagnosis of hypoplastic left heart syndrome make a difference? - A systematic review. Prenat Diagn 2016; 36:854-63. [DOI: 10.1002/pd.4873] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/27/2016] [Accepted: 07/04/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Varsha Thakur
- Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children; University of Toronto; Toronto Canada
| | - Nadia Munk
- Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children; University of Toronto; Toronto Canada
| | - Luc Mertens
- Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children; University of Toronto; Toronto Canada
| | - Lynne E. Nield
- Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children; University of Toronto; Toronto Canada
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Le Port A, Roycroft E, Thakur V, Lavery S. Characterisation of eleven new polymorphic microsatellite markers for the coastal stingray Dasyatis brevicaudata (Dasyatidae Hutton 1875), and cross-amplification in seven dasyatid species. BIOCHEM SYST ECOL 2016. [DOI: 10.1016/j.bse.2016.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Morley S, Thakur V, Danielpour D, Parker R, Arai H, Atkinson J, Barnholtz-Sloan J, Klein E, Manor D. Tocopherol transfer protein sensitizes prostate cancer cells to vitamin E. J Biol Chem 2015; 290:25848. [PMID: 26500292 DOI: 10.1074/jbc.a110.169664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Simard D, Thakur V. Sci-Fri PM: Dosimetry - 03: Delta4 diode absolute dose response for large and small target volume IMRT QA. Med Phys 2014. [DOI: 10.1118/1.4894958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
Rho GTPases are molecular "switches" that cycle between "on" (GTP-bound) and "off" (GDP-bound) states and regulate numerous cellular activities such as gene expression, protein synthesis, cytoskeletal rearrangements, and metabolic responses. Dysregulation of GTPases is a key feature of many diseases, especially cancers. Guanine nucleotide exchange factors (GEFs) of the Dbl family are activated by mitogenic cell surface receptors and activate the Rho family GTPases Cdc42, Rac1, and RhoA. The molecular mechanisms that regulate GEFs from the Dbl family are poorly understood. Our studies reveal that Dbl is phosphorylated on tyrosine residues upon stimulation by growth factors and that this event is critical for the regulated activation of the GEF. These findings uncover a novel layer of complexity in the physiological regulation of this protein.
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Affiliation(s)
- Meghana Gupta
- From the Departments of Pharmacology, and Nutrition, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44106
| | - Xiaojun Qi
- Nutrition, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44106
| | - Varsha Thakur
- Nutrition, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44106
| | - Danny Manor
- From the Departments of Pharmacology, and Nutrition, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44106
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Chung S, Thakur V, Atkinson J, Parker R, Manor D. Dynamic regulation of hepatic vitamin E secretion by the α‐tocopherol transfer protein (LB410). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.lb410] [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)
- Stacey Chung
- Nutrition Case Western Reserve UniversityClevelandOHUnited States
| | - Varsha Thakur
- Nutrition Case Western Reserve UniversityClevelandOHUnited States
| | | | - Robert Parker
- Nutritional Sciences Cornell UniversityIthacaNYUnited States
| | - Danny Manor
- Nutrition Case Western Reserve UniversityClevelandOHUnited States
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Affiliation(s)
- Lynn Ulatowski
- Nutrition Case Western Reserve UnivClevelandOHUnited States
| | - Varsha Thakur
- Nutrition Case Western Reserve UnivClevelandOHUnited States
| | - Danny Manor
- Nutrition and Pharmacology Case Western Reserve UnivClevelandOHUnited States
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Thakur V, Talwar M, Singh PP. Low free to total PSA ratio is not a good discriminator of chronic prostatitis and prostate cancer: An Indian experience. Indian J Cancer 2014; 51:335-337. [PMID: 25494133 DOI: 10.4103/0019-509x.146790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims: To find out the utility of free to total PSA ratio in discriminating chronic prostatitis and prostate cancer. Setting and design: The patients visited urology clinics at Batra Hospital and Medical Research Center, New Delhi. Background: The use of serum free to total PSA as a diagnostic tool for prostate cancer has led to early detection of prostate cancer; however, the effect of inflammation on f/t PSA ratio restricts its use in early detection of cancer. Materials and Methods: The study was conducted in age related 101 patients which include 27 carcinoma patients (group I), 34 BPH patients (group II) and 40 chronic prostatitis patients (group III). Serum total PSA (tPSA) and free PSA (fPSA) were analyzed on Elecsys 2010. These were compared with histological reports of biopsy specimen. Other biochemistry tests were done on Randox Imola. P Value was calculated using one way ANOVA with posthoc Bonferroni analysis. Results: Serum total PSA levels were comparable in group I and III and were higher than group II (P < 0.049). Serum fPSA in group I was not significantly different from group II and III, However, group II has higher levels than group III (P < 0.035). Difference was significant for f/t PSA ratio in group I and II (P < 0.00) and group II and III (P < 0.000).Group I and III were with comparable levels (P < 0.807). Conclusions: f/t PSA ratio is not a good discriminator for malignancy and chronic prostatitis. This limitation of f/t PSA ratio must be taken into consideration while interpreting the results clinically.
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Affiliation(s)
- V Thakur
- Department of Laboratory Medicine, Clinical Biochemistry Lab, New Delhi, India
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Thakur V, Ruo R, Seuntjens J, Parker W, Doucet R, Soisson E. SU-E-T-429: Delivery Accuracy of Stereotactic Radiosurgery with Tomotherapy Using Treatment Planning System Version V4.0 and the Recent Upgrade V4.2. Med Phys 2013. [DOI: 10.1118/1.4814863] [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] Open
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Thakur V, Fouron JC, Mertens L, Jaeggi ET. Diagnosis and management of fetal heart failure. Can J Cardiol 2013; 29:759-67. [PMID: 23664320 DOI: 10.1016/j.cjca.2013.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 11/25/2022] Open
Abstract
Congestive fetal heart failure, defined as inability of the heart to deliver adequate blood flow to organs such as the brain, liver, and kidneys, is a common final outcome of many intrauterine disease states that may lead to fetal demise. Advances in fetal medicine during the past 3 decades now provide the diagnostic tools to detect and also treat conditions that may lead to fetal heart failure. Fetal echocardiographic findings depend on severity of diastolic and systolic dysfunction of both ventricles. At an advanced stage, findings include cardiomegaly; valvar regurgitation; venous congestion; fetal edema and effusions; oligohydramnios; and preferential shunting of blood flow to the brain, heart, and adrenals in the distressed fetus. A useful diagnostic tool to quantify severity of heart failure is the cardiovascular profile score, which is a composite score based on 5 different echocardiographic parameters. To predict outcomes, the score should be interpreted in the context of the underlying disease, as different causes of intrauterine heart failure may have highly variable outcomes. Low fetal cardiac output may result from a myocardial disease (cardiomyopathy, myocarditis, ischemia), abnormal loading conditions (arterial hypertension, obstructive structural heart disease, atrioventricular malformations, twin-to-twin transfusion), arrhythmia, or external cardiac compression (pleural and/or pericardial effusions, cardiac tumours). Treatment options are available for several of these conditions.
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Affiliation(s)
- Varsha Thakur
- Fetal Cardiac Program, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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