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Nahain AA, Li J, Modhiran N, Watterson D, Li JP, Ignjatovic V, Monagle P, Tsanaktsidis J, Vamvounis G, Ferro V. Antiviral Activities of Heparan Sulfate Mimetic RAFT Polymers Against Mosquito-borne Viruses. ACS Appl Bio Mater 2024. [PMID: 38699864 DOI: 10.1021/acsabm.3c01223] [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] [Indexed: 05/05/2024]
Abstract
Mosquito-borne viruses are a major worldwide health problem associated with high morbidity and mortality rates and significant impacts on national healthcare budgets. The development of antiviral drugs for both the treatment and prophylaxis of these diseases is thus of considerable importance. To address the need for therapeutics with antiviral activity, a library of heparan sulfate mimetic polymers was screened against dengue virus (DENV), Yellow fever virus (YFV), Zika virus (ZIKV), and Ross River virus (RRV). The polymers were prepared by RAFT polymerization of various acidic monomers with a target MW of 20 kDa (average Mn ∼ 27 kDa by GPC). Among the polymers, poly(SS), a homopolymer of sodium styrenesulfonate, was identified as a broad spectrum antiviral with activity against all the tested viruses and particularly potent inhibition of YFV (IC50 = 310 pM). Our results further uncovered that poly(SS) exhibited a robust inhibition of ZIKV infection in both mosquito and human cell lines, which points out the potential functions of poly(SS) in preventing mosquito-borne viruses associated diseases by blocking viral transmission in their mosquito vectors and mitigating viral infection in patients.
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Affiliation(s)
- Abdullah Al Nahain
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Jinlin Li
- Department of Medical Biochemistry and Microbiology, The Biomedical Center, University of Uppsala, 75123 Uppsala, Sweden
| | - Naphak Modhiran
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Daniel Watterson
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Jin-Ping Li
- Department of Medical Biochemistry and Microbiology, The Biomedical Center, University of Uppsala, 75123 Uppsala, Sweden
| | - Vera Ignjatovic
- Haematology Research, Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Paul Monagle
- Haematology Research, Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria 3052, Australia
- Department of Clinical Haematology, Royal Children's Hospital, Parkville, Victoria 3052, Australia
| | - John Tsanaktsidis
- CSIRO Manufacturing, Research Way, Clayton, Victoria 3168, Australia
| | - George Vamvounis
- College of Science and Engineering, James Cook University, Townsville, QLD 4811, Australia
| | - Vito Ferro
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
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McGrady ME, Ignjatovic V, Jones S, Bruce A, Goldenberg NA, Rizzi M, Thornburg CD, Todd KE, Luchtman-Jones L. Evaluation, analysis, and reporting of medication adherence for clinical trials of anticoagulants in children: Guidance from the ISTH SSC Subcommittee on Pediatric and Neonatal Thrombosis and Hemostasis. J Thromb Haemost 2024:S1538-7836(24)00217-4. [PMID: 38642706 DOI: 10.1016/j.jtha.2024.04.003] [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: 02/01/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/22/2024]
Abstract
In response to growing recognition that non-adherence prevents children, adolescents, and young adults from achieving the therapeutic benefits of anticoagulant medication, the ISTH SSC Subcommittee on Pediatric and Neonatal Thrombosis and Hemostasis convened a working party on medication adherence. The primary aim of this manuscript was to synthesize recommendations from the larger adherence science literature to provide guidance regarding the classification, collection, and interpretation of anticoagulation adherence data. The secondary aim of this manuscript was to evaluate the degree to which trials published from 2013 to 2023 adhered to these guidance recommendations. As less than half of all trials reported on adherence and none included all recommended elements, the proposed ISTH SSC guidance has the potential to enhance the rigor and reproducibility of pediatric anticoagulant research.
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Affiliation(s)
- Meghan E McGrady
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Vera Ignjatovic
- Haematology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Sophie Jones
- Haematology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Clinical Haematology, The Royal Children's Hospital, Melbourne, Australia; Department of Nursing, The University of Melbourne, Parkville, VIC, Australia
| | - Aisha Bruce
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Neil A Goldenberg
- Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL, USA; Departments of Pediatrics and Medicine, Divisions of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mattia Rizzi
- Hematology/Oncology Unit, Division of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Courtney D Thornburg
- Division of Pediatric Hematology/Oncology, Rady Children's Hospital San Diego, San Diego, CA, USA; Department of Pediatrics, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Kevin E Todd
- Department of Pediatric Hematology/Oncology, Children's Hospital of the King's Daughters, Norfolk, VA, USA
| | - Lori Luchtman-Jones
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Swaney EEK, Babl FE, Rausa VC, Anderson N, Hearps SJC, Parkin G, Hart-Smith G, Zaw T, Carroll L, Takagi M, Seal ML, Davis GA, Anderson V, Ignjatovic V. Discovery of Alpha-1-Antichymotrypsin as a Marker of Delayed Recovery from Concussion in Children. J Neurotrauma 2024. [PMID: 38597719 DOI: 10.1089/neu.2023.0503] [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] [Indexed: 04/11/2024] Open
Abstract
Of the four million children who experience a concussion each year, 30-50% of children will experience delayed recovery, where they will continue to experience symptoms more than two weeks after their injury. Delayed recovery from concussion encompasses emotional, behavioral, physical, and cognitive symptoms, and as such, there is an increased focus on developing an objective tool to determine risk of delayed recovery. This study aimed to identify a blood protein signature predictive of delayed recovery from concussion in children. Plasma samples were collected from children who presented to the Emergency Department at the Royal Children's Hospital, Melbourne, within 48h post-concussion. This study involved a discovery and validation phase. For the discovery phase, untargeted proteomics analysis was performed using single window acquisition of all theoretical mass spectra to identify blood proteins differentially abundant in samples from children with and without delayed recovery from concussion. A subset of these proteins was then validated in a separate participant cohort using multiple reaction monitoring and enzyme linked immunosorbent assay. A blood protein signature predictive of delayed recovery from concussion was modeled using a Support Vector Machine, a machine learning approach. In the discovery phase, 22 blood proteins were differentially abundant in age- and sex-matched samples from children with (n = 9) and without (n = 9) delayed recovery from concussion, six of whom were chosen for validation. In the validation phase, alpha-1-ACT was shown to be significantly lower in children with delayed recovery (n = 12) compared with those without delayed recovery (n = 28), those with orthopedic injuries (n = 7) and healthy controls (n = 33). A model consisting of alpha-1-ACT concentration stratified children based on recovery from concussion with an 0.88 area under the curve. We have identified that alpha-1-ACT differentiates between children at risk of delayed recovery from those without delayed recovery from concussion. To our knowledge, this is the first study to identify alpha-1-ACT as a potential marker of delayed recovery from concussion in children. Multi-site studies are required to further validate this finding before use in a clinical setting.
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Affiliation(s)
- Ella E K Swaney
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Vanessa C Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Georgia Parkin
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gene Hart-Smith
- Australian Proteomics Analysis Facility, Macquarie University, Sydney, New South Wales, Australia
| | - Thiri Zaw
- Australian Proteomics Analysis Facility, Macquarie University, Sydney, New South Wales, Australia
| | - Luke Carroll
- Australian Proteomics Analysis Facility, Macquarie University, Sydney, New South Wales, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Marc L Seal
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
- Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL, USA
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Swaney EEK, Hearps S, Monagle P, Roehrl MHA, Ignjatovic V. Technical report: The clinically useful selection of proteins protocol: An approach to identify clinically useful proteins for validation. J Proteomics 2024; 296:105110. [PMID: 38325730 DOI: 10.1016/j.jprot.2024.105110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/09/2024]
Abstract
Clinical proteomics studies aiming to develop markers of clinical outcome or disease typically involve distinct discovery and validation stages, neither of which focus on the clinical applicability of the candidate markers studied. Our clinically useful selection of proteins (CUSP) protocol proposes a rational approach, with statistical and non-statistical components, to identify proteins for the validation phase of studies that could be most effective markers of disease or clinical outcome. Additionally, this protocol considers commercially available analysis methods for each selected protein to ensure that use of this prospective marker is easily translated into clinical practice. SIGNIFICANCE: When developing proteomic markers of clinical outcomes, there is currently no consideration at the validation stage of how to implement such markers into a clinical setting. This has been identified by several studies as a limitation to the progression of research findings from proteomics studies. When integrated into a proteomic workflow, the CUSP protocol allows for a strategically designed validation study that improves researchers' abilities to translate research findings from discovery-based proteomics into clinical practice.
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Affiliation(s)
- Ella E K Swaney
- Haematology Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Melbourne 3052, Australia; Department of Paediatrics, University of Melbourne, Melbourne 3050, Australia
| | - Stephen Hearps
- Clinical Epidaemiology and Biostatistics, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Melbourne 3052, Australia
| | - Paul Monagle
- Haematology Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Melbourne 3052, Australia; Department of Paediatrics, University of Melbourne, Melbourne 3050, Australia; Department of Clinical Haematology, The Royal Children's Hospital, 50 Flemington Road, Melbourne 3052, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Sydney 2031, Australia
| | - Michael H A Roehrl
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Vera Ignjatovic
- Haematology Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Melbourne 3052, Australia; Department of Paediatrics, University of Melbourne, Melbourne 3050, Australia; Johns Hopkins All Children's Institute for Clinical and Translational Research, 600 5(th) Street South, Suite 3200, St. Petersburg, FL 33701, USA; Department of Pediatrics, School of Medicine, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218, USA.
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5
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Fan F, Babl FE, Swaney EEK, Hearps SJC, Takagi M, Emery-Corbin SJ, Dagley LF, Yousef J, Parkin GM, Rausa VC, Anderson N, Fabiano F, Dunne K, Seal M, Davis GA, Attard C, Anderson V, Ignjatovic V. Capillary blood protein markers of posttraumatic headache in children after concussion. J Neurosurg Pediatr 2024:1-9. [PMID: 38457794 DOI: 10.3171/2024.2.peds23551] [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] [Received: 12/04/2023] [Accepted: 02/07/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Posttraumatic headache (PTH) represents the most common acute and persistent symptom in children after concussion, yet there is no blood protein signature to stratify the risk of PTH after concussion to facilitate early intervention. This discovery study aimed to identify capillary blood protein markers, at emergency department (ED) presentation within 48 hours of concussion, to predict children at risk of persisting PTH at 2 weeks postinjury. METHODS Capillary blood was collected using the Mitra Clamshell device from children aged 8-17 years who presented to the ED of the Royal Children's Hospital, Melbourne, Australia, within 48 hours of sustaining a concussion. Participants were followed up at 2 weeks postinjury to determine PTH status. PTH was defined per clinical guidelines as a new or worsened headache compared with preinjury. An untargeted proteomics analysis using data-independent acquisition (DIA) was performed. Principal component analysis and hierarchical clustering were used to reduce the dimensionality of the protein dataset. RESULTS A total of 907 proteins were reproducibly identified from 82 children within 48 hours of concussion. The mean participant age was 12.78 years (SD 2.54 years, range 8-17 years); 70% of patients were male. Eighty percent met criteria for acute PTH in the ED, while one-third of participants with follow-up experienced PTH at 2 weeks postinjury (range 8-16 days). Hemoglobin subunit zeta (HBZ), cystatin B (CSTB), beta-ala-his dipeptidase (CNDP1), hemoglobin subunit gamma-1 (HBG1), and zyxin (ZYX) were weakly associated with PTH at 2 weeks postinjury based on up to a 7% increase in the PTH group despite nonsignificant Benjamini-Hochberg adjusted p values. CONCLUSIONS This discovery study determined that no capillary blood protein markers, measured at ED presentation within 48 hours of concussion, can predict children at risk of persisting PTH at 2 weeks postinjury. While HBZ, CSTB, CNDP1, HBG1, and ZYX were weakly associated with PTH at 2 weeks postinjury, there was no specific blood protein signature predictor of PTH in children after concussion. There is an urgent need to discover new blood biomarkers associated with PTH to facilitate risk stratification and improve clinical management of pediatric concussion.
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Affiliation(s)
- Feiven Fan
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 2Melbourne School of Psychological Sciences, University of Melbourne, Victoria
| | - Franz E Babl
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- Departments of3Pediatrics
- 4Critical Care, and
- 5Emergency Department, Royal Children's Hospital, Melbourne, Victoria
| | - Ella E K Swaney
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- Departments of3Pediatrics
| | - Stephen J C Hearps
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 4Critical Care, and
| | - Michael Takagi
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 2Melbourne School of Psychological Sciences, University of Melbourne, Victoria
- 6Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria
| | - Samantha J Emery-Corbin
- 7Advanced Technology and Biology Division, Walter and Eliza Hall Institute, Melbourne, Victoria
- 8Medical Biology, University of Melbourne, Victoria
| | - Laura F Dagley
- 7Advanced Technology and Biology Division, Walter and Eliza Hall Institute, Melbourne, Victoria
- 8Medical Biology, University of Melbourne, Victoria
| | - Jumana Yousef
- 7Advanced Technology and Biology Division, Walter and Eliza Hall Institute, Melbourne, Victoria
- 8Medical Biology, University of Melbourne, Victoria
| | | | - Vanessa C Rausa
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- Departments of3Pediatrics
| | | | - Fabian Fabiano
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 2Melbourne School of Psychological Sciences, University of Melbourne, Victoria
| | - Kevin Dunne
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- Departments of3Pediatrics
- 9Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Victoria
| | - Marc Seal
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- Departments of3Pediatrics
| | - Gavin A Davis
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 10Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne, Victoria
| | - Chantal Attard
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- Departments of3Pediatrics
| | - Vicki Anderson
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 2Melbourne School of Psychological Sciences, University of Melbourne, Victoria
- Departments of3Pediatrics
- 11Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Vera Ignjatovic
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- Departments of3Pediatrics
- 12Johns Hopkins All Children's Institute for Clinical & Translational Research, St. Petersburg, Florida; and
- 13Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Kovac M, Balint MT, Milenkovic M, Basaric D, Tomic B, Balint B, Ignjatovic V. Assessment of Factor VIII Activity and D-Dimer Levels in the Post-COVID Period. Hamostaseologie 2024. [PMID: 38428838 DOI: 10.1055/a-2238-4744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024] Open
Abstract
Changes in the hemostatic system during COVID infection lead to hypercoagulability. Numerous studies have evaluated hemostatic abnormalities in COVID patients during acute infection, in the period of hospitalization. However, the hemostatic status following hospital discharge has not been sufficiently assessed. Considering the importance of FVIII and D-dimer levels as markers for the assessment of thrombosis, our study aimed to evaluate changes in these markers, as well as the influence of patient's age and clinical presentation of COVID infection on those hemostatic markers in the post-COVID phase. This prospective study (July 2020 to December 2022) included 115 COVID patients, 68 (59%) with asymptomatic/mild and 47 (41%) with moderate/severe clinical presentation. Patient follow-up included laboratory evaluation of FVIII and D-dimer levels at 1, 3, and 6 months following the COVID infection. Three months after the COVID infection, elevated FVIII was recorded in 44% of younger versus 65% of older individuals, p = 0.05, respectively, and 30 versus 57% (p = 0.008) 6 months post-COVID infection. With a focus on clinical presentation, a higher number of patients with moderate/severe COVID had elevated FVIII activity, but a statistically significant difference was observed only for the 6 months (32% mild vs. 53% moderate/severe, p = 0.041) post-infection time point. Following a COVID infection, an increase in FVIII activity suggests a continued hypercoagulable state in the post-COVID period and correlates with elevated D-dimer levels. This increase in FVIII is more pronounced in patients with moderate/severe clinical picture and those patients older than 50 years.
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Affiliation(s)
- Mirjana Kovac
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Hemostasis, Blood Transfusion Institute of Serbia, Belgrade, Serbia
| | - Milena Todorovic Balint
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for hematology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Marija Milenkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Emergency Centre, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Dusica Basaric
- Department of Hemostasis, Blood Transfusion Institute of Serbia, Belgrade, Serbia
| | - Branko Tomic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Bela Balint
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Vera Ignjatovic
- Johns Hopkins All Children's Institute for Clinical and Translational Research, United States
- Johns Hopkins University School of Medicine, St. Petersburg, Florida, United States
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Sochet AA, Jaffray J, Branchford BR, Havlicek EE, Mosha M, Amankwah EK, Ignjatovic V, Faustino EVS, Goldenberg NA. Hospital-Acquired Venous Thromboembolism and Invasive Mechanical Ventilation: A Report From the Children's Hospital Acquired Thrombosis Consortium. Pediatr Crit Care Med 2024; 25:e82-e90. [PMID: 37882641 PMCID: PMC10843146 DOI: 10.1097/pcc.0000000000003383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVES To determine if the duration of invasive mechanical ventilation (IMV) was associated with hospital-acquired venous thromboembolism (HA-VTE) among critically ill children. DESIGN A multicenter, matched case-control study as a secondary analysis of Children's Hospital Acquired Thrombosis (CHAT) Consortium registry. SETTING PICUs within U.S. CHAT Consortium participating centers. PATIENTS Children younger than 21 years old admitted to a PICU receiving IMV for greater than or equal to 1 day duration from January 2012 to March 2022 were included for study. Cases with HA-VTE were matched 1:2 to controls without HA-VTE by patient age groups: younger than 1, 1-12, and older than 12 years. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was IMV duration in days. Descriptive data included demographics, anthropometrics, HA-VTE characteristics (i.e., type, location, and timing), central venous catheterization data, thromboprophylaxis practices, and Braden Q mobility scores. Descriptive, comparative, and associative (multivariate conditional logistic regression for HA-VTE) statistics were employed. A total of 152 cases were matched to 304 controls. Cases with HA-VTE were diagnosed at a median of 7 days (interquartile range [IQR], 3-16 d) after IMV. The HA-VTE were limb deep venous thromboses in 130 of 152 (85.5%) and frequently central venous catheterization-related (111/152, 73%). Cases with HA-VTE experienced a longer length of stay (median, 34 d [IQR, 18-62 d] vs. 11.5 d [IQR, 6-21 d]; p < 0.001) and IMV duration (median, 7 d [IQR, 4-15 d] vs. 4 d [IQR, 1-7 d]; p < 0.001) as compared with controls. In a multivariate logistic model, greater IMV duration (adjusted odds ratio, 1.09; 95% CI, 1.01-1.17; p = 0.023) was independently associated with HA-VTE. CONCLUSIONS Among critically ill children undergoing IMV, HA-VTE was associated with greater IMV duration. If prospectively validated, IMV duration should be included as part of prothrombotic risk stratification and future pediatric thromboprophylaxis trials.
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Affiliation(s)
- Anthony A. Sochet
- Department of Medicine, Divisions of Critical Care Medicine , Johns Hopkins All Children’s Hospital, St. Petersburg, FL
- Institute for Clinical and Translational Research, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julie Jaffray
- Department of Pediatrics, Division of Hematology/Oncology, Rady Children’s Hospital, San Diego, CA
| | - Brian R. Branchford
- Division of Hematology, Oncology, and Bone Marrow Transplant, Medical College of Wisconsin, Milwaukee, WI and Versiti Medical Sciences Institute, Milwaukee, WI
| | - Elizabeth E. Havlicek
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Maua Mosha
- Institute for Clinical and Translational Research, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | - Ernest K. Amankwah
- Institute for Clinical and Translational Research, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vera Ignjatovic
- Institute for Clinical and Translational Research, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Neil A. Goldenberg
- Cancer and Blood Disorders Institute, Division of Hematology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
- Institute for Clinical and Translational Research, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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8
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Fabiano F, Takagi M, Anderson N, Babl FE, Bressan S, Clarke C, Davies K, Davis GA, Dunne K, Hearps S, Ignjatovic V, Rausa VC, Seal M, Anderson V. Fatigue recovery and connected factors following paediatric concussion. Br J Sports Med 2024; 58:59-65. [PMID: 37699656 DOI: 10.1136/bjsports-2023-106894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE Using a biopsychosocial framework and the three-factor fatigue model, we aimed to (1) plot recovery of fatigue over the 3 months following paediatric concussion and (2) explore factors associated with persisting fatigue during the first 3 months postconcussion. METHODS 240 children and adolescents aged 5-18 years (M=11.64, SD=3.16) completed assessments from time of injury to 3 months postinjury. Separate linear mixed effects models were conducted for child and parent ratings on the PedsQL-Multidimensional Fatigue Scale to plot recovery across domains (General, Cognitive, Sleep/Rest) and Total fatigue, from 1 week to 3 months postinjury. Two-block hierarchical regression analyses were then conducted for parent and child ratings of fatigue at each time point, with age, sex and acute symptoms in block 1 and child and parent mental health variables added to block 2. RESULTS There was a significant reduction in both child and parent ratings across the 3 months postinjury for all fatigue domains (all p<0.001). For both child and parent fatigue ratings, child mental health was the most significant factor associated with fatigue at all time points. Adding child and parent mental health variables in the second block of the regression substantially increased the variance explained for both child and parent ratings of fatigue. CONCLUSION Our findings confirm that fatigue improves during the first 3 months postconcussion and highlights the importance of considering child and parent mental health screening when assessing patients with persisting postconcussive symptoms.
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Affiliation(s)
- Fabian Fabiano
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Michael Takagi
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Silvia Bressan
- Department of Women's and Children's Health, Università degli Studi di Padova, Padova, Italy
| | - Cathriona Clarke
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Katie Davies
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Cabrini Health, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Rehabilitation, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vera Ignjatovic
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
- Departments of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vanessa C Rausa
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Marc Seal
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
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9
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Fan F, Anderson V, Morawakage T, Khan N, Shapiro JS, Ignjatovic V, Takagi M. Post-traumatic headache pathophysiology in paediatric concussion: A systematic review. Neurosci Biobehav Rev 2024; 156:105498. [PMID: 38043751 DOI: 10.1016/j.neubiorev.2023.105498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/05/2023]
Abstract
Post-traumatic headache (PTH) represents the most common acute and persistent symptom following concussion in children, yet the underlying pathophysiology remains unclear. This systematic review sought to: (i) rigorously examine the current evidence of PTH pathophysiology in paediatric concussion (0-18 years), (ii) assess the quality of evidence, and (iii) provide directions for future research in accordance with PRISMA guidelines. Eligible studies (n = 19) totalling 1214 concussion participants investigated cerebrovascular function (n = 6), white matter integrity (n = 3), functional connectivity (n = 3), electrophysiology (n = 1), neurometabolics (n = 2), biological fluid markers (n = 4), vestibular and oculomotor function (n = 4); two studies used a multi-modal approach. Majority of studies were rated as fair quality (90%) and Level 3 evidence (84%). The true underlying mechanisms of PTH following paediatric concussion remain unclear. Overall quality of the available evidence is generally weak with a fair risk of bias and characterised by relative scarcity and lack of specificity of PTH pathophysiology. Future research is required to rigorously isolate pathophysiology specific to PTH with strict adherence to clinical definitions and standardised measurement tools of PTH.
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Affiliation(s)
- Feiven Fan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia.
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Psychology Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Noor Khan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Jesse S Shapiro
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Vera Ignjatovic
- Department of Paediatrics, University of Melbourne, Victoria, Australia; Institute for Clinical & Translational Research, Johns Hopkins All Children's, St Petersburg, FL, USA; Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
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10
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Abstract
Multi-omics approaches are being used increasingly to study physiological and pathophysiologic processes. Proteomics specifically focuses on the study of proteins as functional elements and key contributors to, and markers of the phenotype, as well as targets for diagnostic and therapeutic approaches. Depending on the condition, the plasma proteome can mirror the platelet proteome, and hence play an important role in elucidating both physiologic and pathologic processes. In fact, both plasma and platelet protein signatures have been shown to be important in the setting of thrombosis-prone disease states such as atherosclerosis and cancer. Plasma and platelet proteomes are increasingly being studied as a part of a single entity, as is the case with patient-centric sample collection approaches such as capillary blood. Future studies should cut across the plasma and platelet proteome silos, taking advantage of the vast knowledge available when they are considered as part of the same studies, rather than studied as distinct entities.
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Affiliation(s)
- Steven Bruzek
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Marisol Betensky
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins All Children's Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Jorge Di Paola
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Thomas Diacovo
- Departments of Pediatrics and Pharmacology, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA USA
| | - Neil Goldenberg
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,Department of Pediatrics and Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Vera Ignjatovic
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,Department of Pediatrics, Johns Hopkins University, Baltimore, USA
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11
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Havlicek EE, Goldman ZA, Faustino EVS, Ignjatovic V, Goldenberg NA, Sochet AA. Hospital-acquired venous thromboembolism during invasive mechanical ventilation in children: a single-center, retrospective cohort study. J Thromb Haemost 2023; 21:3145-3152. [PMID: 37423387 DOI: 10.1016/j.jtha.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/01/2023] [Accepted: 06/29/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Invasive mechanical ventilation (IMV) has been independently associated with hospital-acquired venous thromboembolism (HA-VTE) among critically ill children, including extremity deep venous thrombosis and pulmonary embolism. OBJECTIVES We aimed to characterize the frequency and timing of HA-VTE following IMV exposure. METHODS This was a single-center, retrospective cohort study including children aged <18 years, hospitalized in a pediatric intensive care unit, undergoing mechanical ventilation for >24 hours from October 2020 through April 2022. Encounters with an existing tracheostomy or receiving treatment for HA-VTE prior to endotracheal intubation were excluded. The primary outcomes characterized clinically-relevant HA-VTE, including timing after intubation, location, and the presence of known hypercoagulability risk factors. Secondary outcomes were IMV exposure magnitude, defined by IMV duration and ventilator parameters (ie, volumetric, barometric, and oxygenation indices). RESULTS Of 170 consecutive, eligible encounters, 18 (10.6%) experienced HA-VTE at a median of 4 days (IQR, 1.4-6.4) following endotracheal intubation. Those with HA-VTE had an increased frequency of a prior venous thromboembolism (27.8% vs 8.6%, P = .027). No differences in frequency of other HA-VTE risk factors (ie, acute immobility, hematologic malignancy, sepsis, and COVID-19-related illness), presence of a concurrent central venous catheter, or the magnitude of IMV exposure were noted. CONCLUSION Children undergoing IMV experience HA-VTE at markedly higher rates than previously estimated in the general pediatric intensive care unit population after endotracheal intubation. While prospective validation is needed, these findings are an important step toward informing the development of risk-stratified thromboprophylaxis trials in critically ill children.
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Affiliation(s)
- Elizabeth E Havlicek
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA; Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
| | - Zachary A Goldman
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | | | - Vera Ignjatovic
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA; Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Neil A Goldenberg
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA; Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA; Department of Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anthony A Sochet
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA; Department of Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Medicine, Division of Critical Care Medicine, Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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12
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Drop J, Letunica N, Van Den Helm S, Heleen van Ommen C, Wildschut E, de Hoog M, van Rosmalen J, Barton R, Yaw HP, Newall F, Horton SB, Chiletti R, Johansen A, Best D, McKittrick J, Butt W, d’Udekem Y, MacLaren G, Linden MD, Ignjatovic V, Attard C, Monagle P. Factors XI and XII in extracorporeal membrane oxygenation: longitudinal profile in children. Res Pract Thromb Haemost 2023; 7:102252. [PMID: 38193071 PMCID: PMC10772870 DOI: 10.1016/j.rpth.2023.102252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 01/10/2024] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) is used in children with cardiopulmonary failure. While the majority of ECMO centers use unfractionated heparin, other anticoagulants, including factor XI and factor XII inhibitors are emerging, which may prove suitable for ECMO patients. However, before these anticoagulants can be applied in these patients, baseline data of FXI and FXII changes need to be acquired. Objectives This study aimed to describe the longitudinal profile of FXI and FXII antigenic levels and function before, during, and after ECMO in children. Methods This is a prospective observational study in neonatal and pediatric patients with ECMO (<18 years). All patients with venoarterial ECMO and with sufficient plasma volume collected before ECMO, on day 1 and day 3, and 24 hours postdecannulation were included. Antigenic levels and functional activity of FXI and FXII were determined in these samples. Longitudinal profiles of these values were created using a linear mixed model. Results Sixteen patients were included in this study. Mean FXI and FXII antigenic levels (U/mL) changed from 7.9 and 53.2 before ECMO to 6.0 and 34.5 on day 3 and they recovered to 8.8 and 39.4, respectively, after stopping ECMO. Function (%) of FXI and FXII decreased from 59.1 and 59.0 to 49.0 and 50.7 on day 3 and recovered to 66.0 and 54.4, respectively. Conclusion This study provides the first insights into changes of the contact pathway in children undergoing ECMO. FXI and FXII antigen and function change during ECMO. Results from this study can be used as starting point for future contact pathway anticoagulant studies in pediatric patients with ECMO.
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Affiliation(s)
- Joppe Drop
- Department of Paediatrics, Division of Paediatric Hematology, Erasmus Medical Centre—Sophia Children’s Hospital, Rotterdam, South Holland, The Netherlands
- Department of Paediatrics, Division of Paediatric Intensive Care and Paediatric Surgery, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, South Holland, The Netherlands
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Natasha Letunica
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Suelyn Van Den Helm
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - C. Heleen van Ommen
- Department of Paediatrics, Division of Paediatric Hematology, Erasmus Medical Centre—Sophia Children’s Hospital, Rotterdam, South Holland, The Netherlands
| | - Enno Wildschut
- Department of Paediatrics, Division of Paediatric Intensive Care and Paediatric Surgery, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, South Holland, The Netherlands
| | - Matthijs de Hoog
- Department of Paediatrics, Division of Paediatric Intensive Care and Paediatric Surgery, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, South Holland, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, South Holland, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, South Holland, The Netherlands
| | - Rebecca Barton
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Clinical Haematology, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Hui Ping Yaw
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Fiona Newall
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Clinical Haematology, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Stephen B. Horton
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Cardiac Surgery, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Roberto Chiletti
- Department of Intensive Care, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Paediatric Intensive Care Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amy Johansen
- Department of Intensive Care, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Paediatric Intensive Care Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Derek Best
- Department of Intensive Care, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Paediatric Intensive Care Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Joanne McKittrick
- Department of Intensive Care, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Warwick Butt
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Paediatric Intensive Care Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yves d’Udekem
- Department of Cardiac Surgery, Children’s National Heart Institute, Washington DC, USA
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Health System, Singapore
| | - Matthew D. Linden
- School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Vera Ignjatovic
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Johns Hopkins All Children’s Institute for Clinical and Translational Research, St Petersburg, Florida, USA
- Department of Paediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chantal Attard
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Monagle
- Haematology Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Clinical Haematology, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, New South Wales, Australia
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13
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Van Den Helm S, McCafferty C, Letunica N, Chau KY, Monagle P, Ignjatovic V. Platelet function in neonates and children. Thromb Res 2023; 231:236-246. [PMID: 36997443 DOI: 10.1016/j.thromres.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/22/2022] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
Platelets are major regulators of haemostasis and coagulation. The primary role of platelets in coagulation is to form a stable clot and stop bleeding. Studies of platelet phenotype and function in neonates and children have been restricted by the large volumes required for many common platelet function tests such as platelet aggregometry. Developmental changes in platelets have not been as well described as developmental changes in plasma coagulation proteins, and overall, platelet phenotype and function in neonates and children has been understudied when compared to adults. Recent developments in more sensitive platelet function testing methods requiring smaller blood volumes such as flow cytometry has enabled recent studies to further investigate platelet phenotype and function in neonates and children. In this review we will provide an overview of recent advances from the past five years in platelets in the context of developmental haemostasis, as well as the role of platelets in neonatal paediatric disease.
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Affiliation(s)
- Suelyn Van Den Helm
- Haematology Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Conor McCafferty
- Haematology Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Natasha Letunica
- Haematology Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Ka Ying Chau
- Haematology Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Paul Monagle
- Haematology Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Department of Clinical Haematology, The Royal Children's Hospital, Melbourne, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Vera Ignjatovic
- Haematology Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Johns Hopkins All Children's Hospital, St Petersburg, USA.
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14
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Fan F, Beare R, Takagi M, Anderson N, Bressan S, Clarke CJ, Davis GA, Dunne K, Fabiano F, Hearps SJC, Ignjatovic V, Parkin G, Rausa VC, Seal M, Shapiro JS, Babl FE, Anderson V. Cerebral blood flow in children with persisting postconcussive symptoms and posttraumatic headache at 2 weeks postconcussion. J Neurosurg Pediatr 2023:1-8. [PMID: 37086163 DOI: 10.3171/2023.3.peds2339] [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] [Received: 01/26/2023] [Accepted: 03/10/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE Persisting postconcussive symptoms (pPCS), particularly headache, can significantly disrupt children's recovery and functioning. However, the underlying pathophysiology of these symptoms remains unclear. The goal in this study was to determine whether pPCS are related to cerebral blood flow (CBF) at 2 weeks postconcussion. The authors also investigated whether variations in CBF can explain the increased risk of acute posttraumatic headache (PTH) in female children following concussion. METHODS As part of a prospective, longitudinal study, the authors recruited children 5-18 years old who were admitted to the emergency department of a tertiary pediatric hospital with a concussion sustained within 48 hours of admission. Participants underwent pseudocontinuous arterial spin labeling MRI at 2 weeks postconcussion to quantify global mean gray and white matter perfusion (in ml/100 g/min). Conventional frequentist analysis and Bayesian analysis were performed. RESULTS Comparison of recovered (n = 26) and symptomatic (n = 12) groups (mean age 13.15 years, SD 2.69 years; 28 male) found no differences in mean global gray and white matter perfusion at 2 weeks postconcussion (Bayes factors > 3). Although female sex was identified as a risk factor for PTH with migraine features (p = 0.003), there was no difference in CBF between female children with and without PTH. CONCLUSIONS Global CBF was not associated with pPCS and female PTH at 2 weeks after pediatric concussion. These findings provide evidence against the use of CBF measured by arterial spin labeling as an acute biomarker for pediatric concussion recovery.
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Affiliation(s)
- Feiven Fan
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 2Melbourne School of Psychological Sciences, University of Melbourne, Victoria
| | - Richard Beare
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 3National Centre for Healthy Ageing and Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michael Takagi
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 2Melbourne School of Psychological Sciences, University of Melbourne, Victoria
| | | | - Silvia Bressan
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 4Department of Women's and Children's Health, University of Padova, Italy
| | | | - Gavin A Davis
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 5Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne, Victoria
| | - Kevin Dunne
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 6Department of Pediatrics, University of Melbourne, Victoria
- 7Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Fabian Fabiano
- 1Murdoch Children's Research Institute, Melbourne, Victoria
| | | | - Vera Ignjatovic
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 8Institute for Clinical and Translational Research, Johns Hopkins All Children's, St. Petersburg, Florida
| | - Georgia Parkin
- 1Murdoch Children's Research Institute, Melbourne, Victoria
| | | | - Marc Seal
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 6Department of Pediatrics, University of Melbourne, Victoria
| | - Jesse S Shapiro
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 9School of Psychology, Deakin University, Geelong, Victoria
| | - Franz E Babl
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 6Department of Pediatrics, University of Melbourne, Victoria
- 10Emergency Department, Royal Children's Hospital, Melbourne, Victoria; and
| | - Vicki Anderson
- 1Murdoch Children's Research Institute, Melbourne, Victoria
- 2Melbourne School of Psychological Sciences, University of Melbourne, Victoria
- 6Department of Pediatrics, University of Melbourne, Victoria
- 11Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
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15
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Van Den Helm S, Letunica N, Barton R, Weaver A, Yaw HP, Karlaftis V, McCafferty C, Cai T, Newall F, Horton SB, Chiletti R, Johansen A, Best D, McKittrick J, Butt W, d'Udekem Y, MacLaren G, Linden MD, Ignjatovic V, Monagle P. Changes in von Willebrand Factor Multimers, Concentration, and Function During Pediatric Extracorporeal Membrane Oxygenation. Pediatr Crit Care Med 2023; 24:268-276. [PMID: 36602314 DOI: 10.1097/pcc.0000000000003152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To investigate changes in von Willebrand factor (VWF) concentration, function, and multimers during pediatric extracorporeal membrane oxygenation (ECMO) and determine whether routine monitoring of VWF during ECMO would be useful in predicting bleeding. DESIGN Prospective observational study of pediatric ECMO patients from April 2017 to May 2019. SETTING The PICU in a large, tertiary referral pediatric ECMO center. PATIENTS Twenty-five neonates and children (< 18 yr) supported by venoarterial ECMO. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Arterial blood samples were collected within 24 hours pre-ECMO, daily for the first 5 days of ECMO, every second day until decannulation, and 24 hours post-ECMO. The STA R Max analyzer was used to measure VWF antigen (VWF:Ag) and ristocetin cofactor (VWF:RCo) activity. VWF collagen binding (VWF:CB) was measured using an enzyme-linked immunosorbent assay. VWF multimers were measured using the semi-automated Hydragel 11 VWF Multimer assay. Corresponding clinical data for each patient was also recorded. A total of 25 venoarterial ECMO patients were recruited (median age, 73 d; interquartile range [IQR], 3 d to 1 yr). The median ECMO duration was 4 days (IQR, 3-8 d) and 15 patients had at least one major bleed during ECMO. The percentage of high molecular weight multimers (HMWM) decreased and intermediate molecular weight multimers increased while patients were on ECMO, irrespective of a bleeding status. VWF:Ag increased and the VWF:RCo/VWF:Ag and VWF:CB/VWF:Ag ratios decreased while patients were on ECMO compared with the baseline pre-ECMO samples and healthy children. CONCLUSIONS Neonates and children on ECMO exhibited a loss of HMWM and lower VWF:CB/VWF:Ag and VWF:RCo/VWF:Ag ratios compared with healthy children, irrespective of major bleeding occurring. Therefore, monitoring VWF during ECMO would not be useful in predicting bleeding in these patients and changes to other hemostatic factors should be investigated to further understand bleeding during ECMO.
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Affiliation(s)
- Suelyn Van Den Helm
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Natasha Letunica
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Rebecca Barton
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Department of Clinical Haematology, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Intensive Care, The Royal Children's Hospital, Melbourne, VIC, Australia
- Paediatric Intensive Care Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Department of Cardiac Surgery, Children's National Heart Institute, Washington, DC
- Cardiothoracic Intensive Care Unit, National University Health System, Singapore
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Asami Weaver
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Hui Ping Yaw
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Vasiliki Karlaftis
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Conor McCafferty
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Tengyi Cai
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Fiona Newall
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Department of Clinical Haematology, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Intensive Care, The Royal Children's Hospital, Melbourne, VIC, Australia
- Paediatric Intensive Care Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Department of Cardiac Surgery, Children's National Heart Institute, Washington, DC
- Cardiothoracic Intensive Care Unit, National University Health System, Singapore
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Stephen B Horton
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Roberto Chiletti
- Department of Intensive Care, The Royal Children's Hospital, Melbourne, VIC, Australia
- Paediatric Intensive Care Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Amy Johansen
- Department of Intensive Care, The Royal Children's Hospital, Melbourne, VIC, Australia
- Paediatric Intensive Care Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Derek Best
- Department of Intensive Care, The Royal Children's Hospital, Melbourne, VIC, Australia
- Paediatric Intensive Care Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Joanne McKittrick
- Department of Intensive Care, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Warwick Butt
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Children's National Heart Institute, Washington, DC
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Health System, Singapore
| | - Matthew D Linden
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Vera Ignjatovic
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Paul Monagle
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
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16
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Ryan FJ, Norton TS, McCafferty C, Blake SJ, Stevens NE, James J, Eden GL, Tee YC, Benson SC, Masavuli MG, Yeow AEL, Abayasingam A, Agapiou D, Stevens H, Zecha J, Messina NL, Curtis N, Ignjatovic V, Monagle P, Tran H, McFadyen JD, Bull RA, Grubor-Bauk B, Lynn MA, Botten R, Barry SE, Lynn DJ. A systems immunology study comparing innate and adaptive immune responses in adults to COVID-19 mRNA and adenovirus vectored vaccines. Cell Rep Med 2023; 4:100971. [PMID: 36871558 PMCID: PMC9935276 DOI: 10.1016/j.xcrm.2023.100971] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/23/2022] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Abstract
Identifying the molecular mechanisms that promote optimal immune responses to coronavirus disease 2019 (COVID-19) vaccination is critical for future rational vaccine design. Here, we longitudinally profile innate and adaptive immune responses in 102 adults after the first, second, and third doses of mRNA or adenovirus-vectored COVID-19 vaccines. Using a multi-omics approach, we identify key differences in the immune responses induced by ChAdOx1-S and BNT162b2 that correlate with antigen-specific antibody and T cell responses or vaccine reactogenicity. Unexpectedly, we observe that vaccination with ChAdOx1-S, but not BNT162b2, induces an adenoviral vector-specific memory response after the first dose, which correlates with the expression of proteins with roles in thrombosis with potential implications for thrombosis with thrombocytopenia syndrome (TTS), a rare but serious adverse event linked to adenovirus-vectored vaccines. The COVID-19 Vaccine Immune Responses Study thus represents a major resource that can be used to understand the immunogenicity and reactogenicity of these COVID-19 vaccines.
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Affiliation(s)
- Feargal J Ryan
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Todd S Norton
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia
| | - Conor McCafferty
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Stephen J Blake
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Natalie E Stevens
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Jane James
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia
| | - Georgina L Eden
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia
| | - Yee C Tee
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Saoirse C Benson
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Makutiro G Masavuli
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA 5011, Australia
| | - Arthur E L Yeow
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA 5011, Australia
| | - Arunasingam Abayasingam
- School of Medical Sciences, Faculty of Medicine, UNSW, Sydney, NSW 2052, Australia; The Kirby Institute, Sydney, NSW 2052, Australia
| | | | - Hannah Stevens
- Clinical Haematology Department, Alfred Hospital, Melbourne, VIC 3004, Australia; Australian Centre for Blood Diseases, Monash University, Melbourne, VIC 3800, Australia
| | - Jana Zecha
- Dynamic Omics, Centre for Genomics Research, Discovery Sciences, R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Nicole L Messina
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3010, Australia; Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia
| | - Nigel Curtis
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3010, Australia; Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia
| | - Vera Ignjatovic
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Paul Monagle
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Huyen Tran
- Clinical Haematology Department, Alfred Hospital, Melbourne, VIC 3004, Australia; Australian Centre for Blood Diseases, Monash University, Melbourne, VIC 3800, Australia
| | - James D McFadyen
- Clinical Haematology Department, Alfred Hospital, Melbourne, VIC 3004, Australia; Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Rowena A Bull
- School of Medical Sciences, Faculty of Medicine, UNSW, Sydney, NSW 2052, Australia; The Kirby Institute, Sydney, NSW 2052, Australia
| | - Branka Grubor-Bauk
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA 5011, Australia
| | - Miriam A Lynn
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Rochelle Botten
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia
| | - Simone E Barry
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - David J Lynn
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia.
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17
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McCafferty C, Letunica N, Swaney E, Tengyi C, Monagle P, Ignjatovic V, Attard C. Blood Collection Processing and Handling for Plasma and Serum Proteomics. Methods Mol Biol 2023; 2628:33-40. [PMID: 36781777 DOI: 10.1007/978-1-0716-2978-9_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The plasma and serum proteome has enormous potential as a tool for understanding the health of a number of physiological systems. Despite this potential, the use of plasma and serum proteomics clinically and for research is limited, and there are no strict guidelines on how samples should be collected and prepared for proteomic analysis. Given the sensitivity of proteomic analysis, there are a number of pre-analytical variables that should be considered and determined prior to undertaking proteomics-based methodologies.In this chapter, we provide an example of a blood processing protocol and highlight major considerations for pre-analytical variables involving the collection, processing, and handling of blood samples for plasma and serum proteomics. We provide comprehensive notes on aspects of the protocol that must be considered before commencing sample collections for a proteomic study as well as a thorough checklist to be used when designing new proteomic studies.
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Affiliation(s)
- Conor McCafferty
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Natasha Letunica
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ella Swaney
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Cai Tengyi
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Paul Monagle
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Haematology, Royal Children's Hospital, Melbourne, VIC, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Vera Ignjatovic
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Chantal Attard
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
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18
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Letunica N, McCafferty C, Swaney E, Cai T, Monagle P, Ignjatovic V, Attard C. Proteomic Applications and Considerations: From Research to Patient Care. Methods Mol Biol 2023; 2628:181-192. [PMID: 36781786 DOI: 10.1007/978-1-0716-2978-9_12] [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] [Indexed: 02/15/2023]
Abstract
Despite technological advancements in the field of proteomics, the rate at which serum and plasma biomarkers identified using proteomic approaches are translated into clinical use remains extremely low. In this chapter, we describe recent technological advancements and analytical strategies in proteomic methods. We also describe the progress of proteomic blood-based biomarkers to date and discuss what the future of proteomics might entail with the use of multi-omic approaches and implementing machine learning on large proteomic datasets. Lastly, we provide several key considerations for biomarker studies, ranging from sample type to the use of reference samples, in order to achieve progress from bench to bedside, ultimately improving patient diagnosis, disease, and/or therapeutic monitoring and care.
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Affiliation(s)
- Natasha Letunica
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Conor McCafferty
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Ella Swaney
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Tengyi Cai
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Paul Monagle
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Department of Clinical Haematology, Royal Children's Hospital, Melbourne, VIC, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Vera Ignjatovic
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, USA.,Department of Pediatrics, Johns Hopkins University, Baltimore, USA
| | - Chantal Attard
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia. .,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia. .,The Royal Children's Hospital, Parkville, VIC, Australia.
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19
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Swaney EEK, Cai T, Seal ML, Ignjatovic V. Blood biomarkers of secondary outcomes following concussion: A systematic review. Front Neurol 2023; 14:989974. [PMID: 36925940 PMCID: PMC10011122 DOI: 10.3389/fneur.2023.989974] [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: 07/09/2022] [Accepted: 01/31/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Blood biomarkers have been identified as an alternative tool for predicting secondary outcomes following concussion. This systematic review aimed to summarize the literature on blood biomarkers of secondary outcomes following concussion in both pediatric and adult cohorts. Methods A literature search of Embase, Medline and PubMed was conducted. Two reviewers independently assessed retrieved studies to determine inclusion in systematic review synthesis. Results A total of 1771 unique studies were retrieved, 58 of which were included in the final synthesis. S100B, GFAP and tau were identified as being associated with secondary outcomes following concussion. Seventeen percent of studies were performed in a solely pediatric setting. Conclusions Validation of biomarkers associated with secondary outcomes following concussion have been largely limited by heterogeneous study cohorts and definitions of concussion and mTBI, presenting a hurdle for translation of these markers into clinical practice. Additionally, there was an underrepresentation of studies which investigated pediatric cohorts. Adult markers are not appropriate for children, therefore pediatric specific markers of secondary outcomes following concussion present the biggest gap in this field.
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Affiliation(s)
- Ella E K Swaney
- Department of Haematology, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Tengyi Cai
- Department of Haematology, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Marc L Seal
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Vera Ignjatovic
- Department of Haematology, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States.,Department of Pediatrics, Johns Hopkins University, Baltimore, MD, United States
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20
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Cai T, McCafferty C, Van Den Helm S, Letunica N, Attard C, Monagle P, Ignjatovic V. Protocol for the Investigation of Plasma and Whole Blood Clot Property of Fibrin Fiber Thickness Using Scanning Electron Microscopy. Methods Mol Biol 2023; 2663:775-786. [PMID: 37204752 DOI: 10.1007/978-1-0716-3175-1_52] [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] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Blood clot formation represents a key component of the coagulation process for preventing excessive hemorrhage. The structural characteristics of blood clots are associated with their strength and susceptibility to fibrinolysis. Scanning electron microscopy is a technique that allows for state-of-the-art image capture of blood clots, providing visualization of topography, fibrin thickness, fibrin network density, and blood cell involvement and morphology. In this chapter, we provide a detailed protocol for characterization of plasma and whole blood clot structure using SEM, covering the spectrum from blood collection, in vitro clot formation, sample preparation for SEM, imaging, and image analysis, specifically focusing on the measurement of fibrin fiber thickness.
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Affiliation(s)
- Tengyi Cai
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Conor McCafferty
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Suelyn Van Den Helm
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | | | - Chantal Attard
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Paul Monagle
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- The Royal Children's Hospital, Parkville, Australia
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, Parkville, Australia.
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.
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21
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Abrehart T, Suryadinata R, McCafferty C, Jacobson J, Ignjatovic V, Robinson P, Crawford NW, Monagle P, Subbarao K, Satzke C, Wurzel D. Age-related differences in SARS-CoV-2 binding factors: An explanation for reduced susceptibility to severe COVID-19 among children? Paediatr Respir Rev 2022; 44:61-69. [PMID: 35227628 PMCID: PMC8823960 DOI: 10.1016/j.prrv.2022.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 02/07/2023]
Abstract
CONTEXT In contrast with other respiratory viruses, children infected with SARS-CoV-2 are largely spared from severe COVID-19. OBJECTIVES To critically assess age-related differences in three host proteins involved in SARS-CoV-2 cellular entry: angiotensin-converting enzyme 2 (ACE2), transmembrane serine protease 2 (TMPRSS2) and furin. METHODS We systematically searched Medline, Embase, and PubMed databases for relevant publications. Studies were eligible if they evaluated ACE2, TMPRSS2 or furin expression, methylation, or protein level in children. RESULTS Sixteen papers were included. Age-dependent differences in membrane-bound and soluble ACE2 were shown in several studies, with ACE2 expression increasing with age. TMPRSS2 and furin are key proteases involved in SARS-CoV-2 spike protein cleavage. TMPRSS2 expression is increased by circulating androgens and is thus low in pre-pubertal children. Furin has not currently been well researched. LIMITATIONS High levels of study heterogeneity. CONCLUSIONS Low expression of key host proteins may partially explain the reduced incidence of severe COVID-19 among children, although further research is needed.
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Affiliation(s)
- Thomas Abrehart
- Department of Paediatrics, the University of Melbourne, Parkville, Australia.
| | - Randy Suryadinata
- Department of Respiratory Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia,Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
| | - Conor McCafferty
- Department of Paediatrics, the University of Melbourne, Parkville, Australia,Haematology, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Jonathan Jacobson
- Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia,Department of Microbiology and Immunology, the University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Vera Ignjatovic
- Department of Paediatrics, the University of Melbourne, Parkville, Australia,Haematology, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Phil Robinson
- Department of Paediatrics, the University of Melbourne, Parkville, Australia,Department of Respiratory Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia,Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
| | - Nigel W. Crawford
- Department of Paediatrics, the University of Melbourne, Parkville, Australia,Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
| | - Paul Monagle
- Department of Paediatrics, the University of Melbourne, Parkville, Australia,Haematology, Murdoch Children’s Research Institute, Melbourne, Australia,Department of Haematology, Royal Children’s Hospital, Parkville, Australia,Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - Kanta Subbarao
- WHO Collaborating Centre for Reference and Research on Influenza, the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia,Department of Microbiology and Immunology, the University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Catherine Satzke
- Department of Paediatrics, the University of Melbourne, Parkville, Australia,Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia,Department of Microbiology and Immunology, the University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Danielle Wurzel
- Department of Paediatrics, the University of Melbourne, Parkville, Australia,Department of Respiratory Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia,Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia,Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Victoria, Australia
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22
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Letunica N, Karlaftis V, Monagle P, Ignjatovic V. Newborn and Pediatric Reference Intervals for Coagulation Assays Using Novel Reagents. Thromb Haemost 2022; 122:2042-2044. [PMID: 36343639 DOI: 10.1055/s-0042-1756437] [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: 11/09/2022]
Affiliation(s)
- Natasha Letunica
- Haematology, Murdoch Children's Research Institute, Melbourne, Australia
| | - Vasiliki Karlaftis
- Haematology, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Paul Monagle
- Haematology, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Clinical Haematology, Royal Children's Hospital, Melbourne, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Vera Ignjatovic
- Haematology, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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23
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Lee LYY, Suryadinata R, McCafferty C, Ignjatovic V, Purcell DFJ, Robinson P, Morton CJ, Parker MW, Anderson GP, Monagle P, Subbarao K, Neil JA. Heparin Inhibits SARS-CoV-2 Replication in Human Nasal Epithelial Cells. Viruses 2022; 14:v14122620. [PMID: 36560624 PMCID: PMC9785945 DOI: 10.3390/v14122620] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022] Open
Abstract
SARS-CoV-2 is the causative agent of the COVID-19 pandemic. Vaccination, supported by social and public health measures, has proven efficacious for reducing disease severity and virus spread. However, the emergence of highly transmissible viral variants that escape prior immunity highlights the need for additional mitigation approaches. Heparin binds the SARS-CoV-2 spike protein and can inhibit virus entry and replication in susceptible human cell lines and bronchial epithelial cells. Primary infection predominantly occurs via the nasal epithelium, but the nasal cell biology of SARS-CoV-2 is not well studied. We hypothesized that prophylactic intranasal administration of heparin may provide strain-agnostic protection for household contacts or those in high-risk settings against SARS-CoV-2 infection. Therefore, we investigated the ability of heparin to inhibit SARS-CoV-2 infection and replication in differentiated human nasal epithelial cells and showed that prolonged exposure to heparin inhibits virus infection. Furthermore, we establish a method for PCR detection of SARS-CoV-2 viral genomes in heparin-treated samples that can be adapted for the detection of viruses in clinical studies.
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Affiliation(s)
- Leo Yi Yang Lee
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Randy Suryadinata
- Department of Respiratory Medicine, Royal Children’s Hospital, Parkville, VIC 3052, Australia
- Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Conor McCafferty
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
- Haematology, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Vera Ignjatovic
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Damian F. J. Purcell
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Phil Robinson
- Department of Respiratory Medicine, Royal Children’s Hospital, Parkville, VIC 3052, Australia
- Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Craig J. Morton
- Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Michael W. Parker
- Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia
- St. Vincent’s Institute of Medical Research, Fitzroy, VIC 3065, Australia
| | - Gary P. Anderson
- Lung Health Research Centre, Department of Biochemistry and Pharmacology, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Paul Monagle
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
- Haematology, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Haematology, Royal Children’s Hospital, Parkville, VIC 3052, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Kanta Subbarao
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, VIC 3000, Australia
- Correspondence:
| | - Jessica A. Neil
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
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24
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Kovac M, Mitic G, Milenkovic M, Basaric D, Tomic B, Markovic O, Zdravkovic M, Ignjatovic V. Thrombosis risk assessment in patients with congenital thrombophilia during COVID - 19 infection. Thromb Res 2022; 218:151-156. [PMID: 36054979 PMCID: PMC9392558 DOI: 10.1016/j.thromres.2022.08.020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/10/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022]
Abstract
Background Coagulation dysfunction represents a serious complication in patients during the COVID-19 infection, while fulminant thrombotic complications emerge as critical issues in individuals with severe COVID-19. In addition to a severe clinical presentation, comorbidities and age significantly contribute to the development of thrombotic complications in this disease. However, there is very little data on association of congenital thrombophilia and thrombotic events in the setting of COVID-19. Our study aimed to evaluate the risk of COVID-19 associated thrombosis in patients with congenital thrombophilia. Methods This prospective, case-control study included patients with confirmed COVID-19 infection, followed 6 months post-confirmation. The final outcome was a symptomatic thrombotic event. In total, 90 COVID-19 patients, 30 with known congenital thrombophilia and 60 patients without thrombophilia within the period July 2020–November 2021, were included in the study. Evaluation of hemostatic parameters including FVIII activity and D-dimer was performed for all patients at 1 month, 3 months and 6 months post-COVID-19 diagnosis. Results Symptomatic thrombotic events were observed in 7 out of 30 (23 %) COVID-19 patients with thrombophilia, and 12 out of 60 (20 %) without thrombophilia, P = 0.715. In addition, the two patient groups had comparable localization of thrombotic events, time to thrombotic event, effect of antithrombotic treatment and changes in FVIII activity, while D-dimer level were significantly increased in patients without thrombophilia. Conclusion Our findings suggest that patients with congenital thrombophilia, irrespective of their age, a mild clinical picture and absence of comorbidities, should receive anticoagulant prophylaxis, adjusted based on the specific genetic defect.
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Affiliation(s)
- Mirjana Kovac
- Faculty of Medicine, University of Belgrade, Serbia; Blood Transfusion Institute of Serbia, Hemostasis Department, Belgrade, Serbia.
| | - Gorana Mitic
- Faculty of Medicine Novi Sad, University of Novi Sad, Serbia
| | - Marija Milenkovic
- Faculty of Medicine, University of Belgrade, Serbia; University Clinical Centre of Serbia, Belgrade, Serbia
| | - Dusica Basaric
- Blood Transfusion Institute of Serbia, Hemostasis Department, Belgrade, Serbia
| | - Branko Tomic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Olivera Markovic
- Faculty of Medicine, University of Belgrade, Serbia; University Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia
| | - Marija Zdravkovic
- Faculty of Medicine, University of Belgrade, Serbia; University Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Australia
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25
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McGrady ME, Todd K, Ignjatovic V, Jones S, Rizzi M, Luchtman-Jones L, Thornburg CD. Results of an international survey on adherence with anticoagulation in children, adolescents, and young adults: Communication from the ISTH SSC Subcommittee on Pediatric and Neonatal Thrombosis and Hemostasis. J Thromb Haemost 2022; 20:1720-1728. [PMID: 35427434 DOI: 10.1111/jth.15730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 08/31/2023]
Abstract
BACKGROUND The ISTH Scientific and Standardization Committee (SSC) Subcommittee on Pediatric/Neonatal Thrombosis and Hemostasis convened a working group on medication adherence to begin to understand the current state of clinical practice to inform priority areas for efforts to improve adherence for children, and adolescents and young adults (AYA) prescribed anticoagulants. OBJECTIVES We sought to survey an international group of clinicians involved in anticoagulation management in children and/or AYA about perceptions of medication on health outcomes, clinical practice related to medication adherence, and barriers to assessing and improving medication adherence. METHODS Clinicians involved in anticoagulation management in children and/or AYA were surveyed via REDCap® . Descriptive statistics were used to summarize demographic and clinical characteristics and responses to multiple choice and Likert-type questions. Free-text answers were coded based on the Behaviour Change Technique Taxonomy and the Expert Recommendations for Implement Change project. RESULTS AND CONCLUSIONS There were 200 participants, 90% of whom were pediatric hematology/oncology physicians. Based on the results, which demonstrate that clinicians are concerned about impact of poor medication adherence and have limited resources to identify and improve adherence, the working group has identified next steps to further understand impact of medication adherence on anticoagulation-related health outcomes, address the need for validated measures to assess medication adherence for all anticoagulants prescribed to this population, and develop an intervention and implementation research agenda to improve outcomes.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kevin Todd
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatric Hematology/Oncology, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
| | - Vera Ignjatovic
- Haematology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Sophie Jones
- Haematology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Clinical Haematology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Nursing, The University of Melbourne, Parkville, Victoria, Australia
| | - Mattia Rizzi
- Hematology/Oncology Unit, Division of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Lori Luchtman-Jones
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Courtney D Thornburg
- Division of Pediatric Hematology/Oncology, Rady Children's Hospital San Diego, San Diego, California, USA
- Department of Pediatrics, UC San Diego School of Medicine, La Jolla, California, USA
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26
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McCafferty C, Lee L, Cai T, Praporski S, Stolper J, Karlaftis V, Attard C, Myint D, Carey LM, Howells DW, Donnan GA, Davis S, Ma H, Crewther S, Nguyen VA, Van Den Helm S, Letunica N, Swaney E, Elliott D, Subbarao K, Ignjatovic V, Monagle P. Fibrin clot characteristics and anticoagulant response in a SARS‐CoV‐2‐infected endothelial model. eJHaem 2022; 3:326-334. [PMID: 35602246 PMCID: PMC9110985 DOI: 10.1002/jha2.407] [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] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022]
Abstract
Coronavirus disease 2019 (COVID‐19) patients have increased thrombosis risk. With increasing age, there is an increase in COVID‐19 severity. Additionally, adults with a history of vasculopathy have the highest thrombotic risk in COVID‐19. The mechanisms of these clinical differences in risk remain unclear. Human umbilical vein endothelial cells (HUVECs) were infected with SARS‐CoV‐2, influenza A/Singapore/6/86 (H1N1) or mock‐infected prior to incubation with plasma from healthy children, healthy adults or vasculopathic adults. Fibrin on surface of cells was observed using scanning electron microscopy, and fibrin characteristics were quantified. This experiment was repeated in the presence of bivalirudin, defibrotide, low‐molecular‐weight‐heparin (LMWH) and unfractionated heparin (UFH). Fibrin formed on SARS‐CoV‐2 infected HUVECs was densely packed and contained more fibrin compared to mock‐infected cells. Fibrin generated from child plasma was the thicker than fibrin generated in vasculopathic adult plasma (p = 0.0165). Clot formation was inhibited by LMWH (0.5 U/ml) and UFH (0.1–0.7 U/ml). We show that in the context of the SARS‐CoV‐2 infection on an endothelial culture, plasma from vasculopathic adults produces fibrin clots with thinner fibrin, indicating that the plasma coagulation system may play a role in determining the thrombotic outcome of SARS‐CoV‐2 infection. Heparinoid anticoagulants were most effective at preventing clot formation.
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Affiliation(s)
- Conor McCafferty
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
- Haematology Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Leo Lee
- Department of Microbiology and Immunology The Peter Doherty Institute for Infection and Immunity The University of Melbourne Melbourne Victoria Australia
| | - Tengyi Cai
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
- Haematology Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Slavica Praporski
- Haematology Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Julian Stolper
- Heart Regeneration Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Vasiliki Karlaftis
- Haematology Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Chantal Attard
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
- Haematology Murdoch Children's Research Institute Melbourne Victoria Australia
| | - David Myint
- TA Scientific Pty. Ltd. Taren Point Sydney New South Wales Australia
| | - Leeanne M. Carey
- Department of Occupational Therapy Social Work and Social Policy La Trobe University Melbourne Victoria Australia
- Neurorehabilitation and Recovery Florey Institute of Neuroscience and Mental Health University of Melbourne Melbourne Victoria Australia
| | - David W. Howells
- Tasmanian School of Medicine University of Tasmania Hobart Tasmania Australia
| | - Geoffrey A. Donnan
- Melbourne Brain Centre Royal Melbourne Hospital and University of Melbourne Melbourne Victoria Australia
| | - Stephen Davis
- Melbourne Brain Centre Royal Melbourne Hospital and University of Melbourne Melbourne Victoria Australia
| | - Henry Ma
- Department of Neurology and Stroke Monash Health Hospital Melbourne Victoria Australia
| | - Sheila Crewther
- Department of Psychology and Counselling La Trobe University Melbourne Victoria Australia
| | - Vinh A. Nguyen
- Department of Psychology and Counselling La Trobe University Melbourne Victoria Australia
| | - Suelyn Van Den Helm
- Haematology Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Natasha Letunica
- Haematology Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Ella Swaney
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
- Haematology Murdoch Children's Research Institute Melbourne Victoria Australia
| | - David Elliott
- Heart Regeneration Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Kanta Subbarao
- Department of Microbiology and Immunology The Peter Doherty Institute for Infection and Immunity The University of Melbourne Melbourne Victoria Australia
- WHO Collaborating Centre for Reference and Research on Influenza The Peter Doherty Institute for Infection and Immunity Melbourne Victoria Australia
| | - Vera Ignjatovic
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
- Haematology Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Paul Monagle
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
- Haematology Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Clinical Haematology The Royal Children's Hospital Melbourne Victoria Australia
- Kids Cancer Centre Sydney Children's Hospital Randwick New South Wales Australia
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27
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Drop J, Van Den Helm S, Monagle P, Wildschut E, de Hoog M, Gunput ST, Newall F, Dalton HJ, MacLaren G, Ignjatovic V, van Ommen CH. Coagulation in pediatric extracorporeal membrane oxygenation: A systematic review of studies shows lack of standardized reporting. Res Pract Thromb Haemost 2022; 6:e12687. [PMID: 35382349 PMCID: PMC8961047 DOI: 10.1002/rth2.12687] [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] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives Extracorporeal membrane oxygenation (ECMO) involves complex coagulation management and frequent hemostatic complications. ECMO practice between centers is variable. To compare results between coagulation studies, standardized definitions and clear documentation of ECMO practice is essential. We assessed how study population, outcome definitions, and ECMO‐, coagulation‐, and transfusion‐related parameters were described in pediatric ECMO studies. Data sources Embase, Medline, Web of Science, Cochrane Library and Google Scholar. Study selection English original studies of pediatric ECMO patients describing hemostatic tests or outcome. Data extraction Eligibility was assessed following PRISMA guidelines. Study population, outcome and ECMO‐, coagulation, and transfusion parameters were summarized. Data synthesis A total of 107 of 1312 records were included. Study population parameters most frequently included (gestational) age (79%), gender (60%), and (birth) weight (59%). Outcomes, including definitions of bleeding (29%), thrombosis (15%), and survival (43%), were described using various definitions. Description of pump type, oxygenator and cannulation mode occurred in 49%, 45%, and 36% of studies, respectively. The main coagulation test (53%), its reference ranges (49%), and frequency of testing (24%) were the most prevalent reported coagulation parameters. The transfusion thresholds for platelets, red blood cells, and fibrinogen were described in 27%, 18%, and 18% of studies, respectively. Conclusions This systematic review demonstrates a widespread lack of detail or standardization of several parameters in coagulation research of pediatric ECMO patients. We suggest several parameters that might be included in future coagulation studies. We encourage the ECMO community to adopt and refine this list of parameters and to use standardized definitions in future research.
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Affiliation(s)
- Joppe Drop
- Pediatric HematologyErasmus University Medical Center – Sophia Children’s HospitalRotterdamThe Netherlands
- Pediatric Intensive CareErasmus University Medical Center – Sophia Children’s HospitalRotterdamThe Netherlands
| | | | - Paul Monagle
- HematologyMurdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PediatricsThe University of MelbourneMelbourneVictoriaAustralia
- Department of Clinical HematologyThe Royal Children’s HospitalMelbourneVictoriaAustralia
- Kids Cancer CentreSydney Children’s HospitalSydneyNew South WalesAustralia
| | - Enno Wildschut
- Pediatric Intensive CareErasmus University Medical Center – Sophia Children’s HospitalRotterdamThe Netherlands
| | - Matthijs de Hoog
- Pediatric Intensive CareErasmus University Medical Center – Sophia Children’s HospitalRotterdamThe Netherlands
| | | | - Fiona Newall
- HematologyMurdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PediatricsThe University of MelbourneMelbourneVictoriaAustralia
- Department of Clinical HematologyThe Royal Children’s HospitalMelbourneVictoriaAustralia
| | - Heidi J. Dalton
- Department of PediatricsINOVA Heart and Vascular InstituteFalls ChurchVirginiaUSA
- Department of PediatricsVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Graeme MacLaren
- HematologyMurdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PediatricsThe University of MelbourneMelbourneVictoriaAustralia
- Department of Paediatric Intensive CareThe Royal Children's HospitalMelbourneVictoriaAustralia
- Cardiothoracic Intensive Care UnitNational University Health SystemSingapore CitySingapore
| | - Vera Ignjatovic
- HematologyMurdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PediatricsThe University of MelbourneMelbourneVictoriaAustralia
| | - C. Heleen van Ommen
- Pediatric HematologyErasmus University Medical Center – Sophia Children’s HospitalRotterdamThe Netherlands
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28
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Majek P, Sovova Z, Pecankova K, Cermak J, Gasova Z, Pecherkova P, Ignjatovic V, Dyr JE. Mass spectrometry, data re-analysis, and homology modelling predict posttranslational modifications of leucine-rich alpha-2-glycoprotein as a marker of myelodysplastic syndrome. Cancer Biomark 2022; 34:485-492. [PMID: 35275518 DOI: 10.3233/cbm-210033] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Leucine-rich alpha-2-glycoprotein (LRG) has been repeatedly proposed as a potential plasma biomarker for myelodysplastic syndrome (MDS). OBJECTIVE The goal of our work was to establish the total LRG plasma level and LRG posttranslational modifications (PTMs) as a suitable MDS biomarker. METHODS The total plasma LRG concentration was determined with ELISA, whilst the LRG-specific PTMs and their locations, were established using mass spectrometry and public mass spectrometry data re-analysis. Homology modelling and sequence analysis were used to establish the potential impact of PTMs on LRG functions via their impact on the LRG structure. RESULTS While the results showed that the total LRG plasma concentration is not a suitable MDS marker, alterations within two LRG sites correlated with MDS diagnosis (p= 0.0011). Sequence analysis and the homology model suggest the influence of PTMs within the two LRG sites on the function of this protein. CONCLUSIONS We report the presence of LRG proteoforms that correlate with diagnosis in the plasma of MDS patients. The combination of mass spectrometry, re-analysis of publicly available data, and homology modelling, represents an approach that can be used for any protein to predict clinically relevant protein sites for biomarker research despite the character of the PTMs being unknown.
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Affiliation(s)
- Pavel Majek
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Zofie Sovova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Klara Pecankova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Jaroslav Cermak
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Zdenka Gasova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Pavla Pecherkova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, Parkville Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville Victoria, Australia
| | - Jan E Dyr
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
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29
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Thomas M, Greaves RF, Tingay DG, Loh TP, Ignjatovic V, Newall F, Oeum M, Tran MTC, Rajapaksa AE. Current and emerging technologies for the timely screening and diagnosis of neonatal jaundice. Crit Rev Clin Lab Sci 2022; 59:332-352. [PMID: 35188857 DOI: 10.1080/10408363.2022.2038074] [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] [Indexed: 11/03/2022]
Abstract
Neonatal jaundice is one of the most common clinical conditions affecting newborns. For most newborns, jaundice is harmless, however, a proportion of newborns develops severe neonatal jaundice requiring therapeutic interventions, accentuating the need to have reliable and accurate screening tools for timely recognition across different health settings. The gold standard method in diagnosing jaundice involves a blood test and requires specialized hospital-based laboratory instruments. Despite technological advancements in point-of-care laboratory medicine, there is limited accessibility of the specialized devices and sample stability in geographically remote areas. Lack of suitable testing options leads to delays in timely diagnosis and treatment of clinically significant jaundice in developed and developing countries alike. There has been an ever-increasing need for a low-cost, simple to use screening technology to improve timely diagnosis and management of neonatal jaundice. Consequently, several point-of-care (POC) devices have been developed to address this concern. This paper aims to review the literature, focusing on emerging technologies in the screening and diagnosing of neonatal jaundice. We report on the challenges associated with the existing screening tools, followed by an overview of emerging sensors currently in pre-clinical development and the emerging POC devices in clinical trials to advance the screening of neonatal jaundice. The benefits offered by emerging POC devices include their ease of use, low cost, and the accessibility of rapid response test results. However, further clinical trials are required to overcome the current limitations of the emerging POC's before their implementation in clinical settings. Hence, the need for a simple to use, low-cost POC jaundice detection technology for newborns remains an unsolved challenge globally.
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Affiliation(s)
- Mercy Thomas
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Department of Nursing, Royal Children's Hospital, Melbourne, Australia
| | - Ronda F Greaves
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,Victorian Clinical Genetics Services, Melbourne, Australia.,International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy
| | - David G Tingay
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Neonatology, Royal Children's Hospital, Melbourne, Australia
| | - Tze Ping Loh
- International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy.,Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Vera Ignjatovic
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Hematology, Murdoch Children's Research Institute, Melbourne, Australia
| | - Fiona Newall
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Nursing, Royal Children's Hospital, Melbourne, Australia
| | - Michelle Oeum
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia
| | - Mai Thi Chi Tran
- International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy.,National Children's Hospital, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | - Anushi E Rajapaksa
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Think Project Global, Melbourne, Australia
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30
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Jurasz P, Ignjatovic V, Lordkipanidzé M. Editorial: Established and Novel Roles of Platelets in Health and Disease. Front Cardiovasc Med 2022; 9:835615. [PMID: 35174235 PMCID: PMC8841832 DOI: 10.3389/fcvm.2022.835615] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paul Jurasz
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Vera Ignjatovic
- Department of Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Marie Lordkipanidzé
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- *Correspondence: Marie Lordkipanidzé
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31
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Van Den Helm S, Yaw HP, Letunica N, Barton R, Weaver A, Newall F, Horton SB, Chiletti R, Johansen A, Best D, McKittrick J, Butt W, d'Udekem Y, MacLaren G, Linden MD, Ignjatovic V, Monagle P. Platelet Phenotype and Function Changes With Increasing Duration of Extracorporeal Membrane Oxygenation. Crit Care Med 2022; 50:1236-1245. [PMID: 35020670 DOI: 10.1097/ccm.0000000000005435] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate platelet pathophysiology associated with pediatric extracorporeal membrane oxygenation (ECMO). DESIGN Prospective observational study of neonatal and pediatric ECMO patients from September 1, 2016, to December 31, 2019. SETTING The PICU in a large tertiary referral pediatric ECMO center. PATIENTS Eighty-seven neonates and children (< 18 yr) supported by ECMO. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Arterial blood samples were collected on days 1, 2, and 5 of ECMO and were analyzed by whole blood flow cytometry. Corresponding clinical data for each patient was also recorded. A total of 87 patients were recruited (median age, 65 d; interquartile range [IQR], 7 d to 4 yr). The median duration of ECMO was 5 days (IQR, 3-8 d) with a median length of stay in PICU and hospital of 18 days (IQR, 10-29 d) and 35 days (IQR, 19-75 d), respectively. Forty-two patients (48%) had at least one major bleed according to a priori determined definitions, and 12 patients (14%) had at least one thrombotic event during ECMO. Platelet fibrinogen receptor expression decreased (median fluorescence intensity [MFI], 29,256 vs 26,544; p = 0.0005), while von Willebrand Factor expression increased (MFI: 7,620 vs 8,829; p = 0.0459) from day 2 to day 5 of ECMO. Platelet response to agonist, Thrombin Receptor Activator Peptide 6, also decreased from day 2 to day 5 of ECMO, as measured by binding with anti-P-selectin, PAC-1 (binds activated GPIIb/IIIa), and anti-CD63 monoclonal antibodies (P-selectin area under the curve [AUC]: 63.46 vs 42.82, respectively, p = 0.0022; PAC-1 AUC: 93.75 vs 74.46, p = 0.0191; CD63 AUC: 55.69 vs 41.76, p = 0.0020). CONCLUSIONS The loss of platelet response over time may contribute to bleeding during ECMO. These novel insights may be useful in understanding mechanisms of bleeding in pediatric ECMO and monitoring platelet markers clinically could allow for prediction or early detection of bleeding and thrombosis.
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Affiliation(s)
- Suelyn Van Den Helm
- Haematology, Murdoch Children's Research Institute, Melbourne, VIC, Australia. Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia. Department of Clinical Haematology, The Royal Children's Hospital, Melbourne, VIC, Australia. Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, VIC, Australia. Department of Intensive Care, The Royal Children's Hospital, Melbourne, VIC, Australia. Paediatric Intensive Care Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia. Department of Cardiac Surgery, Children's National Heart Institute, Washington, DC. Cardiothoracic Intensive Care Unit, National University Health System, Singapore. School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia. Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
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32
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Van Den Helm S, Sparks CN, Ignjatovic V, Monagle P, Attard C. Increased Risk for Thromboembolism After Fontan Surgery: Considerations for Thromboprophylaxis. Front Pediatr 2022; 10:803408. [PMID: 35419321 PMCID: PMC8996130 DOI: 10.3389/fped.2022.803408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
The Fontan circulation introduces an increased risk of thromboembolism which is associated with substantial mortality and morbidity. Adverse outcomes of thromboembolic complications post-Fontan surgery vary in both nature and severity, ranging from local tissue infarction and pulmonary embolism to Fontan failure and ischemic stroke. Furthermore, recent studies have identified that subclinical stroke is common yet underdiagnosed in Fontan patients. Fontan patients are commonly treated with antiplatelet agents and/or anticoagulants as primary thromboprophylaxis. Optimal thromboprophylaxis management in the Fontan population is still unclear, and clinical consensus remains elusive despite the growing literature on the subject. This perspective will describe the nature of thromboembolism post-Fontan surgery and provide evidence for the use of both current and emerging thromboprophylaxis options for children and adults living with Fontan circulation.
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Affiliation(s)
- Suelyn Van Den Helm
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Christopher Noel Sparks
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Anatomy and Physiology, The University of Melbourne, Melbourne, VIC, Australia
| | - Vera Ignjatovic
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Paul Monagle
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,Department of Haematology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Chantal Attard
- Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Anatomy and Physiology, The University of Melbourne, Melbourne, VIC, Australia
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33
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Letunica N, Van Den Helm S, Barton R, Weaver A, Karlaftis V, Monagle P, Ignjatovic V. The proportion of low and intermediate molecular weight von Willebrand Factor multimers are different in neonates and infants compared to adults. Thromb Haemost 2021; 122:1239-1242. [PMID: 34753190 DOI: 10.1055/a-1692-1199] [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: 10/19/2022]
Affiliation(s)
- Natasha Letunica
- Haematology Research, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Suelyn Van Den Helm
- Haematology Research, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Rebecca Barton
- Haematology Research, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Clinical Haematology, Royal Children's Hospital, Melbourne, Australia
| | - Asami Weaver
- Haematology Research, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Vasiliki Karlaftis
- Haematology Research, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Paul Monagle
- Haematology Research, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Clinical Haematology, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, Australia
| | - Vera Ignjatovic
- Haematology Research, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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34
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Letunica N, Van Den Helm S, McCafferty C, Swaney E, Cai T, Attard C, Karlaftis V, Monagle P, Ignjatovic V. Proteomics in Thrombosis and Haemostasis. Thromb Haemost 2021; 122:1076-1084. [PMID: 34753192 DOI: 10.1055/a-1690-8897] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
No Abstract.
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Affiliation(s)
- Natasha Letunica
- Haematology, Murdoch Childrens Research Institute, Parkville, Australia
| | | | - Conor McCafferty
- Haematology, Murdoch Childrens Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Ella Swaney
- Haematology, Murdoch Childrens Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Tengyi Cai
- Haematology, Murdoch Childrens Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Chantal Attard
- Haematology, Murdoch Childrens Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Vasiliki Karlaftis
- Haematology, Murdoch Childrens Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Paul Monagle
- Haematology, Murdoch Childrens Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Clinical Haematology, The Royal Children's Hospital Melbourne, Parkville, Australia.,Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, Australia
| | - Vera Ignjatovic
- Haematology, Murdoch Childrens Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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35
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Neeland MR, Bannister S, Clifford V, Nguyen J, Dohle K, Overmars I, Toh ZQ, Anderson J, Donato CM, Sarkar S, Do LAH, McCafferty C, Licciardi PV, Ignjatovic V, Monagle P, Bines JE, Mulholland K, Curtis N, McNab S, Steer AC, Burgner DP, Saffery R, Tosif S, Crawford NW. Children and Adults in a Household Cohort Study Have Robust Longitudinal Immune Responses Following SARS-CoV-2 Infection or Exposure. Front Immunol 2021; 12:741639. [PMID: 34721408 PMCID: PMC8548628 DOI: 10.3389/fimmu.2021.741639] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Children have reduced severity of COVID-19 compared to adults and typically have mild or asymptomatic disease. The immunological mechanisms underlying these age-related differences in clinical outcomes remain unexplained. Here, we quantify 23 immune cell populations in 141 samples from children and adults with mild COVID-19 and their PCR-negative close household contacts at acute and convalescent time points. Children with COVID-19 displayed marked reductions in myeloid cells during infection, most prominent in children under the age of five. Recovery from infection in both children and adults was characterised by the generation of CD8 TCM and CD4 TCM up to 9 weeks post infection. SARS-CoV-2-exposed close contacts also had immunological changes over time despite no evidence of confirmed SARS-CoV-2 infection on PCR testing. This included an increase in low-density neutrophils during convalescence in both exposed children and adults, as well as increases in CD8 TCM and CD4 TCM in exposed adults. In comparison to children with other common respiratory viral infections, those with COVID-19 had a greater change in innate and T cell-mediated immune responses over time. These findings provide new mechanistic insights into the immune response during and after recovery from COVID-19 in both children and adults.
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Affiliation(s)
- Melanie R Neeland
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Samantha Bannister
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Infectious Diseases Unit, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Vanessa Clifford
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Infectious Diseases Unit, The Royal Children's Hospital, Parkville, VIC, Australia.,Laboratory Services, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Jill Nguyen
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Kate Dohle
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Isabella Overmars
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Zheng Quan Toh
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Jeremy Anderson
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Celeste M Donato
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Sohinee Sarkar
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Lien Anh Ha Do
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Conor McCafferty
- Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Paul V Licciardi
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Vera Ignjatovic
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Paul Monagle
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Clinical Haematology, The Royal Children's Hospital, Parkville, VIC, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Julie E Bines
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, VIC, Australia
| | - Kim Mulholland
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Infectious Diseases Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nigel Curtis
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Infectious Diseases Unit, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Sarah McNab
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, VIC, Australia
| | - Andrew C Steer
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Infectious Diseases Unit, The Royal Children's Hospital, Parkville, VIC, Australia
| | - David P Burgner
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Infectious Diseases Unit, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Richard Saffery
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Shidan Tosif
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Department of General Medicine, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Nigel W Crawford
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Department of General Medicine, The Royal Children's Hospital, Parkville, VIC, Australia
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36
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Deutsch EW, Omenn GS, Sun Z, Maes M, Pernemalm M, Palaniappan KK, Letunica N, Vandenbrouck Y, Brun V, Tao SC, Yu X, Geyer PE, Ignjatovic V, Moritz RL, Schwenk JM. Advances and Utility of the Human Plasma Proteome. J Proteome Res 2021; 20:5241-5263. [PMID: 34672606 PMCID: PMC9469506 DOI: 10.1021/acs.jproteome.1c00657] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The study of proteins circulating in blood offers tremendous opportunities to diagnose, stratify, or possibly prevent diseases. With recent technological advances and the urgent need to understand the effects of COVID-19, the proteomic analysis of blood-derived serum and plasma has become even more important for studying human biology and pathophysiology. Here we provide views and perspectives about technological developments and possible clinical applications that use mass-spectrometry(MS)- or affinity-based methods. We discuss examples where plasma proteomics contributed valuable insights into SARS-CoV-2 infections, aging, and hemostasis and the opportunities offered by combining proteomics with genetic data. As a contribution to the Human Proteome Organization (HUPO) Human Plasma Proteome Project (HPPP), we present the Human Plasma PeptideAtlas build 2021-07 that comprises 4395 canonical and 1482 additional nonredundant human proteins detected in 240 MS-based experiments. In addition, we report the new Human Extracellular Vesicle PeptideAtlas 2021-06, which comprises five studies and 2757 canonical proteins detected in extracellular vesicles circulating in blood, of which 74% (2047) are in common with the plasma PeptideAtlas. Our overview summarizes the recent advances, impactful applications, and ongoing challenges for translating plasma proteomics into utility for precision medicine.
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Affiliation(s)
- Eric W Deutsch
- Institute for Systems Biology, Seattle, Washington 98109, United States
| | - Gilbert S Omenn
- Institute for Systems Biology, Seattle, Washington 98109, United States.,Departments of Computational Medicine & Bioinformatics, Internal Medicine, and Human Genetics and School of Public Health, University of Michigan, Ann Arbor, Michigan 48109-2218, United States
| | - Zhi Sun
- Institute for Systems Biology, Seattle, Washington 98109, United States
| | - Michal Maes
- Institute for Systems Biology, Seattle, Washington 98109, United States
| | - Maria Pernemalm
- Department of Oncology and Pathology/Science for Life Laboratory, Karolinska Institutet, 171 65 Stockholm, Sweden
| | | | - Natasha Letunica
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Victoria, Australia
| | - Yves Vandenbrouck
- Université Grenoble Alpes, CEA, Inserm U1292, Grenoble 38000, France
| | - Virginie Brun
- Université Grenoble Alpes, CEA, Inserm U1292, Grenoble 38000, France
| | - Sheng-Ce Tao
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, B207 SCSB Building, 800 Dongchuan Road, Shanghai 200240, China
| | - Xiaobo Yu
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences-Beijing (PHOENIX Center), Beijing Institute of Lifeomics, Beijing 102206, China
| | - Philipp E Geyer
- OmicEra Diagnostics GmbH, Behringstr. 6, 82152 Planegg, Germany
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Victoria, Australia
| | - Robert L Moritz
- Institute for Systems Biology, Seattle, Washington 98109, United States
| | - Jochen M Schwenk
- Affinity Proteomics, Science for Life Laboratory, Department of Protein Science, KTH Royal Institute of Technology, Tomtebodavägen 23, SE-171 65 Solna, Sweden
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37
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Monagle P, Ng AP, Linden M, Ignjatovic V, Farley A, Taoudi S, Pasricha SR, Torresi J. Vaccine-induced immune thrombosis and thrombocytopenia syndrome following adenovirus-vectored severe acute respiratory syndrome coronavirus 2 vaccination: a novel hypothesis regarding mechanisms and implications for future vaccine development. Immunol Cell Biol 2021; 99:1006-1010. [PMID: 34664303 PMCID: PMC8652900 DOI: 10.1111/imcb.12505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 01/02/2023]
Abstract
We hypothesize that thrombosis with thrombocytopenia syndrome recently described after administration of adenovirus‐vectored vaccines for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) occurs as a result of the unique properties of the adenovirus vectors, which can have widespread biodistribution throughout the body. The antigen is delivered to megakaryocyte cells, which act as part of the primary immune system and distribute the antigen within progeny platelets, also a key component of the immune system. The interaction of the antigen induces preformed antiplatelet factor 4 (PF4) antibodies to bind to PF4–heparan sulfate complexes in the absence of exogenous heparin, at sites where the heparan sulfate concentration in the vascular glycocalyx is optimal for complex formation, causing thrombosis and thrombocytopenia as observed clinically. This hypothesis is testable in cell culture and animal models, and potentially in vivo, and if proven correct has significant implications for vaccine development and our understanding of the links between the coagulation and immune systems.
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Affiliation(s)
- Paul Monagle
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,Department of Clinical Haematology, Royal Children's Hospital, Melbourne, VIC, Australia.,Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ashley P Ng
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Matthew Linden
- School of Biomedical Science, University of Western Australia, Crawley, WA, Australia
| | - Vera Ignjatovic
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Haematology Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Alison Farley
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
| | - Samir Taoudi
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
| | - Sant Rayn Pasricha
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Joseph Torresi
- Department of Microbiology and Immunology, Peter Doherty Institute, The University of Melbourne, VIC, Australia
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38
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Shapiro JS, Takagi M, Silk T, Anderson N, Clarke C, Davis GA, Hearps SJ, Ignjatovic V, Rausa V, Seal ML, Babl FE, Anderson V. No Evidence of a Difference in Susceptibility-Weighted Imaging Lesion Burden or Functional Network Connectivity between Children with Typical and Delayed Recovery Two Weeks Post-Concussion. J Neurotrauma 2021; 38:2384-2390. [PMID: 33823646 PMCID: PMC8881952 DOI: 10.1089/neu.2021.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Susceptibility weighted imaging (SWI) and resting state functional magnetic resonance imaging have been highlighted as two novel neuroimaging modalities that have been underutilized when attempting to predict whether a child with concussion will recover normally or have a delayed recovery course. This study aimed to investigate whether there was a difference between children who recover normally from a concussion and children with delayed recovery in terms of SWI lesion burden and resting state network makeup. Forty-one children who presented to the emergency department of a tertiary level pediatric hospital with concussion participated in this study as a part of a larger prospective, longitudinal observational cohort study into concussion assessment and recovery. Children underwent neuroimaging 2 weeks post-injury and were classified as either normally recovering (n = 27), or delayed recovering (n = 14) based on their post-concussion symptoms at 2 weeks post-injury. No participants showed lesions detected using SWI; therefore, no group differences could be assessed. No between-group resting state network differences were uncovered using dual regression analysis. These findings, alongside previously published work, suggest that potential causes of delayed recovery from concussion may not be found using current neuroimaging paradigms.
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Affiliation(s)
- Jesse S. Shapiro
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Monash School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Monash School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Tim Silk
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gavin A. Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Vera Ignjatovic
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Vanessa Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Marc L. Seal
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Franz E. Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
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39
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Sezgin G, Li L, Westbrook J, Wearne E, Azar D, McLeod A, Pearce C, Ignjatovic V, Monagle P, Georgiou A. Influence of serum iron test results on the diagnosis of iron deficiency in children: a retrospective observational study. BMJ Open 2021; 11:e046865. [PMID: 34226221 PMCID: PMC8258555 DOI: 10.1136/bmjopen-2020-046865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Serum iron results are not indicative of iron deficiency yet may be incorrectly used to diagnose iron deficiency instead of serum ferritin results. Our objective was to determine the association between serum iron test results and iron-deficiency diagnosis in children by general practitioners. DESIGN, SETTING, PATIENTS AND MAIN OUTCOME MEASURES A retrospective observational study of 14 187 children aged 1-18 years with serum ferritin and serum iron test results from 137 general practices in Victoria, Australia, between 2008 and 2018. Generalised estimating equation models calculating ORs were used to determine the association between serum iron test results (main exposure measure) and iron-deficiency diagnosis (outcome measure) in the following two population groups: (1) iron-deplete population, defined as having a serum ferritin <12 µg/L if aged <5 years and <15 µg/L if aged ≥5 years and (2) iron-replete population, defined as having a serum ferritin >30 µg/L. RESULTS 3484 tests were iron deplete and 15 528 were iron replete. Iron-deplete children were less likely to be diagnosed with iron deficiency if they had normal serum iron levels (adjusted OR (AOR): 0.73; 95% CI 0.57 to 0.96). Iron-replete children had greater odds of an iron-deficiency diagnosis if they had low serum iron results (AOR: 2.59; 95% CI 1.72 to 3.89). Other contributors to an iron-deficiency diagnosis were female sex and having anaemia. CONCLUSION Serum ferritin alone remains the best means of diagnosing iron deficiency. Reliance on serum iron test results by general practitioners is leading to significant overdiagnosis and underdiagnosis of iron deficiency in children.
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Affiliation(s)
- Gorkem Sezgin
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Ling Li
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Elisabeth Wearne
- Gippsland Primary Health Network, Traralgon, Victoria, Australia
| | - Denise Azar
- Gippsland Primary Health Network, Traralgon, Victoria, Australia
| | - Adam McLeod
- Outcome Health, Burwood, Victoria, Australia
| | | | - Vera Ignjatovic
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Paul Monagle
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - A Georgiou
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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40
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McCafferty C, Van Den Helm S, Letunica N, Attard C, Karlaftis V, Cai T, Praporski S, Swaney E, Burgner D, Neeland M, Dohle K, Crawford NW, Clucas L, Tosif S, Ignjatovic V, Monagle P. Increased platelet activation in SARS-CoV-2 infected non-hospitalised children and adults, and their household contacts. Br J Haematol 2021; 195:90-94. [PMID: 34101171 PMCID: PMC8239564 DOI: 10.1111/bjh.17629] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Conor McCafferty
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | | | - Chantal Attard
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Tengyi Cai
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Ella Swaney
- Murdoch Children's Research Institute, Melbourne, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Australia.,Department of General Medicine, Royal Children's Hospital, Parkville, Australia
| | - Melanie Neeland
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Kate Dohle
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Nigel W Crawford
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of General Medicine, Royal Children's Hospital, Parkville, Australia
| | - Luisa Clucas
- Department of Haematology, Royal Children's Hospital, Parkville, Australia.,Immunisation Service, Royal Children's Hospital, Parkville, Australia
| | - Shidan Tosif
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of General Medicine, Royal Children's Hospital, Parkville, Australia
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Paul Monagle
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Haematology, Royal Children's Hospital, Parkville, Australia
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41
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Daems JJN, Attard C, Van Den Helm S, Breur J, D'Udekem Y, du Plessis K, Wilson TG, Winlaw D, Gentles TL, Monagle P, Ignjatovic V. Cross-sectional assessment of haemostatic profile and hepatic dysfunction in Fontan patients. Open Heart 2021; 8:openhrt-2020-001460. [PMID: 33972403 PMCID: PMC8112412 DOI: 10.1136/openhrt-2020-001460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/24/2020] [Accepted: 02/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background Fontan-associated liver disease is accompanied by a hypercoagulable state. While hepatic dysfunction in Fontan patients is common, its relationship with haemostatic changes and clinical outcomes in this patient population remains unclear. Objective To correlate liver dysfunction and haemostatic profiles with clinical outcomes in the Fontan population. Patients/methods Patients were enrolled in a multicentre, cross-sectional study in Australia and New Zealand. Hepatic structure and function were assessed using serum-based calculations (Fibrotest and model for end-stage liver disease excluding international normalised ratio scores). Haemostatic profiles were assessed by Thrombin Generation. Platelet function was assessed via Platelet Factor 4 (PF4) and P-selectin (P-SEL). Clinical outcomes were obtained from the Australian and New Zealand Fontan Registry. Results Seventy-three patients participated in the study (mean age 18.9±8.5 years with a mean of 13.5±6.9 years post-Fontan). The Endogenous Thrombin Potential (ETP) for patients who suffered thrombotic events (TE) (1366.4±66.2 nM/min) was higher compared with patients with major bleeding events (1011.1±138.4 nM/min) (p=0.03). Except for a negative correlation between Fibrotest-score and PF4 (p=0.045), PF4 and P-SEL concentrations did not correlate with markers of hepatic dysfunction or structural abnormality. Conclusions Increased ETP is associated with TE during clinical follow-up after Fontan. This study reinforces that hepatic dysfunction may contribute to the derangement of coagulation factors, impacting the individual risk of haemostatic complications for the Fontan population.
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Affiliation(s)
| | - Chantal Attard
- Heamatology Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Suelyn Van Den Helm
- Heamatology Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Johannes Breur
- Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Yves D'Udekem
- Heart Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Karin du Plessis
- Paediatrics, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Thomas G Wilson
- Heart Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - David Winlaw
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Cardiothoracic Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Thomas L Gentles
- Paediatric and Congenital Cardiology, Starship Childrens Hospital, Auckland, New Zealand
| | - Paul Monagle
- Heamatology Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Paediatrics and Clinical Hematology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Vera Ignjatovic
- Heamatology Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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42
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Letunica N, Cai T, Cameron F, Monagle P, Ignjatovic V, Attard C. Investigating potential protein markers of cardiovascular disease in children with type 1 diabetes mellitus. Proteomics Clin Appl 2021; 15:e2000060. [PMID: 33587825 DOI: 10.1002/prca.202000060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/01/2020] [Accepted: 12/17/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is a metabolic disease characterized by dysglycaemia. Cardiovascular disease (CVD) is a major complication among T1DM patients and the leading cause of mortality later in life. METHODS The study subjects consisted of T1DM children with poor glycemic control (HbA1c > 7.5%) and healthy age and gender matched controls. Venous blood samples were collected and tested by utilizing a novel immunoassay panel with 96 protein biomarkers. Data were analyzed using non-linear regression analysis and the expression of biomarkers was compared between T1DM and healthy control groups using an unpaired student's t-test. Dynamic principal component analysis (PCA) was operated based on the differentially expressed proteins. RESULTS Ten T1DM children and 10 healthy controls were analyzed. Twelve CVD markers show significant differential expression between T1DM patients and healthy controls (p < 0.05). Dynamic PCA clustering based on differentially expressed proteins demonstrated an obvious clustering between the two populations. CONCLUSIONS This preliminary study reveals the feasibility of utilizing a novel immunoassay panel to investigate potential biomarkers for predicting incipient CVD in children with T1DM. In future, longitudinal studies are required to track the relationships between measurements of the selected protein markers and the development of CVD in T1DM patients.
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Affiliation(s)
- Natasha Letunica
- Haematology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Tengyi Cai
- Haematology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Fergus Cameron
- Haematology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, Australia.,Department of Endocrinology and Diabetes and Centre for Hormone Research, Royal Children's Hospital, Parkville, Australia
| | - Paul Monagle
- Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, Australia.,Department of Clinical Haematology, Royal Children's Hospital, Parkville, Australia
| | - Vera Ignjatovic
- Haematology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, Australia
| | - Chantal Attard
- Haematology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, Australia
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Crichton A, Ignjatovic V, Babl FE, Oakley E, Greenham M, Hearps S, Delzoppo C, Beauchamp MH, Guerguerian AM, Boutis K, Hubara E, Hutchison J, Anderson V. Interleukin-8 Predicts Fatigue at 12 Months Post-Injury in Children with Traumatic Brain Injury. J Neurotrauma 2021; 38:1151-1163. [PMID: 31880977 DOI: 10.1089/neu.2018.6083] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/23/2022] Open
Abstract
Despite many children experiencing fatigue after childhood brain injury, little is known about the predictors of this complaint. To date, traditional indices of traumatic brain injury (TBI) severity have not predicted reliably persisting fatigue (up to three years post-injury). This study aimed to establish whether persisting fatigue is predicted by serum biomarker concentrations in child TBI. We examined whether acute serum biomarker expression would improve prediction models of 12-month fatigue based on injury severity. Blood samples were collected from 87 children (1-17 years at injury) sustaining mild to severe TBI (Glasgow Coma Scale [GCS] range 3-15; mean 12.43; classified as mild TBI [n = 50, 57%] vs. moderate/severe TBI [n = 37, 43%]), and presenting to the emergency departments (ED) and pediatric intensive care units (PICU) at one of three tertiary pediatric hospitals (Royal Children's Hospital (RCH); Hospital for Sick Children (HSC), Toronto; St Justine Children's Hospital (SJH), Montreal). Six serum biomarker concentrations were measured within 24 h of injury (interleukin-6, interleukin-8 [IL-8], soluble vascular cell adhesion molecule [SVCAM], S100 calcium binding protein B [S100B], neuron specific enolase [NSE], and soluble neural cell adhesion molecule [sNCAM]). Fatigue at 12 months post-injury was measured using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (parent report), classified as present/absent using previously derived cut-points. At 12 months post-injury, 22% of participants experienced fatigue. A model including IL-8 was the best serum biomarker for estimating the probability of children experiencing fatigue at 12 months post-injury. The IL-8 also significantly improved predictive models of fatigue based on severity.
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Affiliation(s)
- Alison Crichton
- Murdoch Children's Research Institute, Melbourne, Australia.,Monash University Faculty of Medicine Nursing and Health Sciences, School of Clinical Sciences, The Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Ed Oakley
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Mardee Greenham
- Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Stephen Hearps
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Carmel Delzoppo
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Canada.,Research Center, Ste-Justine Hospital, Montreal, Canada
| | - Anne-Marie Guerguerian
- Critical Care Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada.,Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute, Toronto, Canada.,The Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | - Kathy Boutis
- Paediatric Emergency Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Evyatar Hubara
- Critical Care Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Jamie Hutchison
- Critical Care Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada.,Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute, Toronto, Canada.,The Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
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Letunica N, Cai T, Cheong JLY, Doyle LW, Monagle P, Ignjatovic V. The use of proteomics for blood biomarker research in premature infants: a scoping review. Clin Proteomics 2021; 18:13. [PMID: 33853516 PMCID: PMC8048323 DOI: 10.1186/s12014-021-09316-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/18/2021] [Indexed: 12/18/2022] Open
Abstract
Over the last decade, the use of proteomics in the setting of prematurity has increased and has enabled researchers to successfully identify biomarkers for an array of associated morbidities. The objective of this scoping review was to identify the existing literature, as well as any knowledge gaps related to proteomic biomarker discoveries in the setting of prematurity. A scoping review was conducted using PubMed, Embase and Medline databases following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The study selection process yielded a total of 700 records, of which 13 studies were included in this review. Most studies used a tandem Mass Spectrometry (MS/MS) proteomics approach to identify key biomarkers. The corresponding studies identified proteins associated with retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotising enterocolitis (NEC), late onset sepsis (LOS) and gestational age. This scoping review demonstrates the limited use of proteomics to identify biomarkers associated with severe complications of prematurity. Further research is warranted to identify biomarkers of other important morbidities associated with prematurity, such as intraventricular haemorrhage (IVH) and cerebral palsy, and to investigate the mechanisms associated with these outcomes.
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Affiliation(s)
- Natasha Letunica
- Haematology Research Laboratory, Murdoch Children's Research Institute, Parkville, Australia
| | - Tengyi Cai
- Haematology Research Laboratory, Murdoch Children's Research Institute, Parkville, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Study (VIBeS), Murdoch Children's Research Institute, Parkville, Australia.,Department of Obstetrics and Gynecology, The Royal Women's Hospital, Parkville, Australia.,Newborn Research, The Royal Women's Hospital, Parkville, Australia
| | - Lex W Doyle
- Victorian Infant Brain Study (VIBeS), Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Australia.,Department of Obstetrics and Gynecology, The Royal Women's Hospital, Parkville, Australia.,Newborn Research, The Royal Women's Hospital, Parkville, Australia
| | - Paul Monagle
- Haematology Research Laboratory, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Australia.,Department of Clinical Haematology, Royal Children's Hospital, Parkville, Australia
| | - Vera Ignjatovic
- Haematology Research Laboratory, Murdoch Children's Research Institute, Parkville, Australia. .,Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Australia.
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45
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Lesmana A, Tian P, Karlaftis V, Hearps S, Monagle P, Ignjatovic V, Elwood N. Continuous reference intervals for leukocyte telomere length in children: the method matters. Clin Chem Lab Med 2021; 59:1279-1288. [PMID: 33711214 DOI: 10.1515/cclm-2021-0059] [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: 01/13/2021] [Accepted: 02/25/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Children with very short telomeres commonly develop bone marrow failure and other severe diseases. Identifying the individuals with short telomeres can improve outcome of bone marrow transplantation, with accurate diagnosis requiring the use of age-matched reference intervals (RIs). This study aimed to establish RIs for telomere length (TL) in children using three commonly used methods for TL measurement. METHODS Healthy children aged 30 days to 18 years were recruited for assessment using age as a continuous variable. Venous blood samples were collected and leukocyte TL was measured using terminal restriction fragment (TRF) analysis, quantitative PCR (QPCR) and flow cytometry with fluorescence in situ hybridization (Flow-FISH). Fractional polynomial model and quantile regression were performed to generate continuous RIs. Factors that might contribute to variation in TL, such as gender, were also examined. RESULTS A total of 212 samples were analyzed. Continuous RIs are presented as functions of age. TRF analysis and QPCR showed significant negative correlation between TL and age (r=-0.28 and r=-0.38, p<0.001). In contrast, Flow-FISH showed no change in TL with age (r=-0.08, p=0.23). Gender did not have significant influence on TL in children. CONCLUSIONS This study provides three options to assess TL in children by establishing method-specific continuous RIs. Choosing which method to use will depend on several factors such as amount and type of sample available and required sensitivity to age-related change.
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Affiliation(s)
- Analia Lesmana
- Murdoch Children's Research Institute, Parkville, Australia
| | - Pei Tian
- Murdoch Children's Research Institute, Parkville, Australia
| | - Vasiliki Karlaftis
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Stephen Hearps
- Murdoch Children's Research Institute, Parkville, Australia
| | - Paul Monagle
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,The Royal Children's Hospital, Parkville, Australia
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Ngaire Elwood
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
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Thomas M, Hardikar W, Greaves RF, Tingay DG, Loh TP, Ignjatovic V, Newall F, Rajapaksa AE. Mechanism of bilirubin elimination in urine: insights and prospects for neonatal jaundice. Clin Chem Lab Med 2021; 59:1025-1033. [PMID: 33554547 DOI: 10.1515/cclm-2020-1759] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 11/26/2020] [Accepted: 12/22/2020] [Indexed: 11/15/2022]
Abstract
Despite a century of research, bilirubin metabolism and the transport mechanisms responsible for homeostasis of bilirubin in serum remain controversial. Emerging evidence on the hepatic membrane transporters and inherited disorders of bilirubin metabolism have contributed to a greater understanding of the various steps involved in bilirubin homeostasis and its associated excretory pathways. We discuss these recent research findings on hepatic membrane transporters and evaluate their significance on the newborn bilirubin metabolism and excretion. New insights gained speculate that a proportion of conjugated bilirubin is excreted via the renal system, as an alternative to the intestinal excretion, even in normal physiological jaundice with no associated pathological concerns. Finally, this paper discusses the clinical relevance of targeting the altered renal excretory pathway, as bilirubin in urine may hold diagnostic importance in screening for neonatal jaundice.
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Affiliation(s)
- Mercy Thomas
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Nursing, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Winita Hardikar
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Gastroenterology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Ronda F Greaves
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - David G Tingay
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Victoria, Australia.,Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Vera Ignjatovic
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Haematology Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Fiona Newall
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Nursing, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anushi E Rajapaksa
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Victoria, Australia
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Attard C, Monagle PT, d'Udekem Y, Mackay MT, Briody J, Cordina R, Hassan EB, Simm P, Rice K, Ignjatovic V. Long-term outcomes of warfarin versus aspirin after Fontan surgery. J Thorac Cardiovasc Surg 2021; 162:1218-1228.e3. [PMID: 33563422 DOI: 10.1016/j.jtcvs.2020.12.102] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/27/2020] [Accepted: 12/21/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Because of the nature of the Fontan physiology, patients are at an increased risk of thromboembolic complications. As such, warfarin or aspirin is generally prescribed lifelong for thromboprophylaxis. This study aimed to compare long-term rates of cerebrovascular injury, thrombosis, bleeding, bone mineral density, and quality of life in people living with Fontan circulation receiving warfarin compared with aspirin. METHODS This was a multicenter study of a selected cohort from the Australia and New Zealand Fontan population. Participants underwent cerebral magnetic resonance imaging to detect the presence of cerebrovascular injury (n = 84) and dual-energy X-ray absorptiometry to assess bone mineral density (n = 120). Bleeding (n = 100) and quality of life (n = 90) were assessed using validated questionnaires: Warfarin and Aspirin Bleeding assessment tool and Pediatric Quality of Life Inventory, respectively. RESULTS Stroke was detected in 33 participants (39%), with only 7 (6%) being clinically symptomatic. There was no association between stroke and Fontan type or thromboprophylaxis type. Microhemorrhage and white matter injury were detected in most participants (96% and 86%, respectively), regardless of thromboprophylaxis type. Bleeding rates were high in both groups; however, bleeding was more frequent in the warfarin group. Bone mineral density was reduced in our cohort compared with the general population; however, this was further attenuated in the warfarin group. Quality of life was similar between the warfarin and aspirin groups. Home international normalized ratio monitoring was associated with better quality of life scores in the warfarin group. CONCLUSIONS Cerebrovascular injury is a frequent occurrence in the Australia and New Zealand Fontan population regardless of thromboprophylaxis type. No benefit of long-term warfarin prophylaxis could be demonstrated over aspirin; however, consideration must be given to important clinical features such as cardiac function and lung function. Furthermore, the association of reduced bone health in children receiving warfarin warrants further mechanistic studies.
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Affiliation(s)
- Chantal Attard
- Murdoch Children's Research Institute, Parkville, Australia; The University of Melbourne, Parkville, Australia.
| | - Paul T Monagle
- Murdoch Children's Research Institute, Parkville, Australia; The University of Melbourne, Parkville, Australia; The Royal Children's Hospital, Parkville, Australia
| | - Yves d'Udekem
- Murdoch Children's Research Institute, Parkville, Australia; The University of Melbourne, Parkville, Australia; The Royal Children's Hospital, Parkville, Australia
| | - Mark T Mackay
- Murdoch Children's Research Institute, Parkville, Australia; The University of Melbourne, Parkville, Australia; The Royal Children's Hospital, Parkville, Australia
| | - Julie Briody
- Nuclear Medicine, The Children's Hospital at Westmead, Westmead, Australia; The University of Sydney Children's Hospital, Westmead Clinical School, Westmead, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Faculty of Medicine and Health Sciences, University of Sydney, Sydney, Australia
| | - Ebrahim Bani Hassan
- Australian Institute for Musculoskeletal Science, The University of Melbourne and Western Health, Melbourne, Australia; Department of Medicine-Western Health, The University of Melbourne, Melbourne, Australia
| | - Peter Simm
- Murdoch Children's Research Institute, Parkville, Australia; The Royal Children's Hospital, Parkville, Australia; Department of Paediatric Endocrinology and Diabetes, Monash Children's Hospital, Clayton, Australia
| | - Kathryn Rice
- Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, Parkville, Australia; The University of Melbourne, Parkville, Australia
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Vukomanovic V, Matovic M, Djukic A, Ignjatovic V, Vuleta K, Djukic S, Simic Vukomanovic I. THE ROLE OF TUMOR-SEEKING RADIOPHARMACEUTICALS IN THE DIAGNOSIS AND MANAGEMENT OF ADRENAL TUMORS. Acta Endocrinol (Buchar) 2020; 16:316-323. [PMID: 33363653 DOI: 10.4183/aeb.2020.316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Context The variety of tumor-seeking radiopharmaceuticals, which are currently in clinical use, may have a potential role as imaging agents for adrenal gland tumors, due to physiological characteristics of this organ. Objective The purpose of this study was to evaluate the diagnostic potential of 99mTc-HYNIC-TOC, 99mTc(V)-DMSA, and 99mTc-MIBI in the assessment of adrenal tumors, by correlating with imaging findings and histopathologic results. Design The research is designed as a cross-sectional prospective study. Patients and method The study included 50 patients with adrenal tumors (19 hormone-secreting and 31 nonfunctioning) and 23 controls without adrenal involvement. In all patients, single-photon emission computed tomography (SPECT) was performed, using qualitative and semiquantitative analysis. The tumor to non-tumor tracer uptake was conducted by using a region-of-interest technique. Adrenal to background (A/B) ratio was calculated in all cases. Results 99mTc-HYNIC-TOC scintigraphy showed a high statistical significance between A/B ratios, while other two tracers resulted in a lower sensitivity, specificity and accuracy. Futhermore, 99mTc-HYNIC-TOC could have a high diagnostic yield to detect adrenal tumors (the receiver-operating-characteristic curve analysis, A/B ratio cut-off value of 8.40). Conclusion A semiquantitative SPECT analysis showed that 99mTc-HYNIC-TOC is a highly sensitive tumor-seeking agent for the accurate localization of adrenal tumors.
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Affiliation(s)
- V Vukomanovic
- Clinical Center Kragujevac - Nuclear Medicine Department, University of Kragujevac, Faculty of Medical Sciences - Kragujevac, Serbia.,Department of Nuclear Medicine and Oncology, Kragujevac, Serbia
| | - M Matovic
- Clinical Center Kragujevac - Nuclear Medicine Department, University of Kragujevac, Faculty of Medical Sciences - Kragujevac, Serbia
| | - A Djukic
- Clinical Center Kragujevac - Nuclear Medicine Department, University of Kragujevac, Faculty of Medical Sciences - Kragujevac, Serbia.,Department of Pathophysiology, Kragujevac, Serbia
| | - V Ignjatovic
- Clinical Center Kragujevac - Nuclear Medicine Department, University of Kragujevac, Faculty of Medical Sciences - Kragujevac, Serbia.,Department of Nuclear Medicine and Oncology, Kragujevac, Serbia
| | - K Vuleta
- Clinical Center Kragujevac - Nuclear Medicine Department, University of Kragujevac, Faculty of Medical Sciences - Kragujevac, Serbia
| | - S Djukic
- Department of Internal Medicine, Kragujevac, Serbia
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Hoq M, Canterford L, Matthews S, Khanom G, Ignjatovic V, Monagle P, Donath S, Carlin J. Statistical methods used in the estimation of age-specific paediatric reference intervals for laboratory blood tests: A systematic review. Clin Biochem 2020; 85:12-19. [DOI: 10.1016/j.clinbiochem.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/06/2020] [Accepted: 08/09/2020] [Indexed: 01/01/2023]
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50
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Sezgin G, Monagle P, Loh TP, Ignjatovic V, Hoq M, Pearce C, McLeod A, Westbrook J, Li L, Georgiou A. Clinical thresholds for diagnosing iron deficiency: comparison of functional assessment of serum ferritin to population based centiles. Sci Rep 2020; 10:18233. [PMID: 33106588 PMCID: PMC7589482 DOI: 10.1038/s41598-020-75435-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/15/2020] [Indexed: 11/09/2022] Open
Abstract
Low serum ferritin is diagnostic of iron deficiency, yet its published lower cut-off values are highly variable, particularly for pediatric populations. Lower cut-off values are commonly reported as 2.5th percentiles, and is based on the variation of ferritin values in the population. Our objective was to determine whether a functional approach based on iron deficient erythropoiesis could provide a better alternative. Utilizing 64,443 ferritin test results from pediatric electronic health records, we conducted various statistical techniques to derive 2.5th percentiles, and also derived functional reference limits through the association between ferritin and erythrocyte parameters: hemoglobin, mean corpuscular volume, mean cell hemoglobin concentration, and red cell distribution width. We find that lower limits of reference intervals derived as centiles are too low for clinical interpretation. Functional limits indicate iron deficiency anemia starts to occur when ferritin levels reach 10 µg/L, and are largely similar between genders and age groups. In comparison, centiles (2.5%) presented with lower limits overall, with varying levels depending on age and gender. Functionally-derived limits better reflects the underlying physiology of a patient, and may provide a basis for deriving a threshold related to treatment of iron deficiency and any other biomarker with functional outcomes.
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Affiliation(s)
- Gorkem Sezgin
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Ryde, NSW, 2109, Australia.
| | - Paul Monagle
- Department of Pediatrics, The University of Melbourne, Parkville, VIC, Australia
- Hematology Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Hematology, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Kent Ridge, Singapore
| | - Vera Ignjatovic
- Department of Pediatrics, The University of Melbourne, Parkville, VIC, Australia
- Hematology Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Monsurul Hoq
- Department of Pediatrics, The University of Melbourne, Parkville, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | | | - Adam McLeod
- Outcome Health, East Burwood, VIC, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Ryde, NSW, 2109, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Ryde, NSW, 2109, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Ryde, NSW, 2109, Australia
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