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Kuhnl A, Kirkwood AA, Roddie C, Menne T, Tholouli E, Bloor A, Besley C, Chaganti S, Osborne W, Norman J, Gibb A, Sharplin K, Cuadrado M, Correia de Farias M, Cheok K, Neill L, Latif AL, González Arias C, Uttenthal B, Jones C, Johnson R, McMillan A, Sanderson R, Townsend W. CAR T in patients with large B-cell lymphoma not fit for autologous transplant. Br J Haematol 2023. [PMID: 37082780 DOI: 10.1111/bjh.18810] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 01/11/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023]
Abstract
Large B-cell lymphoma (LBCL) patients with comorbidities and/or advanced age are increasingly considered for treatment with CD19 CAR T, but data on the clinical benefit of CAR T in the less fit patient population are still limited. We analysed outcomes of consecutive patients approved for treatment with axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) by the UK National CAR T Clinical Panel, according to fitness for autologous stem cell transplant (ASCT). 81/404 (20%) of approved patients were deemed unfit for ASCT. Unfit patients were more likely to receive tisa-cel versus axi-cel (52% vs. 48%) compared to 20% versus 80% in ASCT-fit patients; p < 0.0001. The drop-out rate from approval to infusion was significantly higher in the ASCT-unfit group (34.6% vs. 23.5%; p = 0.042). Among infused patients, response rate, progression-free and overall survival were similar in both cohorts. CAR T was well-tolerated in ASCT-unfit patients with an incidence of grade ≥3 cytokine release syndrome and neurotoxicity of 2% and 11%, respectively. Results from this multicentre real-world cohort demonstrate that CD19 CAR T can be safely delivered in carefully selected older patients and patients with comorbidities who are not deemed suitable for transplant.
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Affiliation(s)
- A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - A A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - C Roddie
- Department of Haematology, University College London Hospitals, London, UK
- UCL Cancer Institute, University College London, London, UK
| | - T Menne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - E Tholouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Bloor
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - C Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - S Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - W Osborne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Gibb
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - K Sharplin
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - M Cuadrado
- Department of Haematology, King's College Hospital, London, UK
| | | | - K Cheok
- Department of Haematology, University College London Hospitals, London, UK
| | - L Neill
- Department of Haematology, University College London Hospitals, London, UK
| | - A L Latif
- Department of Haematology, Queen Elizabeth II Hospital, Glasgow, UK
| | | | - B Uttenthal
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - R Johnson
- Department of Haematology, St. James's Hospital, Leeds, UK
| | - A McMillan
- Department of Haematology, Nottingham University Hospitals, Nottingham, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | - W Townsend
- Department of Haematology, University College London Hospitals, London, UK
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Northend M, Wilson W, Osborne W, Fox CP, Davies AJ, El‐Sharkawi D, Phillips EH, Sim HW, Sadullah S, Shah N, Peng YY, Qureshi I, Addada J, Mora RF, Phillips N, Kuhnl A, Davies E, Wrench D, McKay P, Karpha I, Cowley A, Karim R, Challenor S, Singh V, Burton C, Auer R, Williams C, Broom A, Roddie C, Townsend W. POLATUZUMAB VEDOTIN WITH BENDAMUSTINE AND RITUXIMAB FOR RELAPSED/REFRACTORY HIGH‐GRADE B‐CELL LYMPHOMA: THE UK EXPERIENCE. Hematol Oncol 2021. [DOI: 10.1002/hon.86_2880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M. Northend
- University College London Hospitals NHS Foundation Trust Department of Haematology London UK
| | - W. Wilson
- Cancer Research UK & UCL Cancer Trials Centre Haematology Trials Team London UK
| | - W. Osborne
- The Newcastle‐upon‐Tyne Hospitals NHS Foundation Trust Department of Haematology Newcastle‐upon‐Tyne UK
| | - C. P. Fox
- Nottingham University Hospitals NHS Trust Department of Haematology Nottingham UK
| | - A. J Davies
- University of Southampton Southampton Cancer Research UK/NIHR Experimental Cancer Medicines Centre Southampton UK
| | - D. El‐Sharkawi
- The Royal Marsden NHS Foundation Trust Department of Haematology London UK
| | - E. H. Phillips
- University of Manchester The Christie NHS Foundation Trust Manchester UK
| | - H. W. Sim
- London North West University Healthcare NHS Trust Department of Haematology London UK
| | - S. Sadullah
- James Paget University Hospitals NHS Foundation Trust Department of Haematology Great Yarmouth UK
| | - N. Shah
- Norfolk & Norwich University Hospitals NHS Foundation Trust Department of Haematology Norwich UK
| | - Y. Y. Peng
- St George's University Hospital NHS Foundation Trust Department of Haematology London UK
| | - I. Qureshi
- University Hospitals Birmingham NHS Foundation Trust Department of Haematology Birmingham UK
| | - J. Addada
- University Hospitals of Derby & Burton NHS Foundation Trust Department of Haematology Derby UK
| | - R. F. Mora
- Nottingham University Hospitals NHS Trust Department of Haematology Nottingham UK
| | - N. Phillips
- University Hospital of North Midlands NHS Trust Department of Haematology Stoke‐on‐Trent UK
| | - A. Kuhnl
- King's College Hospital NHS Foundation Trust Department of Haematology London UK
| | - E. Davies
- Manchester University NHS Foundation Trust Department of Haematology London UK
| | - D. Wrench
- Guy's & St Thomas' Hospitals NHS Foundation Trust Department of Haematology London UK
| | - P. McKay
- Beatson West of Scotland Cancer Centre Department of Haematology Glasgow UK
| | - I. Karpha
- The Clatterbridge Cancer Centre NHS Foundation Trust Department of Haematology Liverpool UK
| | - A. Cowley
- East Sussex Healthcare NHS Trust Department of Haematology East Sussex UK
| | - R. Karim
- Dorset Healthcare University NHS Foundation Trust Department of Haematology Dorchester UK
| | - S. Challenor
- Royal Cornwall NHS Trust Department of Haematology Truro UK
| | - V. Singh
- Aintree University Hospital Department of Haematology Liverpool UK
| | - C. Burton
- Leeds Teaching Hospitals NHS Trust Department of Haematology Leeds UK
| | - R. Auer
- Bart's Health NHS Trust Department of Haemato‐Oncology London UK
| | - C. Williams
- Northumbria Healthcare NHS Foundation Trust Department of Haematology Hexham UK
| | - A. Broom
- Western General Hospital Department of Haematology Edinburgh UK
| | - C. Roddie
- University College London Hospitals NHS Foundation Trust Department of Haematology London UK
| | - W. Townsend
- University College London Hospitals NHS Foundation Trust Department of Haematology London UK
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Cheesman S, Shah R, Lambert J, Cwynarski K, Townsend W, McNamara C, Virchis A, Ardeshna K. PF312 RESPONSES TO R-CHOP CHEMOTHERAPY INCORPORATING BIOSIMILAR RITUXIMAB (TRUXIMA®) FOR THE FIRST LINE TREATMENT OF DIFFUSE LARGE B-CELL LYMPHOMA – INITIAL EXPERIENCE AT UNIVERSITY COLLEGE LONDON HOSPITAL. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000559460.76601.7a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Phillips E, Pepper A, Townsend W, Coulter E, Salisbury J, Apollonio B, Devereux S, Patten P. PS1304 FOLLICULAR HELPER T-CELLS FORM MUTUALLY SUPPORTIVE INTERACTIONS WITH FOLLICULAR LYMPHOMA B-CELLS THAT MAY SUPPORT TUMOUR GROWTH. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000563496.54236.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Jurczak W, Rule S, Townsend W, Tucker D, Sarholz B, Scheele J, Gribben J, Zinzani P. Phase I/II, first in human trial with M7583, a Bruton’s tyrosine kinase inhibitor (BTKi), in patients with B cell malignancies. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy286.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cuadrado M, Afaq A, Kayani I, Cwynarski K, Lambert J, Townsend W, McNamara C. Utility of baseline assessment with FDG-PET-CT compared with CT Scanning in people with diffuse large B-cell lymphoma (DLBCL). Hematol Oncol 2017. [DOI: 10.1002/hon.2439_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M. Cuadrado
- Haematology; University College London Hospital; London UK
| | - A. Afaq
- Nuclear Medicine; University College London Hospital; London UK
| | - I. Kayani
- Nuclear Medicine; University College London Hospital; London UK
| | - K. Cwynarski
- Haematology; University College London Hospital; London UK
| | - J. Lambert
- Haematology; University College London Hospital; London UK
| | - W. Townsend
- Haematology; University College London Hospital; London UK
| | - C. McNamara
- Haematology; University College London Hospital; London UK
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Gladue H, Altorok N, Townsend W, Mclaughlin V, Khanna D. FRI0507 Screening and diagnostic modalities in connective tissue disease-associated pulmonary arterial hypertension: a systematic review. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
The unique challenges that laboratories in Queensland and New South Wales faced during the response to the 2007 equine influenza outbreak and how these were managed are described.
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Affiliation(s)
- L Brown
- Elizabeth Macarthur Agricultural Institute, Menangle, New South Wales 2568, Australia
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Begg AP, Reece RL, Hum S, Townsend W, Gordon A, Carrick J. Pathological changes in horses dying with equine influenza in Australia, 2007. Aust Vet J 2011; 89 Suppl 1:19-22. [DOI: 10.1111/j.1751-0813.2011.00731.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Townsend W, Cross NCP, Waghorn K, Somana K, Ramsay A, Thomson K, Peggs K. Clinical evidence for a graft-versus-tumour effect following allogeneic HSCT for t(8;13) atypical myeloproliferative disorder. Bone Marrow Transplant 2009; 44:197-9. [PMID: 19234514 DOI: 10.1038/bmt.2008.448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Zehntner S, Townsend W, Parkes J, Schmidt C, Down M, Bell J, Mulligan R, O'Rourke M, Ellem K, Thomas R. Tumor metastasis biopsy as a surrogate marker of response to melanoma immunotherapy. Pathology 1999; 31:116-22. [PMID: 10399166 DOI: 10.1080/003130299105296] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In patients undergoing immunotherapy for metastatic melanoma, the clinical response in immunotherapeutic trials may be partial or difficult to detect. Tumor metastasis biopsy allows direct characterisation of an anti-tumor immunological response. During a phase I/II trial of granulocyte macrophage colony stimulating factor (GM-CSF) transduced autologous melanoma immunotherapy, the cellular response was examined by immunohistochemical analysis in a limited number of tumor biopsies taken from patients who either responded or progressed. Clinical response was associated with tumor infiltration by CD4+ and CD8+ T-cells, macrophages and differentiated dendritic cells (DC), and expression of HLA-DR by the tumor cells. This tumor infiltration was associated with increased melanoma-specific peripheral blood precursor cytotoxic T-lymphocyte (pCTL) and the ability to obtain tumor-infiltrating lymphocytes in vitro. In contrast, progression or a lack of clinical response was associated with a lack of T-cell and DC infiltration into the tumor tissue in all such biopsies. Macrophages and eosinophils infiltrated these tumors, while T-cells and DC were present at some distance from the tumor. These preliminary data strongly suggest that the location and extent of T-cell and DC infiltration, as well as the expression of HLA-DR by tumor cells are associated with a clinical response in this form of melanoma immunotherapy.
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Affiliation(s)
- S Zehntner
- University of Queensland Department of Medicine, Princess Alexandra Hospital, Australia
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Pettit AR, Quinn C, MacDonald KP, Cavanagh LL, Thomas G, Townsend W, Handel M, Thomas R. Nuclear localization of RelB is associated with effective antigen-presenting cell function. J Immunol 1997; 159:3681-91. [PMID: 9378953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Dendritic cells (DC) are potent APCs that enter resting tissues as precursors and, after Ag exposure, differentiate and migrate to draining lymph nodes. The phenotype of RelB knockout mice implicates this member of the NF kappa B/Rel family in DC differentiation. To further elucidate the role of RelB in DC differentiation, mRNA, intracellular protein expression, and DNA binding activity of RelB were examined in immature and differentiated human DC, as well as other PB mononuclear cell populations. RelB protein and mRNA were detected constitutively in lymphocytes and in activated monocytes, differentiated DC, and monocyte-derived DC. Immunohistochemical staining demonstrated RelB within the differentiated lymph node interdigitating DC and follicular DC, but not undifferentiated DC in normal skin. Active nuclear RelB was detected by supershift assay only in differentiated DC derived from either PB precursors or monocytes and in activated B cells. These RelB+ APC were potent stimulators of the MLR. The data indicate that RelB expression is regulated both transcriptionally and post-translationally in myeloid cells. Within the nucleus, RelB may specifically transactivate genes that are critical for APC function.
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Affiliation(s)
- A R Pettit
- Centre for Immunology and Cancer Research, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
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Pettit AR, Quinn C, MacDonald KP, Cavanagh LL, Thomas G, Townsend W, Handel M, Thomas R. Nuclear localization of RelB is associated with effective antigen-presenting cell function. The Journal of Immunology 1997. [DOI: 10.4049/jimmunol.159.8.3681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Dendritic cells (DC) are potent APCs that enter resting tissues as precursors and, after Ag exposure, differentiate and migrate to draining lymph nodes. The phenotype of RelB knockout mice implicates this member of the NF kappa B/Rel family in DC differentiation. To further elucidate the role of RelB in DC differentiation, mRNA, intracellular protein expression, and DNA binding activity of RelB were examined in immature and differentiated human DC, as well as other PB mononuclear cell populations. RelB protein and mRNA were detected constitutively in lymphocytes and in activated monocytes, differentiated DC, and monocyte-derived DC. Immunohistochemical staining demonstrated RelB within the differentiated lymph node interdigitating DC and follicular DC, but not undifferentiated DC in normal skin. Active nuclear RelB was detected by supershift assay only in differentiated DC derived from either PB precursors or monocytes and in activated B cells. These RelB+ APC were potent stimulators of the MLR. The data indicate that RelB expression is regulated both transcriptionally and post-translationally in myeloid cells. Within the nucleus, RelB may specifically transactivate genes that are critical for APC function.
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Affiliation(s)
- A R Pettit
- Centre for Immunology and Cancer Research, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - C Quinn
- Centre for Immunology and Cancer Research, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - K P MacDonald
- Centre for Immunology and Cancer Research, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - L L Cavanagh
- Centre for Immunology and Cancer Research, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - G Thomas
- Centre for Immunology and Cancer Research, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - W Townsend
- Centre for Immunology and Cancer Research, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - M Handel
- Centre for Immunology and Cancer Research, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - R Thomas
- Centre for Immunology and Cancer Research, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
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Abstract
BACKGROUND The Hermansky-Pudlak syndrome (HPS) is defined by the autosomal recessively inherited triad of tyrosinase-positive oculocutaneous albinism, bleeding diathesis and accumulation of ceroid in tissues. Late complications include: interstitial pulmonary fibrosis; inflammatory bowel disease; and renal failure. PATIENTS AND METHODS We undertook a non-concurrent prospective study of 55 Puerto Rican patients with HPS (age range 1 to 54 yrs; mean = 19.7 yrs). These patients had a comprehensive ocular examination and a systemic evaluation for HPS. RESULTS Visual acuities ranged from 20/50 to 5/200. All patients had nystagmus. Forty-three patients had strabismus; esotropia was found in 24 patients; exotropia in 18 patients; and one patient had hypertropia. Posterior embryotoxon occurred in 15 patients and Axenfeld anomaly in 4 patients. Iris pigmentation varied from minimal to almost completely normal. Three patients had cataract formation. The retina was typically albinotic with macular hypoplasia. All patients had cutaneous albinism, bleeding diathesis and various systemic manifestations as part of HPS. CONCLUSION Ocular findings in HPS include reduced visual acuity; congenital nystagmus, strabismus and cataract. Diagnosis of the syndrome ought to be made preoperatively to help minimize the potential complications associated with bleeding diathesis at the time of extraocular muscle and intraocular surgery in patients with HPS.
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Affiliation(s)
- N J Izquierdo
- Department of Ophthalmology, Medical Sciences Campus, University of Puerto Rico, San Juan
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Beeler MF, Townsend W, Fisher K. The editor's final report--1989. Am J Clin Pathol 1990; 93:831-2. [PMID: 2346139 DOI: 10.1093/ajcp/93.6.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Beeler MF, Townsend W, Fisher K. The editor's report--1988. Am J Clin Pathol 1989; 91:742-3. [PMID: 2729187 DOI: 10.1093/ajcp/91.6.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Affiliation(s)
- H P Lehmann
- Department of Pathology, Louisiana State University Medical School, New Orleans
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Dalvi RR, Townsend W. Involvement of hepatic mixed function oxidase enzyme system in the oxidative metabolism of methanol. Chem Pharm Bull (Tokyo) 1976; 24:2128-31. [PMID: 991363 DOI: 10.1248/cpb.24.2128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Garland EC, Townsend W. THE STATE OF THE MUSCLES IN ANIMALS POISONED BY STRYCHNINE. West J Med 1856. [DOI: 10.1136/bmj.s3-4.181.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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